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For Your Health: You’ve Got This. Don’t Give Up on Quitting Smoking

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It’s a number to celebrate: 3.9 million. That’s the likely number of Americans saved from lung cancer since 1970 with efforts to curb cigarette smoking. Seen another way, this translates to over 76 million years added to people’s lives. It’s truly astounding and doesn’t even include the impact from lower risks of many other cancers and diseases caused by smoking.

Looking ahead, these gains will only grow as fewer youth and young adults take up smoking — and as more people who currently smoke, quit.

Quitting, though, isn’t easy — as anyone who’s done it can tell you. But thousands of people do it every day, and right now in the U.S. there are more people who used to smoke than who currently smoke.

For those who want to quit — or are just thinking about it — getting support can really help, doubling the chances of success. This can include reaching out to your health care clinic or provider for assistance.

There’s also free support at 1-800-QUIT-NOW (1-800-784-8669) and smokefree.gov, which offers texting tools, an app and other services.

Support usually includes a mix of medication as well as in-person and virtual classes and programs. Medications can be prescription drugs, like bupropion, as well as nicotine replacement therapy, like gums and patches. These help with nicotine withdrawal and cravings. Programs and classes can help with developing skills and behaviors for staying smoke-free.

“Services like the smokefree.gov texting program provide encouraging, motivating daily messages,” said Dr. Li-Shiun Chen, director of smoking cessation at WashU Medicine and Siteman Cancer Center. “A lot of my patients love that. They wake up and get a text that says, ‘Hey, it’s a new day. Why don’t you take a walk outside instead of lighting a cigarette?’”

Along with such support, one of the most important approaches to quitting is simply to keep at it.

“On average, it takes a person seven to nine attempts to succeed,” Chen said. “One gentleman we worked with tried 13 times, but then he succeeded with help from a lifestyle coach and medicine. He said that support made all the difference. So, don’t worry about failure. It’s very important to keep trying, even just to reduce how much you smoke.”

FDA-approved products, like nicotine replacement therapy, have the best evidence for helping with quitting. But electronic cigarettes and vaping, which aren’t FDA-approved, may have a role in certain situations, Chen said. “In an adult who smokes cigarettes routinely, actually transitioning to safe vaping is harm reduction. ‘Safe vaping’ means just nicotine — not adding cannabis, not adding flavors. And this type of vaping can be an intermediate step to getting rid of tobacco.”

Vaping, though, is a double-edged sword, Chen warned. It has some inherent dangers, and kids should totally avoid it. Among other risks, it can lead to nicotine addiction and tobacco smoking. “If you’re a 12-year-old, vaping is really bad.”

No matter how long you’ve been smoking or how old or healthy you are — in almost any situation, really — there are important benefits to quitting. And these benefits start just days in and build over the years. Breathing quickly improves. Food starts tasting better. And wrinkles on the face from early aging can start to relax. Then, the risk of serious diseases like cancer, stroke, heart disease, lung disease and dementia begin to drop, with some eventually reversing to the same risk as someone who never smoked.

“Quitting smoking can add about 13 years of life back to a person, but it’s not only a longer life, it’s also a higher quality of life,” Chen concluded. “It’s an amazing opportunity to improve your health, and it’s the best thing you can do for yourself and your loved ones.”

Happy holidays, and happy New Year.

Connecting cancer patients to tobacco treatment is aim of $7.5 million, WashU-led trial

Cancer patients who quit smoking live significantly longer than those who don’t

The science is clear: Cancer patients who quit smoking fare much better than those who don’t. Quitters respond better to treatment and are less likely to see their disease come back or develop a new cancer, and they have a lower risk of other serious conditions such as heart disease. Quitting is hard, but people who participate in evidence-based tobacco-treatment programs are three times more likely to succeed in kicking the habit.

Still, despite the proven benefits of quitting, most cancer patients and survivors who smoke never receive treatment for their tobacco use.

A large-scale, multicenter trial led by researchers at Washington University in St. Louis aims to reduce the burden of cancer by getting more survivors the support they need to quit smoking. The trial — a four-year study to be conducted at 72 cancer centers across eight states, including Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine — will test different clinic-based approaches to connecting cancer survivors to tobacco treatment. The goal is to develop evidence-based recommendations on how to choose, implement and sustain an effective tobacco-treatment strategy at a cancer clinic.

“Even though smoking cessation is part of the standard of care, six out of seven patients with cancer who smoke are not getting any tobacco treatment, so they continue to smoke, and eventually they die early,” said Li-Shiun Chen, MD, MPH, ScD, a professor of psychiatry at WashU Medicine and one of three principal investigators on the trial. “That’s a big missed opportunity. We already know an important way to reduce cancer deaths, and we’re not implementing it.”

Chen and the two other principal investigators — Ross Brownson, PhD, and Alex Ramsey, PhD — are research members at Siteman.

A previous effort to integrate tobacco cessation into cancer care nationwide revealed sobering results. In 2017, the National Cancer Institute (NCI) launched the Cancer Center Cessation Initiative, an ambitious plan to roll out tobacco-treatment programs at the then-52 NCI-designated Comprehensive Cancer Centers nationwide. A five-year analysis revealed that the centers had succeeded in connecting only 15% of their cancer patients with such care, with huge variation in connection rates across centers.

“Scaling up is not a simple thing,” said Brownson, who is also the Steven H. and Susan U. Lipstein Professor at the WashU School of Public Health. “Many of these centers used similar strategies, but the results were varied. We need to understand why a strategy that was effective for one center didn’t work at another one, and what alternative strategy would be more effective.”

