1. Sep 2026
    1. Reviewer #1 (Public review):

      Summary of strengths:

      Thank you very much for giving me the opportunity to review this very interesting paper. The research question is intriguing, allowing to address commonly observed co-morbidities between depression and anxiety and their dissociable and opposite relationship to mood fluctuations and sensitivity to reward prediction errors. The computational analyses are very in-depth, including many state of the art checks and validations. Finally, another strength is the inclusion of several large or very large samples, including a patient sample in addition to the general population sample.

      Comments on revised version.

      I want to thank the authors for taking the time to answer all my questions. Their answers were very thoughtful and well argued. I found the theoretical explanations very helpful for explaining their approach and ideas further. In particular, it was fascinating to see how including a single non-orthogonalized depression or anxiety scored show no effect, but including them in simultaneously revealed their previously observed patterns.

    2. Reviewer #2 (Public review):

      Summary:

      Despite their common co-occurrence, depression and anxiety are known to alter mood fluctuations in opposite ways. Here, the authors aimed at distinguishing depression-specific from anxiety-specific from psychopathology-general effects of reward processing on mood fluctuations, focusing on reward prediction errors (RPE) which are known to be linked to mood fluctuations. This mechanistic study aims at uncovering the process through which these psychopathologies are associated with mood modulations. The authors were able to appropriately test their hypothesis and obtained results corroborating their conclusions.

      This work provides a convincing demonstration of the relevance of computational psychiatry (Huys et al, 2016) and the use of decision neuroscience to shed light on the interplay of anxiety and depression and mood.

      Comments on revised version.

      (1) Methodological & Theoretical Framework: The authors used a tripartite model to effectively distinguish depression vs anxiety dimensions from broad psychopathology/distress.

      (2) Possible theoretical confounds: This manuscript addressed adequately the concerns one would have regarding risk-attitudes.

      (3) Computational Rigor: The computational model elegantly separates reward expectations (EV in the model) from outcome processing through RPE, which are two sequential cognitive processes, providing a fine-grained mechanistic account of mood fluctuations.

      (4) Clear & Logical Results Structure: In response to feedback provided during the previous round of review (previously cited as a recommendation for authors), the authors re-organized the Results section into three distinct, easy-to-navigate subsections (Depression, Anxiety, and Depression vs. Anxiety), which substantially improves readability and clarity.

      (5) Neurobiological Context: The Discussion has been enriched with a well-integrated overview of the neural circuits (striatal-midbrain dopaminergic, vmPFC, OFC, and anterior insula) likely underpinning RPE-driven mood updates, which is sure to improve the translational interest of this work.

      (6) Transparent Reporting: The authors had already provided a trustworthy writing approach when referring to trending statistical results. In this revised manuscript, they have been exceptionally transparent regarding study limitations, data collection timelines (addressing potential AI-related artifacts), and statistical power constraints.

      Status of Previous Weaknesses & Suggested Revisions

      (1) Clinical Sample Size and Anxiety-Specific Effects

      Previous Concern: The sample size of the clinical sample (N=116) may not be sufficient to detect anxiety-specific effects due to the high rate of comorbid anxious depression. It would be beneficial to include the number of MDD vs GAD vs anxious depression diagnoses in the clinical population as this would be likely to shine light on the power limitations.

      • Author Revision: The authors have fully addressed this point by adding a diagnostic breakdown in Table S8 which details the diagnosis, illness duration, and medication status. They also included details of the power analysis (Discussion, pages 17-18) putting into perspective their results and provided two possible literature-informed interpretations of their findings. This is also reflected in their updated Abstract.

      (2) Re-organization of Results

      Previous Suggestion: The results sections 2 (depression) and 3 (anxiety) could be improved by reducing the back and forth between factors throughout the results. It may be useful to split them into 3 sections: depression only, anxiety only, depression vs anxiety.

      • Author Revision: The Results section was restructured as suggested, cleanly isolating depression-specific associations, anxiety-specific associations, and direct statistical comparisons between the two ("differential associations" in the manuscript).

      (3) Neurocircuitry Discussion

      Previous Suggestion: In the discussion, authors could have mentioned the brain areas most likely to be involved in these processes, both cognitive and psychopathological, as previous studies (such as Cecchi et al, 2022) have aimed at identifying regions involved in RPE processing while modulating mood in health. A short section on this would be useful to the neuropsychiatric community.

      • Author Revision: A concise section was added to the Discussion mapping computational parameters onto striatal, prefrontal, and insular circuitry (see Strengths #5).

      Conclusion:

      The authors have satisfactorily resolved all minor-to-moderate issues raised in the previous review.

    3. Reviewer #3 (Public review):

      Summary:

      In this submission Wang and colleagues jointly examine the association between depression and anxiety symptoms and individuals' affective reactivity to reward prediction errors in Ruttledge et al.'s gambling paradigm. Taking a bifactor approach to anxiety and depression in several non-clinical (and one clinical sample), the authors find that anxiety-specific symptoms relate to over-reactivity of mood to reward prediction errors (RPEs) as well as heightened mood variability , while depression-specific symptoms relate to blunted mood sensitivity to RPEs. These depression-, but not-anxiety specific relationships replicated in patient samples.

      Strengths:

      I was impressed that the data-driven, transdiagnostic approach employed by the authors uncovered specific relationships between anxiety and depression-specific factors and RPE reactivity in a well characterized task and computational model, especially in a non-clinical sample. This sheds new light on how these affective processes may be perturbed-and importantly, in different ways-by anxiety and depression symptoms. Likewise, the replication of the depression-specific finding (RPE hypo-reactivity) in a clinical sample was nice to see.

      Weaknesses:

      While the anxiety- and depression-specific factors had differential effects on mood variability (Fig 2A-D) and RPE reactivity (Fig 2E-G) in all samples, such that the correlations between the two factors and these mood parameters were significantly different, the anxiety factor was not consistently (significantly) associated with either mood-related parameter across samples. However, the authors resolve anxiety-specific predictive effects when they collapse across datasets. While it is intuitive that achieving a larger effective sample size would afford the power necessary to detect such individual differences, this struck me as a major caveat for this set of results.

      The associations the authors observe between the 'common factor' of depression and anxiety and risk-aptitudes tendencies-presumably the alpha (exponent) parameter in a prospect theory-type subjective value model. But where is this analysis explained? (i.e. how was this model formulated and how were risk attitude parameters estimated?) And what is the interpretation of this finding-is there precedent for looking at risk attitudes in this task? And why would these predictive effects only be observed in relation to the common, but not unique factors of anxiety and depression?

      Comments on revised version.

      I believe the weaknesses identified in the previous round of review have been adequately addressed by the authors, and my suggestions concerning clarity of presentation have by and large been implemented by the authors.

    4. Author response:

      The following is the authors’ response to the original reviews.

      eLife Assessment

      This important study uses a tripartite transdiagnostic computational framework to distinguish depression-specific, anxiety-specific, and shared psychopathology dimensions, in their relationships to mood variability and mood reactivity to reward prediction errors across multiple large non-clinical cohorts and a clinical sample. The evidence is convincing overall because the study combines large samples, a well-characterized gambling task and in-depth computational and psychometric analyses, and it replicates the depression-specific association with blunted reward prediction error-sensitivity in a clinical sample. However, the anxiety-specific effects are less consistently supported across individual datasets, may be underpowered in the clinical cohort because of comorbidity, and some aspects of the factor-analytic, risk-attitude, and mediation analyses would benefit from clearer explanation. These findings advance a mechanistic account of how distinct symptom dimensions differentially shape reward-based mood updating and variability, providing a principled framework for future transdiagnostic modeling.

      We thank the editors and reviewers for this important assessment.

      Regarding inconsistent results for anxiety-related effects in healthy datasets. Although the anxiety-specific factor showed associations in the expected direction across healthy datasets, these associations were not significant in several individual datasets. Specifically, anxiety-specific scores were positively correlated with mood variation (laboratory dataset: r = 0.10, p = 0.531; online dataset 1: r = 0.08, p = 0.026; online dataset 2: r = 0.19, p = 0.004) and with RPE-related mood sensitivity (laboratory dataset: r = 0.04, p = 0.820; online dataset 1: r = 0.05, p = 0.216; online dataset 2: r = 0.19, p = 0.004; Figures 2A–C and 2E–G). This pattern may partly reflect limited statistical power at the single-dataset level. Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, we conducted pooled analyses to obtain a more stable estimate. Importantly, these analyses included dataset as a random intercept in mixed-effects models to account for between-dataset differences. Thus, the pooled analysis provides an integrated estimate across samples, conceptually similar to an individual-participant-data meta-analytic approach. The pooled results provided evidence for the expected anxiety-specific associations with greater mood variability and heightened RPE-related mood sensitivity in non-clinical participants (mood variation: t = 3.46, p < 0.001; RPE-related mood sensitivity: t = 2.60, p = 0.009). In addition, we conducted a mini meta-analysis, and results support that anxiety is associated with intensified mood fluctuations and increased mood sensitivity to RPE in non-clinical participants. We have clarified this point below:

      Pages 10-11:

      “Correlations between the anxiety-specific factor and mood variation were positive in direction across datasets, although they were not statistically significant in several datasets (the laboratory dataset: r = 0.10, p = 0.531; the online dataset 1: r = 0.08, p = 0.026; the online dataset 2: r = 0.19, p = 0.004). Similarly, correlations between the anxiety-specific factor and β<sub>RPE</sub> were positive in direction but statistically inconsistent across datasets (the laboratory dataset: r = 0.04, p = 0.820; the online dataset 1: r = 0.05, p = 0.216; the online dataset 2: r = 0.19, p = 0.004; Figure 2A-C & 2E-G). Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, and because reliable individual differences often require large samples to detect[48], we combined the laboratory dataset, online dataset 1, and online dataset 2 (total N = 1,026). This approach is analogous to an individual-participant-data meta-analytic analysis. We fitted linear mixed-effects models predicting mood variation and β<sub>RPE</sub> from the three bifactor scores, with dataset included as a random intercept to account for dataset-level variability. For mood variation, the anxiety-specific factor was positively associated with mood variation (t = 3.46, p < 0.001), whereas the depression-specific factor was negatively associated with mood variation (t = -6.13, p < 0.001). For RPE-related mood sensitivity, the anxiety-specific factor was positively associated with β<sub>RPE</sub> (t = 2.60, p = 0.009), whereas the depression-specific factor was negatively associated with β<sub>RPE</sub> (t = -5.30, p < 0.001). These associations remained significant after controlling for gender, age, task earnings, and mood drift. In addition, we performed a mini meta-analysis on these correlation coefficients[49]. Results showed significant positive correlation for both mood variation and RPE-related mood sensitivity (mood variation: Z = 3.399, 95 % CI for correlation coefficient r [0.045, 0.166]; RPE-related mood sensitivity: Z = 2.618, 95 % CI for correlation coefficient r [0.021, 0.143]), supporting that anxiety is associated with intensified mood fluctuations and increased mood sensitivity to RPE in non-clinical participants.”

      We also admit that the anxiety-related effects were less robust than the depression-related effects and were detectable only in the pooled dataset (n = 1,026); therefore, they require further replication in larger samples.

      Page 17:

      “Notably, the anxiety-related effects were less robust than the depression-related effects and were detectable only in the pooled dataset (n = 1,026); therefore, they require further replication in larger samples.”

      Regarding be underpowered sample size in the clinical cohort. We agree that the clinical sample may have been underpowered to detect anxiety-specific effects, especially given the high comorbidity between anxiety and depression in affective disorders (Table S8). Based on the effect size observed in the non-clinical datasets (r = 0.079), we estimated that a sample size of 1,226 would be required to detect this effect with 80% statistical power using a two-tailed test with α = .05. This estimate is substantially larger than the current clinical sample size (n = 116). Although these covariate analyses support the robustness of the depression-related effect, they do not resolve whether the absence of the anxiety-related effect reflects limited power or true clinical discontinuity. We also revised the Discussion to explicitly acknowledge that the anxiety-related effect observed in the pooled non-clinical dataset was not replicated in the clinical sample. We now note two possible interpretations. First, this discontinuity may reflect limited statistical power in the clinical sample. Second, and more speculatively, it may reflect a disruption of mood homeostasis in affective disorders (Paulus, 2007). In non-clinical individuals, the counterbalancing associations of depression- and anxiety-related traits with mood variation may contribute to emotional equilibrium. In contrast, affective disorders may involve a loss of this regulatory balance, reducing the ability to stabilize mood in the face of competing depression- and anxiety-related affective signals. We have revised the manuscript as follows:

      Pages 12-13:

      “To test whether abnormalities in RPE-driven mood fluctuations can serve as clinically relevant computational markers of depression- and anxiety-related symptom dimensions, we recruited patients with affective disorders (n = 116) to complete the same questionnaire battery and gambling task with momentary mood ratings (Figure 1). Demographic, psychological, and clinical characteristics are summarized in Table 1 and Table S8. We observed significant negative correlations between depression-specific scores and both mood variation (r = -0.239, p = 0.009) and RPE-related mood sensitivity (β_RPE; r = -0.216, p = 0.020). These associations remained significant after controlling for demographic and clinical covariates, task earnings, and mood drift (ps < 0.05). Bootstrap validation yielded consistent results. Mediation analyses further showed that reduced mood sensitivity to RPEs statistically mediated the association between depression-specific scores and lower mood fluctuations (a × b = -0.141, 95% CI = [-0.261, -0.038], p = 0.021; Figure 3). However, we did not observe significant correlation with anxiety (mood variation: r = -0.092, p = 0.327; β_RPE: r = -0.095, p = 0.311).”

