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Real-World Efficacy and Safety of Standard-of-Care Chimeric Antigen Receptor T-Cell (CART) and Bispecific T-Cell Engager (TCE) Therapies in Relapsed/Refractory Multiple Myeloma (RRMM).

We aimed to evaluate the real-world (RW) efficacy and safety of standard-of-care CART versus TCE therapies in relapsed/refractory myeloma (RRMM), to assess utilization, outcomes, and tolerability of these therapies in a RW oncology in the US. Data were derived from the US-based, electronic health record-derived deidentified Flatiron Health Research Database, 2021-2024. A total of 419 patients (CART n = 220; TCE n = 199) with a confirmed diagnosis of myeloma who received CART or TCE as a standard-of-care treatment after at least 2 prior lines of therapy were included. Patients in the CART cohort were younger, had better ECOG PS, and a higher receipt of a prior autologous stem cell transplant versus bispecific TCE cohort. In CART versus TCE cohort, the overall response rates (ORR) were 83.3% versus 66.3%, median duration of response 7.9 months versus 4.3 months, progression free survival (PFS) 13.6 months versus 10.5 months, and overall survival (OS) of 29.8 months versus 21.9 months, respectively. A higher percentage of hematologic toxicity, infections, and cytokine release syndrome (CRS) were noted in the CART versus TCE cohort. This study provides insights on the RW effectiveness of CART versus TCE in the treatment of RRMM; highlights the differences in patient selection, clinical responses, treatment duration, and toxicity profiles.

CART

Early immune dysregulation in Mtb/SIV co-infection resists cART treatment at the single-cell level.

Using single-cell transcriptomics of bronchoalveolar lavage cells from Mtb/SIV co-infected rhesus macaques on cART, we reveal profound immune dysregulation during early SIV co-infection of latent tuberculosis. SIV induces a sharp decline in CD4+ T cells, NK, and NKT cells, with incomplete recovery of Mtb-specific TH1 effector responses despite viral suppression. Instead, a persistent TH17-skewed environment emerges, alongside sustained myeloid inflammation driven by Type I interferon signaling and pro-inflammatory regulators such as KLF6 and NFKB1. Ligand-receptor network analyses demonstrate expanded CD4+ T cell-macrophage crosstalk and loss of immune homeostasis that cART fails to fully restore. These findings expose how SIV remodels the pulmonary immune landscape to impair protective immunity against Mtb, providing a transcriptomic framework to explain TB reactivation in HIV infection. Our work highlights the urgent need for adjunctive immunotherapies to complement cART, aiming to rebalance immune responses and improve TB control in co-infected individuals.

HIV

Discarding Bedside Cart Paper-Packaged Supplies Between Patients: What Evidence Is Required?

BACKGROUND: Discarding paper-packaged sterile supplies from bedside supply carts between patients in pediatric intensive care units (PICUs) is a potential practice to target for environmental stewardship. OBJECTIVES: To determine opinions about this practice, including what evidence should be required to implement and what evidence would be adequate to abandon it. METHODS: A survey was distributed to all pediatric intensivists engaged in multicenter research in Canada and to all PICU nurses at one institution in Canada. RESULTS: The response rate was 75 of 254 (30%). The practice occurred in 54 (72%) of the respondents' units. Ten respondents (13%) agreed the practice was effective in preventing nosocomial infections. Most respondents agreed the practice should be based on empirical evidence, including a combination of improved patient outcomes (n = 57, 76%), rate of contamination of supplies within the supply carts (n = 55, 73%), and survivability of pathogens inoculated onto paper (n = 56, 75%). Most respondents agreed they would be comfortable with a randomized controlled trial (n = 52, 69%) and would support action based on the results (n = 54, 72%). The potential trial outcome most highly ranked was next-patient nosocomial infection with pathogen from the previous patient (n = 23, 31%); this was ranked more often by intensivists (P = .005). Other outcomes highly ranked included next-patient colonization with pathogen from the previous patient (n = 44, 59%) and pathogen detection on supplies within the supply cart (n = 43, 57%). CONCLUSIONS: Most respondents agreed that the practice was not based on empirical evidence, agreed the practice should be based on empirical evidence, and would agree to a randomized trial with patient-important outcomes.

