Prediabetes Genotyping Identifies Who Benefits from Vitamin D

Genotyping could help identify people who would most benefit from vitamin D supplements to prevent their progression to diabetes, further analysis of a clinical trial suggests.

The genetic association study indicated that individuals with glycemic indicators of prediabetes could benefit from supplementation with 4000 IU/d of vitamin D3 if they carried specific genetic polymorphisms.

Two genotypes of the ApaI vitamin D receptor polymorphism (VDR) were linked to a risk reduction when these vitamin supplements were taken compared with placebo, according to the report in JAMA Open.

“Our exploratory findings, if confirmed, hold promise for high-dose vitamin D3 as a targeted, personalized approach to reducing the risk of type 2 diabetes among selected adults with prediabetes,” reported Bess Dawson-Hughes, MD, from the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston, and co-workers.

“The magnitude of the observed risk reduction among participants with AC and CC alleles of the ApaI polymorphism, if confirmed in an independent clinical trial, would have clinical implications for the management of prediabetes.”

There are four major polymorphisms in the vitamin D receptor: FokI, BsmI, ApaI, and TaqI. While the FokI polymorphism produces a shorter vitamin D receptor with enhanced transcriptional activity, the BsmI, ApaI, and TaqI polymorphisms influence mRNA stability, posttranscriptional regulation, and translational efficiency.

ApaI is strongly associated with metabolic syndrome and obesity, which are both major risk factors for type 2 diabetes.

In an extended analysis of the Vitamin D and Type 2 Diabetes (D2d) trial, researchers examined whether VDR gene variants modified the results of the trial.

The primary outcome of the original trial, conducted in people who achieved at least two of the three glycemic criteria for prediabetes, did not reach statistical significance in the intention-to-treat analysis. However, further examination revealed that the effect of vitamin D3 depended on the achieved intratrial serum 25-hydroxyvitamin D (25[OH]D) levels.

Dawson-Hughes and team therefore examined common VDR polymorphisms in the D2d trial to see whether these polymorphisms were associated with reduced diabetes risk among participants who achieved higher intratrial mean 25(OH)D level, in a discovery-level analysis.

They then conducted a test phase to determine whether participants’ VDR genetic profile modified the response to vitamin D3 supplementation compared with placebo.

Among 2098 participants in the D2d trial, the 618 carrying the AA alleles experienced no reduction in risk of progression to type 2 diabetes either when achieving higher intratrial 25(OH)D concentrations or when using vitamin D3 4000 IUs per day for a median of 2.5 years after adjusting for race, sex, and body mass index, among other variables.

However, the 1480 participants with ApaI AC and CC genotypes—representing 71% of the study population—had a progressively lower risk of type 2 diabetes at intratrial 25(OH)D levels of 40 ng/ml or higher.

Participants with these genotypes had a 19% reduction in the risk of progressing to type 2 diabetes over the same period (Hazard ratio=0.81).

“If confirmed, a 19% risk reduction in conversion to type 2 diabetes with vitamin D3 supplementation would not be trivial,” the authors concluded, noting that assessment of a single VDR polymorphism is inexpensive and now widely available.

In a Commentary article accompanying the study, Michael Holick, PhD, and Arash Shirvani, PhD, both from Boston University, added: “The enormity of the disease burden of diabetes worldwide and the confirmation that vitamin D supplementation of 4000 IUs per day markedly reduces risk of developing it should be a wake-up call and the impetus for health organizations to develop strategies to improve vitamin D status for children and adults with food fortification programs, implementation of supplementation, and sensible sun exposure recommendations for those who are at risk.”

The post Prediabetes Genotyping Identifies Who Benefits from Vitamin D appeared first on Inside Precision Medicine.

New ADC Yields Encouraging Clinical Benefit in Platinum-Resistant Ovarian Cancer

Patients with advanced platinum-resistant ovarian cancer whose disease had progressed on standard therapy experienced clinical benefit when treated with the investigational antibody-drug conjugate (ADC) QLS5132.

