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7 hours agoShareSaveNat WrightHealth ProducerShareSaveGetty ImagesSanctions for doctors guilty of sexual misconduct in the UK are too lenient in around a quarter of cases, a review suggests.The Medical Practitioners Tribunal Service (MPTS) stands accused of failing victims and compounding their trauma. The criticism is based on the outcomes of 46 cases with offences including harassment, rape, and assaults of patients, colleagues and children. Some medics were handed suspensions instead of following General Medical Council advice to strike them off the medical register. The MPTS says it recognises the impact tribunal decisions have on all those involved and will soon publish new guidance for tribunals. The MPTS is the body that takes evidence and rules on whether doctors are fit to practice in the United Kingdom. It is independent of but funded by and accountable to the doctors’ regulator – the General Medical Council – responsible for investigating complaints and bringing prosecutions against doctors. This new study by six independent academics, analysed 222 MPTS tribunal cases heard between August 2023 and August 2024. Of these cases, 46 involved proven sexual misconduct.Harassment and groomingOne of the 46 cases from 2024 involved a UK transplant surgeon who was given an eight month suspension despite misconduct spanning over a decade.He was accused of abuses of power, targeting multiple trainees under his supervision, sexual harassment, non-consensual touching during surgery and racism. The General Medical Council (GMC) wanted to strike him off altogether and, along with the Professional Standards Authority, appealed what was seen as a lenient MPTS decision.Another more recent case involved a doctor who knowingly entered into a sexual relationship with a vulnerable patient whom he had pursued and groomed from the age of 14.He was suspended for 12 months rather than struck off. The panel cited evidence of insight, remediation, and remorse.The report authors highlighted inconsistency in the sanctions imposed on doctors, a chronic lack of training for tribunal members and poor support for victims and witnesses.’A system more skilled at facilitating abusers’Most of these cases involving sexual misconduct – 65% – led to doctors being struck off and barred from practicing, but 35% resulted in only a short suspension. Nearly one in four sanctions (23.9%) imposed in these cases were more lenient than recommendations from the GMC and in no case did the tribunal impose tougher sanctions.All the doctors involved in the sexual misconduct cases were men, and almost all of them were consultants, GPs or registrars.Several cases involved multiple victims, which the researchers say demonstrates repeated and systemic abuse – some over a period of 9 years.Mei Nortley, a consultant vascular surgeon and lead author of the research says the MPTS needs to consider whether it is doing its job properly.”Allowing rapists, sexual predators and those who use manipulation and coercion to return as practising doctors brings this into question,” she said.In recent months, the MPTS has begun to update its guidance for tribunals and on sanctions, focusing on sexual misconduct cases. But the Royal College of Surgeons of England (RCS England) said the finding show the current system of medical regulation is failing.Vice President Prof Vivien Lees, Vice President of RCS England, said: “Guidance alone is not enough. Tribunal panels must be trained and apply it consistently to ensure fair, robust decisions.”RCS England will hold the MPTS to account to ensure these vital changes are fully delivered.”The General Medical Council said it takes “a zero-tolerance and proactive approach” to all forms of sexual misconduct.”Where we feel the sanctions applied by the independent tribunal are too lenient – we can, and do appeal. “A significant proportion of our appeals are successful and result in stronger sanctions.”Failing staff and patientsTamzin Cuming and Prof Carrie Newlands from the Working Party on Sexual Misconduct in Surgery (WPSMS) said: “Right now, the system gives little more than a slap on the wrist for abuse, when only erasure and accountability can ensure safety.”Without reform, powerful perpetrators will continue with impunity. A spokesman for the MPTS said it was important that doctors had a fair hearing.”We will soon publish a new suite of guidance for tribunals, covering all aspects of our hearings. “It will draw together existing guidance and recent case law, as well as best practice from other jurisdictions, to assist tribunals in reaching consistent and well-reasoned decisions,” he said.