Humans

Augmented kurtosis-based projection pursuit: a novel, advanced machine learning approach for multi-omics data analysis and integration.

Due to the heterogeneity of multi-omics data, exacting their maximum information potential remains a challenge. Whereas some solutions have been offered, most cannot overcome the large linear dynamic range associated with such data, while others require large biological effect sizes to produce meaningful models. Here, we (i) perform a comprehensive benchmarking of multi-omics data analysis tools, and (ii) introduce kurtosis-based projection pursuit analysis, augmented with classification and regression trees (kPPA-CART) as a robust, easy-to-implement alternative. Using ground truth data, we demonstrate that kPPA-CART exhibits superiority in inferring biological significance from low-intensity (low-count) features and studies with small biological effect sizes. Applying it to experimental breast cancer data from The Cancer Genome Atlas, we identify novel genes that cluster the samples into subtypes that mimic the canonical PAM50 classes with notable improvements. Validating with external metastatic breast cancer data from the AURORA US consortium, kPPA-CART identifies genes that are associated with poor event-free survival and additional clustering associated with increased tumor mutational burden. Finally, we provide an R package and an online implementation of kPPA-CART.

Humans

Decoding spatiotemporal fibrotic and cellular immunosuppression of therapeutic T cells in live pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDA) is profoundly immunosuppressive. To help define this behavior, we present integrated experimental and computational frameworks to elucidate therapeutic T cell dynamics. Through the development of TME-CARTographer (TME-CART), a computational pipeline integrating high-dimensional data, graph theory, behavior analysis, and deep learning (DL), we present quantitative insights on 4D T cell-TME interactions in live PDA tumors. Mapping physical immunosuppression demonstrates that collagen fiber architectures direct migration while concomitantly limiting off-axis movement, creating immune exclusion zones. Expanding these findings, we establish that the collagen matrix harbors and spatially organizes immunosuppressive myeloid cells to serve as cooperative co-modulators of T cell behaviors, including migration, sampling, repulsion, and sequestration. Consistent with these findings, DL defines both linear and nonlinear collagen matrix and cellular neighborhood interactions as drivers of T cell behavior. The TME-CART DL framework also accurately predicts shifts in immunosuppression following depletion of myeloid cells. Overall, we identify synergistic barriers impeding anti-tumor T cell behaviors and present TME-CART as a discovery platform for interpreting complex 4D data to enhance the understanding and design of immunotherapies.

Journal Article

Multimodal intervention benefits: Responder analysis of J-MINT PRIME Kanagawa trial.

INTRODUCTION: The J-MINT PRIME Kanagawa trial was an 18-month multimodal intervention (incorporating exercise, nutrition, and metabolic management) for dementia prevention. Because the primary analysis showed no significant benefits, we performed an exploratory responder analysis to identify responsive subpopulations. METHODS: We analyzed the Full Analysis Set comprising 188 participants. Classification and regression tree (CART) analysis, applied to the intervention arm, identified baseline predictors of cognitive improvement. These rules were then applied to the entire cohort to evaluate treatment effects on the Mini-Mental State Examination (MMSE) using fully adjusted mixed-effects models for repeated measures (MMRM). RESULTS: CART identified a "Target Group" (N = 108) characterized by baseline profiles such as an MMSE score < 28 or specific metabolic ranges (e.g., LDL-C < 135 mg/dL). Within this target group, the intervention significantly preserved MMSE trajectories compared with the control group (group &#xd7; time interaction, P = 0.022). In contrast, the Non-Target Group (N = 80), consisting of high-functioning individuals (MMSE &#x2265; 28), exhibited no significant group &#xd7; time interaction. DISCUSSION: Multimodal interventions may effectively preserve global cognition in older adults with sub-threshold cognitive decline. Careful targeting of appropriate populations, while considering potential longitudinal measurement artifacts (e.g., practice effects), is essential. These findings provide a hypothesis-generating framework that warrants external validation in future prevention trials.

Humans

Otolithic-acoustic interaction in the control of eye movement.

