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Fast and simultaneous forward and reverse blood grouping has long remained elusive. Forward blood grouping detects antigens on red blood cells, whereas reverse grouping identifies specific antibodies present in plasma. We developed a paper-based assay using immobilized antibodies and bromocresol green dye for rapid and reliable blood grouping, where dye-assisted color changes corresponding to distinct blood components provide a visual readout. ABO antigens and five major Rhesus antigens could be detected within 30 s, and simultaneous forward and reverse ABO blood grouping using small volumes (100 μl) of whole blood was achieved within 2 min through on-chip plasma separation without centrifugation. A machine-learning method was developed to classify the spectral plots corresponding to dye-based color changes, which enabled reproducible automatic grouping. Using optimized operating parameters, the dye-assisted paper assay exhibited comparable accuracy and reproducibility to the classical gel-card assays in grouping 3550 human blood samples. When translated to the assembly line and low-cost manufacturing, the proposed approach may be developed into a cost-effective and robust universal blood-grouping platform., (Copyright © 2017, American Association for the Advancement of Science.)

In developed nations, monitoring for drug-induced liver injury through serial measurements of serum transaminases [aspartate aminotransferase (AST) and alanine aminotransferase (ALT)] in at-risk individuals is the standard of care. Despite the need, monitoring for drug-related hepatotoxicity in resource-limited settings is often limited by expense and logistics, even for patients at highest risk. This article describes the development and clinical testing of a paper-based, multiplexed microfluidic assay designed for rapid, semiquantitative measurement of AST and ALT in a fingerstick specimen. Using 223 clinical specimens obtained by venipuncture and 10 fingerstick specimens from healthy volunteers, we have shown that our assay can, in 15 min, provide visual measurements of AST and ALT in whole blood or serum, which allow the user to place those values into one of three readout "bins" [<3× upper limit of normal (ULN), 3 to 5× ULN, and >5× ULN, corresponding to tuberculosis/HIV treatment guidelines] with >90% accuracy. These data suggest that the ultimate point-of-care fingerstick device will have high impact on patient care in low-resource settings.

The article reports on the accuracy of blood grouping using dye-assisted paper-based point-of-care assay. It cites on the proposal of the assay which integrates the F&R tests into a single POC chip using a visual readout strategy. The article also reports on the accurate and reliable recognition of blood agglutination as a prerequisite for developing blood-grouping assay by observing blood aggregation.

Current COVID-19 vaccines provide robust protection against severe disease but minimal protection against acquisition of infection. Intramuscularly administered COVID-19 vaccines induce robust serum neutralizing antibodies (NAbs), but their ability to boost mucosal immune responses remains to be determined. In this study, we show that the XBB.1.5 messenger RNA (mRNA) boosters result in increased serum neutralization to multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in humans, including the dominant circulating variant JN.1. In contrast, we found that the XBB.1.5 mRNA booster did not augment mucosal NAbs or mucosal IgA responses, although acute SARS-CoV-2 XBB infection substantially increased mucosal antibody responses. These data demonstrate that current XBB.1.5 mRNA boosters substantially enhance peripheral antibody responses but do not robustly increase mucosal antibody responses. Our data highlight a separation between the peripheral and mucosal immune systems in humans and emphasize the importance of developing next-generation vaccines to augment mucosal immunity to protect against respiratory virus infections. Editor's summary: mRNA vaccines for SARS-CoV-2 elicit robust antibody responses in the circulation, which aid in protection from severe disease. However, the extent to which mRNA vaccines, which are delivered intramuscularly, can elicit mucosal immune responses is unclear. In a pair of papers, Declercq et al. and Lasrado et al. come to distinct conclusions. Using human nasal swab samples in both studies, Declercq et al. show that repeated vaccination for SARS-CoV-2 promotes neutralizing antibodies in the nose, whereas Lasrado et al. observed no obvious increase in neutralizing antibody titers after booster vaccination. These differing results may be due to the number of SARS-CoV-2 vaccinations or exposures, time since last exposure, and experimental approaches, but this pair of papers underscores the need to better understand the mucosal immune response in humans. —Courtney Malo [ABSTRACT FROM AUTHOR]

To prevent infection by respiratory viruses and consequently limit virus circulation, vaccines need to promote mucosal immunity. The extent to which the currently used messenger RNA (mRNA)–based COVID-19 vaccines induce mucosal immunity remains poorly characterized. We evaluated mucosal neutralizing antibody responses in a cohort of 183 individuals. Participants were sampled at several time points after primary adenovirus vector–based or mRNA-based COVID-19 vaccination and after mRNA-based booster vaccinations. Our findings revealed that repeated vaccination with mRNA boosters promoted severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralizing antibodies in nasal secretions. Nasal and serum neutralizing antibody titers of both IgG and IgA isotypes correlated to one another. We investigated the source of these mucosal antibodies in a mouse model wherein mice received repeated mRNA vaccines for SARS-CoV-2. These experiments indicated that neutralizing antibody–producing cells reside in the spleen and bone marrow, whereas no proof of tissue homing to the respiratory mucosa was observed, despite the detection of mucosal antibodies. Serum transfer experiments confirmed that circulating antibodies were able to migrate to the respiratory mucosa. Collectively, these results demonstrate that, especially upon repeated vaccination, the currently used COVID-19 mRNA vaccines can elicit mucosal neutralizing antibodies and that vaccination might also stimulate mucosal immunity induced by previous SARS-CoV-2 infection. Moreover, migration of circulating antibodies to the respiratory mucosa might be a main mechanism. These findings advance our understanding of mRNA vaccine–induced immunity and have implications for the design of vaccine strategies to combat respiratory infections. Editor's summary: mRNA vaccines for SARS-CoV-2 elicit robust antibody responses in the circulation, which aid in protection from severe disease. However, the extent to which mRNA vaccines, which are delivered intramuscularly, can elicit mucosal immune responses is unclear. In a pair of papers, Declercq et al. and Lasrado et al. come to distinct conclusions. Using human nasal swab samples in both studies, Declercq et al. show that repeated vaccination for SARS-CoV-2 promotes neutralizing antibodies in the nose, whereas Lasrado et al. observed no obvious increase in neutralizing antibody titers after booster vaccination. These differing results may be due to the number of SARS-CoV-2 vaccinations or exposures, time since last exposure, and experimental approaches, but this pair of papers underscores the need to better understand the mucosal immune response in humans. —Courtney Malo [ABSTRACT FROM AUTHOR]

Machine learning for health must be reproducible to ensure reliable clinical use. We evaluated 511 scientific papers across several machine learning subfields and found that machine learning for health compared poorly to other areas regarding reproducibility metrics, such as dataset and code accessibility. We propose recommendations to address this problem. [ABSTRACT FROM AUTHOR]

The adjuvant AS01 plays a key role in the immunogenicity of several approved human vaccines with demonstrated high efficacy. Its adjuvant effect relies on activation of the innate immune system. However, specific effects of AS01-adjuvanted vaccines on innate cell function and epigenetic remodeling, as described for Bacille Calmette-Guérin (BCG) and influenza vaccines, are still unknown. We assessed the long-term functional and epigenetic changes in circulating monocytes and dendritic cells induced by a model vaccine containing hepatitis B surface antigen and AS01 in healthy adults (NCT01777295). The AS01-adjuvanted vaccine, but not an Alum-adjuvanted vaccine, increased the number of circulating monocytes and their expression of human leukocyte antigen (HLA)–DR, which correlated with the magnitude of the memory CD4+ T cell response. Single-cell analyses revealed epigenetic alterations in monocyte and dendritic cell subsets, affecting accessibility of transcription factors involved in cell functions including activator protein-1 (AP-1), GATA, C/EBP, and interferon regulatory factor. The functional changes were characterized by a reduced proinflammatory response to Toll-like receptor activation and an improved response to interferon-γ, a cytokine critical for the adjuvant's mode of action. Epigenetic changes were most evident shortly after the second vaccine dose in CD14+ monocytes, for which accessibility differences of some transcription factors could persist for up to 6 months postvaccination. Together, we show that reprogramming of monocyte subsets occurs after vaccination with an AS01-adjuvanted vaccine, an effect that may contribute to the impact of vaccination beyond antigen-specific protection. Editor's summary: Most vaccines based on recombinant antigens rely on coadministration with an adjuvant to elicit a robust immune response. Although adjuvants are needed for many vaccines, it is less clear which adjuvant(s) should be paired with each immunogen. In two papers, Bechtold et al. and Arunachalam et al. performed comparative analyses to assess the effect of different adjuvants on the immune response. Bechtold et al. showed that an AS01-adjuvanted hepatitis B virus vaccine, which induces robust CD4+ T cell responses against the vaccine antigen, also elicited trained immunity in human recipients, which was not observed in an Alum-adjuvanted vaccine. Arunachalam et al. found that Matrix-M and 3M-052 + Alum adjuvantation induced robust immune responses to the R21 malaria vaccine in nonhuman primates, but a third comparator, GLA-LSQ, elicited a lower magnitude of response that was short lived. Although Matrix-M and 3M-052 + Alum induced robust and durable antibody responses, they elicited distinct innate immune responses, demonstrating that multiple innate immune mechanisms can program durable vaccine-induced immunity. These head-to-head comparisons in both humans and nonhuman primates demonstrate that selecting an adjuvant should be done carefully and that different adjuvants have distinct effects on both innate and adaptive immunity. —Courtney Malo [ABSTRACT FROM AUTHOR]

Authorization of the Matrix-M (MM)–adjuvanted R21 vaccine by three countries and its subsequent endorsement by the World Health Organization for malaria prevention in children are a milestone in the fight against malaria. Yet, our understanding of the innate and adaptive immune responses elicited by this vaccine remains limited. Here, we compared three clinically relevant adjuvants [3M-052 + aluminum hydroxide (Alum) (3M), a TLR7/8 agonist formulated in Alum; GLA-LSQ, a TLR4 agonist formulated in liposomes with QS-21; and MM, the now-approved adjuvant for R21] for their capacity to induce durable immune responses to R21 in macaques. R21 adjuvanted with 3M on a 0, 8, and 23–week schedule elicited anti-circumsporozoite antibody responses comparable in magnitude to the R21/MM vaccine administered using a 0-4-8–week regimen and persisted up to 72 weeks with a half-life of 337 days. A booster dose at 72 weeks induced a recall response similar to the R21/MM vaccination. In contrast, R21/GLA-LSQ immunization induced a lower, short-lived response at the dose used. Consistent with the durable serum antibody responses, MM and 3M induced long-lived plasma cells in the bone marrow and other tissues, including the spleen. Furthermore, whereas 3M stimulated potent and persistent antiviral transcriptional and cytokine signatures after primary and booster immunizations, MM induced enhanced expression of interferon- and TH2-related signatures more highly after the booster vaccination. Collectively, these findings provide a resource on the immune responses of three clinically relevant adjuvants with R21 and highlight the promise of 3M as another adjuvant for malarial vaccines. Editor's summary: Most vaccines based on recombinant antigens rely on coadministration with an adjuvant to elicit a robust immune response. Although adjuvants are needed for many vaccines, it is less clear which adjuvant(s) should be paired with each immunogen. In two papers, Bechtold et al. and Arunachalam et al. performed comparative analyses to assess the effect of different adjuvants on the immune response. Bechtold et al. showed that an AS01-adjuvanted hepatitis B virus vaccine, which induces robust CD4+ T cell responses against the vaccine antigen, also elicited trained immunity in human recipients, which was not observed in an alum-adjuvanted vaccine. Arunachalam et al. found that Matrix-M and 3M-052 + aluminum hydroxide (Alum) adjuvantation induced robust immune responses to the R21 malaria vaccine in nonhuman primates, but a third comparator, GLA-LSQ, elicited a lower magnitude of response that was short lived. Although Matrix-M and 3M-052 + Alum induced robust and durable antibody responses, they elicited distinct innate immune responses, demonstrating that multiple innate immune mechanisms can program durable vaccine-induced immunity. These head-to-head comparisons in both humans and nonhuman primates demonstrate that selecting an adjuvant should be done carefully and that different adjuvants have distinct effects on both innate and adaptive immunity. —Courtney Malo [ABSTRACT FROM AUTHOR]

