ROCHESTER, Minn. — An international study led by Mayo Clinic researchers has identified interleukin-6 (IL-6) receptor blockers as a promising option for preventing relapses in myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD). MOGAD is a rare autoimmune neurological disorder that can cause vision loss, paralysis and other serious neurological complications.

The study, published in JAMA Neurology, provides one of the largest real-world evaluations to date of IL-6 receptor blockade in patients with MOGAD and offers new evidence to help guide treatment decisions while randomized clinical trials are underway.

MOGAD occurs when the immune system mistakenly attacks myelin, the protective coating surrounding nerve fibers in the brain, spinal cord and optic nerves. In some patients, the disease causes repeated inflammatory attacks, or relapses, that can lead to accumulating neurological disability. Although several therapies are used off-label, there are currently no treatments approved specifically for preventing relapses in MOGAD.

The study focused on two medications, tocilizumab and satralizumab, that belong to a class of drugs known as IL-6 receptor blockers. Researchers believe the immune signaling protein IL-6 plays an important role in the inflammation that damages myelin in people diagnosed with MOGAD. By blocking that immune signaling pathway, these medications are designed to reduce inflammation and help prevent future relapses.

"Interleukin-6 receptor blockers appear to be a promising treatment option for people living with MOGAD," says Eoin Flanagan, M.B., B.Ch., a neurologist at Mayo Clinic and senior author of the study. "While we await results from randomized clinical trials, these findings provide additional evidence that these medications may help limit the neurological disability that can accumulate with repeated attacks.”

Researchers evaluated 116 patients treated with IL-6 receptor blockers across multiple centers in North and South America, making it the largest observational study of its kind. Most participants received tocilizumab, which is widely available around the world, while a smaller number received satralizumab. The study found that patients had substantially fewer relapses after starting treatment and that the medications had a generally favorable safety profile, though infections remain an important consideration for clinicians.

Because MOGAD is uncommon, individual medical centers often care for relatively small numbers of patients, making it difficult to study new treatments. This multinational collaboration allowed researchers to evaluate outcomes across various patient populations while expanding the evidence for IL-6 receptor blockade in MOGAD.

"Rare diseases require collaboration," says Andreu Vilaseca Jolonch, M.D., first author of the study and a neurology fellow at Mayo Clinic. "By bringing together patients and researchers across multiple countries, we were able to generate stronger evidence than any single center could produce alone. That collaboration not only strengthened this study but also created a foundation for future research."

Multiple clinical trials evaluating treatments for MOGAD are underway, and observational studies such as this one help provide important evidence while physicians await those results.

"There is growing optimism for patients with MOGAD," Dr. Flanagan says. "New treatments are emerging, and we're trying to bring the best treatment options to patients while continuing to learn which therapies work best."

This research was supported by the National Institutes of Health (R01NS113828). One patient included in the study was supported by National Institutes of Health grant R01AI170863-01A1.

 For a complete list of authors, disclosures and funding, review the JAMA Neurology article.

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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.

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

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JACKSONVILLE, Fla. — Mayo Clinic researchers have developed an experimental drug with the help of artificial intelligence (AI) to target the "undruggable" PDZ-domain of GIPC1 protein that helps different types of cancer, including pancreatic cancer, to grow and resist treatment. In laboratory studies, the drug slowed tumor growth, improved survival and enhanced the effects of the chemotherapy drug gemcitabine.

The findings, published in Cell Reports, also demonstrate how AI could help develop a small molecule inhibitor of a target protein that can be less toxic and speed the discovery of new cancer treatments.

Pancreatic cancer is one of the most difficult cancers to treat because it is often diagnosed after it has spread and is resistant to many current therapies. While survival rates remain low, advances in research are creating new opportunities to develop more effective treatments. This study represents one of those promising advances, offering a potential new strategy for targeting pancreatic cancer.

