Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 20 appraisals
The American journal of pathology
An Integrated Machine Learning and Genomic Framework for Precise Detection of Gastric Cancer
This study presents a novel integrative approach for the analysis of high-dimensional gene expression data, leveraging the complementary strengths of unsupervised clustering and supervised classification. Using K-means clustering, the data set is stratified into three distinct clusters, revealing intrinsic biological patterns and relationships. The resulting cluster assignments are subsequently used as pseudolabels to train machine learning models, including support vector machines, random forest, and a stacking ensemble classifier. To validate and enhance the robustness of clustering, complementary methods, such as hierarchical clustering and density-based spatial clustering of applications with noise (DBSCAN), are used, with results visualized through principal component analysis-driven dimensionality reduction. The high predictive accuracy achieved by the classifiers underlines the separability and reliability of the identified clusters. Furthermore, feature importance analysis highlighted key genetic determinants within each cluster, offering actionable insights into potential biomarkers and critical genomic features. This framework bridges the gap between exploratory unsupervised learning and predictive supervised modeling, providing a scalable and interpretable method for analyzing complex genomic data sets. Its applicability extends to biomarker discovery, patient stratification, and other precision medicine applications, emphasizing its utility in advancing genomic research and clinical practice.
3 Aug 2026
Read appraisal →Genome biology
IDEAL-Age: an interpretable deep learning framework for single-cell resolution profiling of immunological aging
Immunosenescence increases susceptibility to infection and reduces vaccine responsiveness, yet bulk transcriptomic clocks obscure the cellular heterogeneity underlying this process. Here, we present IDEAL-Age, an interpretable deep learning framework that operates directly on single-cell PBMC transcriptomes. Benchmarking against 35 methods across independent cohorts demonstrates superior predictive performance. The framework's interpretability uncovers linear and non-linear gene contribution trajectories that reveal phase-specific physiological transitions, and identifies youth-associated or aging-associated cellular roles. Application to systemic lupus erythematosus reveals accelerated immunological aging driven by interferon-associated monocyte shifts. IDEAL-Age establishes a high-resolution computational framework for deciphering systemic immune aging.
27 July 2026
Read appraisal →Nucleic acids research
ChIP-Atlas 2025 update: 10-year anniversary of a data-mining platform for exploring epigenomic landscape
ChIP-Atlas (https://chip-atlas.org/) is a data-mining platform that systematically processes and integrates public epigenomic profiling data, including ChIP-seq, ATAC-seq, DNase-seq, and Bisulfite-seq, together with curated sample metadata, currently encompassing >460 000 experiments across multiple model organisms. In this 2025 update, an experiment-level quality control framework was embedded in every experiment page, enabling intuitive assessment of data reliability and representativeness. In addition, a parametric analysis of gene set enrichment-based module was implemented, allowing enrichment analysis directly from continuous RNA-seq count tables without relying on threshold-defined, discrete gene lists, thereby helping elucidate underlying gene regulatory mechanisms. Combined with sustained data expansion, these updates advance ChIP-Atlas into a more quantitative and flexible platform for exploring the epigenomic landscape in multicellular organisms, marking its 10th anniversary.
13 July 2026
Read appraisal →Nucleic acids research
FABIAN-variant 2026: improved prediction of the effects of DNA variants on transcription factor binding
Variants in promoters and enhancers can alter the binding of transcription factors (TFs), but their functional assessment remains difficult. FABIAN-variant is a web application that predicts the effects of DNA variants on TF binding by comparing position weight matrix (PWM) and transcription factor flexible model (TFFM) scores between reference and variant alleles. Here, we present FABIAN-variant 2026, a major update that expands the prediction model library from ~5000 to over 40 000 models for >1500 human TFs, sourced from nine PWM databases and including 1290 TFFMs. The application now supports the mouse genome (GRCm38 and GRCm39) with over 35 000 models for >1100 mouse TFs. An optional BPNet deep learning scorer provides neural network-based binding predictions for 240 human TFs. Known TF binding site information has been expanded from three to five sources. Predictions for over 1400 heterodimer TF complexes have been added. The web server has been rewritten in Rust and the scoring engine optimized, reducing runtime by ~70%. A RESTful JSON API and a standalone command-line version enable programmatic access and local high-throughput analysis. FABIAN-variant 2026 is available at https://fabianapp.org/variant26/. The web server is free and open to all users and there is no login requirement.