This correction notice addresses an error in the figures of a research article titled "A β-Arrestin–Biased Agonist of the Parathyroid Hormone Receptor (PTH1R) Promotes Bone Formation Independent of G Protein Activation." The error involved the insertion of the same image in Fig. 4A for vehicle-treated samples for WT and βarrestin2 KO, but rotated 90°. However, this error does not affect any of the data or conclusions of the paper. The revised figure removes the images for vehicle-treated samples and includes the actual data in the bar graphs of the remaining panels. [Extracted from the article]

Blood lactate concentration is an established circulating biomarker for measuring muscle acidity and can be evaluated for monitoring endurance, training routines, or athletic performance. Sweat is an alternative biofluid that may serve similar purposes and offers the advantage of noninvasive collection and continuous monitoring. The relationship between blood lactate and dynamic sweat biochemistry for wearable engineering applications in physiological fitness remains poorly defined. Here, we developed a microfluidic wearable band with an integrated colorimetric timer and biochemical assays that temporally captures sweat and measures pH and lactate concentration. A colorimetric silver nanoplasmonic assay was used to measure the concentration of lactate, and dye-conjugated SiO2 nanoparticle–agarose composite materials supported dynamic pH analysis. We evaluated these sweat biomarkers in relation to blood lactate in human participant studies during cycling exercise of varying intensity. Iontophoresis-generated sweat pH from regions of actively working muscles decreased with increasing heart rate during exercise and was negatively correlated with blood lactate concentration. In contrast, sweat pH from nonworking muscles did not correlate with blood lactate concentration. Changes in sweat pH and blood lactate were observed in participants who did not regularly exercise but not in individuals who regularly exercised, suggesting a relationship to physical fitness and supporting further development for noninvasive, biochemical fitness evaluations. Editor's summary: The makeup of our sweat has the potential to be used to noninvasively monitor health during exercise. Here, Cho et al. develop a wearable microfluidic band to measure local sweat biochemistry of muscles in human participants during rest or cycling exercise. The device incorporates a colorimetric "timer" that allows the collection of longitudinal sweat pH and lactate concentration measurements. Blood lactate concentration, a known circulating biomarker of muscle activity, was correlated with local sweat pH over actively working muscles. Therefore, changes in sweat pH during exercise may be an indicator of muscle fatigue. —Molly Ogle [ABSTRACT FROM AUTHOR]

There is enormous variation in the extent to which fetal Zika virus (fZIKV) infection affects the developing brain. Despite the neural consequences of fZIKV infection observed in people and animal models, many open questions about the relationship between infection dynamics and fetal and infant development remain. To further understand how ZIKV affects the developing nervous system and the behavioral consequences of prenatal infection, we adopted a nonhuman primate model of fZIKV infection in which we inoculated pregnant rhesus macaques and their fetuses with ZIKV in the early second trimester of fetal development. We then tracked their health across gestation and characterized infant development across the first month of life. ZIKV-infected pregnant mothers had long periods of viremia and mild changes to their hematological profiles. ZIKV RNA concentrations, an indicator of infection magnitude, were higher in mothers whose fetuses were male, and the magnitude of ZIKV RNA in the mothers' plasma or amniotic fluid predicted infant outcomes. The magnitude of ZIKV RNA was negatively associated with infant growth across the first month of life, affecting males' growth more than females' growth, although for most metrics, both males and females evidenced slower growth rates as compared with control animals whose mothers were not ZIKV inoculated. Compared with control infants, fZIKV infants also spent more time with their mothers during the first month of life, a social behavior difference that may have long-lasting consequences on psychosocial development during childhood. Editor's summary: Pregnant women infected with Zika virus (ZIKV) can vertically transmit virus to fetuses, which has been linked to congenital ZIKV syndrome. Understanding how ZIKV infection affects prenatal and neonatal development is critical for human health. Here, Saron et al. and Moadab et al. use cynomolgus and rhesus macaque models, respectively, to understand how maternal ZIKV infection influences fetal development. Saron et al. found that pre-existing immunity to dengue virus, a related flavivirus, worsened severity of CZS. Moadab et al. found that maternal ZIKV infection alone was sufficient to reduce infant size and affect social behaviors. Together, these papers shed light on the impacts of ZIKV infection on fetal and early life development. —Christiana Fogg and Courtney Malo [ABSTRACT FROM AUTHOR]

Zika virus (ZIKV) is a mosquito-borne flavivirus that can vertically transmit from mother to fetus, potentially causing congenital defects, including microcephaly. It is not fully understood why some fetuses experience severe complications after in utero exposure to ZIKV, whereas others do not. Given the antigenic similarity between ZIKV and the closely related virus dengue (DENV) and the potential of DENV-specific antibodies to enhance ZIKV disease severity in mice, we questioned whether maternal DENV immunity could influence fetal outcomes in a nonhuman primate model of ZIKV vertical transmission. We found significantly increased severity of congenital Zika syndrome (CZS) in fetuses of DENV-immune cynomolgus macaques infected with ZIKV in early pregnancy compared with naïve controls, which occurred despite no effect on maternal ZIKV infection or antibody responses. Ultrasound measurements of head circumference and biparietal diameter measurements taken sequentially throughout pregnancy demonstrated CZS in fetuses of DENV-immune pregnant macaques. Furthermore, severe CZS enhanced by DENV immunity was typified by reduced cortical thickness and increased frequency of neuronal death, hemorrhaging, cellular infiltrations, calcifications, and lissencephaly in fetal brains. This study shows that maternal immunity to DENV can worsen ZIKV neurological outcomes in fetal primates, and it provides an animal model of vertical transmission closely approximating human developmental timelines that could be used to investigate severe ZIKV disease outcomes and interventions in fetuses. Editor's summary: Pregnant women infected with Zika virus (ZIKV) can vertically transmit virus to fetuses, which has been linked to congenital ZIKV syndrome. Understanding how ZIKV infection affects prenatal and neonatal development is critical for human health. Here, Saron et al. and Moadab et al. used cynomolgus and rhesus macaque models, respectively, to understand how maternal ZIKV infection influences fetal development. Saron et al. found that preexisting immunity to dengue virus, a related flavivirus, worsened severity of CZS. Moadab et al. found that maternal ZIKV infection alone was sufficient to reduce infant size and affect social behaviors. Together, these papers shed light on the impacts of ZIKV infection on fetal and early life development. —Christiana Fogg and Courtney Malo [ABSTRACT FROM AUTHOR]

In the Research Article "Gene-edited and -engineered stem cell platform drives immunotherapy for brain metastatic melanomas" by N. Kanaya et al., Fig. 4 contained two errors. The images presented as CD3 immunofluorescence staining (SC-oHSV group) in Fig. 4F and as CD8 immunofluorescence staining (SC-oHSV group) in Fig. 4H were incorrect. These images have now been corrected. The text and overall findings of the study are unchanged. The online PDF and HTML (full text) have been updated. These corrections do not affect the interpretation of the data or the conclusions of the paper. [Extracted from the article]

This correction notice addresses an unintentional error in the research article "Inhibiting the oncogenic translation program is an effective therapeutic strategy in multiple myeloma" by S. Manier et al. The error involved duplicating MCL-1 of MM1S instead of MYC in H929 in Fig. 7C. The correct figure has been included in the PDF and HTML versions of the article. The correction also provides clarification about the proteins run on the same gel in Fig. 5C and fig. S4, explaining that the tubulin control lanes are identical for certain conditions because they were performed on the same membrane. The correction emphasizes that these errors do not impact the interpretation of the data or the scientific content of the paper. [Extracted from the article]

This correction notice addresses errors in the Research Article "A functional identification platform reveals frequent, spontaneous neoantigen-specific T cell responses in patients with cancer" by A. M. Miller et al. The correction involves the clarification of the identification of peptides tested in the ELISPOT and flow cytometry experiments, as well as the correction of the numbering of Peptide 2 in Figure S1. The correction does not impact the data quantification, interpretation, or the conclusions of the paper. The online PDF and HTML versions of the article have been updated to reflect these corrections. [Extracted from the article]

Hepatic inflammation is a common trigger of chronic liver disease. Macrophage activation is a predictive parameter for survival in patients with cirrhosis. Ring finger protein 41 (RNF41) negatively regulates proinflammatory cytokines and receptors; however, the precise involvement of macrophage RNF41 in liver cirrhosis remains unknown. Here, we sought to understand how RNF41 dictates macrophage fate in hepatic fibrosis and repair within the inflammatory milieu. We found that RNF41 expression is down-regulated in CD11b+ macrophages recruited to mouse fibrotic liver and to patient cirrhotic liver regardless of cirrhosis etiology. Prolonged inflammation with TNF-α progressively reduced macrophage RNF41 expression. We designed a macrophage-selective gene therapy with dendrimer-graphite nanoparticles (DGNPs) to explore the influence of macrophage RNF41 restoration and depletion in liver fibrosis and regeneration. RNF41 expression induced in CD11b+ macrophages by DGNP-conjugated plasmids ameliorated liver fibrosis, reduced liver injury, and stimulated hepatic regeneration in fibrotic mice with or without hepatectomy. This therapeutic effect was mainly mediated by the induction of insulin-like growth factor 1. Conversely, depletion of macrophage RNF41 worsened inflammation, fibrosis, hepatic damage, and survival. Our data reveal implications of macrophage RNF41 in the control of hepatic inflammation, fibrosis, and regeneration and provide a rationale for therapeutic strategies in chronic liver disease and potentially other diseases characterized by inflammation and fibrosis. Editor's summary: Macrophages are known to contribute to liver disease and repair, but strategies are needed to modulate their behavior to promote disease resolution. Moreno-Lanceta et al. show that the E3 ubiquitin ligase RNF41 is down-regulated in macrophages during liver fibrogenesis in humans and mice. Macrophage-targeting nanoparticles bearing plasmids increased RNF41 expression in macrophages in mouse models of liver injury, resulting in improved hepatic fibrosis and regeneration. This paper demonstrates the relevance of macrophage RNF41 in the development and amelioration of chronic liver disease. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Necroptosis contributes to hepatocyte death in nonalcoholic steatohepatitis (NASH), but the fate and roles of necroptotic hepatocytes (necHCs) in NASH remain unknown. We show here that the accumulation of necHCs in human and mouse NASH liver is associated with an up-regulation of the "don't-eat-me" ligand CD47 on necHCs, but not on apoptotic hepatocytes, and an increase in the CD47 receptor SIRPα on liver macrophages, consistent with impaired macrophage-mediated clearance of necHCs. In vitro, necHC clearance by primary liver macrophages was enhanced by treatment with either anti-CD47 or anti-SIRPα. In a proof-of-concept mouse model of inducible hepatocyte necroptosis, anti-CD47 antibody treatment increased necHC uptake by liver macrophages and inhibited markers of hepatic stellate cell (HSC) activation, which is responsible for liver fibrogenesis. Treatment of two mouse models of diet-induced NASH with anti-CD47, anti-SIRPα, or AAV8-H1-shCD47 to silence CD47 in hepatocytes increased the uptake of necHC by liver macrophages and decreased markers of HSC activation and liver fibrosis. Anti-SIRPα treatment avoided the adverse effect of anemia found in anti-CD47–treated mice. These findings provide evidence that impaired clearance of necHCs by liver macrophages due to CD47-SIRPα up-regulation contributes to fibrotic NASH, and suggest therapeutic blockade of the CD47-SIRPα axis as a strategy to decrease the accumulation of necHCs in NASH liver and dampen the progression of hepatic fibrosis. Targeting necroptosis in NASH: Impaired efferocytosis of dying cells is known to contribute to inflammation in nonalcoholic steatohepatitis (NASH). Shi et al. now show that impaired efferocytosis of necroptotic hepatocytes contributes to liver fibrosis in NASH. Targeting the CD47 "don't eat me" signal on these necroptotic hepatocytes decreased the progression of hepatic fibrosis in a preclinical NASH model, and an anti-SIRPα antibody achieved similar results to anti-CD47, but without eliciting anemia in the mice. This paper implicates necroptotic hepatocytes in NASH fibrosis and suggests that this pathway may be targetable.—CAC [ABSTRACT FROM AUTHOR]