Using AI, in collaboration with Sravathi AI Technology for IP Sharing, a company based in Bangalore, India, the research team screened nearly 40,000 potential compounds before identifying one that blocks GIPC1. The experimental drug also showed early signs of changing the environment around tumors in ways that could improve future combination therapies. Additional studies are needed before it can be tested in people.

"Pancreatic cancer has remained exceptionally difficult to treat because tumors rapidly adapt and become resistant to many available therapies," says Debabrata (Dev) Mukhopadhyay, Ph.D., senior author of the study and a cancer researcher at Mayo Clinic in Florida. "Our study demonstrates that AI can help us identify entirely new therapeutic opportunities against targets that have historically been considered undruggable. While these findings are preclinical, they provide a strong foundation for the next phase of research."

The therapy remains experimental, and additional studies are needed to evaluate its safety and determine whether it can advance to clinical trials.

This research was supported in part by the National Institutes of Health, the Florida State Fund for the Casey DeSantis Cancer Research Program and the U.S. Department of Defense. 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.

Media contact:

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

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ROCHESTER, Minn. — Mayo Clinic researchers have identified a protein that cancer cells use to shut down the body's immune response, a discovery that could help scientists develop new treatments that make cancer immunotherapies more effective.

Published in the Journal of Clinical Investigation, the study identifies a previously unknown role for a protein called TRAILshort, which acts like an immune "off switch." The researchers found that TRAILshort prevents T cells — the immune system's primary cancer-fighting cells — from recognizing and destroying cancer and virus-infected cells. In preclinical models, blocking the protein restored T-cell activity and improved immune response. 

The researchers also found that TRAILshort reduces the effectiveness of chimeric antigen receptor-T cell therapy (CAR-T cell therapy), one of the most advanced forms of cancer immunotherapy. Their findings suggest that therapies designed to block TRAILshort could improve CAR-T treatment and potentially benefit other immune-based cancer therapies.

"What strikes me most is that TRAILshort appears in cancer, HIV, COVID-19, tuberculosis, lupus and Crohn's disease — almost every condition where the immune system is failing or misfiring. That tells us we may have identified a fundamental switch in human immunity, not just a curiosity in one disease," says Andrew Badley, M.D., senior author of the study. Dr. Badley is the HH Sheikh Khalifa Bin Zayed Al Nahyan Professor of Infectious Diseases and an immunologist at Mayo Clinic.

How cancer disrupts the immune response 

Mayo Clinic researchers first discovered TRAILshort while studying HIV nearly 15 years ago. In 2020, they found that cancer cells also produce the protein, but how it suppressed T-cell activity remained unknown. This new study reveals the mechanism for the first time.

Researchers found elevated levels of TRAILshort in melanoma, lung, breast, pancreatic and ovarian cancers, as well as Hodgkin lymphoma. Elevated levels also were found in infectious diseases, including COVID-19, tuberculosis and hepatitis C.

Using highly specific antibodies and engineered preclinical models, the team found that TRAILshort activates SHP-1, a protein that acts as a molecular brake, shutting down T cells before they can attack diseased cells.

"This is the first study to show that TRAILshort doesn't just block cell death — it also acts as a signaling molecule that directly suppresses T-cell activity," says Shahrzad Jalali, Ph.D., a research scientist at Mayo Clinic and lead author of the study. "That reveals an entirely new role for the protein in regulating the immune response."

Why TRAILshort is a potential target for new therapies

The findings suggest several potential therapeutic applications.

Researchers found that TRAILshort significantly reduced CAR-T therapy's ability to control tumors in preclinical models. Blocking the protein restored immune activity, suggesting that targeting it could be a new strategy to improve CAR-T therapy and other immunotherapies. The researchers also believe that TRAILshort could serve as a biomarker to help identify tumors more likely to respond to targeted therapies.

"Discovering the role of TRAILshort and how it inhibits CAR-T cells opens the door for a new therapeutic strategy to improve their activity," says Saad Kenderian, M.B. Ch.B., an oncologist at Mayo Clinic Comprehensive Cancer Center and study co-author. "This is an important step as we work to make CAR-T therapy more effective for patients with cancer."