That need drove Chen, Brownson and Ramsey, who is also an associate professor of psychiatry at WashU Medicine, to propose the Implementation Science to Scale and Sustain Tobacco Treatment Leveraging a Point of Care Paradigm and Health Information Technology (IMPACT) trial. The three researchers co-lead the trial in collaboration with experts and colleagues at the University of Pennsylvania, Vanderbilt University Medical Center and the St. Louis VA Medical Center. The trial, which will be implemented at cancer clinics affiliated with the four hub sites, aims to determine how to match strategy to clinic, taking into consideration such factors as the size of a clinic, the barriers to receiving care faced by its patients, and the institutional support and resources available. The WashU team is implementing the trial at clinics affiliated with Siteman, where Chen serves as director of the Tobacco Treatment Program.

The trial is supported by a $6.9 million grant from the NCI, with an additional $600,000 provided by Siteman. It is one of four projects in the NCI’s Scaling-up and Maintaining Evidence-based Interventions to Maximize Impact on Cancer (SUMMIT) initiative, a major investment in improving cancer prevention and control by studying how to implement proven interventions in real-world settings.

As part of the trial, each clinic will be randomized to one of four strategies: usual care, referral to a specialist, point of care, or combined referral and point of care. The referral strategy is the most common way of getting patients into tobacco care: The oncologist asks about smoking during a regular visit and refers those who answer yes to a tobacco-treatment specialist. The patient then makes an appointment to meet the specialist at a separate visit. The strategy can work well when a cancer center is able to fund enough tobacco specialists, and patients have the time, resources and willingness to add more appointments to their calendars.

The point-of-care model was developed by Chen and colleagues at Siteman during a time when no tobacco-treatment specialists were on staff. In this model, all hands are on deck: Medical assistants, staff nurses, and nurse practitioners conduct the tobacco-use assessment, provide brief advice to quit smoking and queue cessation medication orders for the clinician to prescribe. They also refer patients to free phone, text or app-based cessation services such as Quitline, a phone-based service available nationwide at 1-800-QUIT-NOW; text messaging cessation services, reachable by texting QUITNOW to 333888; or an app supported by Smokefree.gov. In a recent study, Chen and colleagues showed that a point-of-care approach can be very effective at helping cancer patients quit smoking and improving outcomes.

The record of the Cancer Center Cessation Initiative suggests that many of the clinics may not initially succeed with the strategy they are assigned. Those that are unable to connect at least 15% of eligible patients to tobacco treatment after 18 months will be offered the options of continuing the current strategy, if more time is thought to be helpful; trying a different strategy; or modifying their strategy to include personalized tobacco-treatment plans based on each patient’s unique genetic, clinical and environmental factors.

In those clinics that do succeed, the focus will shift to sustainability. New clinical practices, even successful ones, are at risk of being abandoned when funding ends or priorities change. To minimize this risk, clinics will be provided either general sustainability support, or clinic-specific support based on data from the Clinical Sustainability Assessment Tool. The validated tool — developed at WashU Public Health’s Center for Public Health Systems Science — provides a systematic way to assess the factors that promote sustainability of clinical practices.

“Even when we know what treatments or prevention tools work, we don’t know enough about how we can implement them quickly, scale them up more widely or sustain them long enough,” Ramsey said. “The ultimate goal is to make sure that every single cancer patient who smokes is engaged with treatment, but the route to get there is going to be different for each clinic. We need to figure out which strategies will work best in which context, so we can use the evidence-based tools we already have to improve people’s health.”

Learn about smoking cessation tools available to our patients and community members.

Nasal drops fight brain tumors noninvasively

Nano-sized medicine boosts anti-cancer immune response, eradicates tumors in mice

Researchers at Washington University School of Medicine in St. Louis, along with collaborators at Northwestern University, have developed a noninvasive approach to treat one of the most aggressive and deadly brain cancers. Their technology uses precisely engineered structures assembled from nano-size materials to deliver potent tumor-fighting medicine to the brain through nasal drops. The novel delivery method is less invasive than similar treatments in development and was shown in mice to effectively treat glioblastoma by boosting the brain’s immune response.

The findings were published this month in PNAS.

Glioblastoma tumors form from brain cells called astrocytes and are the most common kind of brain cancer, affecting roughly three in 100,000 people in the U.S. Glioblastoma generally progresses very quickly and is almost always fatal. There are no curative treatments for the disease, in part because delivering medicines to the brain remains extremely challenging.

“We wanted to change this reality and develop a noninvasive treatment that activates the immune response to attack glioblastoma,” said Alexander H. Stegh, PhD, a professor and vice chair of research in the WashU Medicine Taylor Family Department of Neurosurgery and co-corresponding author of the study. Stegh also is research director of The Brain Tumor Center at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. “With this research, we’ve shown that precisely engineered nanostructures, called spherical nucleic acids, can safely and effectively activate powerful immune pathways within the brain. This redefines how cancer immunotherapy can be achieved in otherwise difficult-to-access tumors.”

Cold Tumors Warmed with STING

Glioblastoma tumors are known as “cold tumors” because they do not induce the body’s natural immune response as do so-called “hot tumors” that are easier to treat with immunotherapies. Researchers have developed ways to spark an immune reaction against tumors by stimulating a pathway within cells called STING, which stands for stimulator of interferon genes. STING is triggered when a cell detects foreign DNA and activates the immune system to respond to the threat.

