Research roundup: Recent publications from Emory faculty and staff

May 7, 2025

Research publications

Winship Cancer Institute

Pre-surgical cabozantinib may improve outcomes in kidney cancer

A phase 2 clinical trial led by researchers at the Winship Cancer Institute has demonstrated that cabozantinib, a targeted therapy currently approved for advanced kidney cancer, may offer significant benefits when used before surgery in patients with locally advanced, nonmetastatic clear cell renal cell carcinoma.

The findings, published in Nature Cancer, suggest that cabozantinib not only shrinks tumors but also enhances immune activity within the tumor microenvironment — challenging traditional views on neoadjuvant therapy — treatment given before surgery to help shrink tumors and improve surgical outcomes.

Corresponding authors include Winship researchers and Emory University School of Medicine faculty members Mehmet A. Bilen, MD, Haydn Kissick, PhD and Viraj Master, MD, PhD. Co-first author BaoHan T. Vo, PhD, is a scientist in the Department of Urology.

Citation: Bilen, M. A., Vo, B. T., Liu, Y., Greenwald, R., Davarpanah, A. H., McGuire, D., ... & Master, V. A. (2025). Neoadjuvant cabozantinib for locally advanced nonmetastatic clear cell renal cell carcinoma: a phase 2 trial. Nature Cancer, 1-13.

Algorithm-based approach improves access to palliative care

Palliative care is a specialized medical approach focused on improving quality of life for people with serious illnesses, including advanced cancer, by managing symptoms and providing emotional support.

A study published in JAMA Network Open shows how embedding an algorithm-driven referral system into electronic health records significantly increases the use of palliative care for patients with advanced cancer, ensuring that high-risk patients receive greater and timelier access to high-quality care to address their symptoms and goals of care. The Be-A-PAL trial, a pragmatic randomized controlled study, tested an automated default referral system for outpatient palliative care across 15 clinics in the Tennessee Oncology network, a major community oncology provider.

Study authors include Ravi B. Parikh, MD, medical director of the Winship Data and Technology Applications Shared Resource, and associate professor of hematology and medical oncology.

Citation: Parikh, R. B., Ferrell, W. J., Li, Y., Chen, J., Bilbrey, L., Johnson, N., ... & Mudumbi, S. (2025). Algorithm-Based Palliative Care in Patients With Cancer: A Cluster Randomized Clinical Trial. JAMA Network Open, 8(2), e2458576-e2458576.

School of Medicine

Harnessing the NAT10 protein for possible new cancer therapies

NAT10 is a protein that frequently appears at high levels in cancer cells, helping them divide rapidly and resist treatment, while also making it a prime target for new therapies. A team led by Emory’s Blerta Xhemalçe, PhD, recently discovered an important mechanism for how NAT10 regulates gene expression and protein production.

Xhemalçe, associate professor of biochemistry, studied the complex tangles of DNA and RNA known as R-loops that sometimes appear when DNA creates messenger RNA. They found NAT10 can modify these tangles in ways that make it harder for the cell to launch an inflammatory response. NAT10, in other words, helps keep the cell calm by hiding potential molecular triggers that could cause inflammation. Their research, published in Science Advances, provides new insights into how cells manage genetic information and control inflammatory responses at a molecular level and suggests that NAT10 could be a good drug target in anti-cancer and anti-viral therapies.

Citation: Debnath, T. et al. (2025) NAT10 and N4-acetylcytidine restrain R-loop levels and
related inflammatory responses

Study reveals potential biomarkers for monitoring and evaluating risk of lung disease in early life cystic fibrosis, Emory researchers find

A recent study of cystic fibrosis (CF) infants and toddlers, conducted by a multinational team of researchers including several from the Emory-affiliated Center for Cystic Fibrosis and Airways Disease Research (CF-AIR), has revealed potential metabolite biomarkers for monitoring and evaluating risk of lung disease in early life CF. The study, published recently in European Respiratory Journal Open Research, with Joshua Chandler, PhD, assistant professor of pulmonary medicine as the corresponding author, identified metabolites associated with lung inflammation and lung structural damage, including three that sensitively predict future bronchiectasis risk more precisely than previously established biomarkers.

Citation: Mansour, S., Slimmen, L. J., Silva, G. L., Collins, G. L., Giacalone, V. D., Margaroli, C., ... & Chandler, J. D. (2025). Early life elevations of methionine oxidation and ornithine track and predict cystic fibrosis structural lung disease. ERJ Open Research.

Emory researcher examines higher suicide risk among musicians

New research by Dorian Lamis, PhD, associate professor of psychiatry and behavioral sciences at the School of Medicine, highlights the elevated suicide risks among musicians.