Beyond cancer, researchers say TRAILshort  may eventually provide a way to selectively reduce harmful immune activity in autoimmune diseases or transplantation without broadly suppressing the immune system.

"In cancer, there's too much TRAILshort, so our goal is to get rid of it with antibodies that remove it. In autoimmune disease, there's not enough TRAILshort, so our goal is to deliver more," Dr. Badley says.

Additional studies are needed to determine whether these approaches are safe and effective in patients.

"What excites us most is that this discovery gives us a new, actionable way to regulate the immune system," Dr. Badley says. "By targeting TRAILshort, we may be able to strengthen immune responses against cancer and chronic infections or, in other diseases, reduce harmful immune activity."

This research is part of a broader effort at Mayo Clinic known as the Precure Research initiative. It focuses on developing tools to help clinicians detect and address disease-related changes earlier, before symptoms appear or conditions become harder to treat. This discovery identifies the molecular mechanism behind T-cell failure across cancer and chronic infection, giving researchers a defined target and a road map for therapeutic development.

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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ROCHESTER, Minn. — A visit from a therapy animal may do more than lift spirits. A new study in Mayo Clinic Proceedings highlights how animal-assisted treatment can support inpatient stroke rehabilitation. Patients who interacted with therapy animals showed greater engagement in their treatment, increased physical activity and longer mobility compared with those who did not.

The findings suggest a promising approach to addressing common barriers patients face with stroke recovery, including limited motivation, reduced energy, lack of companionship and decreased interest in therapy activities. By incorporating trained therapy dog-handler teams into rehabilitation care, patients can do a variety of activities including walking, playing fetch, and petting or brushing the dog.

"The presence of a therapy dog can change the entire dynamic of a rehabilitation session," says Whitney Romine, manager of animal-assisted services at Mayo Clinic. "Patients often share that they feel more grounded, safe and empowered to engage in therapy activities, which can make a meaningful difference in their recovery experience."

The paper, "The Impact of Animal-Assisted Treatment on Inpatient Stroke Rehabilitation," shows how patient care could be improved using a clinical care delivery model that includes qualified animal handler teams. The study also explores how these changes could be applied across a variety of medical specialties and patient populations.

"Stroke recovery can be challenging, particularly when patients face barriers such as low motivation or limited energy," says Brent Bauer, M.D., a physician in internal medicine at Mayo Clinic. "This research demonstrates that animal-assisted treatment may offer a practical and effective way to enhance engagement and support better rehabilitation outcomes."

Watch: Dr. Brent Bauer discusses the benefits of therapy dogs

Journalists: Sound bites and broll with Dr. Bauer are in the downloads at the end of the post. Please courtesy: "Brent Bauer, M.D./General Internal Medicine/Mayo Clinic."

This research was conducted in collaboration with Nestlé Purina PetCare. For a complete list of authors, disclosures and funding, review the study.

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About Mayo Clinic Proceedings
Mayo Clinic Proceedings is a peer-reviewed medical journal that publishes original research and reviews across clinical and translational science.

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

The post Mayo Clinic study highlights benefits of animal-assisted treatment in stroke rehabilitation (VIDEO) appeared first on Mayo Clinic News Network.

SAO PAULO and ROCHESTER, Minn. — Mayo Clinic and Einstein Hospital Israelita today announced a milestone in their collaboration to advance responsible artificial intelligence (AI)-enabled healthcare innovation. Einstein's de-identified clinical data is now available through Mayo Clinic Platform's secure, privacy-preserving global healthcare innovation ecosystem. The collaboration strengthens South American representation in global health datasets and enables researchers and innovators to develop, validate, and scale AI-enabled solutions across a broader representation of patient populations.

"Working with leading hospitals around the world, like Einstein Hospital Israelita, Mayo Clinic Platform is curating the world's data and assembling the world's innovators to advance healthcare transformation," says John Halamka, M.D., Dwight and Dian Diercks president, Mayo Clinic Platform. "By building a global health data network, we can accelerate the discovery, development and deployment of trusted AI-enabled solutions to improve care for patients everywhere."