Nitazenes — a class of highly potent synthetic opioids — are rapidly emerging as a major contributor to the overdose crisis, according to a Pain Medicine review published on Sept 14 by authors from Vanderbilt University Medical Center and the University of Pittsburgh Medical Center.
Originally developed in the 1950s but never approved for clinical use, these substances are over 20 times more potent than fentanyl and hundreds to thousands of times more potent than morphine.
They can come in liquid, pills or powder form and have been found in substances sold via social media and on the illicit drug market since 2019.
Created as a potential pain reliever but never approved for medical use in humans or studied in a clinical trial, nitazenes are an illegal Schedule I drug that can be difficult to detect with standard drug tests and are often mixed into counterfeit pills or other street drugs.
“For patients, especially those with opioid use disorder or those exposed to illicit substances, nitazenes pose a serious and often hidden threat,” said co-author Shravani Durbhakula, MD, associate professor of Anesthesiology, Division of Pain Medicine at Vanderbilt University Medical Center.
“Because these drugs may not show up on routine toxicology screens, clinicians could miss a critical piece of the diagnosis during overdose treatment. Patients may also need higher or repeated doses of naloxone to reverse their effects,” she said.
The Tennessee State Unintentional Drug Overdose Reporting System (TN SUDORS) identified a total of 92 nitazene-involved fatal drug overdoses among Tennessee residents from 2019-2023.

In Tennessee, naloxone was administered in only one in three deaths involving nitazenes, and in all nitazene-involved deaths the drug was laced with other substances, most commonly fentanyl and methamphetamine.
“Many people consuming nitazenes don’t even know they’re taking them,” Durbhakula said. “These substances are often adulterants in pills sold as other opioids, making public education more important than ever.
“We also want to stress that this is not just a drug issue; it is a public health emergency. Addressing it will require collaboration between clinicians, public health officials, law enforcement and community organizations to implement harm-reduction strategies, support addiction treatment, and raise awareness about these evolving threats,” she added.
The authors recommend expanding access to new test strips that can detect nitazenes and for at-risk patients to have access to take-home naloxone, addiction treatment and education about counterfeit pills.
“Nitazenes are an emerging class of synthetic opioids that are even more potent than fentanyl and often undetected by routine drug tests,” said corresponding author Ryan Mortman, MD, a resident in the Department of Physical Medicine and Rehabilitation at the University of Pittsburgh Medical Center.
“Their rapid spread in the illicit drug market, combined with the difficulty of reversing overdoses, underscores the urgent need for public awareness, early recognition, and expanded access to harm-reduction tools such as naloxone,” he said.
Co-authorTrent Emerick, MD, associate professor of Anesthesiology and Perioperative Medicine and Bioengineering at the University of Pittsburgh’s School of Medicine, said next steps are to generate human clinical data to better understand nitazenes’ effects, especially long-term health impacts, metabolism and response to treatments like naloxone.
“The opioid crisis continues to evolve, and a thorough understanding of the mechanisms and risks of nitazenes is crucial for pain physicians, anesthesiologists and other providers,” Emerick said.

Two healthcare workers get COVID-19 vaccinations on the same day. Both show strong antibody responses initially, but six months later one stays healthy while the other contracts the virus. A new study published in Science Translational Medicine could help explain this difference.
Researchers tracked individuals’ antibody levels after vaccinations and identified four distinct patterns of immune response after the first booster vaccination. Notably, the group that started with the highest antibody levels but experienced a faster decline were infected earlier. People with lower blood levels of IgA(S) antibodies, which protect the nose and throat, were also at higher risk. The findings suggest that monitoring how antibody levels change over time could assist in identifying individuals at greater risk of infection.
Led by scientists from Nagoya University in Japan, the research team measured antibody levels in 2,526 people over 18 months to see how vaccine responses changed between the first vaccination and later booster shots. They developed a mathematical classification system for COVID-19 vaccine responses using long-term tracking and AI-based computer analysis, becoming the first to systematically identify and characterize the “rapid-decliner” group.
The researchers found that immune responses fell into four clear patterns: some people maintained high antibody levels over time (durable responders), others started with strong levels but lost them quickly (rapid-decliners), a third group produced few antibodies that also declined rapidly (vulnerable responders), and the rest fell in between (intermediate responders).
Immunity that peaks early and then drops
According to Shingo Iwami, senior author and professor at Nagoya University’s Graduate School of Science, the results for the rapid-decliner group were surprising. “In spite of their impressive initial immune response, they caught COVID-19 sooner than other groups, while durable responders maintained protection for longer periods. One-time blood tests for IgG antibodies, the antibody type we used for classification, couldn’t detect this risk. Only by tracking changes over months did we see the pattern,” he explained.
A breakthrough or subsequent infection refers to infections that occur after vaccination because the virus overcomes the immune protection that vaccines provide. The researchers found that people whose antibodies declined faster, either because they started low or dropped quickly (vulnerable responders and rapid-decliners), were slightly more likely to get breakthrough infections earlier.

