Evidence map›Paper›PMID 41908150›Full record

ArticleFrontiers in genetics2026

Fragmenting the future with FLARE: a comprehensive fragmentomics pipeline based on long-read nanopore sequencing.

Marica Ficorilli, Marta Lucchetta, Deborah Lenoci, Ilenia Rolli, Nicole Farina, Valentina Cristofaro, Lorenzo Giannini, Arianna Ottini, Alberto Deganello, Stefano Cavalieri and 2 more

Abstract read
In one paragraph

Article in Frontiers in genetics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Marica FicorilliIntegrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Marta LucchettaIntegrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Deborah LenociIntegrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Ilenia RolliIntegrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Nicole FarinaHead and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Valentina CristofaroOtolaryngology Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Lorenzo GianniniOtolaryngology Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Arianna OttiniHead and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Alberto DeganelloOtolaryngology Head and Neck Surgery Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
Stefano CavalieriHead and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Lisa LicitraHead and Neck Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy.
Loris De CeccoIntegrated Biology of Rare Tumors, Department of Experimental Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Purpose: Cell-free DNA (cfDNA) fragmentation patterns carry biological information beyond fragment length, revealing nuclease activity, chromatin organization, and tissue of origin. Fragmentomics has emerged as a powerful approach to improve circulating tumor DNA (ctDNA) detection, particularly at low tumor fractions. However, most current methods are designed for short-read sequencing, limiting their applicability to third-generation technologies. Here, we present FLARE (Fragmentation and Long-read Analysis of Regulatory Epigenetics), an integrated fragmentomics pipeline optimized for Oxford Nanopore long-read sequencing. Methods: FLARE preserves native cfDNA fragment ends and integrates copy number profiling, tumor fraction estimation, sequence-specific end-motif analysis, and methylation-based features to enable comprehensive characterization of cfDNA fragmentation. Plasma cfDNA from six patients with recurrent or metastatic head and neck squamous cell carcinoma (HNSCC) treated with nivolumab was analyzed at baseline (C1D1) and during therapy (C5D1). Results: Genome-wide copy number analysis revealed recurrent chromosomal alterations consistent with HNSCC biology, with ichorCNA-derived tumor fractions ranging from 0% to 12.8%. Tumor fraction estimates derived from methylation-based fragmentomic features showed concordant trends, providing an independent measure of tumor burden and correlating with clinical response. End-motif analysis based on 5'4-mer frequencies, combined with non-negative matrix factorization (NMF), identified predominant A-end and G-end patterns, consistent with apoptosis-associated nuclease activity. Conclusion: FLARE provides a robust and scalable framework for fragmentomic analysis using long-read sequencing, enabling simultaneous investigation of structural and sequence-level cfDNA features. This approach demonstrates the technical feasibility of integrated fragmentomic analyses on Nanopore cfDNA data and supports the future integration of native methylation and transcription factor binding site analyses.

Indexed as

cfDNA fragmentationcopy number profilingflarefragmentation and long-read analysis of regulatory epigeneticsfragmentomics pipelinehead and neck squamous cell carcinomaHNSCClong-read nanopore sequencing

Identifiers

PMID41908150
PMCPMC13021139

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.