Immunothrombosis and vascular heterogeneity in cerebral cavernous malformation.

Cerebral cavernous malformation (CCM) is a neurovascular disease that results in various neurological symptoms. Thrombi have been reported in surgically resected CCM patient biopsies, but the molecular signatures of these thrombi remain elusive. Here, we investigated the kinetics of thrombi formation in CCM and how thrombi affect the vasculature and contribute to cerebral hypoxia. We used RNA sequencing to investigate the transcriptome of mouse brain endothelial cells with an inducible endothelial-specific Ccm3 knock-out (Ccm3-iECKO). We found that Ccm3-deficient brain endothelial cells had a higher expression of genes related to the coagulation cascade and hypoxia when compared with wild-type brain endothelial cells. Immunofluorescent assays identified key molecular signatures of thrombi such as fibrin, von Willebrand factor, and activated platelets in Ccm3-iECKO mice and human CCM biopsies. Notably, we identified polyhedrocytes in Ccm3-iECKO mice and human CCM biopsies and report it for the first time. We also found that the parenchyma surrounding CCM lesions is hypoxic and that more thrombi correlate with higher levels of hypoxia. We created an in vitro model to study CCM pathology and found that human brain endothelial cells deficient for CCM3 expressed elevated levels of plasminogen activator inhibitor-1 and had a redistribution of von Willebrand factor. With transcriptomics, comprehensive imaging, and an in vitro CCM preclinical model, this study provides experimental evidence that genes and proteins related to the coagulation cascade affect the brain vasculature and promote neurological side effects such as hypoxia in CCMs. This study supports the concept that antithrombotic therapy may be beneficial for patients with CCM.

Paladin is a phosphoinositide phosphatase regulating endosomal VEGFR2 signalling and angiogenesis.

Cell signalling governs cellular behaviour and is therefore subject to tight spatiotemporal regulation. Signalling output is modulated by specialized cell membranes and vesicles which contain unique combinations of lipids and proteins. The phosphatidylinositol 4,5-bisphosphate (PI(4,5)P2 ), an important component of the plasma membrane as well as other subcellular membranes, is involved in multiple processes, including signalling. However, which enzymes control the turnover of non-plasma membrane PI(4,5)P2 , and their impact on cell signalling and function at the organismal level are unknown. Here, we identify Paladin as a vascular PI(4,5)P2 phosphatase regulating VEGFR2 endosomal signalling and angiogenesis. Paladin is localized to endosomal and Golgi compartments and interacts with vascular endothelial growth factor receptor 2 (VEGFR2) in vitro and in vivo. Loss of Paladin results in increased internalization of VEGFR2, over-activation of extracellular regulated kinase 1/2, and hypersprouting of endothelial cells in the developing retina of mice. These findings suggest that inhibition of Paladin, or other endosomal PI(4,5)P2 phosphatases, could be exploited to modulate VEGFR2 signalling and angiogenesis, when direct and full inhibition of the receptor is undesirable.

Production of mixed element actinide reference particulates to support nuclear safeguards using THESEUS, an aerosol-based particulate synthetic methodology.

The THermally Evaporated Spray for Engineered Uniform particulateS (THESEUS) production platform was developed to generate highly uniform mixed actinide oxide particles. The particulate synthesis platform builds on previous efforts and utilizes an aerosol-based technology to generate, calcine, characterize, and aggregate a monodisperse oxide phase particle product. In this study, particles comprised of uranium oxide, incorporated with varying compositions of thorium, were produced. Th/U test materials with 232Th concentrations between 1 ppm and 10%, ratioed to 238U, were successfully generated with in situ calcination at 600 °C and characterized by in situ aerodynamic particle size spectrometry and ex situ microanalytical methods. Populations of monodisperse particulates (geometric standard deviation - GSD < 1.15) with an average diameter near 1 µm were generatated and micro-Raman spectroscopy of individual particles identified U3O8 as the primary material phase for the range of Th/U samples analyzed. Single particle measurements and automated particle analyses by secondary ion mass spectrometry (SIMS) were performed. Uniform inter-particle elemental and isotopic homogeneity for uranium and thorium isotopes was characterized by SIMS, and a 232Th/238U relative sensitivity factor of 0.53 was determined. SIMS results demonstrated differences in the 232Th/238U profiling behavior for Th/U particulates with increased Th content (>1%). Despite the observed profiling behavior, single particle measurements of the 10% Th sample indicate inter-particle homogeneity. This work represents the first systematic study of Th/U microparticulate reference materials generated and intended for nuclear safeguards applications and serves as a demonstration of THESEUS to support a sustained capability for the production mixed-element particulate reference materials.

