ROCHESTER, Minn. — Photon therapy offers strong outcomes in treating oropharyngeal cancers; however, some radiation can reach and damage nearby healthy tissue. The damage can lead to side effects that may be severe for some patients. In a new nationwide study published in The Lancet that included Mayo Clinic, investigators found that patients with oropharyngeal cancer can live longer with fewer side effects if treated with proton beam radiation therapy.

Photon radiation therapy, which uses X-rays to cure cancers, is a standard treatment for a type of throat cancer called oropharyngeal cancer. Rates of oropharyngeal cancers are increasing in the U.S., mainly driven by HPV infection.

Reducing the toll of treatment 

Proton beam therapy has been used for years in children, where research shows it lowers both short- and long-term treatment-related side effects. "Protons have been studied extensively in pediatric populations and consistently demonstrate reduced short- and long-term toxicity," says Nadia Laack, M.D., chair of the Department of Radiation Oncology at Mayo Clinic in Rochester. "It has been more difficult to prove the benefits in adult cancer because many adult studies have not measured side effects as carefully or as long." 

To explore whether the same advantages apply to adults, investigators directly compared proton beam therapy with modern photon radiation called intensity-modulated radiation therapy (IMRT), which precisely targets tumors while limiting exposure to nearby healthy tissue. "It is effective as an oropharyngeal cancer treatment, but there's always some incidental dose to surrounding tissues because of the physical nature of X-rays," says Daniel Ma, M.D., radiation oncologist at Mayo Clinic and the Mayo site primary investigator of the study. This incidental dose of radiation can sometimes cause long-term complications, including pain, problems with swallowing and a weakened jawbone.

To alleviate these unwanted side effects, investigators studied proton beam radiation therapy as a treatment option. "Protons are charged particles that can stop at a certain depth, so the delivery is more focused," says Dr. Ma. "If you set up your proton fields thoughtfully, you can avoid irradiating critical structures like the mouth, voice box and swallowing muscles. That's the advantage of proton therapy and why we decided to investigate it within a clinical trial."

Mayo Clinic was one of 18 participating institutions around the U.S. that enrolled patients in the first-ever phase 3 randomized trial comparing the two types of radiation for oropharyngeal cancer. Dr. Ma collaborated with Robert Foote, M.D., emeritus professor of radiation oncology at Mayo Clinic and senior author of the study, and Samir Patel, M.D., radiation oncologist at Mayo Clinic, to help lead Mayo Clinic’s involvement in the study.

Study results found that proton beam therapy weakened the immune system by 15% less than photon therapy. It also lowered the risk of severe swallowing problems by 13% and reduced the need for feeding tubes by more than 13%.

An unexpected outcome 

The treatments were similar in effectiveness in controlling cancer growth and spread, so Dr. Ma expected survival to be approximately the same, but the survival results were surprising.  

"Unexpectedly, we found that the overall survival at five years was 91% with proton therapy and 81% with photon therapy," he says. 

These results weren't immediately apparent. "The survival benefit in our study didn't start separating out until three years and wasn't apparent until five years, so longer follow-up with patients was key," he says. 

Dr. Ma says this result is likely due to a variety of factors, including less toxicity and immune suppression. He adds, "Because of this, we feel strongly that proton therapy should be a standard treatment for oropharyngeal cancer patients who can tolerate and receive it." 

"This study is important because it confirms what we believe to be true in many adult cancer cases: reducing toxicity has a meaningful impact on quality of life and long-term outcomes," says Dr. Laack. "As our treatments improve and our patients live longer, reducing toxicity and improving quality of life is more important than ever." 

The study was led by The University of Texas MD Anderson Cancer Center. Review the study for a complete list of authors, disclosures and funding. 

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About Mayo Clinic 
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact: 

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu 

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Early in his medical training, Sarosh Irani, B.M., B.Ch., D.Phil., met a patient who would change the course of his career. The woman, in her mid-30s, arrived at the hospital confused, trembling and wracked by seizures. She was losing her memory and her ability to walk. Yet unlike many with such severe neurological decline, she recovered completely.

Her turnaround came after the clinical team discovered a particular antibody in her blood — proof that her immune system had attacked her brain. When they suppressed that immune response, her symptoms disappeared. The discovery not only changed that woman's life but also opened a window into a new, potentially reversible, facet of medicine — one in which the immune system itself could explain devastating brain diseases.

That revelation propelled Dr. Irani into a field that bridges neurology and immunology, one that continues to expand today from his laboratory at Mayo Clinic in Florida.

A burgeoning field

Dr. Irani's first passion was psychiatry. "I wanted to understand disorders of the mind," he recalls. But he found that the field lacked the molecular footholds that could make its mysteries scientifically tractable. “You couldn't put your hands on the biology,” he says. "There were too many inferences and not enough mechanisms."