After booster vaccinations, 29% of participants fell into the durable responder category, 28% were vulnerable responders, and 19% were rapid-decliners. The remaining participants showed intermediate patterns. The differences in breakthrough infection rates between groups were modest — 5.2% for durable responders and 6% for vulnerable and rapid-decliners.
Breakthrough infections linked to IgA(S) antibody levels
The study also revealed that participants who experienced breakthrough infections had lower levels of IgA(S) antibodies in their blood several weeks after vaccination. These antibodies protect the nose and throat and are our first line of defense against respiratory viruses.
Importantly, the researchers found a strong correlation between blood IgA(S) levels and nasal IgA(S) levels, suggesting that blood tests can reliably indicate the strength of immune protection in airways. As a result, measuring blood IgA(S) levels after vaccination may help identify individuals at higher risk for breakthrough infection, especially among vulnerable groups.
While these results provide a foundation for future research, Professor Iwami emphasized the importance of identifying the underlying biological mechanisms responsible for the rapid decline in antibody levels in order to develop more effective vaccination strategies. Previous research points to factors such as age, genetic variation, vaccine-specific characteristics, and environmental influences, including sleep habits, stress levels, and medications being taken at the same time.
“This is the first time we’ve been able to clearly group how people respond to COVID-19 vaccines,” Professor Iwami noted. “Identifying the rapid-decliner pattern is especially important — it helps explain why some people may need boosters sooner than others. This could potentially contribute to better, more personalized vaccination strategies. However, whether antibody testing can be used widely depends on cost, accuracy, and if the benefits are worthwhile compared to current strategies. More research is needed to understand its full potential.”

Just nowShareSaveCraig BuchanSouth EastShareSaveGetty ImagesA hospital boss has apologised after a Kent emergency department resorted to using its cafe as a makeshift ward.A&E staff at William Harvey Hospital in Ashford decided to screen off the building’s cafe on Tuesday to create space for treating patients.East Kent Hospitals University NHS Foundation Trust said the move was due to “significant demand”.Trust chief executive Tracey Fletcher said: “We know this is unacceptable and we are very sorry to patients who have been cared for in this way.”A “small number” of patients were looked after in the cafe until emergency patients could be moved to other wards in the hospital, the trust said.Labour MP for Ashford Sojan Joseph said it was “not acceptable” to use corridors to care for patients but said staff worked “incredibly hard under very difficult circumstances caused by a decade and a half of cuts”.He said: “It’s something I saw there during my time as a nurse. However, senior management across East Kent Hospitals must do more to step up and improve standards across all levels of care.”Ken Rodgers, chairman of Concern for Health in East Kent, said: “This type of patient experience will never end unless there is serious investment in east Kent instead of sticking plaster-type cures.”Acute care in east Kent will “eventually collapse” without intervention, he added.He said he had written to Health Secretary Wes Streeting, inviting him to visit the area’s hospitals and calling for further investment.The Department of Health and Social Care has been approached for a comment.Ms Fletcher said it was “sometimes necessary” to treat patients in corridors despite staff’s efforts, but that use of the cafe, first reported by Kent Online, “will not be allowed to happen again”.The trust was ranked 101 out of 134 in a league table of trusts’ performance that NHS England published earlier this month.More on this storyRelated internet links

Researchers at the University of Gothenburg have made light-powered gears on a micrometer scale. This paves the way for the smallest on-chip motors in history, which can fit inside a strand of hair.
Gears are everywhere – from clocks and cars to robots and wind turbines. For more than 30 years, researchers have been trying to create even smaller gears in order to construct micro-engines. But progress stalled at 0.1 millimeters, as it was not possible to build the drive trains needed to make them move any smaller.
Researchers from Gothenburg University, among others, have now broken through this barrier by ditching traditional mechanical drive trains and instead using laser light to set the gears in motion directly.
Gears powered by light
In their new study, the researchers shows that microscopic machines can be driven by optical metamaterials – small, patterned structures that can capture and control light on a nanoscale. Using traditional lithography, gears with an optical metamaterial are manufactured with silicon directly on a microchip, with the gear having a diameter of a few tens of micrometers. By shining a laser on the metamaterial, the researchers can make the gear wheel spin. The intensity of the laser light controls the speed, and it is also possible to change the direction of the gear wheel by changing the polarization of the light.
The researchers are thus close to creating micromotors.
A new way of thinking
“We have built a gear train in which a light-driven gear sets the entire chain in motion. The gears can also convert rotation into linear motion, perform periodic movements and control microscopic mirrors to deflect light,” says the study’s first author, Gan Wang, a researcher in soft matter physics at the University of Gothenburg.