13 July 2026
Read appraisal →PloS one
Machine learning-based analysis of drug resistance mutations in Mycobacterium tuberculosis
Tuberculosis is a deadly airborne disease caused by Mycobacterium tuberculosis. Drug-resistant tuberculosis presents significant challenges for treatment and control of the disease. Resistant strains of Mycobacterium tuberculosis arise from specific mutations in the bacterium. Identification and characterization of resistance-associated mutations are crucial for effective treatment strategies because the first- and second-line drugs for the disease target distinct genes in the bacterium and serve different purposes. Our study developed a machine learning prediction model to analyze mutations across multiple drug-resistance types. The proposed framework predicts drug-resistance mutations across four drug-resistance types, including Rifampicin Resistance, Isoniazid Resistance, Multidrug Resistance, and Pre-extensively Drug-Resistant tuberculosis. The NIAID-NIH TB portal is a publicly available dataset of tuberculosis patients, including drug-resistance information. Our study analyzed 3,065 cases of drug-resistant TB. Eight supervised ML algorithms were implemented for the study. A Random Forest classifier with 10-fold cross-validation shows higher predictive performance than the other seven algorithms considered for further analysis. Significant drug resistance mutations were identified using SHapley Additive exPlanations feature importance. The World Health Organisation mutation catalogues, considered the gold standard for drug-resistant mutations, were used to evaluate prediction results. Mutations not reported in the WHO catalogues were identified during the post-prediction comparative analysis stage, as they may represent potential resistance-conferring markers warranting further investigation, including structural and functional validation or experimental validation. The mutations are rpoB-I480T, rpoC-G332R, L527V, gyrA-D94V, KatG-G99E, A106V, W191R, W328C, T380I, and M420T. The study further checks the stability and pathogenicity of the mutations using computational tools, including I-Mutant 2.0 and PredictSNP. The findings added more clarity and further evidence for the significance of the mutation, based on its contribution to drug resistance.
11 July 2026
Read appraisal →Cell host & microbe
Predicting antimicrobial resistance for precision medicine
Antibiotics are among medicine's greatest successes, but resistance evolution threatens their continued efficacy. Decades of research have deepened our understanding of the mechanisms and evolutionary dynamics of antimicrobial resistance. More recently, advances in machine learning (ML) and artificial intelligence (AI) show promise in predicting antimicrobial resistance in pathogens based on rapid whole-genome sequencing and other accessible data. In this perspective, we highlight advances in understanding the mechanisms and spread of antimicrobial resistance. We discuss how this knowledge, coupled with ML- and AI-based approaches, can inform the prediction of resistance and a precision-medicine strategy that targets pathogenic bacteria specifically, thereby limiting resistance evolution and collateral damage to the microbiome. These accurate predictions of bacterial vulnerabilities will enable the adaptation of classical antimicrobial treatments with adjuvants, as well as the use of novel, narrow-spectrum therapeutics. Implementing these strategies, while also identifying key challenges, will help bring this strategy into clinical practice.
10 July 2026
Read appraisal →Briefings in bioinformatics
Literature-informed gene extraction and ranking for multimodal data fusion.
