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ASGCT President Terry Flotte Touts Rare Disease Initiatives as His Term Ends

President of the American Society of Gene and Cell Therapy (ASGCT), Terry Flotte, MD, is excited to host this year’s conference in his own backyard. It will be a short drive east on the Mass Turnpike from his office at UMass Chan Medical School in Worcester to the Menino Convention and Exhibition Center in Boston’s Seaport district. Flotte is hopeful that the 2026 conference will draw the largest attendance in the meeting’s history. His tenure as president ends this week on the last day of the conference, May 15.

In the run-up to this year’s conference, GEN spoke with Flotte, who is also Editor in Chief of GEN’s sister journal Human Gene Therapy, about the central themes and most anticipated sessions at this year’s conference. “I have a full dance card, let me tell you,” Flotte joked. The conference will highlight several themes of Flotte’s productive tenure.

 

(This interview has been edited for length and clarity.)

 

GEN: Terry, what’s the theme of this year’s ASGCT conference?

Terry Flotte: We’re working very hard on access for rare and ultra-rare conditions and have been for some time. You’ll see that in the presidential symposium. This is in the context of our mission to improve access to rare disease cell and gene therapy (CGT). This is the guiding principle of our strategic plan: we want to work for universal access to CGT. There are two orthogonal axes to this: I’m focusing on rare and ultra-rare diseases. ASGCT is going to continue to work in parallel on universal access in a more global context.

We have created a first-of-its-kind exchange for shelved CGTs. An increasing number of CGTs for rare and ultra-rare diseases are being discontinued or deprioritized after they reach the clinical stage—not because they lack clinical efficacy but because they lack market viability. We have partnered with Orphan Therapeutics Accelerator to create a new entity called CGTxchange. This collaborative venture is meeting the need of these promising clinical-stage CGTs that are not progressing. This entity will be an AI-enabled digital platform that will list the available clinical-stage CGT programs and generate AI-enhanced profiles, digest the data, score them for their level of advancement and the robustness of their responses, and essentially shorten the due diligence that investors normally have to do, enabling the connections to work faster.

I estimate there’s at least 50-100 of these programs. We had our own personal experience with Sio Gene Therapies [formerly Axovant] on both GM1 and GM2 gangliosidosis. This is part of a broader set of initiatives. Over the past few years, we created a taskforce in response to this increasing rate of discontinuation of these therapies. The two main outgrowths that the ASGCT board has endorsed are to create a consortium of CGT developers that might be able to offer non-profits less expensive manufacturing in a limited way but also work toward a drug master file sharing data for those who benefit from the less expensive vectors—in addition to the clearinghouse I just mentioned.

 

 

GEN: What else is new this year?

Flotte: A new thing for ASGCT is we’re having a patient advocate presenting. Terry Pirovolakis pioneered the CGT therapy for spastic paraplegia type 50 (SPG50) by developing his own company, Elpida Therapeutics, which has taken SPG50 to the clinic and now is doing that for other rare and ultra-rare diseases.

The second example is from Claire Booth, MBBS, PhD, (Great Ormond Street Children’s Hospital, London). Her team has received market authorization to be the

pseudo-commercial manufacturer of a fully licensed therapeutic for different forms of SCID.

Those are two direct examples of alternatives to get things to the clinic, other than getting a new commercial sponsor. [Hopefully] we can end up getting more of those picked up, whether through the CGTxchange or direct outreach. We’re also going to honor Timothy Yu, MD, PhD, with the Jerry Mendell Translational Research Award. He will be talking about the N=1 Collaborative with the parallel effort with oligonucleotide therapeutics. There is a purposeful theme to this meeting, aiming to make a big change in how things can get to the clinic and stay in the clinic.

 

GEN: Last year in New Orleans, the conference was dominated by the Baby KJ story. Will anything stand out in the same way this year?

Flotte: We are honoring the three primary authors of the Baby KJ story—Kiran Musunuru, MD, PhD, Rebecca Ahrens-Niklas, MD, PhD, and Fyodor Urnov, PhD.

I have also selected the work of Lindsey George, MD (Children’s Hospital of Philadelphia) as a presidential abstract. She is going to present the first case of an AAV-induced tumor—or at least an aggressive and autonomously growing malignancy…. This occurred in an MPS1 patient who received a high dose of AAV into the ventricles. It is not exactly a meningioma, but it’s arising from the neuroepithelial cells lining the ventricles. The tumor has AAV integrated with a strong promoter immediately upstream of a known oncogene. I put that into the presidential lecture, even though it’s not good news—but I’m not a [gene therapy] campaign manager here! I think this is a significant finding that we’ll have to pay attention to.