      Pages 17-18:

      “Notably, the pattern of heightened RPE sensitivity observed in the pooled non-clinical dataset was not observed in the clinical sample. On the one hand, this discontinuity may reflect that the clinical sample was underpowered to detect anxiety-specific effects, especially given the high comorbidity between anxiety and depression in affective disorders (Table S8). Based on the effect size observed in the non-clinical datasets (r = 0.079), we estimated that a sample size of 1,226 would be required to detect this effect with 80% statistical power using a two-tailed test with α = .05. This estimate is substantially larger than the current clinical sample size (n = 116). On the other hand, it may reflect a disruption of mood homeostasis in clinical populations[41,58]. In non-clinical individuals, counterbalancing associations of depression- and anxiety-related traits with mood variation may help maintain emotional equilibrium. In contrast, affective disorders may involve a loss of such regulatory balance, reducing the ability to stabilize mood in the face of competing depression- and anxiety-related affective signals.”

      Abstract:

      “Results showed that depression was associated with dampened mood fluctuations due to mood hyposensitivity to RPE. Importantly, this pattern was also found in patients with affective disorders. In contrast, anxiety correlated with heightened mood fluctuations stemming from mood hypersensitivity to RPE in non-clinical participants.”

      We have also revised the manuscript accordingly to make the factor-analytic, risk-attitude, and mediation analyses clear.

      Reviewer #1 (Public review):

      Summary:

      This is a very interesting paper. The research question is intriguing, allowing the authors to address commonly observed comorbidities between depression and anxiety and their dissociable and opposite relationship to mood fluctuations and sensitivity to reward prediction errors. The computational analyses are very in-depth, including many state-of-the-art checks and validations. Another strength is the inclusion of several large or very large samples, including a patient sample in addition to the general population sample.

      I have the following questions:

      (1) Factor analysis

      I found the hierarchical organization of the factors interesting. While this is a very common procedure in, for example, the field of intelligence (producing sub-scores and a general g factor), it is not yet very commonly used in the field of computational psychiatry (though it has been validated before for anxiety/depression, so it is used here with good reason). I was also impressed by the methodological depth. In particular, it was of note how thoroughly done it was (for example, repeating the EFA on the second half of the data set). I have one question though: is the sample size too small for the exploratory analyses, given the number of items? Given the stability across the half-split, I imagine it is not. Perhaps the authors could spell out how many items, what would be the recommended standard for a subject-to-item ratio, and comment on this. A very technical point, the authors should specify how they extracted the factor scores from the other data sets (is it using the Thurstone or Bartlett method)? From experience (though not doing a hierarchical factor analysis), Bartlett can be somewhat better compared to the default (Thurstone) - better as in the resulting factors more closely recapitulating the factor correlations in the original sample (and independence of responses of other participants in a sample for computing a person's factor score). Could you also comment on similarities or divergences in this hierarchical factor analysis approach from another one recently used transdiagnostically in Wise et al. (2026, Translational Psychiatry)?

      We thank the Reviewer for the positive evaluation of our hierarchical factor-analytic approach and for recognizing the methodological depth of our analyses. We are particularly grateful for the Reviewer’s constructive suggestions regarding the participant-to-item ratio, factor score extraction, and the relation between our approach and recent transdiagnostic hierarchical factor-analytic work.

      First, hierarchical organization. As the Reviewer noted, hierarchical and bifactor representations have a well-established tradition in intelligence research, where they are used to model the g factor alongside domain-specific abilities (e.g., Reise, 2012; Rodriguez et al., 2016). Crucially, the use of such hierarchical structures in the present study was motivated primarily by theory and evidence from anxiety and depression research, rather than by analogy to intelligence research alone. This tradition can be traced back to the tripartite model of anxiety and depression (Clark & Watson, 1991), which distinguished a broad shared component of general distress or negative affect from more specific anxiety- and depression-related components. Subsequent psychometric work has further supported bifactor and hierarchical representations of anxiety and depression symptoms, including models that separate a general internalizing/distress factor from symptom-specific dimensions (e.g., Simms et al., 2008). More recently, similar hierarchical symptom structures have also been adopted in computational psychiatry to relate shared and specific affective symptom dimensions to task-derived computational parameters (Gagne et al., 2020, 2022; see Wise et al., 2023 for a review). Thus, the bifactor structure used here provides a theoretically motivated way to capture both the variance shared by anxiety and depression and the symptom-specific variance relevant to our computational analyses. We have clarified this point in the revised manuscript as follows:

      Pages 3-4:

      “Recent work has used bifactor models of the tripartite model of depression and anxiety to clarify their distinct features and differential influences on decision-making[31,32]. The tripartite model of anxiety and depression proposes that these two symptom dimensions share a broad general distress or negative affect component while also including symptom-specific components: low positive affect/anhedonia is more specific to depression, whereas physiological hyperarousal is more specific to anxiety[30,33,34]. Bifactor analysis offers a way to model this structure statistically. In a bifactor model, symptoms load on a general factor reflecting their shared variance and on specific factors capturing residual variance in narrower symptom dimensions after accounting for the general factor. Although bifactor and hierarchical models have long been used in psychometrics, e.g., intelligence research[35,36], their application to anxiety and depression is grounded in the tripartite model and subsequent psychometric work distinguishing general internalizing/distress from symptom-specific dimensions. This framework has recently been extended to computational psychiatry, where shared and specific affective symptom dimensions have been linked to task-derived computational parameters. For example, Gagne et al. (2022) used bifactor analysis to show that depression was associated with weaker prior beliefs, whereas anxiety was associated with a stronger negative bias in belief updatin31.”

      Second, the participant-to-item ratio. We agree that the ratio of 450 participants to 128 items in the EFA split-half sample, approximately 3.5:1, is below some conventional sample-size recommendations for exploratory factor analysis, including the often-cited recommendation of five participants per item (Costello & Osborne, 2005). However, as the Reviewer noted, the split-half analysis showed a stable factor structure, and the independent CFA in the other split-half sample further supported the robustness of the solution. Importantly, participant-to-item ratios are only one criterion for evaluating factor recovery. De Winter, Dodou, and Wieringa (2009) demonstrated that reliable EFA solutions may be obtained even with relatively small samples when the data are well-conditioned, such as when factor loadings are high, the number of factors is small, and each factor is defined by multiple items. These conditions were largely met in our data. We have clarified this point in the revised manuscript as follows:

      Supplementary Page 3:

      “In addition, the ratio of 450 participants to 128 items in the EFA split-half sample, approximately 3.5:1, is below some conventional sample-size recommendations for EFA, including the often-cited recommendation of five participants per item[8]. However, the split-half EFA yielded a stable factor structure, and the independent CFA further supported the robustness of this solution. Moreover, reliable EFA solutions may be obtained even with relatively small samples when the data are well-conditioned, such as when factor loadings are high, the number of factors is small, and each factor is defined by multiple items9. These conditions were largely met in our data.”

      Next, factor score extraction. We followed prior work using bifactor modeling in computational psychiatry (Gagne et al., 2020) and extracted factor scores with the Anderson–Rubin method, implemented using psych::factor.scores with method = "Anderson". This approach yields standardized and mutually orthogonal factor scores, which is particularly appropriate for our subsequent correlation analyses because it produces orthogonal scores and therefore avoids multicollinearity among the general, depression-specific, and anxiety-specific factors. In addition, as suggested by the Reviewer, we extracted factor scores using the Bartlett method from an oblique bifactor model, which allowed the depression- and anxiety-specific factors to correlate. In the combined dataset (n = 1,026), anxiety- and depression-specific scores were significantly correlated when extracted using the Bartlett method (r = 0.638, p < 0.001), whereas, as expected, they were effectively uncorrelated when extracted using the Anderson–Rubin method (r < 0.001, p = 1.000). This comparison suggests that the Anderson–Rubin method is more appropriate for our analytic aim of estimating the unique associations of shared and symptom-specific components with task-derived parameters, because it separates the general distress/internalizing factor from the statistically separable residual anxiety- and depression-specific components. For this reason, we retained the Anderson–Rubin factor scores in the main analyses. We have clarified this point in the revised manuscript as follows:

      Supplementary Page 3:

      “For factor score extraction, we followed prior work using bifactor modeling in computational psychiatry[10] and extracted factor scores with the Anderson–Rubin method, implemented using psych::factor.scores with method = "Anderson". This approach yields standardized and mutually orthogonal factor scores, which is particularly appropriate for our subsequent correlation analyses because it avoids multicollinearity among the general, depression-specific, and anxiety-specific factors. As a robustness check, we also extracted factor scores using the Bartlett method from an oblique bifactor model, which allowed the depression- and anxiety-specific factors to correlate. In the combined dataset (n = 1,026), anxiety- and depression-specific scores were significantly correlated when extracted using the Bartlett method (r = 0.638, p < 0.001), whereas, as expected, they were effectively uncorrelated when extracted using the Anderson–Rubin method (r < 0.001, p = 1.000). This comparison suggests that the Anderson–Rubin method is more appropriate for our analytic aim of isolating the unique contributions of shared and symptom-specific variance, because it separates the general distress/internalizing factor from residual anxiety- and depression-specific components. Thus, we retained the Anderson–Rubin factor scores in the main analyses.”

      Finally, the similarities and differences between our hierarchical factor-analytic approach and the recent transdiagnostic hierarchical factor-analytic approach of Wise et al. (2026). Both approaches fit EFA models with different numbers of factors and use cross-level correlations to characterize hierarchical symptom structure. However, Wise et al. (2026) applied this framework to a broader symptom battery covering transdiagnostic and neurodevelopmental dimensions, identifying a hierarchy that included a general psychopathology factor and more specific dimensions such as internalizing, externalizing, inattentive/neurodevelopmental, mood/anxiety, and withdrawal. In contrast, our study focused more narrowly on anxiety and depression dimensions, with the goal of deriving symptom factors that could be linked to task-derived computational parameters. Accordingly, whether the current findings are specific to anxiety- and depression-related symptom dimensions or instead reflect broader transdiagnostic psychopathology or nonspecific response-related variance remains unknown. Future studies should include measures covering a wider range of psychiatric dimensions, such as internalizing, externalizing, inattentive/neurodevelopmental, mood/anxiety, and withdrawal dimensions identified by Wise et al. (2026), to better determine whether the links among symptom dimensions, RPE-related mood sensitivity, and mood variability are disorder-specific or transdiagnostic. We have discussed this point in the revised manuscript as follows: Page 19:

      “Future studies should include measures covering a wider range of psychiatric dimensions, such as internalizing, externalizing, inattentive/neurodevelopmental, mood/anxiety, and withdrawal dimensions identified by Wise et al. (2026)[59], to better characterize whether links among symptom dimensions, RPE sensitivity, and mood variability are disorder-specific or transdiagnostic.”

      (2) Linking factors to task parameters

      As I understand it, the authors relate the orthogonalized depression/anxiety to task parameters (sensitivity to RPEs on mood and mood variations) using correlations. In order to have a better understanding of how this relates to other commonly used approaches, I would pose two questions:

      (i) What are the correlations when the full (non-orthogonalized) factor scores for depression and anxiety are used? Are the signs the same?

      (ii) What are the results when, instead of the independent correlations, the authors perform b_RPE ~ anxiety + depression (again using the non-orthogonalized factors)? I'm assuming all of these analyses should give the same results if the authors' hypothesis of opposing effects of anxiety and depression holds true.

      We thank the Reviewer for these helpful comments. Our original analyses used orthogonalized depression- and anxiety-specific factor scores because this approach is aligned with our analytic aim of separating shared and symptom-specific variance within the tripartite/bifactor framework of anxiety and depression (Clark & Watson, 1991), and has been used in prior work (Gagne et al., 2020, 2022; see Wise et al., 2023 for a review). Orthogonalization allows us to statistically separate the shared distress component from the symptom-specific components of anxiety and depression, which was central to our hypothesis regarding their opposing associations with task-derived parameters. As expected, the orthogonalized anxiety- and depression-specific factor scores were uncorrelated in the combined dataset (r < 0.001, p = 1.000; n = 1,026). By contrast, the full non-orthogonalized depression and anxiety scores retained substantial shared variance and were highly correlated (r = 0.638, p < 0.001; n = 1,026), making their separate associations less straightforward to interpret.

      Nevertheless, we agree that analyses using the full non-orthogonalized depression and anxiety scores provide an important comparison with more commonly used non-orthogonal symptom-score approaches. We therefore conducted the analyses suggested by the Reviewer. When the full depression and anxiety scores were entered separately into linear mixed-effects models predicting RPE-related mood sensitivity, with dataset included as a random intercept, the anxiety association was not significant (anxiety: b = 0.002, t = 1.130, p = 0.259; depression: b = -0.008, t = -3.732, p < 0.001). By contrast, when the full non-orthogonalized anxiety and depression scores were entered simultaneously in the same linear mixed-effects model, the original pattern was replicated: anxiety and depression showed opposing associations with RPE-related mood sensitivity (anxiety: b = 0.012, t = 4.619, p < 0.001; depression: b = -0.017, t = -5.851, p < 0.001). This pattern is consistent with a mutual suppression effect: shared variance between anxiety and depression may obscure their unique associations when examined separately, whereas the simultaneous regression model reveals their opposing symptom-specific associations.

      Together, these supplementary analyses support our original interpretation that RPE-related mood sensitivity is associated with the separable anxiety- and depression-specific components in opposite directions. We have revised the manuscript as follows:

      Supplementary Pages 3-4:

      “We further analyzed non-orthogonalized full depression and anxiety scores to assess the robustness of our results. When full depression and anxiety scores were entered in separate linear mixed-effects models predicting RPE-related mood sensitivity, with dataset included as a random intercept, the anxiety association was not significant (anxiety: b = 0.002, t = 1.130, p = 0.259; depression: b = -0.008, t = -3.732, p < 0.001). By contrast, when the full non-orthogonalized anxiety and depression scores were entered simultaneously in the same linear mixed-effects model, the original pattern was replicated: anxiety and depression showed opposing associations with RPE-related mood sensitivity (anxiety: b = 0.012, t = 4.619, p < 0.001; depression: b = -0.017, t = -5.851, p < 0.001). This pattern is consistent with a mutual suppression effect: shared variance between anxiety and depression may obscure their unique associations when examined separately, whereas simultaneous regression reveals their opposing symptom-specific associations. These results support our interpretation that RPE-related mood sensitivity is linked to the separable anxiety- and depression-specific components.”