Past studies have shown that drugs activating STING in glioblastoma tumors can prime the body’s immune system to better fight the cancer. However, these agents break down quickly in the body and must be delivered directly into the tumor to work. Because repeated dosing is required for sustained benefit, relying on direct intratumoral administration requires highly invasive procedures.

“We really wanted to minimize patients having to go through that when they are already ill, and I thought that we could use the spherical nucleic acid platforms to deliver these drugs in a noninvasive way,” said Akanksha Mahajan, PhD, a postdoctoral research associate in Stegh’s lab and the first author on the study.

To overcome the problem, the Stegh team collaborated with co-corresponding author Chad A. Mirkin, PhD, director of the International Institute for Nanotechnology and the Rathmann Professor of Chemistry at Northwestern University, and his team. Mirkin invented spherical nucleic acids, a class of nanostructures that arrange DNA or RNA densely around a nanoparticle core, and he has shown that they have greater therapeutic potency compared to the standard delivery methods. The WashU Medicine and Northwestern researchers prepared a new class of spherical nucleic acids with gold cores studded with short snippets of DNA to trigger activation of the STING pathway in specific immune cells. To deliver these drugs to the brain, the team turned to the nose.

Intranasal therapy has been explored as a potential delivery method for medications targeting the brain, but no nanoscale therapies had yet been developed using this method to activate immune responses against brain cancers.

“This is the first time that it has been shown that we can increase immune cell activation in glioblastoma tumors when we deliver nanoscale therapeutics from the nose to the brain,” Mahajan said.

The team wanted to show that this approach could be used to deliver the medicine selectively to the brain, and that it would act on the appropriate cells once it got there.

For the first objective, they used a molecular tag on the spherical nucleic acid that was visible under near-infrared light. They found that the nanomedicine, when delivered as droplets into the nasal passages of mice with glioblastoma, traveled along the path of the main nerve that connects facial muscles to the brain. The immune response evoked in the brain by the medicine was concentrated in the specific immune cells, especially those in the tumor itself, and triggered some helpful responses in the lymph nodes. The medicine did not spread to other parts of the body where it might cause unwanted side effects.

Examinations of immune cells in and near the tumor showed that the therapy successfully activated the STING pathway and armed the immune system to fight the tumor.

When applied in combination with drugs designed to help activate T lymphocytes, another type of immune cell, the new therapy eradicated the tumors with just one or two doses and induced long-term immunity against their recurrence. Taken together, the results were much better than those of current STING-activating immune therapies.

Stegh cautioned that firing up the STING pathway isn’t capable of curing glioblastomas without reinforcement from other therapeutic approaches. Turning on the STING pathway by itself isn’t enough to fight glioblastoma, because the tumor has many ways to block or shut down the immune response that STING is meant to activate. His team is looking to add capabilities to their nanostructure that activate other immune responses. This could allow physicians to double or triple the therapeutic targets all in a single therapy.

“This is an approach that offers hope for safer, more effective treatments for glioblastoma and potentially other immune treatment-resistant cancers, and it marks a critical step toward clinical application,” said Stegh.

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Mahajan AS, Dussold C, Kim, S, Jarvis R, Hurley LA, Tommasini-Ghelfi S, Park J, Forsyth CM, Zhang B, Miska J, Heimberger AB, Mirkin CA, Stegh AH. cGAS-agonistic spherical nucleic acids reprogram the glioblastoma immune microenvironment and promote antitumor immunity. PNAS. Nov. 4, 2025. DOI: 10.1073/pnas.2409557122

This work was supported by the National Cancer Institute of the NIH (grant numbers P50CA221747 and R01CA275430), the NIH (grants R01CA120813, R01NS120547, and R01CA272639), the Melanoma Research Foundation, the Chicago Cancer Baseball Charities at the Lurie Cancer Center of Northwestern University and grants from Cellularity, Alnylam, and AbbVie. Imaging at Siteman Cancer Center Small Animal Cancer Imaging was supported by NIH instrumentation grants S10OD027042, S10OD025264, and National Cancer Institute Cancer Center grant P30CA091842. PET and MRI imaging was supported by Robert H. Lurie Comprehensive Cancer Center Grant P30CA060553.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Competing interests: Alexander Stegh is a shareholder of Exicure Inc., which develops SNA therapeutic platforms. Mirkin is a shareholder in Flashpoint, which develops SNA-based therapeutics. Stegh and Mirkin are co-inventors on patent US20150031745A1, which describes SNA nanoconjugates to cross the blood-brain barrier.

Timing may be key to effective cancer treatments

When doctors biopsy and treat cancer may be just as important as how they treat it. New research from Erik Herzog, PhD, the Viktor Hamburger Distinguished Professor in biology at Washington University in St. Louis and a research member at Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, revealed that when a treatment is given may play a key role in how well brain cancer patients respond to their chemotherapy.

Recently published in the Journal of Neuro-Oncology, the study centers around glioblastoma, an aggressive and treatment-resistant brain cancer that affects more than 300,000 people worldwide every year. The standard treatment plan for this cancer is the common chemotherapy drug temozolomide (TMZ), but its effectiveness is limited. Many tumors fight back with a DNA repair enzyme called MGMT that helps the cancer cells survive TMZ’s attacks.

However, the study finds that MGMT activity levels aren’t constant. Both MGMT methylation — which turns the gene off — and the amount of MGMT protein fluctuate throughout the day. This led the researchers to test if the timing of tumor biopsy would also influence diagnostic results. Colleagues at WashU Medicine — Joshua Rubin, MD, PhD, Will Leidig and Omar Butt, MD, PhD — provided five years of patient biopsy data, which Herzog and his team analyzed.