He turned to neurology just as scientists were discovering that neurological conditions could, in fact, be autoimmune diseases.

Dr. Irani joined, and subsequently led, the University of Oxford's autoimmune neurology lab, where he helped identify several antibodies that define distinct syndromes — including the antibodies LGI1 and CASPR2, now standard diagnostic markers for treatable forms of various autoimmune neurological conditions.

"What was once a medical curiosity has become a thriving field," says Dr. Irani, who came to Mayo Clinic in 2023. "Twenty years ago, there were no known antibodies affecting the brain. Now we know 20 or 30 such antibodies, and each one represents a potential cure."

Toward Precure

For Irani, these discoveries connect directly to Mayo Clinic's Precure initiative, which aims to predict and prevent disease before symptoms appear. "There are very few examples in medicine where we have a tractable handle on what's causing the disease," he explains. "Here we know the antibodies cause the disease. So the question is simple: How and why are they made? If we can work out causation, we can get close to pre-cure."

His lab is tackling that question through two complementary approaches: exploring patients' genetic predispositions and studying their immune cells. One variant, for example — in an HLA gene involved in presenting proteins to the immune system — appears in more than 90 percent of patients with a particular autoimmune neurological condition.

But genes alone do not tell the whole story. Irani suspects that environmental triggers, such as infections or even medications, act as the final push. "It's likely a multi-hit process," he says. "You need the gene, a misbehaving immune cell and an environmental spark."

His lab is studying patients' own immune cells to trace where this autoimmune process begins. Evidence increasingly points to the periphery, not the brain, as the starting point. That idea is supported by emerging research on the brain's lymphatic drainage system, which helps clear waste and immune molecules.

Early clues to autoimmunity

Recently, Dr. Irani and colleagues showed that biomarkers of neurodegeneration can be detected in the lymph nodes of the neck. These lymph nodes drain byproducts and proteins resulting from brain activity via a network of tiny lymphatic vessels.

Using ultrasound-guided fine-needle aspiration — a quick sampling technique similar to drawing blood — the team measured several proteins including amyloid beta and tau, proteins that build up in Alzheimer's disease, as well as other markers of brain cell health. They found that almost all of these proteins were found in much higher quantities in the lymph nodes than in the blood, especially one called phosphorylated tau (pTau181), which was 266 times more concentrated.

Strikingly, pTau181 levels in lymph nodes decreased with age, suggesting that the brain's ability to clear toxic proteins through lymphatic drainage declines over time — potentially contributing to diseases like Alzheimer's. The discovery also challenges one of medicine's oldest assumptions: that the brain is "immune-privileged" and largely sealed off from the body's immune system.

"This is the first direct evidence that brain proteins accumulate in cervical lymph nodes in living people," says Dr. Irani. "It opens up a minimally invasive way to study how the brain clears waste — and how that process falters with age."

Lymph node aspiration is far less invasive than spinal taps, yet it could offer powerful insight into brain health, aging, and disease progression.

Brain on fire

Dr. Irani's research has come full circle with a new study in The Lancet Psychiatry. The research focuses on patients with autoimmune encephalitis — a condition popularized by the book and movie "Brain on Fire"— whose illnesses often first appear to be psychiatric. The work shows that these patients can be distinguished from others by a simple scoring system based on how rapidly symptoms appear and how they evolve.

"It's a mixture of symptoms — depression, anxiety, psychosis, sleep and eating disturbances — all unfolding over days," he says. "If clinicians recognize that pattern early, we can treat it before irreversible brain injury occurs."

Current therapies for autoimmune encephalitis rely on broad immunosuppression — powerful drugs that quiet the entire immune system and leave patients vulnerable to infection. Dr. Irani envisions a more refined approach that involves the selective silencing of only the harmful immune cells while preserving the rest.

"We want to pick off just the bits causing trouble," he says. "If we can identify exactly what the immune system is attacking, we can teach it tolerance only to that target."

That vision, he believes, could extend to other conditions where the immune system plays a role, potentially informing treatments for dementia, cancer and even common psychiatric disorders. "We're trying to translate these observations to more widespread diseases," he says. "There's enormous potential."

The post Mayo Clinic researcher redefines the brain’s immune connection appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — A new Mayo Clinic study published in the New England Journal of Medicine has uncovered that an off-the-shelf, dual-antibody therapy can generate deep and durable responses in extramedullary multiple myeloma — one of the most aggressive and treatment-resistant forms of the disease. 

"We are seeing powerful responses in a disease that historically has resisted every therapy," says Shaji Kumar, M.D., a Mayo Clinic Comprehensive Cancer Center hematologist and senior author of the study. "By recruiting T cells in two distinct ways at once, this dual-target antibody strategy can generate responses in patients who have had very few effective options." 