Peptic ulcer disease is a frequent clinical problem with potentially serious complications such as bleeding or perforation. A decisive factor in the pathogenesis of peptic ulcers is gastric acid, the secretion of which is controlled by the hormone gastrin released from gastric G cells. However, the molecular mechanisms regulating gastrin plasma concentrations are poorly understood. Here, we identified a semaphorin-plexin signaling pathway that operates in gastric G cells to inhibit gastrin expression on a transcriptional level, thereby limiting food-stimulated gastrin release and gastric acid secretion. Using a systematic siRNA screening approach combined with biochemical, cell biology, and in vivo mouse experiments, we found that the RasGAP protein Rasal1 is a central mediator of plexin signal transduction, which suppresses gastrin expression through inactivation of the small GTPase R-Ras. Moreover, we show that Rasal1 is pathophysiologically relevant for the pathogenesis of peptic ulcers induced by nonsteroidal anti-inflammatory drugs (NSAIDs), a main risk factor of peptic ulcers in humans. Last, we show that application of recombinant semaphorin 4D alleviates peptic ulcer disease in mice in vivo, demonstrating that this signaling pathway can be harnessed pharmacologically. This study unravels a mode of G cell regulation that is functionally important in gastric homeostasis and disease. Easing gastric acid: Proton pump inhibitors are commonly used to treat gastric acid–related issues, but these drugs may have serious long-term side effects. Xu et al. show that semaphorin-plexin-RasGAP signaling represses gastrin mRNA expression and food-induced gastric acid secretion. Intravenous administration of semaphorin 4D ameliorated nonsteroidal anti-inflammatory drug–induced peptic ulcers in mouse models. This paper establishes a signaling axis that may help in the treatment of peptic ulcer disease. [ABSTRACT FROM AUTHOR]

A growing body of evidence suggests interplay between the gut microbiota and the pathogenesis of nonalcoholic fatty liver disease (NAFLD). However, the role of the gut microbiome in early detection of NAFLD is unclear. Prospective studies are necessary for identifying reliable, microbiome markers for early NAFLD. We evaluated 2487 individuals in a community-based cohort who were followed up 4.6 years after initial clinical examination and biospecimen sampling. Metagenomic and metabolomic characterizations using stool and serum samples taken at baseline were performed for 90 participants who progressed to NAFLD and 90 controls who remained NAFLD free at the follow-up visit. Cases and controls were matched for gender, age, body mass index (BMI) at baseline and follow-up, and 4-year BMI change. Machine learning models integrating baseline microbial signatures (14 features) correctly classified participants (auROCs of 0.72 to 0.80) based on their NAFLD status and liver fat accumulation at the 4-year follow up, outperforming other prognostic clinical models (auROCs of 0.58 to 0.60). We confirmed the biological relevance of the microbiome features by testing their diagnostic ability in four external NAFLD case-control cohorts examined by biopsy or magnetic resonance spectroscopy, from Asia, Europe, and the United States. Our findings raise the possibility of using gut microbiota for early clinical warning of NAFLD development. Fatty liver and the gut: An understanding the biology of nonalcoholic liver disease (NAFLD) is growing but still incomplete. Leung et al. examined how the gut microbiome changed during disease development compared to healthy individuals in a large prospective cohort. The authors also developed a proof-of-principle classifier that combined baseline microbial signatures and serum metabolomic data to differentiate future cases from controls. This paper sheds light on the alteration of the microbiome during NAFLD. [ABSTRACT FROM AUTHOR]

Praziquantel's target: Praziquantel (PZQ) is a critical antiparasitic drug used to treat schistosomiasis and other parasitic helminths, but its mechanism has not been resolved. A pair of manuscripts by Park et al. and Le Clec'h et al. identified a Schistosoma mansoni transient receptor potential melastatin ion channel (TRPMPZQ) as the target of PZQ. Park et al. characterized a PZQ binding pocket in TRPMPZQ using ligand-based screening and targeted mutagenesis and confirmed that it was broadly conserved in other parasitic flatworms. Le Clec'h et al. used a genome-wide association screen and marker-assisted selection to identify TRPMPZQ as being responsible for variation in PZQ sensitivity and examine sequence variation in TRPMPZQ from field isolates. Together, these papers robustly confirm that TRPMPZQ is the molecular target of PZQ and provide critical information for monitoring PZQ resistance in the field. Mass drug administration with praziquantel (PZQ) monotherapy is considered the mainstay for control and elimination of the parasites causing schistosomiasis in humans. This drug shows imperfect cure rates in the field, and parasites showing reduced PZQ response can be selected in the laboratory, but the extent of resistance in Schistosoma mansoni populations is unknown. We examined the genetic basis of the variation in response in a PZQ-selected S. mansoni population (SmLE-PZQ-R) in which 35% of the parasitic worms survive high-dose PZQ (73 micrograms per milliliter) treatment. We used genome-wide association to map loci underlying PZQ response and identified a transient receptor potential (Sm.TRPMPZQ) channel (Smp_246790) within the major chromosome 3 peak that is activated by nanomolar concentrations of PZQ. The PZQ response showed recessive inheritance and marker-assisted selection of parasites at a single Sm.TRPMPZQ SNP that produced populations of PZQ-enriched resistant (PZQ-ER) and PZQ-enriched sensitive (PZQ-ES) parasites, exhibiting >377-fold difference in PZQ response. The PZQ-ER parasites survived treatment in rodents at higher frequencies compared with PZQ-ES, and resistant parasites exhibited 2.25-fold lower expression of Sm.TRPMPZQ relative to sensitive parasites. Specific chemical blockers of Sm.TRPMPZQ enhanced PZQ resistance, whereas Sm.TRPMPZQ activators increased sensitivity. We surveyed Sm.TRPMPZQ sequence variations in 259 parasites from different global sites and identified one nonsense mutation that resulted in a truncated protein with no PZQ binding site. Our results demonstrate that Sm.TRPMPZQ underlies variation in PZQ responses in S. mansoni and provides an approach for monitoring emerging PZQ-resistant alleles in schistosome elimination programs. [ABSTRACT FROM AUTHOR]

Praziquantel's Target: Praziquantel (PZQ) is a critical antiparasitic drug used to treat schistosomiasis and other parasitic helminths, but its mechanism has not been resolved. A pair of manuscripts by Park et al. and Le Clec'h et al. identified a Schistosoma mansoni transient receptor potential melastatin ion channel (TRPMPZQ) as the target of PZQ. Park et al. characterized a PZQ binding pocket in TRPMPZQ using ligand-based screening and targeted mutagenesis and confirmed that it was broadly conserved in other parasitic flatworms. Le Clec'h et al. used a genome-wide association screen and marker-assisted selection to identify TRPMPZQ as being responsible for variation in PZQ sensitivity and examine sequence variation in TRPMPZQ from field isolates. Together, these papers robustly confirm that TRPMPZQ is the molecular target of PZQ and provide critical information for monitoring PZQ resistance in the field. Praziquantel (PZQ) is an essential medicine for treating parasitic flatworm infections such as schistosomiasis, which afflicts over 250 million people. However, PZQ is not universally effective, lacking activity against liver flukes of the Fasciola genus. The reason for this insensitivity is unclear, as the mechanism of PZQ action is unknown. Here, we use ligand- and target-based methods to demonstrate that PZQ activates a transient receptor potential melastatin ion channel (TRPMPZQ) in schistosomes by engaging a hydrophobic ligand binding pocket within the voltage sensor–like domain of the channel to cause calcium entry and worm paralysis. PZQ activates TRPMPZQ homologs in other PZQ-sensitive flukes, but not Fasciola hepatica. However, a single amino acid change in the F. hepatica TRPMPZQ binding pocket, to mimic schistosome TRPMPZQ, confers PZQ sensitivity. After decades of clinical use, the molecular basis of PZQ action at a druggable TRP channel is resolved. [ABSTRACT FROM AUTHOR]

Smart toilets are a key tool for enabling precision health monitoring in the home, but such passive monitoring has ethical considerations. [ABSTRACT FROM AUTHOR]

Pancreatic ductal adenocarcinoma (PDAC) is a lethal malignancy that is often resistant to therapy. An immune suppressive tumor microenvironment (TME) and oncogenic mutations in KRAS have both been implicated as drivers of resistance to therapy. Mitogen-activated protein kinase (MAPK) inhibition has not yet shown clinical efficacy, likely because of rapid acquisition of tumor-intrinsic resistance. However, the unique PDAC TME may also be a driver of resistance. We found that long-term focal adhesion kinase (FAK) inhibitor treatment led to hyperactivation of the RAS/MAPK pathway in PDAC cells in mouse models and tissues from patients with PDAC. Concomitant inhibition of both FAK (with VS-4718) and rapidly accelerated fibrosarcoma and MAPK kinase (RAF-MEK) (with avutometinib) induced tumor growth inhibition and increased survival across multiple PDAC mouse models. In the TME, cancer-associated fibroblasts (CAFs) impaired the down-regulation of MYC by RAF-MEK inhibition in PDAC cells, resulting in resistance. By contrast, FAK inhibition reprogramed CAFs to suppress the production of FGF1, which can drive resistance to RAF-MEK inhibition. The addition of chemotherapy to combined FAK and RAF-MEK inhibition led to tumor regression, a decrease in liver metastasis, and improved survival in KRAS-driven PDAC mouse models. Combination of FAK and RAF-MEK inhibition alone improved antitumor immunity and priming of T cell responses in response to chemotherapy. These findings provided the rationale for an ongoing clinical trial evaluating the efficacy of avutometinib and defactinib in combination with gemcitabine and nab-paclitaxel in patients with PDAC and may suggest further paths for combined stromal and tumor-targeting therapies. Editor's summary: Pancreatic ductal adenocarcinoma (PDAC) often becomes resistant to therapy. It is unclear how combining different therapies could overcome tumor resistance. Liu et al. showed that combining focal adhesion kinase (FAK) inhibition with rapidly accelerated fibrosarcoma and mitogen-activated protein kinase kinase (RAF-MEK) inhibition improved survival and inhibited tumor growth in mouse PDAC models. Sequencing and cell culture experiments confirmed that cancer-associated fibroblasts in the tumor microenvironment were responsible for therapy resistance. Combining FAK and RAF-MEK inhibition with chemotherapy resulted in tumor regression, increased survival, and decreased liver metastasis in mouse models. Together, these results suggest that targeting both stromal and tumor factors involved in therapy resistance could improve PDAC responses to treatment. —Brandon Berry [ABSTRACT FROM AUTHOR]