This finding is according to results from a Phase I clinical trial presented at the American Association for Cancer Research (AACR) Annual Meeting 2026, held in San Diego.

Patients diagnosed with platinum-resistant ovarian cancer face both a poor prognosis and limited treatment options, explained Tao Zhu, MD, chief physician and vice president of Zhejiang Cancer Hospital in China, who presented the study.

Zhu and collaborators tested an investigational ADC, QLS5132, which targets the protein CLDN6. QLS5132 combines a CLDN6-targeting monoclonal antibody with a cytotoxic payload, topoisomerase-1 inhibitor, at a drug-to-antibody ratio of 8:1. CLDN6, Zhu said, makes an ideal target as a protein with very high expression on the surface of ovarian cancer cells and minimal cell-surface expression in healthy tissues.

“The primary purpose of this first-in-human study was to evaluate the safety, tolerability, and pharmacokinetic profile of QLS5132 in patients with platinum-resistant ovarian cancer and determine the recommended Phase II dose for future clinical development,” Zhu said. “Additionally, we aimed to assess preliminary antitumor activity to establish an early signal of clinical benefit in this heavily pretreated population with limited options.”

The Phase I, single-arm, dose-escalation trial enrolled 28 patients with a median age of 57.5 who had been diagnosed with advanced platinum-resistant ovarian cancer and who had experienced progression while on standard therapy. The research team administered QLS5132 as an intravenous infusion every three weeks at dose levels of 1.6 mg/kg, 3.2 mg/kg, 4.8 mg/kg, 5.6 mg/kg, and 6.4 mg/kg.

Treatment-related adverse events (TRAEs) occurred in 26 (92.9%) patients, with nausea, anorexia, anemia, and weakness occurring most frequently. Nine (32.1%) patients experienced TRAEs of grade 3 or higher, and of those grade ≥3 TRAEs, seven were instances of hematological toxicity. No TRAEs led to treatment discontinuation or death, and no patients experienced interstitial lung disease, ocular toxicity, or febrile neutropenia, Zhu said.

After a median follow-up of 2.2 months, nine patients had a partial response at various dose levels. Two of these partial responses occurred in patients who had no detectable CLDN6 expression.

Across all dose levels, 18 evaluable patients experienced an objective response rate of 50% and a disease control rate of 94.4%. When calculated for the 17 evaluable patients who had received dose levels ≥3.2 mg/kg, the objective response rate and disease control rate rose to 52.9% and 100%, respectively. These responses to QLS5132 occurred irrespective of patients’ CLDN6 expression levels at baseline.

“The most encouraging finding from our study was that QLS5132 demonstrated compelling antitumor activity in patients with platinum-resistant ovarian cancer, with an objective response rate exceeding 50%,” said Zhu. “Equally important, at the potential recommended Phase II dose, we observed a favorable safety profile with no reported cases of interstitial lung disease, ocular toxicity, oral mucositis, or febrile neutropenia.”

Zhu also noted that, though more research would be needed to confirm, preliminary data indicated antitumor activity from QLS5132 regardless of CLDN6 expression levels—which, he said, could expand its potential as a treatment option to a broad cohort of patients with platinum-resistant ovarian cancer.

Zhu acknowledged that further research would be needed to fully understand why QLS5132 can have anticancer effects in patients with undetectable CLDN6 tumoral expression. But he suggested the phenomenon may have a few explanations, including tumor heterogeneity, as well as a potent bystander effect resulting in antitumor efficacy even in cells with low or no CLDN6 expression.

“These findings support the advancement of QLS5132 into Phase III studies, with the goal of providing a much-needed new treatment option for these patients,” said Zhu.

Some limitations of this study include a small sample size and an exploratory single-arm design.

This study was funded by Qilu Pharmaceutical. Zhu discloses no conflicts of interest.