      Minor comments:

      (1) The authors should write down when the data were collected for each study. This is because AI capabilities have massively increased since ~2020 in quite specific steps (with the public release of new AI models), meaning that AI is likely to have been able to do tasks and questionnaires without detection if data were collected recently.

      We thank the Reviewer for this important comment. We have now added the data collection periods for each dataset in Table 1. The laboratory and clinical dataset were collected in a controlled laboratory setting rather than through online testing. As shown in Table 1, all online experiments were conducted before November 2022, prior to the public release of ChatGPT and its broad entry into public awareness. Therefore, our data were unlikely to have been substantially affected by AI-assisted responding. We have clarified this point in the revised manuscript as follows:

      Page 20:

      “See Table 1 for demographic information and data collection periods. Because online data collection may raise concerns about AI-generated responses, we note that artificial intelligence tools, such as ChatGPT, became widely known to the public in November 2022, whereas all online experiments in the present study were conducted before November 2022 (see Table 1). Therefore, these data were unlikely to have been substantially affected by participants’ use of AI tools.”

      (2) The authors should include a statement in the methods section that checks for AI were done. If none yet, could you do any? Recent papers (Westwood, PNAS 2025; van der Stigchel PNAS, 2026) point to the risk since at least the release of o4-mini (used in the cited paper to create very human-like behaviour).

      We thank the Reviewer for this helpful comment. We have clarified this point in the revised manuscript as follows:

      Page 20:

      “See Table 1 for demographic information and data collection periods. Because online data collection may raise concerns about AI-generated responses, we note that artificial intelligence tools, such as ChatGPT, became widely known to the public in November 2022, whereas all online experiments in the present study were conducted before November 2022 (see Table 1). Therefore, these data were unlikely to have been substantially affected by participants’ use of AI tools.”

      (3) It would have been good to collect questionnaires of other, thought to be unrelated psychiatric traits, like compulsivity or schizophrenia symptoms, to check the specificity of the results, also under the assumption that higher scores on either of these skewed questionnaires can pick up individual differences in 'bad questionnaire completion'. The authors should comment on the absence of other questionnaires in the discussion in the limitations section.

      We thank the Reviewer for this helpful comment. We agree that the absence of broader psychiatric trait measures limits our ability to evaluate the specificity of the observed associations. Our symptom assessment focused specifically on anxiety and depression because the study was motivated by hypotheses about their potentially opposing links with RPE sensitivity and mood variability. Although previous research has shown intact mood sensitivity to RPEs in individuals with suicidal thoughts and behaviors (Wang et al., 2026), we cannot determine whether the current findings are specific to anxiety- and depression-related symptom dimensions or instead reflect broader transdiagnostic psychopathology or nonspecific response-style variance.

      Regarding the concern that higher scores on symptom questionnaires with skewed score distributions may partly capture individual differences in poor-quality questionnaire responding, we note that we implemented strict data-quality procedures for both questionnaire and task data. Four attention-check items were embedded throughout the questionnaire battery, requiring participants to select a prespecified response, for example, “Please select the second option for this item.” Similarly, four attention-check trials were embedded throughout the gambling task. For example, participants were asked to choose between a certain gain of 20 points and a gamble with possible outcomes of 35 and 55 points, for which the dominant response was to choose the gamble option. Participants who failed any of these attention checks were excluded. In addition, our behavioral and mood data reproduced key patterns reported in previous studies (Rutledge et al., 2014 & 2015) using momentary mood ratings during gambling tasks, including higher mood following gains than following losses and systematic mood drift over time (all ps < 0.001). These procedures and validation checks reduce the likelihood that the present findings were driven by poor questionnaire or task completion. We have clarified this point in the revised manuscript as follows:

      Page 19:

      “Second, our symptom assessment focused specifically on anxiety and depression. This choice was motivated by our primary hypotheses, but it limits our ability to evaluate the specificity of the observed associations. Recent work has shown that individuals with suicidal thoughts and behaviors exhibit reduced mood sensitivity to certain rewards (CR), but not to RPEs[49], suggesting that the current RPE-related effects are not driven by suicide-related processes. However, because we did not assess other psychiatric dimensions, such as compulsivity or schizophrenia-spectrum symptoms, we cannot determine whether the current findings are specific to anxiety- and depression-related symptom dimensions or instead reflect broader transdiagnostic psychopathology or nonspecific response-related variance. Future studies should include measures covering a wider range of psychiatric dimensions, such as internalizing, externalizing, inattentive/neurodevelopmental, mood/anxiety, and withdrawal dimensions identified by Wise et al. (2026)[59], to better characterize whether links among symptom dimensions, RPE sensitivity, and mood variability are disorder-specific or transdiagnostic.”

      Page 20:

      “Participants were excluded if 1) they failed any of the attentional checks (4 items); 2) they made the same choices for all items; 3) they responded with extreme inconsistency in two similar questionnaires (difference in z-scores out of ±2).”

      Page 21:

      “There were four items for attentional checks, which required the participants to make a specific choice and were embedded in the entire measurements, e.g., ‘please select the second option for this item’.”

      Page 22:

      “We also set 4 trials embedded in the entire task for attentional checks. For example, participants were asked to make a choice between a certain gain 20 and a gamble 35/55, where the correct response for this trial was the gamble choice.”

      Page 5:

      “Choice data (e.g., gambling rates) and mood data (e.g., initial mood, mean mood, and mood variation) showed patterns similar to those reported in previous studies measuring momentary mood during gambling tasks (Figure S2 & S3)[10,45]. We also replicated established effects on momentary mood: mood was higher following gains than following losses, and mood drifted over time (all ps < 0.001; Figure S4).”

      (4) The authors could include a more explicit sentence in the abstract stating that the anxiety result did not hold up in the clinical population.

      We thank the Reviewer for this helpful comment. We have clarified this point in the revised manuscript as follows:

      Abstract:

      “Results showed that depression was associated with dampened mood fluctuations due to mood hyposensitivity to RPE. Importantly, this pattern was also found in patients with affective disorders. In contrast, anxiety correlated with heightened mood fluctuations stemming from mood hypersensitivity to RPE in non-clinical participants.”

      Reviewer #2 (Public review):

      Summary:

      Despite their common co-occurrence, depression and anxiety are known to alter mood fluctuations in opposite ways. Here, the authors aimed at distinguishing depression-specific from anxiety-specific from psychopathology-general effects of reward processing on mood fluctuations, focusing on reward prediction errors (RPEs), which are known to be linked to mood fluctuations. This mechanistic study aims at uncovering the process through which these psychopathologies are associated with mood modulations. The authors were able to appropriately test their hypothesis and obtained results corroborating their conclusions.

      This work provides a convincing demonstration of the relevance of computational psychiatry (Huys et al, 2016) and the use of decision neuroscience to shed light on the interplay of anxiety, depression, and mood.

      Strengths:

      The authors used a tripartite model to distinguish depression vs anxiety, as well as a computational model distinguishing reward expectation (EV in the model) from outcome processing through RPE, which are two sequential cognitive processes.

      The manuscript adequately addresses the concerns one would have regarding risk-attitudes and regarding referring to trending statistical results.

      Weaknesses:

      The sample size of the clinical sample (N=116) may not be sufficient to detect anxiety-specific effects due to the high rate of comorbid anxious depression. It would be beneficial to include the number of MDD vs GAD vs anxious depression diagnoses in the clinical population, as this would likely shine light on the power limitations.

      We thank the Reviewer for this helpful comment. We agree that the clinical sample may have been underpowered to detect anxiety-specific effects, especially given the high comorbidity between anxiety and depression in affective disorders (see Table S8 for diagnosis, illness duration, and medication status). Based on the effect size observed in the non-clinical datasets (r = 0.079), we estimated that a sample size of 1,226 would be required to detect this effect with 80% statistical power using a two-tailed test with α = .05. This estimate is substantially larger than the current clinical sample size (n = 116). Although these covariate analyses support the robustness of the depression-related effect, they do not resolve whether the absence of the anxiety-related effect reflects limited power or true clinical discontinuity.

      We also revised the Discussion to explicitly acknowledge that the anxiety-related effect observed in the pooled non-clinical dataset was not replicated in the clinical sample. We now note two possible interpretations. First, this discontinuity may reflect limited statistical power in the clinical sample. Second, and more speculatively, it may reflect a disruption of mood homeostasis in affective disorders (Paulus, 2007). In non-clinical individuals, the counterbalancing associations of depression- and anxiety-related traits with mood variation may contribute to emotional equilibrium. In contrast, affective disorders may involve a loss of this regulatory balance, reducing the ability to stabilize mood in the face of competing depression- and anxiety-related affective signals. We have revised the manuscript as follows:

      Pages 12-13:

      “To test whether abnormalities in RPE-driven mood fluctuations can serve as clinically relevant computational markers of depression- and anxiety-related symptom dimensions, we recruited patients with affective disorders (n = 116) to complete the same questionnaire battery and gambling task with momentary mood ratings (Figure 1). Demographic, psychological, and clinical characteristics are summarized in Table 1 and Table S8. We observed significant negative correlations between depression-specific scores and both mood variation (r = -0.239, p = 0.009) and RPE-related mood sensitivity (β<sub>RPE</sub>; r = -0.216, p = 0.020). These associations remained significant after controlling for demographic and clinical covariates, task earnings, and mood drift (ps < 0.05). Bootstrap validation yielded consistent results. Mediation analyses further showed that reduced mood sensitivity to RPEs statistically mediated the association between depression-specific scores and lower mood fluctuations (a × b = -0.141, 95% CI = [-0.261, -0.038], p = 0.021; Figure 3). However, we did not observe significant correlation with anxiety (mood variation: r = -0.092, p = 0.327; β_RPE: r = -0.095, p = 0.311).”

      Pages 17-18:

      “Notably, the pattern of heightened RPE sensitivity observed in the pooled non-clinical dataset was not observed in the clinical sample. On the one hand, this discontinuity may reflect that the clinical sample was underpowered to detect anxiety-specific effects, especially given the high comorbidity between anxiety and depression in affective disorders (Table S8). Based on the effect size observed in the non-clinical datasets (r = 0.079), we estimated that a sample size of 1,226 would be required to detect this effect with 80% statistical power using a two-tailed test with α = .05. This estimate is substantially larger than the current clinical sample size (n = 116). On the other hand, it may reflect a disruption of mood homeostasis in clinical populations[41,58]. In non-clinical individuals, counterbalancing associations of depression- and anxiety-related traits with mood variation may help maintain emotional equilibrium. In contrast, affective disorders may involve a loss of such regulatory balance, reducing the ability to stabilize mood in the face of competing depression- and anxiety-related affective signals.”

      Abstract:

      “Results showed that depression was associated with dampened mood fluctuations due to mood hyposensitivity to RPE. Importantly, this pattern was also found in patients with affective disorders. In contrast, anxiety correlated with heightened mood fluctuations stemming from mood hypersensitivity to RPE in non-clinical participants.”

      Reviewer #3 (Public review):

      Summary:

      In this submission, Wang and colleagues jointly examine the association between depression and anxiety symptoms and individuals' affective reactivity to reward prediction errors in Ruttledge et al.'s gambling paradigm. Taking a bifactor approach to anxiety and depression in several non-clinical (and one clinical sample), the authors find that anxiety-specific symptoms relate to over-reactivity of mood to reward prediction errors (RPEs) as well as heightened mood variability, while depression-specific symptoms relate to blunted mood sensitivity to RPEs. These depression- but not anxiety-specific relationships replicated in patient samples.

      Strengths:

      I was impressed that the data-driven, transdiagnostic approach employed by the authors uncovered specific relationships between anxiety and depression-specific factors and RPE reactivity in a well characterized task and computational model, especially in a non-clinical sample. This sheds new light on how these affective processes may be perturbed-and importantly, in different ways-by anxiety and depression symptoms. Likewise, the replication of the depression-specific finding (RPE hypo-reactivity) in a clinical sample was nice to see.

      Weaknesses:

      (1) While the anxiety- and depression-specific factors had differential effects on mood variability (Figure 2A-D) and RPE reactivity (Figure 2E-G) in all samples, such that the correlations between the two factors and these mood parameters were significantly different, the anxiety factor was not consistently (significantly) associated with either mood-related parameter across samples. However, the authors resolve anxiety-specific predictive effects when they collapse across datasets. While it is intuitive that achieving a larger effective sample size would afford the power necessary to detect such individual differences, this struck me as a major caveat for this set of results.

      We thank the Reviewer for this important comment. Although the anxiety-specific factor showed associations in the expected direction across datasets, these associations were not significant in several individual datasets. Specifically, anxiety-specific scores were positively correlated with mood variation (laboratory dataset: r = 0.10, p = 0.531; online dataset 1: r = 0.08, p = 0.026; online dataset 2: r = 0.19, p = 0.004) and with RPE-related mood sensitivity (laboratory dataset: r = 0.04, p = 0.820; online dataset 1: r = 0.05, p = 0.216; online dataset 2: r = 0.19, p = 0.004; Figures 2A–C and 2E–G). This pattern may partly reflect limited statistical power at the single-dataset level.

      Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, we conducted pooled analyses to obtain a more stable estimate. Importantly, these analyses included dataset as a random intercept in mixed-effects models to account for between-dataset differences. Thus, the pooled analysis provides an integrated estimate across samples, conceptually similar to an individual-participant-data meta-analytic approach. The pooled results provided evidence for the expected anxiety-specific associations with greater mood variability and heightened RPE-related mood sensitivity (mood variation: t = 3.46, p < 0.001; RPE-related mood sensitivity: t = 2.60, p = 0.009). In addition, we conducted a mini meta-analysis, and results support that anxiety is associated with intensified mood fluctuations and increased mood sensitivity to RPE.

      However, we have clarified in the revised manuscript that the anxiety-related effects were less robust than the depression-related effects and require further replication in larger samples.

      Pages 10-11:

      “Correlations between the anxiety-specific factor and mood variation were positive in direction across datasets, although they were not statistically significant in several datasets (the laboratory dataset: r = 0.10, p = 0.531; the online dataset 1: r = 0.08, p = 0.026; the online dataset 2: r = 0.19, p = 0.004). Similarly, correlations between the anxiety-specific factor and β<sub>RPE</sub> were positive in direction but statistically inconsistent across datasets (the laboratory dataset: r = 0.04, p = 0.820; the online dataset 1: r = 0.05, p = 0.216; the online dataset 2: r = 0.19, p = 0.004; Figure 2A-C & 2E-G). Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, and because reliable individual differences often require large samples to detect[48], we combined the laboratory dataset, online dataset 1, and online dataset 2 (total N = 1,026). This approach is analogous to an individual-participant-data meta-analytic analysis. We fitted linear mixed-effects models predicting mood variation and β<sub>RPE</sub> from the three bifactor scores, with dataset included as a random intercept to account for dataset-level variability. For mood variation, the anxiety-specific factor was positively associated with mood variation (t = 3.46, p < 0.001), whereas the depression-specific factor was negatively associated with mood variation (t = -6.13, p < 0.001). For RPE-related mood sensitivity, the anxiety-specific factor was positively associated with β<sub>RPE</sub> (t = 2.60, p = 0.009), whereas the depression-specific factor was negatively associated with β<sub>RPE</sub> (t = -5.30, p < 0.001). These associations remained significant after controlling for gender, age, task earnings, and mood drift. In addition, we performed a mini meta-analysis on these correlation coefficients[49]. Results showed significant positive correlation for both mood variation and RPE-related mood sensitivity (mood variation: Z = 3.399, 95 % CI for correlation coefficient r [0.045, 0.166]; RPE-related mood sensitivity: Z = 2.618, 95 % CI for correlation coefficient r [0.021, 0.143]), supporting that anxiety is associated with intensified mood fluctuations and increased mood sensitivity to RPE.”

      Page 17:

      “Notably, the anxiety-related effects were less robust than the depression-related effects and were detectable only in the pooled dataset (n = 1,026); therefore, they require further replication in larger samples.”

      (2) The authors observe associations between the 'common factor' of depression and anxiety and risk-attitude tendencies, presumably the alpha (exponent) parameter in a prospect theory-type subjective value model. But where is this analysis explained? (i.e. how was this model formulated and how were risk attitude parameters estimated?) And what is the interpretation of this finding - is there precedent for looking at risk attitudes in this task? And why would these predictive effects only be observed in relation to the common, but not unique, factors of anxiety and depression?

      We apologize for the unclear statement. We have added a description of the computational modeling of choice behavior. Please see our revisions below:

      Page 13:

      “Choice parameters were estimated using an established approach–avoidance prospect theory model[10,45,49], which included loss aversion, domain-specific risk attitude parameters in the gain and loss domains, and value-independent Pavlovian approach and avoidance parameters (see Supplementary Note 7 for details of the computational choice models). In this model, risk attitude was quantified by the exponent parameter α in a prospect-theory-inspired subjective value function. Lower α values reflect greater risk aversion, whereas values closer to or above 1 reflect more linear or risk-seeking valuation.”

      Supplementary Pages 8-9:

      Note 7: Computational model of gambling choice

      To quantify how different events impacted participants’ momentary moods during the gambling In line with previous studies[14,15], our choice model space included expected value model (cM1), prospect theory model (cM2)[16], and approach-avoidance prospect theory model (cM3)[14]. For cM2 (Equations 6-9), there were 3 parameters, including risk aversion (α, range: [0.3, 1.3]), loss aversion (λ: [0.5, 5]), and inverse temperature (μ: [0, 10]).

      Where V<sub>gain</sub> and V<sub>loss</sub> are the objective gain and loss from a gamble, respectively. Please note thatV<sub>gain</sub> is 0 in loss trials and V<sub>loss</sub> is 0 in gain trials. V<sub>certain</sub> is the objective value for the certain option. U<sub>gamble</sub> and U<sub>certain</sub> denote the subjective utilities of the gamble and the certain option, respectively. Choice probability for gamble (P<sub>gamble</sub>) is determined by the softmax rule. Building on cM2, cM3 decomposes the decision process into risk-attitude-driven valuation (e.g., loss and risk aversion) and value-insensitive motivational components (Equations 6-8 & 10-12). That is, choice probability for P<sub>gamble</sub> in cM3 is jointly determined by the softmax rule and approach/avoidance parameters (β<sub>gain</sub>: [-1, 1], β<sub>loss</sub>: [-1, 1]). Approach/avoidance parameters are not applied in mixed trials. Please note that a higher gambling rate does not imply a change in risk attitude per se: it can arise from an increased value-insensitive approach bias even when risk-attitude parameters are comparable between groups. Risk attitude is indeed conceptualized in economics as the curvature of the utility function (i.e., the subjective value) of the objective outcomes, with concave curves associated with risk aversion, and convex curves associated with risk seeking[17,18]. By contrast, the approach or avoidance bias apply to all the value. A possible interpretation of the approach bias is that participant approach the option with the highest possible gain (the lottery) in the gain frame; the avoidance bias would then reflect a tendency to systematically avoid the highest potential losses (the lottery) in the loss frame.

      Model comparison using BIC revealed that the winning model for each dataset was the approach-avoidance prospect theory model (cM3; mean R<sup>2</sup> = 0.51 for the laboratory dataset, 0.49 for the online dataset1, 0.54 for the online dataset 2, and 0.40 for the clinical dataset; Table S9).

      Please also see our interpretation of this finding below:

      Page 18:

      “With respect to decision-making, prior literature using risky decision-making tasks without feedback has linked pathological anxiety to greater risk aversion[58]. In line with this, our results from a risky decision-making task with feedback suggest that the common factor, rather than anxiety-specific variance per se, is more consistently associated with risk aversion. This suggests that heightened gain-domain risk aversion may be a transdiagnostic feature of internalizing psychopathology, rather than being uniquely attributable to anxiety.”

      Recommendations for the authors:

      Reviewer #1 (Recommendations for the authors):

      Thank you very much for giving me the opportunity to review this very interesting paper.

      Recommendations:

      (1) Add more specific ethics information than "study was approved by ethics committee of Beijing normal university".

      We thank the Reviewer for this important comment. We have added approval number. Please see our revision below:

      Page 20:

      “The study was approved by the Ethics Committee of Beijing Normal University (approve number: ICBIR_A_0016_028). Written or electronic informed consent was obtained from all participants before participation.”

      (2) Add information on how participants were recruited. I think the websites listed only hosted the experiment/questionnaires?

      We thank the Reviewer for pointing this out. We have revised the relevant text as follows:

      Page 20:

      “A total of 2634 participants via online platforms (questionnaires from https://www.wjx.cn and tasks from https://www.naodao.com) took part in five experiments, including a psychometric experiment, a laboratory experiment, two online replication experiments. Participants were recruited through participant pools and study advertisement. For online experiments, interested participants accessed the study through an online link and completed the questionnaires and task remotely. For the laboratory experiment, participants completed the study in a controlled laboratory setting.”

      (3) Typo in Figure 1A, grey panel - psychometric.

      We apologize for the typo. We have corrected typographical errors throughout the manuscript.

      (4) In the Discussion, there is a section on r-to-z transformations, and I was not quite sure what in the Results this links to.

      We thank the Reviewer for pointing out the unclear statement. Please see our revision below:

      Page 18:

      “First, although anxiety- and depression-related associations differed consistently, the anxiety-specific associations themselves were less robust across datasets.”

      **Reviewer #2 (Recommendations for the authors):&&

      The Results sections 2 (depression) and 3 (anxiety) could be improved by reducing the back and forth between factors throughout the results. It may be useful to split them into 3 sections: depression only, anxiety only, and depression vs anxiety.

      We thank the Reviewer for this helpful suggestion. As suggested, we have reorganized this part into three sections: depression, anxiety, and depression versus anxiety. Please see our revision below:

      Page 12:

      “Differential associations of depression and anxiety with mood fluctuations. To directly test whether depression- and anxiety-specific factors differed in their associations with mood dynamics, we compared the corresponding correlations. These comparisons showed that depression-specific associations were significantly more negative than anxiety-specific associations for both mood variation (laboratory dataset: Z = -1.84, p = 0.033; online dataset 1: Z = -5.36, p < 0.001; online dataset 2: Z = -3.42, p < 0.001) and β_RPE (laboratory dataset: Z = -1.77, p = 0.038; online dataset 1: Z = -3.67, p < 0.001; online dataset 2: Z = -4.00, p < 0.001; Figures 2A–C and 2E–G). These results support distinct associations of depression- and anxiety-specific factors with RPE-related mood dynamics.”

      In the discussion, the authors could have mentioned the brain areas most likely to be involved in these processes, both cognitive and psychopathological, as previous studies (such as Cecchi et al, 2022) have aimed at identifying regions involved in RPE processing while modulating mood in health. A short section on this would be useful to the neuropsychiatric community.

      We thank the Reviewer for this helpful suggestion. We agree that the Discussion would benefit from a more explicit consideration of the neural systems that may support RPE-related mood updating and their relevance to psychopathology. We have revised the Discussion accordingly, as shown below:

      Page 16:

      “Although the present study did not include neuroimaging, the observed computational dissociation may map onto partially distinct neural systems involved in reward learning, mood updating, and affective psychopathology. RPE processing has been consistently linked to striatal–midbrain dopaminergic reward-learning circuits[8,50]. The integration of these reward-learning signals into subjective mood and value-based decision-making may further involve the ventral medial prefrontal cortex and orbitofrontal cortex[44]. In addition, the anterior insula may be particularly relevant for integrating feedback-related signals with affective and interoceptive states[8,44], potentially linking RPE processing to anxiety- and depression-related mood dynamics. Consistent with this view, Cecchi et al. (2022)[51] used intracranial EEG to show that feedback-related neural activity tracks mood fluctuations and risky choice. Future neuroimaging studies should test whether depression-related reductions and anxiety-related increases in RPE-related mood sensitivity are associated with altered interactions among striatal, prefrontal, and insular circuits.”

      Reviewer #3 (Recommendations for the authors):

      (1) The authors need to present a clearer definition of the terms "bifactor analysis" and "tripartite model" in the Introduction. What does tripartite mean in this context? What are the assumptions of such bifactor analyses (e.g. as used in Gagne et al. and the present work) and how, in broad strokes, are they carried out? These are important constructs to clarify for readers outside the computational psychiatry niche.

      We thank the Reviewer for this helpful suggestion. We have revised the Introduction accordingly, as shown below:

      Page 3:

      “Recent work has used bifactor models of the tripartite model of depression and anxiety to clarify their distinct features and differential influences on decision-making[31,32]. The tripartite model of anxiety and depression proposes that these two symptom dimensions share a broad general distress or negative affect component while also including symptom-specific components: low positive affect/anhedonia is more specific to depression, whereas physiological hyperarousal is more specific to anxiety[30,33,34]. Bifactor analysis offers a way to model this structure statistically. In a bifactor model, symptoms load on a general factor reflecting their shared variance and on specific factors capturing residual variance in narrower symptom dimensions after accounting for the general factor.”

      (2) Previous examinations of depression and RPE reactivity in this task paradigm, as the authors note (e.g. Rutledge et al., 2017), observed that individuals diagnosed with depression showed an intact association between RPEs and mood. In other words, there was no previously observed relationship between depression and affective reactivity to RPEs in this task context. Here, the authors find that the "unique" depression factor identified by the authors (in a non-clinical sample) is associated with blunted RPE sensitivity - this is worth commenting on specifically.

      We thank the Reviewer for this helpful suggestion. We have discussed this point in the Discussion. Please also see it below:

      Pages 15-16:

      “Our computational model not only replicates the important role of RPEs in mood dynamics but also highlights the divergent mediating roles of RPE-related mood sensitivity in the associations of depression and anxiety with mood fluctuations. The opposite associations of depression and anxiety with mood sensitivity to RPEs complement previous findings of apparently intact RPE-related mood sensitivity in depression[12,25,37]. These findings further underscore the necessity of decomposing shared and specific components of depression and anxiety in studies of mood dynamics, which can enhance our understanding of their distinct associations with emotion processing and cognitive flexibility. This point is consistent with bifactor-based work showing that shared and specific symptom dimensions can have different computational correlates. For example, Gagne et al. (2020) showed that bifactor-derived symptom dimensions differentially relate to maladaptation to environmental volatility[32], complementing previous findings that trait anxiety is associated with inflexible adjustment to volatility[32].”

      (3) There is a note (line 247) about the interpretation of the correlations in Figure 2, which attempts to explain away the inconsistent relationships between the anxiety-specific factor and mood variability as well as RPE reactivity observed in Figure 2. I can't say I understand the authors' point here about "signs of positive correlations", so I would say the authors need to clarify their logic here. More to the point, the authors only resolve anxiety-specific predictive effects when they collapse across these datasets. As discussed above (see 'weaknesses'), this is a serious limitation in my view and needs to be discussed as such in the paper.

