Category: 8. Health

  • Shingles and RSV vaccines with AS01 adjuvant reduce dementia risk

    Shingles and RSV vaccines with AS01 adjuvant reduce dementia risk

    New research reveals that vaccines enhanced with the AS01 adjuvant may help shield the aging brain from dementia, potentially redefining vaccine benefits beyond infectious disease protection.

    Study: Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections. Image Credit: ahmetmapush / Shutterstock

    In a recent study in npj Vaccines, researchers demonstrated the short-term (18-month) protective effects of the AS01 adjuvant against the risk of subsequent dementia. This retrospective research leveraged electronic health record data (EHR) from the TriNetX US Collaborative Network, comprising more than 436,000 US adults, approximately half of whom were administered an AS01-adjuvanted vaccine, while the rest received a comparable non-AS01-adjuvanted flu vaccine.

    Study findings revealed that participants administered AS01-adjuvanted vaccines (Shingrix or Arexvy) were at a significantly lower risk of dementia over the following 18 months than participants who received the flu vaccine. This result remained robust, irrespective of vaccine type or participant sex, suggesting that the protective effects may be attributed mainly to the adjuvant (AS01) and its potential neuroprotective immune responses. These findings open a new frontier in preventive neurology, potentially positioning AS01-adjuvanted vaccines as promising candidates for delaying or preventing dementia.

    Background

    Dementia is an umbrella term for several age-associated progressive cognitive declines that can severely hamper daily activities. Dementia represents a global public health concern, estimated to impact more than 57 million people (2021), most of whom are women. In today’s aging world, dementia prevalence continues to rise, with projections suggesting that 139 million adults will have dementia by 2050.

    Unfortunately, dementia remains without a cure, with current research efforts focused on identifying its risk factors and developing effective preventive interventions. In light of this, the current research group made an intriguing discovery in their previous work: Shingrix, a shingles vaccine, was associated with a lower risk of dementia compared to live anti-varicella-zoster virus vaccines.

    Researchers hypothesized that this either meant that shingles was linked to dementia, or AS01, an adjuvant added to Shingrix to improve its efficacy (no AS01 in live vaccines), was contributing to the observed reduced dementia risk. However, these findings were observational, which raises questions about whether this benefit was derived from better viral protection (against shingles or the varicella-zoster virus) or from interactions between the immune-boosting agents.

    About the study

    In the present study, researchers sought to isolate the effects of potential shingles-dementia associations by explicitly investigating if AS01 can alter the short-term risk of dementia diagnosis. To do this, they compared individuals who received AS01-adjuvanted vaccines with controls who received a flu vaccine devoid of AS01.

    The study compared the relative risk of dementia diagnosis among members of each cohort over the subsequent 18 months. Participant data was obtained from the United States (US) TriNetX Collaborative Network. The electronic health record (EHR) dataset comprised 436,788 US adults (60+ yrs; majority between 70-73) who were administered Shingrix (n = 103,798), Arexvy (another AS01-adjuvanted RSV vaccine; n = 35,938), or a non-AS01-adjuvanted vaccine against the common flu.

    Notably, the controls were sociodemographically and medically matched (66 variables) to cases via propensity score matching. Outcomes of interest included positive dementia diagnoses (International Classification of Diseases [ICD-10] codes) within the 18 months following study enrolment/vaccine administration.

    Statistical analyses included the Kaplan-Meier estimator for calculating incidences of outcomes, the generalised Schoenfeld approach for assumption testing, and clinically meaningful estimations using a restricted mean time lost (RMTL) model. The primary statistical comparisons were between these vaccine-defined cohorts, and analyses were also stratified by sex.

    Study findings

    The study demonstrated several compelling findings. First, AS01-adjuvanted vaccines showed impressive short-term (18 months) protective effects against the risk of dementia. Participants who received Arexvy showed a 29% lower risk of dementia compared to controls, while those who received Shingrix showed an 18% reduction. Those who received both vaccines saw a 37% lower risk.

    Notably, the protective impacts of these vaccines were statistically indistinguishable, strengthening support that the AS01 adjuvant, the only commonality between the vaccines, is a plausible explanation for the observed protective effect. Independent laboratory studies bolster this idea, though the paper’s authors note that the exact mechanisms remain speculative. They highlight that AS01 activates innate immune cells, such as microglia, thereby enhancing pathogen clearance and reducing inflammation processes implicated in Alzheimer’s disease and the risk and progression of dementia.

    Interestingly, the authors report a key limitation that may mean the protective effect is even stronger than observed. The RSV vaccine group likely included some patients who received a non-AS01 vaccine, suggesting the true impact of the AS01-adjuvanted vaccine (Arexvy) may be underestimated.

    In contrast, the hypothesized anti-viral benefits of these vaccines on dementia risk (and by extension, the potential associations between the diseases and dementia) remain unlikely. These results remained robust following sensitivity testing and adjustments for vaccine type and sex. However, the authors stress that, because the study is observational, it reveals that unmeasured confounding factors may influence an association rather than a proven causal link, and the findings.