Rubin and Butt, both WashU Medicine neuro-oncologists, also are Siteman research members. Butt treats adults at The Brain Tumor Center at Siteman. Rubin treats pediatric patients at Siteman Kids at St. Louis Children’s Hospital.

“Presently, methylation is used for diagnostic purposes in cancer, particularly for identifying brain tumors with varying molecular subtypes that are correlated with differences in treatment response,” Rubin explained.

This new research focused on whether methylation levels are stable or if they might change with time of day.

“We found, repeatedly, an increased likelihood of morning biopsies being scored as methylated,” Herzog said. This means that taking a biopsy at different times of day could influence how doctors diagnose tumors. “We are hopeful that this chronodiagnostic approach will help identify better ways to treat this devastating disease.”

These circadian cycles in MGMT gene and protein expression also regulate tumor sensitivity to TMZ over the course of a day. “When we found that TMZ is more effective in the morning, we wondered if, perhaps, this coincides with when there is less MGMT around to repair TMZ-induced damage,” Herzog said.

To better understand how this timing works, Maria Gonzalez-Aponte, a graduate student in the Herzog lab, measured MGMT levels throughout the day in tumor cells and patient GBM samples. With Olivia Walch, a math biologist and co-author of the research, they created a mathematical model to predict when TMZ would be most effective relative to the daily rhythm in MGMT.

“I love when math pushes us past intuition and helps us see something new,” Walch said.

The model predicted that, because TMZ takes several hours to cause DNA damage and to activate cell death, dosing TMZ right after MGMT protein peaks gives the drug the best and longest window to act while the tumor’s repair mechanisms are slower.

“My main takeaway from the modeling part of this work is that, while chronomedicine sounds simple in theory, figuring out what that right time is can be tough,” Walch said.

Dosing time can depend on a multitude of factors, including dose and individual variations in circadian rhythms. “The good news is that math gives us a way to chop away at that complexity and get closer to answers that intuition alone can’t give us,” she added.

Herzog is optimistic that this research will also one day improve the effectiveness of other drugs with similar modes of action that have known circadian targets. Beyond testing chronotherapy with TMZ, the Herzog lab is looking forward to evaluating the importance of the time of day for other signals known to promote or suppress GMB growth. This includes substances like dexamethasone, a drug used to control brain swelling. “It may be important to avoid treatment at times of day when it also promotes tumor growth,” Herzog said.

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Gonzalez-Aponte MF, Huang Y, Leidig, WA et al. Circadian variation in MGMT promoter methylation and expression predicts sensitivity to temozolomide in glioblastoma. J Neurooncol 176, 36 (2026). DOI

This work was supported by National Institutes of Health (NIH) Grants NINDS R21NS120003 and NCI R01NS134885, and Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine.

Ratner receives $9.86 million grant to study cancers caused by retrovirus

Lee Ratner, MD, PhD, the Alan A. and Edith L. Wolff Professor of Oncology at WashU Medicine, has been awarded a five-year, $9.86 million grant from the National Institutes of Health (NIH) to investigate cancers caused by human retroviruses. This NIH Research Program Project Grant, which includes collaborators at The Ohio State University, supports a multidisciplinary effort aimed at solving a range of related problems focused on a central theme.

Led by Ratner, who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine, the projects are focused on developing ways to prevent and treat cancers caused by a virus called human T-cell leukemia virus type 1 (HTLV-1). When HTLV-1 infects the immune system’s T cells, they live longer than they should, letting genetic mutations build up that could lead the cells to become cancerous. This sometimes leads to a life-threatening blood cancer called adult T-cell leukemia or T-cell lymphoma.

With this new funding, Ratner and his colleagues will build on their studies of vaccines and how they could help prevent and treat HTLV-1 infections in an effort to stop the cancer from ever developing. With the goal of developing better therapies for patients with these cancers, the researchers are also investigating how infected T cells change their environment to ensure their own growth and survival. One example is Ratner’s work with Deborah Veis, MD, PhD, of WashU Medicine’s Division of Bone and Mineral Diseases, showing infected T cells produce small particles called extracellular vesicles that contribute to the destruction of bone tissue. Developing ways to counter such environmental changes could lead to new therapeutic strategies for patients.

For Your Health: Genetic testing for cancer is becoming more common. What should we know?



Of the many advances in science and technology over the past 25 years, genetic testing is arguably one of the most notable. Once a rare part of health care, it is now becoming much more common. And it’s possible that someone you know — or maybe even you — has had it done. Most often, people get genetic testing to settle curiosity about which parts of the world their ancestors may have come from or to connect with relatives from other branches of their family tree.

But genetic testing can also reveal important information about our health, including the risk of cancer.

“Genetic testing for cancer risk uses a saliva sample or blood sample to look for changes in specific genes — or pieces of DNA — that are associated with increased risk of certain types of cancers,” said Erin Linnenbringer, PhD, a board-certified genetic counselor and associate professor at WashU Medicine.

There are many genes that are related to cancer. Two of the most well-known examples are BRCA1 and BRCA2, Linnenbringer added. Women with harmful changes — known as “variants” or “mutations” — in these genes have a much greater risk of developing breast, ovarian and pancreatic cancer. Men with these mutations also have a greater risk of breast and pancreatic cancer as well as prostate cancer.