Lindsey is not saying that nobody should ever do this again. She’s going to point out aspects of this that were very manageable and how this patient overall has a dramatically better outcome than they would have without the therapy. In a way, [this is] somewhat like when those leukemia cases developed in Europe in the early SCID [gene therapy] trials. It is in a way parallel to that.

 

GEN: This will be your last conference as president of ASGCT!

Flotte: Yes, it ends on May 15th! We only get to be president for one year. I started the Rare Disease Task Force as vice president. This was my cause over the past three years [as an officer]. I’m very pleased we were able to stand this up.

We have an actual corporation, a joint venture, 50% owned by ASGCT. We set up this manufacturing consortium. Somewhat related, we set up our own charitable foundation, the ASGCT Foundation. We will have our first event—a gala at the conference. It will have a lot of time to grow. The foundation has just been incorporated as a subsidiary not-for-profit.

 

GEN: How do you view things at FDA currently?

Flotte: We will have a fireside chat with the new director of CBER, Katherine Szarama, PhD. We are very encouraged—she’s a very highly trained professional. We love that FDA is paying a lot of attention to rare diseases, but we need some scientific and evidence-based guidelines on how to do this consistently. We’re looking to someone who has regulatory experience.

 

GEN: What else has got you and your colleagues in the gene therapy space excited of late?

Flotte: I’m hoping we’re going to better understand high-dose AAV toxicity… I think what we’ve got is several different syndromes, but many of them may have a common link… We’ve been seeing with high-dose AAV a very broad distribution, but the doses are incredibly high and there have been deaths—the DMD patient deaths that occurred in the first two weeks are the best-known examples, but there have been other ones.

In my lab, we’re trying to figure out the primary pathogenesis. We have found a number of situations with unexpected vector expression in the endothelial cells and then seeing vascular leakage into some of these tissues causing tissue injury. So, in the post-mortem analysis we helped on, we saw high expression in the lungs and alveolar capillaries. They had diffuse leakage into the capillaries leading to a syndrome known as acute respiratory distress syndrome (ARDS). But in some of the others where they’re seeing some complement activation, we think that small vessel injury could be a convergent pathway. Now, where does this come into play in the broader sense?

One of the holy grails of recent AAV gene therapy is to design an AAV capsule that efficiently crosses the blood-brain barrier. Many diseases that are appropriate for AAV are diseases of the central nervous system (CNS). You can think of, for instance, the easiest cells to access in the CNS are the spinal motor neurons, hence the SMA1 treatment, Zolgensma. So, if you treat an SMA newborn, that is essentially solved or at least adequately solved. But in none of the diseases that affect the brain have we seen an IV gene therapy that is robustly efficacious—just giving an AAV at a high enough dose to get across the blood-brain barrier. Many different companies are trying to develop AAV capsids that will penetrate the blood-brain barrier, the first one that got to clinic was a vector designed by Capsida Biotherapeutics. But the first patient treated on the Capsida trial developed cerebral edema and died.

One of the important challenges for the field is to understand if we can separate a blood-brain barrier penetration from endothelial cell toxicity, because you could think perhaps a vector designed to get through the blood-brain barrier could cause injury as it crosses to the endothelial cells in the brain. I think there may be ways around this, but to me this is a central issue because the CNS is affected in so many single-gene disorders. The parents see a child who has a disability or degenerating, as in Tay-Sachs, and they want to be able to do an IV therapy. They don’t want to have to have a direct brain injection or some other invasive intervention. So that’s what I’m looking for at ASGCT 2026.

 

 

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Synthesizing a Natural Sunscreen and Antioxidant in E. coli

Researchers at Jiangnan University have engineered microbial “cell factories” to sustainably produce the UV-protective compound gadusol, a compound that could eventually serve as a sunscreen ingredient and an antioxidant additive.

Found in the eggs of various fish and other marine organisms, gadusol helps protect against ultraviolet damage. However, “it is scarce in nature, and extracting it is inefficient and can carry environmental costs,” said research lead Ping Zhang, PhD. “We want to find a scalable and greener way to produce gadusol.” Previous efforts to acquire gadusol have relied mainly on extraction from fish eggs or tissues at specific developmental timepoints. For their reported study, rather than harvest the molecule from nature, the team turned microbes into mini chemical factories, increasing yield more than 90 times.

The researchers reported on their developments in Trends in Biotechnology, in a paper titled “Multidimensionally engineered Escherichia coli for efficient gadusol biosynthesis with high-throughput quantitative analysis, in which concluded “This work provides valuable insights into gadusol biosynthesis and establishes a solid basis for future investigations into the feasibility of its industrial applications.”