The approach combines two engineered antibodies, talquetamab and teclistamab, that simultaneously engage T cells and force them to attack myeloma cells through two separate immune pathways. Unlike CAR-T cell therapy, which requires custom manufacturing, this regimen is delivered as a standard infusion-center injection. 

In a trial involving 90 patients, 79% responded to treatment, and 54% achieved no detectable disease by imaging or blood testing. Among responders, nearly two-thirds maintained disease control at one year, a striking improvement for a subtype that typically carries a months-long prognosis. 

This is the first large, prospective study defined specifically by PET/MRI scan and focused exclusively on true extramedullary myeloma, not a mix of para- and extramedullary disease. Serious side effects were common. Infection was one serious side effect and underscores the importance of comprehensive supportive care alongside immunotherapy. 

The next big questions are whether this dual-target strategy can be moved earlier in the disease course, how safety can be optimized further through infection monitoring and prevention, and whether similar "two-locks, one-key" immune designs can be applied to other hard-to-treat cancers. 

For a complete list of authors, disclosures and funding, review the study. 

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About Mayo Clinic  
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

About Mayo Clinic Comprehensive Cancer Center  
Designated as a comprehensive cancer center by the National Cancer Institute, Mayo Clinic Comprehensive Cancer Center is defining the cancer center of the future, focused on delivering the world's most exceptional patient-centered cancer care for everyone. At Mayo Clinic Comprehensive Cancer Center, a culture of innovation and collaboration is driving research breakthroughs in cancer detection, prevention and treatment to change lives. 

Media contact:  

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

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At Mayo Clinic, biomedical engineer Benjamin Brinkmann, Ph.D., is developing tools and technologies that help reveal brain patterns — making epileptic seizures more predictable and, one day, preventable. 

In a neurology lab at Mayo Clinic, Dr. Benjamin Brinkmann studies the brain's electrical rhythms across days, weeks and months — searching for patterns that reveal when seizures are most likely to occur. Working with neuroscientists and clinicians, he combines data from brain waves, vital signs and imaging to develop tools that interpret those signals and help guide patient care. 

Epilepsy is a brain disorder that causes recurring seizures — sudden bursts of electrical activity that can interrupt movement, speech or awareness. About 3.4 million people in the U.S. live with the condition. For many, medication keeps seizures under control. But for those with drug-resistant epilepsy, the episodes can occur without warning — disrupting routines and independence. 

Dr. Brinkmann, a biomedical engineer, has dedicated his career to improving care for people with epilepsy. Working with Mayo Clinic's epilepsy team, he helps identify where seizures begin in the brain — essential information for those whose epilepsy is difficult to control. His long-term goal is to move from forecasting seizures to stopping them before they start. 

A clearer picture of epilepsy, one signal at a time

One example of that work is a study Dr. Brinkmann led with international collaborators. They tested a small implant that sits just under the skin behind the ear, recording brain activity as people go about their day. The device helps provide a more accurate picture than seizure diaries, which can miss or misclassify episodes. Accurate and continuous monitoring helps doctors track seizure patterns and adjust treatment.

Over 15 months, the team collected more than 72,000 hours of brainwave data from people with epilepsy. They recorded 754 seizures — nearly twice as many as were reported in diaries. About half of the study participants wore the device more than 20 hours a day and reported it did not interfere with daily life. The findings suggest that long-term, at-home brain monitoring can uncover seizure patterns missed in short clinic visits. 

Smartwatch uses AI to forecast seizures 

Dr. Brinkmann also led a study on wearable technology — a smartwatch that uses artificial intelligence to help forecast seizures before they happen. 

The watch tracks heart rate, movement, skin conductance and temperature, using machine learning to help clinicians find patterns that may signal a seizure. In findings published in Epilepsia, the team correctly predicted about 75% of seizures, with few false alarms. 

Dr. Brinkmann says the idea is simple: to give people a warning. A few minutes' notice can mean calling a caregiver, sitting down or avoiding a risky activity. In the future, those alerts could even trigger treatments automatically, using medication or gentle brain stimulation when seizure risk is high. 

Building the future of epilepsy care

Together, the implant and smartwatch studies show what's possible when brain activity can be tracked continuously. The research is opening a new window into how seizures develop and helping shape the next generation of neurotechnology at Mayo Clinic. 

Dr. Brinkmann's work contributes to Mayo's BIONIC program — short for Bioelectronics Neuromodulation Innovation to Cure — which unites scientists and clinicians to develop smarter, more responsive technologies and therapeutics for the brain, spine and nervous system. The goal is ambitious: systems that can sense trouble and respond instantly to stop it. 