Inflammation and neutrophil extracellular traps in cerebral cavernous malformation.

Cerebral Cavernous Malformation (CCM) is a brain vascular disease with various neurological symptoms. In this study, we describe the inflammatory profile in CCM and show for the first time the formation of neutrophil extracellular traps (NETs) in rodents and humans with CCM. Through RNA-seq analysis of cerebellum endothelial cells from wild-type mice and mice with an endothelial cell-specific ablation of the Ccm3 gene (Ccm3iECKO), we show that endothelial cells from Ccm3iECKO mice have an increased expression of inflammation-related genes. These genes encode proinflammatory cytokines and chemokines, as well as adhesion molecules, which promote recruitment of inflammatory and immune cells. Similarly, immunoassays showed elevated levels of these cytokines and chemokines in the cerebellum of the Ccm3iECKO mice. Consistently, both flow cytometry and immunofluorescence analysis showed infiltration of different subsets of leukocytes into the CCM lesions. Neutrophils, which are known to fight against infection through different strategies, including the formation of NETs, represented the leukocyte subset within the most pronounced increase in CCM. Here, we detected elevated levels of NETs in the blood and the deposition of NETs in the cerebral cavernomas of Ccm3iECKO mice. Degradation of NETs by DNase I treatment improved the vascular barrier. The deposition of NETs in the cavernomas  of patients with CCM confirms the clinical relevance of NETs in CCM.

Palmdelphin Regulates Nuclear Resilience to Mechanical Stress in the Endothelium.

BACKGROUND: PALMD (palmdelphin) belongs to the family of paralemmin proteins implicated in cytoskeletal regulation. Single nucleotide polymorphisms in the PALMD locus that result in reduced expression are strong risk factors for development of calcific aortic valve stenosis and predict severity of the disease. METHODS: Immunodetection and public database screening showed dominant expression of PALMD in endothelial cells (ECs) in brain and cardiovascular tissues including aortic valves. Mass spectrometry, coimmunoprecipitation, and immunofluorescent staining allowed identification of PALMD partners. The consequence of loss of PALMD expression was assessed in small interferring RNA-treated EC cultures, knockout mice, and human valve samples. RNA sequencing of ECs and transcript arrays on valve samples from an aortic valve study cohort including patients with the single nucleotide polymorphism rs7543130 informed about gene regulatory changes. RESULTS: ECs express the cytosolic PALMD-KKVI splice variant, which associated with RANGAP1 (RAN GTP hydrolyase activating protein 1). RANGAP1 regulates the activity of the GTPase RAN and thereby nucleocytoplasmic shuttling via XPO1 (Exportin1). Reduced PALMD expression resulted in subcellular relocalization of RANGAP1 and XPO1, and nuclear arrest of the XPO1 cargoes p53 and p21. This indicates an important role for PALMD in nucleocytoplasmic transport and consequently in gene regulation because of the effect on localization of transcriptional regulators. Changes in EC responsiveness on loss of PALMD expression included failure to form a perinuclear actin cap when exposed to flow, indicating lack of protection against mechanical stress. Loss of the actin cap correlated with misalignment of the nuclear long axis relative to the cell body, observed in PALMD-deficient ECs, Palmd-/- mouse aorta, and human aortic valve samples derived from patients with calcific aortic valve stenosis. In agreement with these changes in EC behavior, gene ontology analysis showed enrichment of nuclear- and cytoskeleton-related terms in PALMD-silenced ECs. CONCLUSIONS: We identify RANGAP1 as a PALMD partner in ECs. Disrupting the PALMD/RANGAP1 complex alters the subcellular localization of RANGAP1 and XPO1, and leads to nuclear arrest of the XPO1 cargoes p53 and p21, accompanied by gene regulatory changes and loss of actin-dependent nuclear resilience. Combined, these consequences of reduced PALMD expression provide a mechanistic underpinning for PALMD's contribution to calcific aortic valve stenosis pathology.

Liquid Processing of Interfacially Grown Iron-Oxide Flowers into 2D-Platelets Yields Lithium-Ion Battery Anodes with Capacities of Twice the Theoretical Value.