Published biomedical experiments provide an increasingly rich collection of results and identify genes potentially involved in diverse biological mechanisms. However, individual studies are often confined to narrow experimental contexts and are restricted to single omics layers. Cross-study knowledge aggregation can broaden this perspective and enable the construction of global, context-aware gene rankings. Recent developments in natural language processing have made large-scale literature mining increasingly feasible. This enables the systematic extraction and fusion of symbolic knowledge from published experiments. We present pathXcite, a software that extracts genes associated with specific contexts, such as diseases or biological mechanisms from the literature, and ranks them by contextual relevance. These relevance-based gene rankings can compress a scientific context into a symbolic representation. This representation enables diverse downstream analyses, including cross-context comparisons, network-based analysis, enrichment analysis, and integration with experimental omics data. In multiple use cases, we show how our extraction and fusion strategy can be applied to uncover hidden aspects in biological data.
6 July 2026
Read appraisal →Briefings in bioinformatics
EssTFNet: integration of adaptive time-frequency and DNA language models for interpretable human essential gene prediction
Essential genes are defined as indispensable for an organism's survival. The loss of function of these genes results in cell death or an inability to complete the normal life cycle. Research on essential genes is pivotal in elucidating the origin and evolution of life, as well as in identifying potential therapeutic targets. Therefore, predicting essential genes is of great scientific importance and has many applications in basic research and the biomedical field. In this study, we propose EssTFNet, a novel, interpretable deep learning framework that combines adaptive time-frequency analysis with a DNA language model to achieve accurate prediction of human essential genes while enabling mechanistic biological interpretation. EssTFNet leverages the architecture of ATFNet, which maps DNA and protein sequences into equivalent time-series signals to extract periodic and nonstationary features, enhancing the model's capacity to capture complex sequence patterns. Through feature selection and architectural optimization, EssTFNet achieves a favorable balance among prediction accuracy, model interpretability, and cross-tissue generalization. On the S1 benchmark task, EssTFNet outperformed mainstream sequence-based deep learning methods, achieving an area under the curve of 0.9679 and an area under the precision-recall curve of 0.8491. Additionally, the DeepLIFT attribution method was employed to identify functional motifs associated with gene essentiality, offering valuable insights for experimental validation. For the convenience of researchers, we have developed an easy-to-use web server and made it along with the source code in a GitHub repository: https://github.com/QIANJINYDX/EssTFNet. Overall, this study presents a potentially useful methodological framework for human essential genes prediction, which could provide valuable insights for future research and applications in this field.
5 July 2026
Read appraisal →Journal of advanced research
scMapNet: Marker-based cell type annotation of scRNA-seq data via vision transfer learning with tabular-to-image transformations
INTRODUCTION: Identifying cell types is a key step in single-cell RNA sequencing data analysis that aids in understanding cellular heterogeneity and facilitates downstream analyses such as those concerning cell-cell interactions and data integration. Cell-type annotation methods often rely on unsupervised clustering algorithms, followed by manual or automatic annotation via marker genes, which are prone to inefficiency and inconsistency. Supervised methods, while more automated and consistent, have gained remarkable attention because of the rapid growth of large-scale, high-quality single-cell datasets. However, these methods cannot effectively leverage cellular marker knowledge and much unlabelled data. OBJECTIVES: This study aims to introduce a novel deep learning method, scMapNet, which can sufficiently learn cellular marker knowledge and information from unlabelled data. METHODS: scMapNet is a self-supervised deep learning model based on masked autoencoders (MAE) and vision transformer (ViT), which adopts treemap transformations to leverage cell marker information and capture information by pretraining on large amounts of unlabelled data. RESULTS: scMapNet outperforms six competing methods across diverse datasets, excelling in accuracy and batch insensitivity. Moreover, scMapNet can effectively extract attention gene information, providing strong support for cell type identification. The models and codes are available at https://github.com/Yuz7/scMapNet. CONCLUSION: scMapNet shows significant performance in annotation accuracy and batch insensitivity. Besides, this method also has good interpretability and can provide biological insights for researchers.