In Dr. Brinkmann's lab, every signal adds to that future — each one bringing a clearer picture of epilepsy and what care might look like in the years ahead. 

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ROCHESTER, Minn. — For many people living with cancer, symptoms such as pain, anxiety or insomnia can quickly spiral into an emergency room visit. Such visits can be financially costly and take an emotional toll on patients and their caregivers.  

A new study led by Mayo Clinic researchers found that using digital check-ins and a remote care team can help patients manage symptoms before they reach a crisis point.

"Our goal was simple but ambitious," says study lead Andrea Cheville, M.D., professor of Physical Medicine and Rehabilitation in the Mayo Clinic Comprehensive Cancer Center. "We wanted to see if automating symptom check-ins and care through the electronic health record could improve patients' lives without adding to the burden on oncology teams. What we found is that this approach not only eased symptoms like anxiety and depression but also kept thousands of patients out of the hospital. That tells us technology can help us successfully extend the reach and efficacy of care." 

For Becky Johnson, participating in the Enhanced EHR-Facilitated Cancer Symptom Control Trial (E2C2) meant better sleep — despite the anxiety she felt about her double breast cancer diagnosis in 2022 at the age of 40. 

"I was continually Googling for more information about treatments, prognosis, new terminology and the experiences of others. And the steroid medications I took for treatment prior to chemo messed with my ability to sleep, too. It got to a point where my body's norm was to wake in the middle of the night and not fall back asleep, taking a toll on my ability to heal," says Johnson, program director for the Mayo Clinic School of Health Sciences Sonography Program. 

As part of the trial, Johnson regularly submitted digital surveys about various aspects of her health. Insomnia quickly rose to the top, prompting a phone call from a nurse, who counseled Johnson on ways to get a better night's rest. The nurse also gave Johnson a link to a self-paced online class with sleep strategies based in cognitive behavioral therapy.  

"A virtual or phone call visit, especially when I didn't have anything physically wrong, was so convenient and efficient," says Johnson. The intervention helped, and her sleep improved.  

To make such interventions possible, the researchers developed automations in the Plummer Chart, the software system that manages patients' electronic health records (EHRs) and helps Mayo teams coordinate care. Between 2019 and 2023, just over 50,200 patients across 15 cancer specialties at Mayo Clinic enrolled in the E2C2 trial. Like Johnson, they filled out short surveys about pain, fatigue, sleep, anxiety and other symptoms before clinic visits or monthly between visits. The system automatically sorted their responses. Mild scores were simply logged, moderate ones triggered the system to send the patient self-care tips, and severe scores prompted outreach by a remote symptom care manager — a nurse or social worker who could work with patients via phone or video. 

Behind the scenes, the software became both an automated traffic controller and safety net. For care teams, it routed information to patients automatically so they could focus on the work that required their expertise. For patients, it made getting support easier, with no additional appointments or travel. 

The trial results showed that the automated surveys and responses built into the EHR made care more efficient and, ultimately, improved patients' symptoms.  

• Patients reported less anxiety and depression, with modest improvements in other symptoms. 

• Patients had 40% to 60% fewer acute care encounters, including emergency visits, hospitalizations, and ICU admissions. 

All of this was achieved with just 2-3 full-time care managers plus 20 percent of one physician's time supporting more than 50,000 study participants. 

The E2C2 trial showcases a new approach to using digital tools in cancer care. By automating routine monitoring and triaging of patient symptoms and well-being through the patient's electronic health record, a small care team can support a large patient population. 

"The gains we saw are encouraging and point to a scalable way to extend supportive oncology care beyond the clinic walls, meeting patients where they are," says Dr. Cheville. "The next step is to ensure that these tools are available to healthcare teams, enabling them to efficiently reach every patient who needs supportive care." 

The E2C2 trial was funded by the National Institutes of Health, National Cancer Institute (NCI) as part of the Cancer Moonshot℠. The study was conducted as part of NCI’s IMPACT Consortium. Review the study for a complete list of authors, disclosures and additional funding.

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About Mayo Clinic  
Mayo Clinic  is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.   

Media contact:   

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu  

The post Small team, big impact: Automation helps relieve symptoms to keep cancer patients out of the ER  appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Mayo Clinic researchers have developed and tested a new 3D surface scanning approach that gives neurosurgeons even greater precision when operating deep inside the brain.  

The system aligns a patient's head, facial features and surgical head frame with brain images, achieving sub-millimeter accuracy — a level of precision that can make a critical difference in delicate procedures. 

In a feasibility study published in the Journal of Neurosurgery, the 3D scanning method proved more accurate than the CT scan typically used during neurosurgery, all while eliminating exposure to radiation.  

