A Text Messaging–Based Program to Transition From Basal Insulin to Glucagon-Like Peptide-1 Receptor Agonists in Safety-Net Diabetes Care: Pilot Quality Improvement Intervention Study

Background: Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and basal insulin both lower blood sugar, but while insulin puts people at risk of hypoglycemia and weight gain, GLP-1 RAs do not. In addition, GLP-1 RAs have added cardiometabolic and renal benefits. For these reasons, when possible, many primary care providers prefer their patients with type 2 diabetes to be from basal insulin to a GLP-1 RA. This transition process can be labor intensive, requiring multiple dosing adjustments and a watchful eye for hypoglycemia and hyperglycemia. The Mobile Insulin Titration Intervention (MITI)–GLP1 program uses SMS text messaging–based technology to support a streamlined and supervised transition process from basal insulin to a GLP-1 RA. This program takes place at a multilingual safety-net clinic. Objective: Our objectives were to assess program feasibility and acceptability to determine whether the intervention was doable, practical, and worthy of further investigation via a larger controlled trial. Preliminary clinical outcomes are also discussed in this paper. Methods: Patients were enrolled on a secure web platform that sent them a daily SMS text message asking the following: “What was your fasting blood sugar this morning?” Each weekday, texted responses containing patients’ fasting blood sugar levels were checked for alarm values, and once weekly, patients were called and advised on whether and how to lower their basal insulin and increase their GLP-1 RA dose. The program was co-run by general internal medicine physicians and nurses and continued until the patient had their insulin stopped completely and/or their GLP-1 RA dose reached the maximum, or 16 weeks elapsed. All enrolled patients were included in the analyses. Results: A total of 72 patients completed the pilot program. Feasibility and acceptability were high. Of 3671 SMS text messages sent by the program, 3520 (95.89%) received a response from patients. Of 719 cumulative weeks in which Thursday titration phone calls were attempted, successful connections with patients were made in 649 (90.26%) instances. Preliminary clinical outcomes were promising. Insulin doses were meaningfully reduced (55/72, 76.39% had their basal insulin reduced by at least 50%; 45/72, 62.5% had their insulin stopped completely). GLP-1 RA doses were meaningfully increased (64/72, 88.89% had their GLP-1 RA dose increased by ≥1 level; 45/72, 62.5% were discharged on the maximum dose of their GLP-1 RA). There was minimal hypoglycemia (5/3520, 0.14% of the SMS text messages reported a value of <80 mg/dL) and hyperglycemia (1/3520, 0.03% of the SMS text messages reported a value of >400 mg/dL). Conclusions: A general internal medicine–run MITI-GLP1 pilot program using SMS text messaging and interdisciplinary teamwork between internists and nurses is a feasible and acceptable intervention for safely and effectively transitioning people with well-controlled type 2 diabetes away from basal insulin and toward a GLP-1 RA.

BBB Access Route via Proteomic Vascular Mapping

A limiting feature of many neurological therapies is the ability of molecules to cross the blood-brain barrier (BBB) from the circulatory system. Since the BBB prevents simple diffusion of materials across the divide, identifying the proteins responsible for transport is necessary for effective design of BBB-crossing therapies.

“So basically, everything in the circulating blood, if they want to have an exchange with the organ, they need to pass through this interface,” says senior author Jiefu Li, PhD, Janelia Research Campus Group Leader at the Howard Hughes Medical Institute.

Identification of the structures within blood vessels involved with the processes of molecular movement across the BBB has been somewhat elusive. However, Li and his team have developed a technique that not only identifies proteins within the luminal surface—the inner lining—of the vasculature, but also works in vivo, allowing them to track how these features change across the aging brain.

“Understanding how the blood-brain barrier works, particularly figuring out the molecular targets that you can play with to open and close the barrier, will provide new possibilities for drug delivery,” Li says.

Their work is published in Science in a paper entitled, “Luminal surface proteome of the brain vasculature uncovers blood-brain barrier regulators.”