The ability to integrate such machines directly onto a chip and drive them with light opens up entirely new possibilities. Since laser light does not require any fixed contact with the machine and is easy to control, the micromotor can be scaled up to complex microsystems.
“This is a fundamentally new way of thinking about mechanics on a microscale. By replacing bulky couplings with light, we can finally overcome the size barrier,” says Gan Wang.
Cell size
With these advances, researchers are beginning to imagine micro- and nanomachines that can control light, manipulate small particles or be integrated into future lab-on-a-chip systems. A gear wheel can be as small as 16-20 micrometers, and there are human cells of that size. Medicine is a field that is within reach, believes Gan Wang.
“We can use the new micromotors as pumps inside the human body, for example to regulate various flows. I am also looking at how they function as valves that open and close.”

1 day agoShareSaveAnoushka Mutanda-Dougherty,Melanie Stewart-Smith andVictoria FarncombeFame Under Fire podcastShareSaveGetty ImagesEmmanuel Macron and his wife, Brigitte, are planning to present photographic and scientific evidence to a US court to prove Mrs Macron is a woman.Their lawyer says the French president and Mrs Macron will present the documentation in a defamation suit they have taken against the right-wing influencer Candace Owens after she promoted her belief that Brigitte Macron was born male.Ms Owens’ lawyers have responded with a motion to dismiss the claim.Speaking to the BBC’s Fame Under Fire podcast, the Macrons’ lawyer in the case, Tom Clare, said Mrs Macron had found the claims “incredibly upsetting” and they were a “distraction” to the French president.”I don’t want to suggest that it somehow has thrown him off his game. But just like anybody who is juggling a career and a family life as well, when your family is under attack, it wears on you. And he’s not immune from that because he’s the president of a country,” he said.Mr Clare said there would be “expert testimony that will come out that will be scientific in nature” and while he would not reveal, at this stage, its exact nature, he said the couple were prepared to demonstrate fully “both generically and specifically” that the allegations are false.”It is incredibly upsetting to think that you have to go and subject yourself, to put this type of proof forward,” he said.”It is a process that she will have to subject herself to in a very public way. But she’s willing to do it. She is firmly resolved to do what it takes to set the record straight.”If that unpleasantness and that discomfort that she has of opening herself up in that way is what it takes to set a record straight and stop this, she’s 100% ready to meet that burden.”When asked if the Macrons would be supplying pictures of Brigitte pregnant and raising her children, Mr Clare said they existed and would be presented in court where there are rules and standards.Ms Owens, a former commentator for conservative US outlet Daily Wire who has millions of followers on social media, has repeatedly promoted her view that Brigitte Macron is a man.In March 2024, she claimed she would stake her “entire professional reputation” on the allegation.The allegation originated in fringe online spaces years earlier, notably through a 2021 YouTube video by French bloggers Amandine Roy and Natacha Rey.The Macrons initially won a defamation case in France against Roy and Rey in 2024, but that ruling was overturned on appeal in 2025 on freedom of expression grounds, not on the basis of truth. The Macrons are appealing the decision.In July, the Macrons filed a lawsuit against Ms Owens in the US. It alleges she “disregarded all credible evidence disproving her claim in favour of platforming known conspiracy theorists and proven defamers”.In American defamation cases against public figures, plaintiffs are required to prove “actual malice” – that the defendant knowingly spread false information or acted with reckless disregard for the truth.Candace OwensIn August, Emmanuel Macron explained to French magazine, Paris Match, why they had chosen to pursue legal action.”This is about defending my honour! Because this is nonsense. This is someone who knew full well that she had false information and did so with the aim of causing harm, in the service of an ideology and with established connections to far-right leaders.”Ms Owens’ lawyers have responded to the Macrons’ lawsuit with a motion to dismiss, arguing that the case should not have been filed in Delaware, as she says it does not relate to her businesses, which are incorporated in the state. They claim forcing her to defend the case in Delaware would cause “substantial financial and operational hardship”.The BBC has approached Candace Owens’ legal team for a comment. She has previously said she believes what she is saying is true and there is nothing more American than free speech and the ability to criticise.

