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Advancement in hepatocellular carcinoma research: Biomarkers, therapeutics approaches and impact of artificial intelligence

Comput Biol Med. 2025 Nov;198(Pt A):111120. doi: 10.1016/j.compbiomed.2025.111120. Epub 2025 Sep 29.

ABSTRACT

Cancer is a leading, highly complex, and deadly disease that has become a major concern in modern medicine. Hepatocellular carcinoma is the most common primary liver cancer and a leading cause of global cancer mortality. Its development is predominantly associated with chronic liver diseases such as hepatitis B and C infections, cirrhosis, alcohol consumption, and non-alcoholic fatty liver disease. Molecular mechanisms underlying HCC involve genetic mutations, epigenetic changes, and disrupted signalling pathways, including Wnt/β-catenin and PI3K/AKT/mTOR. Early diagnosis remains challenging, as most cases are detected at advanced stages, limiting curative treatment options. Diagnostic advancements, including biomarkers like alpha-fetoprotein and cutting-edge imaging techniques such as CT, MRI, and ultrasound-based radiomics, have improved early detection. Treatment strategies depend on the disease stage, ranging from curative options like surgical resection and liver transplantation to palliative therapies, including transarterial chemoembolization, systemic therapies, and immunotherapy. Immune checkpoint inhibitors targeting PD-1/PD-L1 and CTLA-4 have shown promise for advanced HCC. In this review we discuss about emerging technologies, including artificial intelligence and multi-omics platforms for HCC management by enhancing diagnostic accuracy, identifying novel therapeutic targets, and enabling personalized treatments. Despite these advancements, the prognosis for HCC patients remains poor, underscoring the need for continued research into early detection, innovative therapies, and translational applications to effectively address this global health challenge.

PMID:41027344 | DOI:10.1016/j.compbiomed.2025.111120

The tumour microenvironment in pancreatic cancer - new clinical challenges, but more opportunities

Nat Rev Clin Oncol. 2025 Oct 3. doi: 10.1038/s41571-025-01077-z. Online ahead of print.

ABSTRACT

Patients with advanced-stage pancreatic ductal adenocarcinoma (PDAC) predominantly receive chemotherapy, and despite initial responses in some patients, most will have disease progression and often dismal outcomes. This lack of clinical effectiveness partly reflects not only cancer cell-intrinsic factors but also the presence of a tumour microenvironment (TME) that precludes access of both systemic therapies and circulating immune cells to the primary tumour, as well as supporting the growth of PDAC cells. Combined with improved preclinical models of PDAC, advances in single-cell spatial multi-omics and machine learning-based models have provided novel methods of untangling the complexities of the TME. In this Review, we focus on the desmoplastic stroma and both the intratumoural and intertumoural heterogeneity of PDAC, with an emphasis on cancer-associated fibroblasts and their surrounding immune cell niches. We describe new approaches in converting the immunologically 'cold' PDAC TME into a 'hot' TME by priming T cell activation, overcoming T cell exhaustion and unravelling myeloid cell-mediated immunosuppression. Furthermore, we explore integrated targets involving the TME, such as points of convergence among tumour, stromal and immune cell metabolism as well as oncogenic KRAS signalling. Finally, building on our experience with failed clinical trials in the past, we consider how this evolving comprehensive understanding of the TME will ensure future success in developing more effective therapies for patients with PDAC.

PMID:41044427 | DOI:10.1038/s41571-025-01077-z

Clinical validation of an AI-based blood testing device for diagnosis and prognosis of acute infection and sepsis

Nature Medicine, Published online: 30 September 2025; doi:10.1038/s41591-025-03933-y

In a prospective study enrolling 1,222 patients from 22 emergency departments, a device using a machine-learning-based signature of blood mRNAs demonstrated clinically acceptable performance to diagnose bacterial and viral infections and to predict the all-cause need for critical care interventions within 7 days, with benchmark to established biomarkers and risk scores.

