Unlocking the chemical potential of filamentous fungi using prime editing

Nature Biotechnology, Published online: 02 July 2026; doi:10.1038/s41587-026-03219-9

We developed the prime editor fPE7max, which is optimized for filamentous fungi and enables precise genome engineering — from single-base substitutions to kilobase-scale insertions and multi-kilobase deletions, across diverse species. Editing of translation-regulatory elements for a pleiotropic metabolic regulator unlocked previously inaccessible biosynthetic pathways and uncovered new fungal metabolites.

Why high scores do not mean application readiness for health AI

Nature Medicine, Published online: 02 July 2026; doi:10.1038/s41591-026-04500-9

Large language models achieve high scores on health application benchmarks, yet adversarial stress tests now reveal prevalent brittleness — shortcut reliance, fragile visual grounding and fabricated reasoning traces — which exposes substantial gaps between benchmark performance and the robustness evidence needed to support claims of readiness for medical decision-support and patient-facing applications.

Access to an mHealth Tool for Symptom Management in Pediatric Oncology Care: Triangulation Study

Background: Digital health offers opportunities to facilitate symptom assessments and communication for children with cancer, particularly after discharge. However, access to these tools must be established to ensure that they effectively support the user. PicPecc (Pictorial Support in Person-Centered Care for Children) is a mobile health tool developed to enable children to remotely assess symptoms and communicate with health care professionals. Understanding access to PicPecc is essential for evaluating its use in pediatric oncology. Objective: The aim was to test a digital intervention with PicPecc in pediatric oncology care through the lens of access to technology. Methods: This study uses a triangulation approach to determine access to digital technology through an intervention, PicPecc outside hospital. Fourteen children (6‐17 y), 5 parents, and 6 nurses from 2 pediatric oncology units in Sweden participated. Children were encouraged to use PicPecc for 2 weeks (achieving a median of 14, IQR 9.75-16 days) following hospital discharge to assess pain, nausea, sleep disturbances, and feelings using an assessment scale, pictures, personal notes, and a chat function. Nurses monitored assessments and responded via the administrative interface. Access was analyzed through interviews and an instrument, and by recording the consumption of PicPecc. Data analysis was based on the 5 dimensions of access (availability, accessibility, accommodation, affordability, and acceptability). Results: The intervention, PicPecc outside hospital, supported availability by enabling children to communicate symptoms in a safe and structured way. Children and parents mentioned feeling safe when they were discharged from the hospital, and nurses perceived it as a valuable complement to follow-up after discharge. PicPecc outside hospital was generally accessible, although initial challenges with log-in procedures related to the PIN code were common. Barriers related to accommodation included interpreting the scale and obtaining an overview of assessments. Affordability was high, as internet access and device availability were not barriers; however, children’s motivation varied depending on symptom burden. Acceptability was strong among children up to 12 years of age, who appreciated the design and gaming function, while the older children found the visual design less age-appropriate. Conclusions: Access to the mobile health tool, PicPecc outside hospital, appears promising for supporting remote symptom assessment in pediatric oncology, particularly among children up to 12 years of age. However, identified barriers, such as motivational factors and integration into the health care system, need to be addressed.
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Agreement Between Reasoning-Oriented Generative AI Models and Clinical Educators in Evaluating Japanese Objective Structured Clinical Examination Transcripts: Preliminary Comparative Study

