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Mini Review Open Access
PharmacoGWAS for Drug Response: Study Design, Phenotype and Exposure Definition, Bioinformatics Pipelines, Functional Interpretation, and Clinical Translation
Nabil Zaid, Dalal Loutfi, Lamyaa Benchikhi, Banacer Himmi, Oussama Badad, Hajar El Baroudi, Younes Zaid, Rajaa Tissir, Hassan Ghazal
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2026.00021
Abstract
Inter-individual variability in drug efficacy and toxicity remains a major obstacle to precision therapeutics. Candidate-gene pharmacogenomics and star-allele-based guidelines have [...] Read more.

Inter-individual variability in drug efficacy and toxicity remains a major obstacle to precision therapeutics. Candidate-gene pharmacogenomics and star-allele-based guidelines have established clinically useful examples, but they cannot capture the full spectrum of mechanisms that shape drug response. Pharmacogenomic genome-wide association studies (pharmacoGWAS) extend this framework by enabling discovery beyond known pharmacogenes and can identify human genetic variants associated with efficacy, adverse drug reactions, dose requirements, pharmacokinetics, and pharmacodynamics. This mini-review aims to summarize practical principles for human pharmacoGWAS, with emphasis on study design, phenotype and exposure definition, reproducible bioinformatics pipelines, gene-expression-based functional interpretation, and clinical translation. This review discusses randomized trials, prospective cohorts, biobanks, electronic health records, claims databases, and rare adverse-event designs, highlighting the specific biases that arise because drug response is defined among exposed individuals. It then outlines core analytical steps, including genotype quality control, imputation, ancestry-aware association testing, mixed models, survival and longitudinal analyses, rare-variant aggregation, replication, and meta-analysis. Particular attention is given to expression quantitative trait loci, splicing quantitative trait loci, and protein quantitative trait loci, tissue prioritization informed by the Genotype-Tissue Expression project, transcriptome-wide association studies, and colocalization as tools for prioritizing candidate genes and plausible mechanisms. Finally, we propose a translation framework connecting discovery to clinical validity, guideline development, electronic health record decision support, and equitable implementation across diverse populations. When combined with rigorous epidemiology and functional genomics, pharmacoGWAS may help translate genome-wide signals into safer and more effective prescribing.

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Editorial Open Access
LDL Desialylation as a Trigger of Atherogenesis: Sialidase Inhibition as a Novel Anti-atherosclerotic Strategy
Veronika A. Myasoedova, Nikolay A. Orekhov, Alexey V. Churov, Alexander N. Orekhov
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2024.00062
Review Article Open Access
The Role of Macrophages in Atherosclerosis Development
Evgeny Bezsonov, Darina Gavrilova, Eugene Grebenshchikov, Alexandr Grinev, Elisaveta Puchinova, Vlad Kuzmin, Arman Oganesyan, Denis Bogomolov, Tatyana Degtyarevskaya, Yuliya Lazareva, Andrey Vinokurov, Iza Berechikidze
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2025.00080
Abstract
Atherosclerosis is a chronic inflammatory vascular disease in which macrophages play central roles in lipid uptake, foam cell formation, plaque progression, plaque instability and, [...] Read more.

Atherosclerosis is a chronic inflammatory vascular disease in which macrophages play central roles in lipid uptake, foam cell formation, plaque progression, plaque instability and, under certain conditions, plaque regression. This narrative review summarizes current knowledge on macrophage biology in atherosclerosis, with emphasis on macrophage phenotypic diversity, monocyte-endothelial interactions, foam cell formation, extracellular matrix remodeling, immune-cell interactions, cytokine signaling, mitochondrial dysfunction and cellular senescence. The review also discusses emerging macrophage-targeted strategies, including modulation of inflammatory activity, macrophage polarization, cholesterol efflux and lipid homeostasis. Although these approaches provide promising mechanistic and therapeutic insights, many remain at the preclinical stage. Further studies are needed to validate macrophage subtype-specific biomarkers, clarify the interaction between mitochondrial dysfunction and senescence, and evaluate safe and effective combination strategies for clinical translation.