Exploring Attitudes and Obstacles Around Digital Public Health Tools: Insights From a Statewide Cross-Sectional Survey on Washington’s Vaccine Verification System

Background: Development and use of digital public health tools surged during the COVID-19 pandemic. Among these tools, vaccine verification systems emerged as alternatives to paper vaccine records, aiming to help limit the spread of disease. In November 2021, the Washington State Department of Health launched “WA Verify,” a QR code–based vaccine verification system built on the SMART Health Card framework, providing residents with a convenient way to store and share proof of vaccination digitally. However, WA Verify was developed and deployed before assessments and public input regarding potential adoption challenges—such as concerns about privacy, surveillance, data sharing, trust in the technology, and the managing organizations—could be completed. Objective: This analysis used statewide survey data from Washington to identify and characterize barriers and facilitators to the adoption of WA Verify, and to understand how factors such as data privacy, security, attitudes toward public health policies and communication, and technological proficiency may influence acceptance and uptake of digital public health tools. Methods: A cross-sectional statewide survey was distributed between September 2022 and January 2023 to a random sample of 5000 Washington households. Respondents were categorized into 3 groups based on their responses indicating WA Verify “users,” “potential users,” or “unlikely users.” Comparisons were made between groups regarding experiences with and opinions on COVID-19 vaccine and test verification, public health policies, communication, digital tools, technological proficiency, sociodemographic characteristics, and health history. Poststratification weights were applied to reduce nonresponse bias. Results: Of the 1401 respondents, 359 (25.6% unweighted, 25.8% weighted) were users, 662 (47.3% unweighted, 49.8% weighted) were potential users, and 380 (27.1% unweighted, 24.4% weighted) were unlikely users. All percentages reported are based on weighted data. Compared with users and potential users, unlikely users were more likely to oppose policies requiring proof of COVID-19 vaccination or negative test results (users: 6.0%, potential users: 13.6%, unlikely users: 65.9%). Unlikely users were more likely to cite concerns about personal health data security and phone hacking or tracking, though these concerns were also notable among potential users and users. Users and potential users were more likely to perceive a digital vaccine verification system as convenient (users: 96.5%, potential users: 92.3%, unlikely users: 38.1%) and indicated openness to receiving relevant information from a range of sources. Unlikely users were more likely to report not owning a smartphone and demonstrated lower technological proficiency (users: 12.3%, potential users: 15.9%, unlikely users: 32.3%), indicating a technological divide between groups. Conclusions: While nearly three-quarters of respondents had either already adopted or were willing to adopt a tool like WA Verify, concerns about data security, lower technological proficiency, and distrust of public health characterized those least likely to adopt such tools. Identifying barriers to adoption among “unlikely users” is essential for developing effective communication strategies—such as targeted marketing and community engagement—to improve adoption and ensure equitable access to public health technologies.

Genomically matched therapy in advanced solid tumors: the randomized phase 2 ROME trial

Nature Medicine, Published online: 29 September 2025; doi:10.1038/s41591-025-03918-x

In the proof-of-concept phase 2 ROME trial, comprehensive genomic profiling followed by molecular tumor board evaluation and randomization of patients with metastatic solid cancer to receive personalized therapy or standard of care led to a significantly higher objective response rate and longer progression-free survival in patients who received personalized therapy.

Multi-Omics Feature Selection to Identify Biomarkers for Hepatocellular Carcinoma

Metabolites. 2025 Aug 28;15(9):575. doi: 10.3390/metabo15090575.

ABSTRACT

INTRODUCTION: Hepatocellular carcinoma (HCC), the most prevalent form of liver cancer, ranks as the third leading cause of mortality globally. Patients diagnosed with HCC exhibit a dismal prognosis mostly due to the emergence of symptoms in the advanced stages of the disease. Moreover, conventional biomarkers demonstrate insufficient efficacy in the early detection of HCC, hence highlighting the need for the identification of novel and more effective biomarkers.

METHODS: In this paper, we investigate methods for integration of multi-omics data we generated by both untargeted and targeted mass spectrometric analysis of serum samples from HCC cases and patients with liver cirrhosis. Specifically, the performances of several feature selection methods are evaluated on their abilities to identify a panel of multi-omics features that distinguish HCC cases from cirrhotic controls.

RESULTS: The integrative analysis identified key molecules associated with liver including such as leucine and isoleucine as well as SERPINA1, which is involved in LXR/RXR Activation and Acute Response signaling. A new method that uses recursive feature selection in conjunction with a transformer-based deep learning model as an estimator led to more promising results compared to other deep learning methods that perform disease classification and feature selection sequentially.