7 hours agoShareSaveJosh ElginLondonShareSaveGetty ImagesGonorrhoea vaccines and a new antibiotic treatment are being offered at a Soho bar as part of an effort to reduce rates of sexually transmitted infections (STIs).The pop-up events, which are being hosted in G-A-Y Bar, aim to make it easier for those at the highest risk to get the vaccine.Figures show that gay and bisexual men are disproportionately affected by STIs, accounting for 75% of syphilis and 70% gonorrhoea cases in London last year.The events have been organised by 56 Dean Street, an NHS clinic which has been at the forefront of innovations in sexual health, including same-day STI testing and expanded access to PrEP, a medication that helps prevent HIV.Lawrence O’Connell, a senior nurse at the clinic, said stigma and anxiety around clinical settings can prevent people from seeking support, which is why 56 Dean Street wanted to “be out and be seen” and meet people where they are.A recent event saw a long queue stretch down Old Compton Street, and inside, booths had been turned into makeshift consultation rooms. G-A-Y maintained its party atmosphere as pop anthems continued playing in the background.Josh Elgin/BBCThe outreach events are part of a wider public health push to tackle rising STI rates. In 2023, gonorrhoea cases in England reached a record high with over 85,000 diagnoses, triple the number reported in 2012. Although that figure dropped to 71,000 last year, experts are increasingly worried about a small but growing number of antibiotic resistant cases.The vaccine, which began being rolled out last month, was originally developed to protect against meningitis B, but recent studies suggested it reduced the risk of gonorrhoea by around 40%. It not only protects individuals, but also helps to break the chain of infection, which experts say will reduce the overall spread.’It’s not shameful’Other STIs are also on the rise, with syphilis cases last year reaching their highest level in seven decades. Alongside the vaccine, a new antibiotic treatment known as DoxyPEP is also being offered at the pop-ups. If taken within 72 hours of sex, it significantly reduces the risk of contracting infections like chlamydia and syphilis.Its use is being carefully monitored due to concerns about antibiotic resistance.DoxyPEP is currently only recommended for gay and bisexual men and trans women who have recently had an STI or who regularly have new sexual partners. Mr O’Connell said the likelihood of resistance is low, and encouraged people at risk to visit the clinic and speak to someone about whether it is right for them.What is gonorrhoea?Gonorrhoea is a sexually transmitted infection passed on through unprotected sex. It’s treated with antibiotics. If it’s not treated, it can cause serious health problems.Not everyone gets symptoms of gonorrhoea, but for people who do, they usually start around two weeks after infection, although they sometimes do not appear until many months later.If gonorrhoea is not treated, it can cause serious problems including:Eye infections An infection of the womb, fallopian tubes and ovaries (pelvic inflammatory disease), which can lead to infertility if not treatedInfection in the testicles or prostate (prostatitis) More than 550 people have attended the pop-up events at G-A-Y so far. Andrew and Calum came together after seeing it advertised on social media. Calum said he felt fortunate the two friends talked openly about sexual health with each other. “It’s something we talk about a lot. It’s really nice; it’s not shameful.”Andrew said he was keen to get the vaccine and DoxyPEP as soon as he could. “We’re single and we live in London. We may as well be safe.” Calum believes that within the community “there is a focus on HIV,” but less so for other STIs.Josh Elgin/BBCEla attended the pop-up after initially being told by a local sexual health clinic that they might not meet the eligibility criteria.”People are very aware that trans people exist, but sometimes I have to fight my corner. I’ve been told before I should masc up to get a vaccine,” they said.”Knowing I’ve got DoxyPEP and the vaccine will take a lot of anxiety off sex for me.”Mr O’Connell said the treatments shouldn’t be seen as standalone solutions, but as an extra level of protection alongside other measures like using condoms and taking PrEP.People who may be eligible for the vaccine and DoxyPEP are asked to contact their local sexual health clinic. An additional two events are scheduled at G-A-Y on 18 and 25 September, between 16:00 – 19:00.Listen to the best of BBC Radio London on Sounds and follow BBC London on Facebook, X, and Instagram. Send your story ideas to hello.bbclondon@bbc.co.uk, externalMore on this storyRelated internet links