Researchers say the approach could make complex procedures, such as deep brain stimulation, drainage and biopsies safer and more efficient, while enhancing patient comfort. Because it integrates with most surgical navigation systems, it may also bring high-precision guidance to operating rooms that don't have a CT scanner. 

How the new 3D approach works 

Using cameras and structured-light scanning, the new system creates high-resolution 3D models of the patient's face and the surgical frame that keeps the head still. It merges these images into a detailed spatial “map” of the patient's position in the operating room. That map is then matched with pre-surgery brain scans, such as MRI or CT images, giving surgeons precise, real-time guidance to reach the exact target in the brain.  

In the study, the system's computer analysis aligned images with an average precision of 0.14 millimeters — compared with about 0.20 millimeters typically achieved with CT scans. The difference is roughly the width of a pencil tip, but in delicate brain surgery, that fraction can be enough to affect accuracy. 

Teamwork behind the breakthrough 

The project combined Mayo Clinic's engineering and surgical expertise. Jaeyun Sung, Ph.D., a Mayo Clinic computational biologist, clinical AI researcher and corresponding author, led the engineering and computational work. Dr. Sung focuses on using engineering and computer science to develop advanced precision medicine tools for patient care.  

"When engineers and neurosurgeons look at the same challenge, we see different details, and that's where breakthroughs can happen," Dr. Sung says. "This is about building the next generation of surgical tools that bring engineering-level, sub-millimeter precision directly into the operating room." 

Kendall Lee, M.D., Ph.D., a Mayo Clinic neurosurgeon, led the surgical integration of the technology and said it could make a real difference for patients and improve his practice.  

"Some of the most important steps in neurosurgery happen before we even begin the operation," Dr. Lee says. "This new 3D scanning method is safe, quick and cost-effective, and it can help us hit the right target more accurately, improving how we care for patients."  

Basel Sharaf, M.D., D.D.S., a Mayo Clinic surgeon and lead author of the study, sees even greater possibilities ahead for the technology.  

"In the future, 3D surface scanning could be as simple as using a smartphone," Dr. Sharaf says. "With advanced AI, the system could adapt in real time, even predicting small shifts in the brain to help surgeons work with greater accuracy and a smoother workflow."  

Next Steps: Advancing automation, AI and clinical validation

The team is now working to add automation and artificial intelligence to help make the process faster and easier to use. They are also testing new hardware and running a larger clinical trial to further evaluate the technique's effectiveness in brain surgery.  

Review the study for a complete list of authors, disclosures and funding.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Tia Ford, Mayo Clinic Communications, newsbureau@mayo.edu 

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ROCHESTER, Minn. — For some patients with the most common type of lung cancer, known as lung adenocarcinoma, there's new hope. In a new study published in Cell Reports, Mayo Clinic researchers have found several previously unknown genetic and cellular processes that occur in lung adenocarcinoma tumors that respond well to immunotherapy.

A recently approved group of drugs — immune checkpoint inhibitors — can boost the body's ability to eliminate a tumor and even keep the cancer from coming back. However, while the medications work well for some people, the drugs aren't effective for many other patients with the disease — and researchers are trying to determine why. 

"Our study describes the events that occur when a patient's tumor harbors only one copy of a cancer-causing gene, which occurs in 20% of cases," says Alan P. Fields, Ph.D., a cancer biologist at Mayo Clinic Comprehensive Cancer Center and the principal investigator of the study. 

The research team found that the missing tumor-driving gene, known as PRKCI, results in tumors that are less aggressive. The missing gene also cultivates a more powerful immune response to tumors. Surprisingly, the research team found the improved immune response occurs with help from unexpected players: senescent tumor cells, also known as "zombie cells," which are typically associated with negative consequences of disease and aging. 

The study identified markers that may predict a positive response to immunotherapy and "ultimately may help clinicians stratify patients who are candidates for immune checkpoint inhibitors," says Joey Nguyen, a graduate student at Mayo Clinic Graduate School of Biomedical Sciences and lead author of the publication. 

Addressing the nation's leading cause of cancer death

Lung adenocarcinoma represents 40% of lung cancers in the U.S. and is the leading cause of cancer death. It's strongly associated with smoking, but it's also the most common type of lung cancer to occur in people who have never smoked, likely because of a combination of genetics and other environmental factors.  

Dr. Fields' lab at Mayo Clinic in Florida has long studied the effect of the PRKCI gene, which drives tumor growth. The gene also suppresses the immune system, keeping cancer-killing immune cells at bay. Because lung tumors depend on the gene to proliferate, Dr. Fields' team was surprised to find that in cases where a copy of the gene is missing, lung adenocarcinoma tumors still occur. Nguyen, who was studying PRKCI in the lab, was inspired to try to learn more about those unusual tumors.  