The post New ADC Yields Encouraging Clinical Benefit in Platinum-Resistant Ovarian Cancer appeared first on GEN – Genetic Engineering and Biotechnology News.

Novel KIR‑CAR T Approach Shows Early Activity Against Solid Tumors

CAR T cell therapies have revolutionized outcomes for certain blood cancers, yet their impact on solid tumors has lagged. The field has long wrestled with T cell exhaustion—a state in which engineered cells lose their potency and fail to sustain an anti‑tumor response.

At this year’s AACR annual meeting in San Diego, researchers from the Perelman School of Medicine at the University of Pennsylvania presented first‑in‑human Phase I data pointing to a possible solution. Their novel “KIR‑CAR” T cell therapy demonstrated a favorable safety profile and early signals of activity across multiple solid tumor types.

The investigational therapy, SynKIR-110, represents a departure from traditional CAR T designs. Rather than using a single-chain receptor, the therapy is modeled after natural killer (NK) cell receptors and uses a “multi-chain” architecture.

This design separates tumor recognition from activation, effectively creating an intrinsic “on-off” mechanism. The T cell remains in a resting state until it encounters its target, at which point the receptor components assemble to trigger an immune attack.

“The KIR-CAR design provides a natural ‘on-off’ mechanism, which helps avoid the problem of T cell exhaustion,” said Janos L. Tanyi, MD, PhD, principal investigator of the study. “The CAR turns on when it finds its target, kills it, and then rests, rather than constantly burning energy.”

This contrasts with conventional CAR T cells, which remain continuously active and can become depleted over time, limiting their effectiveness—particularly in the more complex microenvironment of solid tumors.

The Phase I dose-escalation trial enrolled nine patients with advanced, mesothelin-expressing cancers, including ovarian cancer, mesothelioma, and cholangiocarcinoma. These patients had limited treatment options, having received an average of four prior lines of therapy.

Although the primary goal of the study was to assess safety, early signs of efficacy were observed. Disease stabilization was reported in four patients, and one patient in the highest dose cohort achieved an ongoing partial response.

“These are cancer types that have never had an approved cell therapy,” Tanyi said. “We’re seeing good efficacy signals, even at low doses, and limited toxicity.”

The results suggest that the therapy may be able to generate meaningful anti-tumor responses even in heavily pretreated populations.

Safety has been another major barrier for CAR T therapies, particularly in solid tumors. However, the KIR-CAR approach appears to mitigate some of these concerns.

No dose-limiting toxicities were observed in the initial cohorts. Cytokine release syndrome (CRS), a common side effect of CAR T therapy, occurred in 33% of patients but was limited to low-grade events. Notably, there were no cases of immune effector cell-associated neurotoxicity syndrome (ICANS), a more severe complication sometimes seen with CAR T therapies.

The ability to limit toxicity while maintaining activity is a key step toward broader application of cell therapies in solid tumors.

SynKIR-110 targets mesothelin, a protein expressed on the surface of several solid tumors but largely absent from normal tissues. This makes it an attractive target for immunotherapy, particularly in cancers such as ovarian cancer and mesothelioma, where treatment options are limited.

The trial results indicate that the therapy’s activity is not confined to a single tumor type, raising the possibility of broader applicability across mesothelin-expressing cancers.

The findings come amid growing efforts to adapt CAR T technology for solid tumors. While the approach has revolutionized hematologic malignancies, solid tumors present additional challenges, including immunosuppressive microenvironments, physical barriers to T cell infiltration, and antigen heterogeneity.

Researchers are exploring multiple strategies to address these barriers, including improved targeting, combination therapies, and next-generation receptor designs such as KIR-CAR.

As noted by CAR T pioneer Carl June, MD, advancing cellular therapies into solid tumors remains a central goal for the field.

The Phase I study continues to enroll patients, aiming for a 42‑person cohort to define the maximum tolerated dose ahead of Phase II. Early readouts show that CAR T expansion rises with dose, a pattern that may translate into stronger anti‑tumor activity at higher levels.