After allogeneic hematopoietic cell transplantation (HCT), a very small number of donor stem cells reconstitute the recipient hematopoietic system, whereas the donor is left with a near-normal pool of stem cells. We hypothesized that the increased replicative stress on transplanted donor cells in the recipient could lead to the disproportionate proliferation of clonal hematopoiesis (CH) variants. We obtained blood samples from 16 related donor-recipient pairs at a median of 33.8 years (range: 6.6 to 45.7) after HCT, including the longest surviving HCT recipients in the world. For 11 of 16 pairs, a donor sample from the time of HCT was available for comparison. We performed ultrasensitive duplex sequencing of genes recurrently mutated in myeloid malignancies and CH, as well as a set of functionally neutral genomic regions representative of human genomic content at large. CH variants were observed in all donors, even those as young as 12 years old. Where donor pre-HCT sample was available, the average mutation rate in donors compared to recipients post-HCT was similar (2.0% versus 2.6% per year, respectively) within genes recurrently mutated in myeloid malignancies. Twenty-two (5.6%) of the 393 variants shared between paired donors and recipients post-HCT showed ≥10-fold higher variant allele frequency (VAF) in the recipient. A longer time since HCT was positively associated with the expansion of shared variant VAFs in the recipient. In conclusion, even decades after HCT, there does not appear to be widespread accelerated clonal expansion in the transplanted cells, highlighting the immense regenerative capacity of the human hematopoietic system. Editor's summary: Donor-associated clonal hematopoiesis (CH) has been reported in recipients of allogeneic hematopoietic cell transplantation (HCT); however, an inability to detect ultralow-frequency variants has prevented a better understanding of the impact of HCT on clonal dynamics. Here, Ueda Oshima and colleagues used ultrasensitive duplex sequencing to characterize blood samples from a unique cohort of 16 donor-recipient pairs, collected up to 46 years after allogeneic HCT. The average mutation rate per year was similar between donors and recipients after HCT, and only 5.6% of variants shared between paired donors and recipients were substantially expanded in the recipient compared with the donor. Although larger studies with more time points are needed, the data from this unique cohort suggest that preferential expansion of donor CH variants in recipients of HCT is low. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Cryptosporidiosis is a diarrheal disease caused by infection with Cryptosporidium spp. parasites and is a leading cause of death in malnourished children worldwide. The only approved treatment, nitazoxanide, has limited efficacy in this at-risk patient population. Additional safe therapeutics are urgently required to tackle this unmet medical need. However, the development of anti-cryptosporidial drugs is hindered by a lack of understanding of the optimal compound properties required to treat this gastrointestinal infection. To address this knowledge gap, a diverse set of potent lysyl-tRNA synthetase inhibitors was profiled to identify optimal physicochemical and pharmacokinetic properties required for efficacy in a chronic mouse model of infection. The results from this comprehensive study illustrated the importance of balancing solubility and permeability to achieve efficacy in vivo. Our results establish in vitro criteria for solubility and permeability that are predictive of compound efficacy in vivo to guide the optimization of anti-cryptosporidial drugs. Two compounds from chemically distinct series (DDD489 and DDD508) were identified as demonstrating superior efficacy and prioritized for further evaluation. Both compounds achieved marked parasite reduction in immunocompromised mouse models and a disease-relevant calf model of infection. On the basis of these promising data, these compounds have been selected for progression to preclinical safety studies, expanding the portfolio of potential treatments for this neglected infectious disease. Editor's summary: Cryptosporidium spp. parasites are a major cause of potentially fatal, severe diarrhea in malnourished children, with no vaccine available and no reliably effective treatment for this at-risk population. Caldwell et al. studied the physiochemical properties required for lysyl-tRNA synthetase targeting anti-cryptosporidial compounds to be effective given the unique intracellular but extracytoplasmic location of infecting protozoa in the small intestine. Testing of two chemically distinct lead compounds in immunocompromised mouse and neonatal calf models showed improvement in infection, suggesting that these leads should be prioritized for further efficacy and safety studies. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Intraoperative surgical margin assessment remains a challenge during breast-conserving surgery. Here, we report a combined strategy of immuno–positron emission tomography (PET) for preoperative detection of breast cancer and guided assessment of margins in breast-conserving surgery through second near-infrared (NIR-II) fluorescence imaging of trophoblastic cell surface antigen 2 (TROP2). We demonstrated that the intensity of PET signals in the tumors was nearly five times higher than in normal breast tissue with a zirconium-89 tracer conjugated to sacituzumab govitecan (SG) in a mouse spontaneous breast cancer model, enabling the identification of tumors. We further generated a NIR-II probe of indocyanine green conjugated to SG (ICG-SG) and developed a rapid incubation imaging method for intraoperative margin assessment in a relevant time window for the operation workflow. The ICG-SG NIR-II fluorescence image guidance was first verified to remove tumors completely and accurately in mouse breast cancer models. Moreover, the rapid incubation imaging method was applied to distinguish benign and malignant breast lesions in samples from 26 patients with breast cancer. Therefore, we have developed both nuclide and optical probes targeting TROP2 for rapid and precise identification of tumor margins during breast-conserving surgery in humans. Editor's summary: Identification of tumor borders is essential for effective surgical management of breast cancer. TROP2 is expressed in breast tumors but not normal mammary tissues. Here, Chen et al. developed imaging probes with the TROP2-targeted sacituzumab govitecan (SG) antibody-drug conjugate to assist surgeons in determining tumor versus normal mammary tissues before and during surgery. Labeling of SG with the near-infrared (NIR) fluorophore indocyanine green (ICG) supported the identification of TROP2+ tumor margins in NIR-II–guided surgery in murine breast tumor models. A rapid ex vivo tissue staining method with SG-ICG was also developed to intraoperatively evaluate TROP2+ tumor margins during human breast-conserving surgery. TROP2 probes are a promising approach for improving surgical removal of breast tumors. —Molly Ogle [ABSTRACT FROM AUTHOR]

Regulatory T cells (Tregs) make major contributions to immune homeostasis. Because Treg dysfunction can lead to both allo- and autoimmunity, there is interest in correcting these disorders through Treg adoptive transfer. Two of the central challenges in clinically deploying Treg cellular therapies are ensuring phenotypic stability and maximizing potency. Here, we describe an approach to address both issues through the creation of OX40 ligand (OX40L)–specific chimeric antigen receptor (CAR)–Tregs under the control of a synthetic forkhead box P3 (FOXP3) promoter. The creation of these CAR-Tregs enabled selective Treg stimulation by engagement of OX40L, a key activation antigen in alloimmunity, including both graft-versus-host disease and solid organ transplant rejection, and autoimmunity, including rheumatoid arthritis, systemic sclerosis, and systemic lupus erythematosus. We demonstrated that OX40L–CAR-Tregs were robustly activated in the presence of OX40L-expressing cells, leading to up-regulation of Treg suppressive proteins without induction of proinflammatory cytokine production. Compared with control Tregs, OX40L–CAR-Tregs more potently suppressed alloreactive T cell proliferation in vitro and were directly inhibitory toward activated monocyte-derived dendritic cells (DCs). We identified trogocytosis as one of the central mechanisms by which these CAR-Tregs effectively decrease extracellular display of OX40L, resulting in decreased DC stimulatory capacity. OX40L–CAR-Tregs demonstrated an enhanced ability to control xenogeneic graft-versus-host disease compared with control Tregs without abolishing the graft-versus-leukemia effect. These results suggest that OX40L–CAR-Tregs may have wide applicability as a potent cellular therapy to control both allo- and autoimmune diseases. Editor's summary: Regulatory T cell (Treg) therapies have emerged as a promising approach for diseases ranging from autoimmunity to transplantation, but delivery of a mixed pool of Tregs has not proven consistently successful. To make an improved Treg-based therapy, Rui et al. developed OX40L–CAR-Tregs, where expression of an OX40 ligand (OX40L)–specific chimeric antigen receptor (CAR) is expressed only in Tregs that have turned on the master Treg transcription factor FoxP3. The authors showed that OX40L–CAR-Tregs outperformed control, standard Tregs in their ability to suppress effector T cells, in part through their ability to strip OX40L from the surface of antigen-presenting cells. In vivo, OX40L–CAR-Tregs were able to suppress development of graft-versus-host disease without an obvious detrimental effect on the antileukemia response, supporting further development of this potent cellular therapy. —Courtney Malo [ABSTRACT FROM AUTHOR]

