Microbiome analysis suggests that gut microbial changes in Parkinson’s disease evolve progressively from healthy individuals to genetically at-risk individuals to clinically affected patients, with the degree of dysbiosis correlating with disease progression.
It is well known that both mental health conditions (MHCs)1 and low income2 increase the risk for communicable and non-communicable diseases. However, previous studies have not comprehensively investigated potential interactions in the effects of mental disorders and income on physical health. In their Article, Linda Ejlskov and colleagues assessed the risks of a broad range of physical health conditions (PHCs) across income strata in people with and without MHCs.3 According to their results, MHCs and low income seem to operate as independent, additive risk factors, with some notable exceptions.
Non-communicable diseases remain the leading cause of mortality and disability worldwide and account for most health loss in high-income countries, including Italy.1 Cardiovascular diseases, cancers, diabetes, and chronic respiratory diseases are largely driven by modifiable behavioural, metabolic, and environmental exposures.2 Characterising the distribution of these risk factors and quantifying their contribution to population health is central to modern epidemiology and public health.
The concept of multimorbidity, the co-occurrence of two or more long-term conditions, has become an important focus for research in the burden of ill-health associated with ageing. A burgeoning literature shows that the prevalence of multimorbidity is substantial, even though estimates vary according to definition and method of ascertainment.1 Not many studies have taken a longitudinal approach and evaluated the incidence of multimorbidity. In The Lancet Public Health, Eirion Slade and colleagues2 report on the incidence of multiple long-term conditions, also known as multimorbidity, in an electronic health records dataset for nearly the whole of England, UK.
The notion of compression of morbidity was the guiding principle of public health a generation ago. If one could postpone the onset of chronic disease and disability to a later age, the total lifetime burden of illness could be reduced, compressing it into a shorter period at the end of life. The goal was to increase not only lifespans, but also healthspans. Public health systems are designed to enable individuals to live long, healthy lives, before experiencing a brief, sudden decline in their final months.
The adverse effects of high levels of alcohol consumption on cognitive function have been documented, including using Mendelian randomisation.1 Maintaining cognitive function is a priority for individuals as they age. However, the increasing size and health needs of the ageing population globally brings challenges for provision of preventive and therapeutic interventions.
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We’re back with more data from the AACR meeting! Among the highlights today: a first look at a drug Merck acquired from China, a fascinating but potentially controversial use for CAR-T, and American oncology’s geography problem. Don’t forget: Tuesday night we will host a live event in San Diego, and we also have a virtual recap of the AACR conference on Thursday.
CAR-T shows deep response in smoldering myeloma
In an early phase trial, investigators at Dana-Farber Cancer Institute treated 20 high risk smoldering multiple myeloma patients with Carvykti, a BCMA directed CAR-T therapy. The idea was to use the immunotherapy on patients with the multiple myeloma precursor condition, hoping to prevent the active cancer in patients at high risk of progression.
Pfizer executive Andrew Baum, a former analyst at the investment bank Citi who joined the company in June 2024 to redirect its strategic approach, has left his role as an executive vice president and chief strategy and innovation officer, the company confirmed Monday. He will continue as an adviser to Pfizer CEO Albert Bourla until the end of the year.
Pfizer and sources familiar with the matter described the move as stemming from both a sense that Baum had accomplished what he set out to do and a streamlining of Pfizer’s operations.
“Pfizer regularly evaluates its operations to ensure it is best positioned to deliver on the company’s business in the near-term and beyond,” the company said in a statement. It said that organizational and leadership changes would “position Pfizer to move faster, make clearer decisions, and advance innovation across the enterprise.”
Damage to the liver in patients developing end-stage liver disease has become too severe for the organ’s normally extraordinary regenerative capacity to repair or compensate for that damage. Once this point of no return has been reached the only option is an organ transplant. However, donor livers are in high demand and very limited supply.
Ambitious efforts are on the way that eventually could enable the engineering of entire implantable liver organs. However, the maximum size of laboratory-engineered liver constructs remains limited and cannot yet provide therapeutic benefits for patients. A research team at the Wyss Institute at Harvard University, Boston University, and MIT has now approached this important problem from a different angle.
“We asked if it would be possible to first implant a small-scale liver construct and then drive it to expand in the body following its engraftment,” said Christopher Chen, MD, PhD, a Wyss Institute core faculty member and the William Fairfield Warren Distinguished professor of biomedical engineering and director of the Biological Design Center at Boston University. “A sufficiently grown, functional ‘satellite liver’ could immediately relieve the metabolic burden in a damaged liver and help bridge the time until a transplant becomes available.”
Chen co-led the research together with associate faculty member Sangeeta Bhatia, MD, PhD, who is the John J. and Dorothy Wilson Professor of Health Sciences and Technology and of Electrical Engineering and Computer Science at the Koch Institute for Integrative Cancer Research at MIT, and a Howard Hughes Medical Institute investigator. Chen is also a leader of the Wyss Institute’s 3D Organ Engineering Initiative, and team lead of the recently awarded ARPA-H PRINT-supported ImPLANT project, which focuses on whole organ liver engineering at the Wyss and collaborating institutions.