While still preliminary, the findings highlight the potential of multi‑chain CAR designs to sustain activity without added toxicity. If confirmed, KIR‑CAR therapies could usher in a new generation of engineered immune cells that more closely mirror natural immune regulation.

For now, the data offer a promising sign that CAR T innovation may finally be gaining ground in solid tumors.

The post Novel KIR‑CAR T Approach Shows Early Activity Against Solid Tumors appeared first on GEN – Genetic Engineering and Biotechnology News.

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Earliest Events of Lung Cancer Development Mapped

Researchers at Memorial Sloan Kettering (MSK) Cancer Center have identified the earliest cellular and molecular events that create the needed conditions for lung cancer cells to begin their growth into a tumor. The study, published in Nature, describes how cells with cancer-causing mutations initiate a coordinated chain of events to involve nearby fibroblasts and immune cells to create a microenvironment conducive to tumor growth at the very start of disease.

“We also found that this transformation of the local neighborhood is reversible, if caught early enough. This opens the door to new treatment and prevention strategies,” said senior author Joo-Hyeon Lee, PhD, an associate member in the developmental biology program at MSK.

The research focused on lung alveolar type II (AT2) stem cells that acquire mutations in the KRAS gene. Rather than simply proliferating, the mutant cells enter a regenerative-like state that resembles tissue repair. In this state, they produce amphiregulin (AREG), a signaling molecule that initiates communication with surrounding cells. AREG activates nearby fibroblasts through EGFR signaling, which prompts them to adopt a fibrotic, injury-like state which results in a remodeling of the extracellular matrix.

Within the microenvironment created, fibroblasts play a central role in shielding emerging tumor cells by producing a fibrous scaffold that supports tumor growth while also releasing signals that alter the activity of immune cells. Macrophages recruited to the site undergo reprogramming, shifting away from fighting the tumor toward phenotypes that suppress immune responses. Neutrophils and regulatory T cells are also recruited, further dampening anti-tumor immunity. This coordinated activity creates a protective niche in which the cells with the KRAS mutation can grow without being eliminated.

“These reciprocal interactions establish a self-sustaining epithelial–stromal–immune circuit that generates a tumor-permissive niche before malignant outgrowth,” the researches wrote. This loop reinforces itself: mutant cells sustain fibroblast activation, fibroblasts reshape immune responses, and immune cells further support tumor-promoting conditions.

The study builds on prior research in the Lee lab into lung injury and repair, which showed that normal regenerative programs involve temporary activation of stem cells and fibroblasts. In cancer, however, this process becomes dysregulated. Mutant cells remain locked in a regenerative state, continuously signaling to their environment. Earlier work by the same group had identified these regenerative states as a feature of early tumorigenesis.

To identify the mechanisms involved, the MSK first used mouse models of lung cancer carrying KRAS mutations. Through lineage tracing and single-cell analyses, they tracked individual cells to map how interactions with fibroblasts and immune cells evolved over time. They then used tissue samples from patients with early-stage lung adenocarcinoma and found returned the same result of cancer cells producing high levels of AREG and adjacent fibrotic fibroblasts.

Importantly, the team demonstrated that disrupting this communication network can prevent tumor formation. Blocking AREG signaling with an EGFR inhibitor kept fibroblasts and immune cells in their normal states and significantly impaired tumor development. Similarly, removing the AREG gene from mutant cells prevented the formation of the tumor-supportive niche. Even after early lesions had formed, inhibiting KRAS activity reversed many of the changes that had already occurred in the microenvironment.

The implications of this research to influence for cancer care are substantial. The identification of early signaling events and microenvironmental changes suggests new biomarkers for detecting lung cancer before it becomes advanced. High levels of AREG or evidence of fibroblast activation could indicate the presence of precancerous lesions, which could be particularly important for screening those at high risk of developing cancer, such as long-term smokers.