X-linked chronic granulomatous disease (X-CGD) is an inborn error of immunity (IEI) resulting from genetic mutations in the cytochrome b-245 beta chain (CYBB) gene. The applicability of base editors (BEs) to correct mutations that cause X-CGD is constrained by the requirement of Cas enzymes to recognize specific protospacer adjacent motifs (PAMs). Our recently engineered PAMless Cas enzyme, SpRY, can overcome the PAM limitation. However, the efficiency, specificity, and applicability of SpRY-based BEs to correct mutations in human hematopoietic stem and progenitor cells (HSPCs) have not been thoroughly examined. Here, we demonstrated that the adenine BE ABE8e-SpRY can access a range of target sites in HSPCs to correct mutations causative of X-CGD. For the prototypical X-CGD mutation CYBB c.676C>T, ABE8e-SpRY achieved up to 70% correction, reaching efficiencies greater than three-and-one-half times higher than previous CRISPR nuclease and donor template approaches. We profiled potential off-target DNA edits, transcriptome-wide RNA edits, and chromosomal perturbations in base-edited HSPCs, which together revealed minimal off-target or bystander edits. Edited alleles persisted after transplantation of the base-edited HSPCs into immunodeficient mice. Together, these investigational new drug–enabling studies demonstrated efficient and precise correction of an X-CGD mutation with PAMless BEs, supporting a first-in-human clinical trial (NCT06325709) and providing a potential blueprint for treatment of other IEI mutations. Editor's summary: Gene therapy for the treatment of X-linked chronic granulomatous disease, using autologous hematopoietic stem and progenitor cells (HSPCs) transduced with lentiviruses containing the sequence of the corrected cytochrome b-245 beta chain (CYBB) gene, is limited by the use of a weak promoter to reduce the risk of transactivating nearby oncogenes and by a lack of physiological regulation of transgene expression. Base editing could overcome these concerns, but base editors use Cas9 enzymes that require the presence of a protospacer adjacent motif (PAM), limiting their use. Here, Bzhilyanskaya and colleagues optimized the PAMless Cas9 enzyme SpRY with the adenine base editor ABE8e, ultimately correcting two mutations in CYBB in patient HSPCs with high efficiency and specificity. This work underlies the ongoing clinical trial NCT06325709. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Neuropathic pain is a debilitating chronic condition that lacks effective treatment. The role of cytokine- and chemokine-mediated neuroinflammation in its pathogenesis has been well documented. Follistatin (FST) is a secreted protein known to antagonize the biological activity of cytokines in the transforming growth factor–β (TGF-β) superfamily. The involvement of FST in neuropathic pain and the underlying mechanism remain largely unknown. Here, we report that FST was up-regulated in A-fiber sensory neurons after spinal nerve ligation (SNL) in mice. Inhibition or deletion of FST alleviated neuropathic pain and reduced the nociceptive neuron hyperexcitability induced by SNL. Conversely, intrathecal or intraplantar injection of recombinant FST, or overexpression of FST in the dorsal root ganglion (DRG) neurons, induced pain hypersensitivity. Furthermore, exogenous FST increased neuronal excitability in nociceptive neurons. The biolayer interferometry (BLI) assay and coimmunoprecipitation (co-IP) demonstrated direct binding of FST to the insulin-like growth factor–1 receptor (IGF1R), and IGF1R inhibition reduced FST-induced activation of extracellular signal–regulated kinase (ERK) and protein kinase B (AKT), as well as neuronal hyperexcitability. Further co-IP analysis revealed that the N-terminal domain of FST exhibits the highest affinity for IGF1R, and blocking this interaction with a peptide derived from FST attenuated Nav1.7-mediated neuronal hyperexcitability and neuropathic pain after SNL. In addition, FST enhanced neuronal excitability in human DRG neurons through IGF1R. Collectively, our findings suggest that FST, released from A-fiber neurons, enhances Nav1.7-mediated hyperexcitability of nociceptive neurons by binding to IGF1R, making it a potential target for neuropathic pain treatment. Editor's summary: Neuroinflammation contributes to the pathogenesis of neuropathic pain. The characterization of signaling pathways involved could help to identify new therapeutic targets. Here, Jiang et al. used a mouse model to show that the glycoprotein follistatin (FST) was up-regulated in sensory neurons in the dorsal root ganglia (DRG) after spinal nerve ligation. FST injections were sufficient to drive mechanical hypersensitivity and excitability of DRG neurons. FST interacted with insulin-like growth factor–1 receptor, and a peptide that blocked these interactions could alleviate neuropathic pain–related behaviors and FST-mediated voltage-gated sodium channel currents, highlighting a potential therapeutic strategy that warrants further examination. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Early life stress (ELS) yields cognitive impairments of unknown molecular and physiological origin. We found that fragmented maternal care of mice during a neonatal critical period from postnatal days P2–9 elevated dopamine receptor D2R and suppressed D4R expression, specifically within the anterior cingulate cortex (ACC) in only the male offspring. This was associated with poor performance on a two-choice visual attention task, which was acutely rescued in adulthood by local or systemic pharmacological rebalancing of D2R/D4R activity. Furthermore, ELS male mice demonstrated heightened hypothalamic orexin and persistently disrupted sleep. Given that acute sleep deprivation in normally reared male mice mimicked the ACC dopamine receptor subtype modulation and disrupted attention of ELS mice, sleep loss likely underlies cognitive deficits in ELS mice. Likewise, sleep impairment mediated the attention deficits associated with early adversity in human children, as demonstrated by path analysis on data collected with multiple questionnaires for a large child cohort. A deeper understanding of the sex-specific cognitive consequences of ELS thus has the potential to reveal therapeutic strategies for overcoming them. Editor's summary: Early life adversity (ELA) can have cognitive impacts that persist into adulthood, but the underlying brain mechanisms remain elusive. Here, Makino et al. show that fragmented maternal care led to cognitive dysfunction in adult male, but not female, mice. These findings were associated with disrupted sleep patterns and dysregulated dopamine receptor expression in the anterior cingulate cortex. Acute sleep disruption mimicked ELA-induced changes, and pharmacological rebalancing of DR signaling rescued cognitive dysfunction. Analysis of data from a cohort of young children showed that adversity negatively affected attention, and this relationship was mediated by poor sleep, indicating that the coupling of adversity, sleep, and attention is conserved across species. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Despite effective countermeasures, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) persists worldwide because of its ability to diversify and evade human immunity. This evasion stems from amino acid substitutions, particularly in the receptor binding domain (RBD) of the spike protein that confers resistance to vaccine-induced antibodies and antibody therapeutics. To constrain viral escape through resistance mutations, we combined antibody variable regions that recognize different RBD sites into multispecific antibodies. Here, we describe multispecific antibodies, including a trivalent trispecific antibody that potently neutralized diverse SARS-CoV-2 variants and prevented virus escape more effectively than single antibodies or mixtures of the parental antibodies. Despite being generated before the appearance of Omicron, this trispecific antibody neutralized all major Omicron variants through BA.4/BA.5 at nanomolar concentrations. Negative stain electron microscopy suggested that synergistic neutralization was achieved by engaging different epitopes in specific orientations that facilitated binding across more than one spike protein. Moreover, a tetravalent trispecific antibody containing the same variable regions as the trivalent trispecific antibody also protected Syrian hamsters against Omicron variants BA.1, BA.2, and BA.5 challenge, each of which uses different amino acid substitutions to mediate escape from therapeutic antibodies. These results demonstrated that multispecific antibodies have the potential to provide broad SARS-CoV-2 coverage, decrease the likelihood of escape, simplify treatment, and provide a strategy for antibody therapies that could help eliminate pandemic spread for this and other pathogens. Editor's summary: Monoclonal antibodies were an essential component of the COVID-19 treatment toolbox, at least until Omicron and its subvariants arose. As new variants wipe out efficacy of existing monoclonal antibodies, new options are urgently needed, especially to protect immunocompromised individuals who cannot make antibodies of their own. Here, Misasi et al. developed a series of multispecific antibodies that were able to more broadly neutralize SARS-CoV-2 pseudoviruses than their monoclonal antibody counterparts. One trivalent trispecific antibody combination was also able to prevent pseudovirus escape in vitro. To avoid heavy/light chain mispairing, the authors made that trivalent trispecific antibody into a tetravalent trispecific antibody. When administered to mice prophylactically, this antibody was able to confer protection against challenge with BA.1, BA.2, and BA.5. These data highlight the potential of multispecific antibodies as a long-term component of the COVID-19 toolbox. —Courtney Malo [ABSTRACT FROM AUTHOR]

Myeloproliferative neoplasms are stem cell–driven cancers associated with a large burden of morbidity and mortality. Most patients present with early-stage disease, but a substantial proportion progress to myelofibrosis or secondary leukemia, advanced cancers with a poor prognosis and high symptom burden. Currently, it remains difficult to predict progression, and therapies that reliably prevent or reverse fibrosis are lacking. A major bottleneck to the discovery of disease-modifying therapies has been an incomplete understanding of the interplay between perturbed cellular and molecular states. Several cell types have individually been implicated, but a comprehensive analysis of myelofibrotic bone marrow is lacking. We therefore mapped the cross-talk between bone marrow cell types in myelofibrotic bone marrow. We found that inflammation and fibrosis are orchestrated by a "quartet" of immune and stromal cell lineages, with basophils and mast cells creating a TNF signaling hub, communicating with megakaryocytes, mesenchymal stromal cells, and proinflammatory fibroblasts. We identified the β-galactoside–binding protein galectin-1 as a biomarker of progression to myelofibrosis and poor survival in multiple patient cohorts and as a promising therapeutic target, with reduced myeloproliferation and fibrosis in vitro and in vivo and improved survival after galectin-1 inhibition. In human bone marrow organoids, TNF increased galectin-1 expression, suggesting a feedback loop wherein the proinflammatory myeloproliferative neoplasm clone creates a self-reinforcing niche, fueling progression to advanced disease. This study provides a resource for studying hematopoietic cell–niche interactions, with relevance for cancer-associated inflammation and disorders of tissue fibrosis. Editor's summary: Myeloproliferative neoplasms can transition to advanced cancers with poor prognosis. Predicting progression and reversing the associated myelofibrosis remain difficult. Li, Colombo, and Wang et al. present a mouse cancer-stroma interactome for myelofibrosis and show that galectin-1 is a potential inflammation-related target for treating disease. Mesenchymal stem cells, eosinophils, basophils, and mast cells were each implicated in an inflammatory niche that drove myelofibrosis progression. Inhibiting galectin-1 with a monoclonal antibody in a mouse model of myeloproliferative neoplasm decreased fibrosis and cell proliferation and had a beneficial effect on survival. Galectin-1 was associated with myelofibrosis and poor survival in multiple human cohorts. These results suggest that galectin-1 may be a target to alter the inflammatory niche and to reduce fibrosis in myeloproliferative neoplasms. —Brandon Berry [ABSTRACT FROM AUTHOR]

Respiratory syncytial virus (RSV) infects nearly all children by 2 years of age and is a leading cause of pediatric hospitalizations. A subset of children with RSV infection (RSV+ children) develop respiratory failure requiring intensive care, but immune mechanisms distinguishing severe pediatric RSV infection are not fully elucidated. Natural killer (NK) cells are key innate immune effectors of viral host defense. In this study of 47 critically ill RSV+ children, we coupled NK cell immunophenotype and cytotoxic function with clinical parameters to identify an NK cell immune signature of severe pediatric RSV disease. Airway NK cells were increased in intubated RSV+ children with severe hypoxemia and prolonged duration of mechanical ventilation and were correlated with clinical severity scores. Peripheral blood NK cells were decreased in RSV+ patients and had altered activating receptor expression, with increased expression of CD69 and decreased expression of NKG2D. Ex vivo, circulating NK cells from RSV+ patients exhibited functional impairment characterized by decreased cytotoxicity as well as aberrant immune synapse assembly and lytic granule trafficking. NK cell frequency and phenotype correlated with clinical measures that defined disease severity. These findings implicate a role for NK cells in mediating RSV immunopathology and suggest that an altered NK cell immunophenotype is associated with severe RSV disease in young children. Editor's summary: Nearly all children are infected with respiratory syncytial virus (RSV) by 2 years of age. Although most children only develop mild symptoms, some can develop severe diseases requiring hospitalization. To better understand the potential drivers of severe disease, Reilly et al. analyzed airway and peripheral blood immune cells from pediatric patients infected with RSV requiring hospitalization. The authors found that natural killer (NK) cells were increased in the airways of children with severe RSV. A corresponding decrease was observed in peripheral blood NK cells. Moreover, the NK cells exhibited an altered phenotype and were less effective at killing target cells ex vivo. These data suggest that these NK cells may be drivers of RSV immunopathology. —Courtney Malo [ABSTRACT FROM AUTHOR]