How do fish survive sunlight in the open waters without getting burned? They make their own natural sunscreen. Gadusol is “a naturally occurring cyclohexenone compound that has attracted significant attention due to its potent UV-absorbing properties and broad biological functionalities,” the authors wrote. “Gadusol, as a cyclohexenone compound with potent antioxidant and biological properties, has shown significant potential for applications in pharmaceuticals, cosmetics, and nutraceuticals.”

The compound has been identified in the eggs of various fish species, including zebrafish, salmon, and sturgeon, as well as in coral reef ecosystems, where it shields marine embryos and coral from UV radiation. Moreover, the researchers explained, “Beyond its photoprotective role, gadusol also demonstrates pronounced antioxidant activity, with extracts from fish eggs exhibiting free radical scavenging capacity comparable to that of ascorbic acid under physiological pH and even superior chain-breaking activity against peroxyl radicals.”

However, the team pointed out, extracting gadusol from fish eggs is labor intensive and costly, and results in low yields.  For their newly reported study the team rebuilt a zebrafish’s pathway for making gadusol inside the bacterium Escherichia coli, then tweaked the microbes’ genetics and growing conditions. “In this study, we constructed the gadusol biosynthetic pathway in E. coli and established an integrated engineering strategy to enable its efficient production,” they noted.

These modifications increased gadusol yield by nearly 93 times, from 45.2 milligrams per liter to 4.2 grams per liter. The compound’s antioxidant property inspired a useful shortcut, in the form of a color-based screening test. In the test, a purple chemical signal turns yellow when gadusol neutralizes free radicals. This color shift allows researchers to quickly identify bacterial strains that produce more of the compound. “Compared with traditional chemical analysis, this approach is more convenient, efficient, and economical,” said senior author Ruirui Xu,” PhD.  “In addition, an efficient downstream process for gadusol extraction and purification was established, strengthening the translational potential of this platform,” the authors noted.

Producing gadusol through a microbial cell factory for sun protection. [Science Center for Future Foods, Jiangnan University]
Producing gadusol through a microbial cell factory for sun protection. [Science Center for Future Foods, Jiangnan University]

The lab-made compound showed promise in preliminary UV-protection tests. “Achieving this level of production in the lab is very promising,” says Zhang. “It suggests that we may be able to meet future demand for natural sunscreen ingredients through microbial production.” The compound may offer more than just sun protection. In experiments, gadusol showed antioxidant activity comparable to that of vitamin C, suggesting it may help neutralize cell-damaging free radicals from UV exposure.

In their paper the authors suggested that “Beyond laboratory-scale optimization, this work demonstrates a practical and scalable route for manufacturing gadusol, a natural, nontoxic UV-protective, and antioxidant cyclohexenone.” The research comes amid growing interest in alternatives to some conventional sunscreen ingredients, which can irritate sensitive skin, harm marine organisms, or rely on petrochemicals. Gadusol’s combination of UV protection and antioxidant activity could make it an attractive ingredient for sunscreens and skin-care products. The team in addition pointed out, “By enabling sustainable microbial production independent of marine extraction, this strategy provides a renewable alternative to synthetic UV filters and antioxidants that may raise environmental or health concerns.”

But gadusol won’t make it into our beach bags just yet. The study did not compare gadusol head-to-head with commercial sunscreens, nor assess long-term safety or large-scale manufacturing. Regulatory approval would also be needed. Still, Xu believes that the research provides a starting point for moving gadusol toward practical applications. Based on current technology, he expects to start seeing some products appear on the market within two years.

“For small molecules with application potential, we hope people look beyond traditional extraction methods,” Zhang commented. “Microbial cell factories are emerging as a greener and more sustainable way to bring laboratory discoveries into real-world use.”

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Officials say $1.3 billion in Medicaid money to California will be deferred over suspicions of fraud

WASHINGTON — Vice President JD Vance on Wednesday announced new steps in the Trump administration’s initiative to root out fraud in federal health programs, including a $1.3 billion deferral in Medicaid reimbursements to California.

“These fraudulent health care providers are getting rich by giving people medications they don’t even need,” Vance said during an event at the White House, adding that taxpayers and program beneficiaries are victimized by such fraud.

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TNBC Ecotypes Reveal Molecular Signatures Tied to Chemotherapy Response

Researchers at The University of Texas MD Anderson Cancer Center have identified immune cell and tumor-specific features in triple-negative breast cancer (TNBC) that may help predict which patients are most likely to respond to chemotherapy before treatment begins, according to a study published in Nature. Using single-cell and spatial transcriptomic analyses of pretreatment tumor samples, the team identified specific macrophage subtypes and cancer-cell gene expression programs associated with response to neoadjuvant chemotherapy (NAC). The team also developed a 13-gene panel and a machine learning model that could help classify tumors according to their likelihood of responding to chemotherapy.