      We apologize for the unclear statement. Although the anxiety-specific factor showed associations in the expected direction across datasets, these associations were not significant in several individual datasets. Specifically, anxiety-specific scores were positively correlated with mood variation (laboratory dataset: r = 0.10, p = 0.531; online dataset 1: r = 0.08, p = 0.026; online dataset 2: r = 0.19, p = 0.004) and with RPE-related mood sensitivity (laboratory dataset: r = 0.04, p = 0.820; online dataset 1: r = 0.05, p = 0.216; online dataset 2: r = 0.19, p = 0.004; Figures 2A–C and 2E–G). This pattern may partly reflect limited statistical power at the single-dataset level.

      Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, we conducted pooled analyses to obtain a more stable estimate. Importantly, these analyses included dataset as a random intercept in mixed-effects models to account for between-dataset differences. Thus, the pooled analysis provides an integrated estimate across samples, conceptually similar to an individual-participant-data meta-analytic approach. The pooled results provided evidence for the expected anxiety-specific associations with greater mood variability and heightened RPE-related mood sensitivity (mood variation: t = 3.46, p < 0.001; RPE-related mood sensitivity: t = 2.60, p = 0.009). We have revised it to make it clear. Please see our revisions below:

      Pages 10-11:

      “Correlations between the anxiety-specific factor and mood variation were positive in direction across datasets, although they were not statistically significant in several datasets (the laboratory dataset: r = 0.10, p = 0.531; the online dataset 1: r = 0.08, p = 0.026; the online dataset 2: r = 0.19, p = 0.004). Similarly, correlations between the anxiety-specific factor and β_RPE were positive in direction but statistically inconsistent across datasets (the laboratory dataset: r = 0.04, p = 0.820; the online dataset 1: r = 0.05, p = 0.216; the online dataset 2: r = 0.19, p = 0.004; Figure 2A-C & 2E-G). Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, and because reliable individual differences often require large samples to detect, we combined the laboratory dataset, online dataset 1, and online dataset 2 (total N = 1,026). This approach is analogous to an individual-participant-data meta-analytic analysis while accounting for dataset-level variability. Because these datasets used comparable task and questionnaire procedures and showed positive effect directions, and because reliable individual differences often require large samples to detect[48], we combined the laboratory dataset, online dataset 1, and online dataset 2 (total N = 1,026). This approach is analogous to an individual-participant-data meta-analytic analysis while accounting for dataset-level variability. We fitted linear mixed-effects models predicting mood variation and β<sub>RPE</sub> from the three bifactor scores, with dataset included as a random intercept. For mood variation, the anxiety-specific factor was positively associated with mood variation (t = 3.46, p < 0.001), whereas the depression-specific factor was negatively associated with mood variation (t = -6.13, p < 0.001). For RPE-related mood sensitivity, the anxiety-specific factor was positively associated with β<sub>RPE</sub> (t = 2.60, p = 0.009), whereas the depression-specific factor was negatively associated with β<sub>RPE</sub> (t = -5.30, p < 0.001).”

      Page 17:

      “Notably, the anxiety-related effects were less robust than the depression-related effects and were detectable only in the pooled dataset (n = 1,026); therefore, they require further replication in larger samples.”

      (4) I expected to see that the authors would also investigate relationships between anxiety/depression related factors and the decay (gamma) parameter in the 'Happiness equation', which is presumably estimated from the data here. While I don't have a strong intuition about directions of (or presence of) predictive relationships here, doesn't it stand to reason that different aspects of psychopathology examined here might map onto how long- (versus short-) lasting the effects of, say, RPEs are, upon mood?

      We thank the Reviewer for this important comment. In the healthy datasets, we fitted a linear mixed-effects model predicting the decay parameter (γ) from the three bifactor scores, with dataset included as a random intercept. None of the factors showed a significant association with γ (common: t = 0.708, p = 0.479; anxiety: t = 0.564, p = 0.573; depression: t = 1.146, p = 0.252). In the clinical dataset, we fitted a linear model predicting γ from the three bifactor scores and again found no significant associations (common: t = -0.036, p = 0.972; anxiety: t = -0.047, p = 0.963; depression: t = 0.052, p = 0.959). We have clarified this point in the revised manuscript as follows:

      Supplementary Page 5:

      “In the healthy datasets, we conducted a linear mixed-effect model against decay parameter (gamma) with all three factors, with dataset as a random factor. Results did not show significant effect (common: t = 0.708, p = 0.479; anxiety: t = 0.564, p = 0.573; depression: t = 1.146, p = 0.252). In the clinical dataset, we conducted a linear model against decay parameter (gamma) with all three factors and found no significant effect (common: t = -0.036, p = 0.972; anxiety: t = -0.047, p = 0.963; depression: t = 0.052, p = 0.959).”

      (5) The rationale for and interpretation of the mediation model, which presumably aims to explain the relationships between anxiety- and depression-specific factors, RPE reactivity, and mood variability was barely explained by the authors. At present, I'm not sure what the added value of this analysis is. The authors should either remove or explain/motivate the mediation more clearly.

      We thank the Reviewer for this helpful comment. The rationale for the mediation analysis is that mood variability in the task is not only a descriptive behavioral outcome, but may also arise from the degree to which momentary mood is updated by RPEs. Therefore, if depression is associated with reduced RPE-related mood sensitivity and anxiety with increased RPE-related mood sensitivity, these alterations should statistically account for their opposite associations with mood variability. The mediation model directly tested this possibility by examining whether RPE-related mood sensitivity accounted for the association between symptom-specific factors and mood variability. We have clarified this rationale in the revised manuscript as follows:

      Page 10:

      “Given the strong correlation between β<sub>RPE</sub> and mood variation (rs > 0.67, ps < 0.001), we further conducted a mediation analysis to examine whether individual differences in RPE-related mood sensitivity statistically accounted for the association between depression loading and mood variation. This analysis was motivated by the hypothesis that depression-related dampening of mood variability may arise, at least in part, from reduced mood sensitivity to RPEs.”

      (6) This submission would benefit from extensive English language copy editing. There are many passages in the paper (in fact, too many to list here) that suffer from either grammatical errors or clarity issues.

      We apologize for these mistakes. We have corrected the typographical errors throughout the manuscript.

    1. In an efficient market

      Application: Investing in the Stock Market • Recommendations from investment advisors cannot help us outperform the market. • A hot tip is probably based on information that is already contained in the price of the stock. • Stock prices respond to announcements only when the information is new and unexpected. • A “buy-and-hold” strategy is the most sensible strategy for the small investor (savings of transaction costs) or buy shares into a mutual fund.

    1. Im Fall von b) ist für jeden beigezogenen Dritten i.S.v. §38 Abs. 2 des Reglements der SROPolyReg ein Gesuch um Beizug Dritter, eine schriftliche Vereinbarung und eine Gesuchsseite 10für alle involvierten natürlichen Personen einzureichen. Für regulierte beigezogene Dritte i.S.v. §38Abs. 1 des Reglements ist kein separates Gesuch erforderlich. Es muss jedoch auch hier für allenatürlichen Personen eine Gesuchsseite 10 eingereicht werden.

      The requirements provided here are more extensive than those stipulated by Art. 28 para. 1 AMLO-FINMA and margin no. 53 of the FINMA circular 2016/7 as in force (and presumably also as to be amended); specifically, "adding one copy of page 10 of the application form for each of the individuals involved" will de facto rule out sub-contracting to larger providers, e.g. such employing dozens of employees.

      Also see Section 38 of the Polyreg regulations as referred to in the Polyreg application form.

    1. 3bis Als Beraterinnen und Berater gelten natürliche und juristische Personen, die für Dritte berufsmässig bei finanziellen Transaktionen einschliesslich der Mittelbeschaffung im Zusammenhang mit folgenden konkreten Rechtsvorgängen mitwirken:a. Kauf und Verkauf von Grundstücken; b. Gründung und Errichtung von nicht operativen Rechtseinheiten mit Sitz in der Schweiz oder von Rechtseinheiten mit Sitz im Ausland; c. Führung und Verwaltung von nicht operativen Rechtseinheiten; d. Einlagen und Ausschüttungen von nicht operativen Rechtseinheiten; e. Kauf und Verkauf von Rechtseinheiten, sofern der Kauf oder Verkauf durch eine nicht operative Rechtseinheit erfolgt.313ter Als Beraterinnen und Berater gelten zudem natürliche und juristische Personen, die berufsmässig für die Dauer von mehr als sechs Monaten Adressen oder Räume als Domizil oder Sitz für Rechtseinheiten bereitstellen.32

      .

    1. 8 Voraussetzungen für den Beizug Dritter1 Der Finanzintermediär kann zur Identifizierung der Vertragspartei und der Ver-treter juristischer Personen, zur Feststellung der wirtschaftlich berechtigten Person,zur erneuten Identifizierung oder Feststellung der wirtschaftlich berechtigten Personund zur Durchführung der besonderen Abklärungspflicht eine Hilfsperson im Sinnevon Art. 2 Abs. 2 Bst. b GwV oder einen anderen Finanzintermediär beiziehen, soferndieser einer gleichwertigen Aufsicht und Regelung in Bezug auf die Bekämpfung derGeldwäscherei untersteht.2 Auf schriftliches Gesuch hin kann die SRO PolyReg einem Finanzintermediärbei Vorliegen zureichender Gründe die Bewilligung erteilen, zur Erfüllung der Sorg-faltspflichten einen anderen Dritten, der nicht Finanzintermediär im Sinne von Absatz1 ist, beizuziehen, sofern er mit diesem eine schriftliche Vereinbarung abschliesst undsicherstellt, dass der Dritte sorgfältig ausgewählt und über seine Aufgaben instruiertist sowie bezüglich der Pflichterfüllung kontrolliert wird.

      Vgl. Art. 28 GwV-FINMA sowie S. 10 Polyreg-Aufnahmegesuch-Antrag sowie Rn. 53 des FINMA-Rundschreibens 2016/7 "Video- und Online-Identifizierung" in der aktuellen sowie – voraussichtlich – künftigen Fassung.

    1. Art. 28 Abs. 1 GwV-FINMA:Der Finanzintermediär darf [...] mittels ei-ner schriftlichen Vereinbarung beauftra-gen, wenn [...]Die Auftragserteilung kann auch elekt-ronisch erfolgen, bspw. mittels digitalerSignatur.

      .

    1. Importantly, I think there is a world in which software doesn’t go away, but its role must change. In this analogy, data, state, and APIs will be persistent storage, akin to NAND, whereas human-oriented consumption software will likely become obsolete. All horizontal software companies oriented at human-based consumption are obsolete. The entire model will be focused on fast information processors (AI Agents), using tokens to transform them and depositing the answers back into memory. Software itself must change to support this core mechanism, as the compute engine at the top of the hierarchy is primarily nonhuman, namely an AI agent.

      Lion

    1. quick votes map from Strong No through Strong Yes to 10, 30, 50, 70, and 90

      My sense is that it might be clearer just to show the numbers for quick votes (rather than the signs that may be read differently by people who don't read instructions carefully) (?)

    2. Calibration and stability answer different questions. Calibration asks whether AI ratings line up with human judgments. Stability asks whether the same papers keep similar ratings when the model is run again or a substantively equivalent instruction is reworded. A system can be stable but wrong, so stability is a reproducibility diagnostic rather than an accuracy claim. Our pilot covers 24 selected papers with 192 repeated ratings and remains exploratory; it is not a full-dashboard reliability estimate.

      I might misunderstand this, but should there be an assessment of prompt and run stability (rather than just an explanation of what it means)?

  2. www.researchsquare.com www.researchsquare.com
    1. eLife Assessment

      This important study reports that Sox17 is key to the formation and function of the Sertoli valve, a transition region between the rete testis and seminiferous tubules that remains an understudied domain of testicular biology. The supporting data are convincing. This work will be of interest to developmental and reproductive biologists, as well as andrologists who work on male fertility and men's health.

    2. Reviewer #1 (Public review):

      Summary:

      This manuscript is an excellent follow-up to your 2022 study, in which Sox17 expression was localized to the rete testis and shown to be required for proper formation of the Sertoli cell valve (transition region). By using Nr5a1-Cre to drive conditional deletion of Sox17 specifically in rete testis cells, you demonstrate that testis weights remain normal at 2 weeks of age but become significantly reduced by 8 weeks in Sox17-cKO males. At the later time point, the seminiferous epithelium is severely disrupted, with apparent arrest of spermiogenesis: the epididymal lumen is essentially devoid of sperm, and most tubules lack elongated spermatids.

      Strengths:

      Clearly shows the role of Sox17 in Sertoli cells being important to the SV function. The SV (transition region) between the rete testis and seminiferous tubules remains an understudied domain of testicular biology. The present work, together with your prior study, highlights intriguing mechanisms operating in this specialized niche.

      Weaknesses:

      The available data do not fully explain either the developmental assembly of the Sertoli valve or the precise consequences of its functional disruption. These studies are nonetheless valuable precisely because they raise more questions than they answer; the conceptual implications are thought-provoking.

    3. Reviewer #2 (Public review):

      This manuscript investigates the role of SOX17 in the formation and function of the Sertoli valve (SV) at the interface between seminiferous tubules and the rete testis (RT). Building on previous work showing that rete testis-specific deletion of Sox17 disrupts SV formation, leading to defective spermiogenesis and male infertility, the authors explore how SOX17 overexpression in Sertoli cells regulate SV of rodent testes.

      Using transgenic mouse models with ectopic Sox17 expression in Sertoli cells, the study demonstrates that SOX17 is not only required but can also modulate SV formation. Ectopic expression in Sertoli cells induces expansion of the SV structure and partially rescues SV defects and spermatogenesis in RT-specific Sox17 conditional knockout animals. The data support a model in which SOX17 acts through paracrine signaling to regulate SV formation, although the precise mechanisms remain to be clarified.