3 July 2026
Read appraisal →BioEssays : news and reviews in molecular, cellular and developmental biology
AI in Genomics: From Variant Calling to Multi-Omics Integration
Artificial intelligence (AI) strategies are revolutionizing genomics by extracting complex patterns that traditional statistical pipelines are likely to miss. This mini-review aims to provide a concise overview of how AI is transforming major genomic technologies including variant calling, gene expression analysis, single-cell transcriptomics, CRISPR-Cas9 optimization, and multi-omics integration. In genome sequencing, machine learning variant callers greatly improve the accuracy and the rate at which single nucleotide and structural variants are called. In bulk RNA-Seq, AI augmented quantification, denoising, and differential expression modules complement the highly established STAR-featureCounts-DESeq2 pipeline, revealing subtle signals in big data sets. In single cell transcriptomics, deep learning approaches enhance batch correction, automate cell type annotation, and track developmental trajectories, hence clarifying cellular heterogeneity. AI-assisted guide RNA design, outcome prediction, and nuclease engineering enable more efficient CRISPR-Cas9 editing, reducing experimental cycles, and off-target effects. Finally, integrated platforms that combine genomic, transcriptomic, epigenomic, proteomic, and metabolomic layers provide an integrative view of cellular regulation and disease mechanisms. The review also covers current limitations, sparsity of data, model bias, privacy, and the need for standardized benchmarks and offers future directions in the form of interpretable models, collaborative learning, and open science practices. Together, these developments render AI an indispensable partner to unravel genomic complexity and accelerate precision medicine applications.
3 July 2026
Read appraisal →Open biology
Deep learning in tumour genomics: from multi-omics integration to precision oncology
Cancer remains a leading cause of death globally, with nearly 10 million deaths in 2020. Advances in genomic technologies have revolutionized cancer research, shifting focus towards precision medicine based on comprehensive tumour genomic profiling. Concurrently, deep learning (DL) has emerged as a powerful paradigm for complex biological data. This review critically assesses recent advances in DL applications for tumour genomics, emphasizing four key domains: DNA sequencing analysis for mutation detection, gene expression profiling for cancer subtype classification, methylation function prediction for epigenetic characterization and integrative multi-omics approaches for comprehensive tumour profiling. We systematically analyse how different DL architectures-including convolutional neural networks, recurrent neural networks, graph neural networks, autoencoders and transformers-address specific challenges in cancer genomics. Our review highlights how these approaches significantly enhance detection sensitivity for genomic alterations, improve cancer subtype stratification, identify novel biomarkers and optimize therapeutic target selection. We examine technical challenges in DL implementation, including model interpretability, data scarcity, computational requirements and integration issues, alongside emerging solutions such as explainable AI, federated learning, and multi-modal frameworks. By synthesizing methodological innovations and identifying research directions, this review provides bioinformaticians and cancer researchers with a roadmap for leveraging DL to advance precision oncology.
2 July 2026
Read appraisal →The pharmacogenomics journal
Development and validation of an open data model for pharmacogenetics to enable semantic interoperability in clinical practice
Pharmacogenetics uses genetic testing to improve the safety and effectiveness of prescribed medicines, yet implementation at scale remains limited due to the absence of interoperable health IT solutions that integrate results into prescribing workflows. This study aimed to develop and validate open data standards for pharmacogenetic results to enable interoperability across healthcare systems. A baseline data model was constructed using the open standard openEHR by synthesising literature, genomic sequencing outputs, and international data specifications, and refined through iterative workshops with the Global Alliance for Genomics and Health. The model underwent two rounds of structured peer review involving 24 experts from 10 countries. Mapping to HL7 FHIR was evaluated using both manual and automated approaches, including the FHIR-Connect tool. The resulting standardised pharmacogenetic data model separates test results from therapeutic implications and incorporates recognised terminologies such as SNOMED CT and HGNC. It achieved international consensus and is published on the openEHR Clinical Knowledge Manager platform. Mapping to HL7 FHIR demonstrated bidirectional information flow within healthcare systems, with automated mapping enabling scalable and reusable transformations. This work provides a framework for storing and exchanging pharmacogenetic test results, supporting semantic harmonisation, interoperability, and integration with clinical decision support systems. Open data standards for pharmacogenetic test results therefore offer a foundation for scalable implementation of pharmacogenetics in routine clinical practice.