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Original Article Open Access
Predictive Values of the Blood CHG Index Combined with MHR or TG/HDL-C for Non-ST-Segment Elevation Acute Coronary Syndrome: A Cross-sectional Diagnostic Study
Jing Yan, Rong Chen, Xia Li, Yilei Li, Jie Hu, Pengfei Li
Published online July 29, 2026
Exploratory Research and Hypothesis in Medicine. doi:10.14218/ERHM.2026.00005
Abstract
This study aimed to evaluate the predictive value of cholesterol, high-density lipoprotein, and glucose index (CHG index) alone and combined with the monocyte-to-high-density lipoprotein [...] Read more.

This study aimed to evaluate the predictive value of cholesterol, high-density lipoprotein, and glucose index (CHG index) alone and combined with the monocyte-to-high-density lipoprotein cholesterol ratio (MHR) or triglyceride-to-high-density lipoprotein cholesterol ratio (TG/HDL-C) for NSTE-ACS.

This cross-sectional diagnostic study included 150 patients with NSTE-ACS and 76 healthy controls. Based on the median Gensini score, patients were divided into high-risk (Gensini score ≥51, n = 75) and low-risk groups (Gensini score <51, n = 75). MHR, TG/HDL-C, and CHG index were compared between patients and controls and between high- and low-risk groups. Their correlations with Gensini scores were assessed. Univariate and Multivariate binary logistic regression analysis was performed to identify factors independently associated with high-risk coronary lesions among patients with NSTE-ACS. The predictive performance of individual indicators (MHR, TG/HDL-C, and CHG index) and their combinations was evaluated using receiver operating characteristic curve analysis.

MHR, TG/HDL-C, and CHG index were significantly higher in the patient group than in the control group (all P < 0.001) and the high-risk group than the low-risk group. Those indicators positively correlated with Gensini scores and were independently associated with high-risk coronary lesions among patients with NSTE-ACS (odds ratio (OR) = 16.051, 95% confidence interval (CI): 13.677-99.650 for MHR; OR = 3.562, 95% CI: 1.868-6.793 for TG/HDL-C; and OR = 2.455, 95% CI: 1.040-5.791 for CHG index). The areas under the curve (AUCs) were 0.803 (95% CI: 0.730-0.876) for MHR, 0.746 (95% CI: 0.666-0.826) for TG/HDL-C, and 0.659 (95% CI: 0.573-0.746) for CHG index. The combination of CHG index and TG/HDL-C achieved an AUC of 0.821 (95% CI: 0.755-0.887), while the combination of CHG index and MHR achieved the higher AUC of 0.872 (95% CI: 0.815-0.929).

MHR, TG/HDL-C, and CHG index are independently associated with high-risk coronary lesions among patients with NSTE-ACS. Combining CHG index with MHR or TG/HDL-C shows numerically higher AUCs for identifying high-risk coronary lesions.

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Review Article Open Access
Functional Interpretation of Differential Gene Expression in Cancer: From Lists to Mechanisms
Amancio Carnero
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2026.00011
Abstract
High-throughput transcriptomic technologies have made differential gene expression analysis a cornerstone of cancer research by generating extensive lists of differentially expressed [...] Read more.

High-throughput transcriptomic technologies have made differential gene expression analysis a cornerstone of cancer research by generating extensive lists of differentially expressed genes across tumor types and conditions. However, such lists provide limited biological insight without functional and mechanistic interpretation. This review examines the transition from descriptive gene expression profiles to a mechanistic understanding of cancer biology. We discuss integrative approaches that place expression changes within signaling pathways, transcriptional regulatory networks, and protein–protein interaction networks, thereby helping to identify functional modules and candidate upstream regulators. We emphasize the context-dependent nature of gene expression, which is shaped by genetic alterations, epigenetic landscapes, microenvironmental signals, and cellular heterogeneity. We also examine methodological advances, including gene set enrichment analysis, network-based modeling, and integration of genomic, epigenomic, proteomic, metabolomic, and single-cell transcriptomic data. Case studies across cancer types illustrate how mechanistic analyses can reveal context-specific transcriptional programs associated with oncogenic signaling, tumor suppression, metabolic reprogramming, epithelial–mesenchymal transition, and tumor–immune interactions. We highlight potential translational applications, including candidate biomarker discovery, prioritization of druggable targets, rational design of combination therapies, and investigation of therapeutic resistance. Finally, we discuss current challenges and emerging technologies, such as spatial transcriptomics and clustered regularly interspaced short palindromic repeats (CRISPR)-based perturbation screens, that are advancing the field toward dynamic, systems-level models of tumor biology. Integrating computational analyses with experimental validation can help translate transcriptomic data into clinically relevant hypotheses for precision oncology and personalized cancer therapy.