While most gene mutations don’t increase cancer risk as much as those in BRCA1 and BRCA2 can, they can still have an important impact. And knowing that can help with managing the increased risk from a mutation. Screening tests or regular health exams can begin at younger ages and be done more often, which can help find a cancer earlier when it’s more treatable. And, for some types of cancer, medication, surgery or screening can even help prevent the disease.

Right now, this type of genetic testing is typically ordered through a health-care professional and is done in people who have had cancer or have a strong family history of cancer.

“People who are diagnosed with an adult-onset cancer at a young age, such as having breast cancer before the age of 40, who have been diagnosed with an aggressive or late-stage cancer, or who have certain types of rare cancers, like ovarian cancer or pancreatic cancer, should consider having genetic testing,” Linnenbringer said. “The same is true if you have more than one relative on your mom or dad’s side of the family who has had cancer, or if your parent, brother or sister was diagnosed with cancer at a young age.”

If you have concerns about your family history and cancer risk, the first step is often sharing that with your health-care provider. “They may be comfortable reviewing your family history and ordering an appropriate genetic test, or they may refer you to a genetic counselor or other specialist,” Linnenbringer said. “You can also search for a counselor near you, at findageneticcounselor.nsgc.org.”

Genetic counselors are a great resource for thinking through the elements that go into deciding if genetic testing is right for you. “They are health-care professionals with specialized training in both genetics and patient communication and counseling,” Linnenbringer said. In addition to assessing cancer risk from your personal and family history, genetic counselors can also help with considering the implications of testing that might not immediately come to mind. This can include its possible effect on life insurance and emotional health, as well as other family members — who may have the same mutations that your testing could find.

If you don’t have a good idea of your family health history, the upcoming holidays can be a fantastic opportunity to connect with family members and get more details. Try to find out the types of cancer any relatives may have had, and around what age they were diagnosed. It can also be helpful to know if any have had genetic testing. This may not always be the easiest conversation, but it can be worth the effort — providing valuable information about whether genetic counseling or genetic testing may make sense.

Looking to the future, Linnenbringer feels the benefits of genetic testing will likely only increase as we learn more through continued research and expanded testing across a wider range of people.

WashU researchers at Siteman honored with NIH Director’s awards

Three investigators recognized by high-risk, high-reward research program

Three WashU researchers at Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine have received prestigious and highly competitive awards through the National Institutes of Health (NIH) Director’s High-Risk, High-Reward Research program. The awards support unconventional approaches to major challenges in biomedical and behavioral research.

Andrew L. Young, MD, PhD, and Janet Sorrells, PhD, each have received the NIH Director’s Early Independence Award, which supports the launch of research careers for exceptional junior scientists who recently received their doctoral degree or completed clinical training.

Michael P. Meers, PhD, has received the NIH Director’s New Innovator Award, which supports unusually innovative research from investigators who are within 10 years of their final degree or clinical residency and have not yet received a large independent NIH grant.

Understanding Aging’s Effect on Cancer Risk

Young, an assistant professor in the Division of Hematology at WashU Medicine, studies how genetic mutations in blood and bone marrow cells acquired with age contribute to cancer risk. Most previous work in this area has looked at mutations in individuals who have already developed cancer, to see which mutations might have been responsible. Young’s research will focus on studying such mutations in cancer-free adults at advanced ages to better understand who goes on to develop cancer and why.

Because most of these cancer-related mutations can exist in the body for long periods of time but never lead to cancer, studying such genetic changes in healthy adults could provide new clues to preventing cancer.

“We have a relatively good understanding of how germline genetic risk, such as inherited BCRA1 mutations, and environmental exposures such as smoking lead to disease,” said Young, who treats patients at Siteman Cancer Center. “But we know less about how the genomic changes associated with ‘normal’ aging drive the development of disease and could be used to predict or prevent those diseases. This support will allow us to conduct the foundational experiments necessary to understanding how aging affects our bodies at the genomic level and how those genomic changes influence human disease.”

Boosting the Efficiency of Regenerating Tissue

Meers, an assistant professor in the Department of Genetics at WashU Medicine, is focused on developing new tools and techniques to help guide stem cells to becoming specific mature cell types. Such tools could nurture the nascent field of regenerative medicine, in which stem cells or even specialized cell types, such as skin cells, could be reprogrammed to form new tissues and organs that could replace those damaged by disease or injury.

Most existing processes for directing cells to take on particular functions or identities are inefficient in producing the targeted cell type, making them unsuitable to treating human disease. Meers and his team are developing a novel time-lapse profiling method to monitor changes in how a cell’s genes are regulated as it goes through the reprogramming process. A better understanding of these changes could lead to the development of more precise and efficient cell conversion methods that are more suitable for human therapeutics.

“Some of the most groundbreaking, paradigm-shifting science has historically come from the sorts of research that took risks, and we’re pleased to have the opportunity to pursue that sort of research with this NIH support,” Meers said. “This award is a green light to focus solely and without distraction on exactly what we think will make the greatest positive impact on scientific knowledge and human health.”

Revealing the Origins of Inflammatory Bowel Disease

Sorrells, an assistant professor in the Preston M. Green Department of Electrical & Systems Engineering at the McKelvey School of Engineering, is focused on developing a new imaging tool to study inflammatory bowel disease (IBD), a chronic gastrointestinal disorder that increases the risk of colorectal cancer. Significant gaps exist in the knowledge of how host cells and intestinal microbes interact in real time within the intestinal microenvironment.