For Einstein Hospital Israelita, the milestone reinforces its role as one of the global and leading institutions in health innovation, enabling the development and validation of AI-enabled solutions through Mayo Clinic Platform's secure environment while contributing regional clinical perspectives to global research. The collaboration also creates opportunities for multicenter studies, responsible algorithm validation and future innovation opportunities to connect healthcare professionals, researchers and digital health innovators.

To prepare for this data collaboration, Einstein Hospital Israelita joined Mayo Clinic Platform's Early Adopter Program to learn how to best use the Platform's tools and capabilities to advance global AI research.

"Einstein is now taking a more strategic role in one of the most relevant global health data networks focused on innovation. This advancement marks the completion of a technological adaptation stage for secure cloud data access and paves the way for the development, validation, and implementation of AI-based solutions and algorithms. It will also enable secure multicenter studies with privacy protection to advance medical practice, resulting in greater capacity to scale projects to global standards," says Sidney Klajner, president of Einstein Hospital Israelita.

This global health data network, called Mayo Clinic Platform_Connect, now includes eight members and spans seven countries across three continents. Connect brings broad representation in genetics, demographics and lifestyles to provide a massive repository of analyzable data for research and responsible AI development to transform healthcare globally. All data remains de-identified and under the control of each participating healthcare organization.

Connect's founding members include Brazil's Einstein Hospital Israelita, Canada's University Health Network, Israel's Sheba Medical Center, Mayo Clinic and Mercy in the United States. Additional partners include Aga Khan University in Kenya and Seoul National University Hospital in South Korea.

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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 Platform
Mayo Clinic Platform is a strategic initiative of Mayo Clinic that enables collaboration, data-driven innovation and responsible AI development to transform healthcare globally. Mayo Clinic Platform is reimagining healthcare as an ecosystem — one where data, digital solutions, and expertise flow seamlessly between innovators and care teams to improve care for patients everywhere.

About Einstein Hospital Israelita
Einstein Hospital Israelita is one of Latin America's leading healthcare, education, research and innovation institutions. Based in Sao Paulo, Brazil, Einstein combines high-complexity care, scientific research, digital health capabilities and partnerships with global organizations to advance healthcare transformation. Through initiatives in artificial intelligence, data science, technology validation and innovation, Einstein works to translate knowledge into better care, broader access and improved outcomes for patients in Brazil and beyond.

Media contacts:

• Caroline Auger, Mayo Clinic Communications, newsbureau@mayo.edu
• Luna Aghata, Einstein Hospital Israelita Communications, imprensa@einstein.br  

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ROCHESTER, Minn. — A series of Mayo Clinic studies is helping reshape scientists' understanding of senescent, or "zombie," cells — aging cells that no longer divide but remain metabolically active and release inflammatory molecules that contribute to age-related diseases.

Published across Nature journals, the studies authored by scientists within the Robert and Arlene Kogod Center on Aging move the field beyond recognizing that senescent cells contribute to aging. Together, they provide new tools to identify these cells, uncover mechanisms that drive inflammation and explore strategies to reduce their effects in preclinical models. In collaboration with researchers across the U.S., they are part of an ambitious project to map senescent cells across different tissues. The project is called the Cellular Senescence Network (SenNet) Consortium and is funded by the National Institutes of Health Common Fund. Its primary objective is to compile comprehensive atlases of senescent cells within the human body over a lifetime.  

"This body of work is moving the aging field forward to precisely identify, understand and target the specific senescent cells that contribute to age-related dysfunction, which is the necessary groundwork to develop new therapies that support healthy aging," says Marissa Schafer, Ph.D., a Mayo Clinic researcher whose laboratory led several of the studies.

Exploring new therapeutic strategies

Several studies evaluated approaches designed to reduce the burden or harmful effects of senescent cells in preclinical models.