CONCLUSIONS: The findings in this study reinforce the importance of adapting or extending deep learning models to support robust feature selection, especially for integration of multi-omics data with limited sample size to avoid the risk of overfitting and the need for evaluation of the multi-omics features discovered in this study via blood samples from a larger and independent cohort to identify robust biomarkers for HCC.

PMID:41002959 | PMC:PMC12471784 | DOI:10.3390/metabo15090575

Association of HTR1F with Prognosis, Tumor Immune Microenvironment, and Drug Sensitivity in Cancer: A Multi-Omics Perspective

27 September 2025 at 18:00

Biomedicines. 2025 Sep 11;13(9):2238. doi: 10.3390/biomedicines13092238.

ABSTRACT

Background:HTR1F (5-Hydroxytryptamine Receptor 1F) encodes a G protein-coupled receptor involved in serotonin signaling. Although dysregulated HTR1F expression has been implicated in certain malignancies, its biological functions and clinical significance across cancer types remain largely unexplored. Methods: We performed an integrative pan-cancer analysis of transcriptomic and pharmacogenomic datasets covering 34 cancer types (PAN-CAN cohort, N = 19,131; normal tissues, G = 60,499). Drug sensitivity and molecular docking analyses were conducted using the GSCALite database. The protein-protein interaction (PPI) network of HTR1F was constructed via the STRING database. Additionally, we evaluated the effects of HTR1F overexpression on proliferation and invasion in human lung squamous cell carcinoma (LUSC) cell lines NCI-H520 and NCI-H226. Results:HTR1F expression was significantly upregulated in 17 cancer types and was associated with poor prognosis, with LUSC showing an AUC of 0.912 for 1-year survival prediction. In LUSC, 695 genes were upregulated and 67 downregulated in response to HTR1F overexpression. HTR1F expression correlated with immune-related genes, immune checkpoints, tumor-infiltrating immune cells, tumor mutation burden (TMB), microsatellite instability (MSI), and drug responses. Genomic alterations, including amplification and deletion, were positively associated with HTR1F expression. Drug sensitivity analysis identified compounds such as sotrastaurin (-10.2 kcal/mol), austocystin D (-9.7 kcal/mol), and tivozanib (-9.3 kcal/mol) as potentially effective inhibitors based on predicted binding affinity. Functional enrichment analyses (GO, KEGG) and GSEA revealed that HTR1F is primarily involved in cell cycle regulation, DNA replication, cellular senescence, and immune-related pathways. Functional validation showed that HTR1F overexpression promotes proliferation of LUSC cells via the MAPK signaling pathway. Conclusions: Our integrative analysis highlights HTR1F as a potential biomarker associated with prognosis, immune modulation, and drug sensitivity across multiple cancer types. These findings provide a foundation for future experimental and clinical studies to explore HTR1F-targeted therapies.

PMID:41007799 | PMC:PMC12467612 | DOI:10.3390/biomedicines13092238

Using Large Language Models to Assess the Consistency of Randomized Controlled Trials on AI Interventions With CONSORT-AI: Cross-Sectional Survey

Background: Chatbots based on large language models (LLMs) have shown promise in evaluating the consistency of research. Previously, researchers used LLM to assess if randomized controlled trial (RCT) abstracts adhered to the CONSORT-Abstract guidelines. However, the consistency of artificial intelligence (AI) interventional RCTs align with the CONSORT-AI standards by LLMs remains unclear. Objective: The aim of this study is to identify the consistency of randomized controlled trials on AI interventions with CONSORT-AI using chatbots based on LLMs. Methods: This cross-sectional study employed six LLM models to assess the consistency of RCTs on AI interventions. The sample selection is based on articles published in JAMA Network Open, which included a total of 41 RCTs. All queries were submitted to LLMs through an API interface with a temperature setting of 0 to ensure deterministic responses. One researcher posed the questions to each model, while another independently verified the responses for validity before recording the results. The Overall Consistency Score (OCS), recall, inter-rater reliability and consistency of contents were analyzed. Results: We found gpt-4-0125-preview has the best average OCS (86.5%, 95%CI: 82.5%-90.5% and 81.6%, 95% CI: 77.6%-85.6%), followed by gpt-4-1106-preview(80.3%, 95%CI: 76.3%-84.3% and 78.0%, 95% CI: 74.0%-82.0%). The model with the worst average OCS is gpt-3.5-turbo-0125 (61.9%, 95%CI: 57.9%-65.9% and 63.0%, 95% CI: 59.0%-67.0%). Among the 11 unique items of CONSORT-AI, Item 2 (“State the inclusion and exclusion criteria at the level of the input data”) received the poorest overall evaluation across six models, with an average OCS of 48.8%. For other items, those with an average OCS greater than 80% across the six models included Items 1, 5, 8, and 9. Conclusions: GPT-4 variants demonstrate strong performance in assessing the consistency of RCTs with CONSORT-AI. Nonetheless, refining the prompts could enhance the precision and consistency of the outcomes. While AI tools like GPT-4 variants are valuable, they are not yet fully autonomous in addressing complex and nuanced tasks such as adherence to CONSORT-AI standards. Therefore, integrating AI with higher levels of human supervision and expertise will be crucial to ensuring more reliable and efficient evaluations, ultimately advancing the quality of medical research.