Sorrells is developing an integrated optical imaging platform that can observe the intestinal microenvironment in mice with unprecedented spatial and temporal resolution. Most laboratory methods rely on bulk analysis of extracted tissue, which eliminates spatial context, or use imaging techniques that cannot achieve both the resolution and the speed needed to capture microbial behavior and host metabolism in vivo.

“We lose the ability to look at complicated dynamics that happen on the seconds scale within biological systems, and we also lose the ability to get higher throughput of larger areas,” she said. “One of the goals of this grant is to develop a new method for label-free super-resolution, with nonlinear optical microscopy.”

Sorrells’ approach ensures that the measurements reflect native physiology rather than an experimental artifact.

“The application is to look at a living gut microbiome,” she said. “Seeing how both bacteria and host cells are interacting over time and looking at how that changes spatially will help us better understand the many factors at play in the gut microbiome. Looking at live bacteria-host interactions will allow us to understand healthy and diseased states.”

The new imaging tool also could be used to study other complex tissue microenvironments, including those relevant to cancer, infection and autoimmune disorders.

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This work is supported by NIH grant numbers DP2 GM164659-01 (Meers), DP5 OD038607-01 (Sorrells) and DP5 OD039424-01 (Young). This work is solely the responsibility of the authors and does not necessarily represent the official views of the NIH.

Puram named Head of Otolaryngology

Leading physician-scientist and head and neck cancer specialist also revered as a mentor

Sidharth “Sid” V. Puram, MD, PhD, has been named the head of the Department of Otolaryngology — Head & Neck Surgery and the Lindburg Professor of Otolaryngology at Washington University School of Medicine in St. Louis. A nationally recognized physician-scientist specializing in head and neck cancer surgery, Puram currently serves as the Joseph B. Kimbrough Professor and director of the department’s Division of Head & Neck Surgery. He also is co-director of the Robert Ebert and Greg Stubblefield Head and Neck Tumor Center at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine. Puram’s new appointment begins Nov. 1, 2025.

His research has advanced understanding of tumor growth, treatment resistance and metastasis in head and neck cancers — discoveries that have opened new options for treating these challenging tumors.

“Dr. Puram is an exceptionally talented physician-scientist and mentor who was unanimously selected by our leadership team from an outstanding pool of candidates,” said David H. Perlmutter, MD, executive vice chancellor for medical affairs, the Spencer T. and Ann W. Olin Distinguished Professor and the George and Carol Bauer Dean of WashU Medicine, who announced Puram’s new appointment. “He will be leading a department that has always been esteemed but has grown in accomplishments and reputation in the last decade under the leadership of Dr. Craig Buchman. We believe Dr. Puram will inspire the otolaryngology team at WashU Medicine, with our partners at BJC HealthCare, to even greater impact and advance the science-based practice of care for patients with upper airways disorders in the coming decades.”

Puram’s research explores tumor heterogeneity — the complex ecosystem of diverse cells within a cancer and how they communicate with one another — a focus that has garnered significant funding from the National Institutes of Health (NIH). Understanding the cellular and genetic make-up of tumors can help scientists and clinicians identify and target the specific cells implicated in troubling behaviors seen in cancer such as tumor invasion, spread and resistance to therapy. His research has informed several innovative clinical trials and identified still other potential treatment avenues.

Detailing the diversity within tumors has pointed the way toward precision treatments for certain kinds of head and neck cancers and provides a foundation for developing therapies more tailored to the tumors of individual patients.

Through his leadership of the Division of Head & Neck Surgery at WashU Medicine, Puram has guided growth in both faculty and patient referrals while also establishing new collaborations with other departments to broaden the expertise offered to head and neck cancer patients with complex clinical needs. In his role as co-director of the Robert Ebert and Greg Stubblefield Head and Neck Tumor Center, Puram has overseen a coordinated clinical program including head and neck specialists, oral health services, ancillary care and mental health care, among other services, with care coordination driven by patient navigation. This innovative, multidisciplinary approach is designed to improve patient outcomes by supporting patients throughout their cancer treatment while improving communication among the care team.

These programs reflect the department’s broader leadership in research and patient care. The department is the fifth-highest recipient of NIH research funding for otolaryngology departments. Each year, its physicians care for more than 120,000 patients and perform more than 11,000 surgeries, including nose and sinus operations; cochlear implants and other procedures to restore hearing; facial reconstruction surgeries; procedures to improve voice and swallowing; pediatric upper airway surgeries; and cancer surgeries.

“Otolaryngology at WashU Medicine is like no other in the U.S. in terms of its academic rigor and the collegiality of the faculty and researchers, so it is a great honor to have been selected to lead the department,” said Puram. “We have a fantastic team of physicians, researchers and trainees here who are absolutely committed to delivering the highest standard of care for our patients today and to carrying out rigorous research that will benefit the patients of tomorrow. Our team continues to push the boundaries through innovative surgical techniques and research projects that will disrupt traditional paradigms of care. I’m very excited to be able to carry that mission forward.”

As a head and neck cancer specialist, Puram is in the rare position as a physician of being both his patients’ surgeon and primary oncologist. With a particular focus on reconstructive surgery after the removal of head and neck cancer, he helps many patients return to their lives and minimize damage to key functions such as speech, swallowing, taste, hearing and smell.

Puram earned his bachelor’s degree from the Massachusetts Institute of Technology and earned both his MD and PhD from Harvard Medical School in 2013. For his graduate research, Puram identified signaling pathways in brain cells that affect the shape of their dendrites, which are key recipients of information.