Using mice, the team developed a proteomic profiling method that can be used not only in brain vasculature, but throughout the body. “Briefly, a lectin-conjugated peroxidase is perfused and anchored to the luminal surface of blood vessels to catalyze the biotinylation of adjacent proteins, thereby enabling subsequent protein enrichment and mass spectrometry analysis,” wrote the authors.

They tested the method in the brain, kidney and intestine, in both mice and northern tree shrew, showing functionality and applicability across organs and species.

“This will allow us to say: we know that the vasculature system is doing different things in different organs and it relies on this luminal surface, but how does that happen? What are the molecular players there?” Li says.

Using quantitative proteomics of the luminal surface—from early development through adulthood and aging—they found that over time there was a decrease in angiogenic and transport proteins. They also found an increase in proteins that increased stiffness in the vasculature.

In addition to developing this in vivo technique, the team identified two proteins that are temporally distinct in their expression while both playing a role in modulating BBB permeability. Knockouts of nitric oxide synthase Nos3 and arginine transporter Slc7a1 resulted in BBB leakage in neonates, but not adults, while genetic screens identified hyaluronidase HYAL2 as being required for maintaining BBB integrity throughout the lifespan of mice.

“What we know now is that we have two new pathways, potentially, to open the blood-brain barrier and to inform some therapeutic developments,” says Li.

Utilization of this proteomic based method in vivo both opens up new avenues of functional research across the cardiovascular system, and also provides data and a methodology for novel therapeutic targets for crossing the BBB.

“This method solves an important need but it’s also a very easy-to-use method, so everyone can use it,” Li says.

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Labguru Customer Portal Launched for CRO/CDMO and Client Collaboration

Officials at Cenevo say the company has launched the Labguru Customer Portal to help streamline client communication for CROs, CDMOs, and others.

CROs and CDMOs operate in high-throughput, service-driven environments where speed, accuracy, and transparency are critical, explains Eran Sandman, product manager, Cenevo. Labguru allows CROs and CDMOs to centralize operational visibility across departments and projects, standardize workflows, and manage multiple client programs at scale, he adds.

Integrated with Labguru’s ELN and LIMS platforms, the new portal was designed to extend internal workflows to support external collaborators. With this structured approach, labs experience increased efficiency while minimizing version conflicts, human error, and compliance risks, maintains Sandman, noting that clients can submit requests, monitor progress and access results, while labs retain full control and visibility over shared information.

Lab managers can use the portal to gain actionable insights across every client individually and all clients in aggregate, as they relate to equipment and consumables usage, client activity trends, regulatory compliance, and other critical information, points out Sandman.

“Our goal is to make our clients’ operations run more smoothly,” he says. “High-performing CROs are moving toward shared digital environments. With the Customer Portal, CROs and their clients are able to see the same information and collaboration becomes faster and more strategic. Lab managers don’t have to spend all their time on back-and-forth communications.”

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Rangatahi Youth-Led Dissemination Campaign for Cocreated Eating and Well-Being Guidelines: Process and Pilot Implementation Evaluation

