Dan McSmith retweeted
Metabolic control by liver–kidney crosstalk and glucagon in health and disease dlvr.it/TVhsVT
Dan McSmith retweeted
2026 Nobel Prize in Physiology or Medicine
Karl Deisseroth • Peter Hegemann • Georg Nagel
For discoveries on light-gated ion channels and optogenetics.
THE BIG IDEA
Light became a biological switch.
Channelrhodopsins allowed researchers to control selected cells — especially neurons — with remarkable temporal precision.
WHY IT CHANGED NEUROSCIENCE
Before: observe which circuits are active.
Now: switch a defined circuit ON or OFF → test what it actually does.
This transformed research in:
• memory & behaviour
• Parkinson’s disease & epilepsy
• psychiatric disorders
• vision restoration
• neural-circuit mapping
FROM ALGAE → ION CHANNELS → BRAIN CIRCUITS
A striking example of how fundamental biology can completely reshape experimental medicine.
Landmark papers:
Science. 2002;296:2395–2398
DOI: 10.1126/science.1072068
Nat Neurosci. 2005;8:1263–1268
DOI: 10.1038/nn1525
#NobelPrize2026 #Optogenetics #Neuroscience #Medicine
Dan McSmith retweeted
Contrast-Associated Acute Kidney Injury: Comprehensive Review of Risk Factors, Pathophysiology, Definition and Management
CCR Journal Watch
criticalcarereviews.com/late…
Dan McSmith retweeted
🧬 Anti-Ro Isn’t Just One Antibody
Ro60 ≠ Ro52.
Across 891 SLE/Sjögren disease studies, only 20.9% tested for and reported anti-Ro60 and anti-Ro52 as separate autoantibodies.
75% did neither, while 4.2% tested them separately but didn’t report the results separately.
In other words, nearly 4 in 5 studies did not clearly distinguish them in both testing and reporting.
A 17-member international Delphi panel therefore unanimously recommended:
🧬 anti-TROVE2/Ro60
🧬 anti-TRIM21/Ro52
If the targets are different, our reporting should be different too.
#RheumattDoc #MedTwitter #RheumTwitter #rheumatology @docakx @IhabFathiSulima @CelestinoGutirr @DurgaPrasannaM1
Dan McSmith retweeted
Surviving sepsis guidelines represents the constant battle between 'evidence based' and 'expert led' clinical practice.
The clinicians writing the guidelines are bright and thoughtful intensivists (I know many of them!).
The challenge is, when generating guidelines, you are handcuffed to recommendations based almost entirely systematic review level evidence.
Immediately, all nuance is immediately lost because those studies do not (and never will) adequately capture individual patient hemodynamics and management.
I think surviving sepsis is kind of like ACLS --> it is the bare minimum for what we should do in sepsis care but not the gold standard we should chase.
The Surviving Sepsis Campaign has shaped sepsis care for decades. But do some of its core recommendations now lag behind the physiology and the evidence?
Rory Spiegel @TheEMNerd led this new dissenting opinion, which I was very pleased to contribute to.
We challenge:
• fixed 30 mL/kg fluid loading
• chasing lactate with fluid
• fluid responsiveness as a sufficient reason to give fluid
• pressure-centric resuscitation
• the omission of POCUS from modern haemodynamic assessment
• rigid bundle-driven care
The argument is not for less treatment. It is for more individualised, physiology-driven treatment of shock.
authors.elsevier.com/c/1npdk…
The 2026 Surviving Sepsis Campaign Guidelines: The dissenting opinion
Spiegel et al. AJEM, just published.
Dan McSmith retweeted
Lograron convertir células de glioblastoma en células presentadoras de antígeno @CellPressNews
El glioblastoma es un tumor "frío" que presenta pocos antígenos y evade al sistema inmune, por eso es difícil de abordar con inmunoterapia.
Con un screen de CRISPR encontraron cuatro factores de transcripción que alcanzan para convertir células de glioblastoma en células dendríticas.
En varios modelos de ratón eso generó inmunidad antitumoral sistémica y duradera, y sumó efecto a los inhibidores de checkpoint.
Es en ratones, así que falta. Pero es por acá 👍
doi.org/10.1016/j.xcrm.2026.…
Dan McSmith retweeted
The Surviving Sepsis Campaign has shaped sepsis care for decades. But do some of its core recommendations now lag behind the physiology and the evidence?
Rory Spiegel @TheEMNerd led this new dissenting opinion, which I was very pleased to contribute to.