“This study provides novel insights into the gene-expression programs and the different cell states of the tumor microenvironment in patients with triple-negative breast cancer,” said Nicholas Navin, PhD, chair of systems biology at MD Anderson. “Importantly, we’ve identified certain programs and macrophage subtypes that are associated with good responses to neoadjuvant chemotherapy, which has tremendous potential to improve patient outcomes.”

TNBC accounts for between 10% and 20% of breast cancer cases. Because it lacks estrogen, progesterone, and HER2 receptors, treatment options are limited, resulting in a higher rate of recurrence compared with other form of breast cancer. Chemotherapy is the main treatment approach, particularly in early-stage disease, where neoadjuvant chemotherapy can achieve pathological complete response in 40% to 50% of patients. However, treatment outcomes vary widely from patient to patient, and researchers have been looking for ways that can better predict response before therapy begins.

For this study, the researchers analyzed pretreatment core biopsy samples from treatment-naive patients with early-stage TNBC. They performed single-cell RNA sequencing on 427,857 cells collected from 101 patients and spatial transcriptomic profiling on tumors from 44 patients. The findings also were compared with normal breast tissue data from the Human Breast Cell Atlas.

Based on their testing the researchers classified TNBC tumors into four patient-level “archetypes” based on cancer-cell gene expression patterns. They also identified 13 metaprograms that reflected heterogeneity within tumors at the single-cell level.

The tumor microenvironment consisted of 49 immune and stromal cell states organized into eight cellular communities, or ecotypes, defined by the co-occurrence of cancer cells and surrounding immune cell populations. Researchers found these cellular neighborhoods were associated both with tumor archetypes and chemotherapy response.

The study homed in on macrophages, a type of immune cell that has received less attention in TNBC research than T cells. The investigators said that seven of eight macrophage cell states were significantly associated with treatment response, while none of the 14 T-cell and natural killer-cell states showed significant associations with NAC response.

Macrophage subtypes linked to interferon signaling and complement activity, identified as Mac-IFN and Mac-lip-C1Q, were more abundant in patients who achieved pathological complete response. By comparison, two macrophages associated with angiogenesis and extracellular matrix remodeling, called Mac-angio and Mac-ECM, were enriched in patients with residual disease after chemotherapy.

The team also found that tumors linked to good response to NAC showed increased interferon signaling and elevated expression of human leukocyte antigen class II genes. Researchers said these findings indicate that cancer cells themselves may actively participate in modulating immune signaling related to chemotherapy response.

As part of their work, the researchers developed a 13-gene transcriptional signature panel developed from the single-cell analyses that can be used as a predictive model for chemotherapy response. Researchers said the model’s predictions correlated with chemotherapy response and overall survival across multiple public TNBC cohorts.

These new findings have the potential to influence how patients with TNBC are treated in the future by helping clinicians identify which patients are more likely to benefit from standard chemotherapy and which patients may need alternative therapeutic strategies earlier.

In addition, “these findings suggest that targeting specific macrophage subtypes could potentially provide new therapeutic opportunities in TNBC,” the researchers wrote.

The MD Anderson team noted that the study is one of the first large-scale single-cell genomic studies of TNBC integrating cancer cells, immune cells and treatment-response data. Earlier research exploring tumor heterogeneity has often lacked therapy response information, focused only on cancer cells or immune cells separately, or included relatively small patient cohorts.

Whether single-cell RNA seq could eventually become a basis for predictive diagnostics remains an open question. Today, the method is still expensive and technically challenging, two hindrances to it wider adoption. The researchers noted, however, that advances in sample multiplexing and other methods compatible with formalin-fixed paraffin-embedded tissue could make it feasible in the future.

Clinton Yam, MD, an associate professor of breast medical oncology at MD Anderson, said the findings could support more individualized approaches to TNBC care.

“These insights provide an important foundation for improving our understanding of why different TNBC tumors respond differently to chemotherapy, and the findings have strong potential to inform future strategies aimed at better predicting treatment response and guiding more individualized care for patients with triple-negative breast cancer.”

Future research will focus on validating the predictive models in prospective patient cohorts and evaluating TNBC treated with chemo-immunotherapy, which has become the standard of care when TNBC is detected early. The researchers also plan to study longitudinal tumor samples collected before, during, and after treatment to better understand how cancer cells and the tumor microenvironment evolve over time and how those changes relate to chemotherapy response and survival.