      Overall, this is a well-executed study with novel and significant findings. The ability to experimentally manipulate SV size is particularly compelling and provides a valuable framework to study fluid dynamics and epithelial interactions in the testis. This work will be of broad interest to the reproductive biology and developmental biology communities.

    4. Author response:

      The following is the authors’ response to the original reviews.

      Public Reviews:

      Reviewer #1 (Public review):

      Summary:

      This manuscript is an excellent follow-up to your 2022 study, in which Sox17 expression was localized to the rete testis and shown to be required for proper formation of the Sertoli cell valve (transition region). By using Nr5a1-Cre to drive conditional deletion of Sox17 specifically in rete testis cells, you demonstrate that testis weights remain normal at 2 weeks of age but become significantly reduced by 8 weeks in Sox17-cKO males. At the later time point, the seminiferous epithelium is severely disrupted, with apparent arrest of spermiogenesis: the epididymal lumen is essentially devoid of sperm, and most tubules lack elongated spermatids.

      Strengths:

      The study clearly shows the role of Sox17 in Sertoli cells as being important to SV function. The SV (transition region) between the rete testis and seminiferous tubules remains an understudied domain of testicular biology. The present work, together with the authors' prior study, highlights intriguing mechanisms operating in this specialized niche.

      Weaknesses:

      At the same time, the available data do not yet fully explain either the developmental assembly of the Sertoli valve or the precise consequences of its functional disruption. These studies are nonetheless valuable precisely because they raise more questions than they answer; the conceptual implications are thought-provoking.

      Reviewer #2 (Public review):

      This manuscript investigates the role of SOX17 in the formation and function of the Sertoli valve (SV) at the interface between seminiferous tubules and the rete testis (RT). Building on previous work showing that rete testis-specific deletion of Sox17 disrupts SV formation, leading to defective spermiogenesis and male infertility, the authors explore how SOX17 overexpression in Sertoli cells regulates the SV of rodent testes.

      Using transgenic mouse models with ectopic Sox17 expression in Sertoli cells, the study demonstrates that SOX17 is not only required but can also modulate SV formation. Ectopic expression in Sertoli cells induces expansion of the SV structure and partially rescues SV defects and spermatogenesis in RT-specific Sox17 conditional knockout animals. The data support a model in which SOX17 acts through paracrine signaling to regulate SV formation, although the precise mechanisms remain to be clarified.

      Overall, this is a well-executed study with novel and significant findings. The ability to experimentally manipulate SV size is particularly compelling and provides a valuable framework to study fluid dynamics and epithelial interactions in the testis. This work will be of broad interest to the reproductive biology and developmental biology communities.

      Reviewer #3 (Public review):

      Summary:

      These studies are based on previously published work that showed that deletion of expression of the Sox17 gene in the testis essentially deleted the formation of the Sertoli valve in the Rete testis. The authors extended this work by constructing a vector that resulted in increased Sox17 expression by Sertoli cells and enhanced formation of the Sertoli valve in both wild type and Sox17 knockout mice. The work provides strong evidence supporting the requirement for Sox17 expression to allow formation of the Sertoli valve.

      Strengths:

      The general approach was to express Sox17 from a Tg mouse that expressed Sox17 from Sertoli cells. This Tg mouse was bred into both the WT and the Sox17 KO mouse. The Sertoli valve was enhanced in both the WT/Tg mouse and KO/Tg mouse, showing that ectopic Sox17 could compensate in the Sox17 Ko and act in a concentration-dependent manner in the WT mouse. The results are strong and support the conclusions from the authors. The results were as expected from the original paper describing the KO of Sox 17. These results strengthen these conclusions and provide ideas for additional conclusions. These studies were technically challenging, and the authors provided a very solid manuscript.

      Weaknesses:

      The authors refer several times to high or low expression, but it all appears to be based on immunohistochemistry, and there is no real quantification using PCR, for example. The process used for cell quantification lacks a rationale for why certain numbers were assigned.

      We sincerely thank the reviewers for their careful evaluation of our manuscript and for their constructive and encouraging comments. We are grateful for the recognition of the significance of the Sertoli valve as an understudied transition region between the rete testis and seminiferous tubules, as well as for the positive assessment of our genetic approach and the evidence that ectopic SOX17 expression can modulate SV formation. We have carefully considered all points raised in the assessment and have revised the manuscript accordingly. The major revisions include:

      (1) Clarification of the scope and limitations of the study (Reviewers #1 and #2):

      In response to the comments that the developmental assembly of the Sertoli valve and the precise consequences of its functional disruption remain incompletely understood, we clarified the scope and limitations of the present study at the end of 7th paragraph in the Discussion. Although our findings support a model in which SOX17 regulates SV formation through paracrine signaling, the downstream effectors and precise molecular mechanisms remain to be identified. We therefore revised the Discussion to avoid overinterpretation of the molecular mechanisms and to emphasize that comprehensive mechanistic analyses, including transcriptomic analyses using the Tg mouse model, represent an important direction for future research. We also added histological analyses of the earliest detectable lesions at 4 weeks of age and low-magnification images of adult Sox17 cKO testes (new Figure S1), revealing selective sloughing of round spermatids despite preserved Sertoli cell architecture and subsequent mosaic spermatogenic defects among individual seminiferous tubules. These observations provide additional insights into the altered luminal microenvironment and suggest that spermatogenic defects may progress in a tubule-by-tubule manner.

      (2) Clarification of quantitative analysis and methodology (Reviewer #3):

      In response to concerns regarding the basis and methodology of cell quantification, we revised the Methods to provide detailed information on tissue preparation, fixation, orientation of the rete testis–Sertoli valve region, and the criteria used for quantitative analysis of SV-associated Sertoli cells (new Figure S4). We clarified that Sertoli cells were counted within the SV region extending approximately 100 μm from the RT boundary, including Sertoli cells protruding into the RT lumen, based on previously established criteria (Aiyama et al., 2015).

      (3) Clarification of the limitations of expression-level assessment (Reviewer #3):

      In response to concerns regarding the quantitative assessment of SOX17 and other SV-associated molecules, we clarified the technical limitations of selectively isolating the very small SV region and obtaining sufficient material for quantitative molecular analyses such as qPCR at the end of 7th paragraph in the Discussion. We therefore clarified that expression of SV-associated molecules in the present study was primarily evaluated using histological and immunohistochemical approaches and added the relevant text to acknowledge these limitations.

      We also made additional revisions to clarify each mouse Tg line, phenotypic descriptions, standardize gene nomenclature, improve methodological descriptions, and refine the relevant Discussion where appropriate.

      We sincerely appreciate the reviewers’ thoughtful and constructive comments. Their feedback has helped us clarify the scope of our conclusions, strengthen the methodological descriptions, and improve the overall presentation of the study. All changes have been incorporated into the revised manuscript.

      Recommendations for the authors:

      Reviewer #1 (Recommendations for the authors):

      (i) Although the current paper is not responsible for interpreting the 2022 findings, both datasets show reduced spermatid production accompanied by multinucleated giant germ-cell syncytia. This phenotype has been attributed to backflow of tubular fluid and consequent microenvironmental perturbation. While this is a reasonable hypothesis, it is not entirely consistent with earlier experimental observations. Complete ligation of the efferent ductules reliably produces giant cells, whereas estrogen-receptor knockout, which also causes massive luminal fluid accumulation, does not. In addition, ligation of the testicular artery itself can induce giant-cell formation. Although this may have already been answered in the papers, can you be sure that a direct or indirect effect on the vasculature can be excluded in the Sox17-cKO model?

      We thank the reviewer for this important comment. In our models, SOX17 expression was manipulated specifically in the Sertoli cell lineage, either by SF1-Cre-mediated Sox17 deletion or by ectopic SOX17 expression under the hAMH-promoter. SOX17-expressing vascular endothelial cells were not targeted in either model, making a direct effect of Sox17 manipulation on the testicular vasculature unlikely. Moreover, the partial rescue of the Sox17 cKO phenotype by hAMH-Sox17 supports the interpretation that the phenotype primarily results from altered SOX17 function in Sertoli cells and RT epithelia.

      However, indirect effects on the vascular or interstitial environment by aberrant luminal flow cannot be completely excluded, particularly with the substantial accumulation of sloughed round spermatids (giant cells) within the rete testis. Addressing the potential for an initial luminal flow defect, we newly added histological images of 4-week-old testes (Figure S1), where selective post-meiotic germ cell sloughing occurs despite preserved Sertoli cell process architecture, suggesting an altered adluminal microenvironment that impairs Sertoli–spermatid adhesion. Furthermore, low-magnification images of adult mature Sox17 cKO testes (Figure S1B) display a mosaic pattern of spermatogenic defects across individual tubules. While 3D reconstruction was not conducted, this structural pattern supports the view that spermatogenic failure progresses on a tubule-by-tubule basis, potentially linked to the structural integrity of individual Sertoli valves.

      (ii) A related and important unresolved issue is the total number of Sertoli cells per testis in cKO males. The number of Sertoli cells per tubule cross-section is reported to be equivalent to controls; however, the substantial reduction in testis weight implies a corresponding reduction in tubule length. Under these conditions, maintenance of a normal per-cross-section count would still be compatible with an overall decrease in total Sertoli-cell number. Although it is generally accepted that murine Sertoli cells exit the cell cycle around postnatal day 15, continued growth of the testis may still occur in the Sertoli valve region, where Sertoli cells retain proliferative capacity. Your discussion of possible heterogeneity in the embryonic origin of Sertoli cells near the rete testis is therefore particularly intriguing and commendable. Should this hypothesis be substantiated, it would raise the possibility that Sertoli cells derived from the valve region, especially those that migrate into the seminiferous tubules, are intrinsically less competent to support full spermatogenesis than those of classic gonadal-ridge origin.

      To help readers appreciate the overall severity and topographic distribution of the spermatogenic defect (particularly in tubule segments distant from the rete), inclusion of a low-magnification photomicrograph of a well-fixed (Bouin's) testicular cross-section would be very useful.

      We thank the reviewer for this important comment. We agree that the maintenance of Sertoli cell numbers per seminiferous tubule cross-section does not necessarily indicate preservation of the total Sertoli cell number per testis, particularly given the substantial reduction in testis size and potential reduction in overall seminiferous tubule length. Although total Sertoli cell numbers can theoretically be estimated using stereological approaches, such analyses are technically demanding and beyond the scope of the present study.

      We also appreciate the reviewer’s insightful suggestion regarding potential heterogeneity among Sertoli cell populations. Sertoli cells associated with the Sertoli valve region may have distinct developmental origins or functional properties compared with classical gonadal ridge-derived Sertoli cells, which could potentially influence their capacity to support complete spermatogenesis. Although this hypothesis was not directly tested in this study, we have expanded the Discussion to highlight the developmental and functional heterogeneity of Sertoli cell populations associated with the Sertoli valve as an important topic for future investigation.

      In addition, as requested, we have added a low-magnification image of well-preserved testicular cross-sections in Supplementary Figure S1B to better illustrate the overall severity and topographic distribution of spermatogenic defects throughout the testis.

      Specific Comments:

      (1) Figure 3A and associated fertility/histology data. The results state that epididymal spermatozoa were detected in only 2 of 7 cKO;Tg males at 8 weeks of age, yet Materials and Methods indicate that spermatogenesis was evaluated in only 5 males. a) Were the remaining two males also examined histologically? b) It would be interesting to determine if the severity of pathological changes was the same in regions more distant from the rete testis, or possibly different tubules. See: Nakata H, Wakayama T, Sonomura T, Honma S, Hatta T and Iseki S (2015). "Three-dimensional structure of seminiferous tubules in the adult mouse." J Anat 227(5): 686-694. c) In addition, mating trials were performed with four independent cKO;Tg males, two of which sired offspring. It is unclear whether the testes of these four mating males were included among the five (or seven) animals evaluated for histology, and whether the two fertile males correspond exactly to the two individuals that retained epididymal sperm. Please clarify these relationships explicitly so that readers can correctly interpret the link between histological findings and fertility.

      We thank the reviewer for this important comment. We apologize that the relationship among the groups of animals used for histological analysis, epididymal sperm detection, and fertility assessment was not sufficiently clear in the original manuscript. Because this study focused specifically on the anatomically minute RT–SV region, our sampling strategy had to prioritize the maximal utilization of this limited tissue. In this study, the RT–SV region, the remaining testicular tissue, and the epididymis were processed separately as three tissue blocks for each animal (Figure S4) and were independently evaluated for distinct analysis sets. Briefly, the proximal quarter containing the rete testis and Sertoli valve region was used for SV analysis, whereas the remaining three-quarters of the testis were used for evaluation of spermatogenesis, and the epididymis was analyzed separately for the presence of spermatozoa. Therefore, due to these technical requirements, tissue allocation, and independent analytical evaluation, the numbers of animals used for RT–SV analysis, testicular histology, epididymal sperm detection, and fertility testing were not identical.

      For quantitative histological analyses, we also used virgin males to minimize potential variation associated with mating experience and to allow comparison with age-matched littermate controls. Therefore, these animals were not used for fertility testing. Fertility assessment was performed using an independent cohort of cKO; Tg males that were subjected to long-term mating trials with wild-type females. Thus, fertility outcomes and histological findings were not designed to be directly matched at the individual level.

      In response to the reviewer’s suggestion, we have clarified the selection of experimental animals and the relationship among fertility assessment and histological analyses in the Materials and Methods and added a schematic illustration of the sampling strategy in Figure S4. We also corrected the citation for Nakata H et al., 2015 in the revised manuscript.

      (2) Page 8, line 301 (Sertoli-cell quantification). The description of the counting method-"counted in each ... (~100 μm from the edge of the RT; Fig. 4C)"-is ambiguous.