Background: Youth should be partners in the development and dissemination of health information created for their demographic. The Manaora Rangatahi (youth) Guidelines comprise 10 eating and 10 wellbeing messages that were cocreated with rangatahi Māori (Māori youth) in Hawke’s Bay, New Zealand, and then disseminated through a digital media campaign. Objective: This study aimed to present the process evaluation of the co-design and implementation of the pilot digital media dissemination campaign of the Manaora Rangatahi Guidelines. Methods: The 17 rangatahi who were involved in the cocreation of the guidelines codeveloped a dissemination plan, filmed video clips for each of the 20 messages, and supported the 20-week digital media campaign. The codevelopment process over 4 wānanga (workshops) is described and critiqued, and the implementation was assessed using the data analytics from Instagram and TikTok, the main social media platforms for dissemination. The rangatahi participated in a short postcampaign review survey. Results: The dissemination plan included a website for the messages, a campaign name and logo, apparel with messaging and QR codes, and the design of a digital media campaign featuring the participating rangatahi. Video clips of each of the guideline messages featuring the rangatahi were professionally developed with support from 3 Māori influencers and a video production company. The 10 phases of the campaign involved the release of 2 messages (one eating and one wellbeing) every fortnight over 20 weeks. Instagram and TikTok analytics showed that the campaign achieved >1.48 million impressions and >19,000 engagement actions (eg, likes, comments, and sharing). The mean engagement rate (Instagram 6.2%, TikTok 1.2%) was greater than or similar to the platforms’ medians across all industries (0.36% and 1.73%, respectively). Various paid promotion strategies boosted the number of impressions, and paying one of the influencers to promote the messages in phase 8 created a more than 10-fold increase in impressions on Instagram. The estimated cost of the overall campaign was NZ $125,000 (US $72,500). The majority (about 60%) of rangatahi felt the campaign was successful and engaging. Conclusions: Rangatahi have expert knowledge in how to disseminate messages to their peers. They successfully co-designed and pilot-tested the implementation of a low-cost digital media campaign using peer-to-peer messaging and videos, which achieved substantial reach. The dissemination reach was good, but was significantly influenced by paid promotions. The cost per thousand impressions was equivalent to or better than much larger government-funded health promotion social media campaigns targeting youth. The development and dissemination of eating and well-being messages aimed at youth should ideally involve partnering with the target audience to enhance the relevance and reach of the messages. A well-funded dissemination campaign with paid promotions through influencers and digital platforms could expect to achieve substantial awareness of the messages.

DNA Uptake in Cholera May Increase Defense Mechanisms

Cholera, caused by the bacterium Vibrio cholerae, remains a major global health threat. Like most bacteria, Vibrio cholerae lives under constant attack from viruses. To survive, bacteria equip themselves with antiviral immune systems. Previous work has shown that V. cholerae carries a large genetic element called a sedentary chromosomal integron (SCI). This structure contains hundreds of small mobile DNA units known as “gene cassettes” arranged in a long array, like a chain of pearls. A new study by researchers at the School of Life Sciences, Ecole Polytechnique Fédérale de Lausanne (EPFL), has now shown that V. cholerae can efficiently acquire new SCI gene cassettes from extracellular DNA released by other V. cholerae strains, and non-cholera vibrio species, potentially adding to their own defense arsenals.

Research lead Melanie Blokesch, PhD, and colleagues reported on their findings in Science, in a paper titled “Competence-mediated DNA uptake diversifies Vibrio cholerae sedentary chromosomal integrons,” in which they concluded “Given the widespread presence of SCIs and the conservation of natural competence across the genus, we propose that SCIs function as genus-wide reservoirs of exchangeable protective genes.”

Bacteria often survive viral attack and environmental stress by sharing genes that enhance their defenses, the authors wrote. A “defining genomic feature” of V. cholerae is its sedentary chromosomal integron (SCI), a genetic element containing hundreds of mostly promoterless gene cassettes. While the function of many cassettes remains unknown, some do encode antiviral immune systems. “Although most cassettes encode proteins of unknown function, ~10% encode phage defense systems, suggesting that SCIs as well as mobile integrons function as reservoirs, or “biobanks,” of defense genes,” the authors continued.

However, most of these genes are located far from the start of the array and remain silent. Prevailing models proposed that cassettes could be internally reshuffled to activate them, yet no such rearrangements have been observed in the pandemic lineage of V. cholerae for decades. “Cassettes are thought to reshuffle under stress to the favorable first array position, yet the SCI in pandemic V. cholerae has remained static for more than 60 years.”

This raises a key question: if internal reshuffling is rare, how are cassette-encoded immune systems activated, and how do new cassettes enter the array at all? To address this question, a team led by Blokesch at the Laboratory of Molecular Microbiology at EPFL investigated whether the SCI might capture gene cassettes from genetic material entering the cell from the outside. “We asked whether SCI cassettes move horizontally rather than by intracellular reshuffling.”

A key feature of this process is natural competence, the ability of bacteria to take up free DNA from their surroundings. V. cholerae becomes naturally competent when it grows on chitinous surfaces, a polymer found in the shells of crustaceans that is abundant in aquatic environments.