Iron oxide (Fe2 O3 ) is an abundant and potentially low-cost material for fabricating lithium-ion battery anodes. Here, the growth of α-Fe2 O3 nano-flowers at an electrified liquid-liquid interface is demonstrated. Sonication is used to convert these flowers into quasi-2D platelets with lateral sizes in the range of hundreds of nanometers and thicknesses in the range of tens of nanometers. These nanoplatelets can be combined with carbon nanotubes to form porous, conductive composites which can be used as electrodes in lithium-ion batteries. Using a standard activation process, these anodes display good cycling stability, reasonable rate performance and low-rate capacities approaching 1500 mAh g-1 , consistent with the current state-of-the-art for Fe2 O3 . However, by using an extended activation process, it is found that the morphology of these composites can be significantly changed, rendering the iron oxide amorphous and significantly increasing the porosity and internal surface area. These morphological changes yield anodes with very good cycling stability and low-rate capacity exceeding 2000 mAh g-1 , which is competitive with the best anode materials in the literature. However, the data implies that, after activation, the iron oxide displays a reduced solid-state lithium-ion diffusion coefficient resulting in somewhat degraded rate performance.

Flexor digitorum brevis utilizes elastic strain energy to contribute to both work generation and energy absorption at the foot.

The central nervous system utilizes tendon compliance of the intrinsic foot muscles to aid the foot's arch spring, storing and returning energy in its tendinous tissues. Recently, the intrinsic foot muscles have been shown to adapt their energetic contributions during a variety of locomotor tasks to fulfil centre of mass work demands. However, the mechanism by which the small intrinsic foot muscles are able to make versatile energetic contributions remains unknown. Therefore, we examined the muscle-tendon dynamics of the flexor digitorum brevis during stepping, jumping and landing tasks to see whether the central nervous system regulates muscle activation magnitude and timing to enable energy storage and return to enhance energetic contributions. In step-ups and jumps, energy was stored in the tendinous tissue during arch compression; during arch recoil, the fascicles shortened at a slower rate than the tendinous tissues while the foot generated energy. In step-downs and landings, the tendinous tissues elongated more and at greater rates than the fascicles during arch compression while the foot absorbed energy. These results indicate that the central nervous system utilizes arch compression to store elastic energy in the tendinous tissues of the intrinsic foot muscles to add or remove mechanical energy when the body accelerates or decelerates. This study provides evidence for an adaptive mechanism to enable the foot's energetic versatility and further indicates the value of tendon compliance in distal lower limb muscle-tendon units in locomotion.

Dysregulated Hemostasis and Immunothrombosis in Cerebral Cavernous Malformations.

Cerebral cavernous malformation (CCM) is a neurovascular disease that affects 0.5% of the general population. For a long time, CCM research focused on genetic mutations, endothelial junctions and proliferation, but recently, transcriptome and proteome studies have revealed that the hemostatic system and neuroinflammation play a crucial role in the development and severity of cavernomas, with some of these publications coming from our group. The aim of this review is to give an overview of the latest molecular insights into the interaction between CCM-deficient endothelial cells with blood components and the neurovascular unit. Specifically, we underscore how endothelial dysfunction can result in dysregulated hemostasis, bleeding, hypoxia and neurological symptoms. We conducted a thorough review of the literature and found a field that is increasingly poised to regard CCM as a hemostatic disease, which may have implications for therapy.

Propranolol Reduces the Development of Lesions and Rescues Barrier Function in Cerebral Cavernous Malformations: A Preclinical Study.

[Figure: see text].

The energetic function of the human foot and its muscles during accelerations and decelerations.

The human foot is known to aid propulsion by storing and returning elastic energy during steady-state locomotion. While its function during other tasks is less clear, recent evidence suggests the foot and its intrinsic muscles can also generate or dissipate energy based on the energetic requirements of the center of mass during non-steady-state locomotion. In order to examine contributions of the foot and its muscles to non-steady-state locomotion, we compared the energetics of the foot and ankle joint while jumping and landing before and after the application of a tibial nerve block. Under normal conditions, energetic contributions of the foot rose as work demands increased, while the relative contributions of the foot to center of mass work remained constant with increasing work demands. Under the nerve block, foot contributions to both jumping and landing decreased. Additionally, ankle contributions were also decreased under the influence of the block for both tasks. Our results reinforce findings that foot and ankle function mirror the energetic requirements of the center of mass and provide novel evidence that foot contributions remain relatively constant under increasing energetic demands. Also, while the intrinsic muscles can modulate the energetic capacity of the foot, their removal accounted for only a 3% decrement in total center of mass work. Therefore, the small size of intrinsic muscles appears to limit their capacity to contribute to center of mass work. However, their role in contributing to ankle work capacity is likely important for the energetics of movement.