14 June 2026
Read appraisal →Renal failure
Unveiling the role of air pollution in diabetic kidney disease: an integrated study combining network toxicology, machine learning, and Mendelian randomization
Diabetic kidney disease (DKD) is a major and severe complication associated with diabetes. Air pollution is not only an independent risk factor for metabolic disorders but also an "accelerator" of DKD progression. This study seeks to investigate the molecular pathways connecting air pollution to DKD. Multiple databases were integrated to obtain potential target genes of 10 common air pollutants. The gene expression omnibus (GEO) database was employed to acquire DKD datasets. Differential expression analysis and weighted correlation network analysis (WGCNA) were performed to identify DKD-related genes. 12 machine learning algorithms were utilized to generate 113 unique predictive models, which were employed to select hub genes. Subsequently, MR, single-cell, gene set enrichment analysis (GSEA), and immune infiltration analyses were performed, followed by molecular docking of hub genes with air pollutants. A total of 714 targets were identified from 10 air pollutants, and 80 potential targets were identified from DKD transcriptomic data. Machine learning methods identified 5 hub genes that are closely associated with DKD. Mendelian randomization (MR) analysis indicated that, among the five hub genes, only NOS3 demonstrated a statistically significant causal association with DKD. Immune infiltration analysis found that hub genes were closely related to immune cells. Molecular docking validation indicated that certain air pollutants can stably bind with hub genes such as NOS3 and PTGS2. Air pollutants may be linked to alterations in various biological processes, potentially involving key genes such as ADH5, CASP3, NOS3, PTGS2, and SDHB, including potential metabolic reprogramming, inflammatory processes, and immune microenvironment changes.
26 May 2026
Read appraisal →The Journal of clinical endocrinology and metabolism
Predicting incident type 2 diabetes using wearable activity and polygenic risk: A survival-modeling study in All of Us
BACKGROUND: Evidence is limited on whether daily step counts are uniform across individuals or whether combining them with genetic risk improves prediction of type 2 diabetes (T2D), both essential for precision prevention. We aimed to assess whether objectively measured daily step count and Polygenic Risk Score (PRS) predict the incidence of T2D, and to evaluate the predictive performance of machine-learning models. METHODS: We conducted a prospective cohort study of 4589 adults in the National Institutes of Health's All of Us Research Program with valid Fitbit step data and whole-genome-derived PRS, excluding individuals with T2D before or within a 180-day lead-in period. Incident T2D was defined by HbA1c ≥ 6.5%, plasma glucose ≥126 mg/dL, or an All of Us T2D condition record. We evaluated Cox and machine-learning survival models. FINDINGS: Over a median of 2.92 years (15 340 person-years), 265 participants developed T2D (5.77% cumulative incidence; 17.27 per 1000 person-years). Risk-reducing thresholds were ∼7000 steps/day (P < .001) but differed by PRS group (∼7800 high vs ∼5800 low; P < .001). Each additional 1000 steps/day was associated with lower T2D risk (adjusted hazards ratio, 0.83; 95% CI, 0.79-0.88; P < .005), whereas each 1-SD higher PRS was associated with higher T2D risk (adjusted hazards ratio, 2.62; 2.32-2.96; P < .005). Adding steps to a clinical model increased the C-index from 0.748 to 0.774; adding PRS increased it to 0.867. Penalized Cox achieved the highest discrimination (C-index 0.859), followed by survival support vector machine (0.85) and classical Cox (0.846). Calibration was best with Random Survival Forests. INTERPRETATION: Step-count thresholds for reducing T2D risk varied across genetic risk groups, indicating that step counts do not confer uniform protection. Step counts and PRS provided independent, complementary predictive information, and their combination improved prediction of incident T2D.