We challenge:
• fixed 30 mL/kg fluid loading
• chasing lactate with fluid
• fluid responsiveness as a sufficient reason to give fluid
• pressure-centric resuscitation
• the omission of POCUS from modern haemodynamic assessment
• rigid bundle-driven care
The argument is not for less treatment. It is for more individualised, physiology-driven treatment of shock.
authors.elsevier.com/c/1npdk…
The 2026 Surviving Sepsis Campaign Guidelines: The dissenting opinion
Spiegel et al. AJEM, just published.
Dan McSmith retweeted
Want a quick tour of how we should personalize IV fluid resuscitation? This paper quickly reviews the literature to help us optimize resuscitation. 🎩 tip to the authors including @DrMCecconi
eddyjoemd.com/foamed
Dan McSmith retweeted
En los 20 días que llevo en la UCI aprendiendo POCUS creo que he hecho alrededor de 320 diapositivas (320 le calculo, muchas de imágenes y videos eso sí).
Si pudiese resumir el 90% de la información a un solo sitio es a esta página, RECOMENDADA.
pocus101.com
Dan McSmith retweeted
🚨 2025 EULAR RA management update — 5 points to remember
• Start DMARDs early and treat to target
• Methotrexate remains the first strategy
• If csDMARD strategy fails → add a bDMARD
• JAK inhibitors require careful risk assessment
• In sustained remission, reduce cautiously rather than stop DMARDs abruptly
One major change: the previous prognostic-factor–based split after csDMARD failure has been removed.
— Dr. Aravind Palraj
#RheumatoidArthritis #Rheumatology @IhabFathiSulima #EULAR #DMARDs #MedEd
🤖 Made with AI
Rheumatoid Arthritis in 2025 isn’t about “which biologic is best.”
It’s about phenotype + serostatus + lung involvement + CV risk.
High CRP → IL-6
Seropositive erosive → Rituximab
RA-ILD → Abatacept / Rituximab
High CV risk → Avoid JAK
Modern RA therapy = risk-stratified precision medicine.
#RheumatoidArthritis #Rheumatology #Biologics #JAKinhibitors #IL6 @DrAkhilX @IhabFathiSulima #AutoimmuneDisease #MedEd #RheumTwitter #EULAR #ACR
Dan McSmith retweeted
Optimizing Drug Therapy in ECMO-Supported Critically Ill Adults: A Narrative Review and Clinical Guide
criticalcarereviews.com/late…
Join us to read 1 paper per day and stay up-to-date as we cover the spectrum of critical care across 2026
Dan McSmith retweeted
Precipitants of Acute Heart Failure: A State-of-the-art Review from an International Expert Group
CCR Journal Watch
criticalcarereviews.com/late…
Dan McSmith retweeted
🥼New in #SepsisAndSevereInfection:
Overlap-weighted retrospective cohort study of early versus delayed renal replacement therapy in sepsis-associated AKI
doi.org/rn2v
#CritCare #Sepsis #SevereInfection #RRT
Dan McSmith retweeted
📅 We are pleased to announce that Jafron Biomedical will be attending the following academic and industrial events this October.
Check the event calendar below and add these dates to your travel plans 👉 We look forward to meeting you at our booths!
#hemoadsorption #medtech
Dan McSmith retweeted
Macrophage Rejuvenation Reverses Organ Aging rapamycin.news/t/macrophage-…
Dan McSmith retweeted
This review aims to equip researchers with a clear understanding of the current technological landscape and to accelerate the adoption of #SpatialMultiomics methods in biomedical research: doi.org/10.1172/jci.insight.…
Multiomic Analysis Identifies T-cell Subsets and Mechanisms of Epithelial Interaction in Idiopathic Pulmonary Fibrosis by Haikuo Li @HaikuoLi and colleagues @sjtu1896 & @WashU.
Dan McSmith retweeted
🧬 What if mitochondrial ATP does more than power T cells—what if it directly helps determine their identity by controlling chromatin accessibility?
A fascinating new Cell study provides a mechanistic bridge between immunometabolism and epigenetics, showing that mitochondrial ATP production can support the chromatin remodeling required for CD8⁺ T-cell effector differentiation.
The key molecule is D-α-hydroxybutyrate (DAHB).
Rather than functioning primarily as a fuel, DAHB acts as a metabolic signal that reprograms activated CD8⁺ T cells:
DAHB → OXPHOS ↑ → fatty-acid oxidation ↑ → phosphocreatine ↑ → local ATP buffering → BAF-dependent chromatin remodeling → effector genes ↑ → stronger antitumor immunity.
That is a remarkable metabolism-to-chromatin circuit.
