Nature Medicine最新文献

{"title":"Precision Omics Initiative Sweden (PROMISE) will integrate research with healthcare","authors":"Anders Kämpe, Sanna Gudmundsson, Colum P. Walsh, Kerstin Lindblad-Toh, Åsa Johansson, Anna Clareborn, Adam Ameur, Anders Edsjö, Thoas Fioretos, Hans Ehrencrona, Daniel Eriksson, Tove Fall, Paul W. Franks, Ulf Gyllensten, Margareta Haag, Anna Hagwall, Maria Johansson Soller, Janne Lehtiö, Yi Lu, Patrik K. E. Magnusson, Erik Melén, Beatrice Melin, Karl Michaëlsson, Ann Nordgren, Jessica Nordlund, Lao H. Saal, Jochen M. Schwenk, Per Sikora, Johan Sundström, Fulya Taylan, Bethany Van Guelpen, Mia Wadelius, Anna Wedell, Valtteri Wirta, Päivi Östling, Bo Jacobsson, Tobias Sjöblom, Bengt Persson, Richard Rosenquist, Anna Lindstrand, Tuuli Lappalainen","doi":"10.1038/s41591-025-03631-9","DOIUrl":"https://doi.org/10.1038/s41591-025-03631-9","url":null,"abstract":"<p>Data-driven research and precision ‘-omics’ technologies have immense transformative potential to provide tailored treatment and care, embodying the principles of precision medicine. Sweden is a global leader in adopting genomic tools in healthcare. Still, national research datasets from human cohorts are too fragmented or too small to meet the needs of modern precision ‘-omics’ research. This positions Sweden behind its peer countries, with unmet research and healthcare implementation opportunities. However, the country is exceptionally well placed to change course, expand research data resources and adopt unique designs that integrate research and healthcare.</p><p>Here, we present Precision Omics Initiative Sweden (PROMISE)¹ and its three pillars: to generate extensive new large-scale multi-omics data with integration of selected existing research, registry and healthcare data; to maximize research use of ‘-omics’ data created in healthcare; and to develop an improved data-access framework.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"22 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Allogeneic NK cells with a bispecific innate cell engager in refractory relapsed lymphoma: a phase 1 trial","authors":"Yago Nieto, Pinaki Banerjee, Indreshpal Kaur, Rafet Basar, Ye Li, May Daher, Hind Rafei, Lucila N. Kerbauy, Mecit Kaplan, David Marin, Lori Griffin, Melissa Barnett, Roland Bassett, Nadima Uprety, Rejeena Shrestha, Francia Reyes Silva, Sanjida Islam, Christina Ganesh, Zephanie Borneo, Jeremy Ramdial, Alejandro Ramirez, Chitra Hosing, Amin Alousi, Uday Popat, Muzaffar Qazilbash, Sairah Ahmed, Swaminathan Iyer, Tania P. Sainz, Francisco Vega, Natalie W. Fowlkes, Karenza Alexis, Michael Emig, Andreas Harstrick, Andre Overesch, Elizabeth J. Shpall, Katayoun Rezvani","doi":"10.1038/s41591-025-03640-8","DOIUrl":"https://doi.org/10.1038/s41591-025-03640-8","url":null,"abstract":"<p>Outcomes of patients with CD30-positive (CD30⁺) lymphomas have improved with the advent of brentuximab vedotin (BV) and, in Hodgkin lymphoma, anti-PD1 checkpoint inhibitors (CPI). However, there is a need for new therapies for patients with tumors refractory to both BV and CPI, who face dismal outcomes. AFM13—a CD30/CD16A bispecific antibody—activates natural killer (NK) cells to kill CD30⁺ cells. Here we studied cord-blood-derived cytokine-preactivated and expanded NK cells precomplexed with AFM13 (AFM13-NK) in patients with CD30⁺ lymphoma refractory to BV and CPI. The primary endpoint of this phase 1 trial was to establish the safety and recommended phase 2 dose of AFM13-NK followed by intravenous AFM13 infusions. Secondary endpoints included the overall response rate and complete response (CR) rate, event-free survival and overall survival, and persistence of infused AFM13-NK cells. This is the final analysis of this trial; 42 heavily pretreated patients received 2 to 4 cycles of lymphodepletion followed by AFM13-NK cell infusion at 3 dose levels (10⁶, 10⁷ and 10⁸ kg⁻¹) and 3 weekly AFM13 infusions. No cytokine release syndrome, neurotoxicity or graft-versus-host disease was observed. The highest NK dose was established as the recommended phase 2 dose. Donor NK cells peaked in blood 1 day postinfusion, persisted up to 3 weeks and trafficked to tumor sites. The overall response and CR rates were 92.9% and 66.7%, respectively. At a median follow-up of 20 months, the 2-year event-free and overall survival rates were 26.2% and 76.2%, respectively. Eleven patients (6 with and 5 without consolidation) remained in CR at 14–40 months. This therapy showed encouraging preliminary safety and efficacy. ClinicalTrials.gov Identifier: NCT04074746.