Colorectal cancer is the second leading cause of cancer death worldwide. If detected early, it can be efficiently treated, but the cost and discomfort of colonoscopies — the main diagnostic method currently in use — often result in delayed diagnosis. Using machine learning algorithms, a team from the University of Geneva (UNIGE) identified for the first time all human gut bacteria to a level of detail that makes it possible to understand the physiological importance of the different microbial subgroups. This inventory was then used to detect the presence of colorectal cancer according to the bacteria present in simple stool samples, a non-invasive and low-cost screening tool. The potential applications are vast, ranging from the diagnosis of other cancers to a better understanding of the links between gut microbiota and health. These findings are published in Cell Host & Microbe.
Colorectal cancer is often diagnosed at an advanced stage when treatment options are limited. This underscores the need for simpler, less invasive diagnostic tools, particularly in the face of a still unexplained rise in cases among young adults. While it has long been known that gut microbiota plays a role in the development of colorectal cancer, translating these findings into clinical practice has proven challenging. This is because different strains of the same bacterial species can have opposite effects, with some promoting the disease and others having no effect.
“Instead of relying on the analysis of the various species composing the microbiota, which does not capture all meaningful differences, or of bacterial strains, which vary greatly from one individual to another, we focused on an intermediate level of the microbiota, the subspecies,” explains Mirko Trajkovski, full professor in the Department of Cell Physiology and Metabolism and in the Diabetes Centre at the UNIGE Faculty of Medicine, who led this research. “The subspecies resolution is specific and can capture the differences in how bacteria function and contribute to diseases including cancer, while remaining general enough to detect these changes among different groups of individuals, populations, or countries.”
With the help of machine learning
The first step was to analyse huge amounts of data. “As a bioinformatician, the challenge was to come up with an innovative approach for mass data analysis,” recalls Matija Trickovic, PhD student in the laboratory of Mirko Trajkovski and first author of this study. “We successfully developed the first comprehensive catalogue of human gut microbiota subspecies, together with a precise and efficient method to use it both for research and in the clinic.”
By combining this catalogue with existing clinical data, the scientists developed a model that can predict the presence of colorectal cancer solely based on the bacteria present in stool samples. “Although we were confident in our strategy, the results were striking,” enthuses Matija Trickovic. “Our method detected 90% of cancer cases, a result very close to the 94% detection rate achieved by colonoscopies and better than all current non-invasive detection methods.”
By integrating more clinical data, this model could become even more precise and match the accuracy of colonoscopy. It could become a routine screening tool and facilitate the early detection of colorectal cancer, which would then be confirmed by colonoscopy but only in a selected group of patients.
A new world of applications
A first clinical trial is being set up in collaboration with the Geneva University Hospitals (HUG) to determine more precisely the cancer stages and the lesions that can be detected. However, the applications go beyond colorectal cancer. By studying the differences between subspecies from the same bacterial species, researchers can now identify the mechanisms of action by which the gut microbiota influences human health. “The same method could soon be used to develop non-invasive diagnostic tools for a wide range of diseases, all based on a single microbiota analysis,” concludes Mirko Trajkovski.

An international team of scientists has revealed how rogue rings of DNA that float outside of our chromosomes — known as extrachromosomal DNA, or ecDNA — can drive the growth of a large proportion of glioblastomas, the most common and aggressive adult brain cancer. The discovery could open the door to much-needed new approaches to diagnose glioblastoma early, track its progress and treat it more effectively.
The findings, published on September 8 in Cancer Discovery, are the first to suggest that ecDNA rings containing cancer-driving genes often appear in the earliest stages of glioblastoma’s development — and in some cases, even before the tumour has fully formed. This early arrival may set the stage for the cancer’s rapid growth, adaptability and resistance to treatment.
The study was led by Dr Benjamin Werner at Queen Mary University of London and Professor Paul Mischel at Stanford University, both part of Cancer Grand Challenges’ team eDyNAmiC, as well as Professor Charlie Swanton at The Francis Crick Institute.
Tackling cancer’s toughest challenges
Glioblastoma is one of the most challenging cancers to treat, with median survival remaining at around 14 months and little improvement in recent decades. New approaches for earlier detection and more effective treatment are urgently needed.
ecDNA is emerging as a potentially important player in many adult and paediatric cancers, including glioblastoma, but its role is complex and mysterious. The Cancer Grand Challenges initiative — founded by Cancer Research UK and the National Cancer Institute in the US — identified understanding ecDNA as one of the toughest challenges facing the field today. In 2022, they funded team eDyNAmiC — a $25m international, cross-disciplinary consortium of experts in cancer, clinical research, evolutionary biology, computer science and mathematics — to decipher ecDNA’s role and identify ways to target it. The current study marks an important advance in team eDyNAmiC’s work.
Excavating a tumor’s past
In their new study, team eDyNAmiC and their collaborators integrated genomic and imaging data from patients with glioblastoma with advanced computational modelling of the evolution of ecDNAs in space and time.