Background: Medical interview training faces limitations in both implementation and evaluation. While generative artificial intelligence (GenAI) offers a potential solution, it remains unclear whether reasoning-oriented models improve evaluation, particularly for the Japanese language. Objective: We assessed scoring patterns to evaluate the agreement between reasoning-oriented GenAI model scores and clinical educator consensus ratings in Japanese medical interview training. Methods: This study was conducted at a medical university in Japan using original Japanese-language text data derived from medical interview training. Postgraduate year 1 and 2 residents were involved. Two blinded human clinical educators independently evaluated the transcripts and reached consensus through discussion. These consensus ratings were used as a practical reference standard, while preconsensus agreement was also assessed to characterize interhuman variability. Two GenAI models, GPT-5.2 Thinking (OpenAI) and Gemini 3.0 Pro (Google LLC), independently evaluated the same transcripts directly. Each GenAI model generated a single zero-shot evaluation per transcript using default settings. All evaluations used a standardized 6-domain Objective Structured Clinical Examination rubric (patient care, history taking, physical examination, accuracy and organization of clinical information, clinical reasoning, and management) scored on a 1‐6 Likert scale, where 1 indicates inferior, and 6 indicates excellent. We compared mean evaluation scores using the Wilcoxon signed-rank test and assessed interrater reliability using intraclass correlation coefficients between the GenAI models and the clinical educators. Results: Clinical educators and both GenAI models rated the entire dataset of 40 transcripts by 20 included residents. Clinical educator consensus ratings yielded the highest overall mean scores (5.18, 95% CI 5.06 to 5.30). Comparatively, both GenAI models demonstrated significantly lower scores: GPT-5.2 Thinking assigned the lowest overall score (3.68, 95% CI 3.62 to 3.72; <.001), followed by Gemini 3.0 Pro (4.09, 95% CI 3.97 to 4.21; <.001). This discrepancy was most pronounced in the management domain, where GPT-5.2 Thinking assigned 2.93 (95% CI 2.79 to 3.06) compared with the clinical educator consensus mean score of 5.20 (95% CI 4.91 to 5.49). Agreement between the GenAI models and the clinical educator consensus ratings was poor across all domains, with overall intraclass correlation coefficients of 0.04 (95% CI 0.00 to 0.09) for GPT-5.2 Thinking and 0.22 (95% CI 0.10 to 0.35) for Gemini 3.0 Pro. Conclusions: In this preliminary, single-center, transcript-based Japanese-language study, single-run zero-shot evaluations by GPT-5.2 Thinking and Gemini 3.0 Pro showed lower scores and poor agreement with the clinical educator consensus ratings. These findings should be interpreted cautiously because multiple outputs, prompt-sensitivity analyses, local validation, and model-parameter comparisons were not performed. Under the specific conditions tested, these models should not be used as standalone evaluators for Japanese Objective Structured Clinical Examination medical interview transcripts. Whether these models can provide useful formative feedback remains a hypothesis. Trial Registration: UMIN-CTR Clinical Trial UMIN000053747; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000061336

Experiences With Technology Among Adults Aging With HIV Engaged in an Online Community–Based Exercise Intervention Study: Longitudinal Qualitative Descriptive Study and Secondary Data Analysis

Background: As individuals with HIV live longer, many now face the health consequences of aging and multimorbidity, known as disability. Exercise can mitigate disability; however, engagement in exercise among adults living with HIV varies. Technology-based interventions, such as telerehabilitation, may help mitigate geographical, financial, and time barriers to community-based exercise (CBE). However, little is known about the experiences with technology uptake and usage among adults living with HIV. Understanding these experiences is essential to inform the design of inclusive, accessible, and sustainable online interventions. Objective: This study aimed to describe experiences with technology uptake and usage among adults aging with HIV participating in a 6-month online CBE intervention and explore how these experiences changed over time, from baseline to postintervention. Methods: We conducted a longitudinal qualitative descriptive study and secondary analysis using interview data from adults living with HIV who were engaged in a CBE intervention study in Toronto, Canada. Participants engaged in a 6-month online CBE intervention consisting of thrice-weekly exercise supervised biweekly through online personal coaching sessions, weekly group exercise classes, and monthly self-management education sessions (via Zoom). The technology used included Zoom software and a webcam, as well as the Sweat for Good YMCA app and the YMCA Virtuagym website; participants wore a wireless physical activity monitor (Fitbit Inspire 2) throughout. Participants completed interviews at baseline and postintervention. We conducted a group-based content analysis of interview transcripts, focusing on digital access, setup, usage, and perceptions of technology. Questionnaire data describing digital literacy and access to technology provided additional context to the interview data. Results: Eleven participants completed at least one interview. We analyzed 19 interview transcripts from 11 participants (women: n=6, 55%; men: n=5, 45%; median age 52, IQR 45-60 y). Experiences with technology uptake and usage among adults aging with HIV were characterized by four components: (1) preparations for technology (technology setup), (2) interactions with technology (preferences for different types of technology, preferences for mode of delivery, and ease of usage), (3) facilitators and satisfaction with technology (facilitators to technology uptake and usage and satisfaction with technology), and (4) challenges and frustrations with technology (barriers to technology uptake and usage and frustrations with technology). Experiences with technology across participants were influenced by intrinsic contextual factors (prior exposure to technology) and extrinsic contextual factors (COVID-19 pandemic and technological and social support). Conclusions: Experiences with technology among adults aging with HIV engaging in an online CBE intervention varied from increasing ease of use to increasingly burdensome over time. Results highlight the need to incorporate personal preferences and ongoing technological support when implementing online CBE with adults aging with HIV.
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STAT+: Medicare takes another swing at 340B cuts to hospitals