The post TNBC Ecotypes Reveal Molecular Signatures Tied to Chemotherapy Response appeared first on Inside Precision Medicine.

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Opinion: The hantavirus is a wake-up call. Will the Trump administration answer it?

Arriving in the isolation ward of a biocontainment hospital is an unsettling, scary experience. In 2014, I spent 19 days in one while being treated for Ebola, watching the news cycle churn around me as my world receded to a small window, a phone, and the handful of providers in protective suits who came into my room every day.

More than a dozen Americans are living some version of that right now in a Nebraska quarantine facility — passengers from the MV Hondius, the cruise ship that is at the center of a small but instructive outbreak of Andes hantavirus.

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Automatic Speech Recognition and Large Language Models for Multilingual Pathology Report Generation: Proof-of-Concept Study

Background: Accurate transcription of pathology gross examination dictation is important for clinical documentation, but multilingual dictation remains challenging in settings where clinicians mix Chinese and English while final pathology reports are written in English. Objective: This study aimed to evaluate whether a Whisper-based automatic speech recognition (ASR) pipeline guided by contextual system messages and combined with open-source large language models (LLMs; Qwen2:72b, Llama3.1:70b, Gemma2:27b) could improve multilingual (Chinese-English) pathology dictation transcription accuracy and generate clinically appropriate English gross description reports. Methods: We conducted a controlled proof-of-concept study using 125 simulated mixed Chinese-English pathology gross examination audio recordings created by physicians or pathologists. Audio recordings were transcribed using Whisper ASR with and without a contextual system message. The ASR transcripts were then converted into English gross description reports using 3 open-source LLMs: Qwen2:72b, Llama3.1:70b, and Gemma2:27b. Outcomes included character error rate, Bilingual Evaluation Understudy, Recall-Oriented Understudy for Gisting Evaluation (ROUGE)-1, ROUGE-2, ROUGE-L, Metric for Evaluation of Translation with Explicit Ordering, pathologist Win-Tie-Lose rankings, report-level error categories, inference time, and interrater agreement. Results: The ASR contextual system message reduced the mean character error rate from 0.344 (SD 0.176; 95% CI 0.313‐0.375) to 0.066 (SD 0.100; 95% CI 0.048‐0.084; <.001). Qwen2:72b achieved the highest automated metric scores, including a Bilingual Evaluation Understudy of 0.644 (SD 0.307), ROUGE-1 of 0.866 (SD 0.163), ROUGE-2 of 0.771 (SD 0.235), ROUGE-L of 0.842 (SD 0.178), and Metric for Evaluation of Translation with Explicit Ordering of 0.805 (SD 0.214). Pathologist-coded total error rates were 16.8% (21/125) for Qwen2:72b, 45.6% (57/125) for Llama3.1:70b, and 92.8% (116/125) for Gemma2:27b. The exact agreement between the 2 pathologists across full ranking categories was 76.8% (96/125; Cohen κ=0.668), and agreement on the top-ranked model or tied top group was 81.6% (102/125; Cohen κ=0.722). Conclusions: In this proof-of-concept evaluation, contextual prompting improved ASR transcription accuracy, and Qwen2:72b generated the most accurate English pathology reports among the evaluated LLMs. However, the study used simulated audio recordings, a local vocabulary prompt, and report-level rather than term-level clinical annotation. LLM-generated reports should therefore be considered draft documentation requiring pathologist verification, and prospective validation in real clinical workflows is needed before clinical deployment.
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ApexGO: AI-Driven Approach to Faster Antibiotic Discovery

Antibiotic resistance is on the rise around the world, creating an urgent need for faster and more dependable approaches to design antimicrobial candidates. While AI-driven methods have accelerated antimicrobial discovery, most have focused on screening fixed libraries or generating broad candidate sets.

Now, researchers at the University of Pennsylvania have developed ApexGO—a novel, AI-powered method that starts with a small number of candidates and improves them, using a predictive algorithm to evaluate each modification and guide the next.

“Antibiotic discovery is fundamentally a search problem across an enormous molecular space. ApexGO gives us a way to navigate that space with far more direction,” says César de la Fuente, PhD, presidential associate professor in the School of Engineering and Applied Science at UPenn.

This work is published Nature Machine Intelligence in the paper, “A generative artificial intelligence approach for peptide antibiotic optimization.”