Myc-dependent endothelial proliferation is controlled by phosphotyrosine 1212 in VEGF receptor-2.

Exaggerated signaling by vascular endothelial growth factor (VEGF)-A and its receptor, VEGFR2, in pathologies results in poor vessel function. Still, pharmacological suppression of VEGFA/VEGFR2 may aggravate disease. Delineating VEGFR2 signaling in vivo provides strategies for suppression of specific VEGFR2-induced pathways. Three VEGFR2 tyrosine residues (Y949, Y1212, and Y1173) induce downstream signaling. Here, we show that knock-in of phenylalanine to create VEGFR2 Y1212F in C57Bl/6 and FVB mouse strains leads to loss of growth factor receptor-bound protein 2- and phosphoinositide 3'-kinase (PI3K)p85 signaling. C57Bl/6 Vegfr2Y1212F/Y1212F show reduced embryonic endothelial cell (EC) proliferation and partial lethality. FVB Vegfr2Y1212F/Y1212F show reduced postnatal EC proliferation. Reduced EC proliferation in Vegfr2Y1212F/Y1212F explants is rescued by c-Myc overexpression. We conclude that VEGFR2 Y1212 signaling induces activation of extracellular-signal-regulated kinase (ERK)1/2 and Akt pathways required for c-Myc-dependent gene regulation, endothelial proliferation, and vessel stability.

Expanding medical student interaction in neurology with a redesigned student interest group in neurology (sign) chapter.

BACKGROUND: Student Interest Group in Neurology (SIGN) chapters across the medical schools in the United States provide opportunities for medical students to participate in clinical, research, and service activities in neurology. Despite these, applicants for the field of neurology have traditionally been low. METHODS: Following changes were introduced: an open board style SIGN chapter executive committee with greater active engagement of first and second year students. New activities included journal clubs, hands on workshops, celebration/cause events (example ALS walk). In addition, a free neurology clinic was introduced. Activities were planned in consultation with office of medical education, and were organized during 'down times'. Data on student enrollment, activities successfully carried out, students interested in neurology residency, number of neurology-related research projects with student involvement were collected prior to changes and compared to values after changes were introduced. RESULTS: Post intervention, student engagement in neurology activities and projects increased significantly. However, a similar increase in applications to neurology residency was not yet observed. CONCLUSIONS: An open chapter with early engagement and involvement of first and second year medical students, creating a variety of chapter activities with greater hands on involvement, planned in conjunction with office of medical education has reinvigorated our SIGN chapter.

Elongated microparticles tuned for targeting hyaluronic acid delivery to specific skin strata.

OBJECTIVE: Microneedle or fractional laser applications are the most common topical delivery enhancement platforms. However, these methods of drug delivery are not skin strata specific. Drug delivery approaches which could target specific stratum of the skin remains a challenge. Elongated microparticles (EMPs) have been used in enhancing drug delivery into the skin. The aim of this study was to evaluate, for the first time, elongated silica microparticles with two different length profiles to enhance delivery of hyaluronic acid into different strata of human skin. METHODS: Two types of EMPs-long (milled EMPs) or short (etched EMPs) length ranges were characterized. A prototypical liquid formulation (Fluorescent hyaluronic acid) with and without EMP enhancement were evaluated for hyaluronic acid delivery in ex-vivo human skin. High performance liquid chromatography, Typhoon fluorescence scanning system, laser scanning confocal microscopy and reflectance confocal microscopy (RCM) were used to validate F-HA stability, visualize fluorescein in the skin, image the depth of F-HA delivery in the skin and define EMP penetration in skin strata, respectively. Statistical analysis was conducted using GraphPad Prism 6 software (GraphPad Software Inc, USA). RESULTS: Fluorescein-hyaluronic acid was stable and EMP enhanced skin penetration. RCM revealed that 'etched EMP' penetrated the skin to the stratum spinosum level. The vast majority (97.8%; p < 0.001) of the etched EMP did not penetrate completely through the viable epidermis and no obvious penetration into the dermis. In contrast, milled EMP showed 41-fold increase in penetration compared to the etched EMP but penetrated beyond the dermoepidermal junction. CONCLUSION: EMPs can enhance delivery of hyaluronic acid. Using EMPs with defined length distributions, which can be tuned for a specific stratum of the skin, can achieve targeted hyaluronic acid delivery.

