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A Non-Canonical Role of SMAD4 in Regulating 3D Genome Architecture to Inhibit Lung Squamous Cell Carcinoma Development

Adv Sci (Weinh). 2026 May 26:e75839. doi: 10.1002/advs.75839. Online ahead of print.

ABSTRACT

Lung squamous cell carcinoma (LUSC) lacks clearly defined key drivers and effective targeted therapies, reflecting an incomplete understanding of its molecular pathogenesis. Here, we identify SMAD4 as a critical regulator of three-dimensional (3D) genome organization in LUSC and uncover a mechanistic link between tumor suppressor loss and oncogenic transcriptional activation. By integrating clinical datasets, genetically engineered mouse models, human and murine LUSC cell lines, and multi-omics analyses, we demonstrate that SMAD4 deficiency promotes LUSC progression by unleashing EP300-mediated enhancer-promoter looping at the SOX2 locus. Mechanistically, SMAD4 does not directly bind SOX2 regulatory elements but instead constrains chromatin looping by sequestering EP300 away from loop anchor regions. Loss of SMAD4 leads to enhanced H3K27ac deposition, aberrant SOX2 activation, and increased LUSC tumor cell proliferation. Together, these findings reveal a non-canonical role for a transcription factor (e.g., SMAD4) in regulating dysregulated 3D genome architecture to inhibit tumor development.

PMID:42189071 | DOI:10.1002/advs.75839

Multi-Omics Identification of Biomarkers for High-Altitude Pulmonary Hypertension

J Cardiovasc Dev Dis. 2026 Apr 30;13(5):195. doi: 10.3390/jcdd13050195.

ABSTRACT

(1) Aim: The incidence of high-altitude pulmonary hypertension (HAPH) has risen in recent years and is expected to continue increasing; however, its diagnosis remains challenging. In this study, we employed proteomics and metabolomics to identify the proteins and metabolic biomarkers that contribute to the development of HAPH. (2) Methods: We applied integrated proteomics and metabolomics to match blood samples from 40 HAPH patients and 40 healthy controls in Yunnan's high-altitude regions to characterize molecular profiles, identify biomarkers, and develop a predictive model. (3) Results: Proteomic analysis identified four proteins (A2IPH7, K1C14, PSME2, SERPINE2) commonly dysregulated in HAPH patients from two high-altitude regions. SERPINE2 was notably downregulated and showed a negative correlation with clinical severity, which was further validated in HAPH rat lung tissues and supported by UK Biobank data for idiopathic PAH. Concurrent metabolomics uncovered 11 shared metabolites, largely acyl fatty acids, enriched in pathways such as unsaturated fatty acid synthesis. Integration of these multi-omics data enabled the development of a robust predictive model. (4) Conclusion: Our study identified key protein and metabolic biomarkers involved in HAPH development, which were validated in animal models. Based on these findings, a predictive model was developed, highlighting SERPINE2 and 11 metabolites as promising targets for the prediction and prevention of HAPH.

PMID:42188081 | DOI:10.3390/jcdd13050195

A visual analysis of the research dynamics of biomarkers for lung cancer screening

Clin Epigenetics. 2026 May 26;18(1):90. doi: 10.1186/s13148-026-02084-2.

ABSTRACT

BACKGROUND: Non-invasive biomarkers offer potential to improve risk stratification and early diagnosis of lung cancer, complementing low-dose computed tomography (LDCT) screening. This study employed bibliometric analysis to identify global research trends, collaborative networks, and future directions in lung cancer biomarker research. Publications on lung cancer biomarkers for screening were retrieved from the Web of Science Core Collection (WoSCC). Data processing and visualisation were performed using Citespace, VOSviewer, KH Coder, Latent Dirichlet Allocation (LDA) topic modelling, and the online bibliometric analysis platform. Burst detection analysis was performed to predict emerging research trends.

RESULTS: Analysis of 3636 publications revealed exponential growth in research output since 2014. International collaboration demonstrated a dual-core structure centred on China and the United States, with Chinese institutions showing high publication volumes and American institutions demonstrating greater citation influence. Journal citation mapping revealed three evolutionary phases: basic mechanisms-clinical translation-intelligent integration. LDA topic modelling identified 22 topics grouped into five core research directions: imaging and pathological diagnostic techniques; molecular and omics marker research; liquid biopsy and new detection technologies; clinical and translational medicine research; and tumour biology and treatment mechanisms. Burst detection analysis predicted future four priority areas: epigenetic studies centred on DNA methylation for risk prediction; treatment resistance and invasion mechanisms; liquid biopsy technology development; and targeted therapy clinical trials.