Full article
Original Article Open Access
Clinical–Inflammatory Phenotypes and Circulating hsa_circ_101555 Along the Cirrhosis–Hepatocellular Carcinoma Continuum: A Cross-sectional Study
Nourhan Badwei, Amal Tohamy Abdel Moez, Houssam El-Deen M. Salem, Nashwa El-Khazragy, Mohammed Soliman Gado
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2026.00023
Abstract
The clinical spectrum from cirrhosis to hepatocellular carcinoma (HCC) reflects interactions among hepatic dysfunction, systemic inflammation, and tumor burden. Whether circulating [...] Read more.

The clinical spectrum from cirrhosis to hepatocellular carcinoma (HCC) reflects interactions among hepatic dysfunction, systemic inflammation, and tumor burden. Whether circulating biomarkers add value beyond clinical parameters remains uncertain. This study aimed to evaluate an exploratory Model for End-Stage Liver Disease (MELD)–neutrophil-to-lymphocyte ratio (NLR)-based clinical–inflammatory phenotyping framework for discriminating advanced HCC features and to determine whether circulating hsa_circ_101555 provides incremental discriminatory value beyond this framework.

This single-center cross-sectional study included 92 consecutive patients (30 with cirrhosis without HCC and 62 with HCC). Patients were classified into three exploratory clinical–inflammatory phenotypes using a hierarchical MELD–NLR algorithm (Phenotype I, n = 25; II, n = 33; III, n = 34). Circulating hsa_circ_101555 was quantified by reverse transcription quantitative polymerase chain reaction. Receiver operating characteristic analysis evaluated Barcelona Clinic Liver Cancer stage C among patients with HCC (n = 62; events = 28). Internal validation used bootstrap resampling.

Higher-risk phenotypes included progressively larger proportions of patients with HCC and greater frequencies of advanced tumor characteristics. The combined MELD–NLR model showed the highest discrimination (the area under the receiver operating characteristic curve (AUC) 0.90; 95% confidence interval 0.82–0.97), with 85.7% sensitivity, 82.4% specificity, and 83.9% accuracy. This performance exceeded that of NLR alone (AUC, 0.80) and MELD alone (AUC, 0.77). Circulating hsa_circ_101555 was associated with smaller tumors and an earlier Barcelona Clinic Liver Cancer stage but showed modest discrimination (AUC, 0.69) and did not improve the MELD–NLR model (ΔAUC = 0.002; DeLong P = 0.79).

The exploratory MELD–NLR-based clinical–inflammatory framework identifies patient groups with differing frequencies of advanced HCC features. Circulating hsa_circ_101555 provides no incremental discriminatory value beyond routinely available clinical–inflammatory parameters and requires external validation before clinical use.

Full article
Editorial Open Access
Perspectives on Cancer Immunotherapy Discussed at a 2025 Symposium in Cuba
Yuriy L. Orlov, Monica R. Bequet, Peter V. Shegai, Dania M. Vazquez, Anton V. Snegovoy, Julio R. Fernández, Inna A. Apolikhina, Daria V. Bagdasarova, Alexander N. Kuznetsov, Oleg I. Apolikhin, Marta Ayala Avila, Andrey D. Kaprin
Published online July 29, 2026
Gene Expression. doi:10.14218/GE.2025.00081
Study Protocol Open Access
The Effects of Green Rooibos Tea Extract on Anxiety Levels (REAL) Study: Protocol for a Single-center Randomized Controlled Trial
Kathryn E. Speer, Andrew J. McKune, Nenad Naumovski
Published online July 27, 2026
Exploratory Research and Hypothesis in Medicine. doi:10.14218/ERHM.2025.00088
Abstract
Anti-anxiety medications may cause adverse effects and can be associated with long-term health risks. Rooibos tea (Aspalathus linearis) contains polyphenolic compounds that may [...] Read more.