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"24 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775415","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical implementation of AI-based screening for risk for opioid use disorder in hospitalized adults","authors":"Majid Afshar, Felice Resnik, Cara Joyce, Madeline Oguss, Dmitriy Dligach, Elizabeth S. Burnside, Anne Gravel Sullivan, Matthew M. Churpek, Brian W. Patterson, Elizabeth Salisbury-Afshar, Frank J. Liao, Cherodeep Goswami, Randy Brown, Marlon P. Mundt","doi":"10.1038/s41591-025-03603-z","DOIUrl":"https://doi.org/10.1038/s41591-025-03603-z","url":null,"abstract":"<p>Adults with opioid use disorder (OUD) are at increased risk for opioid-related complications and repeated hospital admissions. Routine screening for patients at risk for an OUD to prevent complications is not standard practice in many hospitals, leading to missed opportunities for intervention. The adoption of electronic health records (EHRs) and advancements in artificial intelligence (AI) offer a scalable approach to systematically identify at-risk patients for evidence-based care. This pre–post quasi-experimental study evaluated whether an AI-driven OUD screener embedded in the EHR was non-inferior to usual care in identifying patients for addiction medicine consultations, aiming to provide a similarly effective but more scalable alternative to human-led ad hoc consultations. The AI screener used a convolutional neural network to analyze EHR notes in real time, identifying patients at risk and recommending consultations. The primary outcome was the proportion of patients who completed a consultation with an addiction medicine specialist, which included interventions such as outpatient treatment referral, management of complicated withdrawal, medication management for OUD and harm reduction services. The study period consisted of a 16-month pre-intervention phase followed by an 8-month post-intervention phase, during which the AI screener was implemented to support hospital providers in identifying patients for consultation. Consultations did not change between periods (1.35% versus 1.51%, <i>P</i> &lt; 0.001 for non-inferiority). In secondary outcome analysis, the AI screener was associated with a reduction in 30-day readmissions (odds ratio: 0.53, 95% confidence interval: 0.30–0.91, <i>P</i> = 0.02) with an incremental cost of US$6,801 per readmission avoided, demonstrating its potential as a scalable, cost-effective solution for OUD care. ClinicalTrials.gov registration: NCT05745480.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"183 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immune and metabolic effects of African heritage diets versus Western diets in men: a randomized controlled trial","authors":"Godfrey S. Temba, Tal Pecht, Vesla I. Kullaya, Nadira Vadaq, Mary V. Mosha, Thomas Ulas, Sneha Kanungo, Liesbeth van Emst, Lorenzo Bonaguro, Jonas Schulte-Schrepping, Elias Mafuru, Paolo Lionetti, Musa M. Mhlanga, Andre J. van der Ven, Duccio Cavalieri, Leo A. B. Joosten, Reginald A. Kavishe, Blandina T. Mmbaga, Joachim L. Schultze, Mihai G. Netea, Quirijn de Mast","doi":"10.1038/s41591-025-03602-0","DOIUrl":"https://doi.org/10.1038/s41591-025-03602-0","url":null,"abstract":"<p>African heritage diets are increasingly being replaced by Western-style dietary patterns because of urbanization, economic development, increased access to processed foods, globalization and changing social norms. The health consequences of this nutrition transition are not well