CONCLUSIONS: Lung cancer biomarker research has evolved towards multimodal, intelligent screening approaches. Future research priorities include DNA methylation-based markers, circulating microRNA signatures, and artificial intelligence-assisted diagnostic platforms to improve early detection accuracy and complement LDCT screening.

PMID:42185923 | DOI:10.1186/s13148-026-02084-2

A Non-Canonical Role of SMAD4 in Regulating 3D Genome Architecture to Inhibit Lung Squamous Cell Carcinoma Development

Adv Sci (Weinh). 2026 May 26:e75839. doi: 10.1002/advs.75839. Online ahead of print.

ABSTRACT

Lung squamous cell carcinoma (LUSC) lacks clearly defined key drivers and effective targeted therapies, reflecting an incomplete understanding of its molecular pathogenesis. Here, we identify SMAD4 as a critical regulator of three-dimensional (3D) genome organization in LUSC and uncover a mechanistic link between tumor suppressor loss and oncogenic transcriptional activation. By integrating clinical datasets, genetically engineered mouse models, human and murine LUSC cell lines, and multi-omics analyses, we demonstrate that SMAD4 deficiency promotes LUSC progression by unleashing EP300-mediated enhancer-promoter looping at the SOX2 locus. Mechanistically, SMAD4 does not directly bind SOX2 regulatory elements but instead constrains chromatin looping by sequestering EP300 away from loop anchor regions. Loss of SMAD4 leads to enhanced H3K27ac deposition, aberrant SOX2 activation, and increased LUSC tumor cell proliferation. Together, these findings reveal a non-canonical role for a transcription factor (e.g., SMAD4) in regulating dysregulated 3D genome architecture to inhibit tumor development.

PMID:42189071 | DOI:10.1002/advs.75839

Multi-Omics Identification of Biomarkers for High-Altitude Pulmonary Hypertension

J Cardiovasc Dev Dis. 2026 Apr 30;13(5):195. doi: 10.3390/jcdd13050195.

ABSTRACT

(1) Aim: The incidence of high-altitude pulmonary hypertension (HAPH) has risen in recent years and is expected to continue increasing; however, its diagnosis remains challenging. In this study, we employed proteomics and metabolomics to identify the proteins and metabolic biomarkers that contribute to the development of HAPH. (2) Methods: We applied integrated proteomics and metabolomics to match blood samples from 40 HAPH patients and 40 healthy controls in Yunnan's high-altitude regions to characterize molecular profiles, identify biomarkers, and develop a predictive model. (3) Results: Proteomic analysis identified four proteins (A2IPH7, K1C14, PSME2, SERPINE2) commonly dysregulated in HAPH patients from two high-altitude regions. SERPINE2 was notably downregulated and showed a negative correlation with clinical severity, which was further validated in HAPH rat lung tissues and supported by UK Biobank data for idiopathic PAH. Concurrent metabolomics uncovered 11 shared metabolites, largely acyl fatty acids, enriched in pathways such as unsaturated fatty acid synthesis. Integration of these multi-omics data enabled the development of a robust predictive model. (4) Conclusion: Our study identified key protein and metabolic biomarkers involved in HAPH development, which were validated in animal models. Based on these findings, a predictive model was developed, highlighting SERPINE2 and 11 metabolites as promising targets for the prediction and prevention of HAPH.

PMID:42188081 | DOI:10.3390/jcdd13050195

Accelerating Long-Tail Generation in Synchronous RLHF Training via Adaptive Tensor Parallelism

arXiv:2605.23945v1 Announce Type: new Abstract: Reinforcement Learning from Human Feedback (RLHF) has become a key post-training paradigm for improving model quality. However, the synchronous three-stage RLHF pipeline is often bottlenecked by the generation stage, where response-length skew causes the effective batch size to shrink rapidly during decoding, leaving GPUs underutilized while a few long responses remain unfinished. Mainstream frameworks employ a static tensor parallelism (TP) configuration that cannot adapt to changing batch characteristics, leaving substantial performance headroom unexplored. We propose PAT, an adaptive TP method that dynamically reconfigures TP during the generation stage of each RLHF iteration. PAT introduces two key techniques. First, a predictor-guided online reconfiguration method decides both the reconfiguration point and the target TP configuration based on offline profiling, triggering reconfiguration only when the predicted latency benefit outweighs the reconfiguration overhead. Second, a lightweight online reconfiguration mechanism updates only the states and layouts affected by TP changes: it adapts unfinished decoding states through a cost-model-based choice between KV-cache migration and recomputation, performs in-place weight resharding, and reuses cached communication groups. We implement PAT on top of SGLang and integrate it with the VeRL framework. Evaluations on LLaMA3.1-8B and Qwen3-14B using DeepScaleR show that PAT reduces generation latency by up to 34.6% and end-to-end RLHF training iteration latency by up to 27.2% compared to the original VeRL setup.

