predictive biomarkers

The Role of the Intestinal Microbiota in Sepsis Mortality

Project Summary/Abstract Sepsis is a life-threatening condition characterized by a dysregulated host response to infection that can cause multi-organ damage and death. As the leading cause of in-hospital mortality, sepsis mortality rates reach up to 50%, and account for approximately 270,000 deaths and $38 billion annually in health care costs in the United States. Notably, patients with similar medical backgrounds can have vastly different sepsis outcomes— some survive with medical treatment while others die. The reasons for this dichotomy are unknown but is seen across all forms of bacterial bloodstream infections, is not specific to any strain-level differences in the infecting pathogen and cannot be explained by human genetic differences. Human microbiota studies suggest that gut microbial dysbiosis is associated with sepsis mortality and that these alterations influence gut barrier breakdown, leading to gram-negative bacteremia—one of the most common causes of sepsis and mortality. However, there are a lack of studies that investigate the causal role of the intestinal microbiota in sepsis mortality. This K08 proposal will elucidate the role of the intestinal microbiota in sepsis mortality. Utilizing the well- established murine model of sepsis by intraperitoneal injection of lipopolysaccharide (LPS), we combine microbiota taxonomic sequencing and metagenomics, advanced bioinformatic techniques and prediction modeling, with knowledge of mucosal immunity and germ-free mouse systems to characterize the microbiota features and members that correlate with, predict, and cause sepsis mortality. This proposal is organized into two specific aims: (1) identify baseline stool microbial features associated with and predictive of sepsis outcomes and (2) determine how colonization with immunostimulatory microbes heightens sepsis mortality. In this work, I will holistically characterize the host immunologic and microbiota features that are associated with and predictive of mortality and experimentally identify microbes and microbial pathways that cause death in our model. These findings will reveal new microbial and host biomarkers of sepsis mortality and identify novel targets for sepsis prevention and treatment to reduce the overall mortality rate of this deadly disease. My long-term goal is to become an independent physician-scientist who integrates cutting-edge computational methods with experimental biology to identify predictive biomarkers of disease onset and outcomes, investigate how they influence disease processes, and develop novel therapeutic and preventive strategies to improve patient care. This proposal details specific research aims and a structured career development and training plan that will allow me to acquire focused, in-depth and multidisciplinary training under the guidance of an internationally recognized team of experts in clinical infectious diseases, host-microbiota interactions, immunology, immunometabolism, and computational biology. The knowledge generated will address the fundamental role of the microbiota in sepsis outcomes and inform future preventative and therapeutic strategies that will lower the sepsis mortality rate worldwide.

Multimodal computational models for early prediction of peritoneal recurrence in gastric cancer

ABSTRACT Gastric cancer represents a significant disease burden and is a leading cause of cancer-related deaths in the United States and globally. Approximately 80% of gastric cancer patients are diagnosed at an advanced stage, with the peritoneum being the most common site of relapse (peritoneal recurrence) after radical surgery. Nearly 50% of patients with advanced-stage gastric cancer develop peritoneal recurrence post-surgery, resulting in a median survival of only 3–6 months and a markedly reduced quality of life. Early peritoneal recurrence is primarily characterized by micro-metastasis, which traditional imaging techniques struggle to detect due to the small size of metastatic nodules. Predicting the likelihood and timing of peritoneal recurrence is crucial for identifying at- risk patients, enabling timely interventions that could improve survival rates and quality of life. Unfortunately, reliable predictive biomarkers and models for peritoneal recurrence in gastric cancer are lacking in clinical practice, highlighting an urgent need for innovative predictive tools. This proposal aims to develop and validate novel predictive models for early peritoneal recurrence in gastric cancer, leveraging advanced deep learning techniques and multimodal integration of clinical, radiological (CT), and histopathological (hematoxylin and eosin, H&E) data. In Aim 1, we will develop a rational approach for predicting peritoneal recurrence by creating a novel deep learning multimodal method guided by genomics knowledge. Additionally, we will integrate both deep learning-extracted features and traditional hand-crafted radiomics features with clinical data to improve prediction accuracy. Aim 2 focuses on developing a robust prediction model of peritoneal recurrence utilizing a pre-trained foundation model from large-scale H&E image data. Aim 3 will combine CT, H&E, and clinical data to further enhance predictive capabilities, employing an innovative cross-modal collaborative optimization approach for multimodal data integration. All models will be trained and internally validated using a retrospective cohort from Atrium Health Wake Forest Baptist Comprehensive Cancer Center and externally validated in two independent cohorts from additional institutions to ensure robustness across populations and imaging protocols. Additionally, we will compare our models with existing methods, including clinical staging and alternative fusion strategies. If successful, these models will enhance risk stratification and prediction of peritoneal recurrence in gastric cancer patients, significantly improving survival rates and quality of life by identifying those likely to develop peritoneal recurrence post-surgery and facilitating timely intervention. Furthermore, they can help avoid the risk of complications and extra medical costs associated with overtreatment. Since the information is derived from routinely examined CT, H&E and clinical data, they could be seamlessly integrated into current clinical workflows. The AI technology developed through this project has the potential to benefit underserved populations in low- resource settings and reduce healthcare disparities in the U.S.