    A. Association between AS01-adjuvanted vaccines and risk of dementia, negative control outcome, and zoster infection. Each dot and bold number represent the ratio of restricted mean time lost (RMTL) for the comparison between two cohorts, while horizontal lines and numbers in brackets are 95% confidence intervals. RMTL ratios below 1 indicate that the risk is lower in the first cohort (e.g., recipients of the RSV vaccine on the first line) than in the second (e.g., recipients of the flu vaccine). B. Associations between AS01-adjuvanted vaccines (compared to flu vaccine) and risk of dementia in females, males, and in the cohorts including people who developed dementia within the first 3 months post-vaccination.

    Conclusions

    This real-world study contributes to the growing body of evidence that AS01-adjuvanted vaccines may protect brain health beyond their intended viral targets. With both RSV and shingles vaccines showing significant dementia risk reduction (29% for RSV and 18% for shingles), their shared efficacy, rather than specific disease prevention, appears key to their holistic dementia-preventive effects.

    The findings strongly support the need for future randomized clinical trials to confirm these effects and test AS01 boosters for the prevention of dementia. If confirmed, we may be able to harness vaccine platforms not just for infectious disease control, but as tools to delay or prevent cognitive decline, thereby representing a significant paradigm shift in preventive geriatrics.

    Journal reference:

    • Taquet, M., Todd, J.A. & Harrison, P.J. Lower risk of dementia with AS01-adjuvanted vaccination against shingles and respiratory syncytial virus infections. npj Vaccines 10, 130 (2025), DOI — 10.1038/s41541-025-01172-3, https://www.nature.com/articles/s41541-025-01172-3

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  • Study Evaluates Pregnancy and Breast Milk for Clues to Childhood Obesity

    Study Evaluates Pregnancy and Breast Milk for Clues to Childhood Obesity

    Newswise — Childhood obesity may be caused by more than poor diet and insufficient physical activity. The latest research suggests that at least some of the risk for obesity may originate in the womb, where the fetus is exposed to the mother’s metabolic state, including her blood sugar levels.

    This is called “metabolic programming.” When maternal blood sugar is high during pregnancy, children tend to have higher rates of obesity and disordered glucose metabolism. They may have higher body fat in infancy, then childhood and eventually in adulthood. But could this trajectory be altered?

    Researchers at Ann & Robert H. Lurie Children’s Hospital of Chicago and colleagues are now turning their attention to breastfeeding as the next critical stage of metabolic programming. They are investigating how blood sugar levels in pregnancy affect nutrient composition of breast milk, focusing on fatty acids known to regulate offspring body fat. They also are trying to determine the impact on the child’s weight and body fat, accounting for the child’s diet.

    “We are studying the influence of maternal metabolism during pregnancy on both breast milk composition and the child’s metabolism,” said Co-Principal Investigator Jami Josefson, MD, pediatric endocrinologist and scientist at Lurie Children’s, the lead site for the study. “We are considering the entire range of blood sugar levels during pregnancy, from normal to gestational diabetes.”

    Since October 2023, the study enrolled 180 mother/baby pairs, with the goal of enrolling 400. All the mothers in this study were participants in another study that collected detailed metabolic data throughout their pregnancy. These data will be linked to their breast milk composition profiles, as well as body fat measurements of the mother and baby at 1 month, 2 months, 6 months and 2 years of age.

    “We hope to advance understanding of how in utero exposures modify lactational programming,” said Dr. Josefson. “Ultimately, our goal is to identify interventions to mitigate adverse developmental programming and prevent childhood obesity.”

    The Glycemia Range and Offspring Weight and adiposity in response To Human milk (GROWTH) study is funded by Eunice Kennedy Shriver National Institute of Child Health and Human Development.

    Dr. Josefson is the Children’s Research Fund Junior Board Research Scholar at Stanley Manne Children’s Research Institute at Lurie Children’s. She also is Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.

    Daniel Robinson, MD, neonatologist and scientist at Lurie Children’s, is the Co-Principal Investigator on the GROWTH study. He is the Founders’ Board Neonatology Young Research Scholar at Manne Research Institute and Associate Professor of Pediatrics at Northwestern University Feinberg School of Medicine.


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  • Parents face barriers to vaccinating children, says report

    Parents face barriers to vaccinating children, says report

    Getty Images A young child wearing a green top has her sleeve rolled up and is ready to get a vaccine from a doctor (unpictured) whose arms and hands are in view, who is holding a vaccineGetty Images

    Parents are being prevented from vaccinating their children because of obstacles such as difficulty booking appointments and a lack of reminders on what jabs are needed and when, a report suggests.

    Child health experts say “practical or logistical reasons” are discouraging families more often than fears over the vaccines.

    Vaccine uptake in the UK has fallen over the last decade, leading to outbreaks of measles and whooping cough.

    UK health officials say they are committed to working with the NHS to improve vaccine uptake among children.

    ‘Easier access’

    Since 2022, no childhood vaccine in the UK has met the World Health Organisation target of 95% of children vaccinated, which ensures protection of vulnerable people. As a result, measles and other preventable diseases have made a comeback.

    A commission of experts from the Royal College of Paediatrics and Child Health (RCPCH) spent a year looking at why.

    Dr Helen Stewart, officer for health improvement at RCPCH, said the steady decline in vaccination rates in a wealthy country like the UK was “extremely concerning”.

    But she said vaccine hesitancy, when parents waver over getting their children vaccinated, “is only part of a very complex picture”.