Medicare wants to slash payments to hospitals for drugs acquired through the 340B drug discount program by more than a third beginning next year, after the agency said its surveys found some patients paid more for the drugs than the hospitals did. 

Under a proposal released Thursday, Medicare would pay hospitals for 340B drugs at their average sales price minus 33.4%, dramatically less than they’re getting currently, which is that price plus 6%. The provision, part of a proposed rule on hospital outpatient payments, represents the latest swing at what’s become a hotly debated drug discount program, viewed by some as a lifeline for safety-net hospitals and by others as a profit center for wealthy health systems. 

The proposal drew swift condemnation from groups representing nonprofit and academic hospitals, who said it would disproportionately harm safety-net providers. That’s because only these nonprofit facilities are eligible for 340B, while for-profit hospitals are not. Medicare’s proposed rule shows a 7.4% pay increase to for-profit hospitals under the 340B adjustment. 

Continue to STAT+ to read the full story…

STAT+: Lawmakers urge HHS to force Eli Lilly to provide 340B drug discounts to hospitals

Dozens of congressional lawmakers are urging the Trump administration to force Eli Lilly to reinstate mandated price breaks to hospitals that participate in a federal drug discount program but have refused to provide the company with claims data.

In a letter to Department of Health and Human Services Secretary Robert F. Kennedy Jr., the bipartisan group of lawmakers argued that Lilly is failing to comply with federal law by eliminating the price breaks. The drugmaker stopped offering discounts last month to reduce what it calls duplicate discounts paid to the hospitals.

At the time, Lilly targeted 50 larger hospital systems among approximately 1,000 hospitals that had not complied with a new policy that was announced this year. The company maintained that roughly 70% of the hospitals that participate in the discount program, or more than 2,300, had previously provided claims data.

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Synthetic Organizers Aid Creation of Reproducible Kidney Organoids from Stem Cells

University of Southern California (USC) researchers have paired a biological discovery with an engineering feat to create more faithful, reproducible kidney organoid structures, grown from human pluripotent stem cells (hPSCs). By mapping the developing human kidney, the scientists identified a previously unrecognized developmental axis that helps organize the kidney’s nephrons, which are their filtering units. The team then engineered Wnt-secreting “synthetic organizer” cells to recreate aspects of this developmental environment in organoids.

Their advance makes the organoids more reliable models for studying disease and evaluating potential therapies, while supporting long-term efforts to generate transplantable kidney tissue. “It is important that we’re starting to get good reproducibility from organoid models that can lead to robust preclinical models of cell function and disease to benefit patients,” said Nils Lindström, PhD, assistant professor of stem cell biology and regenerative medicine at the Keck School of Medicine of USC. Lindström is co-corresponding author of the team’s published report in Science, titled “Patterning human kidney organoids with synthetic Wnt-secreting organizers.” In their paper, the researchers reported, “Our findings link a spatial organizing geometry in the developing human kidney to controllable engineering in vitro.”