The findings also suggest there could be the development of new therapeutics aimed at preventing cancer development as opposed to treating it once it is established. By targeting the AREG–EGFR signaling axis or disrupting fibroblast activation, clinicians may be able to block tumor development at its earliest stages. Because the team showed these processes can be reversed, there is a window for intervention before the disease becomes resistant to treatment.

“The reversibility of these preneoplastic circuits defines a therapeutic window before progression to treatment-resistant disease,” the researchers wrote.

Next steps for the team include validating biomarkers in clinical populations, refining organoid models to study patient-specific tumor development, and testing preventive therapies that target these newly identified early signaling pathways.

The post Earliest Events of Lung Cancer Development Mapped appeared first on Inside Precision Medicine.

The Download: introducing the Nature issue

This is today’s edition of The Download, our weekday newsletter that provides a daily dose of what’s going on in the world of technology.

Introducing: the Nature issue

When we talk about “nature,” we usually mean something untouched by humans. But little of that world exists today. 

From microplastics in rainforest wildlife to artificial light in the Arctic Ocean, human influence now reaches every corner of Earth. In this context, what even is nature? And should we employ technology to try to make the world more “natural”?  

In our new Nature issue, MIT Technology Review grapples with these questions. We investigate birds that can’t sing, wolves that aren’t wolves, and grass that isn’t grass. We look for the meaning of life under Arctic ice, within ourselves, and in the far future on a distant world, courtesy of new fiction by the renowned author Jeff VanderMeer. 

Together, these stories examine how technology has altered our planet—and how it might be used to repair it. Subscribe now to read the full print issue.

What’s next for large language models?

After ChatGPT launched in late 2022, the OpenAI chatbot became an everyday everything app for hundreds of millions of people. It led to LLMs being heralded as the new future. The entire tech industry was consumed by the inferno, with companies racing to spin up rival products.

But what’s the next big thing after LLMs? More LLMs—but better. Let’s call them LLMs+. Find out how they’re set to become cheaper, more efficient, and more powerful.

—Will Douglas Heaven

LLMs+ is on our list of the 10 Things That Matter in AI Right Now, MIT Technology Review’s guide to what’s really worth your attention in the busy, buzzy world of AI. We’ll be unpacking one item from the list each day here in The Download, so stay tuned.

Will fusion power get cheap? Don’t count on it.

Fusion power could provide a steady, zero-emissions source of electricity in the future—if companies can get plants built and running. But a new study published in Nature Energy suggests that even if that future arrives, it might not come cheap.

The research team aimed to improve predictions of fusion’s future price by estimating the technology’s experience rate—the percentage by which its cost declines every time capacity doubles. Their findings offer new clues on the technology’s path to deployment. Read the full story.

—Casey Crownhart

This story is from The Spark, our weekly climate newsletter. Sign up to receive it in your inbox every Wednesday.

The must-reads

I’ve combed the internet to find you today’s most fun/important/scary/fascinating stories about technology.

1 Trump signaled he’s open to reversing the Anthropic ban
What that really means in practice remains to be seen. (Reuters $)
+ Anthropic says there’s no “kill switch” for its AI. (Axios)
+ “Humans in the loop” in AI warfare is an illusion. (MIT Technology Review)

2 SpaceX plans to manufacture its own GPUs
To support the company’s growing AI ambitions. (Reuters $)
+ Musk is shifting SpaceX’s focus from Mars to AI ahead of its IPO. (NYT $)
+ SpaceX and Tesla may be on a collision course. (FT $)

3 Chinese tech giant Tencent has unveiled its first flagship AI model
A former OpenAI researcher is at the helm. (SCMP)
+ Chinese open models are spreading fast. (MIT Technology Review)

4 High earners are racing ahead on AI, deepening workplace divides
The division in adoption risks widening inequality. (FT $)
+ Startups are bragging they spend more on AI than staff. (404 Media)