    “The reality is that there are many who simply need better support and easier access to appointments,” Dr Stewart said.

    Although confidence in vaccines is still relatively high, the report found barriers to accessing jabs are why many families don’t protect their children.

    Some of the most common barriers include:

    • difficulties getting through to book appointments at GP surgeries
    • difficulties getting time off work for appointments
    • limited transport options or no parking at GP surgeries
    • not seeing the same GP each time so lack of trust
    • not being able to speak to a GP or nurse to ask about the vaccines
    • lack of reminders for jabs being sent out from GP
    • not enough clear information about what jabs their child needs and when

    “One of the findings of this new report is that parents have no easy way to check their child’s vaccination status,” says children’s emergency medicine specialist, Dr Stewart.

    “When I ask if the child is up to date with their vaccinations, the most common response is ‘I think so’.”

    Poorer families, some ethnic minority groups and migrant communities are much less likely to be vaccinated, and these inequalities have become more obvious since the pandemic, the report says.

    It also notes an absence of health visitors often means parents have no one they feel comfortable discussing vaccines openly with.

    Digital red book

    The report recommends using NHS apps to improve the experience of booking jabs, investing and expanding vaccination services, and funding health visitors to deliver some of them.

    It also calls on the development of the ‘digital red book’ to be finalised so parents can keep track of their children’s vaccinations.

    The NHS website lists the full schedule of vaccinations for children, from babies, up to the age of 15.

    Dr Julie Yates, deputy director for immunisation programmes at UK Health Security Agency, said plans were in place to improve childhood vaccine uptake by ensuring more flexible appointment booking systems, making vaccines more widely available across different locations, and making access easier in all communities.

    “Despite the challenges, it is also important to note that parents have high confidence in vaccinations with almost 90% agreeing vaccines are effective,” Dr Yates said.

    Alison Morton, chief executive of the Institute for Health Visitors, said the report presented “a compelling case” to ensure babies and children are protected against serious diseases which can cause so much unnecessary harm.

    Helen Bedford, professor of children’s health at University College London, said improvements needed investment in staff and infrastructure.

    “Our children have the right to be protected from preventable diseases which can cause illness, disability or even death,” she said, adding that a fall in children getting their vaccines had resulted in the deaths of 11 young babies from whooping cough last year. 

    Falling vaccinations among children isn’t just an issue in the UK, in 2023 there were nearly 16 million children who had not had any vaccinations, most of them in south Asia and sub-Saharan Africa.

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  • Levothyroxine’s Role in Mild Pregnancy Hypothyroidism Queried

    Levothyroxine’s Role in Mild Pregnancy Hypothyroidism Queried

    (Boston)—While severe maternal hypothyroidism (low thyroid hormone levels) in pregnancy is known to increase risks of adverse pregnancy outcomes, it is unclear whether mild (subclinical) hypothyroidism causes similarly adverse pregnancy complications. It is also not clear whether maternal hypothyroidism in pregnancy increases risks of gestational diabetes.

    A new study in the journal Lancet Diabetes and Endocrinology (Osinga et al “Association of gestational thyroid function and thyroid autoimmunity with gestational diabetes mellitus: a systematic review and individual-participant meta-analysis”) investigated a potential association between maternal thyroid function in pregnancy and risk of gestational diabetes. The study, which used data from a large sample of patients from several different studies, found low free thyroxine (FT4) levels in pregnancy was associated with increased risk of gestational diabetes (6.5% vs 3.5% in those with normal FT4 levels). However, patients with mild subclinical hypothyroidism (high thyrotropin, or TSH, and normal FT4 level) were not at increased risk of gestational diabetes.

    “Since TSH is used as the screening test for thyroid dysfunction, it is unclear whether these new findings should change the current practice of thyroid function screening in pregnancy,” says Sun Young Lee MD, MSc, assistant professor of medicine at Boston University Chobanian & Avedisian School of Medicine in an accompanying commentary, (https://www.thelancet.com/journals/landia/article/PIIS2213-8587(25)00126-3/fulltext). “Currently available laboratory tests can also result in falsely low FT4 levels in pregnancy because of interference from normal changes in protein levels in pregnancy,” adds Lee who also is an endocrinologist at Boston Medical Center.

    Presently, routinely checking thyroid hormone levels in pregnancy is not recommended. In her commentary, Lee points out that other clinical trials have not shown that treatment of mild maternal hypothyroidism in pregnancy decreases risks of pregnancy complications. “It is unclear whether the findings of this study would advocate for universal screening and treatment of mild subclinical maternal hypothyroidism.”

    Lee believes further clinical trials are needed to study the potential benefit of levothyroxine treatment of low FT4 levels in pregnancy in decreasing risks of pregnancy. In the meantime, she feels more vigilant screening of gestational diabetes in patients with known thyroid disease is important.

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  • New Statistical Method Identifies Hidden Gene Programs Linked to Poor Survival in Aggressive Pancreatic Cancer

    New Statistical Method Identifies Hidden Gene Programs Linked to Poor Survival in Aggressive Pancreatic Cancer

    Newswise — Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest forms of cancer, known for its aggressive behavior and resistance to treatment. Treating PDAC is challenging because the tumors are extraordinarily complex, with a chaotic mix of cells with different behaviors, vulnerabilities, and gene expression patterns.