The research examined interventions, including senolytic drugs, a naturally occurring compound found in tomatoes, and genetic approaches that selectively target senescent cells. In aged mice, these strategies reduced measures of inflammation and improved outcomes associated with aging, including physical frailty, brain inflammation and cognitive performance.

Another study identified IL-23R as a potential blood biomarker that could one day help researchers assess biological aging and monitor responses to future therapies.

Although additional research is needed before these findings can be translated to patient care, the studies provide a stronger scientific foundation for developing more targeted interventions for age-related diseases.

Dr. Schafer is the senior author of the following papers:

• "IL-23R is a senescence-linked circulating and tissue biomarker of aging"
• "Spatial mapping and senolytic targeting of senescent and disease-associated microglia in aged mouse brain white matter"

Revealing why senescent cells drive inflammation

Additional studies uncovered previously unknown mechanisms that help explain why senescent cells produce persistent inflammation.

Researchers found that dysfunctional mitochondria — the structures that generate energy inside cells — contribute to inflammation through multiple pathways. One mechanism involves mitochondrial DNA and RNA activating immune signaling. Another shows that mitochondrial metabolism changes how inflammatory genes are activated through epigenetic regulation.

Together, these discoveries identify potential therapeutic targets that could reduce harmful inflammation without necessarily eliminating senescent cells.

João Passos, Ph.D., is the senior author of the following papers:

• "Distinct senotypes in p16- and p21-positive cells across human and mouse aging tissues"
• "Mitochondrial metabolism and epigenetic crosstalk drive SASP"
• "Mitochondrial RNA cytosolic leakage drives the SASP"

A growing body of research

Taken together, these studies advance the field from demonstrating that senescent cells contribute to aging toward understanding which senescent cells matter most, how they drive disease and how they may be targeted more precisely.

Rather than focusing solely on eliminating senescent cells, the research supports a more nuanced approach that aims to identify the biological pathways responsible for harmful inflammation and develop therapies that selectively interrupt those processes.

Darren Baker, Ph.D., a Mayo Clinic researcher, is the senior author of the paper, "Senotypes define the diverse landscape of senescent cells."

The research is part of a larger effort at Mayo Clinic called the Precure Research initiative, which is 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 studies 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, Mayo Clinic Communications, newsbureau@mayo.edu

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ROCHESTER, Minn. — Researchers have uncovered a previously unknown mechanism that helps aging cells drive the chronic inflammation linked to many age-related diseases. The findings reveal how dysfunctional mitochondria — the cell's energy-producing structures — work with the cell's epigenetic machinery to switch on inflammatory genes, opening the door to a new therapeutic approach for promoting healthier aging.

The study, published in Nature, builds upon years of research showing that senescent, or "zombie," cells accumulate with age. While these cells no longer divide, they remain metabolically active and release a cocktail of inflammatory molecules known as the senescence-associated secretory phenotype, or SASP.

This persistent inflammation is thought to contribute to frailty, cardiovascular disease, cancer, neurodegeneration and other disorders of aging.

"For years, the field has focused on getting rid of senescent cells," says João Passos, Ph.D., a Mayo Clinic researcher and senior author of the study conducted in collaboration with Sanford Burnham Prebys Medical Discovery Institute. "Our strategy has been different. Instead of killing the cells, we asked whether we could switch off the inflammation that makes them harmful."

Previous work from the Passos laboratory demonstrated that damaged mitochondria leak mitochondrial DNA and RNA into the cell, activating immune pathways that trigger inflammation. The new study identifies a second, independent pathway that is equally essential.

"We found that inflammatory signaling alone isn't enough," says Helene Martini, Pharm.D., Ph.D., a Mayo Clinic researcher and first author of the study. "The cells also need a metabolic signal from mitochondria that changes how inflammatory genes are turned on."

The researchers discovered that senescent cells increase production of acetyl-CoA, a molecule generated through mitochondrial metabolism. Acetyl-CoA enables epigenetic modifications — chemical changes that regulate whether genes are switched on or off without altering the DNA sequence itself. These modifications make inflammatory genes more accessible, allowing them to be robustly expressed.