understood. We conducted a randomized controlled trial in the Kilimanjaro region in Northern Tanzania to investigate the immune and metabolic effects of switching between Kilimanjaro heritage-style and Western-style diets for 2 weeks and consuming a traditional fermented banana beverage (‘Mbege’) for 1 week. Seventy-seven young and healthy volunteers assigned male at birth, some living in urban areas and some living in rural areas, were recruited in the trial. Primary outcomes were changes in the immune and metabolic profile before and after the intervention and at the 4-week follow-up. The switch from heritage-style to Western-style diet affected different metabolic pathways associated with noncommunicable diseases and promoted a pro-inflammatory state with impaired whole-blood cytokine responses to microbial stimulation. In contrast, the switch from Western-style to heritage-style diet or consuming the fermented beverage had a largely anti-inflammatory effect. Some of the observed changes in the immune and metabolic profiles persisted at the follow-up, suggesting a sustained impact from the short-term intervention. These findings show the metabolic and immune effects of dietary transitions and the consumption of fermented beverages, underscoring the importance of preserving indigenous dietary practices to mitigate noncommunicable disease risk factors in sub-Saharan Africa. ISRCTN trial registration: ISRCTN15619939.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"58 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143766951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Correction: Improving scientific integrity in Chinese medical institutions with the Hospital Research Integrity Alliance","authors":"Guo Hua","doi":"10.1038/s41591-025-03683-x","DOIUrl":"https://doi.org/10.1038/s41591-025-03683-x","url":null,"abstract":"<p>Correction to: <i>Nature Medicine</i> https://doi.org/10.1038/s41591-025-03595-w, published online 25 March 2025.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"23 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143775422","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Real-time surveillance system for patient deterioration: a pragmatic cluster-randomized controlled trial","authors":"Sarah C. Rossetti, Patricia C. Dykes, Chris Knaplund, Sandy Cho, Jennifer Withall, Graham Lowenthal, David Albers, Rachel Y. Lee, Haomiao Jia, Suzanne Bakken, Min-Jeoung Kang, Frank Y. Chang, Li Zhou, David W. Bates, Temiloluwa Daramola, Fang Liu, Jessica Schwartz-Dillard, Mai Tran, Syed Mohtashim Abbas Bokhari, Jennifer Thate, Kenrick D. Cato","doi":"10.1038/s41591-025-03609-7","DOIUrl":"https://doi.org/10.1038/s41591-025-03609-7","url":null,"abstract":"<p>The COmmunicating Narrative Concerns Entered by RNs (CONCERN) early warning system (EWS) uses real-time nursing surveillance documentation patterns in its machine learning algorithm to identify deterioration risk. We conducted a 1-year, multisite, pragmatic trial with cluster-randomization of 74 clinical units (37 intervention; 37 usual care) across 2 health systems. Eligible adult hospital encounters were included. We tested if outcomes differed between patients whose care teams were and patients whose care teams were not informed by the CONCERN EWS. Coprimary outcomes were in-hospital mortality (examined as instantaneous risk) and length of stay. Secondary outcomes were cardiopulmonary arrest, sepsis, unanticipated intensive care unit transfers and 30-day hospital readmission. Among 60,893 hospital encounters (33,024 intervention; 27,869 usual care), intervention group encounters had 35.6% decreased instantaneous risk of death (adjusted hazard ratio (HR), 0.64; 95% confidence interval (CI), 0.53–0.78; <i>P</i> &lt; 0.0001), 11.2% decreased length of stay (adjusted incidence rate ratio, 0.91; 95% CI, 0.90–0.93; <i>P</i> &lt; 0.0001), 7.5% decreased instantaneous risk of sepsis (adjusted HR, 0.93; 95% CI, 0.86–0.99; <i>P</i> = 0.0317) and 24.9% increased instantaneous risk of unanticipated intensive care unit transfer (adjusted HR, 1.25; 95% CI, 1.09–1.43; <i>P</i> = 0.0011) compared with usual-care group encounters. No adverse events were reported. A machine learning-based EWS, modeled on nursing surveillance patterns, decreased inpatient deterioration risk with statistical significance. ClinicalTrials.gov registration: NCT03911687.