The project, spearheaded by Amy Stoddard, PhD, (MIT ’25), who developed the approach in her doctoral research and then as a postdoctoral fellow, integrates tissue engineering and synthetic biology tools in a genetic strategy the team has named “bioengineered on-demand outgrowth via synthetic biology triggering,” or BOOST. By specifically rewiring the gene expression of primary liver hepatocytes and supportive fibroblast cells, the scientists were able to effectively switch on a tissue growth program in small, engineered liver constructs after their implantation into mice.
“Using engineered liver tissue as a proof-of-concept application, we integrated synthetic biology and tissue engineering tools to build liver tissues that can be expanded on-demand after implantation in vivo,” the team reported in their published paper in Science Advances, which is titled “Synthetic control of implanted engineered liver tissue growth.” In the paper they concluded “In this study, we define the first steps toward an unconventional approach to cell therapy scale-up: engineering a small construct and then inducing it to grow in situ … “This strategy, which we have named BOOST, could provide several key advantages, including circumventing the need for large quantities of cellular raw materials and bypassing the formidable challenge of generating a rapidly perfusable construct that can survive the engraftment period.”
The authors wrote, “Organ transplant is currently the only curative treatment for patients with end-stage organ failure, yet this therapy is inaccessible to many due to the paucity of organs available for transplant.” And while significant progress has been made in the field of engineering tissue-based cell therapies that could represent alternatives, or bridges to transplant, they acknowledge, “… scaling of these constructs to sizes of therapeutic relevance remains a barrier to clinical translation.”
In order to address current challenges associated with fabrication, Chen and colleagues looked at the problem from different angle, asking whether it would be possible to first implant a small-scale construct and then trigger it to expand in situ, after its engraftment into the host.
To be able to induce growth of an implanted small liver constructs in situ within a recipient’s body the researchers first needed to identify the relevant cues that would allow them to do so. “A key first step toward this method of in situ scale-up would be the successful control of cellular growth within the engineered construct after engraftment,” they wrote. Since liver growth is known to be regulated by soluble growth factors (GFs), Stoddard screened a collection of candidate factors to identify those that, when added to cultured human primary hepatocyte cells (HEPs), had the strongest growth-inducing effects.
The genetic “BOOST” strategy integrates tissue engineering and synthetic biology tools to enable on-demand liver growth inside the body. By specifically rewiring the gene expression of primary liver hepatocytes and supportive fibroblast cells, a tissue growth program is switched on in a small, engineered liver construct after its implantation into recipients and upon addition of an inducing agent (shown as a pill). As a result, the hepatocytes in the construct start and continue to proliferate until a desired construct size has been reached and the inducing signal is not provided anymore. In mice, BOOST resulted in robust and healthy liver growth. [Wyss Institute at Harvard University]
“We ended up with a set of four growth factors, HGF, TGFa, WNT2 and RSPO3, that potently induced sparsely scattered HEPs to grow in the culture dish,” said Stoddard. “But when we tested whether they could do the same in 3D liver tissues consisting of densely packed HEPs and fibroblasts, they turned out to be ineffective. This led us to hypothesize that there must be an additional mechanism at work in human HEPs that inhibits cell proliferation in high-density conditions.”
The team homed in on a protein, YAP, that senses mechanical signals, and which was known to move from cells’ cytosol to their nucleus in low-density conditions to help express genes involved in cell proliferation. However, in high-density conditions when cells are compressed, YAP is degraded in the cytosol, which prevents the activation of those target genes and restricts proliferation.
“Importantly, when we overexpressed a non-degradable version of YAP in HEPs, which also reaches the nucleus in high-density conditions to partake in gene regulation, we successfully overrode this density checkpoint in HEPs,” Stoddard said. “Interestingly, we found that HEPs needed to be stimulated with both YAP and GFs in order to grow in densely packed 3D liver tissues.”
Toward the goal of safely inducing and controlling HEP proliferation in a living organism, and eventually human patients, the researchers deployed synthetic biology tools to locally install control of these signaling pathways in HEPs and fibroblast cells within the engineered 3D liver tissues themselves. “We set out to engineer a synthetic biology toolkit capable of locally modulating growth factor and YAP signaling within engineered liver tissue, enabling on-demand control of proliferation even after implantation,” they noted.
The team engineered fibroblast cell lines that each secreted one of the four GFs, and HEPs that expressed the non-degradable YAP protein. And they made the expression of all proteins doxycycline (DOX)-inducible. They determined in time course experiments that a continuous seven-day treatment with DOX led 3D liver tissue composed of engineered cells to robustly expand in size and cell numbers in the culture dish. On DOX removal the HEPs reverted back to a non-proliferating state.