Stop Comparing LLM Agents Without Disclosing the Harness

arXiv:2605.23950v1 Announce Type: new Abstract: This position paper argues that, for long-horizon tasks evaluated across models with comparable frontier capability, the agent execution harness, namely the infrastructure layer that governs context construction, tool interaction, orchestration, and verification around a language model, is often a stronger determinant of agent performance than the model it wraps. We formalize and defend the Binding Constraint Thesis: in this regime, performance variance is governed more by harness configuration than by model choice, and current evaluation protocols therefore systematically misattribute harness-level gains to model improvements. We support this thesis along three lines. First, a control-theoretic formalization treats the harness as the controller of a closed-loop dynamical system and the LLM as the stochastic policy it governs, which explains why small harness changes can produce performance shifts that exceed those obtained by substituting one model for another. Second, published benchmarks, industry deployments, and a controlled variance decomposition show that harness-induced variance can substantially exceed model-induced variance, including cases of model ranking reversal. Third, we propose a harness-aware evaluation framework with a disclosure standard and a variance decomposition protocol. Until harness specifications are disclosed, leaderboard comparisons for long-horizon agents should be treated as incomplete and potentially misleading.

From Accuracy to Auditability: A Survey of Determinism in Financial AI Systems

arXiv:2605.23955v1 Announce Type: new Abstract: Deploying machine learning in regulated financial environments -- credit risk, fraud detection, and anti-money laundering -- exposes critical vulnerabilities in algorithmic reproducibility. While early financial ML addressed statistical challenges such as backtest overfitting, deep neural networks and Generative AI have introduced mechanical nondeterminism rooted in hardware and architecture. This survey provides a systems perspective on reproducibility failures across three modalities now dominant in financial AI: tabular models (post-hoc explanation variance), graph networks (stochastic sampling and temporal asynchrony), and LLM-based agentic workflows (batch-dependent divergence and trajectory drift). We supplement the literature analysis with first-party experiments on public financial datasets -- quantifying explanation rank instability in credit scoring, prediction flip rates in GNN-based fraud detection, and tensor-parallel-induced output divergence in LLM entity extraction. We propose a layered evaluation framework linking modality-specific metrics (RBO, D_cos, TDI, PSD) to audit readiness, and empirically validate the complementarity of logit-level and semantic-level determinism measures.

Low-Cost Labels, Reliable Choices: Rollout-Calibrated Hyper-Heuristics for Job Shop Scheduling

arXiv:2605.23957v1 Announce Type: new Abstract: Learning-assisted hyper-heuristics can select among dispatching rules while preserving the feasibility and interpretability of constructive Job Shop Scheduling Problem (JSSP) heuristics. Their main computational cost lies in label generation rather than model fitting, since each supervised label usually requires rolling out candidate rules from a partial schedule. We study this label-cost problem together with a reliability problem: a learned selector should not switch away from a strong default rule unless the predicted gain is credible. The proposed selector uses regret-normalized rollout labels, a contextual KNN uncertainty estimate, and a gate that acts only when the predicted improvement exceeds an uncertainty-adjusted margin. We also vary rollout depth and breadth to measure the cost-quality trade-off. On synthetic JSSP instances, the gated selector achieves the lowest mean RPD among learned selectors, remains close to the best fixed dispatching rule, and reduces Random-HH mean RPD by more than an order of magnitude.