Early experiments found that the tumors without PRKCI grow less aggressively. The team also found that when PRKCI is missing, lung adenocarcinoma cells behave in an unusual way in their very early development, acquiring characteristics of lung cells that regenerate lung tissue after damage. 

The team collaborated with the lab of systems biology researcher Hu Li, Ph.D., to examine the process at a single cell level. "We found that the loss of PRKCI forces tumor cells to hijack a lung regeneration process to generate a tumor," Nguyen says. 

Tracking the effects of a missing gene

Nguyen also noticed that the tumors without PRKCI showed elevated levels of organized clusters of immune cells, called tertiary lymphoid structures. The presence of those clumped cells can be a sign that immune checkpoint therapy might work for a patient. But were they a result of the single copy of the PRKCI gene? 

Nguyen presented his research at a graduate school seminar where the project caught the attention of postdoctoral fellow Luis Prieto, Ph.D., who had an idea. Dr. Prieto wondered whether the clusters of immune cells might be connected in some way to senescent cells, those that enter a state of arrested development and don't die off. Dr. Prieto works in the lab of researcher Darren Baker, Ph.D., who investigates therapies to eliminate senescent cells in various disease processes.

The collaborating labs were amazed to find that senescent tumor cells actually activate the immune system, leading to the clusters of immune cells that combat the tumor. "The idea that senescent cells may be beneficial in certain settings like this is new to the field, as these 'zombies' are commonly associated with detrimental outcomes," says Dr. Baker, who is a co-corresponding author on the study.

The findings reveal three tumor characteristics that may be used to help clinicians identify candidates for immune checkpoint inhibitors: loss of the PRKCI gene, the presence of senescent tumor cells and an abundance of clustered immune cells. 

Further, says Dr. Fields, his team previously identified an approved drug that can inhibit PRKCI signaling, making a tumor that has the PRKCI gene act more like a tumor without it. 

"Now that we understand how PRKCI is working in a lung tumor, it may be possible to couple a PRKCI inhibitor with immunotherapy, so a future clinical trial that combines these approaches will certainly be an important avenue to explore," he says.

See the study for a complete list of authors, disclosures and funding.

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu 

The post Mayo Clinic researchers identify why some lung tumors respond well to immunotherapy appeared first on Mayo Clinic News Network.

As you gather around the table this Thanksgiving to share meals, stories and traditions, consider taking a moment to talk about something that could save lives: your family's health history.  

Mayo Clinic experts are encouraging families to use the holiday to identify these risks and take proactive steps toward prevention. 

"Hereditary conditions range from autoimmune disorders like celiac disease to cancers tied to genetic mutations," says Joseph Murray, M.D., a gastroenterologist at Mayo Clinic with over 30 years of expertise in treating complex digestive diseases. "Thanksgiving provides a unique opportunity to notice these patterns in your family's health and start conversations that could benefit generations to come." 

Hereditary links to digestive conditions

Two conditions Dr. Murray highlights, celiac disease and eosinophilic esophagitis, can have hereditary components but are not always linked to family history.

"Food is central to Thanksgiving, so it's a perfect time to notice who's avoiding certain dishes," Dr. Murray says. "If someone skips bread or mentions swallowing difficulties, it could point to something hereditary." 

Celiac disease, an autoimmune condition triggered by gluten, can cause symptoms like diarrhea, abdominal pain, bloating, weight loss, anemia, fatigue, skin rashes, mouth ulcers and joint pain. It can be diagnosed at any age and presents in over 300 ways, making testing crucial — especially for those with close relatives at higher risk. 

"For siblings, the risk is as high as 20%," Dr. Murray says. "Accurate diagnosis is key, because eliminating gluten without testing can mask other health issues, such as irritable bowel syndrome or lactose intolerance, and delay treatment." 

Dr. Murray says eosinophilic esophagitis is another condition to be aware of. It involves inflammation of the esophagus that leads to difficulty swallowing or food impaction. In children, symptoms can include vomiting, avoiding certain foods or difficulty gaining weight. In adults, it typically presents as difficulty swallowing or the sensation of food getting stuck, which can sometimes require emergency medical attention. Available treatment options include anti-inflammatory medications and immune-targeted therapies. 

Turning genomics into action

Family health history also plays a vital role in cancer and heart disease prevention, says John Presutti, D.O., a family medicine physician and the Cecilia and Dan Carmichael Family Associate Director for the Center for Individualized Medicine at Mayo Clinic in Florida. In his dual role, Dr. Presutti combines his expertise in primary care with advances in genomics to help patients uncover hereditary risks and take proactive steps. 