Increased plasma creatine concentrations are associated with the risk of type 2 diabetes, but whether this alteration is associated with or causal for impairments in metabolism remains unexplored. Because skeletal muscle is the main disposal site of both creatine and glucose, we investigated the role of intramuscular creatine metabolism in the pathophysiology of insulin resistance in type 2 diabetes. In men with type 2 diabetes, plasma creatine concentrations were increased, and intramuscular phosphocreatine content was reduced. These alterations were coupled to reduced expression of sarcomeric mitochondrial creatine kinase 2 (CKMT2). In C57BL/6 mice fed a high-fat diet, neither supplementation with creatine for 2 weeks nor treatment with the creatine analog β-GPA for 1 week induced changes in glucose tolerance, suggesting that increased circulating creatine was associated with insulin resistance rather than causing it. In C2C12 myotubes, silencing Ckmt2 using small interfering RNA reduced mitochondrial respiration, membrane potential, and glucose oxidation. Electroporation-mediated overexpression of Ckmt2 in skeletal muscle of high-fat diet–fed male mice increased mitochondrial respiration, independent of creatine availability. Given that overexpression of Ckmt2 improved mitochondrial function, we explored whether exercise regulates CKMT2 expression. Analysis of public data revealed that CKMT2 content was up-regulated by exercise training in both humans and mice. We reveal a previously underappreciated role of CKMT2 in mitochondrial homeostasis beyond its function for creatine phosphorylation, independent of insulin action. Collectively, our data provide functional evidence for how CKMT2 mediates mitochondrial dysfunction associated with type 2 diabetes. Editor's summary: Increased plasma creatine is associated with type 2 diabetes, but causation has not been established. Rizo-Roca et al. show that men with type 2 diabetes had increased plasma creatine and decreased muscle phosphocreatine, which was associated with poor glucose handling. In myotubes in vitro, silencing the mitochondria-associated sarcomeric mitochondrial creatine kinase 2 (Ckmt2) gene resulted in impaired mitochondrial functions. In mice fed a high-fat diet, creatine supplementation had no effect on glucose handling, but overexpression of Ckmt2 in muscle improved mitochondrial functions. Data from humans and mice showed that exercise increased CKMT2 and metrics of mitochondrial functions. These results suggest that creatine changes are a consequence rather than a cause of insulin resistance in type 2 diabetes. —Brandon Berry [ABSTRACT FROM AUTHOR]

Globally, severe acute malnutrition (SAM), defined as a weight-for-length z-score more than three SDs below a reference mean (WLZ < −3), affects 14 million children under 5 years of age. Complete anthropometric recovery after standard, short-term interventions is rare, with children often left with moderate acute malnutrition (MAM; WLZ −2 to −3). We conducted a randomized controlled trial (RCT) involving 12- to 18-month-old Bangladeshi children from urban and rural sites, who, after initial hospital-based treatment for SAM, received a 3-month intervention with a microbiome-directed complementary food (MDCF-2) or a calorically more dense, standard ready-to-use supplementary food (RUSF). The rate of WLZ improvement was significantly greater in MDCF-2–treated children (P = 8.73 × 10−3), similar to our previous RCT of Bangladeshi children with MAM without antecedent SAM (P = 0.032). A correlated meta-analysis of plasma levels of 4520 proteins in both RCTs revealed 215 positively associated with WLZ (largely representing musculoskeletal and central nervous system development) and 44 negatively associated (primarily related to immune activation). Moreover, the positively associated proteins were significantly enriched by MDCF-2 (q = 1.1 × 10−6). Characterizing the abundances of 754 bacterial metagenome-assembled genomes in serially collected fecal samples disclosed the effects of acute rehabilitation for SAM on the microbiome and how, during treatment for MAM, specific strains of Prevotella copri function at the intersection between MDCF-2 glycan metabolism and anthropometric recovery. These results provide a rationale for further testing the generalizability of MDCF efficacy and for identifying biomarkers to define treatment responses. Editor's summary: Severe acute malnutrition affects millions of children worldwide. Hartman et al. performed a 3-month randomized controlled trial of a gut microbiome–directed food supplement in 12- to 18-month-old Bangladeshi children living in rural and urban locations with moderate acute malnutrition and who had already been treated in hospital for severe acute malnutrition. Their microbiome-directed complementary food (MDCF-2) improved ponderal growth better than a more calorically dense, commonly used supplement and increased plasma abundance of proteins involved in musculoskeletal and central nervous system development. The authors tied the improvements in the children's health to changes in growth-associated gut microbiome species, most notably Prevotella copri strains and their carbohydrate degrading pathways. —Catherine Charneski [ABSTRACT FROM AUTHOR]

MYC promotes tumor growth through multiple mechanisms. Here, we show that, in human glioblastomas, the variant MYC transcript encodes a 114–amino acid peptide, MYC pre-mRNA encoded protein (MPEP), from the upstream open reading frame (uORF) MPEP. Secreted MPEP promotes patient-derived xenograft tumor growth in vivo, independent of MYC through direct binding, and activation of tropomyosin receptor kinase B (TRKB), which induces downstream AKT-mTOR signaling. Targeting MPEP through genetic ablation reduced growth of patient-derived 4121 and 3691 glioblastoma stem cells. Administration of an MPEP-neutralizing antibody in combination with a small-molecule TRKB inhibitor reduced glioblastoma growth in patient-derived xenograft tumor–bearing mice. The overexpression of MPEP in surgical glioblastoma specimens predicted a poor prognosis, supporting its clinical relevance. In summary, our results demonstrate that tumor-specific translation of a MYC-associated uORF promotes glioblastoma growth, suggesting a new therapeutic strategy for glioblastoma. Editor's summary: Upstream open reading frames (uORFs) are RNA sequences encoding short peptides that mainly function as translational represssors. Here, Li et al. show that the uORF of the oncogene MYC is translated into a peptide (MPEP) that is secreted from glioblastoma stem cells (GSCs). MPEP expression promoted proliferation of GSCs in vitro and accelerated tumorigenesis in a mouse model. MPEP acted through canonical activation of tropomyosin receptor kinase B, which was corroborated by the increase in survival rates of glioblastoma mice undergoing combination treatment with an MPEP antibody and the TRK inhibitor entrecitinib. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Oxidative stress has long been implicated in Parkinson's disease (PD) pathogenesis, although the sources and regulation of reactive oxygen species (ROS) production are poorly defined. Pathogenic mutations in the gene encoding leucine-rich repeat kinase 2 (LRRK2) are associated with increased kinase activity and a greater risk of PD. The substrates and downstream consequences of elevated LRRK2 kinase activity are still being elucidated, but overexpression of mutant LRRK2 has been associated with oxidative stress, and antioxidants reportedly mitigate LRRK2 toxicity. Here, using CRISPR-Cas9 gene-edited HEK293 cells, RAW264.7 macrophages, rat primary ventral midbrain cultures, and PD patient–derived lymphoblastoid cells, we found that elevated LRRK2 kinase activity was associated with increased ROS production and lipid peroxidation and that this was blocked by inhibitors of either LRRK2 kinase or NADPH oxidase 2 (NOX2). Oxidative stress induced by the pesticide rotenone was ameliorated by LRRK2 kinase inhibition and was absent in cells devoid of LRRK2. In a rat model of PD induced by rotenone, a LRRK2 kinase inhibitor prevented the lipid peroxidation and NOX2 activation normally seen in nigral dopaminergic neurons in this model. Mechanistically, LRRK2 kinase activity was shown to regulate phosphorylation of serine-345 in the p47phox subunit of NOX2. This, in turn, led to translocation of p47phox from the cytosol to the membrane-associated gp91phox (NOX2) subunit, activation of the NOX2 enzyme complex, and production of ROS. Thus, LRRK2 kinase activity may drive cellular ROS production in PD through the regulation of NOX2 activity. Editor's summary: Production of reactive oxygen species (ROS) has been implicated in Parkinson's disease (PD) pathogenesis, but the source and regulation of ROS are unclear. Overexpression of mutant leucine-rich repeat kinase 2 (LRRK2), which is known to increase PD risk, is associated with oxidative stress–induced tissue damage. Keeney and colleagues now report in several different cellular models of PD and a rat model that LRRK2 kinase activity regulates phosphorylation of serine-345 in the p47phox subunit of NADPH oxidase 2 (NOX2), leading to NOX2 activation and ROS production. These findings implicate LRRK2 kinase activity in cellular ROS production mediated by NOX2 activity. —Orla Smith [ABSTRACT FROM AUTHOR]

Acute kidney injury (AKI) is a frequent and challenging clinical condition associated with high morbidity and mortality and represents a common complication in critically ill patients with COVID-19. In AKI, renal tubular epithelial cells (TECs) are a primary site of damage, and recovery from AKI depends on TEC plasticity. However, the molecular mechanisms underlying adaptation and maladaptation of TECs in AKI remain largely unclear. Here, our study of an autopsy cohort of patients with COVID-19 provided evidence that injury of TECs by myoglobin, released as a consequence of rhabdomyolysis, is a major pathophysiological mechanism for AKI in severe COVID-19. Analyses of human kidney biopsies, mouse models of myoglobinuric and gentamicin-induced AKI, and mouse kidney tubuloids showed that TEC injury resulted in activation of the glucocorticoid receptor by endogenous glucocorticoids, which aggravated tubular damage. The detrimental effect of endogenous glucocorticoids on injured TECs was exacerbated by the administration of a widely clinically used synthetic glucocorticoid, dexamethasone, as indicated by experiments in mouse models of myoglobinuric- and folic acid–induced AKI, human and mouse kidney tubuloids, and human kidney slice cultures. Mechanistically, studies in mouse models of AKI, mouse tubuloids, and human kidney slice cultures demonstrated that glucocorticoid receptor signaling in injured TECs orchestrated a maladaptive transcriptional program to hinder DNA repair, amplify injury-induced DNA double-strand break formation, and dampen mTOR activity and mitochondrial bioenergetics. This study identifies glucocorticoid receptor activation as a mechanism of epithelial maladaptation, which is functionally important for AKI. Editor's summary: Acute kidney injury (AKI) is a complication of critically ill patients with COVID-19. Dexamethasone is a synthetic glucocorticoid used to treat severe COVID-19. Zhou et al. combined data from patients who died in association with COVID-19, human tissue, and mouse models of AKI and found that renal tubular epithelial cell (TEC) damage from myoglobinuria resulted in glucocorticoid receptor activation and worse injury. Mice given myoglobinuric injury and dexamethasone treatment had exacerbated TEC damage. Human kidney slices and TEC organoids from both humans and mice corroborated this exacerbated damage. Inhibiting endogenous glucocorticoid production or inactivating the glucocorticoid receptor ameliorated TEC damage in these models. TEC damage was linked to DNA damage and mitochondrial impairment. These data suggest that glucocorticoid receptor activation aggravates renal injury. —Brandon Berry [ABSTRACT FROM AUTHOR]

When dysregulated, skin fibrosis can lead to a multitude of pathologies. We provide a framework for understanding the wide clinical spectrum, mechanisms, and management of cutaneous fibrosis encompassing a variety of matrix disorders, fibrohistiocytic neoplasms, injury-induced scarring, and autoimmune scleroses. Underlying such entities are common mechanistic pathways that leverage morphogenic signaling, immune activation, and mechanotransduction to modulate fibroblast function. In light of the limited array of available treatments for cutaneous fibrosis, scientific insights have opened new therapeutic and investigative avenues for conditions that still lack effective interventions. [ABSTRACT FROM AUTHOR]