    In a study published in Nature Genetics, researchers from the University of Chicago developed a powerful statistical method called Generalized Binary Covariance Decomposition (GBCD) to better understand this complexity. This method enables researchers to analyze massive single-cell RNA sequencing datasets and uncover recurring patterns of gene activity across diverse patient tumors.

    By applying GBCD to thousands of individual cancer cells from multiple studies, the team discovered previously hidden gene expression programs, particularly a stress-response signature that is linked to poor survival outcomes. This new method could be a powerful tool for identifying high-risk patients and developing more personalized treatment strategies.

    Understanding tumors’ mixed make-up through variations in gene expression

    Genetic and epigenetic alterations are major drivers of fatal diseases like cancer. These alterations impact cellular function by changing gene expression and leading to transcriptional heterogeneity—a phenomenon in which patterns of gene activity differ across cells. Every tumor contains a complicated mix of cell types and states. Some cells grow rapidly, others remain dormant; Some respond to drugs, others are resistant to treatment.

    “A big question in cancer is, how does gene expression predict or causally impact the way a tumor develops or how patients respond to therapy?” said senior author Matthew Stephens, PhD, FRS, Professor and Chair of the Department of Statistics and Professor of Human Genetics at UChicago. “If we understood how transcriptional variation predicts prognosis and therapy response, then we could improve therapies because transcriptional variation is relatively easy to measure.”

    Sometimes it is not just a single gene, but a set of genes that exhibit coordinated transcriptional changes. These are known as gene expression programs, which can characterize cancer molecular subtypes, influence tumor progression, and affect therapy response.

    Revealing layers within tumor complexity

    Historically, most transcriptomic data came from bulk RNA sequencing, which measures gene expression in a group of cells rather than in individual cells. The issue with bulk transcriptomic data is that it provides measurement at the patient level. In contrast, single-cell RNA sequencing (scRNA-seq) data measures gene expression at single-cell resolution, revealing transcriptional heterogeneity among cells from the same patient.

    Modern technologies like scRNA-seq allow researchers to measure the activity of thousands of genes in individual cancer cells, offering much higher resolution of the transcriptional heterogeneity within tumors. However, the resulting massive datasets pose a challenge: distinguishing meaningful signals from noise.

    In the current study, the team focused on analyzing transcriptional variation using scRNA-seq data. “Studying single-cell data allows us to see much more structure than what we can observe with bulk RNA-seq,” said Yusha Liu, PhD, a former postdoctoral researcher in the Stephens lab who led the study. Unified analysis of scRNA-seq data from multiple studies and patients can identify recurrent patterns of transcriptional variation related to cancer etiology, such as molecular subtypes. There may also be other biological activities or cellular processes occurring in tumor cells that aren’t directly tied to known molecular subtypes but still have significant implications for patient outcomes.

    “Although tumor subtype identification is helpful in guiding treatment choices, the molecular landscape is very complex,” Stephens said. “We are trying to identify gene expression programs using Generalized Binary Covariance Decomposition (GBCD), a statistical method designed to analyze transcriptional heterogeneity in single-cell RNA data and detect patterns beyond known subtypes.” This method allows researchers to break down the complex variation in gene activity into distinct, interpretable components.

    Stress response signature offers clues to pancreatic cancer survival

    To test the new GBCD method, researchers analyzed 35,000 cancer cells from 59 patients with PDAC. GBCD not only identified the well-known “classical” and “basal” PDAC subtypes but also uncovered a previously underappreciated stress-response program strongly associated with poor survival.

    They found that many critical genes in this stress-response program are regulated by ATF4, a key transcription factor involved in the “integrated stress response,” a survival mechanism exploited by cancer cells under harsh conditions. Importantly, this stress program predicted worse outcomes in cancer patients independent of tumor stage or known subtype. Identifying this signature could help explain PDAC’s aggressive nature and inform treatment strategies.

    “The benefit of our approach is that we can perform a unified or integrative analysis of single-cell RNA-seq data from multiple samples across studies,” Liu said. “This greatly increases the number of patient samples and cells, enhancing our power to identify shared transcriptional patterns. The challenge, however, is the high degree of variability between patients, which can mask these subtle shared patterns and that is what GBCD is designed to tackle.”

    According to researchers, the GBCD approach offers a deeper characterization of the transcriptional landscape in pancreatic cancer and could be applied to other cancer types. They hope the tool will advance understanding of cancer biology and etiology, while offering valuable insights to study tumor progression and metastasis.

    The study “Dissecting tumor transcriptional heterogeneity from single-cell RNA-seq data by generalized binary covariance decomposition” was supported by grants from the National Institutes of Health, the University of Chicago Medicine Comprehensive Cancer Center, the Leona M. and Harry B. Helmsley Charitable Trust, the Neuroendocrine Tumor Research Foundation, an Ullman Family Dream Team Award, and the Government of Ontario.

    Additional authors included Scott A. Oakes and Kay F. Macleod from the University of Chicago, and Jason Willwerscheid from Providence College, RI.