In the laboratory, the team mimicked these conditions by growing bacteria on chitin and supplying DNA from different Vibrio cholerae strains or from other Vibrio species. They then tracked whether newly acquired gene cassettes were inserted into the first position of the SCI array.

Through their studies the team confirmed that that V. cholerae can acquire new SCI gene cassettes from extracellular DNA. Collective experimental results, the authors stated, “We show that SCI cassettes are efficiently acquired by naturally competent V. cholerae and inserted at the first SCI array position in an integrase-dependent manner. This process incorporates cassettes not only from other V. cholerae strains but also from diverse Vibrio species.”

In aquatic habitats, DNA is released when bacterial cells are killed by viruses, antimicrobial compounds, or bacterial weapons. Nearby competent bacteria can take up this DNA and incorporate selected fragments into their own SCI. “A loose comparison would be the following,” said Blokesch. “Imagine your grandmother passes away and, as a farewell gift, hands over the immunity she built up against the Spanish flu a century ago, immediately protecting you from that same virus. Wouldn’t that be amazing? This is essentially what we show that V. cholerae can do.”

The team also showed that cassettes inserted in this position are functional. Several defense systems provided protection against viruses that infect Vibrio species, known as vibriophages. They stated, “In this study, we show that SCI diversification efficiently occurs by horizontal transfer linked to the genus’s aquatic lifestyle: DNA released from lysed cells is taken up by naturally competent vibrios and integrated into the first position of the SCI array, the primary site of strong expression, where it confers resistance to phage and potentially other threat,” the wrote in summary. “Together, these results demonstrate that SCI cassettes can cross species boundaries, supporting a model in which SCIs may function as genus-wide reservoirs of exchangeable genes, including defense genes, that confer selective advantages under certain conditions.”

An important exception emerged. In the pandemic 7PET lineage of V. cholerae, the SCI appears largely static. “The SCI of 7PET V. cholerae is large but remarkably stable,” the authors noted. They propose that this reflects adaptation to a human-associated niche. “We propose that this reflects adaptation to a human-associated niche, where chitin is less abundant and competence induction—requiring growth on chitin to high cell density plus relief from catabolite repression is unlikely to occur,” they suggested. “As a result, SCI-mediated diversification may be largely inactive in pandemic strains.”

However, if pandemic strains were to encounter environmental conditions that enable SCI cassette acquisition, they could expand their antiviral defenses. Blokesch commented. “This possibility matters because vibriophage-based approaches are currently being explored to prevent cholera in endemic regions, and such evolutionary flexibility could ultimately affect how effective these strategies remain.”

In their paper the team concluded that since onset of the seventh pandemic, “… acquisition of novel and diverse, large defense-related genomic regions by 7PET strains appears to have been relatively limited. Consequently, reduced SCI-mediated diversification may lower the capacity of this lineage to rapidly evolve new defenses—an important consideration for ongoing efforts to deploy phage-based prophylaxis against cholera in endemic settings such as Bangladesh.”

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New rules for CDC vaccine panel aim to address lawsuit, empower Kennedy’s allies

After a courtroom defeat, Trump administration health officials have revised the governing documents for a key federal vaccine panel to broaden its membership, increase its focus on potential harms of vaccines, and empower allies of health secretary Robert F. Kennedy Jr.

The new charter for the committee that advises the Centers for Disease Control and Prevention on vaccine use appears aimed at trying to evade the type of legal challenge that has left the currently appointed body in limbo. In addition, the document puts greater emphasis on the role of the Advisory Committee on Immunization Practices in studying injuries possibly linked to vaccination  — though the committee has always paid close attention to any emerging evidence that called into question the safety of individual vaccines.

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Seer to Apply Deep Proteomics Tech to Singapore Population Cohort Study

This week, Seer, a developer of proteomics technology, said that scientists involved in the PRECISE-SG100K initiative will use the company’s Proteograph® product suite to profile the plasma proteome of about 10,000 participants. The data from this workflow will be combined with information from the same participants that was generated using Thermo Fisher Scientific’s Olink® Reveal, a next-generation sequencing-based proteomics solution, and its Orbitrap Astral™ mass spectrometers.