20 May 2026
Read appraisal →Blood
Evolution of tumor subclones and T-cell dynamics underlie variable ibrutinib responses in Waldenström macroglobulinemia
To elucidate the molecular basis underlying differential responses and resistance to ibrutinib in Waldenström macroglobulinemia (WM), we conducted a prospective phase 2 trial of ibrutinib monotherapy in treatment-naïve patients. A total of 74 sequential bone marrow (BM) aspirates from 17 patients, collected from baseline through 48 treatment cycles, were profiled using single-cell multiomics. BM cells were segregated primarily into B-cell/plasma cell and T-cell compartments. Longitudinal clonal tracking of malignant B cells/plasma cells identified 3 distinct evolutionary patterns: evolution (early clone contraction with late clone expansion and increasing genomic complexity), devolution (early clone expansion with late clone contraction and genomic simplification), and no evolution (stable clonal architecture). The evolution pattern was strongly associated with disease progression, whereas devolution correlated with durable clinical response. Transcriptomic profiling of resistant clones enabled development and validation of the Waldenström ibrutinib prediction (WIP) score, which predicted treatment response at baseline. Within the WIP signature, LYN emerged as a key regulator; LYN knockdown or inhibition significantly increased WM cell sensitivity to ibrutinib, suggesting a rational combination strategy. In parallel, GZMB+ CD8+ effector-memory T cells expanded after treatment in patients with progressive disease and coexisted with tumor evolution. These cells exhibited persistently impaired cytotoxic programs (eg, GNLY), a dedifferentiated memory-like state, elevated PDCD1 expression, and reduced T-cell receptor diversity. Together, this study provides, to our knowledge, the first single-cell framework of tumor clonal evolution and T-cell dysfunction under ibrutinib in WM, introduces the WIP score as a predictive biomarker for treatment response, and identifies actionable tumor-intrinsic and immune mechanisms driving resistance. This trial was registered at www.ClinicalTrials.gov as NCT02604511.
16 May 2026
Read appraisal →Epigenetics
The role of R-loops-mediated epigenetic regulation in genome stability maintenance and disease pathogenesis: a systematic review.
This systematic review synthesizes current evidence linking R-loops - associated processes with epigenetic regulation, genome stability, and human disease, integrating findings across DNA/RNA/protein modifications and 3D genome organization, and highlighting key mechanistic and technical gaps relevant to future studies, including longer-term translational exploration. Following PRISMA guidelines (Registration No.: INPLASY202560055), PubMed and ScienceDirect databases were searched through 18 January 2026. Two independent reviewers conducted blinded screening via the Rayyan platform. From 1290 initial articles, 71 studies met inclusion criteria. Methodological rigour was assessed using a modified SYRCLE risk-of-bias tool. Thematic synthesis identifies R-loops as recurrent intermediates linking transcription, chromatin regulation, and genome maintenance; feedback-like relationships are reported in selected systems. They spatially impede DNMTs to sustain promoter hypomethylation while recruiting TET enzymes for demethylation, and RNA modifications (e.g. m5C/m6A) may tune hybrid stability and, in some contexts, influence effector recruitment. R-loops facilitate the recruitment of histone-modifying complexes (PRC1/PRC2, G9a/GLP), thereby influencing chromatin landscapes and 3D genome architecture - including associations with TAD boundary insulation and with LLPS-related repair compartments in specific contexts. Dysregulation of R-loop homeostasis links to disease-related epigenetic alterations and genome instability with distinct disease-, locus- and cell-state specificity, and its context-dependent roles in diverse disorders involve transcriptional silencing, DNA damage, replication-transcription conflicts, repair pathways, chromatin regulation and mitochondrial genome maintenance. Integrating DRIP-seq with epigenomic profiling and functional tests supports mapping of context-specific relationships.