“We studied the tumours much like an archaeologist would. Rather than taking a single sample, we excavated multiple sites around the tumour, allowing us to build computational models describing how they evolved. We simulated millions of different scenarios to reconstruct how the earliest ecDNAs emerged, spread, and drove tumour aggressiveness, giving us a clearer picture of the tumour’s origins and progression,” explains senior author Dr Benjamin Werner, a group leader at the Barts Cancer Institute, Queen Mary University of London.
The analysis revealed that most ecDNA rings contained EGFR, a potent cancer-driving gene. EGFR ecDNA appeared early in the cancer’s evolution — even before tumour formation in some patients. It also frequently gained extra changes, such as the EGFRvIII variant, that made the cancer more aggressive and resistant to therapies.
A window of opportunity
“These subtle mechanisms show that there may be a window of opportunity to detect and treat the disease between the first appearance of EGFR ecDNA and the emergence of these more aggressive variants,” suggests Dr Magnus Haughey, a postdoctoral researcher in Dr Werner’s group and one of the paper’s lead authors. “If scientists can develop a reliable test to detect early EGFR ecDNA — for example through a blood test — it could enable them to intervene before the disease becomes harder to treat.”
The study confirmed that ecDNA can carry more than one cancer gene at a time, each of which may uniquely shape how tumours evolve and respond to treatment. This highlights the potential value of tailoring treatments based on a tumour’s ecDNA profile.
Yet many mysteries remain. The researchers now plan to study how different treatments affect the number and types of ecDNA in glioblastoma. Team eDyNAmiC will continue to investigate the role of ecDNAs across a range of cancer types to uncover further opportunities to diagnose cancers earlier, track their progress more precisely, and design smarter treatments.

Charlie Swanton, Deputy Clinical Director and head of the Cancer Evolution and Genome Instability Laboratory at The Francis Crick Institute and chief clinician at Cancer Research UK, says:
“These findings suggest that ecDNA is not just a passenger in glioblastoma, but an early and powerful driver of the disease. By tracing when and how ecDNA arises, we open up the possibility of detecting glioblastoma much earlier and intervening before it becomes so aggressive and resistant to therapy. I hope this might help to drive a new era in how we diagnose, track and treat this devastating cancer.”
Paul Mischel, MD, the Fortinet Founders Professor and professor and vice chair of research in the pathology department at Stanford Medicine, says:
“These findings reveal an important new insight into the role of ecDNA in tumour development and progression. Previous work from our collaborative team and other researchers, has shown that ecDNA can arise early in tumor development, including at the stage of high-grade dysplasia, and it can also arise later to drive tumor progression and treatment resistance. The findings here show that in glioblastoma, there is an early event driven by ecDNA that could potentially be more actionable, raising the possibility that glioblastoma is another cancer for which earlier detection and intervention based upon ecDNA may be possible.”
Director of Cancer Grand Challenges, Dr David Scott, says:
“This study exemplifies the bold, boundary-pushing science Cancer Grand Challenges was created to support. By unravelling the evolutionary history of ecDNA in glioblastoma, team eDyNAmiC is not only deepening our understanding of one of the most devastating cancers but also illuminating new paths for earlier detection and treatment. It’s a powerful reminder that when we bring together diverse disciplines and global talent, we can begin to solve the toughest problems facing cancer research.”

8 hours agoShareSaveKate McGoughEducation reporterShareSave