In other words, mitochondrial DNA and RNA provide the inflammatory alarm, while mitochondrial metabolism grants the molecular "permission" needed to fully activate inflammatory genes.

"This is a completely new pathway," says Dr. Martini. "We found that dysfunctional mitochondria can promote inflammation by controlling epigenetic switches that turn inflammatory genes on."

The team also identified a promising therapeutic target: a mitochondrial citrate transporter known as SLC25A1. Blocking this transporter reduced the supply of acetyl-CoA, limiting activation of inflammatory genes even though the initial immune signals remained present. Together, these findings reveal a previously unrecognized control point that could be exploited to promote healthier aging.

The research is part of a larger effort at Mayo Clinic called the Precure Research initiative, which is 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 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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PHOENIX — An international phase 3 study performed at all three Mayo Clinic destination medical centers found that a new immunotherapy helped many patients with an aggressive form of bladder cancer keep their bladder instead of having it surgically removed. The treatment also kept many patients cancer-free for more than two years and caused mostly mild side effects. The findings were published in The Lancet Oncology.

Patients in the study had high-risk bladder cancer that had returned despite standard treatment with bacillus Calmette-Guérin (BCG). For these patients, surgery to remove the bladder is typically the recommended next step. The new immunotherapy treatment, called cretostimogene grenadenorepvec, produced a complete response, with no detectable signs of cancer in 75% of patients, with many of those responses lasting beyond two years.

"Until now, patients whose cancer returned after BCG therapy have had few effective options besides bladder removal," says Mark Tyson II, M.D., lead author of the study and a urologist at Mayo Clinic in Arizona. "This study shows we may be able to offer many of those patients another option without compromising cancer control."

Among patients whose cancer completely disappeared after treatment, about 60% remained cancer-free two years later. In one patient, the cancer has not returned for more than four years after completing treatment. Most treatment-related side effects were mild, temporary bladder symptoms, and researchers reported no severe treatment-related side effects.

"For patients, this isn't just about treating cancer — it's about preserving quality of life," says Dr. Tyson. "Avoiding bladder removal can have a profound impact on daily living. Seeing patients remain cancer-free for years while keeping their bladder is exactly the outcome we've been hoping to achieve."

The study included 115 patients treated at 41 medical centers across North America, Asia and Australia. Two years after starting treatment, an estimated 81% of patients had not needed surgery to remove their bladder. The researchers concluded that cretostimogene grenadenorepvec could become an important bladder-sparing treatment option for patients whose high-risk bladder cancer has returned after standard BCG therapy. They also noted that the treatment has not been directly compared with other bladder-sparing therapies in clinical trials.

The study was funded by CG Oncology. For a complete list of authors, disclosures and funding, review the study. The therapy remains investigational.

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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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Mayo Clinic oncologist explains risk factors, treatment considerations for patients under 50

PHOENIX — You may have heard that colorectal cancer is increasingly affecting young adults. However, it is not the only gastrointestinal (GI) cancer that doctors are diagnosing in patients below the age of 50, explains Christina Wu, M.D., an oncologist at Mayo Clinic Comprehensive Cancer Center in Arizona.

"People under 50 are not too young to develop gastrointestinal cancers," Dr. Wu says. "If young adults notice new or persistent symptoms, it's important to get them worked up."

At Mayo Clinic, early-onset gastrointestinal cancers are defined as GI cancers diagnosed in people under 50 years old. Research shows that the most common type of early-onset GI cancer worldwide is colorectal cancer, followed by stomach cancer, esophageal cancer and pancreatic cancer. Less common types of early-onset GI cancers include bile duct, gallbladder, appendix, neuroendocrine and small bowel cancers.

"More research needs to be done to understand what causes the rise in incidence of early-onset GI cancers," Dr. Wu says. "We know that certain factors can increase the risk of developing GI cancers, and early detection gives patients a better chance of successful treatment."