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  • Breast Cancer Risk in Younger Women May Be Influenced by Hormone Therapy

    Breast Cancer Risk in Younger Women May Be Influenced by Hormone Therapy

    Scientists at the National Institutes of Health (NIH) have found that two common types of hormone therapy may alter breast cancer risk in women before age 55. Researchers discovered that women treated with unopposed estrogen hormone therapy (E-HT) were less likely to develop the disease than those who did not use hormone therapy. They also found that women treated with estrogen plus progestin hormone therapy (EP-HT) were more likely to develop breast cancer than women who did not use hormone therapy. Together, these results could help to guide clinical recommendations for hormone therapy use among younger women.

    The two hormone therapies analyzed in the study are often used to manage symptoms related to menopause or following hysterectomy (removal of uterus) or oophorectomy (removal of one or both ovaries). Unopposed estrogen therapy is recommended only for women who have had a hysterectomy because of its known association with uterine cancer risk.

    “Hormone therapy can greatly improve the quality of life for women experiencing severe menopausal symptoms or those who have had surgeries that affect their hormone levels,” said lead author Katie O’Brien, Ph.D., of NIH’s National Institute of Environmental Health Sciences (NIEHS). “Our study provides greater understanding of the risks associated with different types of hormone therapy, which we hope will help patients and their doctors develop more informed treatment plans.”

    The researchers conducted a large-scale analysis that included data from more than 459,000 women under 55 years old across North America, Europe, Asia, and Australia. Women who used E-HT had a 14% reduction in breast cancer incidence compared to those who never used hormone therapy. Notably, this protective effect was more pronounced in women who started E-HT at younger ages or who used it longer. In contrast, women using EP-HT experienced a 10% higher rate of breast cancer compared to non-users, with an 18% higher rate seen among women using EP-HT for more than two years relative to those who never used the therapy.

    According to the authors, this suggests that for EP-HT users, the cumulative risk of breast cancer before age 55 could be about 4.5%, compared with a 4.1% risk for women who never used hormone therapy and a 3.6% risk for those who used E-HT. Further, the association between EP-HT and breast cancer was particularly elevated among women who had not undergone hysterectomy or oophorectomy. That highlights the importance of considering gynecological surgery status when evaluating the risks of starting hormone therapy, the researchers noted.

    “These findings underscore the need for personalized medical advice when considering hormone therapy,” said NIEHS scientist and senior author Dale Sandler, Ph.D. “Women and their health care providers should weigh the benefits of symptom relief against the potential risks associated with hormone therapy, especially EP-HT. For women with an intact uterus and ovaries, the increased risk of breast cancer with EP-HT should prompt careful deliberation.”

    The authors noted that their study is consistent with previous large studies that documented similar associations between hormone therapy and breast cancer risk among older and postmenopausal women. This new study extends those findings to younger women, providing essential evidence to help guide decision-making for women as they go through menopause.

    Reference: O’Brien KM, et al. 2025. Hormone therapy use and young-onset breast cancer: a pooled analysis of prospective cohorts included in the Premenopausal Breast Cancer Collaborative Group. Lancet Oncol 26: 911–23.

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  • IBD on the Rise: International Research Highlights Spread in Africa, Asia, and Latin America

    IBD on the Rise: International Research Highlights Spread in Africa, Asia, and Latin America

    Newswise — Inflammatory bowel disease, which includes Crohn’s disease and ulcerative colitis, has long been considered a modern condition of the industrialized West, with cases steadily increasing in North America and Europe throughout the 20th century. New research conducted by an international consortium shows that IBD and related conditions are now spreading through developing regions in Africa, Asia, and Latin America as well.

    The study, published in Nature, used data from more than 500 population-based studies covering more than 80 geographic regions to describe a pattern of four distinct stages IBD progresses through as it first appears in a region and spreads through the population. In describing these stages, the researchers hope to provide resources and guidance to local health care systems for coping with the growing burden of patients with IBD.

    The research was conducted by the Global IBD Visualization of Epidemiology Studies in the 21st Century (GIVES 21) consortium, a group of international IBD and public health experts led by Gilaad G. Kaplan, MD, from the University of Calgary and Siew C. Ng, MBBS, PhD, from the Chinese University of Hong Kong. GIVES21 has built a large repository of IBD epidemiology data and offers open access to the complete dataset for researchers, clinicians, and patients worldwide through a web application.

    “This has been a huge, collaborative effort to understand IBD around the globe,” said GIVES21 team member David T. Rubin, MD, the Joseph B. Kirsner Professor of Medicine at the University of Chicago.

    “Now that we recognize what’s happening with IBD in emerging areas of the world, we can start focusing on being able to treat it in places where these conditions are new. We can also study it in these emerging areas so we might get new clues as to what’s driving this so we can help prevent it,” said Rubin, who is also the newly elected Chair of the International Organization for the study of IBD (IOIBD), which supported the new study.

    Drawing on a century of data

    The team drew on a century’s worth of data about IBD compiled by GIVES21. They analyzed new diagnoses per year and total people living with IBD, and found that it is unfolding in four distinct, predictable stages:

    1. Emergence: Currently seen in low-income countries, with both new and total cases remaining low.
    2. Acceleration in Incidence: Marked by a rapid rise in new diagnoses as regions industrialize and lifestyles shift, though total cases remain limited.
    3. Compounding Prevalence: With incidence stabilizing, prevalence soars—driven by low mortality and accumulating cases in younger populations.
    4. Prevalence Equilibrium: Projected in several high-income regions by 2045, where new diagnoses balance disease related deaths, plateauing overall prevalence.

