Pathological mechanisms of pulmonary arterial hypertension (PAH) remain largely unexplored. Effective treatment of PAH remains a challenge. The aim of this study was to discover the underlying mechanism of PAH through functional metabolomics and to help develop new strategies for prevention and treatment of PAH.Metabolomic profiling of plasma in patients with idiopathic PAH was evaluated through high-performance liquid chromatography mass spectrometry, with spermine identified to be the most significant and validated in another independent cohort. The roles of spermine and spermine synthase were examined in pulmonary arterial smooth muscle cells (PASMCs) and rodent models of pulmonary hypertension.Using targeted metabolomics, plasma spermine levels were found to be higher in patients with idiopathic PAH compared to healthy controls. Spermine administration promoted proliferation and migration of PASMCs and exacerbated vascular remodelling in rodent models of pulmonary hypertension. The spermine-mediated deteriorative effect can be attributed to a corresponding upregulation of its synthase in the pathological process. Inhibition of spermine synthasein vitrosuppressed platelet-derived growth factor-BB-mediated proliferation of PASMCs, andin vivoattenuated monocrotaline-mediated pulmonary hypertension in rats.Plasma spermine promotes pulmonary vascular remodelling. Inhibiting spermine synthesis could be a therapeutic strategy for PAH.

Accurate prognosis prediction is essential for guiding cancer treatment and improving patient outcomes. While recent studies have demonstrated the potential of histopathological images in survival analysis, existing models are typically developed in a cancer-specific manner, lack extensive external validation, and often rely on molecular data that are not routinely available in clinical practice. To address these limitations, we present PROGPATH, a unified model capable of integrating histopathological image features with routinely collected clinical variables to achieve pancancer prognosis prediction. PROGPATH employs a weakly supervised deep learning architecture built upon the foundation model for image encoding. Morphological features are aggregated through an attention-guided multiple instance learning module and fused with clinical information via a cross-attention transformer. A router-based classification strategy further refines the prediction performance. PROGPATH was trained on 7999 whole-slide images (WSIs) from 6,670 patients across 15 cancer types, and extensively validated on 17 external cohorts with a total of 7374 WSIs from 4441 patients, covering 12 cancer types from 8 consortia and institutions across three continents. PROGPATH achieved consistently superior performance compared with state-of-the-art multimodal prognosis prediction models. It demonstrated strong generalizability across cancer types and robustness in stratified subgroups, including early- and advanced-stage patients, treatment cohorts (radiotherapy and pharmaceutical therapy), and biomarker-defined subsets. We further provide model interpretability by identifying pathological patterns critical to PROGPATH’s risk predictions, such as the degree of cell differentiation and extent of necrosis. Together, these results highlight the potential of PROGPATH to support pancancer outcome prediction and inform personalized cancer management strategies.

Cervical cytology is a critical screening strategy for early detection of pre-cancerous and cancerous cervical lesions. The challenge lies in accurately classifying various cervical cytology cell types. Existing automated cervical cytology methods are primarily trained on databases covering a narrow range of coarse-grained cell types, which fail to provide a comprehensive and detailed performance analysis that accurately represents real-world cytopathology conditions. To overcome these limitations, we introduce HiCervix, the most extensive, multi-center cervical cytology dataset currently available to the public. HiCervix includes 40,229 cervical cells from 4,496 whole slide images, categorized into 29 annotated classes. These classes are organized within a three-level hierarchical tree to capture fine-grained subtype information. To exploit the semantic correlation inherent in this hierarchical tree, we propose HierSwin, a hierarchical vision transformer-based classification network. HierSwin serves as a benchmark for detailed feature learning in both coarse-level and fine-level cervical cancer classification tasks. In our comprehensive experiments, HierSwin demonstrated remarkable performance, achieving 92.08% accuracy for coarse-level classification and 82.93% accuracy averaged across all three levels. When compared to board-certified cytopathologists, HierSwin achieved high classification performance (0.8293 versus 0.7359 averaged accuracy), highlighting its potential for clinical applications. This newly released HiCervix dataset, along with our benchmark HierSwin method, is poised to make a substantial impact on the advancement of deep learning algorithms for rapid cervical cancer screening and greatly improve cancer prevention and patient outcomes in real-world clinical settings.

Spatially resolved transcriptomics enable comprehensive measurement of gene expression at subcellular resolution while preserving the spatial context of the tissue microenvironment. While deep learning has shown promise in analyzing SCST datasets, most efforts have focused on sequence data and spatial localization, with limited emphasis on leveraging rich histopathological insights from staining images. We introduce GIST, a deep learning-enabled gene expression and histology integration for spatial cellular profiling. GIST employs histopathology foundation models pretrained on millions of histology images to enhance feature extraction and a hybrid graph transformer model to integrate them with transcriptome features. Validated with datasets from human lung, breast, and colorectal cancers, GIST effectively reveals spatial domains and substantially improves the accuracy of segmenting the microenvironment after denoising transcriptomics data. This enhancement enables more accurate gene expression analysis and aids in identifying prognostic marker genes, outperforming state-of-the-art deep learning methods with a total improvement of up to 49.72%. GIST provides a generalizable framework for integrating histology with spatial transcriptome analysis, revealing novel insights into spatial organization and functional dynamics.