Puram chose otolaryngology as his medical specialty because it provided him the opportunity to perform a variety of anatomically intricate and challenging surgeries while also practicing as a cancer specialist. He completed a residency in otolaryngology in the Massachusetts Eye and Ear Infirmary/Harvard Combined Program in 2018. During his simultaneous postdoctoral fellowship at Massachusetts General Hospital/MIT Broad Institute, Puram published the first single-cell atlas of head and neck cancers. He then completed his training with a clinical fellowship in microvascular reconstruction/head and neck surgical oncology at The Ohio State University Comprehensive Cancer Center – James before coming to WashU Medicine in 2019.

Puram serves on the National Institute of Dental and Craniofacial Research special grants review study section. He is also on the editorial boards of Surgical Oncology Insight, Head & Neck and Frontiers in Oncology. Puram has been recognized by his peers for his teaching, science and clinical skills. He received the American Society for Clinical Investigation Young Physician Scientist Award in 2020 and was named a Fellow of the American College of Surgeons in 2021. He received the Department of Otolaryngology — Head & Neck Surgery Faculty Teaching Award earlier this year.

Breast cancer startup founded by WashU Medicine researchers acquired by Lunit

Prognosia’s AI-based imaging tech could improve prevention, early detection of breast cancer

An innovative biotech startup founded by researchers at Washington University School of Medicine in St. Louis has been acquired by Lunit, a leading company in developing AI-based technologies for cancer prevention and early detection. The WashU startup, Prognosia, was created to develop software that harnesses AI to analyze mammograms and more accurately predict a woman’s five-year risk of developing breast cancer.

The startup’s first software package, Prognosia Breast, received Breakthrough Device Designation from the Food and Drug Administration (FDA) earlier this year, putting it on a fast track to full market approval. Lunit’s acquisition of Prognosia can help accelerate the final steps of the process to bring the technology into the clinic.

Prognosia was co-founded by Graham A. Colditz, MD, DrPH, the Niess-Gain Professor of Surgery at WashU Medicine and associate director of prevention and control at Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine; and Shu (Joy) Jiang, PhD, an associate professor of surgery in the Division of Public Health Sciences in the Department of Surgery at WashU Medicine and a research member at Siteman.

“We are excited to work with Lunit to bring this technology to the clinic,” Jiang said. “Lunit already has the infrastructure in place to streamline production and clinical implementation of our software that would be extraordinarily difficult for a new startup to build from scratch. Integrating our software into their existing systems could help this new technology get into the hands of physicians and patients very quickly.”

The system produces a five-year breast cancer risk score that makes it possible to compare a woman’s personalized risk to an average risk based on national breast cancer incidence rates. This provides a meaningful estimate that is aligned with the U.S. national risk reduction guidelines, so that clinicians will know what options to discuss if a patient’s breast cancer risk is elevated.

“Improved risk prediction can help early detection, which has the potential to increase the likelihood of successful treatment that is less disruptive to people’s lives,” said Colditz, an internationally renowned cancer prevention researcher who has led the field for decades. “We recognized that there is a tremendous wealth of information about breast cancer development already stored and continuing to be newly collected in the form of regular mammograms. Until recently, there was no way to use this information to inform risk prediction or to develop new and better prevention strategies.”

Improving Accuracy

Past research led by Colditz and Jiang has shown their system is more than twice as accurate as the standard method of identifying individuals at high risk of developing breast cancer over the next five years. The standard method is based on questionnaires that include factors such as age, race and family history of breast cancer. Research also has shown that the technology maintains its high performance across multiple demographic groups, including among people of diverse races, ages and differing breast densities.

These results led to the technology’s recent FDA Breakthrough Device designation, which provides an accelerated review process for full market approval with the goal of giving patients and clinicians access to promising new medical devices sooner. The designation recognizes that the software already has undergone rigorous testing and has shown excellent promise in its potential to improve clinical care.

The developers said the technology could be easily integrated into existing clinical workflows and is compatible with both types of mammogram imaging available: the four 2D views of the breast produced by full-field digital mammography and the synthetic 3D view of the breast produced by digital breast tomosynthesis.

A Roadmap for Growth

Colditz and Jiang worked with WashU’s Office of Technology Management (OTM) to found their AI-based biotech startup.

“Prognosia is a superb example of harnessing all the resources available to WashU faculty to accelerate the launch of a company,” said Nichole R. Mercier, PhD, assistant vice chancellor and managing director of OTM. “Dr. Colditz and Dr. Jiang were proactive in adapting and learning through the resources and guidance of WashU’s OTM and the entrepreneurship ecosystem of St. Louis. Through Lunit’s acquisition of Prognosia, we’re excited to see this powerful startup venture become even better positioned to make transformative improvements in breast cancer risk estimation, prevention and early detection.”

Colditz and Jiang said Prognosia would not have been possible without OTM’s GAP funding program, which allowed them to do the work required for the FDA’s Breakthrough Device designation, as well as support from BioGenerator Ventures, which provided both financial support and expertise in business strategy from Entrepreneur-in-Residence David Smoller, PhD.

“With the guidance of OTM and David Smoller, we broadened our perspective beyond the technical aspects of the software to focus on the needs of the health-care providers who will use it to care for patients,” Colditz said. “That shift in mindset has been crucial to developing a technology that’s truly useful in the clinical setting.”

Colditz and Jiang will hold advisory roles at Lunit during the pre-market review process that precedes full FDA approval of the technology and for ongoing development projects. The regulatory plan includes an initial submission for the static model of risk prediction based on mammograms taken at a single timepoint, with a roadmap to expand functionality of the software by analyzing mammograms from the same person taken at multiple timepoints to improve the accuracy of the prediction.