    As a chronic inflammatory condition that is driven by immune system responses, IBD has been linked to so-called Western diets that are high in processed foods, animal products, and sugar while also low in fruits, vegetables, and whole grains. People in industrializing economies tend to adopt more elements of this diet, but that alone doesn’t tell the full story; IBD is increasing in India, for example, which has a high proportion of people who are vegetarian.

    Rubin said other factors may be contributing as well. Growing evidence points to the implications of how food is prepared and stored, as more researchers explore the effects of emulsifiers and microplastics in food on IBD. He also emphasizes that it’s important to remember that IBD is really dozens of distinct different conditions caused by myriad genetic and environmental factors.

    “By understanding where you’re studying the disease, what you’re looking at, and which people are developing IBD, you can get different ideas of what might be driving it, which will help us separate out these different types of IBD and find the right ways to treat them,” Rubin said.

    Applying lessons on a local scale

    As Director of the Inflammatory Bowel Disease Center at UChicago, Rubin hopes to bring some of these same insights home on a smaller scale. He and his colleagues are planning to launch their own epidemiological study in Chicago to understand how different socioeconomic factors and access to care affect the largely Black and Latino patient populations on the south and southwest sides of the city who often have more severe versions of the disease.

    “Even though we have one of the largest IBD centers in the world, there’s a clear disparity in diagnosis and access to expert care just a mile from here,” he said. “Taking something like this at a global level and getting down to the microcosm of the South Side of Chicago is incredibly important to find better ways to diagnose, treat, and eventually prevent IBD our own patients.”


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  • Girls and black children face inequalities in transplant treatment, study shows

    Girls and black children face inequalities in transplant treatment, study shows

    Academics found that some children in need of a kidney transplant are facing inequalities in their care.

    Black children are less likely to be put on the transplant waiting list, as are those from more deprived backgrounds, researchers from the University of Bristol found.

    There are currently 137 children aged 17 and under on the kidney transplant waiting list in the UK.

    Researchers set out to examine whether inequalities exist in access to kidney transplantation among children in the UK by analysing the UK Renal Registry and NHS Blood and Transplant data between 1996 and 2020.

    They found that girls were 12% less likely to be put on a transplant waiting list compared to boys.

    Children from the poorest backgrounds were 33% less likely to be put on the waiting list compared to those from the wealthiest.

    And black children were 19% less likely to be put on the waiting list compared to their white peers.

    Once children are on the waiting list, the disparities related to gender and income appeared to reduce, but disadvantages for black children persisted.

    “We were particularly struck by how early these disparities appear in the transplant process,” said Dr Alice James, lead author of the study.

    “It’s not just about who gets a transplant, but who even gets considered in the first place.

    “Those from black ethnic backgrounds face systemic disadvantages even after being placed on the waitlist, including fewer living donor opportunities.”

    When looking at kidney transplants given by a living donor within two years of being on the waiting list, the odds of getting a transplant are lower among those from poorer backgrounds and children of black or Asian ethnicity, according to the study, which has been presented to the ESOT (European Society for Organ Transplantation) Congress 2025.

    Dr James added: “It is notable – and particularly disquieting – that such disparities are evident even in a paediatric population within a universal healthcare system like the NHS.

    “The persistent disadvantage faced by children from black ethnic backgrounds even after wait-listing is especially striking, suggesting systemic or cultural barriers that extend beyond access alone.”

    On gender inequalities seen in the study, she added: “The gender disparity in wait-listing, with girls being less likely to be wait-listed, may reflect implicit gender biases in clinical decision-making, differences in parental advocacy, or variation in disease presentation and severity between sexes.

    “There may also be social factors influencing clinicians’ assumptions about transplant suitability or family engagement in the transplantation process.

    “While evidence is limited in paediatric populations, adult studies suggest that women are often perceived as less suitable candidates due to comorbidities or psychosocial factors— perceptions that may inadvertently extend to female children.”

    Fiona Loud, policy director at Kidney Care UK, said: “This research is shocking and it’s not good enough to see such heartbreaking inequalities so early in life.

    “There are around 1,000 children receiving kidney replacement therapy via either dialysis or transplant in the UK.

    “This is a relatively small number which should mean we have a real opportunity to change this and make sure we improve things for the future for children and young people.

    “But right now it is very hard for families whose children have kidney failure.

    “More work needs to be done to explore local barriers and raise awareness of the value and importance of living kidney donation through personalised and community education programmes.”

    Professor Derek Manas, medical director for organ and tissue donation at NHS Blood and Transplant, which is responsible for allocating organs to people on the list, said: “These results will help hospital clinical teams across the UK to further understand and mitigate this issue.

    “NHS Blood and Transplant does not decide which individual patients are added to the transplant waiting list, but we do manage how organs are allocated to patients and the research found that once patients are on the waiting list, they had equitable access to donations, irrespective of ethnicity or deprivation.

    “The transplant community has come a long way in ensuring equity once listed but this study confirms we all have more to do.

    “Kidneys also need to be matched and people from the same ethnicity are more likely to be a match.

    “There are currently not enough donors from black and Asian backgrounds and we urge people to show their support for donation on the NHS Organ Donor Register and to tell their families they want to donate.”