Risk factors

Several factors can increase the risk of developing early-onset GI cancers, including genetic conditions, chronic diseases and lifestyle:

• Lynch syndrome and familial adenomatous polyposis are hereditary conditions that are associated with an increased risk of early-onset colorectal cancers.

• Inflammatory bowel disease and primary sclerosing cholangitis can increase the risk of developing GI cancers such as colorectal cancer and cholangiocarcinoma, respectively.

• A sedentary lifestyle, obesity, diets high in processed foods, alcohol consumption, smoking and environmental exposures may be associated with an increased risk of GI cancers.

Early detection and symptoms

Recommendations for when people at average risk for colorectal cancer should be screened vary by country but generally start in their 40s or early 50s. In the U.S., colorectal cancer screening is recommended to start at age 45 for people at average risk; people with risk factors such as a family history of colorectal cancer may need to start screening earlier.

Having a primary care clinician, getting regular health checkups and discussing any health concerns with a healthcare professional can help determine what screening or tests may be needed, depending on individual risk factors.

In some cases, symptoms of early-onset GI cancers may present and be associated with specific cancer types:

• Unintentional weight loss with jaundice and pain may indicate pancreatic cancer.
• Weight loss, pain, and difficulty eating or swallowing may be linked to stomach cancer.
• A persistent change in bowel habits, abdominal pain and iron-deficiency anemia may be associated with colorectal cancer.

"Any new symptoms that are persistent or worrisome should prompt a visit to a healthcare professional to get checked out," Dr. Wu says. "If symptoms are ignored or not investigated, young adults may experience a delay between when they first experience symptoms and a cancer diagnosis. Recognizing symptoms early is important," Dr. Wu explains.

Tailoring care for younger adults  

Young adults diagnosed with GI cancers often need multidisciplinary care due to differences in cancer biology, as well as unique social and life-stage needs.

"Before starting treatment, we perform genetic testing and tumor profiling to identify mutations that may guide targeted therapies," says Dr. Wu. "These advances allow us to provide more personalized and effective treatment for our patients."

In addition, young adults may require support, such as fertility preservation and resources to navigate the emotional and practical challenges of a cancer diagnosis. Mayo Clinic's Early-Onset and Hereditary GI Cancers Program provides specialized, multidisciplinary care for this patient population.

Innovations in treatment

With advances in genetic testing and tumor profiling, cancer care teams can provide more personalized and targeted treatments, including immunotherapy in some cases, and identify patients who may be eligible for clinical trials. Analysis of the tumor helps guide treatment decisions and identify appropriate therapies.

For certain GI cancers, treatment may involve a combination of chemotherapy, radiation (including proton beam therapy) and surgery. Advances in treatment, including minimally invasive approaches and immunotherapy, are improving care for some GI cancers.

Mayo Clinic researchers have been exploring the use of artificial intelligence as an additional aid in the detection of gastrointestinal cancers such as colorectal cancer and pancreatic cancer.

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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:

• Caroline Auger, Mayo Clinic Communications, newsbureau@mayo.edu

The post Colorectal cancer isn’t the only gastrointestinal cancer rising in young adults appeared first on Mayo Clinic News Network.

Decentralized approach increases participation among rural and underserved populations

ROCHESTER, Minn. — A Mayo Clinic study published in JAMA Network Open found that bringing some or all clinical trial-related activities directly to patients can help overcome barriers that prevent many people from participating. Increased participation and expanded access to research was observed for people in rural communities and underserved populations.

The study evaluated Mayo Clinic's decentralized clinical trials program, which allows many research activities to take place outside a traditional research site through services such as remote informed consent, video visits, in-home blood draws, remote monitoring and home delivery of oral study medications. Researchers found the approach expanded the geographic reach of clinical trials while increasing participation among patients who have historically faced barriers to enrollment.

Broader participation can help ensure clinical trial findings better reflect the patients who will ultimately receive new treatments.

"Clinical trials shape the future of medicine," says Tufia Haddad, M.D., a medical oncologist at Mayo Clinic Comprehensive Cancer Center in Rochester and the study's first author. "When we put those trial results into clinical practice, we need to make sure they're representative of all the patients we see."