PRECISE-SG100K is the second phase of a broader initiative in Singapore that aims to support various research studies that advance scientists’ understanding of health and diseases. Touted as a landmark population study of approximately 100,000 Singaporean residents, PRECISE-SG100K is designed to integrate genomic, proteomic, lifestyle, imaging, and other health data from a multi-ancestry Asian population. By combining data from Seer’s Proteograph platform alongside information from other technologies that are being used for the project, the scientists aim to develop what they believe will be one of the most comprehensive multiomic datasets available to date. 

“PRECISE-SG100K is one of the most ambitious and carefully designed multiomic health initiatives in the world,” said Omid Farokhzad, MD, PhD, chair and CEO of Seer. And that fits with Seer’s vision for Proteograph, which was that “deep, unbiased proteomics becomes the mainstay for population-scale multiomic studies.”

Seer already has an existing relationship with Thermo Fisher dating back several years. In 2024, the companies announced a co-marketing and sales agreement that allowed Thermo to jointly promote Proteograph alongside Orbitrap Astral mass spectrometers to provide customers of the Orbitral Astral with an integrated solution for unbiased proteomic analysis. The combined solutions have since been used in a number of large population studies providing high-throughput, deep proteome coverage. 

“A key goal of PRECISE-SG100K is to create a deeply characterized, multi-ancestry resource that can reveal how genetics, environment, and lifestyle shape disease risk and treatment response,” said John Chambers, PhD, chief scientific officer of PRECISE and lead principal investigator of the PRECISE-SG100K study. “By adding deep, unbiased plasma proteomics enabled by Seer and Thermo Fisher, we can more directly link genomic variation to protein networks and health outcomes, uncovering insights critical to ensuring precision medicine reflects the diversity of Asian populations.”

Ultimately, the data generated from population projects like this are expected to support biomarker discovery in key disease areas including cardiometabolic, ophthalmic, and neurologic disorders. They could also inform the development of predictive models for assessing disease risk and response as well as efforts to validate and prioritize biomarkers identified through affinity-based platforms. 

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Peer Mentor Training and Supervision for a Digital Adolescent Depression Treatment in South Africa and Uganda: Mixed Methods Evaluation

Background: Blended digital mental health interventions combining technology with human support are more effective than stand-alone treatments. However, limited research has examined how to train and supervise personnel delivering human support components. The Kuamsha app, a gamified digital intervention for adolescent depression based on behavioral activation, was designed to be paired with low-intensity telephone-based peer support. A structured training and supervision program for peer supporters was codeveloped through workshops with mental health professionals and youth with lived experience of mental health challenges in South Africa and Uganda. To the best of our knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries. Objective: This study assessed the feasibility, acceptability, and fidelity of a training and supervision program for peer supporters delivering a digital mental health intervention in South Africa and Uganda. Methods: We conducted a mixed methods evaluation of the peer mentor program. Quantitative metrics assessed the feasibility of recruitment, retention, and attendance among peer mentors (n=13, South Africa; n=4, Uganda), as well as training acceptability. Fidelity, adherence, and competence were scored at the session level and converted to percentages of the maximum possible score. Linear mixed-effects regression models with a random intercept for provider and site estimated adjusted marginal means (95% CI). In-depth interviews and focus group discussions explored program acceptability and implementation factors. Results: The peer mentor training and supervision program was feasible and acceptable in both settings, with high recruitment (South Africa: n=13/19, 68%; Uganda: 4/4, 100%), retention (South Africa: 9/13, 69%; Uganda: 4/4, 100%), and training attendance rates (89%‐92% in South Africa and 100% in Uganda), alongside qualitative reports of high satisfaction. All peer mentors met a minimum posttraining competency threshold (≥50%), with median competency scores of 70.7% (IQR 45.8%‐78.2%) in South Africa and 75.4% (IQR 73.8%‐77.3%) in Uganda. Independent ratings of recorded calls indicated high overall fidelity in South Africa (84.7%, 95% CI 80.3%‐89.0%) and Uganda (87.7%, 95% CI 83.4%‐92.1%). Adherence was higher in Uganda than South Africa (adjusted mean difference [AMD] 13.30 percentage points, 95% CI 8.99‐17.61; <.001), as was competence (AMD 4.88 percentage points, 95% CI 1.23‐8.53; =.009). The AMD in overall fidelity (3.06 percentage points, 95% CI −0.98 to 7.10) was not statistically significant (=.14). The qualitative findings emphasized the value of ongoing supervision and capacity development, interactive training approaches, and blended delivery models. Conclusions: Locally adapted training and supervision models can strengthen peer mentor capabilities to support digital interventions. Adequate supervisory capacity and incentive structures are critical to sustain engagement, retention, and fidelity. In settings with frequent network disruptions, periodic in-person contact between peer mentors and supervisors may enhance fidelity. Future research should examine how peer mentor fidelity influences user engagement and mental health outcomes. Trial Registration: Pan African Clinical Trials Registry PACTR202206574814636; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=23792 International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2022-065977