OBJECTIF: Les microaiguilles ou le laser fractionné sont couramment utilisés pour augmenter l'absorption d'actif appliqué par voie topique. Toutefois, ces approches ne permettent de cibler une strate spécifique de la peau. Ainsi les méthodes permettant de cibler spécifiquement l'épiderme reste un défi. Les microparticules allongées (EMP) ont déjà été utilisé pour augmenter l'absorption cutanée. L'objectif de l'étude est d'évaluer pour la première fois, la capacité de microparticules allongées de silice (de deux longueurs différentes) à délivrer l'acide hyaluronique dans les différentes couches de la peau. MÉTHODES: Deux types d'EMP, longues (EMP broyé) ou courtes (EMP gravé), ont été caractérisées. Une formulation liquide contenant de l'acide hyaluronique marquée avec une sonde fluorescente (F-HA) a été évaluée avec et sans EMP sur peau humaine ex vivo. La chromatographie liquide haute performance, le scanner à fluorescence Typhoon, la microscopie laser confocal à balayage et la microscopie confocale par réflectance (RCM) ont été utilisées respectivement pour contrôler la stabilité de la F-HA, visualiser le signal de la fluorescéine dans la peau, imager l'absorption du F-HA dans la peau en fonction de la profondeur et caractériser la pénétration des EMP. Les analyses statistiques ont été réalisées avec le logiciel GraphPad Prims 6 (GraphPad Software Inc, USA). RÉSULTATS: L'acide hyaluronique marquée avec la fluorescéine est stable et les EMP permettent d'augmenter son absorption cutanée. Le RCM a montré que les EMP gravées pénètrent dans la peau jusqu'au niveau du stratum spinosum. La grande majorité des EMP gravés (97.8% ; p < 0,001) ne pénètre pas complétement dans l'épiderme viable et aucune pénétration mesurable dans le derme. Au contraire, les EMP broyées ont montrées une pénétration 41 fois plus importantes que les EMP gravées et peuvent aller au-delà de la jonction derme-épiderme. CONCLUSION: Les EMP peuvent augmenter l'absorption cutanée de l'acide hyaluronique. En utilisant des EMP de longueur définie et en ajustant celle-ci, il est même possible de cibler spécifiquement une strate cutanée.

Mixed Reality Interaction and Presentation Techniques for Medical Visualisations.

Mixed, Augmented and Virtual reality technologies are burgeoning with new applications and use cases appearing rapidly. This chapter provides a brief overview of the fundamental display presentation methods; head-worn, hand-held and projector-based displays. We present a summary of visualisation methods that employ these technologies in the medical domain with a diverse range of examples presented including diagnostic and exploration, intervention and clinical, interaction and gestures, and education.

Footwear and Sex Differences in Performance and Joint Kinetics During Maximal Vertical Jumping.

Smith, RE, Paquette, MR, Harry, JR, Powell, DW, and Weiss, LW. Footwear and sex differences in performance and joint kinetics during maximal vertical jumping. J Strength Cond Res 34(6): 1634-1642, 2020-This investigation examined the effects of footwear and sex on vertical jump displacement and joint power contributions. Twenty-three young adults with basketball experience performed 3 maximal countermovement vertical jumps in minimal and standard footwear. Ground reaction force and 3D kinematic data were collected during jumping. Footwear by sex analysis of variance for all dependent variables and effect sizes (d) was computed. An interaction effect showed that men produced greater lower-limb-positive work than women in standard footwear. Men jumped higher than women (d = 2.53) and produced greater peak ankle, knee and hip joint moments (d > 0.99), positive joint powers (d > 1.07) and, positive knee and hip joint work (d > 1.04) with no sex differences for negative joint powers and work (p > 0.05). Minimal footwear produced less peak-positive knee power (d = 0.27) and less positive ankle (d = 0.34) and knee (d = 0.21) joint work than standard footwear. Because negative joint power and work were similar between sexes, men may be better able to use the stretch-shortening cycle compared with women. Higher joint mechanical demands may provide a better vertical jumping training stimulus in standard compared with minimal footwear. Future studies should investigate footwear training effects on performance and joint mechanics during jumping.

SELDI-TOF MS Analysis of Hepatocellular Carcinoma in an Australian Cohort.

