Brain injury describes a variety of injuries to the tissues and blood vessels in the head. It can be external such as in road accident or physical assaults or internal such as a stroke. Regardless, they are largely incurable with a long route to recovery with symptoms-relieving medications and rehabilitation. As such, many therapies were explored including cell therapy. However, not all were evidence based and in many instances banking of patients' desperation, many treatments were done without any evidence from clinical trials. Here, we reviewed clinical trials on clinicaltrials.gov for stroke and spinal cord injury where there are cellular therapies transplanting neural, mesenchymal, and haemopoietic cells. We present and discuss 40 trials involving cell therapies for stroke and 32 for spinal cord injuries that are either completed or active. Although some trials began as long as 20 years ago and have shown encouraging improvements in various scale scores for both stroke and spinal cord injury, cell transplantation for brain injuries remains an evolving field that requires further research before it can be established as a standard treatment.

The rising prevalence of metabolic syndrome (MetS) and gestational diabetes mellitus (GDM) in women of reproductive age highlights their growing susceptibility to future cardiometabolic diseases. Both conditions signal early metabolic dysfunction tied to abdominal adiposity. We investigated whether relative abdominal adipose tissue (AAT) distribution characterises metabolic risk beyond general adiposity. Using magnetic resonance imaging, we quantified superficial (SSAT) and deep (DSAT) subcutaneous, intraperitoneal (IPAT), and retroperitoneal (RPAT) adipose tissue compartments to derive AAT distribution phenotypes from their relative contributions. These phenotypes were characterized with respect to MetS, GDM risk, ectopic fat accumulation, and metabolic profiles. The relative AAT distribution of higher %IPAT and lower %DSAT was a significant determinant for MetS. Women with both lower %IPAT and higher %DSAT exhibited the most favourable metabolic profiles, whereas women with higher %IPAT and lower %DSAT showed increased prevalence of MetS, hepatic steatosis, elevated high-sensitivity C-reactive protein, and 5.36-fold higher odds of developing GDM (95% CI 1.12-27.85). Notably, metabolic differences were observed despite similar overall adiposity including total AAT, body fat percentage, body mass index, and waist circumference. This suggests that AAT accumulation, particularly preferential DSAT over IPAT, captures metabolic heterogeneity and may support precision risk stratification of cardiometabolic disease in women.

Abstract Background As part of Singapore’s effort towards precision medicine tailored to Asian diversity, we describe the implementation of a nationwide reproductive carrier screening program. Using a customised 112-gene panel, incorporating population-specific recessive genetic diseases, we outline the overall program design, and initial efforts of community and stakeholder engagement, to inform culturally appropriate implementation. Methods Participants receive culturally tailored online education regarding our reproductive screening program and are provided results with genetic counselling and reproductive options. Community and stakeholder perspectives were assessed through questionnaires and consultations with religious leaders. Results Recruitment is nation-wide, and since initiation of our pilot phase in September 2024, 1,619 couples have registered interest, with 60% uptake of those deemed eligible. Among the 456 couples that have received results to date, four couples (0.9%) were identified to be at increased risk. Community questionnaire responses (n=1002), involving couples who participated in the program as well as the general public, indicated interest is high (59%) across the cohort but awareness, intent to participate and implications for reproductive options differed by sociodemographic factors such as ancestry and religion. Healthcare professional respondents (n=113) acknowledged carrier screening will be routine in medical care, but report limited confidence and resources. Engagement with religious leaders indicated support for the program. Conclusion These early program outcomes and community engagement are guiding the implementation of expanding population-based carrier screening in Singapore, contingent on addressing practical challenges through equitable outreach and professional training.

OBJECTIVES:In Singapore, diabetes imposes a huge population health and economic burden. Despite that, there is paucity of evidence on the health economics of screening programs for type 2 diabetes, especially in the context of screening after gestational diabetes (GDM). The objective of this study is to assess cost-effectiveness of universal lifelong screening for type 2 diabetes after GDM, which is supported by current guidelines, compared with elective screening where 54% of mothers with GDM undertake one-off screening. Despite the recommendation for universal lifelong screening, only 54% comply with this in the first postpartum year. METHODS:We perform a cost-effectiveness analysis comparing 5 screening strategies, accounting for lifetime costs to the healthcare system and quality of life for Singapore women diagnosed with GDM. In particular, a hybrid decision model, based on a decision tree and Markov models, is implemented to estimate cost and quality-adjusted life-years (QALY). Probabilities, costs, and utilities are obtained from existing literature, governmental databases, the Growing Up in Singapore Towards Healthy Outcomes birth cohort study, and the National University Hospital. RESULTS:Compared with elective screening, universal annual screening reduces cost by SG$19.4 million while adding 3.8 thousand QALYs by each annual cohort of pregnant women. Furthermore, annual screening is cost-effective (lower cost and higher QALY) compared with triennial screening. Sensitivity analysis shows that the findings are robust to parameter specifications. CONCLUSIONS:Universal annual screening of women with a history of GDM is cost-effective for reducing diabetes complications compared with strategies with less frequent screening in Singapore.