    An NHS England spokesperson said: “The decision to place somebody on the transplant list should never be affected by their gender, ethnicity or family income and this analysis is a stark reminder that, whilst we have made progress on tackling health inequalities, much remains to be done – and this will be at the heart of the 10 Year Health Plan.

    “More widely, we know kidney failure disproportionately impacts people from Black African and Black Caribbean heritage so we would always encourage more donors from these backgrounds to come forward, and we have recently launched a new simple genetic blood test for these groups to help reduce the risk of kidney failure.”


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  • New study reveals how MDMA rewires serotonin and oxytocin systems in the brain

    New study reveals how MDMA rewires serotonin and oxytocin systems in the brain

    A new study published in the Journal of Psychopharmacology has found that MDMA’s mood-enhancing effects may be partly driven by changes in brain systems related to serotonin, oxytocin, and vasopressin—neurochemical pathways that are involved in emotional and social behavior. The results support the growing interest in MDMA as a possible treatment for mental health conditions.

    MDMA, commonly known as ecstasy, is a synthetic stimulant with both energizing and hallucinogenic properties. In recent years, researchers have been exploring whether MDMA can be used in controlled therapeutic settings to help people with conditions like post-traumatic stress disorder or social anxiety. Its ability to reduce fear and increase feelings of connection makes it especially promising for patients who struggle with interpersonal difficulties. However, scientists still know relatively little about how MDMA produces these effects in the brain, or how these effects vary depending on dosage.

    To explore these questions, researchers from the Medical University of Lublin and the International Institute of Molecular and Cell Biology in Poland tested the effects of MDMA on 3-week-old zebrafish. This developmental stage is roughly equivalent to adolescence in humans and represents a time when social behaviors are emerging and brain systems involved in emotion are still developing.

    Zebrafish are small freshwater fish native to South Asia that have become widely used in biomedical research. They develop rapidly, are transparent in early stages, and share a high degree of genetic and physiological similarity with humans. Because their brains contain many of the same neurotransmitter systems as mammals, and their behavior can be easily observed and quantified, zebrafish are especially valuable for studying brain development, drug effects, and psychiatric disorders.

    The researchers were particularly interested in how MDMA influences anxiety and sociability, and whether these effects could be linked to oxytocin—a hormone involved in social bonding and emotional regulation.

    The scientists conducted several behavioral tests to assess anxiety and social behavior in the zebrafish. One test measured how closely the fish stuck to the edges of a new environment—a behavior known as thigmotaxis, which is often used as an indicator of anxiety in animals. Another test evaluated how much time the fish spent in a light versus dark area, since zebrafish tend to avoid darkness when they feel safe. Finally, a social preference test measured whether the fish were more likely to spend time near familiar conspecifics, or members of their species.

    The zebrafish were divided into groups and exposed to various concentrations of MDMA. They were also treated with either an oxytocin receptor agonist, which mimics the effects of oxytocin, or an antagonist, which blocks those effects. For comparison, some fish were given diazepam, a known anti-anxiety medication. After behavioral testing, the researchers examined the expression of several genes in the fish’s brains, looking at those related to serotonin signaling, oxytocin, and vasopressin. They also analyzed how MDMA affected specific intracellular pathways involved in mood and behavior, such as AKT and ERK1/2 signaling.

    The researchers found that MDMA had a dose-dependent effect on anxiety. At very low doses, it appeared to increase anxiety-like behavior. But at moderate doses, particularly 2.5 micromolar, MDMA reduced signs of anxiety. Fish at this dose spent more time in the center of a new environment and were quicker to explore dark areas—both behaviors associated with lower anxiety. However, at higher doses, MDMA began to reduce locomotion and showed signs of possible toxicity, suggesting that the therapeutic range is narrow.

    In terms of social behavior, the lowest dose of MDMA (0.5 micromolar) increased the time fish spent near their peers, suggesting enhanced sociability. Interestingly, this prosocial effect was most noticeable at doses that increased anxiety, indicating a complex relationship between emotional and social responses. The oxytocin receptor agonist also promoted social interaction and showed anti-anxiety effects, but only under certain conditions.

    In contrast, the antagonist had no noticeable effect on behavior, which may indicate that blocking the oxytocin system is not enough on its own to alter emotional or social responses in zebrafish.

    On the molecular level, MDMA exposure led to reduced expression of genes involved in serotonin signaling, including two types of serotonin receptors and the serotonin transporter. These changes may reflect the compound’s action on serotonin release, which is known to be one of MDMA’s main effects in the brain.

    At the same time, MDMA increased the expression of genes for oxytocin receptors and reduced the expression of vasopressin receptor genes. While MDMA did not appear to increase actual oxytocin levels in the brain, the changes in receptor expression suggest that it may make brain regions more sensitive to oxytocin’s effects.

    The researchers also found that different doses of MDMA affected specific signaling pathways in the brain. At the lowest tested dose, MDMA reduced activation of the AKT pathway, which has been linked to social behavior in other animals. The oxytocin agonist, on the other hand, increased activity in the ERK1/2 pathway, which is known to be involved in anxiety regulation. These findings suggest that different aspects of MDMA’s effects—its influence on anxiety versus social behavior—may be driven by distinct biological mechanisms.