Activation of extracellular matrix–producing hepatic stellate cells (HSCs) is a key event in liver fibrogenesis. We showed that the expression of the heme-thiolate monooxygenase cytochrome P450 1B1 (CYP1B1) was elevated in human and mouse fibrotic livers and activated HSCs. Systemic or HSC-specific ablation and pharmacological inhibition of CYP1B1 attenuated HSC activation and protected male but not female mice from thioacetamide (TAA)–, carbon tetrachloride (CCl4)–, or bile duct ligation (BDL)–induced liver fibrosis. Metabolomic analysis revealed an increase in the disaccharide trehalose in CYP1B1-deficient HSCs resulting from intestinal suppression of the trehalose-metabolizing enzyme trehalase, whose gene we found to be a target of RARα. Trehalose or its hydrolysis-resistant derivative lactotrehalose exhibited potent antifibrotic activity in vitro and in vivo by functioning as an HSC-specific autophagy inhibitor, which may account for the antifibrotic effect of CYP1B1 inhibition. Our study thus reveals an endobiotic function of CYP1B1 in liver fibrosis in males, mediated by liver-intestine cross-talk and trehalose. At the translational level, pharmacological inhibition of CYP1B1 or the use of trehalose/lactotrehalose may represent therapeutic strategies for liver fibrosis. Editor's summary: Hepatic stellate cells (HSCs) are well-known actors in liver fibrosis, and a better understanding of the factors governing their activity could open up therapeutic opportunities. Tung et al. examined the role of the cytochrome P450 analog CYP1B1 in liver fibrosis, finding that its inhibition or depletion reduced liver pathology in multiple mouse models in a sex-dependent manner. The authors tied the observed antifibrotic effect in males to HSC accumulation of trehalose as a result of inhibition of trehalase in the intestine. As a test of therapeutic potential, male mice fed trehalose or nonhydrolyzable lactotrehalose in drinking water showed reduced liver fibrogenesis, with follow-up analysis of similarly treated HSCs demonstrating reduced autophagic degradation. This study suggests that the metabolite trehalose may play a sex-specific role in liver fibrosis. —Catherine Charneski [ABSTRACT FROM AUTHOR]

Neuroimmune interactions are essential for the development of neuropathic pain, yet the contributions of distinct immune cell populations have not been fully unraveled. Here, we demonstrate the critical role of B cells in promoting mechanical hypersensitivity (allodynia) after peripheral nerve injury in male and female mice. Depletion of B cells with a single injection of anti-CD20 monoclonal antibody at the time of injury prevented the development of allodynia. B cell–deficient (muMT) mice were similarly spared from allodynia. Nerve injury was associated with increased immunoglobulin G (IgG) accumulation in ipsilateral lumbar dorsal root ganglia (DRGs) and dorsal spinal cords. IgG was colocalized with sensory neurons and macrophages in DRGs and microglia in spinal cords. IgG also accumulated in DRG samples from human donors with chronic pain, colocalizing with a marker for macrophages and satellite glia. RNA sequencing revealed a B cell population in naive mouse and human DRGs. A B cell transcriptional signature was enriched in DRGs from human donors with neuropathic pain. Passive transfer of IgG from injured mice induced allodynia in injured muMT recipient mice. The pronociceptive effects of IgG are likely mediated through immune complexes interacting with Fc gamma receptors (FcγRs) expressed by sensory neurons, microglia, and macrophages, given that both mechanical allodynia and hyperexcitability of dissociated DRG neurons were abolished in nerve-injured FcγR-deficient mice. Consistently, the pronociceptive effects of IgG passive transfer were lost in FcγR-deficient mice. These data reveal that a B cell–IgG–FcγR axis is required for the development of neuropathic pain in mice. Editor's summary: B cells contribute to the pathogenesis of neuropathic pain, but the exact mechanisms remain elusive. Lacagnina et al. report increased immunoglobulin G (IgG) in the dorsal root ganglia (DRGs) of mice after peripheral nerve injury (PNI) and patients with chronic pain. Passive transfer of IgG from injured wild-type mice elicited allodynia in PNI mice without B cells (muMT) that were otherwise protected from allodynia. Mice lacking the Fc gamma receptor (FcγR) were also protected from allodynia, and this receptor was necessary for the development of hyperexcitability in DRG neurons upon PNI. The identified B cell–IgG–FcγR axis could help to develop alternative treatment avenues for neuropathic pain. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) results in acute damage and triggers secondary injury responses with sustained neuronal loss and dysfunction. However, the underlying mechanisms for these delayed neuronal pathologies are not entirely understood. SCI results in the swelling of spinal neurons, but the contribution of cell swelling to neuronal loss and functional deficits after SCI has not been systematically characterized. In this study, we devised a three-dimensional image analysis pipeline to evaluate spinal neurons, examining their types, quantities, volumes, and spatial distribution in a double-lateral hemisection SCI mouse model. We found that both excitatory and inhibitory neurons swell and are lost, albeit with distinct temporal patterns. Inhibitory neurons demonstrated marked swelling and decline in number on day 2 after SCI, which resolved by day 14. In contrast, excitatory neurons maintained persistent swelling and continued cell loss for at least 35 days after SCI in mice. Excitatory neurons exhibited sustained expression of the Na+-K+-Cl− cotransporter 1 (NKCC1), whereas inhibitory neurons down-regulated the protein by day 14 after SCI. Treatment with a Food and Drug Administration–approved NKCC1 inhibitor, bumetanide, mitigated swelling of excitatory neurons and reduced their loss in the secondary injury phase after SCI. The administration of bumetanide after SCI in mouse improved locomotor recovery, with functional benefits persisting for at least 4 weeks after treatment cessation. This study advances our understanding of SCI-related pathology and introduces bumetanide as a potential treatment to mitigate sustained neuronal swelling and enhance recovery after SCI. Editor's summary: Spinal neuron swelling occurs after spinal cord injury (SCI), but the mechanisms, dynamics, and relationship of neural swelling to long-term locomotor deficits remain unclear. Here, Li et al. visualized neuronal swelling after SCI in mice using whole-mount tissue and a three-dimensional image analysis pipeline. They found that both excitatory and inhibitory neurons undergo swelling and loss after SCI, but with differing kinetics. Targeting overall tissue edema did not reduce neuronal swelling; however, inhibition of the Na+-K+-Cl− cotransporter 1 (NKCC1) with the FDA-approved drug bumetanide reduced excitatory neuron swelling. Bumetanide given in the first 4 weeks after injury improved recovery of motor function in the presence of excitatory neurons. These findings in mice suggest that excitatory neuronal swelling may be a therapeutic target for reducing functional deficits after SCI. —Molly Ogle [ABSTRACT FROM AUTHOR]

Lower urinary tract infection (UTI) is common but only rarely complicated by pyelonephritis. However, the mechanisms preventing extension to the kidney are unclear. Here, we identified neutrophil extracellular traps (NETs) in healthy human urine that provide an antibacterial defense strategy within the urinary tract. In both in vivo murine models of UTI where uropathogenic E. coli are inoculated into the bladder and ex vivo human urine models, NETs interacted with uromodulin to form large webs that entrapped the bacteria. Peptidyl arginine deiminase 4 (PADI4) inhibition in mice blocked NETosis and resulted in progression of cystitis into pyelonephritis, suggesting that NETosis of urinary neutrophils acts to prevent bacterial ascent into the kidney. Analysis of UK Biobank data revealed that genetic variants in PADI4 that associated with increased risk of rheumatoid arthritis in multiple genome-wide association studies were consistently associated with reduced susceptibility to UTI. Last, we showed that urine dipstick testing for leukocyte esterase was negative in the presence of intact blood neutrophils but became positive when neutrophils were stimulated to NET, and this could be prevented by selective PADI4 inhibition, demonstrating that this test does not detect absolute neutrophil count, as has long been assumed, but specifically detects neutrophils that have undergone NETosis. These findings highlight the role of NETosis in preventing ascending infections in the urinary tract and improve our understanding of one of the most common clinical tests in medicine. Editor's summary: Lower urinary tract infections (UTIs) rarely ascend to the kidney, but the mechanisms underlying this protection are not fully understood. Here, Stewart and colleagues identified neutrophil extracellular traps (NETs) in the urine of healthy individuals that interacted with uromodulin to form webs and entrap bacteria. Inhibition of peptidyl arginine deiminase type 4 (PADI4) reduced NETosis and increased pyelonephritis in mice challenged with uropathogenic E. coli, and an analysis of UK Biobank data revealed that variants in PADI4 were associated with reduced incidence of UTI. The authors also showed that the leukocyte esterase urine dipstick test specifically detects the presence of NETosing neutrophils, highlighting the importance of NETs in both the prevention and diagnosis of UTI. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Acute myeloid leukemia (AML) is a devastating disease initiated and maintained by a rare subset of cells called leukemia stem cells (LSCs). LSCs are responsible for driving disease relapse, making the development of new therapeutic strategies to target LSCs urgently needed. The use of mass spectrometry–based metabolomics profiling has enabled the discovery of unique and targetable metabolic properties in LSCs. However, we do not have a comprehensive understanding of metabolite differences between LSCs and their normal counterparts, hematopoietic stem and progenitor cells (HSPCs). In this study, we used an unbiased mass spectrometry–based metabolomics analysis to define differences in metabolites between primary human LSCs and HSPCs, which revealed that LSCs have a distinct metabolome. Spermidine was the most enriched metabolite in LSCs compared with HSPCs. Pharmacological reduction of spermidine concentrations decreased LSC function but spared normal HSPCs. Polyamine depletion also decreased leukemic burden in patient-derived xenografts. Mechanistically, spermidine depletion induced LSC myeloid differentiation by decreasing eIF5A-dependent protein synthesis, resulting in reduced expression of a select subset of proteins. KAT7, a histone acetyltransferase, was one of the top candidates identified to be down-regulated by spermidine depletion. Overexpression of KAT7 partially rescued polyamine depletion–induced decreased colony-forming ability, demonstrating that loss of KAT7 is an essential part of the mechanism by which spermidine depletion targets AML clonogenic potential. Together, we identified and mechanistically dissected a metabolic vulnerability of LSCs that has the potential to be rapidly translated into clinical trials to improve outcomes for patients with AML. Editor's summary: A major concern for patients with acute myeloid leukemia is relapse after treatment. Leukemic stem cells (LSCs), which reside in the bone marrow and maintain the pool of leukemic cells, are the main culprits behind relapse and thus need to be targeted to prevent relapse from occurring. To identify targetable vulnerabilities of LSCs, Rondeau et al. performed metabolomics profiling of LSCs compared with healthy hematopoietic stem and progenitor cells (HSPCs). They identified the polyamine spermidine as a metabolite specifically enriched in LSCs and then showed that reducing spermidine or total polyamine concentrations could impair LSC function by down-regulating expression of a histone acetyltransferase, KAT7. Polyamine depletion reduced leukemia burden in patient-derived mouse models, suggesting that this could be a therapeutic approach to prevent relapse for patients with AML. —Courtney Malo [ABSTRACT FROM AUTHOR]

The development of the human immune system lasts for several years after birth. The impact of this maturation phase on the quality of adaptive immunity and the acquisition of immunological memory after infection at a young age remains incompletely defined. Here, using an antigen-reactive T cell (ARTE) assay and multidimensional flow cytometry, we profiled circulating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–reactive CD3+CD4+CD154+ T cells in children and adults before infection, during infection, and 11 months after infection, stratifying children into separate age groups and adults according to disease severity. During SARS-CoV-2 infection, children younger than 5 years old displayed a lower antiviral CD4+ T cell response, whereas children older than 5 years and adults with mild disease had, quantitatively and phenotypically, comparable virus-reactive CD4+ T cell responses. Adults with severe disease mounted a response characterized by higher frequencies of virus-reactive proinflammatory and cytotoxic T cells. After SARS-CoV-2 infection, preschool-age children not only maintained neutralizing SARS-CoV-2–reactive antibodies postinfection comparable to adults but also had phenotypically distinct memory T cells displaying high inflammatory features and properties associated with migration toward inflamed sites. Moreover, preschool-age children had markedly fewer circulating virus-reactive memory B cells compared with the other cohorts. Collectively, our results reveal unique facets of antiviral immunity in humans at a young age and indicate that the maturation of adaptive responses against SARS-CoV-2 toward an adult-like profile occurs in a progressive manner. Editor's summary: The immune system continues to develop throughout childhood, and it is established that children have distinct immune responses to vaccines and infections as compared with adults. Here, Manfroi et al. characterized the immune response to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children. The authors found that preschool-age children had a different adaptive immune response, with a lower frequency of antiviral CD4+ T cells, compared with older children and adults; this younger cohort also developed phenotypically distinct memory T and B cell responses after recovery compared with the other cohorts. This study highlights that responses to SARS-CoV-2 infection in young children are unique and reflect the ongoing maturation of the immune system into adulthood. —Courtney Malo [ABSTRACT FROM AUTHOR]