🔥 DAHB pushes CD8⁺ T cells toward a cytotoxic phenotype
DAHB strongly increased:
Perforin
IFN-γ
TNF-family members
GZMB
CCL3/CCL4
and DAHB-pretreated OT-I cells showed approximately 3-fold greater tumor-cell cytotoxicity.
But the metabolic mechanism was unexpected.
DAHB increased ATP-coupled mitochondrial respiration while suppressing glycolysis. Estimated ATP production shifted substantially:
OXPHOS-derived ATP ↑ ~82%
glycolytic ATP ↓ ~23%.
Stable-isotope tracing showed that DAHB itself was not meaningfully oxidized through the TCA cycle.
Instead, it doubled fatty-acid oxidation and redirected glucose away from lactate production toward biosynthetic pathways, including the pentose-phosphate and serine/glycine pathways.
So:
DAHB is not primarily the fuel.
It changes which fuels the T cell uses.
⚡ Then comes the central discovery: phosphocreatine
Untargeted metabolomics identified phosphocreatine (PCr) as the most strongly induced metabolite after DAHB treatment.
This is intriguing because the creatine–phosphocreatine system is usually associated with tissues such as skeletal muscle, heart and brain, where it rapidly transports and buffers high-energy phosphate.
Here, activated T cells appear to exploit the same system.
DAHB increased:
OXPHOS → mitochondrial ATP → PCr ↑ → CKB ↑
and blocking phosphocreatine production with cyclocreatine or creatine-kinase inhibition:
⬇️ perforin
⬇️ IFN-γ
⬇️ tumor killing.
Even more interestingly, CKB accumulated near the nuclear envelope, with DAHB producing >6-fold enrichment of CKB–Lamin B1 proximity signals.
This suggests that PCr may function as an intracellular energy shuttle:
mitochondria → PCr → nucleus → ATP
delivering energetic capacity precisely where ATP-consuming nuclear processes occur.
🧬 And one of those processes is chromatin remodeling
ATAC-seq showed that DAHB increased chromatin accessibility at key effector loci:
Prf1
Ifng
Tnf
while inhibition of PCr synthesis largely reversed these changes.
The investigators then targeted the ATP-dependent BAF/mSWI-SNF chromatin remodeling complex.
Both BAF degradation and inhibition of its BRG1/BRM ATPase activity reduced DAHB-induced perforin and IFN-γ and eliminated the increased accessibility of effector loci.
This creates an elegant mechanistic sequence:
FAO
↓
mitochondrial OXPHOS
↓
ATP
↓
phosphocreatine
↓
nuclear ATP buffering
↓
BAF chromatin-remodeling activity
↓
open Prf1 / Ifng / Tnf loci
↓
CYTOTOXIC T-CELL DIFFERENTIATION
The graphical abstract on page 1 captures this beautifully: mitochondrial ATP is converted into a PCr-based energetic shuttle that connects mitochondrial metabolism to nuclear BAF activity and ultimately cytotoxicity.
🎯 The antitumor consequences were substantial
Ex vivo DAHB conditioning of antigen-specific OT-I cells improved control of EL4-OVA tumors after adoptive transfer.
DAHB also enhanced anti-CTLA-4 therapy in immunocompetent MC38 colorectal cancer and B16 melanoma models, whereas this benefit disappeared in lymphocyte-deficient RAG2-KO mice—supporting an adaptive immune mechanism.
Figure 6 on page 11 is especially compelling: DAHB improves tumor control across adoptive-transfer and checkpoint-blockade experiments.
And the TIL phenotype is interesting.
DAHB-treated tumors contained CD8⁺ T cells with:
⬆️ CD44
⬆️ TCF1
⬆️ antigen-specific gp100⁺ cells
⬇️ PD-1⁺CD39⁺ cells
⬆️ polyfunctional IFN-γ⁺TNF-α⁺ responses
⬆️ T-bet.
Importantly, residual PD-1⁺CD39⁺ cells expressed more TCF1, suggesting enrichment toward a precursor-exhausted rather than terminally exhausted state.
👨⚕️ And the biology translated to human T cells
Under chronic stimulation, DAHB-treated human CD8⁺ T cells maintained:
IFN-γ ↑
TNF-α ↑
PCr ↑
ATP/ADP better preserved
and cyclocreatine partially reversed these effects.
Human CD8⁺ T cells engineered with the NY-ESO-1-specific 1G4 TCR also showed greater cytokine production and stronger killing of A375 melanoma cells after DAHB treatment.
Most importantly, in an A375 xenograft model:
DAHB alone → little effect on tumor growth
but
1G4 T-cell ACT + DAHB → significantly improved tumor control.