“Stem cell–derived organoids have emerged as systems for modeling organ development and generating complex tissue structures in vitro,” the authors wrote. Over the past decade, organoid work has relied on cells’ ability to self-organize into tissue-like structures, often in response to adding chemicals and proteins that act broadly in the whole organoid. “Although this capacity enables organoids to recapitulate many developmental programs, it limits experimental control over tissue architecture, often producing structures that vary between cultures and are difficult to engineer reproducibly,” the team continued. “Understanding how to impose spatial patterning in organoid systems is therefore an important challenge.”

In embryos, spatial patterning is often organized by localized signalling centers, known as developmental organizers. But how organizing geometry is controlled in the developing kidney, and whether it can be recreated in vitro, hasn’t been known.

For their reported study, the team combined spatial transcriptomics of the developing human kidney with synthetic engineering. “We mapped this organizing geometry in developing human kidneys and tested whether a minimal cue of localized WNT signaling could restore spatial control of nephron patterning in organoids,” they explained.

The project began by making tools to copy developmental signals. Postdoctoral researcher Fokion Glykofrydis, PhD, in the Morsut lab, engineered a “synthetic organizer” cell that secreted a Wnt protein that their spatial transcriptomics and other analyses indicated was involved in spatial patterning during kidney development. Graduate student Connor Fausto from the Lindström lab proposed an experiment to test how this Wnt-secreting cell would affect organoid nephrons.

The experiments revealed that the synthetic organizer enabled two key processes essential for building organs: controlling the identity of cells and influencing the shape of developing structures. The synthetic organizer serves as a localized and targeted source that secretes controllable amounts of specific Wnt proteins within the organoid itself. These are key signals that help shape the developing kidney. This creates a signaling environment much more similar to a naturally developing kidney and gives researchers a way to control where and how kidney structures form.

Co-corresponding author Leonardo Morsut, PhD, associate professor of stem cell biology and regenerative medicine, and biomedical engineering at the Keck School of Medicine and USC Viterbi School of Engineering, said, “With our approach, we are trying to control self-organization, and work with it as opposed to try to completely override it.”

Lindström expected Wnt to trigger nephrons to change their identity into cells capable of forming connections with the urine drainage system. What surprised him was that the nephrons also changed shape and elongated toward the source of the Wnt signal, which doesn’t happen when signals are delivered uniformly to the whole organoid. Compared with the developmental process seen in traditional kidney organoids, this elongation toward the Wnt source is more similar to what happens in a naturally developing kidney.

“A single, localized signal did two things at once. It changed what the cells became and physically pulled the tubules toward the source,” Lindström said. “You would not see that with a uniform chemical bath of signals.” Engineered WNT-secreting cellular organizers introduced into kidney organoids restored organizing geometry, the authors noted, “… biasing distal nephron differentiation and orienting nephron morphogenesis toward the signal source, which demonstrates that developmental signaling geometry can be reconstructed synthetically to control tissue patterning.”

The team identified a previously unrecognized axis, a direction along which the developing kidney organizes itself. Developmental biologists have long known about the nephron’s classic “proximal-distal (PD) axis,” which runs from its blood-filtering end to its urine-drainage end. The new axis is defined instead by how close each part of the nephron sits to the collecting duct, the tube system that drains urine and releases Wnt signals during development. Those signals tell the nephron what shape to take and which way to point.

“The study shows that there’s an undiscovered axis that sets up how a nephron looks and forms,” said Lindström. “It’s not every day that you find something new in human development at that level.”

Most kidney organoids contain only nephrons and lack the collecting duct that supplies this local Wnt signal, so they have no such axis and organize in a radially symmetrical pattern. By mapping how kidney cells respond to Wnt at specific locations in the developing kidney, the team recreated that environment in organoids with the synthetic organizer, producing structures that are both more developmentally faithful and more reproducible.