Traumatic spinal cord injury (tSCI) causes an immediate loss of neurological function, and the prediction of recovery is difficult in the acute phase. In this study, we used contrast-enhanced ultrasound imaging to quantify intraspinal vascular disruption acutely after tSCI. In a rodent thoracic tSCI model, contrast-enhanced ultrasound revealed a perfusion area deficit that was positively correlated with injury severity and negatively correlated with hindlimb locomotor function at 8 weeks after injury. The spinal perfusion index was calculated by normalizing the contrast inflow at the injury center to the contrast inflow in the injury periphery. The spinal perfusion index decreased with increasing injury severity and positively correlated with hindlimb locomotor function at 8 weeks after injury. The feasibility of intraoperative contrast-enhanced ultrasound imaging was further tested in a cohort of 27 patients with acute tSCI of varying severity and including both motor-complete and motor-incomplete tSCIs. Both the perfusion area deficit and spinal perfusion index were different between motor-complete and motor-incomplete patients. Moreover, the perfusion area deficit and spinal perfusion index correlated with the injury severity at intake and exhibited a correlation with extent of functional recovery at 6 months. Our data suggest that intraoperative contrast-enhanced, ultrasound-derived metrics are correlated with injury severity and chronic functional outcome after tSCI. Larger clinical studies are required to better assess the reliability of the proposed contrast-enhanced ultrasound biomarkers and their prognostic capacity. Editor's summary: Traumatic spinal cord injury (tSCI) can lead to long-term challenges in motor and sensory function. The neurological examination conducted upon hospital admission may not always provide information regarding the functional outcome of the patient long term. Here, Khaing et al. used intraoperative contrast-enhanced ultrasound to derive two parameters related to blood flow in the injured spinal cord. The authors found that these metrics, perfusion area deficit and spinal perfusion index, were correlated with injury severity in rodents and in a cohort of humans with tSCI. These measurements were also correlated with functional injury severity scores up to 6 months after injury in patients. This study supports further investigation of ultrasound perfusion metrics as candidate markers to predict functional outcome after tSCI. —Molly Ogle [ABSTRACT FROM AUTHOR]

Muscle-specific kinase (MuSK) is essential for the formation, function, and preservation of neuromuscular synapses. Activation of MuSK by a MuSK agonist antibody may stabilize or improve the function of the neuromuscular junction (NMJ) in patients with disorders of the NMJ, such as congenital myasthenia (CM). Here, we generated and characterized ARGX-119, a first-in-class humanized agonist monoclonal antibody specific for MuSK, that is being developed for treatment of patients with neuromuscular diseases. We performed in vitro ligand-binding assays to show that ARGX-119 binds with high affinity to the Frizzled-like domain of human, nonhuman primate, rat, and mouse MuSK, without off-target binding, making it suitable for clinical development. Within the Fc region, ARGX-119 harbors L234A and L235A mutations to diminish potential immune-activating effector functions. Its mode of action is to activate MuSK, without interfering with its natural ligand neural Agrin, and cluster acetylcholine receptors in a dose-dependent manner, thereby stabilizing neuromuscular function. In a mouse model of DOK7 CM, ARGX-119 prevented early postnatal lethality and reversed disease relapse in adult Dok7 CM mice by restoring neuromuscular function and reducing muscle weakness and fatigability in a dose-dependent manner. Pharmacokinetic studies in nonhuman primates, rats, and mice revealed a nonlinear PK behavior of ARGX-119, indicative of target-mediated drug disposition and in vivo target engagement. On the basis of this proof-of-concept study, ARGX-119 has the potential to alleviate neuromuscular diseases hallmarked by impaired neuromuscular synaptic function, warranting further clinical development. Editor's summary: Muscle-specific kinase (MuSK) is required for the formation and maintenance of neuromuscular junctions, the synaptic connections between motor neurons and muscle fibers. Impairments in MuSK signaling cause certain forms of neuromuscular disease such as congenital myasthenic syndrome and myasthenia gravis. Here, Vanhauwaert et al. present the development of ARGX-119, an agonist antibody for MuSK. ARGX-119 activated MuSK in vitro across different species, including humans, and showed no off-target binding. ARGX-119 was safe in healthy mice and rescued motor function, prolonged survival, and reversed disease relapse in a mouse model of congenital myasthenia. These data support further development of ARGX-119 for neuromuscular diseases. —Daniela Neuhofer [ABSTRACT FROM AUTHOR]

Schistosomiasis, a highly prevalent parasitic disease, affects more than 200 million people worldwide. Current diagnostics based on parasite egg detection in stool detect infection only at a late stage, and current antibody-based tests cannot distinguish past from current infection. Here, we developed and used a multiplexed antibody profiling platform to obtain a comprehensive repertoire of antihelminth humoral profiles including isotype, subclass, Fc receptor (FcR) binding, and glycosylation profiles of antigen-specific antibodies. Using Essential Regression (ER) and SLIDE, interpretable machine learning methods, we identified latent factors (context-specific groups) that move beyond biomarkers and provide insights into the pathophysiology of different stages of schistosome infection. By comparing profiles of infected and healthy individuals, we identified modules with unique humoral signatures of active disease, including hallmark signatures of parasitic infection such as elevated immunoglobulin G4 (IgG4). However, we also captured previously uncharacterized humoral responses including elevated FcR binding and specific antibody glycoforms in patients with active infection, helping distinguish them from those without active infection but with equivalent antibody titers. This signature was validated in an independent cohort. Our approach also uncovered two distinct endotypes, nonpatent infection and prior infection, in those who were not actively infected. Higher amounts of IgG1 and FcR1/FcR3A binding were also found to be likely protective of the transition from nonpatent to active infection. Overall, we unveiled markers for antibody-based diagnostics and latent factors underlying the pathogenesis of schistosome infection. Our results suggest that selective antigen targeting could be useful in early detection, thus controlling infection severity. Editor's summary: Schistosomiasis is a parasitic flatworm infection, and diagnosis is based on egg detection in stool. Current tests cannot distinguish between active and past infections. Saha and Chakraborty et al. developed a multiplexed antibody approach that used interpretable machine learning to distinguish different stages of disease. Comparing healthy and infected individuals across two human cohorts from Brazil and Kenya revealed previously uncharacterized signatures of active disease, including increased Fc receptor binding and specific antibody glycoforms. These signatures helped to separate individuals with active infection from those with past infection as well as to establish two distinct endotypes, those with low intensity or early infection and those with cleared prior infections, in those without active infection. These data suggest that profiling of humoral immune responses could be used to diagnose cases of schistosomiasis with higher precision. —Brandon Berry [ABSTRACT FROM AUTHOR]

Autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy (APECED) is a life-threatening monogenic autoimmune disorder primarily caused by biallelic deleterious variants in the autoimmune regulator (AIRE) gene. We prospectively evaluated 104 patients with clinically diagnosed APECED syndrome and identified 17 patients (16%) from 14 kindreds lacking biallelic AIRE variants in exons or flanking intronic regions; 15 had Puerto Rican ancestry. Through whole-genome sequencing, we identified a deep intronic AIRE variant (c.1504-818 G>A) cosegregating with the disease in all 17 patients. We developed a culture system of AIRE-expressing primary patient monocyte-derived dendric cells and demonstrated that c.1504-818 G>A creates a cryptic splice site and activates inclusion of a 109–base pair frame-shifting pseudoexon. We also found low-level AIRE expression in patient-derived lymphoblastoid cell lines (LCLs) and confirmed pseudoexon inclusion in independent extrathymic AIRE–expressing cell lines. Through protein modeling and transcriptomic analyses of AIRE-transfected human embryonic kidney 293 and thymic epithelial cell 4D6 cells, we showed that this variant alters the carboxyl terminus of the AIRE protein, abrogating its function. Last, we developed an antisense oligonucleotide (ASO) that reversed pseudoexon inclusion and restored the normal AIRE transcript sequence in LCLs. Thus, our findings revealed c.1504-818 G>A as a founder APECED-causing AIRE variant in the Puerto Rican population and uncovered pseudoexon inclusion as an ASO-reversible genetic mechanism underlying APECED. Editor's summary: Biallelic mutations in the autoimmune regulator (AIRE) gene cause the autoimmune syndrome APECED (autoimmune polyendocrinopathy-candidiasis-ectodermal dystrophy). Here, Ochoa and colleagues studied 17 patients, predominantly of Puerto Rican ancestry, who were clinically diagnosed with APECED but who lacked biallelic variants in AIRE exons or flanking intronic regions. They identified a deep intronic variant in AIRE that created a cryptic splice site, leading to inclusion of a frame-shifting pseudoexon that resulted in predicted alterations in the C terminus of the protein and loss of protein function. The authors developed an antisense oligonucleotide that restored normal AIRE splicing, suggesting a potential treatment approach for these patients. —Melissa L. Norton [ABSTRACT FROM AUTHOR]

Radiation therapy (RT) activates multiple immunologic effects in the tumor microenvironment (TME), with diverse dose-response relationships observed. We hypothesized that, in contrast with homogeneous RT, a heterogeneous RT dose would simultaneously optimize activation of multiple immunogenic effects in a single TME, resulting in a more effective antitumor immune response. Using high-dose-rate brachytherapy, we treated mice bearing syngeneic tumors with a single fraction of heterogeneous RT at a dose ranging from 2 to 30 gray. When combined with dual immune checkpoint inhibition in murine models, heterogeneous RT generated more potent antitumor responses in distant, nonirradiated tumors compared with any homogeneous dose. The antitumor effect after heterogeneous RT required CD4 and CD8 T cells and low-dose RT to a portion of the tumor. At the 3-day post-RT time point, dose heterogeneity imprinted the targeted TME with spatial differences in immune-related gene expression, antigen presentation, and susceptibility of tumor cells to immune-mediated destruction. At a later 10-day post-RT time point, high-, moderate-, or low-RT-dose regions demonstrated distinct infiltrating immune cell populations. This was associated with an increase in the expression of effector-associated cytokines in circulating CD8 T cells. Consistent with enhanced adaptive immune priming, heterogeneous RT promoted clonal expansion of effector CD8 T cells. These findings illuminate the breadth of dose-dependent effects of RT on the TME and the capacity of heterogeneous RT to promote antitumor immunity when combined with immune checkpoint inhibitors. Editor's summary: Radiation therapy (RT) is usually administered as a single dose across a tumor. However, not all radiation doses are created equal. High radiation doses promote immunogenic cell death, medium radiation doses promote type I interferon responses, and low radiation doses promote inflammatory cytokine production and immune cell trafficking. To reap the benefits of all three doses, Jagodinsky et al. treated murine tumors with heterogeneous RT, where different regions of the tumor were treated with different RT doses. The authors found that this heterogeneous approach outperformed homogeneous dose RT in a T cell–dependent manner and could be combined with immune checkpoint inhibition. These data support further clinical development of heterogeneous RT. —Courtney Malo [ABSTRACT FROM AUTHOR]