That distinction argues that DAHB is functioning primarily as a metabolic adjuvant for T cells, rather than simply acting directly on cancer cells.
💡 The conceptual implication is broader than DAHB
We often describe mitochondrial metabolism as providing enough ATP for cells to “function.”
This study suggests something more specific:
Energy availability can regulate cell fate because chromatin remodeling itself has an energetic cost.
ATP is therefore not merely downstream fuel for an already differentiated effector T cell.
Mitochondrial energy production may participate directly in establishing the epigenetic accessibility required to become and remain an effector cell.
That has potentially important implications for:
CAR-T manufacturing
TCR-engineered T cells
tumor-infiltrating lymphocytes
checkpoint blockade
metabolic preconditioning of adoptive cell therapies.
Instead of engineering only receptors and signaling domains, perhaps we should also engineer the bioenergetic infrastructure that maintains their chromatin state.
There are important caveats.
The molecular sensor through which DAHB activates mitochondrial ETC activity remains unknown. The concentrations used experimentally were high, whether microbiota-derived DAHB ever reaches comparable concentrations in vivo is unclear, and the safety/tolerability of therapeutic systemic DAHB in humans remains untested.
Still, the mechanistic concept is striking:
MITOCHONDRIA → ATP → PHOSPHOCREATINE → BAF → CHROMATIN ACCESSIBILITY → T-CELL FATE → ANTITUMOR IMMUNITY
Metabolism and epigenetics are not separate layers of T-cell biology.
They may be connected by something as fundamental as where ATP is produced—and where that energy is delivered.
📄 Ng C, Fung TS, Li D, et al.
Mitochondrial ATP promotes T cell differentiation through chromatin accessibility.
Cell. 2026;189.
DOI: 10.1016/j.cell.2026.08.023
#CancerImmunology #Immunometabolism #TCells #Mitochondria #OXPHOS #Phosphocreatine #Chromatin #Epigenetics #BAF #TCellExhaustion #Immunotherapy #CART #CellTherapy #CancerMetabolism
Dan McSmith retweeted
🦠 Sepsis management is moving away from rigid protocols and toward physiology guided care.
A new international multidisciplinary Delphi consensus brings together 164 experts from 22 countries, 12 specialties and 105 scientific societies to address some of the most controversial areas of sepsis management. Forty statements ultimately reached consensus across seven domains.
Several findings deserve attention.
For early recognition, NEWS 2 emerged as the preferred bedside tool with 89% agreement, while Sepsis 2, Sepsis 3 and qSOFA did not reach consensus as early recognition tools. Structured sepsis programs, rapid response systems and earlier detection beginning outside the hospital were strongly supported. Interestingly, predictive AI models were also considered potentially useful, although evidence for their clinical impact remains limited.
The hemodynamic recommendations are particularly relevant for critical care.
Capillary refill time received 96% agreement for assessment during the first 3 hours. Venous-arterial CO₂ gradients reached 91% agreement. SvO2, cardiac output derived variables when invasive access is available, and echocardiography for initial assessment were supported. However, echocardiography was not considered a replacement for continuous hemodynamic monitoring.
The same physiology first philosophy appears in fluid management. The panel favored individualized fluid therapy rather than a universal fixed volume, balanced crystalloids and dynamic parameters to guide further fluid administration. Restrictive strategies were preferred after 72 hours. Norepinephrine remained the first line vasopressor and should be initiated early alongside fluids, while vasopressin was supported as an adjunct at norepinephrine doses around 0.25 to 0.5 μg/kg/min.
Another striking recommendation concerns source control: drainage or surgery within 6 hours received 95% agreement, including proceeding despite hemodynamic instability, which received 90% agreement.
Antimicrobial therapy also becomes more individualized: adequate early coverage, PK/PD guided dosing, prolonged infusion of time dependent antibiotics, early adaptation to microbiological results and de escalation when clinical and biomarker evolution permits it. Universal combination therapy was not supported.
The central message is compelling:
Recognize sepsis early. Control the source early. Treat infection adequately. But resuscitate the patient according to physiology, not according to a fixed recipe.
An important limitation should remain in mind. This is expert consensus, not randomized evidence. The authors explicitly acknowledge that some recommendations reflect clinical conviction more strongly than trial data, and representation from low income settings was limited.
Reference 📚
Borges Sa M et al. 2026. International multidisciplinary consensus statement on sepsis code guidelines: A Delphi approach. Journal of Internal Medicine.
doi.org/10.1111/joim.70145






