“What is striking is that ApexGO’s predictions held up in the real world,” says Jacob R. Gardner, PhD, assistant professor in computer and information science (CIS) at UPenn. “ApexGO was optimizing against another computer model, so one concern was that it might find molecules that looked good to the model but failed in the lab. Instead, the majority of the molecules it designed actually worked.”

indeed, 85% of the AI-generated molecules halted bacterial growth, while 72% outperformed the peptides from which they were derived. In mice, two antimicrobial peptides created by ApexGO reduced bacterial counts at levels comparable to the antibiotic polymyxin B.

“This result points toward a future in which we can optimize molecules for a desired function in a fraction of the time,” adds de la Fuente, “using machines to guide discovery through chemical spaces too vast for humans to explore by trial and error.”

For years, the de la Fuente lab has looked for antibiotic candidates in unlikely places, from frog secretions to ancient microbes. Two years ago, the group released APEX, an AI model that predicts whether or not a given peptide is likely to have antimicrobial properties.

“APEX helped us find promising antibiotic candidates in enormous biological datasets,” says Marcelo Torres, PhD, research assistant professor of psychiatry in the Perelman School of Medicine. “ApexGO takes the next step: once we have a promising molecule, it helps us ask how to make it better.”

One part of ApexGO (short for APEX Generative Optimization) suggests molecular tweaks, while the previously published APEX model predicts whether those changes are likely to increase antimicrobial activity. ApexGO then uses those predictions to guide the next round of proposed edits.

While some of the molecules proposed by ApexGO showed promising antibiotic activity, the researchers emphasize that even the best-performing peptides are still early-stage candidates. Before any could be used to treat infections in humans, they would need to be further optimized for safety, stability, and how long they remain active in the body.

Still, the study suggests that AI can help researchers decide which molecules are worth making and testing in the first place. For de la Fuente, the approach could eventually extend beyond antibiotics. “In this case, we wanted to optimize peptides for antimicrobial activity,” he says. “But you could imagine applying the same idea to peptides with other biological functions, like modulating the immune system or targeting tumors.”

“ApexGO shows that AI can do more than predict which molecules might work: it can help us improve them,” adds de la Fuente. “At a time when antibiotic resistance is rising worldwide, we need technologies that help us move faster from an idea to a real therapeutic candidate. ApexGO is an important step toward that future.”

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I’m scared of everything — what does it mean and how do I get over it?

What you’re describing sounds really overwhelming. I’m glad you reached out. The fears you mention — being scared of doing something against your will, worrying you might not have control, and feeling intensely concerned about being judged — are patterns I often see in people with anxiety and, sometimes, people with obsessive-compulsive disorder (OCD). A hallmark of OCD is a deep doubt about control: the fear that you might act in a way that goes against your values, even though you don’t want to. These kinds of fears are called intrusive thoughts. While intrusive thoughts can feel very real and frightening, they are not things you actually intend to do or predictions of things that you will do — they’re unwanted experiences that don’t define you.

Avoiding sports and other things for fear of being judged is also a symptom of anxiety. I can understand how hard it is to tell your family what you’re going through, especially if you have felt ignored in the past. At the same time, your pain deserves to be heard and taken seriously. I encourage you to try talking to your parents again, but if you truly feel like you can’t, consider telling one safe person — whether that’s another family member, a school counselor, or even a teacher you trust. You can write how you’re feeling in a note if speaking feels too hard.

The physical symptoms you mentioned — neck and shoulder pain, fidgeting — are also common in anxiety because our bodies can hold tension when our brains are on high alert. What this likely means is that your brain is caught in a fear loop, constantly scanning for danger around control and judgment.

The good news is that this is very treatable. A mental health professional may recommend a type of cognitive behavioral therapy called exposure and response prevention (ERP). ERP helps you gradually face the situations or thoughts you fear instead of looking for reassurance from someone else or avoiding those situations or thoughts altogether. Over time, ERP teaches your brain that thoughts are just thoughts, not actions, and that you can tolerate uncertainty without something bad happening.

For now, you might try gently labeling upsetting thoughts as anxiety, not facts, and practicing not accepting them as true when they show up. Taking small steps toward what you’ve been avoiding can help you rebuild your confidence, even if it feels uncomfortable at first.

While you can practice managing anxiety or intrusive thoughts on your own, it’s better to have help. Once you talk to someone you know and trust, have them help you reach out to a mental health professional who can provide a more thorough assessment and the appropriate treatment for you. You don’t have to go through this alone, and with the right support, this can get much better.

The post I’m scared of everything — what does it mean and how do I get over it? appeared first on Child Mind Institute.