New center to develop AI-based imaging tools to improve diagnosis, care

WashU Medicine Mallinckrodt Institute of Radiology leads effort on image-based precision medicine

Mallinckrodt Institute of Radiology (MIR) at Washington University School of Medicine in St. Louis is establishing a new center dedicated to developing AI-based imaging tools to improve the diagnosis and precision treatment of cancers, cardiovascular disease, neurological diseases and numerous other conditions. The new Center for Computational and AI-enabled Imaging Sciences brings together collaborators from across WashU Medicine — including Siteman Cancer Center, based at Barnes-Jewish Hospital and WashU Medicine — and others from WashU’s McKelvey School of Engineering.

AI already has shown promise for its ability to analyze vast collections of medical images to generate clinically relevant insights, identifying patterns and anomalies that physicians might otherwise not detect on their own.

“Mallinckrodt Institute of Radiology has long been a national leader in developing innovative imaging technologies, from the invention of positron emission tomography to today’s AI applications in diagnostics and image analysis, and this new center represents an ambitious expansion of our capability,” said Pamela K. Woodard, MD, the Elizabeth E. Mallinckrodt Professor and head of MIR at WashU Medicine. “Integrating AI into imaging will enhance how we diagnose disease, predict its progression and tailor treatments to the unique needs of each patient.”

The new center will help advance AI-driven imaging technologies, such as two recently developed at WashU Medicine — in collaboration with MIR — that are being commercialized. One tool can analyze mammograms to predict an individual patient’s risk of breast cancer over the next five years. Another rapidly maps the brain to help neurosurgeons plan delicate surgeries and avoid sensitive areas that control speech, movement and cognitive function. The center will be a hub for expertise in image analysis that uses sophisticated computing tools to find patterns in datasets of millions of medical images and de-identified patient records, providing insight on both the progression and the potential treatment of disease. The center will also support training on these tools for clinicians and researchers.

The new center will join a growing WashU ecosystem of collaborative AI initiatives that are helping to shape the future of medicine. These include the Center for Health AI (CHAI), which was established as part of the joint agreement to build deeper collaboration between BJC Health System and WashU Medicine and is focused on making health care more personalized and effective for patients and more efficient for providers; and the AI for Health Institute at WashU McKelvey Engineering, which is working on other AI-powered medical innovations.

The Center for Computational and AI-enabled Imaging Sciences will primarily focus on developing AI-based medical imaging applications that integrate information from different imaging types — ranging from digital microscope images of cells to MRI scans to X-rays — to identify clinically informative connections between them. This may include identifying previously unknown early indicators of disease onset that could allow for more effective clinical interventions.

The center will bring together AI imaging experts and researchers from across the Medical Campus, including Siteman Cancer Center, and from the school’s Departments of Medicine, of Neurology, of Psychiatry and of Radiation Oncology.

A Clear Image of the Future of Medicine

The new center will house information from the imaging databases of all the participating departments, collectively representing a range of imaging modalities across many different types of disease. The AI-powered tools developed from those large datasets will enable increasingly precise diagnosis for individual patients, Woodard said.

AI algorithms applied to medical imaging have already been used to detect and classify new subtypes of some disorders in ways that can guide clinical treatment decisions. The breadth of information that will be available at the new center will accelerate this work in a broader range of conditions.

The new center will be led by Mark Anastasio, PhD, a leading expert in computational imaging science and AI for imaging applications. He joins WashU as the Mallinckrodt Endowed Professor of Imaging Sciences for MIR, where he will also be the Vice Chair for Imaging Sciences and AI Research. He will also be Professor of Electrical & Systems Engineering in McKelvey Engineering. Anastasio comes to WashU from the University of Illinois Urbana-Champaign, where he has served as head of the Department of Bioengineering for the past six years.

“Institutions with leading academic medical centers that unite medical data, clinical expertise and advanced AI research will lead the next revolution in healthcare,” said Anastasio. “WashU is exactly such an institution and an ideal home for this center that will enable us to build a community to drive innovation that advances patient care in ways few other institutions can achieve.”

As part of that community building, Anastasio will join the leadership team of the Oncologic Imaging Program at Siteman Cancer Center. He will also be the associate Chief Research Information Officer for Biomedical Imaging at the Institute for Informatics, Data Science & Biostatistics (I2DB), where he will work with institute director Philip R.O. Payne, PhD, the Janet and Bernard Becker Professor of Medicine. Payne is also the chief health AI officer for CHAI and the Vice Chancellor for Biomedical Informatics and Data Science at WashU Medicine.

“AI-enabled imaging has the potential to be as transformative for medicine as earlier waves of innovation — from the adoption of electronic health records to the rise of precision medicine and the advent of real-world evidence generation,” said Payne. “That transformation is being realized here at WashU Medicine because of the dynamic and collaborative environment that exists at our institution, exemplified by leading-edge, transdisciplinary initiatives like this one.”

Aaron Bobick, PhD, dean of WashU McKelvey Engineering and the James M. McKelvey Professor, said dedicated centers such as this will be crucial to maximizing the medical and engineering expertise needed to build out the potential for AI in medical applications.

“Medical imaging offers some of the most exciting challenges in imaging science and artificial intelligence, both of which are core domains for McKelvey Engineering,” said Bobick. “I am certain that the innovations that this center will facilitate by combining the skills of WashU Engineering faculty with the broad range of medical expertise at WashU Medicine will lead to advances that both drive the science forward and benefit patients.”