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"89 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using genetics as a tool to understand female reproductive health better","authors":"","doi":"10.1038/s41591-025-03663-1","DOIUrl":"https://doi.org/10.1038/s41591-025-03663-1","url":null,"abstract":"Genome-wide association analyses of 42 female reproductive disorders identify 195 associations between genetic variants and reproductive health traits, including previously unidentified risk factors for ovarian cysts and uterine fibroids. We characterize the genetic architecture of studied traits and highlight the potential of a polygenic risk score to enhance risk prediction for intrahepatic cholestasis of pregnancy.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"6 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gut microbiome evolution from infancy to 8 years of age","authors":"Sanjam S. Sawhney, Robert Thänert, Anna Thänert, Carla Hall-Moore, I. Malick Ndao, Bejan Mahmud, Barbara B. Warner, Phillip I. Tarr, Gautam Dantas","doi":"10.1038/s41591-025-03610-0","DOIUrl":"https://doi.org/10.1038/s41591-025-03610-0","url":null,"abstract":"<p>The human gut microbiome is most dynamic in early life. Although sweeping changes in taxonomic architecture are well described, it remains unknown how, and to what extent, individual strains colonize and persist and how selective pressures define their genomic architecture. In this study, we combined shotgun sequencing of 1,203 stool samples from 26 mothers and their twins (52 infants), sampled from childbirth to 8 years after birth, with culture-enhanced, deep short-read and long-read stool sequencing from a subset of 10 twins (20 infants) to define transmission, persistence and evolutionary trajectories of gut species from infancy to middle childhood. We constructed 3,995 strain-resolved metagenome-assembled genomes across 399 taxa, and we found that 27.4% persist within individuals. We identified 726 strains shared within families, with Bacteroidales, Oscillospiraceae and Lachnospiraceae, but not Bifidobacteriaceae, vertically transferred. Lastly, we identified weaning as a critical inflection point that accelerates bacterial mutation rates and separates functional profiles of genes accruing mutations.</p>","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"33 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758722","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TAILORing AI-guided treatment for atrial fibrillation","authors":"Zak Loring, Jonathan P. Piccini","doi":"10.1038/s41591-025-03611-z","DOIUrl":"https://doi.org/10.1038/s41591-025-03611-z","url":null,"abstract":"The TAILORED-AF trial used artificial intelligence (AI)-guided mapping to enhance catheter ablation in persistent atrial fibrillation and demonstrated reductions in recurrent atrial fibrillation, but the net clinical benefit remains unclear.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"3 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143758729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mpox poses an ever-increasing epidemic and pandemic risk","authors":"Carlos Maluquer de Motes, David O. Ulaeto","doi":"10.1038/s41591-025-03589-8","DOIUrl":"https://doi.org/10.1038/s41591-025-03589-8","url":null,"abstract":"The human interaction with mpox has changed across its entire endemic range, revealing the endemic and pandemic risk of monkeypox virus and the current knowledge gaps on its biology that hamper virus control.","PeriodicalId":19037,"journal":{"name":"Nature Medicine","volume":"18 1","pages":""},"PeriodicalIF":82.9,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143744750","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}