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Personalized DNA Vaccine Shows Immune Activation and Survival Signals in Glioblastoma Trial

A personalized DNA vaccine targeting up to 40 patient-specific neoantigens generated robust immune responses and encouraging survival outcomes in patients with MGMT-unmethylated glioblastoma in a small Phase I clinical trial, according to new findings published in Nature Cancer.

The study evaluated GNOS-PV01, a personalized therapeutic cancer vaccine developed by Geneos Therapeutics in collaboration with researchers at Washington University School of Medicine in St. Louis. Investigators reported that the vaccine was safe, feasible to administer, and capable of stimulating circulating and tumor-infiltrating T-cell responses in a cancer type long considered highly resistant to immunotherapy.

Glioblastoma remains one of the deadliest cancers, with median survival typically ranging from 12 to 18 months. Patients with MGMT-unmethylated disease face especially poor outcomes because they derive limited benefit from temozolomide, a standard chemotherapy agent commonly used after surgery and radiation.

“Nothing really works in this MGMT-negative or unmethylated glioblastoma patient population,” said Niranjan Sardesai, Geneos’ CEO. “Median survival is around a year, and effective treatments are very much needed.”

The open-label, single-arm GT-20 study enrolled nine patients with newly diagnosed MGMT-unmethylated glioblastoma following surgical resection and radiation therapy. Each patient received a fully individualized vaccine constructed from neoantigens identified through sequencing of their own tumors. Vaccines encoded between 17 and 40 neoantigens per patient.

According to the paper, the vaccine caused no serious adverse events, unexpected toxicities, or dose-limiting toxicities. Eight of the nine evaluable patients developed measurable immune responses. The lone nonresponder had been treated with dexamethasone, an immunosuppressive corticosteroid frequently used in glioblastoma management.

Sardesai emphasized that the immunogenicity findings were particularly notable because glioblastoma is considered an “immune-excluded” tumor with low tumor mutational burden, characteristics that have historically limited the effectiveness of checkpoint inhibitors such as anti–PD-1 therapies.

“Checkpoint-based immunotherapy has not worked in GBM,” he said. “This is a cold tumor.”

The investigators also observed signals of clinical activity. Six-month progression-free survival and 12-month overall survival were each achieved in 66.7% of patients. Median progression-free survival was 8.5 months, while median overall survival reached 16.3 months. Survival at 24 months was 33%, including one patient who remains alive four years after surgery.

“What was very striking was that three of nine patients, or one-third of the patients, had lived more than two years,” Sardesai said. “The two-year survival rate is about 10% to 15%” with standard treatment approaches in this population.

The study also identified an association between stronger CD8-positive T-cell responses and longer survival. Investigators reported that patients generating higher levels of vaccine-induced cytotoxic T cells tended to experience improved overall survival.

One of the most compelling findings involved a long-term survivor who has remained progression-free for nearly five years. Researchers analyzed a brain biopsy obtained approximately three years after treatment initiation and identified vaccine-induced T-cell clones within the tumor tissue that matched T-cell populations detected in the patient’s blood.

“For the first time, we are able to match vaccine-driven immune responses,” Sardesai said. “We are able to see T-cell clones in the blood, and these T-cell clones have infiltrated and are found in her brain.”

The vaccine platform differs from earlier glioblastoma vaccine strategies in several ways. Rather than targeting a small number of antigens, the DNA-based approach allows investigators to incorporate a much larger neoantigen repertoire into each personalized product.

“These patients received as many as 40 different antigens that were identified from their own tumor,” Sardesai said. “Prior treatments had typically been looking at 20 or fewer in GBM.”

He argued that broader antigen targeting may be especially important in glioblastoma because of the disease’s pronounced intratumoral heterogeneity.

“When it comes to targeting cancer, more is better,” he said. “You want to take more shots on goal.”

Another distinguishing feature of the platform is its apparent ability to stimulate CD8-positive killer T cells, which are considered critical for direct tumor cell elimination. Sardesai noted that generating robust CD8 responses has historically been difficult for many cancer vaccine technologies.

Importantly, each vaccine is uniquely manufactured for a single patient.

“These are exquisitely personalized vaccines,” Sardesai said. “Every patient gets their own vaccine.”

The authors cautioned that the findings remain preliminary because of the trial’s small sample size and lack of a control arm. Still, they believe the results justify larger randomized studies.

“We are very encouraged by the data,” Sardesai said. “But this is still only nine patients. We have to replicate these findings in larger, well-controlled studies.”

The company has previously reported results using the same platform in hepatocellular carcinoma, suggesting the strategy could potentially extend across multiple tumor types characterized by immune exclusion and low tumor mutational burden.

“All cancers carry neoantigens,” Sardesai said. “These personalized cancer vaccines provide a very convenient way” to target those tumor-specific alterations across different cancers.