OBJECTIVE:There is an absence of a comprehensive clinical instrument to assess and track the development of non-ideal feeding practices and lifestyle behaviours in early childhood. Our primary aim was to develop and validate an assessment instrument, called Feeding, Lifestyle, Activity Goals (FLAGs), designed to serve as a feeding, lifestyle and activity behaviour checklist for children aged 0-2 years. METHODS:This study took place between January and May 2023. Experts evaluated content validity using the criteria of relevance, clarity, simplicity and ambiguity, to calculate the item content validity index (I-CVI) and scale CVI (S-CVI) (acceptable cutoff ≥ 0.80). Face validity was assessed by caregivers. Repeated assessments were also performed to determine test-retest reliability based on intra-class correlation (ICC) (acceptable cutoff > 0.75). Construct validity was established through principal component analysis (PCA), and internal consistency was measured using Cronbach's α coefficient (acceptable cutoff ≥ 0.70). RESULTS:FLAGs consists of 19 items, with a I-CVI of 1.00 in 12 out of 19 items, and S-CVI average of >0.90 for relevance, simplicity and clarity. Among 198 caregivers, 99.0% responded 'agree' and 'strongly agree' in the criteria of clarity and ambiguity; 99.5% in criterion of relevance, and 100% in criterion of simplicity. PCA showed a two-component structure (55.9% variance). Overall Cronbach's α was 0.71. Participants repeated FLAGs assessment on an average of 9 days apart, with ICC of 0.861 (p < 0.001) for the total FLAGs scores. CONCLUSIONS:We have developed an instrument which assesses an infant's feeding and lifestyle behaviour from 0 to 2 years, and this has been assessed to have acceptable validity and reliability.

It is not clear if conventional liver fat cutoff of 5.56

Introduction: Preconception is a critical period to optimise gamete function and early placental development, essential for successful conception and long-term maternal-child health. However, there is a lack of preconception services and consequently, global fertility rates continue to fall and mothers embark on their pregnancy journey in poor health. There is an urgent need to implement a holistic community-level preconception care programme to optimise risk factors for poor fecundability and improve long-term maternal-child health. Method: We reviewed current evidence on fecundability lifestyle risk factors, the efficacy of existing preconception interventions and the use of digital platforms for health optimisation, to create a new digital-based preconception intervention model that will be implemented via an app. We present the theory, content and mode of delivery of this holistic model targeting couples planning for pregnancy. Results: We propose a new model featuring a user-friendly mobile app, which enables couples to self-assess fecundability risks through a personalised risk score that drives a tailored management plan. This tiered management provides anticipatory guidance supported by evidence-based recommendations, and promotes ongoing engagement for behavioural optimisation and specialist referrals as required. Based on the health belief model, this new model delivered with a mobile app seeks to shift couples’ perceptions about their susceptibility and severity of subfertility, benefits of making a change and barriers to change. Conclusion: Our proposed digital-based intervention model via a mobile app stands to enhance preconception care by providing personalised risk assessments, real-time feedback and tiered management to optimise preconception reproductive health of couples. This model forms a reference content framework for future preconception care intervention delivery.

Studies examining preconception eating behaviours with longitudinal dietary patterns from preconception to late pregnancy as well as gestational weight gain (GWG) are limited. We derived dietary pattern trajectories from preconception to late-pregnancy, and related preconception eating behaviours to these trajectories and GWG. Preconception eating behaviours were assessed using the Three-Factor Eating Questionnaire measuring cognitive restraint (CR) - conscious restriction of food intake, emotional eating (EE) - overeating in response to negative emotions, and uncontrolled eating (UE) - overeating with a feeling of lack of control. Dietary intakes were measured at preconception, 20-21 and 34-36 weeks' gestation with food frequency questionnaires. Dietary patterns were determined using factor analysis, and trajectories derived using group-based trajectory modelling. Inadequate and excessive GWG were defined according to Institute of Medicine guidelines based on weights at preconception and the last antenatal visit (median: 38 weeks' gestation). Two dietary patterns were derived: 'Fast Food, Fried Snacks and Desserts (FFD)' and 'Soup, Fish and Vegetables (SFV)'. Adherence trajectories from preconception to late-pregnancy were characterised as consistently high ("stable-high") and low ("stable-low"). Women with higher UE scores had higher odds of being in the "stable-high" trajectory (n = 34) of the FFD pattern [Odds Ratio (OR): 1.25, 95% Confidence Interval (CI): 1.03, 1.51], compared to "stable-low" (n = 260). Percentages of women with inadequate, adequate or excessive GWG were 21.7% (n = 70), 25.8% (n = 83), and 52.5% (n = 169), respectively; women with higher EE scores had a higher likelihood of excessive GWG [Relative Risk Ratio (RRR): 1.35, 95% CI: 1.02, 1.80], but this association was attenuated after adjusting for preconception body mass index. Eating behaviour interventions to improve dietary patterns among pregnant women may need to start as early as preconception, incorporating strategies to manage UE.