“Introducing tunable WNT-secreting synthetic organizers (SOs) in organoids restored canonical WNT responses, biased distal nephron differentiation, and oriented nephron morphogenesis toward the WNT source,” the investigators stated in summary. The combined results, they suggested, “… demonstrate that the spatial geometry observed in vivo can be reconstructed synthetically to control early nephron patterning and morphogenesis … Synthetic organizers provide a modular way to restore missing spatial interactions without reconstructing the entire collecting duct lineage, complementing approaches that rebuild collecting duct–to–nephron cellular interactions.”

For Morsut, the synthetic organizer is one of several tools his lab is building to control how tissues form, and the one he is most excited about, because it steers development in a way that is powerful but not intrusive. “The synthetic organizer is just a little cluster of cells that don’t build anything themselves,” said Morsut. “But they produce a powerful field that aligns the stem cells and gives them a direction.”

Synthetic organizers offer a modular strategy to reintroduce spatial signaling interactions that are often absent in conventional organoid cultures, the team suggested. “This approach should be broadly applicable to other organoid systems in which spatial signaling environments play instructive roles during development, providing a framework for linking developmental biology with the rational engineering of tissue architecture.

Aligning cells is something embryos do repeatedly as they build themselves, Morsut noted, and the study shows it can now be put to work in an engineering setting, steering the process toward a desired outcome. “At the beginning of my talks, I always show a video of embryonic development,” said Morsut. “You start from a single cell, and you get to a complete organism, and that’s as close to magic as it gets. Now, we open a possibility of controlling this magic technology for building organs. This study shows that we can do that, and I’m excited to see what others will do in other contexts.”

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STAT+: Elevance sues government over $115 million tied to Medicare Advantage star ratings

Elevance Health has sued the U.S. government, alleging that federal efforts to recalculate its Medicare Advantage quality ratings didn’t align with a recent court ruling, costing the health insurer $115 million.

The lawsuit, filed Wednesday in U.S. District Court for the Southern District of Georgia, represents a new tier of drama in the Medicare Advantage program, which is the alternative to traditional Medicare that is run by private insurers. 

The suit centers on star ratings, which are supposed to measure the quality of a health plan’s care and customer service. Plans that meet certain quality thresholds get extra taxpayer-funded bonuses and rebates. 

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Elixirgen Builds Rare Disease Pipeline Around Telomere Biology Disorders and DMD

During the 2026 BIO International convention in San Diego, GEN sat down with Aki Ko, CEO of Elixirgen Therapeutics, to discuss the company’s multi-platform technology development efforts. The company, which was founded in 2017, is developing what it believes are breakthrough technologies that target telomere biology disorders (TBD) and aging as well as mRNA-based therapies.

Its therapy for addressing telomere biology disorders, based on its proprietary ZSCAN4 approach, is the furthest to the clinic. The biotech company will also target other aging-related diseases with the technology. Meanwhile, its efforts in the mRNA space are currently focused on Duchenne Muscular Dystrophy (DMD), although there are plans to pursue other targets there as well. 

Ko founded the company with CSO Minoru Ko, MD, PhD, in 2017. Elixirgen’s 15 employees are based in Baltimore in its office space in the Johns Hopkins Medical campus, although there is no affiliation with the university. This location offers some advantages to the company, according to Ko. Specifically, “we have a wet lab and an animal lab” that has “helped us go from in vivo to in vitro very quickly to test concepts or optimize formulations and things like that.” 

Recently, Elixirgen announced an option agreement with Japan’s Nippon Shinyaku focused on DMD. Under the terms of the agreement, Elixirgen will be responsible for the development of an asset dubbed EXG-7001, a locally administered, full-length dystrophin mRNA therapeutic that is currently in preclinical development for the treatment of DMD.

As part of the deal, Nippon Shinyaku will provide funding for the developmental costs of the therapy. Meanwhile, Elixirgen will receive an upfront payment and is eligible to receive additional development and sales-based milestone payments if the option were to be exercised. Also, Nippon Shinyaku may obtain exclusive worldwide rights to commercialize EXG-7001.