 

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Aberrant Splicing Patterns Could Predict Therapy Response in mRCC

Transcriptomic analysis of more than 100 metastatic renal cell carcinomas (mRCC) has revealed key differences in aberrant alternative gene splicing events between treatment responders and nonresponders that could aid prognostication in future.

“In the near term, these findings could help guide treatment selection by identifying patients more likely to respond to targeted therapies or standard immuno-oncology regimens,” said Patrick Pirrotte, PhD, director of the Integrated Mass Spectrometry Shared Resource at TGen and City of Hope, associate professor in TGen’s Early Detection and Prevention Division, and senior author of the paper.

“Longer term, splicing-derived antigens could provide a foundation for more personalized adoptive immunotherapy strategies tailored to the molecular features of an individual patient’s tumor,” he told Inside Precision Medicine.

Pirrotte explained that “alternative splicing [AS] is a fundamental transcriptional mechanism that expands proteomic diversity in normal cells, but aberrant splicing is increasingly recognized as a feature of cancer that can contribute to tumorigenesis, progression, and metastasis.”

His group, and collaborators, have previously demonstrated that aberrant splicing could act as a broadly relevant biomarker across different malignancies, including ovarian cancer and sarcomatoid renal cell carcinoma, but its diagnostic and predictive potential in mRCC remained largely unexplored.

To address this, Pirrotte and team conducted a retrospective analysis on tumor samples from 101 patients with mRCC who received immune checkpoint inhibitor (n=91) and/or targeted (n=77) therapies. Response rates to each of the therapies were 63% and 77%, respectively.

The researchers report in the Journal for ImmunoTherapy of Cancer that they identified 10 AS events that were specific to mRCC. Six of these were intron retention events and four were exon skipping events.

Differential AS analysis identified 461 slicing events that differed between responders and non-responders to immune checkpoint inhibitors and 253 events that differed between targeted therapy responders and non-responders. In both cases, more than 70% of novel AS events among responders involved intron retention.

“Intron retention was the predominant alternative splicing event observed in patients who responded well to therapy,” observed Pirrotte.

“Mechanistically, intron retention occurs when intronic sequences that are normally removed during RNA processing are retained in the mature transcript. This can generate novel amino acid sequences and, in some cases, tumor-associated antigens derived from aberrant splicing,” he explained. “A high intron-retention burden was associated with an immunogenic tumor microenvironment, marked by adaptive immune activation and enriched antigen processing. In simple terms, these cancer-specific splicing errors may help ‘flag’ tumor cells, making them more visible to the immune system.”

The team then investigated whether differentially spliced sequences shared between the immunotherapy and targeted therapy responder cohorts could potentially act as neoantigenic targets.

This revealed that novel peptide-generating AS events in the genes IFFO1 and ZNF692 were highly expressed among the responders. Both genes are known to play a role in tumorigenesis and metastasis in RCC and colorectal cancer. The researchers note that although the specific impact of AS events within these genes is unclear, the resulting neoantigens could play a role in future treatment approaches.

“It is becoming increasingly feasible to identify splicing-derived neoantigens that could be used in personalized immunotherapy approaches, including adoptive cell therapies such as CAR T-cell or tumor-infiltrating lymphocyte therapies,” said Pirrotte. “These strategies are designed to train or redirect a patient’s immune system to recognize tumor-specific antigen signatures. In this case, the targets would be antigens generated by aberrant splicing events, allowing immune cells to selectively recognize and kill cancer cells.”

Finally, the investigators showed that tumors with higher levels of aberrant splicing were more common among therapy responders than nonresponders. This could potentially be used as a biomarker for treatment response.

“Current biomarkers such as PD-L1 expression and microsatellite instability have shown limited and inconsistent predictive value in mRCC,” said Pirrotte. “In contrast, our study identified a significant association between tumor ‘splicing burden’ (the extent of aberrant splicing) and clinical response to therapy. These findings suggest that the tumor transcriptome, particularly splicing dysregulation, may provide a more informative framework for predicting treatment response and personalizing therapy.”

Before assessment of AS can be implemented in routine clinical practice, the core technologies will need further refinement, including clinically validated RNA sequencing workflows, robust computational pipelines for splicing analysis, and clear regulatory and technical frameworks for using the results to guide treatment decisions or develop biologic therapies.

Pirrotte and team are now assembling validation cohorts to confirm their findings in larger patient populations. They are also expanding their work to other cancer types to determine whether aberrant splicing and splicing-derived antigens represent broadly applicable biomarkers and therapeutic targets.

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