Anti-anxiety medications may cause adverse effects and can be associated with long-term health risks. Rooibos tea (Aspalathus linearis) contains polyphenolic compounds that may confer health benefits. This study aims to investigate the effects of green rooibos extract supplementation on anxiety levels in adults with mild-to-moderate anxiety.

This double-blind, placebo-controlled, randomized controlled trial will enroll 60 adults aged 18-65 years with mild-to-moderate anxiety. Participants will receive either green rooibos extract (19.25 mg aspalathin per capsule; n = 30) or placebo (n = 30). They will take one capsule each morning during the first week and two capsules each morning during the subsequent 7 weeks. The anxiety subscale of the 21-item Depression, Anxiety and Stress Scale will be the primary outcome and will be assessed from baseline to post-intervention. Secondary outcomes will include salivary biomarkers, heart rate variability, sleep quality, and dietary intake. Measurements will be collected at baseline, mid-intervention, and post-intervention.

The findings may help determine whether green rooibos extract supplementation is associated with reduced anxiety and improvements in related health markers in adults with mild-to-moderate anxiety.

Full article
Original Article Open Access
Potential Genetic Causal Associations of Systemic Lupus Erythematosus with Five Hematologic Disorders in the European-ancestry Population: A Bidirectional Two-sample Mendelian Randomization Study
Tianyang Guo, Hui Zhou, Lili Zhang, Rong Chen
Published online July 27, 2026
Exploratory Research and Hypothesis in Medicine. doi:10.14218/ERHM.2026.00013
Abstract
Observational studies indicate frequent associations between systemic lupus erythematosus (SLE) and various hematologic disorders, yet causal inferences are limited by confounding [...] Read more.

Observational studies indicate frequent associations between systemic lupus erythematosus (SLE) and various hematologic disorders, yet causal inferences are limited by confounding and reverse causality. We therefore applied a bidirectional Mendelian randomization (MR) design to assess potential genetic causal associations of SLE with specific hematologic conditions.

We used European-ancestry GWAS summary statistics for SLE (5,201 cases, 9,066 controls) and five hematologic outcomes (vitamin B12 deficiency anemia (B12DA), myelodysplastic syndrome (MDS), immune thrombocytopenia (ITP), agranulocytosis (AGC), iron deficiency anemia (IDA)) from FinnGen. The primary analysis used inverse-variance weighting, supplemented by MR-Egger and weighted median methods, with comprehensive sensitivity analyses, including heterogeneity tests, pleiotropy assessment, and leave-one-out analysis.

Bidirectional MR analysis revealed that genetically predicted SLE increased the risk of B12DA (odds ratio (OR) = 1.08, P < 0.001), and genetically predicted B12DA was associated with an increased risk of SLE (OR = 2.22, P = 1.6 × 10−29). The MDS → SLE association was nominally significant (P = 0.023) but did not survive Bonferroni correction (P < 0.005) and was inconsistent across MR methods. No significant genetic associations were found between SLE and ITP, AGC, or IDA in either direction (all P > 0.005).

This bidirectional MR study provides genetic evidence that SLE increases the risk of B12DA, whereas the reverse direction (B12DA → SLE) should be interpreted cautiously because it was based on only five instruments and was not supported by the Steiger directionality test. No robust genetic associations were found for ITP, AGC, IDA, or MDS. Clinically, monitoring B12DA in SLE patients may be warranted, although screening recommendations await prospective validation.

Full article
Editorial Open Access
Solvent Matters: A Call for Rigorous Consideration of Organic Co-solvents in Drug-target Interaction Studies
Mengqin Guo, Ziyu Zhao, Chuanbin Wu, Zhengwei Huang
Published online July 27, 2026
Journal of Exploratory Research in Pharmacology. doi:10.14218/JERP.2025.00003e
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