Objectives: The Developmental Origins of Health and Disease (DOHaD) concept has gained prominence in maternal and child health (MCH), emphasizing how early-life factors impact later-life non-communicable diseases. However, a knowledge-practice gap exists in applying DOHaD principles among healthcare professionals. Healthy Early Life Moments in Singapore (HELMS) introduced webinars to bridge this gap and empower healthcare professionals. We aimed to conduct a preliminary assessment to gain early insights into the outreach and effectiveness of the educational initiative offered with the HELMS webinars. Methods: We employed a pragmatic serial cross-sectional study approach and targeted healthcare professionals involved in MCH care. We also collected and analyzed data on webinar registration and attendance, participants' profession and organizational affiliations, and post-webinar survey responses. Results: The median webinar attendance rate was 59.6 % (25th-75th percentile: 58.4-60.8 %). Nurses represented 68.6 % of attendees (n=2,589 out of 3,774). Post-webinar surveys revealed over 75 % of the participants providing positive responses to 14 out of 15 survey questions concerning content, delivery, applicability to work, and organization. Conclusions: Assessment of the HELMS webinars provided insight into the outreach and early effectiveness in enhancing healthcare professionals' knowledge and confidence in delivering DOHaD education. Bridging the knowledge-practice gap remains a crucial goal.

Abstract Background Gestational diabetes mellitus (GDM) and insulin resistance (IR) increase the risk of adverse pregnancy outcomes. We aimed to examine the relationship of interstitial glucose assessed by continuous glucose monitoring (CGM) at early gestation, and the subsequent development of IR and GDM, and to determine 24-h interstitial glucose centile distributions in women with normal (non-IR and non-GDM) and suboptimal glycemic status (IR and/or GDM). Methods CGM measurements were taken for 3–10 days at 18–24 weeks’ gestation, followed by fasting serum insulin and oral glucose tolerance testing at 24–28 weeks’ gestation. IR and GDM were determined by the updated Homeostasis Model Assessment of IR score of ≥ 1.22 and 2013 World Health Organization criteria, respectively. Risks of IR and GDM were estimated using modified Poisson models, and hourly interstitial glucose centiles determined using Generalized Additive Models for Location, Scale and Shape. Results This prospective cohort study involved 167 pregnant women in Singapore, with a mean age of 31.7 years, body mass index of 22.9 kg/m2, and gestation of 20.3 weeks. 25% of women exhibited IR and 18% developed GDM. After confounders adjustment, women with suboptimal glycemic control, indicated by higher mean daily glucose (risk ratio 1.42; 95% confidence interval 1.16, 1.73), glucose management indicator (1.08; 1.03, 1.12), and J-index (1.04; 1.02, 1.06), as well as those with greater glycemic variability, indicated by higher standard deviation (1.69; 1.37, 2.09), coefficient of variation (1.03; 1.00, 1.06), and mean amplitude of glycemic excursions (1.4; 1.14, 1.35) derived from CGM in early gestation were associated with higher risks of developing IR in later gestation. These associations were similarly observed for the development of GDM. Centile curves showed that, compared to those with normal glycemic status, women with suboptimal glycemic status had higher glucose levels, with greater fluctuations throughout 24 h. Conclusions In pregnant women who subsequently developed IR and GDM, interstitial glucose levels assessed by CGM were elevated and varied greatly. This supports the potential use of CGM to screen for glycemic changes early in pregnancy.