    As with any study, there are caveats to consider. Most importantly, the study was conducted in zebrafish, whose brains are simpler than those of mammals and lack some structures found in humans. Although zebrafish share many of the same neurotransmitter systems and genetic pathways, findings in fish may not always translate directly to human biology. Additionally, the study only looked at the short-term effects of MDMA, and more work is needed to understand how repeated or long-term exposure might influence behavior or brain function.

    Future research could build on these findings by examining how MDMA affects brain circuits at different developmental stages or by testing how the compound interacts with stress. The researchers also suggested that genetic tools such as CRISPR could be used to further investigate the role of specific receptors in mediating MDMA’s effects. As scientists work toward better treatments for conditions like social anxiety and post-traumatic stress, studies like this one offer a window into how compounds like MDMA could be used not just as recreational drugs, but as tools for healing.

    The study, “Exploring the impact of MDMA and oxytocin ligands on anxiety and social responses: A comprehensive behavioural and molecular study in the zebrafish model,” was authored by Monika Maciag, Olga Doszyn, Artur Wnorowski, Justyna Zmorzynska, and Barbara Budzynska.

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  • Prolonged ED Stays, Boarding Times Among Older Adults Underscore Systemic Hospital Strain

    Prolonged ED Stays, Boarding Times Among Older Adults Underscore Systemic Hospital Strain

    Prolonged emergency department (ED) length of stays and boarding times for older adults significantly increased between 2017 and 2024, highlighting systemic challenges for hospitals across the US, according to a research letter published in JAMA Internal Medicine.1

    The researchers noted that extended ED stays in older adults are associated with a higher risk of adverse events, such as mortality and delirium, as well as treatment delays, worse patient experiences, and loss of privacy. To improve care for this population, CMS implemented the Age-Friendly Hospital Measure in January 2025.2

    This policy requires hospitals to limit total ED length of stay to under 8 hours and ensure admission to occur within 3 hours of the decision to admit. However, national data on these measures have been lacking.1 To address this gap, the researchers conducted a cross-sectional study to establish national benchmarks.

    The recent increase in prolonged emergency department (ED) stays and boarding times for older adults reveals systemic challenges in US hospital care. | Image Credit: chrisdorney – stock.adobe.com

    Using the Epic Cosmos health records database, which includes data from 1633 hospitals, 295 million patients, and 78 million admissions, they analyzed ED encounters from January 2017 to December 2024.3 They focused on 2 key metrics for patients aged 65 and older, namely the proportion with an ED length of stay over 8 hours and the proportion of admitted patients waiting more than 3 hours from bed request to admission.1

    In 2017, 12% of 4,564,359 ED encounters involved a length of stay over 8 hours. By 2024, this rose to 20% of 12,392,737 encounters. The largest increase occurred in academic hospitals, where prolonged stays grew from 22% of 1,787,179 encounters in 2017 to 36% of 4,311,417 encounters in 2024.

    During the same period, boarding times over 3 hours increased from 22% of 1,787,179 encounters in 2017 to 36% of 4,311,417 encounters in 2024. Again, the largest increase was seen in academic hospitals, where boarding rose from 31% in 2017 to 45% in 2024.

    Trend analyses showed small annual increases in both measures from 2017 to 2020 (length of stay, 1.1% [95% CI, 0.6-1.6]; boarding, 2.8% [95% CI, 1.5-4.0]), followed by sharper rises from 2020 to 2022 during the COVID-19 pandemic (length of stay, 4.2% [95% CI, 1.7-6.7]; boarding, 6.1% [95% CI, 2.5-9.8]). In contrast, from 2022 to 2024, both trends slightly declined (length of stay, –1.7% [95% CI, –2.3 to –1.1]; boarding, –3.2% [95% CI, –4.5 to –1.9]).

    Although further investigation is needed, the researchers suggested the increases may be driven by growing patient complexity, increased demand, and ongoing staffing and resource shortages.

    Lastly, they acknowledged the study’s limitations, one being that Epic overrepresents larger and academic hospitals. Also, not all hospitals that use Epic contribute to Cosmos. Despite this, the researchers expressed confidence in their findings and emphasized the need to address the declining ED experience for older US adults.

    “Worsening ED LOSs [lengths of stay] and boarding contribute to ED crowding, reflect systemic health care dysfunction, and, most importantly, harm individual patients,” the authors concluded. “Addressing these trends is critical to safeguarding both the health of older adults and the health systems caring for them.”

    References

    1. Haimovich AD, Berry SD, Landon BE. Prolonged emergency department stays for older US adults. JAMA Intern Med. doi:10.1001/jamainternmed.2025.2006
    2. FY 2025 hospital inpatient prospective payment system (IPPS) and long-term care hospital prospective payment system (LTCH PPS) proposed rule—CMS-1808-P fact sheet. CMS. April 10, 2024. Accessed June 30, 2025. https://www.cms.gov/newsroom/fact-sheets/fy-2025-hospital-inpatient-prospective-payment-system-ipps-and-long-term-care-hospital-prospective
    3. Fast facts on US hospitals, 2024. American Hospital Association. 2024. Accessed June 30, 2025. https://www.aha.org/system/files/media/file/2024/01/fast-facts-on-us-hospitals-2024-20240112.pdf

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