5 Thousands of Samsung workers are demanding a new share of AI profits
Chip-division employees want 15% of the operating profit. (Bloomberg $)
+ Here’s why opinion on AI is so divided. (MIT Technology Review)

6 AI is helping mediocre Korean hackers steal millions
They’re vibe coding their malware. (Wired $)
+ AI is making online crimes easier. (MIT Technology Review)

7 Kalshi suspended three political candidates for betting on their own races
Including a Democrat and a Republican running for Congress. (CNN)
+ And an independent candidate who said he did it to make a point. (Gizmodo)
+ Lawmakers argue that prediction markets are a loophole for gambling. (NPR)

8 A ping-pong robot is beating elite human players for the first time
The Sony AI system was trained with reinforcement learning. (New Scientist)
+ Just days earlier, a humanoid smashed the human half-marathon record. (AP)

9 Crypto scammers are luring ships into the Strait of Hormuz
By falsely promising safe passage. (Ars Technica)

10 ‘Age tech’ could help us grow old comfortably at home
Apps, wearables, and remote monitoring could fill caregiving gaps. (NYT $)

 

Quote of the day

“It’s a hallucinogenic business plan.”

—Ross Gerber, the chief executive of Gerber Kawasaki, an investment firm that owns SpaceX shares, tells the New York Times that he’s unimpressed by Musk’s changing goals for the aerospace company. 

One More Thing

Photos of victims are displayed under white crosses at a memorial for the August 2023 wildfire victims

AP PHOTO/LINDSEY WASSON


This grim but revolutionary DNA technology is changing how we respond to mass disasters

After hundreds went missing in Maui’s deadly fires, victims were identified with rapid DNA analysis—an increasingly vital tool for putting names to the dead in mass-casualty events.

The technology helped identify victims within just a few hours and bring families some closure more quickly than ever before. But it also previews a dark future marked by the rising frequency of catastrophic events.

Find out how this forensic breakthrough is preparing us for a more volatile world.


—Erika Hayasaki

We can still have nice things

A place for comfort, fun and distraction to brighten up your day. (Got any ideas? Drop me a line.)

+ This fascinating dive into botanical history reveals the origins of the first true plants.
+ Here’s how to use Google’s reference desk to find what ordinary search engines miss.
+ Watch duct tape get deconstructed to reveal the physics behind its legendary stickiness.
+ When Radiohead covers Joy Division, the result is a beautiful intersection of two legendary musical eras.

Transcutaneous auricular vagus nerve stimulation for paroxysmal sympathetic hyperactivity syndrome after intracerebral hemorrhage: a hypothesis-generating case report

ObjectiveTo observe the clinical effect of transcutaneous auricular vagus nerve stimulation (taVNS) in drug-refractory paroxysmal sympathetic hyperactivity (PSH).MethodsThis case report describes the clinical course of a 63-year-old male with PSH following intracerebral hemorrhage. PSH episodes were characterized by tachypnea, tachycardia, hypertension, and increased muscle tone. After 2 weeks of combination pharmacotherapy (propranolol, baclofen, gabapentin), blood pressure, heart rate, and muscle tone improved, but tachypnea remained inadequately controlled. Although sedative agents alleviated tachypnea, they led to decreased consciousness level and could not be continued. Subsequently, taVNS was added to the ongoing pharmacotherapy.ResultsAfter 4 weeks of taVNS treatment, PSH episode frequency and tachypnea improved. Baclofen and gabapentin were discontinued, propranolol dosage was reduced, and the patient’s consciousness level showed improvement. After another 4 weeks of continued treatment, only mild tachypnea occurred occasionally under strong stimulation, without other sympathetic symptoms. Consciousness level further improved.ConclusionThis case suggests that taVNS may be a safe adjunctive intervention option for drug-refractory PSH. The symptom relief and consciousness improvement observed during treatment may be related to the application of taVNS.