Abstract Background: NGM707 is a dual antagonist antibody that binds a shared epitope of the immune inhibitory receptors ILT2 (LILRB1) and ILT4 (LILRB2). In preclinical studies, NGM707 reprogrammed suppressive myeloid cells via blockade of ILT2/ILT4 and enhanced NK and CD8+ T cell activity via blockade of ILT2; furthermore, NGM707 and pembrolizumab acted additively in vitro to enhance CD4+ T cell activation in mixed lymphocyte reactions. NGM707-IO-101 (NCT04913337) is a first-in-human Phase 1/2 clinical trial of NGM707 monotherapy and combination with pembrolizumab. Here we report pharmacodynamic and predictive biomarker data from NGM707-IO-101 monotherapy and combination dose escalation cohorts. Methods: Eligible patients with advanced or metastatic solid tumors were enrolled into escalating dose cohorts from 6 to 1800 mg NGM707, alone or in combination with 200 mg pembrolizumab, administered Q3W iv. Biomarker assessments of tumors comprised RNA-sequencing and immunohistochemistry (including ILT2, ILT4, CD163) of archival/baseline (N= 41 IHC, 47 RNA) and paired on-treatment tumor biopsies (N=13 IHC, 21 RNA). Peripheral blood biomarker samples were collected on days 1, 4, 8, and 15 of cycle 1 and prior to dosing at each subsequent cycle. Blood biomarker assessments included circulating cytokines/chemokines, PBMC RNA-sequencing, and flow cytometry immunophenotyping. Baseline biomarkers were associated with anti-tumor activity per RECIST v1.1. Results: Pre-treatment biopsies from patients with disease control (DC) showed higher expression of genes in the 18-gene tumor inflammation signature (TIS) than patients with progressive disease (PD). A composite gene signature incorporating gene sets related to TIS, NK cell activity, and tumor cell proliferation had a statistically stronger association with DC than TIS genes alone. Baseline ILT2/ILT4 target expression (≥1% of tumor area) was observed in 31 (75.6%) patients, with similar levels observed in patients with DC and PD. Pharmacodynamic changes were observed in tumor samples following treatment, including increased expression of gene signatures that reflect myeloid cell activation and a proinflammatory tumor microenvironment. Decreased protein expression of the immunosuppressive myeloid marker CD163 was observed following treatment in both blood and tumor for a subset of patients. Proinflammatory chemokines including CXCL9 increased in serum following treatment. Conclusion: Baseline gene expression signatures have shown an encouraging association with clinical benefit from NGM707 and merit further investigation as promising predictive biomarkers. Protein and gene expression changes reflecting the expected modes of action of NGM707 and pembrolizumab were observed in both peripheral blood and tumor biopsies following treatment. Citation Format: Lisa K. Blum, Hung-I H. Chen, Anushka De Costa, Anjushree Iyer, Geoffrey W. Stone, Nicole D. Galicia, Jerry Chan, Brenda Dampier, Katherine Wu, Ursula Jeffry, Kefei Zhou, Joanne Sloan-Lancaster, Dhiraj Abhayankar, Vladimir Hanes, Hsiao D. Lieu, Daniel D. Kaplan, Julie M. Roda. Pharmacodynamic and predictive biomarker results from the phase I dose escalation study of NGM707, an ILT2/ILT4 dual antagonist antibody, in patients with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3641.

IntroductionPharmacogenetics currently supports clinical decision-making on the basis of a limited number of variants in a few genes and may benefit paediatric prescribing where there is a need for more precise dosing. Integrating genomic information such as methylation into pharmacogenetic models holds the potential to improve their accuracy and consequently prescribing decisions. Cytochrome P450 2D6 (CYP2D6) is a highly polymorphic gene conventionally associated with the metabolism of commonly used drugs and endogenous substrates. We thus sought to predict epigenetic loci from single nucleotide polymorphisms (SNPs) related to CYP2D6 in children from the GUSTO cohort.MethodsBuffy coat DNA methylation was quantified using the Illumina Infinium Methylation EPIC beadchip. CpG sites associated with CYP2D6 were used as outcome variables in Linear Regression, Elastic Net and XGBoost models. We compared feature selection of SNPs from GWAS mQTLs, GTEx eQTLs and SNPs within 2 MB of the CYP2D6 gene and the impact of adding demographic data. The samples were split into training (75%) sets and test (25%) sets for validation. In Elastic Net model and XGBoost models, optimal hyperparameter search was done using 10-fold cross validation. Root Mean Square Error and R-squared values were obtained to investigate each models’ performance. When GWAS was performed to determine SNPs associated with CpG sites, a total of 15 SNPs were identified where several SNPs appeared to influence multiple CpG sites.ResultsOverall, Elastic Net models of genetic features appeared to perform marginally better than heritability estimates and substantially better than Linear Regression and XGBoost models. The addition of nongenetic features appeared to improve performance for some but not all feature sets and probes. The best feature set and Machine Learning (ML) approach differed substantially between CpG sites and a number of top variables were identified for each model.DiscussionThe development of SNP-based prediction models for CYP2D6 CpG methylation in Singaporean children of varying ethnicities in this study has clinical application. With further validation, they may add to the set of tools available to improve precision medicine and pharmacogenetics-based dosing.