14 Apr 2026
Read appraisal →Neuroscience
Limitations and opportunities in multi-omics integration for neurodevelopmental, neurodegenerative and psychiatric disorders: A systematic review
Recent advances in high-throughput technologies have led to an increased generation of biological data across genomics, transcriptomics, proteomics, epigenomics, and metabolomics. However, a major challenge remains: effectively integrating these multi-omics datasets to allow a more holistic understanding of the complex, interconnected mechanisms underlying human diseases. Neurodevelopmental, neurodegenerative, and psychiatric disorders are particularly multifactorial and heterogeneous, making them candidates for multi-omics approaches. In this context, this systematic review assesses the current state of multi-omics integration in neurological research. Records retrieved from five major databases were processed, and 156 studies were included for further analysis. The most frequently studied conditions were Alzheimer's Disease, Depressive Disorder and Parkinson's Disease, with epigenomics-transcriptomics and metagenomics-metabolomics emerging as the most common omics pairings. The field remains dominated by studies integrating pairs of omics layers. Only a limited number of computational tools are currently being applied to the integration of more than two omics layers, highlighting a gap in comprehensive multi-omics modeling. Despite progress, key challenges persist, including data accessibility and the need for standardized frameworks to allow cross-study comparisons. Moreover, most computational findings lack experimental validation in wet-laboratory settings. Future research should address these challenges, develop scalable algorithms for integrating multi-omics data, and leverage large, open-access datasets. Integrating computational predictions with experimental validation could help researchers prioritize high-confidence biomarkers relevant to clinical applications. Collaborative efforts among bioinformaticians, clinicians, and experimentalists will be essential to translating these advances into clinically actionable solutions.
6 Apr 2026
Read appraisal →American journal of human genetics
The Electronic Medical Records and Genomics study: Design and analytic framework for assessing the impact of genome-informed risk assessments.
The Electronic Medical Records and Genomics (eMERGE) Network developed and implemented a genome-informed risk assessment (GIRA) to communicate genomic (polygenic risk scores [PRSs], integrated risk scores [IRSs], and monogenic results), clinical, and family history-based risk for 11 chronic diseases and provide recommended healthcare recommendations. GIRA reports have now been returned to 23,840 participants and their providers in a large prospective cohort study. We present here the study design and analysis framework for assessing the attributable impact of GIRA return. Pre-specified outcomes include (1) provider/participant adoption of recommended healthcare actions, (2) new diagnosis of disease, (3) treatment initiation/intensification, and (4) clinical outcomes (surrogate markers or clinical events). We assess outcomes in high risk vs. not-high-risk participants, adjusting for covariates. We evaluate the effect of PRS/IRS at pre-established high-risk thresholds using regression discontinuity (RD), a quasi-experimental method that mimics randomization near a cutoff, enabling estimation of causal effects and controlling for unobserved confounders. Monogenic and family history-based risk stratification are analyzed using logistic regression. With 23,840 participants and 12 months of follow-up, the study is powered to detect differences of 2%-11% with 80% power (α = 0.05 in the adoption outcome). Longer follow-up will be required to enable assessment of new disease diagnosis, treatment changes, and clinical outcomes. Through innovative RD analyses and defined outcomes and comparison groups, this study will provide new insights into the real-world clinical impact of genomic risk assessment, address critical evidence gaps, advance understanding of genomic medicine outcomes, and inform future research.