Life Biosciences Raises $80M to Fund First Trial of Anti-Aging Gene Therapy  

Life Biosciences has announced an $80 million Series D round, which will fund the completion of a recently started Phase I clinical trial of a gene therapy designed to restore old, damaged cells to a younger, healthier state. 

The Boston-based biotechnology company was co-founded in 2017 by David A. Sinclair, PhD, professor of genetics at Harvard Medical School and founding director of the Paul F. Glenn Laboratories for the Biological Mechanisms of Aging. Sinclair is known internationally as a leading researcher on human aging and longevity, especially for his work on epigenetic changes as drivers of aging and using reprogramming factors to reset the age of cells and tissues. 

The oversubscribed round will support company operations into the second half of 2027, including the conclusion of a Phase I trial launched earlier this year to assess the safety and tolerability of Life Biosciences’ lead program, ER-100. The funds will also go towards exploring new candidates and advancing the company’s broader pipeline of therapeutics for age-related diseases. 

Aging is the main driver and risk factor for most chronic diseases, with over 75% of people over 65 being estimated to suffer from at least one chronic condition. As the world population continues to age, Life Biosciences aims to delay aging processes by rejuvenating cells and restoring their function across many age-related diseases.  

The company’s Partial Epigenetic Reprogramming (PER) platform is designed to partially reprogram the epigenome of old and injured cells through the expression of three Yamanaka factors: OCT4, SOX2, and KLF4 (together known as OSK). These transcription factors have been shown to reset organ-specific epigenetic code without creating induced-pluripotent stem cells, addressing the effects of aging without the risk of fully differentiating cells or inducing the formation of tumors.

This strategy has the potential to address a wide range of age-related diseases across multiple organs and systems within the human body. Life Biosciences’ Phase I clinical trial, which is currently actively recruiting, will assess the safety and tolerability of ER-100 in patients with open-angle glaucoma (OAG) and non-arteritic anterior ischemic optic neuropathy (NAION). The trial will also assess early efficacy endpoints, including multiple measurements of visual function. 

Optic neuropathies like OAG and NAION are driven by damage to retinal ganglion cells, neurons that send sensory signals from the eye to the brain. These cells cannot naturally regenerate, meaning patients suffer permanent vision impairment. Unlike current treatments, which are unable to address the underlying mechanisms of neuronal degeneration, ER-100 aims to directly protect and promote the regeneration of RGC to preserve and restore sight in these patients.  

Jerry McLaughlin, chief executive officer of Life Biosciences, stated that the financing “reflects the growing interest in our platform and the opportunity we have to reverse multiple diseases of aging.”

He added: “This support enables us to advance our lead program, ER-100, through key clinical milestones while continuing the expansion of our pipeline, positioning Life Biosciences to deliver disease-modifying solutions for patients.” 

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