“Current approaches for treating DMD focus on delivering or restoring an incomplete dystrophin protein, and there still remains a significant unmet need for a therapy that can successfully deliver a full-length dystrophin protein,” Ko said in comments about the announcement. “By design, EXG-7001 has the potential to deliver the full-length, complete dystrophin protein that is missing in DMD patients, regardless of their genetic mutation.”

EXG-7001 leverages one of Elixirgen’s core technologies. The company has developed a platform for delivering mRNA-based therapies that it claims addresses the major delivery limitations of current methods. “The key features are that it is a lipid nanoparticle-free, localized mRNA therapeutics platform,” Ko explained to GEN. With this approach, “we’re avoiding some of the complications of gene therapies and delivering genes systemically by going local” and avoiding liver accumulation, which remains “a big issue” for mRNA therapeutics. 

The system has two components. The first component, called RNA tether, is designed to ensure that the RNA stays in the tissue that is injected without migrating to the liver. The second component is the mRNA cargo itself, which the company calls Bobcat® mRNA. Though the lead indication for this technology is DMD, there are other diseases involving large genes that the company could target. 

“We’re able to express the full length protein as mRNA as a single strand” and “it stays where you administer it, which is kind of unusual,” Ko said. Combining RNA tether and Bobcat makes it possible to express large genes and localize them to target tissues even without accumulation in the liver. Preclinical data has demonstrated its effectiveness in mice with no safety concerns associated with administration or treatment. “A full length dystrophin being given to kind of key muscles could potentially change quality of life,” particularly for the non-ambulatory population, Ko said. 

Beyond EXG-7001, Elixigen has other candidates in its pipeline that are much closer to the clinic. Its lead candidate is currently in Phase I/II testing at Cincinnati Children’s Hospital Medical Center. This is an ex vivo cell therapy based on the company’s ZSCAN4 technology, which is designed to extend the telomeres of stem cells in “a controlled way” using a telomerase-independent mechanism. EXG-34217 is comprised of autologous CD34+ hematopoietic stem cells that have been treated ex vivo with EXG-001, a non-integrating, non-transmissible, temperature-sensitive Sendai virus vector encoding human ZSCAN4.

The features of that technology were identified by the company’s CSO and his team while he worked at the National Institutes of Health’s National Institute on Aging. In 2024, the U.S. Food and Drug Administration granted Rare Pediatric Disease Designation to the treatment, dubbed EXG-34217, for the treatment of patients with dyskeratosis congenita and related telomere biology disorders. 

“Telomeres obviously have a relationship with aging, and there are in fact genetic diseases associated with short telomeres and telomerase mutations,” CEO Ko told GEN at BIO. People with TBDs are “born with shorter telomeres typically, but also have a mutation in their telomerase so they are not necessarily maintaining them either.” The result is a type of premature aging, so conditions like bone marrow failure and cytopenia happen earlier in the life of the patient. In fact, “bone marrow failure is one of the largest issues” affecting both adults and young children, CEO Ko said. 

One treatment option in these cases is allogeneic hematopoietic stem cell transplantation (HSCT), he continued. However, people with short telomeres have more fragile genomes that are less resistant to chemotherapy and radiotherapy and are at greater risk of cancer even after HSCT treatment. In an ideal scenario, it would be possible to postpone or avoid HSCT for these patients, and the company’s ZSCAN4-based therapy could make it possible to do that. 

The treatment is currently being tested in adult and pediatric patients in Cincinnati. “We started in adults because this is first-in-human,” but the disease is also very severe in children, Ko said. “Our target ultimately is to make sure as many people with TBDs can get this if they need it.” Early clinical results published in 2025 in a paper in NEJM Evidence show durable telomere extension overall with no treatment-related safety concerns observed over a 24-month and 5-month period after infusion. The trial has been going on for some time, and “we have a lot of longer-term data now” and are “looking toward potential accelerated approval.”

But targeting TBDs is just one indication. “Short telomeres manifest in many different ways,” Ko said. Other potential targets for the company’s technology are aging-related diseases, including things like idiopathic pulmonary fibrosis. 

To date, Elixirgen has raised roughly $34 million from existing investors.

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