In order to examine otolithic contribution to eye movements ten subjects were asked to track either a moving acoustic target or a stationary target during subject linear motion on a cart. The relative displacement between the subject and the target was the same in the two situations. Recordings of eye movements during subject lateral acceleration in the dark without any task, or with the task of tracking an imagined stationary target were made as a control. The frequencies ranged between 0.15 and 0.3 Hz and peak acceleration between 0.55 and 1.2 m/s2. No lateral eye movements (L-nystagmus) were recorded in the dark. Only saccadic eye movements were recorded during the tracking of a moving acoustic target. Slow eye movements interspersed by saccades were observed when the moving subject tracked an imagined or an acoustic stationary target. Contribution of the slow phase to tracking was more important in the presence of an acoustic target than in the presence of imagined target. The results are interpreted in terms of an otolithic contribution to the central reconstruction of the acoustic target velocity, or in terms of an adaptive control of the otolithic-ocular reflex gain. A conceptual model accounting for these interpretations is proposed.

Acoustic Maculae

Rumen motility in experimental acidosis of the rumen in sheep.

In rumen acidosis, induced by infusion of saccharose solution and solutions of different volatile fatty acids and lactic acid into the rumen, and during induced disturbances of acid-base equilibrium in the arterial blood the motility of the dorsal sac of the rumen, the pH of rumen content and the indices of acid-base equilibrium in the arterial blood were investigated. The pH and the indices were determined by the micromethod of Astrup with an Acid-Base-Cart ABC-1 unit. During saccharose-induced acidosis of the rumen the pH of its content was decreased and its motility was strongly inhibited. Acidification of rumen content corresponded to the dissociation constant of a given acid. The motility of the rumen was inhibited most strongly by butyric acid, followed with regard of this effect by acetic acid, propionic acid and lactic acid. It was found that hydrogen ions as well as anions and non-dissociated forms of acids produced in the rumen were responsible for inhibition of this motility and that the rise in the concentration of hydrogen ions in the blood had no inhibitory effect on the motility of the rumen.

Acetates

Blood acid-base equilibrium in experimental acidosis of the rumen in sheep.

Blood acid-base equilibrium in experimental acidosis of the rumen in sheep. Acta Physiol. Pol., 1979, 30 (4): 543--551. Experimental acidosis of the rumen was induced in sheep infusing into it through a fistula a solution of saccharose and solutions of different volatile fatty acids and lactic acid. Arterial-blood acid-base equilibrium indices were determined by the Astrup micromethod with an Acid-Base-Cart ABC-1 unit. It was found that during saccharose-acidosis partly compensated metabolic acidosis develops and that acid-base equilibrium disturbances are caused by all volatile fatty acids and lactic acid. When they are infused in equimolar amounts into the rumen the strongest and earliest disturbances in that equilibrium are caused by acetic acid, followed by butyric, lactic and propionic acids.

Acidosis

BRD9 Degraders Unleash GBAF Chromatin Remodeling Activity in Synovial Sarcoma.

UNLABELLED: Synovial sarcoma incorporates the SS18::SSX fusion oncoprotein into GLTSCR1-containing BRG1/BRM and associated factors (GBAF) complexes, which confers a dependency on the GBAF subunit BRD9. However, synovial sarcoma clinical trials with multiple BRD9 degraders failed to achieve clinically impactful remissions. In this study, we identified a mechanistic framework to explain these results. BRD9 depletion served to blunt proliferation in synovial sarcoma harboring minimal genomic alterations, rare in trial participants. In cultured cells, xenografts, and recombinant-purified complexes, BRD9 loss did not affect GBAF assembly. Although BRD9 degradation in synovial sarcoma reduced GBAF enrichment at target loci, BRD9-less complexes maintained or increased chromatin accessibility and associated gene transcription. Biochemical assays with purified recombinant GBAF demonstrated increased nucleosome sliding in the absence of BRD9. Together, these findings show that BRD9 restrains GBAF activity, with BRD9 degradation increasing enzymatic remodeling and target gene expression by fusion oncoprotein-distributed GBAFs in synovial sarcoma. This subtle epigenetic disturbance creates a low hurdle for synovial sarcoma to surpass, limiting the therapeutic efficacy of BRD9 degraders. SIGNIFICANCE: BRD9 represses the GBAF chromatin remodeling complex, which causes enhanced rather than disrupted SS18::SSX complex activity following BRD9 degradation and explains the lack of efficacy of pharmacological BRD9 degraders in synovial sarcoma.

Sarcoma, Synovial