Functional methods for evaluating the efficacy of retinal optogenetic therapy for vision restoration

Optogenetic therapy is a promising strategy for vision restoration. Functional assays have an important role in assessing the modulation of neural activity in response to light stimulation. Each functional assay needs to be carefully considered and evaluated for the preclinical development of optogenetic approaches to work toward meaningful vision restoration. Each strategy contributes to understanding the efficacy of vision restoration and the physiology of retinal optogenetic therapy. At a molecular level, bioluminescence resonance energy-transfer based and G protein coupling assays can be used. Calcium imaging provides measurements with useful spatial and temporal resolution using fluorescent calcium indicators at the cellular level. Electrophysiological tests can include ex vivo recordings by patch-clamping at single-cell resolution, multielectrode array recordings at the network level, and in vivo recordings at the lateral geniculate nucleus and cortical levels. Behavioural tests such as light avoidance, optomotor response and visual discrimination assess functional restoration in vivo. In this review, each functional assay is discussed in the context of retinal optogenetic therapy with notable examples that have demonstrated vision restoration. The advantages, disadvantages, and limitations of each assay are critically compared to highlight their relative scientific value and applicability across different stages of development. This provides insight into how these methods can be integrated within a translational framework, from molecular validation to behavioural outcomes, to better inform the design of preclinical studies. As clinical trials in optogenetic therapy continue to expand, improved alignment between preclinical functional assays and clinically meaningful endpoints will be essential to maximise translational success.

Speech recognition performance with dual-microphone audio processors in mandarin-speaking cochlear implant users

BackgroundCochlear implant (CI) audio processor upgrades have demonstrated speech recognition benefits in non-tonal language populations, but high-level evidence for native Mandarin-speaking CI users (a tonal language with unique signal processing requirements) remains critically limited. This study aimed to assess the speech perception performance of the SONNET 2 and RONDO 3 dual-microphone audio processors in native Mandarin-speaking CI users.MethodsThis prospective single-subject repeated-measures study enrolled 51 native Mandarin-speaking CI users. Speech recognition performance was tested across five processor configurations: the legacy baseline processor, SONNET 2 (S2) in omnidirectional (S2.OMNI) and adaptive intelligence (S2.Adaptive) modes, and RONDO 3 (R3) in omnidirectional (R3.OMNI) and adaptive intelligence (R3.Adaptive) modes. Outcome measures included monosyllabic words, disyllabic words, and sentence recognition in quiet, and sentence recognition in co-located speech-shaped noise (S0N0 paradigm). The pre-specified primary endpoint was sentence recognition in noise for S2.OMNI vs. the legacy processor; confirmatory linear mixed-effects models (LMMs) and subgroup analyses were exclusively performed for the primary endpoint, with pairwise comparisons for all secondary exploratory endpoints.ResultsIn quiet, all four upgraded configurations yielded significantly higher monosyllabic word recognition scores vs. the legacy baseline (all p < 0.05, FDR-adjusted); all configurations except R3. Adaptive showed significant improvements in disyllabic word recognition (all p < 0.05, FDR-adjusted). In the S0N0 noise condition, S2.OMNI and R3.OMNI significantly enhanced sentence recognition vs. the legacy processor (p < 0.001 and p = 0.011, respectively, FDR-adjusted), while no significant benefit was detected for either adaptive mode after FDR correction. LMM analysis confirmed that upgrading to the S2.OMNI configuration was an independent positive predictor of noise sentence recognition (F = 9.885, p = 0.003), with consistent significant benefits across pediatric/adult and unilateral/bilateral users in pre-specified subgroup analyses.ConclusionThis study provides confirmatory evidence that upgrading to the S2.OMNI configuration significantly improves sentence recognition in noise in native Mandarin-speaking CI users, with consistent benefits across key clinical subgroups. Exploratory analyses show that the S2 and R3 processors also deliver significant improvements in word recognition in quiet, These results fill a critical evidence gap for tonal language CI populations and may help guide clinical device selection.