      (a) Does this mean that cells were counted beginning at the rete boundary and extending radially outward for approximately 100 μm, or is a circumferential sampling area intended? (b) Figure 4C shows a large standard deviation, indicating substantial variability with the current approach. An alternative strategy (for example, counting Sertoli cells within standardized areas or per tubule specifically within the valve region) might reduce variability and improve reproducibility. Regardless of the method ultimately chosen, a more precise, step-by-step description of the quantification protocol is required so that it can be reliably replicated by other laboratories.

      We thank the reviewer for pointing out that the description of the Sertoli cell quantification method was not sufficiently clear. The Sertoli cell quantification was performed using the same criteria as previously described (Aiyama et al., 2015; Uchida et al., 2022), in which SOX9-positive Sertoli cell nuclei within the SV-associated region were counted.

      In the revised manuscript, we have clarified that the SV region was operationally defined as comprising (i) the terminal 100 μm segment of the seminiferous tubule immediately adjacent to the rete testis (RT) and (ii) the protruded SV extending into the RT lumen. Based on the distribution of spermatogonial stem cells, the ~100 μm region extending from the RT boundary along the seminiferous tubule toward the ST side was defined as the SV region (Aiyama et al., 2015). Only sagittal sections showing a continuous RT–SV–ST axis and sectioning the SV approximately through its mid-sagittal plane were included for quantitative analysis.

      Furthermore, to improve reproducibility, we have added a more detailed description of the tissue preparation and quantification procedures in the Materials and Methods and provided a schematic illustration of the quantification strategy in the new Figure S4.

      Reviewer #2 (Recommendations for the authors):

      (1) Phenotypic differences between transgenic lines: the phenotypic differences between the tg26 and tg27 lines are intriguing and warrant further clarification. While tg27 mice exhibit infertility and defective spermatogenesis, tg26 animals remain fertile with SV expansion. Could the authors elaborate on the underlying causes of these differences? In particular, is infertility in tg27 mice due to excessive SOX17 expression impairing Sertoli cell function? A comparison of Sox17 expression levels between tg26 and tg27 lines would be informative. In addition, it would be useful to assess whether acetylated tubulin (Ac-Tub) expression is present in the Sertoli cells of the tg27 mouse testis.

      We thank the reviewer for this highly constructive and insightful comment. We clarified in the revised manuscript that the analysis of the Tg27 mouse was performed using the F0 founder male and added an explanation that only the Tg26 line could be established as its heterogenous SOX17 expression in Sertoli cells did not impair overall fertility. We agree that the phenotypic differences between the Tg26 line and the Tg27 mouse provide important clues regarding the dosage-dependent effects of SOX17 in Sertoli cells. Unfortunately, we were unable to establish a stable, multi-generational transgenic line from this Tg27 founder (F0) male. Consequently, we could not perform detailed molecular or immunohistochemical analyses on this line beyond the initial histological evaluation of the F0 generation presented in Figure 1. For this reason, we cannot provide a quantitative comparison of Sox17 expression levels or evaluate acetylated tubulin (Ac-Tub) expression in Tg27 Sertoli cells.

      To address the reviewer's concern without overstepping the available data, we removed direct quantitative comparisons of Sox17 expression levels between the two lines from the text. Instead, we added a clear description of their contrasting cellular expression patterns - specifically, the mosaic, heterogeneous SOX17 expression in Tg26 Sertoli cells versus the ectopic, uniform SOX17 expression in the infertile #27 F0 male - in the 'Animals' section of Materials and Methods. This mosaic pattern in Tg26 testes suggests the presence of Sertoli cells with low or undetectable SOX17 levels, which may be associated with sustaining overall fertility.

      (2) Mechanism of SOX17 action: although SOX17 is a transcription factor, the author's studies indicate it regulates SV formation via paracrine and/or autocrine signaling. The underlying mechanisms remain unclear. Which downstream factors mediate this effect? The observed upregulation of RSPO1 and WNT4 is suggestive, but more direct evidence would strengthen this conclusion. For example, does SV expansion in tg26 mice depend on the activation of RSPO1/WNT signaling? Additional molecular analyses, such as bulk RNA-seq comparing control and transgenic testes, could help identify pathways regulated by SOX17 and clarify its mode of action.

      We thank the reviewer for this important and insightful suggestion. At present, comprehensive analyses, including scRNA-seq of Sox17 cKO and littermate control testes, have not identified definitive downstream targets of SOX17 (Uchida et al., 2022). As the reviewer rightly points out, the Tg26 mouse model generated in this study represents a valuable tool for investigating SOX17-dependent molecular pathways. To this end, we are currently conducting transcriptomic analyses of Tg26 seminiferous tubules to identify genes altered in SOX17+ Sertoli cells. However, determining whether these candidate genes represent direct transcriptional targets of SOX17 and whether they function specifically in the rete testis-associated region during Sertoli valve formation will require extensive functional and expression studies. Therefore, we feel it would be premature to draw definitive conclusions regarding the underlying molecular mechanisms, including the precise involvement of the RSPO1/WNT signaling pathway, in the present manuscript. Accordingly, rather than overinterpreting the available data, we have revised the Discussion to clarify this limitation (at the end of 7th paragraph in the Discussion). Furthermore, incorporating initial insights from our ongoing Tg26 transcriptomic analyses, we have added a brief discussion, supported by relevant literature, on the possibility that SOX17 may regulate Sertoli valve formation by modulating cell adhesion and extracellular matrix (ECM) organization and altering the responsiveness of SOX17-positive Sertoli cells to morphogenetic signals originating from the rete testis (new 5th paragraph in Discussion).

      (3) Minor comment: Gene nomenclature should be standardized: e.g. line 245, Sox17 and hAMH should be italicized.

      We thank the reviewer for pointing this out. All gene names have been italicized throughout the manuscript.

      Reviewer #3 (Recommendations for the authors):

      No suggestions except to quantify some of the changes in concentration of agents by PCR rather than eyeball levels with immunocytochemistry. Verify the cell quantification procedure used.

      We thank the reviewer for this comment. The Sertoli valve (SV) is an extremely small transitional structure, with only approximately 20 sites per mouse testis. As a result, selective isolation of the SV region to collect sufficient material for molecular analyses, such as quantitative PCR, remains technically challenging. We have therefore added this limitation to the Discussion.

      Regarding the cell quantification procedure, we have clarified the methodology in the revised Materials and Methods and added a schematic illustration in Figure S4. Specifically, the Sertoli cell number in the SV region was quantified by counting SOX9-positive Sertoli cell nuclei within a standardized SV-associated region in RT–SV–ST sagittal sections.

    1. First, we assessed the overall size of the action space by counting the number of unique actions as a function of inventory size during the final ten generations. As expected, individuals with semantic knowledge or social learning explored fewer unique combinations, avoiding options that did not make sense (Fig. 2D). Second, we computed the Shannon entropy of action distributions within each inventory state. Higher entropy indicates more random exploration, while lower entropy reflects more focused, targeted search. As expected, entropy was markedly lower in populations with semantic knowledge (Fig. 2E), indicating that individuals explored fewer, more targeted combinations than individuals without such knowledge. Entropy was also lower in populations with the capacity for social learning, consistent with the idea that social learning reduces individual exploration (45). These results confirm that both semantic knowledge and social learning restrict the action space, making innovation more efficient.

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    Annotators

    1. Over 200 ABCA4 sequence variants have been reported so far in patients with STGD and other retinopathies1,5,6,7,8,9,10,11,12,13,14,15,16,17. We have examined 33 missense mutations, 3 small in-frame deletions and 1 frameshift near the carboxy terminus (Table 1 and Fig. 2), including those mutations most commonly encountered in STGD patients1,5,6,7,8,9,10,11 and several that were reported in AMD patients15. As an initial step in assessing protein folding and stability, we analysed each ABCR variant by immunoblotting and azido-ATP labelling (Fig. 3). Mutations that cause small deletions (delVVAIC1681 and delPAL1761) or introduce charged amino acids into predicted transmembrane domains (G851D and G1886E) produce greatly reduced amounts of protein. Among the ABCR variants that are expressed with normal or nearly normal yield, azido-ATP labelling revealed a subset that is defective in ATP binding. A variety of mutations that lie outside of the nucleotide-binding domains (NBDs) can impair azido-ATP labelling, including L541P, predicted to reside adjacent to a transmembrane domain, and W1408R, which resides between the homologous halves of ABCR (Fig. 2). These data suggest that ATP binding to the NBDs is allosterically coupled to conformational changes in or near the transmembrane regions. Moreover, some mutations within either of the two NBDs abolish or nearly abolish all azido-ATP labelling, as seen, for example, with variants T971N, L1971R, G1977S and E2096K, implying allosteric coupling between the two NBDs, as described for P-glycoprotein22,23.Table 1 Naturally occurring ABCR variants produced in transfected 293 cellsFull size tableFigure 2: Locations of 37 naturally occurring ABCR sequence variants and 4 synthetic mutations.The predicted transmembrane topography and domain structure of ABCR is based on the hydropathy profile and sequence alignment with other ABC transporters. The cytosolic face of the membrane is downward. NBD, nucleotide binding domain; HH, highly hydrophobic domain shared with other members of the ABC1/ABCR subfamily of ABC transporters. A, B and C indicate the sequence motifs characteristic of nucleotide binding folds. Asterisks denote the four synthetic mutations.Full size imageFigure 3: Protein yield and ATP-binding capacity of 37 naturally occurring ABCR variants produced in transiently transfected 293 cells.Membranes were analysed by immunoblotting with affinity-purified anti-ABCR antibodies (top) and photoaffinity labelling with α-32P azido-ATP (bottom). We loaded 1 μg (immunoblotting) or 2.5 μg (azido-ATP labelling) of total membrane protein, as determined by Bradford assay, per track. The mutations that reside in NBD-1 and NBD-2 are indicated above the corresponding lanes. The relative levels of the different variant proteins and the extent of azido-ATP labelling were observed to be highly reproducible in multiple independent experiments. ABCR (large arrowhead); an endogenous 55-kD protein (small arrowhead) serves as an internal control for azido-ATP labelling. Molecular mass standards are shown on the left in kD.Full size imageThe combination of immunoblotting and azido-ATP labelling revealed defects in more than 75% of the variants tested. Among the variants with reduced yield and/or ATP binding are G863A and delG863, the two protein products of a guanosine2588→cytosine mutation that both generates a glycine-to-alanine substitution at codon 863 and activates a cryptic splice acceptor site in exon 17 that results in the removal of codon 863 from approximately 50% of the transcripts10. This is the most common allele among STGD patients in Northern Europe, representing roughly 20% of disease-associated alleles. It is also present at a frequency of approximately 3% in the general population in Northern Europe and approximately 1% in the United States population7,9,10. Genotype-phenotype correlations suggest that it is a mild allele and that it leads to STGD only when paired with a more severe allele10. Relative to wild type, the G863A variant is subtantially impaired and the delG863 variant is mildly impaired (Fig. 3).

      This variant was transfected into HEK 293 cells and appears to show reduced expression and ATP-binding capacity, but no quantities were provided

    1. Patient 4, a 30-year-old individual with the deleterious c.213dupG/p.Ile73Asnfs*26 frameshift mutation and the c.1654G>A/p.Val552Ile missense mutation, displayed mild STGD1 with stage 2 FC and 20/30 VA. The p.Ile73Asnfs*26 mutation is classified as a pathogenic mutation, whereas the p.Val552Ile mutation is classified as likely neutral. Biochemical analysis of the p.Val552Val, however, suggests that this is a mild mutation at a functional level consistent with the clinical assessment of patient 4 (see Discussion section for additional information).

      Case#: Garces Patient 4, Canada

      DiseaseAssertion: mild STGD1

      FamilyInfo:

      CasePresentingHPOs:

      CaseHPOFreeText: 30yo, VA=20/30, FC=Stage 2 (flecks throughout the posterior pole, anterior to the vascular arcades and nasal to the optic disc and relatively normal ERGs but with prolonged dark adaptation)

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: screened for mutations in the ABCA4, CNGB3, and ELOVL4 genes

      PreviouslyPublished: n/a

      Variant: c.213dupG/p.Ile73Asnfs*26; c.1654G>A/p.Val552Ile

      CAID: CA239745

      SupplementalData:

    1. V1 H1 Exon 36.1–3 G>A chr1:94,484,001 c.5196+1137G>A 4 4 0 0

      Case#: Braun Family 3 Proband (from left to right, top to bottom of available pedigrees), female

      DiseaseAssertion: Stargardt

      FamilyInfo: Both parents are unaffected, but only mother has genotype information available since father is deceased. c.1622T>C (p.L541P) and c.3113C>T (p.A1038V) complex variants were maternally inherited.

      CasePresentingHPOs:

      CaseHPOFreeText: "five or more of the following features of ABCA4-associated retinal disease: decreased visual acuity before age 20, decreased visual acuity as the first visual symptom, symmetrical fundus findings, pisciform flecks, beaten metal macular atrophy, bulls-eye maculopathy, peripapillary sparing, vermillion fundus, masked choroid on fluorescein angiography, nummular pigment overlying extensive macular atrophy, central outer retinal atrophy on optical coherence tomography and central scotomas on Goldmann perimetry."

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: one plausible disease-causing mutation detected in ABCA4 after assessing the entire coding sequence and canonical retinal splice junctions with automated bidirectional Sanger sequencing using an ABI 3730 sequencer

      PreviouslyPublished: n/a

      Variant: c.5196+1137G>A; c.1622T>C (p.L541P) and c.3113C>T (p.A1038V) complex variant

      ClinVar: 438100

      CAID: CA26843511

      SupplementalData: pedigree in fig s2

    1. The proband of family 31, F31:II.1, carries a homozygous missense variant within exon 42 of the ABCA4 gene.

      This variant is well-known in exon 42, [M2]: c.5882G > A; p.(Gly1961Glu), rs1800553. The father of the affected patient was deceased; however, the mother was found to be homozygous for the wild type (WT) allele. According to the ACMG standards, M2 is likely pathogenic.

