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Modeling Alternative Conformational States in CASP16.

The CASP16 Ensemble Prediction experiment assessed advances in methods for modeling proteins, nucleic acids, and their complexes in multiple conformational states. Targets included systems with experimental structures determined in two or three states, evaluated by direct comparison to experimental coordinates, as well as domain-linker-domain (D-L-D) targets assessed against statistical models from NMR and SAXS data. This paper focuses on the former class of multi-state targets. Ten ensembles were released as community challenges, including ligand-induced conformational changes, protein-DNA complexes, a trimeric protein, a stem-loop RNA, and multiple oligomeric states of a single RNA. For five targets, some groups produced reasonably accurate models of both reference states (best TM-score >0.75). However, with the exception of one protein-ligand complex (T1214), where an apo structure was available as a template, predictors generally failed to capture key structural details distinguishing the states. Overall, accuracy was significantly lower than for single-state targets in other CASP experiments. The most successful approaches generated multiple AlphaFold2 models using enhanced multiple sequence alignments and sampling protocols, followed by model quality based selection. While the AlphaFold3 server performed well on several targets, individual groups outperformed it in specific cases. By contrast, predictions for one protein-DNA complex, three RNA targets, and multiple oligomeric RNA states consistently fell short (TM-score <0.75). These results highlight both progress and persistent challenges in multi-state prediction. Despite recent advances, accurate modeling of conformational ensembles, particularly RNA and large multimeric assemblies, remains a critical frontier for structural biology.

AlphaFold2

Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.

BACKGROUND AND AIMS: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives. METHODS: We constructed and validated a multi-state microsimulation Markov model for a population of 10,000 individuals aged between 40 and 69 years without CVD, selected randomly from the UK Biobank. The model evaluated Lp(a) testing in individuals not initially classified as high-risk based on age, diabetes status, or the SCORE-2 algorithm. Those with an Lp(a) level &#x2265;105&#xa0;nmol/L (50&#xa0;mg/dL) were treated as high risk (initiation of a statin plus blood pressure lowering). The Lp(a) testing intervention was compared to standard of care. The primary analyses were conducted from the Australian and UK healthcare perspectives in 2023AUD/GBP. A cost adaptation method estimated cost-effectiveness in multiple European countries, Canada, and the USA. RESULTS: Among 10,000 individuals, 1,807 had their treatment modified from Lp(a) testing. This led to 217 and 255 quality-adjusted life years gained in Australia and the UK, respectively, with corresponding incremental cost-effectiveness ratios of 12,134 (cost-effective) and -3,491 (cost-saving). From a societal perspective, Lp(a) testing saved $85 and &#xa3;263 per person in Australia and the UK, respectively. Lp(a) testing was cost-saving among all countries tested in the cost adaptation analysis. CONCLUSIONS: Lp(a) testing in the primary prevention population to reclassify CVD risk and treatment is cost-saving and warranted to prevent CVD.

Humans