LGMT: Logic-Grounded Metamorphic Testing for Evaluating the Reasoning Reliability of LLMs

arXiv:2605.23965v1 Announce Type: new Abstract: Large Language Models (LLMs) achieve strong performance on logical reasoning benchmarks, yet their reliability remains uncertain. Existing evaluations rely on static benchmarks, which fail to assess robustness under logically equivalent transformations and often overestimate reasoning capability. We propose LGMT (Logic-Grounded Metamorphic Testing), an oracle-free framework that leverages first-order logic (FOL) to evaluate LLM reasoning. By deriving metamorphic relations from formal logical equivalences, LGMT constructs semantically invariant test cases and detects reasoning defects through cross-case consistency checking. Experiments on six state-of-the-art LLMs show that LGMT exposes substantial hidden defects missed by traditional reference-based evaluations. We further find that models are particularly sensitive to symbol-level and conclusion-level variations, and that advanced prompting such as Few-shot CoT only partially mitigates these issues. These results suggest that LLM evaluation should move beyond isolated correctness toward robustness under logical invariance. LGMT provides a principled and scalable approach for diagnosing reasoning failures.

Sensing Intelligence as a Trainable Metamaterial Property

arXiv:2605.23967v1 Announce Type: new Abstract: In biological systems, sensing is not performed by the brain alone: the body deforms, vibrates, and filters external stimuli before they are transduced into neural signals. In engineered systems, this processing burden is placed largely on electronics and computation, while the mechanical body is usually designed only for strength and stability. Here, we present sensing intelligence as a trainable property of the body. We show that the geometry of a metamaterial can be optimized to reshape external stimuli into internal signals that are easier for a neural network to interpret. Rather than hand-designing this physical preprocessing, we let the neural network train its own body for sensing by backpropagating the sensing loss to the body's design parameters through differentiable simulation. Across numerical and experimental sensing scenarios, the optimized body improves sensing accuracy by up to fivefold or reduces the number of required electronic sensors by nearly an order of magnitude.

Towards trustworthy agentic AI: a comprehensive survey of safety, robustness, privacy, and system security

arXiv:2605.23989v1 Announce Type: new Abstract: Agentic AI systems -- Large Language Models (LLMs) augmented with planning, tool use, memory, and long-horizon interactions -- can execute complex tasks autonomously, but their multi-step trajectories introduce new failure modes that challenge trustworthiness. This survey provides a focused examination of trustworthy agentic AI through two core dimensions that are critical for high-risk deployments: Safety and Robustness, and Privacy and System Security. For each dimension, we clarify key concepts, identify where risks emerge along the agent workflow, and summarize stage-targeted mitigation strategies. Other trustworthiness aspects (value alignment, transparency, fairness, and accountability) are discussed as relevant context rather than parallel chapters. To support consistent comparison and deployment decisions, we consolidate evaluation into a unified metrics-and-benchmarks hub, emphasizing both outcome and process signals (e.g., constraint violations, trace completeness, and adversarial success rates) and offering scenario-to-metric guidance for release gating. We conclude by outlining open challenges such as self-evolving agents, runtime monitoring and verification, privacy-preserving personalization, and the trust-utility trade-off, and present a case study of real-world security failures in open-source agentic systems. Our goal is to serve as a practical reference for researchers and practitioners building trustworthy agentic systems in high-stakes environments.

Reason--Imagine--Act: Closed-Loop LLM Decision Making with World Models for Autonomous Driving

arXiv:2605.24004v1 Announce Type: new Abstract: Large language models (LLMs) are promising for autonomous driving, but semantics-only decision policies can yield physically unsafe behavior in dynamic traffic. Existing methods either perform online language reasoning without explicit dynamics verification or use world models mainly in offline pipelines, leaving a gap between semantic intent and physical feasibility at decision time. We propose Reason--Imagine--Act (RIA), a closed-loop framework that couples an LLM reasoner with an action-conditioned world model for online safety verification. At each step, the LLM proposes an action template and candidate sub-actions, the world model performs short-horizon rollouts, and a safety scorer selects the safest executable action with feedback to the next reasoning step. Under a unified CARLA point-goal protocol (1000 episodes), RIA achieves 80.05% route completion, 51.10% arrival rate, and 0.20% collision rate. Under the same closed-loop interface, RIA consistently outperforms training-free baselines, including CARLA TM and MADA, on core closed-loop metrics. For reproducibility, code is available at https://github.com/pku-smart-city/source_code/tree/main/RIA.