The study published in Frontiers in Public Health, points to unique mental health challenges, substance abuse, financial instability and the pressures of a public career as key factors increasing suicide risk for musicians, particularly females. Lamis and his coauthor followed patterns in occupational mortality data from both England and the U.S., showing that musicians, actors and entertainers are among the occupational groups with the highest suicide rates.

This vulnerability extends globally and across many cultural contexts, including South Korea’s K-Pop industry. Guided by the Zero Suicide Institute framework, the researchers underscore the urgent need for evidence-based prevention strategies tailored to safeguard the mental health of musicians worldwide, advocating for immediate action to address this critical issue.

Citation: Musgrave, G., & Lamis, D. A. (2025). Musicians, the music industry, and suicide: epidemiology, risk factors, and suggested prevention approaches. Frontiers in Public Health, 13, 1507772.

Advanced imaging provides promising new way to predict surgical outcomes for patients with symptomatic congenital brain malformation

Emory researchers have found a promising new way to predict which patients with a certain congenital brain malformation would respond well to surgical intervention. The results of this preliminary application of a non-invasive advanced imaging approach, published in the Journal of Neurosurgery, could significantly improve the quality of care for patients with Chiari malformation type-I (CM-I), a congenital condition in which the lower part of the cerebellum bulges through the normal opening at the base of the skull and into the spinal canal, leading to headaches, dizziness and impaired balance.

Surgical intervention is often successful but risky. An effective way to identify the conditions that would predict positive surgical outcomes is vital.

The study was led by John Oshinski, PhD, professor of radiology and imaging sciences and biomedical engineering and Daniel Barrow, MD, professor of. The researchers used magnetic resonance imaging (MRI) to measure cerebrospinal fluid (CSF) flow/stroke volume, the amount of cerebrospinal fluid passing through the cerebral aqueduct during a heart cycle. CM-I obstructs normal flow, causing pressure variations in and around the intracranial space.

This impaired CSF flow also increases brain motion, as brain tissue tries to displace CSF to maintain cerebral homeostasis. The researchers found that presurgical measures of cerebral dynamics better predicted improvements to CSF flow and brain motion after surgery than the conventional measure of presurgical tonsillar descent. The team plans to validate the work through a larger clinical trial.

Citation: McIlvain, G., Williams, B., Al Samman, M. M., Mohsenian, S., Barrow, D. L., Loth, F., & Oshinski, J. N. (2025). Measurement of CSF flow and brain motion in Chiari malformation type I. Journal of Neurosurgery.

Fast-track to blindness: Unseen drivers of vision loss among people with diabetes

Emory investigators recently discovered substantial inequities in the level of care for non-proliferative diabetic retinopathy received by U.S. patients. The team, led by senior author Francisco J. Pasquel, MD, associate professor of medicine and global health, examined health records from more than 100,000 U.S. adults held by Epic Cosmos electronic health systems. Their research, published in Diabetes Care, found that only 40% received guideline-recommended care within two years — and 14% progressed to vision-threatening disease during a median 35 months. Guideline care includes two of three: ophthalmology visit, primary care visit and measurement of HbA1c, blood pressure and LDL cholesterol.

What stood out most, says Pasquel, was the inequitable progression to vision-threatening diabetic retinopathy (VTDR). Even when blood-sugar control looked “excellent” (HbA1c < 7 %). Non-Hispanic Black and Hispanic patients were more likely to progress to VTDR. Patients whose pre-diagnosis HbA1c was unknown—a marker of fragmented care — also faced markedly higher risk. These patterns highlight how social determinants and health system gaps, not biology alone, drive sight-threatening outcomes.

The team urges ophthalmologists and primary-care clinicians to close those gaps by tracking and addressing glucose control for every retinopathy patient, embedding automated reminders for dilated eye exams and expanding tele-retinal screening in underserved communities.

“Screening is only half the battle,” Pasquel says. “Preventing avoidable blindness requires closing the loop on follow-up and glycemic control.”

Citation: Varghese, J. S., Ravi Kumar, V., Bartelt, J., Hendrick, A. M., & Pasquel, F. J. (2025). The role of urban residence, race and ethnicity, and glycemic control in receiving standards of care and progression to vision-threatening diabetic retinopathy. Diabetes Care, 48 (1), 29-37.

Rollins School of Public Health

New tool helps identify newborns at risk for opioid withdrawal

Opioid use by pregnant mothers can lead to withdrawal symptoms in their newborns soon after birth. Now, researchers have created a model that predicts severe neonatal opioid withdrawal syndrome (NOWS). Their research, published in Pediatrics, builds upon previous work by Stephen Patrick, MD, professor of health policy and management.

The team’s predictive model is a significant step forward that enables physicians to assess the likelihood of infants developing severe NOWS, using multiple factors. It allows physicians to tailor interventions and decide whether at-risk infants should continue to be hospitalized. It also allows for discharge of infants who are unlikely to return to the hospital for pharmacologic treatment later.