Dr. Presutti also leads Mayo Clinic's pilot program integrating genomic data into clinical care. This initiative offers genomic screening for actionable genetic markers associated with hereditary breast and ovarian cancer syndrome, Lynch syndrome and familial hypercholesterolemia. These markers can inform preemptive interventions and allow for personalized care. 

"Approximately 10% of cancers are inherited," Dr. Presutti says. "Uncovering hidden genetic mutations through family discussions allows us to screen patients earlier and potentially save lives." 

Hereditary breast and ovarian cancer syndrome is linked to mutations in the BRCA1 and BRCA2 genes. Mutations in BRCA1 can lead to a 60% lifetime risk of developing breast cancer and a 40% risk of having ovarian cancer, among other cancers. BRCA2 mutations increase the risk of developing breast cancer to 50% and ovarian cancer to 20%, with additional risks for prostate and pancreatic cancers in males.  

Lynch syndrome is associated with an 80% lifetime risk of developing colorectal cancer and 50% risk of uterine/endometrial cancer. Familial hypercholesterolemia, a genetic disorder that causes dangerously high cholesterol levels, significantly increases the risk of early heart disease and stroke if left untreated. 

 Dr. Presutti encourages families to ask questions such as: 

• Have any family members had cancer or heart disease? 
• At what age were they diagnosed? 
• Are there patterns of chronic illnesses or early deaths in the family? 
  

Detecting early-onset GI cancers

For younger people, family health history can be especially important as rates of gastrointestinal (GI) cancers are on the rise among people under age 55. Mayo Clinic's Early Onset and Hereditary Gastrointestinal Cancers Program aims to address this growing concern, says Niloy Jewel Samadder, M.D., a Mayo Clinic gastroenterologist and cancer geneticist. 

"The rise in young-onset gastrointestinal cancers is a pressing health issue," Dr. Samadder says. "Our goal is to put patients at the center of a collaborative framework of experts working seamlessly together." 

Launched in 2024, the program integrates gastroenterology, oncology, surgery, pathology and genetics to provide comprehensive, patient-centered care. Translational discoveries, such as immunology studies and a multi-omics approach, are also part of the program, helping to tailor treatments to a patient's unique biological profile. 

"This multidisciplinary approach doesn't just address cancer — it uncovers hereditary risks that can guide care for families," Dr. Samadder explains. "It's about creating a roadmap for prevention and better outcomes." 

A tradition that saves lives 

If you discover something significant about your family health history this Thanksgiving, take action: 

• Talk to your primary care provider about screening or preventive measures. 
• Encourage family members to discuss shared health risks with their doctors. 
• Learn about lifestyle changes or early interventions that could lower your risk.
• Stay proactive by keeping your health records updated and sharing them with relatives. 

"Don't just talk about your family health history," Dr. Presutti says. "Act on it. It could save your life." 

The post Why Thanksgiving is the perfect time to share family health history  appeared first on Mayo Clinic News Network.

ROCHESTER, Minn. — Clinicians typically classify meningiomas — the most common type of brain tumor — into three grades, ranging from slow-growing to aggressive.

But a new multi-institutional study suggests that appearances may be deceiving. If a tumor shows activity in a gene called telomerase reverse transcriptase (TERT), it tends to recur more quickly, even if it looks low-grade under the microscope.

The findings, published in Lancet Oncology, could significantly change how doctors diagnose and treat meningiomas.

"High TERT expression is strongly linked to faster disease progression," says Gelareh Zadeh, M.D., Ph.D., a neurosurgeon at Mayo Clinic and senior author of the study. "This makes it a promising new biomarker for identifying patients who may be at greater risk of developing aggressive disease."

This research was presented at the Society for Neuro-Oncology conference on Nov. 22.

"This is one example of how precision diagnostics of cancer may ultimately improve patient outcomes," says Kenneth Aldape, M.D., Mayo Clinic pathologist and study co-author.

An early warning sign

Meningiomas — tumors of the meninges, the protective tissue that surrounds the brain and spinal cord — are generally considered benign. But a small subset of these tumors has a mutation in the TERT gene, which is linked to faster growth and a shorter time before the tumor returns after treatment.

TERT is the active part of telomerase, an enzyme that maintains telomeres, the protective ends of chromosomes. In most healthy adult cells, TERT is switched off. But if it becomes switched back on, it can fuel cancer development by driving unchecked cell growth.

In this study, the researchers wanted to see whether high TERT expression, even in the absence of the TERT genetic mutation, also predicted worse outcomes. They looked at more than 1,200 meningiomas from patients across Canada, Germany and the U.S., and they found that nearly one-third of them had high TERT expression despite not having the mutation.

These patients had earlier tumor regrowth compared to those without TERT expression, though their outcomes were better than patients with full-blown TERT mutations.