Circulating and Mucosal Predictors and Effects of Therapeutic Interleukin-23 Blockade in Crohn's Disease

PROJECT SUMMARY/ABSTRACT Since its discovery 20 years ago, the cytokine interleukin (IL)-23 has increasingly been implicated in the pathogenesis of immune mediated diseases, such as Crohn’s disease (CD). Consequently, four monoclonal antibodies that block IL-23 are currently approved CD therapies, including risankizumab. Although suppression of pathogenic Th17 cells has been widely cited as the mechanism by which IL-23 blockade controls disease, there is a paucity of data to indicate that this is how such therapy works, and a few other immune cell populations expressing the IL-23 receptor could instead be its target. We therefore propose to study how risankizumab affects not only Th17 cells, but also mucosa-associate invariant T (MAIT) cells γδ T cells and (in the colon) type 3 innate lymphoid cells (ILC3s). In addition to quantifying these cells, we will study their gene expression to detect phenotypic differences in treated patients, and in the case of T cells, track their clonal expansion and deletion through their unique T cell receptor sequences. In colon samples, we will use a combination of single cell sequencing of sort-enriched immune cell populations and spatial transcriptomics to characterize cells in situ, at the site of disease, and determine how IL-23 blockade affects their microenvironment in vivo. By contrasting results in patients who do or do not respond therapeutically to IL-23 blockade, we will reveal valuable insights into how this treatment succeeds or fails in CD, in the process identifying predictive biomarkers to guide treatment decisions, and potentially identifying future molecular targets with which to prevent treatment failure.

Applied cognitive neuroscience to improve learning and therapeutics

Advancements in cognitive neuroscience have provided profound insights into the workings of the human brain and the methods used offer opportunities to enhance performance, cognition, and mental health. Drawing upon interdisciplinary collaborations in the University of California San Diego, Human Performance Optimization Lab, this talk explores the application of cognitive neuroscience principles in three domains to improve human performance and alleviate mental health challenges. The first section will discuss studies addressing the role of vision and oculomotor function in athletic performance and the potential to train these foundational abilities to improve performance and sports outcomes. The second domain considers the use of electrophysiological measurements of the brain and heart to detect, and possibly predict, errors in manual performance, as shown in a series of studies with surgeons as they perform robot-assisted surgery. Lastly, findings from clinical trials testing personalized interventional treatments for mood disorders will be discussed in which the temporal and spatial parameters of transcranial magnetic stimulation (TMS) are individualized to test if personalization improves treatment response and can be used as predictive biomarkers to guide treatment selection. Together, these translational studies use the measurement tools and constructs of cognitive neuroscience to improve human performance and well-being.

Circadian/Multidien Molecular Oscillations and Rhythmicity of Epilepsy

The occurrence of seizures at specific times of the day has been consistently observed for centuries in individuals with epilepsy. Electrophysiological recordings provide evidence that seizures have a higher probability of occurring at a given time during the night and day cycle in individuals with epilepsy – the seizure rush hour. Which mechanisms underly such circadian rhythmicity of seizures? Why don’t they occur every day at the same time? Which mechanisms may underly their occurrence outside the rush hour? I shall present a hypothesis: MORE - Molecular Oscillations and Rhythmicity of Epilepsy, a conceptual framework to study and understand the mechanisms underlying the circadian rhythmicity of seizures and their probabilistic nature. The core of the hypothesis is the existence of circa 24h oscillations of gene and protein expression throughout the body in different cells and organs. The orchestrated molecular oscillations control the rhythmicity of numerous body events, such as feeding and sleep. The concept developed here is that molecular oscillations may favor seizure genesis at preferred times, generating the condition for a seizure rush hour. However, the condition is not sufficient, as other factors are necessary for a seizure to occur. Studying these molecular oscillations may help us understand seizure genesis mechanisms and find new therapeutic targets and predictive biomarkers. The MORE hypothesis can be generalized to comorbidities and the slower multidien (week/month period) rhythmicity of seizures.

Predictive biomarkers of altered neurological trajectories consequent to prenatal inflammatory insults