LC-ERD: Mining Latent Logic for Self-Evolving Reasoning via Consistency-Regulated Reward Decomposition

arXiv:2605.24005v1 Announce Type: new Abstract: The evolution of Large Language Model (LLM) reasoning is bottlenecked by the scarcity of high-quality process data. While self-alignment via endogenous rewards offers a solution, mining valid supervision faces three challenges: (1) Label Noise via Mimetic Bias, where rewards prioritize statistical likelihood over logical truth, creating a "correctness illusion" that masks compounding errors; (2) Coarse-Grained Supervision, where sparse global outcomes (e.g., in GRPO) fail to provide granular guidance, treating reasoning chains as monolithic; and (3) Distributional Collapse, where signals fail to generalize without amplifying pre-training biases. To address these, we introduce LC-ERD (Logic-Consistent Endogenous Reward Decomposition), a framework framing self-alignment as latent structure mining. We derive a Variational Logic Potential by aggregating consensus from the model's Latent Logic Expertise (LLE) to denoise the reasoning manifold, and introduce a Multi-Agent Value Decomposition protocol based on the IGM principle to quantify individual step utility. Experiments show LC-ERD delivers a robust self-evolution path, uncovering trade-offs between logic consistency and accuracy while identifying high-value reasoning patterns missed by standard rewards. Our code is available at https://github.com/Reinhardmannn/LC-ERD.

EvoSci: A Bio-Inspired Multi-Agent Framework for the Evolution of Scientific Discovery

arXiv:2605.24018v1 Announce Type: new Abstract: Large language models (LLMs), have shown strong potential in scientific discovery, yet existing methods still face substantial challenges in the design of research workflows and multi-role collaboration mechanisms. To mitigate these issues, we propose EvoSci, a multi-agent scientific collaboration framework, which integrates bio-inspired evolution with knowledge graph modeling. To iteratively generate, evaluate, and refine research ideas, EvoSci incorporates multiple role-based agents, including mentor, researcher, and reviewer. By combining collaborative reasoning, shared memory, and evolutionary feedback, EvoSci significantly enhances the coherence and creativity of scientific exploration. Experiments on real-world research topics demonstrate that EvoSci significantly outperforms strong baselines in LLM-based structured peer-review and comparative ranking evaluations, achieving the highest overall peer-review score (ICLR 4.90) and top ranking (Top-10 = 54). These results suggest its superiority in both scientific idea generation and continuous discovery.

SkillEvolBench: Benchmarking the Evolution from Episodic Experience to Procedural Skills

arXiv:2605.24117v1 Announce Type: new Abstract: Large language model (LLM) agents accumulate rich episodic trajectories while solving real-world tasks, but it remains unclear whether such experience can be distilled into reusable procedural skills. We introduce SkillEvolBench, a diagnostic benchmark for evaluating this step from experience reuse to skill formation. It contains 180 tasks across six real-world agent environments, organized into role-conditioned task families with shared latent procedures. Agents learn from acquisition tasks, update an external skill library using compacted trajectories and verifier feedback, and then face frozen deployment tasks testing context shift, adversarial shortcuts, and composition. By comparing self-generated and curated-start skill evolution against no-skill and raw-trajectory controls, SkillEvolBench separates procedural abstraction from base capability, curated prior knowledge, and direct reuse of episodic traces. Across ten model configurations and three agent harnesses, we find that current agents often adapt locally but rarely form robust reusable skills. Skill-based conditions can improve acquisition or replay, and individual models sometimes gain on specific deployment axes, but these gains are unstable under frozen deployment. Raw-trajectory reuse frequently outperforms distilled skills, suggesting that current abstraction procedures discard contextual and procedural cues that remain useful for future tasks. Capacity and cost analyses further show that writing more skills or larger Tier-3 resource libraries is not sufficient: additional updates can improve coverage while introducing episode-specific drift and procedural clutter. These findings position SkillEvolBench as a testbed for measuring when one-off experience becomes durable procedural knowledge rather than task-local memory.

Palette: A Modular, Controllable, and Efficient Framework for On-demand Authorized Safety Alignment Relaxation in LLMs

arXiv:2605.24154v1 Announce Type: new Abstract: Current safety alignment of foundation models largely follows a \emph{one-size-fits-all} paradigm, applying the same refusal policy across users and contexts. As a result, models may refuse requests that are unsafe for general users but legitimate for authorized professionals, limiting helpfulness in specialized professional settings. Existing approaches either require costly realignment or rely on inference-time steering that suffers from imprecise control and added latency. To this end, we propose \textsc{Palette}, a modular, controllable, and efficient framework that selectively relaxes refusal behavior on authorized target domains while preserving standard safety elsewhere. Our method identifies a refusal direction via multi-objective search and internalizes it into the model through lightweight adaptation. \textsc{Palette} further supports modular composition: it learns domain-specific safety controls independently and composes them through parameter merging, enabling on-demand multi-domain authorization without retraining. Experiments across four safety benchmarks, multiple model variants, and both LLMs and VLMs show that \textsc{Palette} delivers precise safety control without sacrificing general utility, offering a practical path toward foundation models that adapt to diverse professional needs.