    1. The plots of fluorescence anisotropy changes of 11-cis-retinal with wild type and mutant NBD1 protein titrations are shown in Fig. 6, A–C. The binding of mutant G863A was significantly attenuated as indicated by the drastic right shift of the binding isotherm as well as its inability to achieve saturation in the presence of a high concentration of protein (Fig. 6A). Nonlinear regression analysis gave Kd of 8.0 ± 1.3 × 10−8 m, 8.0 ± 2.0 × 10−6 m, and 4.0 ± 1.4 × 10−6 m for the wild type and R943Q and P940R mutations, respectively (Fig. 6 and Table 1). As a consequence of Stargardt disease mutations, 100-fold (R943Q) to 50-fold (P940R) decreases in the binding affinity of the NBD1 domain for 11-cis-retinal were observed. The retinal binding of the G863A mutant was severely attenuated, and the Kd was ≥1.0 × 10−5 m.

      The effects of this variant on 11-cis-retinal interaction with the NBD1 was evaluated via fluorescence anisotropy. The binding of mutant G863A was significantly attenuated (Kd was ≥1.0 × 10−5 m) as indicated by the drastic right shift of the binding isotherm as well as its inability to achieve saturation in the presence of a high concentration of protein (Fig. 6A).

    1. All reported ABCA4 variants (Supplementary Table S1) were classified as follows:

      Patient 38 has this variant and also c.5882G>A p.(Gly1961Glu) (Supplement 4-supplementary table 1). Phase is unknown and more specific phenotype information is not provided.

      clinical diagnosis of STGD1 was supported by the presence of ≥1 (likely) pathogenic ABCA4 variants with a follow-up data of ≥6 months on FAF imaging.

    1. The measurement of ATPase activity has been the only assay available to study the effects of mutations on ABCA4 function. We employed this assay to examine the effects of [L541P; A1038V], R602W and C1490Y mutations on in vitro ATP hydrolysis. Constructs containing wild-type and mutated ABCA4 cDNAs, tagged with the eight amino acid bovine opsin C-terminal epitope (1D4), were expressed in COS7 cells and proteins were purified on a 1D4 affinity column. CHAPS-solubilized ABCA4 was incubated subsequently with ATP, and the hydrolysis rate was estimated with the charcoal method (31).The rate of ATP hydrolysis of the complex allele [L541P; A1038V] was decreased to 68.1% of wild-type ABCA4 (Fig. 3).

      ATPase activity in COS7 cells showed decreased activity (68.1% of wild-type), indicating that this variant impacts protein function (PS3_Supporting; PMIDs). However, this is not a cell type that is counted for PS3 evidence by the ABCA4 VCEP.

    1. Patient 2, a 46-year-old Caucasian woman, presented in July 1998 with a history of progressive decline in visual acuity since the age of 16

      PMID: 10612508

      Gene: ABCA4

      Case#: Patient 2, 46-year-old female

      DiseaseAssertion: STGD1

      FamilyInfo: One of four affected siblings in a family consistent with autosomal recessive inheritance.

      CasePresentingHPOs: HP:0000545 — Decreased visual acuity HP:0007754 — Macular atrophy HP:0030638 — Retinal flecks HP:0000512 — Abnormal fundus morphology

      CaseHPOFreeText: Progressive visual decline since age 16. Best-corrected visual acuity 20/400 in both eyes. Fundus examination showed bilateral symmetrical central chorioretinal atrophy (~3 disc diameters) with prominent pigment deposits and numerous yellow flecks in the posterior pole. Fluorescein angiography demonstrated central hypofluorescence with surrounding hyperfluorescence and peripheral dark choroid.

      CaseNotHPOs: Not reported

      CaseNotHPOFreeText: Not reported

      GenotypingMethod: PCR amplification and direct sequencing of ABCA4 after SSCP screening

      PreviouslyPublished: Yes

      Variant: NM_000350.2:c.2588G>C (p.Gly863Ala) NM_000350.2:c.161G>A (p.Cys54Tyr)

      ClinVar: Not reported

      CAID: Not reported

      SupplementalData: Segregation and sequencing data shown in Figures 1 and 4

    1. A cohort of 500 unrelated IRD patients was sequenced with the targeted NGS panel Genetic Eye Disease test (GEDi)3 and analyzed with a comprehensive approach, which included a standard NGS analysis pipeline detecting single-nucleotide variants (SNVs) and small insertions and deletions (indels),16 interrogation of sequence reads to detect the known pathogenic MAK-Alu insertion,21 and application of NGS read-depth algorithms (ExomeDepth15 and gCNV16) to detect larger deletions and duplications, or CNVs (Fig. 1). In this study we define CNVs as deletions or duplications that range from an average size of an exon (≈50–200 bp) and that are not detectable by standard NGS pipelines, to megabases of DNA.22

      Case#: OGI802_001554

      DiseaseAssertion: IRD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: detection of CNVs on the panel-based NGS Genetic Eye Disease (GEDi) diagnostic test that involves sequencing the exons of all known IRD disease genes

      PreviouslyPublished: n/a

      Variant: c.1715G>C; c.5196+1137G>A

      ClinVar: 99073

      CAID: CA226919

      SupplementalData: Table S2

    1. two cases from two additional families (case 3, 11 years and case 4, 11 years).

      Case#:two cases from two additional families (case 3, 11 years and case 4, 11 years).

      DiseaseAssertion: Stargardt’s Disease

      FamilyInfo: NR

      ParentalTesting: NR

      CasePresentingHPOs: HP:0030500, HP:0011507

      CasePhenotypeFreeText: LogMAR visual acuity for the right and left eye of cases 1–4 was 0.3 and 0.2, 0.1 and 0.1, 0.5 and 0.4, and 0.3 and 0.4, respectively. Gross disruption of the outer retinal layers at the macula in all cases; in two (cases 2 and 4), the presumed external limiting membrane (ELM) peak was broadened with the inner segment ellipsoid band (ISe) missing. Subtle white-yellowish fine dots at the macula and numerous white-yellowish flecks extending anterior to the arcade are shown in the colour fundus photograph of case 1. Autofluorescence (AF) imaging of case 1 detected well-defined dots with high signal at the central macula surrounded by a ring of increased signal and numerous foci with high or low signal extending to the peripheral retina. Case 2 also had subtle white-yellowish fine dots at the central macula and numerous white-yellowish flecks extending anterior to the arcade, both associated with high signal on AF imaging. In addition, case 3 had white-yellowish fine dots at the macula and numerous white-yellowish flecks extending to the periphery, both of which had high or low signal on AF imaging. Case 4 showed subtle fine macular dots mainly in a para-foveal location, which are well-defined on AF imaging.

      CaseNotHPOs: HP:0007401, HP:0000505

      CaseNotPhenotypeFreeText: Most cases with STGD have central macular atrophy with numerous more peripheral flecks (Michaelides et al. 2003). Given their relatively good visual acuity, it is likely that the central macular dots observed in our cases may be an early sign of macular dysfunction before the development of macular atrophy. Similar fine macular dots or a ‘mottled macula’ have also been reported in other inherited retinal diseases

      CasePreviousTesting: The age of disease onset in cases 1–4, defined as either the age at which visual loss was first noted by the subject or in the asymptomatic subjects when abnormal retinal appearance was first detected, was 5, 7, 8, and 6 years old, respectively.

      GenotypingMethod: After informed consent was obtained, blood samples were taken from probands of 2/3 families for ABCA4 screening. A full medical history was obtained, and a full ophthalmologic examination was performed in all cases. Mutation screening of ABCA4 was performed in two probands of the three families, and two likely disease-causing variants were identified in each case; c.768G > T, p.V256V (a previously reported splicing-altering synonymous variant) and c.4363T > C, p.C1455R (a missense variant) in case 1, and c.1906C > T, p.Q636* (a non-sense variant) and c.5461-10 T > C (a disease-associated intronic variant with uncertain effect) in case 3. A blood sample was not available in one proband (case 4).

      Variant: NM_000350.3(ABCA4):c.1906C>T (p.Gln636Ter) and NM_000350.3:c.5461-10T>C

      LegacyVariant: c.1906C>T (p.Gln636Ter) and c.5461-10T>C

      ClinVar: 265012 and 92870

      CAID: CA10588302 and CA220687

      gnomeAD: 1:94528164 G / A and 1:94476951 A / G

      MultipleGeneVariants:No

      PreviouslyPublished: No

      AdditionalInfo: Most symptoms/diagnoses are consistent with Stargardt’s Disease 3, however the probands in the study were younger in age, so many of the symptoms hadn’t progressed much. Also, all of the cases had decent visual acuity, which contradicts a symptom of Stargardt’s Disease 3. Similar fine macular dots or a ‘mottled macula’ have also been reported in other inherited retinal diseases, for example, in those caused by mutations in RDH5 or RPE65, both of which encode proteins with known function in the visual cycle. The thickening of the ELM may be an OCT abnormality that precedes atrophy in the early stages of STGD

    1. ABCA4P28592/1STGDc.6285T>Cp.D2095Drs1801555

      Case#: Patient P28592/1,

      DiseaseAssertion: STGD

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText:

      CaseNotHPOs:

      CaseNotHPOFreeText:

      GenotypingMethod: Custom 300-kb retinal resequencing chip. PCR amplification, DNA fragmentation, and chip hybridization. Hybridization signals were analyzed using Sequence pilot module seq-C mutation detection software (2009). This resequencing approach was validated by Sanger sequence technology.

      PreviouslyPublished: n/a

      Variant: c.635G>A p.(R212H); c.6445C>T p.(R2149X); c.6285T>C p.(D2095D)

      CAID: CA285825

      SupplementalData: n/a

    1. Seventy eyes (38 patients), of which 46 (66%) were female and 24 (34%) male, with RPE atrophy secondary to ABCA4 -related retinopathy (age [years], 45.51 ± 16.70; range 14–78) were included in the study ( Table 1 and see Table, Supplemental Digital Content 2 , http://links.lww.com/IAE/B170 , which shows the individual baseline and progression data of all included eyes).

      Case#: Patient #34, female, 61yo at baseline visit, "intermediate" age of onset

      DiseaseAssertion: ABCA4-related retinopathy with secondary RPE atrophy

      FamilyInfo: n/a

      CasePresentingHPOs:

      CaseHPOFreeText: Inclusion criteria were defined as 1) presence of at least one mutated allele in ABCA4 (NM_000350.2) in Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing 2) a compatible phenotype with flecks at the level of the RPE consistent with ABCA4 -related Stargardt disease 3) presence of RPE atrophy, and 4) serial examinations with an interval of at least 6 months. RPE atrophy to the end-stage (i.e., demarcated lesions with ≥90% darkness of the optic disc under short-wavelength excitation light, DDAF) that previously showed highest interreader agreement.7 The size of DDAF has to be at least 0.05 mm 2 (each single atrophic area in cases of multifocality), and the entire lesion must be completely visualized on the AF image at each visit to be advanced for analysis. Self-reported symptom onset into early-onset (≤10 years), intermediate-onset (11–44 years), and late-onset (≥45 years). ff-ERG based Category: Group 1 contained eyes with normal scotopic and photopic responses; Group 2, eyes with normal scotopic responses, but reduced (over 2 SDs) photopic B-wave and 30-Hz flicker amplitudes; and Group 3, eyes with impairment of both rod- and cone-driven responses. BCVA: OD=n/a, OS=1 [LogMAR] .

      CaseNotHPOs:

      CaseNotHPOFreeText: Insufficient pupil dilation, additional retinal pathology, previous retinal treatment, or other ocular comorbidities substantially affecting image quality led to exclusion from the study

      GenotypingMethod: Sanger sequencing with multiplex ligation-dependent probe amplification analysis or next-generation sequencing

      PreviouslyPublished: possible since Birtel is an author on this paper and the probands both have the same second variant as in PMID: 29555955

      Variant: allele 1: c.3468C>G p.(Tyr1156*) allele 2: c.5059A>T p.(Ile1687Phe)

      ClinVar: n/a

      CAID: CA341290648

      SupplementalData: The supplemental table linked here contains genotype and phenotype information.

    1. Creon. Why did you try to bury your brother?Antigone. I owed it to him. -Creon. I had forbidden it.Antigone. I owed it to him. Those who are not buriedwander eternally and find no rest. If my br~ther "".erealive, and he came home weary after a long day s huntmg,I should kneel down and unlace his boots, I should fetchhim food and drink, I should see that his bed was readyfor him. Polynices is home from the hunt. I owe it to himto unlock the house of the dead in which my father andmv mother are waiting to welcome him. Polynices hasearned his rest.Creon. Polynices was a rebel and a traitor, and youknow it.Antigone. He was my brother.Creon. You heard my edict. It was proclaimed through-out Thebes. You read my edict. It was posted up on thecitv walls.Antigone. Of course I did.Creon. You knew the punishment I decreed for anyperson who attempted to give him ~)Urial.Antigone. Yes, I knew the pumshment. _Creon. Did you by any chance act on the a~sm?pbonthat a daughter of Oedipus, a daughter of Oedipus stub-born pride, was above the law? .Antigone. No, I did not act on that assumption. _Creon. Because if you had acted on that assumpt10n,Antigone, you would have been deeply wrong. Nobodyhas a more sacred obligation to obey the law than thosewho make the law. You are a daughter of lawmakers, adaughter of kings, Antigone. You must ~bserve t~e law

      I thinks this means no matter what Creon thinks her brother did Antigone still sees him as her brother and believes he deserves to be buried. She knows Creon made a law against burying him but she feels that its her responsibility to her family is more important than following the law. This is important to me because it shows how someone can stand for what they believe in is right even when they know they could be punish for it .Antigone is not saying that she does not understand the law she know exactly what Creon ordered but she choose to follow what she believes is right