Integrative Spatial Omics for Systems-Level Mapping of Pathological Niches

bioRxiv [Preprint]. 2025 Sep 17:2025.09.12.675904. doi: 10.1101/2025.09.12.675904.

ABSTRACT

Spatial 'omics technologies are a powerful tool for mapping the relationship between cellular organization and molecular distributions in healthy and diseased tissue microenvironments. Here, we describe a novel multimodal pipeline that represents experimental and computational advances for spatiomolecular analysis of tissue samples across molecular classes. This adaptable method integrates matrix-assisted laser desorption/ionization (MALDI) imaging mass spectrometry (IMS) lipidomics, spatial transcriptomics (ST), multiplexed immunofluorescence microscopy (MxIF), and histopathological staining to uncover spatiomolecular profiles associated with unique cellular niches and pathological features. We demonstrate the power of this approach using two different complex human disease systems: Alzheimer's disease in human brain tissue and type 2 diabetes mellitus in the human pancreas. By identifying molecular markers associated with disease pathology in the pancreas and brain, we shed light on biologically significant pathways that are impacted in these two spatially complex diseases and highlight the powerful potential of accurate, high-resolution multimodal integration approaches.

PMID:41000710 | PMC:PMC12458195 | DOI:10.1101/2025.09.12.675904

FUSION: a web-based application for in-depth exploration of multi-omics data with brightfield histology

Nat Commun. 2025 Sep 25;16(1):8388. doi: 10.1038/s41467-025-63050-9.

ABSTRACT

Spatial technologies examining the cell and tissue microenvironment at near single-cell resolution are revealing important molecular insights. However, few tools enable integrated, interactive analysis of spatial-omics with tissue morphology in the same functional tissue unit. Here, we present FUSION (Functional Unit State Identification in Whole Slide Images), a web-based platform for visualizing and analyzing spatial-omics data with high-resolution histology. FUSION provides workflows for assessing cell compositions, quantitative morphometrics, and comparative tissue analyses. We demonstrate applicability across spatial assays, including 10x Visium, Visium HD, 10x Xenium, Cell DIVE, and PhenoCycler, applied to healthy and diseased tissues from kidney, small intestine, lung, and skin in the Human BioMolecular Atlas Program. FUSION is cloud-based, open-source, and accessible at https://fusion.hubmapconsortium.org/ , hosting over 50 paired datasets and tutorials. In a series of use cases, we show its capacity to distinguish renal glomeruli injury states, quantify morphometric changes, and characterize fibrosis with immune infiltration.

PMID:40998789 | PMC:PMC12462499 | DOI:10.1038/s41467-025-63050-9

Application of Nudges to Design Clinical Decision Support Tools: Systematic Approach Guided by Implementation Science