A Sober Look at Agentic Misalignment in Automated Workflows

arXiv:2605.24197v1 Announce Type: new Abstract: We study a class of emergent misalignment in multi-agent systems (MAS), with a focus on automated workflows, which we refer to agentic misalignment. Although these systems can solve complex tasks, they often fail because agents act according to implicit proxy utilities that do not align with the intended human goals. We formally define these behaviors and analyze them within a Bayesian framework, showing that generic utilities naturally lead to posterior collapse of agents in automated workflows. To address this issue, we propose Agentic Evidence Attribution (AEA), a novel alignment paradigm that improves agent posteriors using context-specific evidence. AEA reasons over agent actions and provides structured evidence to correct misaligned behavior during collaboration. To better understand the role of evidence, we study two instantiations of AEA: self-reflection (internal evidence from the model) and weak-to-strong generalization (external evidence on the agentic trajectory). We show that a small evidence model effectively aligns the MAS by providing orthogonal failure attribution. Our results clarify the sources of agentic misalignment in automated workflows and show that evidence-based alignment can effectively improve agent collaboration and leads to reliable multi-agent systems built on automated workflows.

When Does Multi-Agent RL Improve LLM Workflows? Workflow, Scale, and Policy-Sharing Tradeoffs

arXiv:2605.24202v1 Announce Type: new Abstract: Multi-agent LLM workflows route inference through specialized roles to lift end-task accuracy, but jointly training those roles with reinforcement learning is unstable in ways that are poorly understood. We study when end-to-end RL training of multi-agent LLM workflows improves over their base models, comparing Shared-Policy training, where all roles update one policy, with Isolated-Policy training, where each role has its own parameters. Our experimental matrix spans Eval-Opt, Voting, and Orch-Workers workflows, math and code tasks, and three model scales (0.6B, 1.7B, 4B). We find that multi-agent RL usually improves over base models, but gains depend jointly on workflow, task, and scale, not on policy sharing alone. Isolated-Policy tends to reach higher peak accuracy yet more often falls off a terminal accuracy cliff, while Shared-Policy training does not eliminate failure; it redistributes failure into qualitatively different patterns. We then explain the strongest of these patterns through role-level gradient dynamics induced by workflow topology and policy routing: under Isolated-Policy, parallel same-role agents on shared prompts amplify per-role gradients and drive terminal degradation in Voting and Orch-Workers workflows; under Shared-Policy, asymmetric per-step gradient mass causes the shared policy to be captured by the dominant role, producing different failure signatures by task and workflow. Together, the empirical map and its underlying mechanisms show that policy sharing routes training pressure through different channels rather than offering uniform stability, making it a design choice with workflow- and task-conditional tradeoffs.

ConceptM$^3$oE: Concept-Guided Multimodal Mixture of Experts for Interpretable Computational Pathology

arXiv:2605.24399v1 Announce Type: new Abstract: Healthcare models are transitioning from unimodal prediction toward multimodal reasoning over heterogeneous diagnostic inputs. In computational pathology, for complex tumor subtypes where morphology alone can be challenging to distinguish, pathology reports and molecular measurements may provide additional diagnostic evidence alongside whole-slide images, yet existing models often fail to clarify how diverse signals assemble into recognizable diagnostic concepts. We propose ConceptM$^3$oE (Concept Multimodal MoE), which embeds concept formation directly within interaction-aware mixture-of-experts (MoE) pathways. The architecture decomposes evidence into modality-specific, redundant, and synergistic experts, which are then projected into structured concept bottlenecks mapping latent features to a hierarchy of morphology and biomarker concepts. To prevent the information loss typical of interpretable bottlenecks, we utilize residual pathways within each expert to allow task-relevant signals to flow both through the concepts and directly to the final task prediction, so that high performance is maintained alongside interpretability. Across an institutional pediatric brain tumor cohort and a public glioma cohort, the framework delivers competitive performance to unconstrained models while producing reasoning traces validated by an independent neuropathologist. In data-limited regimes, ConceptM$^3$oE improves limited-data performance, increasing macro-F1 from 56.41% to 66.70% at small training sizes compared to non-concept-informed baselines, while also showing faster training convergence consistent with the regularizing effect of concept learning. This work offers a scalable path toward high-performance medical AI that is inherently verifiable and better aligned with the complex decision-making of clinical practice.
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