However, Stoddard noted, “… when we compared the gene expression of single cells in BOOST-engineered, DOX-induced 3D liver tissue to that of cells in non-engineered or BOOST-engineered, non-induced 3D liver tissue, we noticed that the expansion came with a trade-off: high proliferation rates went hand in hand with a less functional HEP state. While we believe this is a natural trade-off seen in a wide variety of biological settings, we hope to be able to address this in the future, recognizing that the liver also has native re-functionalization signals to harness.”
The litmus test for BOOST-engineered growth in 3D liver tissues was to see whether they would similarly expand following their implantation into living mice that were systemically treated with DOX for the same seven-day duration. Experiments showed that the implanted tissue exhibited a striking 500% increase in proliferation with a doubling of the engineered HEPs alone, and was vascularized to accommodate the metabolic demands of the expanded tissue. The tissue implants were also well tolerated by the mice, with no signs of fibrosis due to invading immune cells and fibroblast inflammation, or of tumor growth.
“These results were particularly exciting to us,” said Stoddard. “Prior to our work, injury to the host liver has always been required to trigger hepatocyte engraftment and proliferation. Here we were able to relieve this dependence, and trigger on-demand growth of implanted liver tissue in a completely healthy host.”
In the future, the team will explore the capacity of BOOSTed liver tissue to rescue the host in the setting of liver injury. “Our BOOST strategy lays the foundation for a future when solid organ cell therapies can be controlled non-surgically according to the needs of patients and their physicians,” Bhatia noted. “Beyond treating liver disease, the premise of BOOST could be applied to other engineered tissue therapeutics that are similarly constrained by challenges associated with tissue scale-up, such as engineered heart or pancreatic tissue to address serious diseases.”
In their paper the authors concluded, “… this work serves as an exciting proof-of-concept demonstration that scale-up of tissues via growth could be possible … Together, this work helps lay the foundations for a future of ‘smart’ tissue therapeutics that can be scaled to a patient’s needs and thereby offer treatment for numerous, previously incurable, diseases.”
<strong>Background:</strong> Effective communication about the relative risks of cigarettes and e-cigarettes can help increase switching away from cigarettes while minimizing unintended use. <strong>Objective:</strong> This study examined comprehension of a proposed modified exposure claim (MEC) about an e-cigarette (IQOS VEEV, the study product [SP]) and the effects of claim exposure on SP use intentions and risk perceptions among adult tobacco users and nonusers. <strong>Methods:</strong> Adult smokers with no intention to quit smoking (S-NIQ, n=606), adult smokers with an intention to quit smoking (S-IQ, n=600), adult e-cigarette users (ECU, n=630), adult former smokers (FS, n=619), adult tobacco and nicotine products (TNP) never-users aged 18-24 years (n=648), and adult TNP never-users aged 25 years and older (n=749; total N=3852) participated in a randomized between-groups online experimental study. Participants viewed a marketing brochure for the SP with (test condition) or without (control condition) an embedded MEC. Outcome measures included claim comprehension, intention to use the SP regularly, and perceived health risk to self from using the SP or smoking cigarettes. <strong>Results:</strong> Most participants were female (n=2110, 54.8%), had a mean age of 40.2 (SD 14.93) years, and were equally split across the 4 US regions. S-IQ and S-NIQ were long-term, frequent cigarette smokers, while 91.4% (566/619) of FS were long-term quitters. ECU on average used e-cigarettes ≥15.2 times per day, and the majority of them (552/630, 87.6%) had started using e-cigarettes more than 12 months before. Most participants correctly understood the key elements of the claim: the SP produces lower levels of harmful chemicals compared to cigarettes (1818/1926, 94.4%), and switching completely from cigarettes to the SP reduces exposure to harmful chemicals (1832/1926, 95.1%). In both conditions, positive intention to use the SP was high among ECU (control: 238/314, 75.8% vs test: 249/315, 79%; <i>P</i>=.33), moderate among S-IQ (control: 127/299, 42.5%; test: 166/299, 55.5%; <i>P</i><.001) and S-NIQ (control: 140/299, 46.8%; test: 166/307, 54.1%; <i>P</i>=.07), low among FS (control: 28/306, 9.2%; test: 33/312, 10.6%; <i>P</i>=.55), and very low among adult TNP never-users aged 18-24 years (control: 3/330, 0.9%; test: 8/318, 2.5%; <i>P</i>=.11), and adult TNP never-users aged 25 years and older (control: 5/373, 1.3% vs test: 12/375, 3.2%; <i>P</i>=.09). All groups understood that the SP posed a lower health risk compared to cigarettes. In all groups, claim exposure was associated with significantly lower risk perception of the SP relative to cigarettes (all comparisons, <i>P</i><.001). <strong>Conclusions:</strong> The tested MEC has the potential to benefit public health by simultaneously increasing already high levels of SP use intention and reducing SP risk perceptions relative to cigarettes among adult tobacco users while generating low levels of use intention among tobacco nonusers. <strong>Trial Registration:</strong>