Citation: Reese, T. J., et al. (2025). Adapting a Risk Prediction Tool for Neonatal Opioid Withdrawal Syndrome. Pediatrics, 155(4), e2024068673.

Emory researchers find retinal microvascular changes in coronary microvascular dysfunction in a pilot study

A collaboration between an Emory cardiologist and an ophthalmologist used optical coherence tomography angiography (OCTA) to reveal promising insights into coronary microvascular dysfunction (CMD). Their study, published in Cardiology Research and Practice, explored whether retinal microvascular changes correlate with CMD, a condition predominantly affecting women and associated with microvascular dysfunction throughout the body.

In CMD, the small blood vessels in the heart fail to provide adequate blood flow to the heart muscle. It’s a complex phenomenon, not fully understood and challenging to diagnose and screen and often requires invasive and specialized testing. In contrast, OCTA is a widely used, non-invasive, rapid imaging technique that visualizes retinal blood flow without dyes, offering a practical screening alternative.

The study, led by Puja K Mehta, MD, associate professor of cardiology, Nieraj Jain, MD, associate professor of ophthalmology and first author Sakshi Shiromani, MD, a research fellow at the Emory Eye Center, compared retinal microvascular density between women diagnosed with CMD and those without the condition.

Results demonstrated significantly lower microvascular density and perfusion density in the CMD group, indicating compromised retinal vascular supply at the microvascular level. These findings highlight the potential of retinal imaging as a valuable tool for evaluating CMD and represent a significant cross-disciplinary collaboration between ophthalmology and cardiology.

Citation: Shiromani et al. (2025) Reduced retinal microvascular density in women with coronary microvascular dysfunction: A pilot study. Am Heart J Plus. Cardiology Research and Practice. PMID: 39995513.

Grants

Emory researchers receive grant to identify biomarkers associated with ALS

Jonathan Glass, MD, director of the Emory ALS Center, and Eleanor Thomas, MD, PhD, an instructor in the Department of Neurology, have been awarded a $330,000 grant to study the identification of biomarkers in the blood of ALS patients, which plays a crucial role in understanding the neurological damage and inflammation associated with the disease. Biomarkers are essential in modern medicine for indicating the presence or progression of conditions. The work of Glass and Thomas is key to developing new diagnostic tools and treatment strategies for ALS. The grant was funded by Hop On A Cure, a nonprofit committed to supporting ALS research established by Zac Brown Band member John Driskell Hopkins following his ALS diagnosis in 2022.

Emory researcher receives grant to develop new methods for assessing brain temperature

A multidisciplinary team led by Candace Fleischer, PhD has received a $2.95 million R01 grant from the National Institutes of Health to develop and then clinically validate a new method for assessing human brain temperature. The project uses both a fully conserved biophysical model complemented by experimental measurements for absolute brain thermometry using magnetic resonance imaging. After validation and model optimization, the team will apply the technology in the clinical setting to evaluate patients with chronic cerebrovascular disease, with the goal of developing brain temperature as a non-invasive prognostic tool that can help improve outcomes for patients with brain injury and illness.

Fleischer, associate professor of radiology and imaging sciences, is joined by Andrei Fedorov, professor in the George W. Woodruff School of Mechanical Engineering at Georgia Tech, Benjamin Risk, associate professor of biostatistics in the Rollins School of Public Health, Fadi Nahab, associate professor of neurology and Jason W. Allen, chair of the Department of Radiology at Indiana University on this project, which builds on the team’s foundational work that won the Georgia CTSA Team Science Award of Distinction in 2024.

School of Nursing R21 grant to study use of smart-speaker system to assess loneliness among older adults

Jane Chung, PhD, associate professor at the Nell Hodgson Woodruff School of Nursing, has transitioned her National Institute on Aging R21 grant to the School of Nursing. The project, titled “HomePal: Developing a Smart Speaker-Based System for In-Home Loneliness Assessment for Older Adults,” aims to leverage everyday digital technologies to enhance the lives of community-dwelling older adults.

Loneliness among older adults can lead to severe health issues, including cognitive decline and cardiovascular disease. Chung’s research addresses this by developing HomePal, a smart speaker-based system that will conduct passive, real-time, in-home loneliness assessments, monitoring speech patterns, mobility, sleep behaviors and smart speaker usage.

The study will involve 70 older adults living alone, collecting data over three months. Participants will complete the UCLA Loneliness Scale biweekly to train machine learning algorithms. The project will also explore barriers to adoption, including privacy and security concerns, to ensure the system is effective and user-friendly. HomePal has the potential to revolutionize loneliness detection and intervention for older adults.

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