Background: Clinical decision support (CDS) is one strategy to increase evidence-based practices by clinicians. Despite its potential, CDS tools have had mixed results and are often disliked by clinicians. Principles from behavioral economics, including “nudges,” may improve the effectiveness and clinician satisfaction of CDS tools. Objective: This paper outlines a pragmatic approach grounded in implementation science to identify and prioritize how to incorporate different types of nudges into CDS tools. Methods: We applied the Messenger, Incentives, Norms, Defaults, Salience, Priming, Affect, Commitments and Ego (MINDSPACE) nudge framework and the Practical, Robust Implementation and Sustainability Model (PRISM) implementation science framework to systematically and pragmatically identify and prioritize different types of nudges for CDS tools. A case example of a CDS tool to improve guideline-concordant prescribing for patients with heart failure was used to illustrate how these frameworks can be applied in real-life scenarios. We describe a process of how these frameworks can be used pragmatically by clinicians and informaticists or more technical CDS builders to apply nudge theory to CDS tools. Results: Four iterative steps guided by PRISM were defined: 1) engage partners for user-centered design, 2) develop a shared understanding of the nudge types, 3) determine the nudge type for the overarching CDS format, and 4) brainstorm and prioritize nudge types and forms to address each modifiable contextual issue. These steps are iterative and intended to be adapted to align with the local resources and needs of various clinical scenarios and settings. We provide illustrative examples of how this approach was applied to the case example, including who we engaged, details of nudge design decisions, and lessons learned. Conclusions: We present a pragmatic approach to guide the selection and prioritization of nudges, informed by implementation science. This approach can be used to comprehensively and systematically consider key issues in designing CDS to optimize clinician satisfaction, effectiveness, equity, and sustainability while minimizing the potential for unintended consequences. The findings can be adapted and generalized to other health settings and clinical situations, advancing the goals of learning health systems to expedite the translation of evidence into practice.

Understanding the Role of Clinical Decision Support Systems Among Hospital Nurses Using the FITT (Fit Between Individuals, Tasks, and Technology) Framework: Qualitative Study

Background: Clinical decision support systems (CDSSs) have gained prominence in health care, aiding professionals in decision-making and improving patient outcomes. While physicians often use CDSSs for diagnosis and treatment optimization, nurses rely on these systems for tasks such as patient monitoring, prioritization, and care planning. In nursing practice, CDSSs can assist with timely detection of clinical deterioration, support infection control, and streamline care documentation. Despite their potential, the adoption and use of CDSSs by nurses face diverse challenges. Barriers such as alarm fatigue, limited usability, lack of integration with workflows, and insufficient training continue to undermine effective implementation. In contrast to the relatively extensive body of research on CDSS use by physicians, studies focusing on nurses remain limited, leaving a gap in understanding the unique facilitators and barriers they encounter. Objective: This study aimed to explore the facilitators and barriers influencing the adoption and use of CDSSs by nurses in hospitals, using an extended Fit Between Individuals, Tasks, and Technology (FITT) framework. Methods: A qualitative study was conducted using semistructured interviews with 22 nurses from across the Netherlands, representing 3 hospital types: general (n=9), top-clinical (n=12), and academic (n=1). The sample included a diverse mix of practicing nurses, nurses-in-training, and clinical nurse information officers, with clinical experience ranging from 1.5 to 38 years. Interview transcripts were analyzed thematically, beginning with an inductive coding approach to identify key factors. These were then categorized deductively using the extended FITT framework. In total, 988 code instances were examined. To ensure analytical rigor, the coding process was separately conducted by 2 researchers and reviewed by an expert panel. Results: A total of 26 distinct factors were identified, categorized into 4 FITT dimensions: technology-individual, technology-task, task-individual, and organizational context. Of these, 11 factors were facilitators (eg, cognition, clarification, and prevention), 7 were barriers (eg, alarm fatigue, poor design, and limited digital proficiency), and 8 were both facilitators and barriers depending on the context (eg, acceptance, workload, and training). In addition, key value tensions emerged, such as the balance between standardization and professional autonomy, and the trade-off between enhanced decision support and increased administrative burden. Conclusions: The findings underscore the complexity of CDSS adoption in nursing practice, highlighting the interaction of facilitators and barriers across FITT dimensions. Practical recommendations include participatory design processes, targeted training programs, advanced alert management systems, and strong organizational support. Addressing value tensions and aligning CDSS functionality with nurses’ workflows can enhance adoption and optimize patient outcomes. Trial Registration:

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01852-3

Multimodal foundation model and benchmark for comprehensive retinal OCT image analysis

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01956-w

Quality safety and disparity of an AI chatbot in managing chronic diseases: simulated patient experiments

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies

npj Digital Medicine, Published online: 25 September 2025; doi:10.1038/s41746-025-01954-y

Ophthalmic drug discovery and development using artificial intelligence and digital health technologies
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