5 Apr 2026
Read appraisal →Clinical genetics
Clinical Feasibility of Long-Read WGS for DNA Methylation Signature Analysis
DNA methylation (DNAm) signatures have emerged as valuable diagnostic biomarkers for rare genetic disorders. To date, the most widely used approach for establishing and validating these signatures has relied on array-based technologies. However, in clinical diagnostics, there is a growing shift from short-read sequencing (SRS) toward long-read sequencing (LRS) technologies. Recent advances in platforms such as Pacific Biosciences (PacBio) and Oxford Nanopore Technologies (ONT) enable direct assessment of DNAm from native DNA, offering improved resolution and reduced technical bias compared to array-based technologies. In this study, we compared DNAm profiles generated by LRS with those obtained from DNAm arrays. DNAm profiles of two individuals with pathogenic KMT2D variants were analyzed using DNAm arrays, LRS using PacBio and ONT, and ONT multiplexed sequencing with adaptive sampling. A support vector machine (SVM) classifier trained on array data, as well as the public classification platform EpigenCentral, yielded correct predictions for all LRS samples, underscoring the potential of LRS platforms in DNAm-based diagnostics. Our results suggest that DNAm profiles generated by LRS align well with DNAm signatures established using DNAm arrays, supporting their feasibility in clinical and research applications with the added benefit of simultaneous methylation and sequence analysis.
4 Apr 2026
Read appraisal →Int J Surg
Multi-omics dissection of high TWAS-active endothelial pathogenesis in pulmonary arterial hypertension: bridging single-cell heterogeneity, machine learning-driven biomarkers, and developmental reprogramming
BACKGROUND: Pulmonary Arterial Hypertension (PAH) is a leading cause of cardiovascular-related mortality worldwide. The emergence of single-cell RNA sequencing (scRNA-seq) has enhanced the ability to dissect cellular heterogeneity in PAH at a granular level. Transcriptome-wide association studies (TWAS) leverage expression quantitative trait loci (eQTL) and genome-wide association study (GWAS) data to identify novel susceptibility genes whose genetically predicted expression correlates with disease risk. However, no study has systematically integrated TWAS with scRNA-seq to unravel the pathogenesis of PAH at single-cell resolution. METHODS: Using TWAS analysis, we identified a set of candidate genes genetically associated with PAH. We then evaluated the differential activity of these genes across PAH cell types at single-cell resolution using AUCell, Ucell, ssGSEA (Single Sample Gene Set Enrichment Analysis), and AddModuleScore algorithms. A subset of endothelial cells exhibiting elevated TWAS activity was identified via quartile-based stratification and designated as the high TWAS activity state (HTS) group. Multi-dimensional analyses, including observed-to-expected ratio (RO/E), CellChat, CytoTRACE (CytoTRACE is based on the robust observation that transcriptional diversity decreases during cell differentiation), and scMetabolism, were employed to characterize the functional and communicative properties of HTS cells. Machine learning algorithms were integrated to identify signature genes of the HTS subpopulation, and a benchmarked random forest model was trained to predict HTS status. We performed immunohistochemistry and quantitative reverse transcription- polymerase chain reaction (qRT-PCR) validation of the signature genes (KLF2, RASIP1 and DEPP1) in PAH and control lung tissues to support their expression patterns. RESULTS: We demonstrated that HTS endothelial cells are strongly associated with PAH pathogenesis, exhibiting significant tissue tropism, enhanced roles in intercellular communication, and a progenitor-like function in endothelial differentiation. Machine learning-based feature selection revealed three robust signature genes: KLF2, RASIP1, and DEPP1. These genes demonstrated exceptional predictive power for identifying HTS cells, suggesting their potential as drivers of endothelial dysfunction in PAH. The random forest model, benchmarked against multiple algorithms, achieved high accuracy in predicting PAH progression using these genes. Immunohistochemical analysis of pulmonary artery and qRT-PCR result of lung tissues addressed the elevated expression of KLF2, RASIP1 and DEPP1 in arterial wall post-PAH. CONCLUSION: This study elucidates endothelial cell heterogeneity in PAH and establishes the central role of HTS cells in disease progression, cellular crosstalk, and developmental reprogramming. Our findings bridge the gap between GWAS and scRNA-seq methodologies and provide a transformative framework for understanding PAH mechanisms.
1 Feb 2026
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