OBJECTIVE:Maternal stress influences in utero brain development and is a modifiable risk factor for offspring psychopathologies. Reward circuitry dysfunction underlies various internalizing and externalizing psychopathologies. This study examined (1) the association between maternal stress and microstructural characteristics of the neonatal nucleus accumbens (NAcc), a major node of the reward circuitry, and (2) whether neonatal NAcc microstructure modulates individual susceptibility to maternal stress in relation to childhood behavioral problems. METHOD:K-means longitudinal cluster analysis was performed to determine trajectories of maternal stress measures (Perceived Stress Scale [PSS], hair cortisol) from preconception to the third trimester. Neonatal NAcc microstructural measures (orientation density index [ODI] and intracellular volume fraction [ICVF]) were compared across trajectories. We then examined the interaction between maternal stress and neonatal NAcc microstructure on child internalizing and externalizing behaviors, assessed between ages 3 and 4 years. RESULTS:Two trajectories of maternal stress magnitude ("low"/"high") were identified for both PSS (n = 287) and hair cortisol (n = 336). Right neonatal NAcc ODI (rNAcc-ODI) was significantly lower in "low" relative to "high" PSS trajectories (n = 77, p = .04). PSS at preconception had the strongest association with rNAcc-ODI (r = 0.293, p = .029). No differences in NAcc microstructure were found between hair cortisol trajectories. A significant interaction between preconception PSS and rNAcc-ODI on externalizing behavior was observed (n = 47, p = .047). CONCLUSION:Our study showed that the preconception period contributes to in utero NAcc development, and that NAcc microstructure modulates individual susceptibility to preconception maternal stress in relation to externalizing problems. PLAIN LANGUAGE SUMMARY:In the S-PRESTO population-based cohort study conducted in Singapore with 351 women and their children, higher levels of maternal perceived stress within the year before pregnancy were associated with increased dendritic complexity within offsprings' nucleus accumbens, indicative of a more advanced developmental profile. Variations in right nucleus accumbens microstructure significantly modulated the association between maternal perceived stress at preconception and externalizing behaviors in early childhood. Study findings suggest that maternal stress in the preconception period accelerates in-utero nucleus accumbens development, leading to differential risk to externalizing problems in later childhood.

Maternal depression and anxiety through pregnancy have lasting societal impacts. It is thus crucial to understand the trajectories of its progression from preconception to postnatal period, and the risk factors associated with it. Within the Bayesian framework, we propose to jointly model seven outcomes, of which two are physiological and five non-physiological indicators of maternal depression and anxiety over time. We model the former two by a Gaussian process and the latter by an autoregressive model, while imposing a multidimensional Dirichlet process prior on the subject-specific random effects to account for subject heterogeneity and induce clustering. The model allows for the inclusion of covariates through a regression term. Our findings reveal four distinct clusters of trajectories of the seven health outcomes, characterising women's mental health progression from before to after pregnancy. Importantly, our results caution against the loose use of hair corticosteroids as a biomarker, or even a causal factor, for pregnancy mental health progression. Additionally, the regression analysis reveals a range of preconception determinants and risk factors for depressive and anxiety symptoms during pregnancy.

Onco-fetal reprogramming of the tumor ecosystem induces fetal developmental signatures in the tumor microenvironment, leading to immunosuppressive features. Here, we employed single-cell RNA sequencing, spatial transcriptomics and bulk RNA sequencing to delineate specific cell subsets involved in hepatocellular carcinoma (HCC) relapse and response to immunotherapy. We identified POSTN + extracellular matrix cancer-associated fibroblasts (EM CAFs) as a prominent onco-fetal interacting hub, promoting tumor progression. Cell–cell communication and spatial transcriptomics analysis revealed crosstalk and co-localization of onco-fetal cells, including POSTN + CAFs, FOLR2 + macrophages and PLVAP + endothelial cells. Further analyses suggest an association between onco-fetal reprogramming and epithelial–mesenchymal transition (EMT), tumor cell proliferation and recruitment of T reg cells, ultimately influencing early relapse and response to immunotherapy. In summary, our study identifies POSTN + CAFs as part of the HCC onco-fetal niche and highlights its potential influence in EMT, relapse and immunotherapy response, paving the way for the use of onco-fetal signatures for therapeutic stratification.