Researchers evaluated 765 clinical trials involving 7,469 participants over 15 months. The percentage of participants living more than 120 miles from a Mayo Clinic campus in Rochester, Minnesota; Phoenix; or Jacksonville, Florida, increased from 18.9% to 29.6%. Enrollment from rural communities increased from 16.6% to 24.9%, while participation among underserved racial and ethnic populations increased from 12.5% to 17.4%.

"We showed that decentralized clinical trial infrastructure can make research access measurable," says Lydia Mercado, M.D., senior research program coordinator at Mayo Clinic in Florida and the study's second author. "By reducing travel requirements and other logistical burdens, we create more realistic opportunities for patients to participate in research."

Bringing research closer to patients

Only a small percentage of patients who are eligible for clinical trials ultimately enroll. In addition to limited awareness of research opportunities, participation often requires frequent visits for physical exams, laboratory testing and safety monitoring — creating significant time and travel burdens for patients and caregivers.

Depending on the study, decentralized clinical trials allow many of those activities to take place closer to where patients live. Participants may review and sign consent forms electronically, meet with research teams through secure video visits, receive in-home blood draws, have oral study medications delivered to their homes, and use wearable devices or other digital tools to monitor their health between visits.

"The most innovative clinical trials are often conducted at academic medical centers, while the majority of healthcare is delivered in community settings," Dr. Haddad says. "We don't want a patient's ZIP code or geography to determine whether they can access these research opportunities."

Researchers emphasize that decentralized approaches do not replace traditional clinical trials but instead move only those activities that can be safely conducted outside a research center. Institutional review boards carefully evaluate study protocols, and research teams determine which assessments can occur remotely while maintaining patient safety and study quality.

"Clinical trials shape the future of medicine. When we put those trial results into clinical practice, we need to make sure they're representative of all the patients we see." - Dr. Tufia Haddad.

Expanding access while maintaining research quality

Researchers also intentionally tracked participation among rural and historically underserved populations to evaluate whether decentralized clinical trials expanded access more equitably.

"We didn't want these decentralized capabilities to widen existing gaps in research participation, but rather our goal was to help close them," Dr. Haddad says. "From the program's inception, we intentionally focused on these metrics."

To help remove technology barriers, the program provides cellular-enabled tablets when needed, selects technologies with demonstrated ease of use, offers technical support and, when appropriate, gives participants options for how they engage with study teams.

"Flexibility is one of the greatest advantages of decentralized clinical trials," Dr. Mercado says. "Studies can be designed around the patient while still meeting scientific objectives."

Shaping the future of clinical trials

The findings support Mayo Clinic's broader Clinical Trials Beyond Walls program, which aims to make research available to all communities.

"Think of what this means for patients who are going through a cancer diagnosis," says Cheryl Willman, M.D., co-author of the study and the Stephen and Barbara Slaggie Executive Director, Mayo Clinic Cancer Programs, and director, Mayo Clinic Comprehensive Cancer Center. Cancer clinical trials are the most common trials at Mayo Clinic that are leveraging decentralized capabilities — 58% of the trials in the study were cancer-related. "Patients are getting access to cutting-edge therapies from the most trusted name in healthcare, all in the healing environment of their home."

The next phase of decentralized trials will focus on expanding collaborations with community healthcare providers so more study activities can be completed closer to patients' homes.

Researchers expect continued advances in mobile diagnostics, remote imaging, digital health technologies and at-home drug treatments that could further reduce the need for travel while maintaining rigorous clinical research.

This work is also part of the Clinical Impact initiative at Mayo Clinic, which aims to bring the promise of clinical trials to more patients, ensuring that they gain access to new therapies as quickly as possible.

"We're already enrolling patients who have never stepped foot in a Mayo Clinic facility," Dr. Haddad says. "The long-term goal is to build an infrastructure that not only serves Mayo Clinic patients but can ultimately help other research organizations reach more patients, regardless of where they live."

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

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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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