"TERT-positive tumors behaved like they were one grade worse than their official diagnosis," says Dr. Zadeh. "For example, a grade 1 tumor with TERT expression acted more like a grade 2."

Guiding treatment decisions

The findings suggest that testing for TERT activity could help doctors predict which patients are at higher risk for recurrence and may need closer monitoring or more intensive treatment.

"Because meningiomas are the most common primary brain tumor, this biomarker could influence how thousands of patients are diagnosed and managed worldwide," says Dr. Zadeh.

"TERT expression can help us more accurately identify patients with aggressive meningiomas," Chloe Gui, M.D., a neurosurgery resident at the University of Toronto, Mayo Clinic research collaborator and the study's lead author, explains on a podcast hosted by The Lancet Oncology. "This information allows us to offer treatment tailored to the tumor's behavior."

The team is currently investigating ways to incorporate TERT expression into the clinical workflow. The research is part of a larger effort at Mayo Clinic called the Precure initiative, focused on developing tools that empower clinicians to predict and intercept biological processes before they evolve into disease or progress into complex, hard-to-treat conditions.

Review the study for a complete list of authors, disclosures and funding. 

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and to providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news.

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post New genetic biomarker flags aggressive brain tumors appeared first on Mayo Clinic News Network.

JACKSONVILLE, Fla. — A major international study led by Mayo Clinic researchers and funded by the National Institutes of Health found that for people with severe carotid artery narrowing who haven't experienced recent stroke symptoms, a minimally invasive procedure called carotid artery stenting, combined with intensive medical therapy, significantly lowered stroke risk compared with medical therapy alone. Traditional surgery (carotid endarterectomy) did not show the same benefit. The research is published in The New England Journal of Medicine.

The Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2) is the largest study to date comparing current treatment approaches for this condition, caused by plaque buildup in the arteries supplying blood to the brain.

Carotid stenosis can lead to a stroke if plaque breaks off and blocks blood flow. Although surgery and stenting have long been used to open these arteries, newer medications and better risk factor control have raised questions about whether these procedures are still needed for people who don't have symptoms.

"Decades ago, surgery clearly helped prevent strokes in many patients," says Thomas Brott, M.D., a neurologist at Mayo Clinic in Florida and the study's senior author. "But medical therapy has improved so much that we needed to reexamine the balance between benefit and risk for people who have no symptoms."

The CREST-2 program consisted of two parallel, randomized clinical trials conducted at 155 medical centers in five countries, including Australia, Canada, Israel, Spain and the U.S. Each enrolled more than 1,200 adults with severe carotid artery narrowing of 70% or greater who had not had a stroke or transient ischemic attack (ministroke) in the past six months.

In one trial, participants received stenting plus intensive medical therapy or medical therapy alone. In the other, participants received endarterectomy plus medical therapy or medical therapy alone.

All participants received comprehensive medical care, including lifestyle coaching and medication as needed, to manage their blood pressure, low-density lipoprotein (LDL) cholesterol and diabetes, and to help them stop smoking.

Working with investigators from the University of Alabama at Birmingham, researchers analyzed the occurrence of stroke and death within 44 days of stenting or surgery. They also analyzed the occurrence of stroke over four years on the same side of the body as the narrowed artery.

The stenting trial found a significant reduction in stroke: over four years, 2.8% of patients treated with stenting and medical therapy had a stroke compared to 6% of those on medical therapy alone (roughly half the risk of stroke). However, in the endarterectomy trial, the difference in stroke rates (3.7% with surgery vs. 5.3% with medical therapy alone) was not statistically significant. Serious complications were uncommon with either procedure.  

The findings provide clearer guidance for physicians and patients considering a preventive procedure. Dr. Brott emphasizes personalized decision-making.

"For some patients — particularly those with more advanced narrowing or plaque that appears unstable or more likely to cause a blockage — stenting may offer added protection, while for others, medical therapy alone may be enough," he says.

Close follow-up and coordinated care helped all participants achieve and maintain significant improvements in their blood pressure and cholesterol levels.

Researchers will continue to track participants for long-term results. They are also studying whether imaging tools can help identify which patients benefit most from each treatment.

For a full list of authors and disclosures, see the paper.

Related: Mayo Clinic Neurologists Lead International Study to Test Best Approach to Stroke Prevention

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About Mayo Clinic
Mayo Clinic is a nonprofit organization committed to innovation in clinical practice, education and research, and providing compassion, expertise and answers to everyone who needs healing. Visit the Mayo Clinic News Network for additional Mayo Clinic news. 

Media contact:

• Julie Ferris-Tillman, Ph.D., Mayo Clinic Communications, newsbureau@mayo.edu

The post Landmark Mayo Clinic study finds stenting reduces stroke risk in people with carotid artery narrowing appeared first on Mayo Clinic News Network.