BACKGROUND: Hepatocellular carcinoma (HCC) is a common cause of cancer death worldwide. Resection offers the best chance of long-term survival, but a consistent adverse prognostic factor is the presence of microvascular invasion (MVI). In this study, surface-enhanced laser desorption/ionization time-of-flight mass spectrometry (SELDI-TOF MS), a high throughput method of analyzing complex samples, was used to explore differentially expressed proteins between HCC and adjacent nontumour liver tissue (ANLT). These findings were correlated with clinical outcomes. MATERIALS AND METHODS: From 2002 to 2011, tumor and ANLT were collected from patients who underwent liver resection and these samples were later prepared for SELDI-TOF MS. Output data were then used to identify proteins capable of discriminating HCC from ANLT. Proteins from the multivariate analysis were then analyzed to determine prognostic factors and the m/z ratios of these proteins were entered into the ExPASy database to infer potential candidates. RESULTS: During the study period, 30 patients had SELDI-TOF MS performed on their HCC and ANLT samples. On multivariate analysis, a panel of four proteins-m/z 5840, m/z 8921, m/z 9961, and m/z 25,872-discriminated HCC from ANLT with an area under the ROC curve of 0.954 (P < 0.001). On prognostic factor assessment, decreased m/z 9961 was significantly associated with the presence of MVI (P = 0.025) and shorter disease-free survival (P = 0.045) in our patients. A potential candidate for this protein was coxsackievirus and adenovirus receptor, isoform 3 (CAR 3/7), which helps maintain tight junction integrity. CONCLUSIONS: Using SELDI TOF-MS, we identified a panel of four proteins with excellent discriminative capacity between HCC and ANLT. Of these, m/z 9961 was the only protein significantly associated with a known poor prognostic factor (presence of MVI) and survival (shorter disease-free survival). While loss of CAR 3/7 could lead to MVI, further research is warranted to validate the identity of protein m/z 9961.

Using patient-derived xenograft models of colorectal liver metastases to predict chemosensitivity.

BACKGROUND: Few in vivo models for colorectal cancer have been demonstrated to show external validity by accurately predicting clinical patient outcomes. Patient-derived xenograft (PDX) models of cancer have characteristics that might provide a form of translational research leading to personalized cancer care. The aim of this pilot study was to assess the feasibility of using PDXs as a platform for predicting patient colorectal liver metastases responses, in this case by correlating PDX and patient tumor responses to either folinic acid, fluorouracil plus oxaliplatin or folinic acid, fluorouracil plus irinotecan-based regimens. METHODS: Sixteen patients underwent potentially curative resection of colorectal liver metastases, and tumors were grafted into NOD.CB17-Prkdcscid/Arc mice. Mice were divided into groups to determine relative tumor growth in response to treatment. Tumors were analyzed by immunohistochemistry for Ki67 and Excision repair cross-complementation group 1. RESULTS: An engraftment rate of 81% was achieved. Overall, there was a 67% positive match rate between eligible patient and PDX chemosensitivity profiles. There was a significant difference in relative decrease in Ki67 expression between sensitive/stable versus resistant PDXs for both treatment regimens. There was no statistically significant correlation between baseline ERCC1 expression and response to Oxaliplatin + 5-Fluorouracil in the PDXs. CONCLUSIONS: This pilot study supports the feasibility of using PDX models of advanced colorectal cancer in larger studies to potentially predict patient chemosensitivity profiles.

The Impact of Different Cross-Training Modalities on Performance and Injury-Related Variables in High School Cross Country Runners.

Paquette, MR, Peel, SA, Smith, RE, Temme, M, and Dwyer, JN. The impact of different cross-training modalities on performance and injury-related variables in high school cross country runners. J Strength Cond Res 32(6): 1745-1753, 2018-There are many different types of aerobic cross-training modalities currently available. It is important to consider the effects that these different modalities have on running performance and injury risks. The purpose of this study was to compare movement quality, running economy (RE) and performance, injury-related biomechanical variables, and hip muscle strength before and after training with different cross-training modalities in high school runners. Thirty-one high school male runners trained for 4 weeks in 1 of 3 cross-training modalities, in addition to a running-only (n = 9) group, for which training sessions replaced 2 easy runs per week: cycling (CYCLE; n = 6), indoor elliptical (n = 7), and outdoor elliptical bike (EBIKE; n = 9). Functional movement screen (FMS), RE, 3,000-m performance, hip kinematics, and hip muscle strength were assessed. Paired t-tests and Cohen's d effect sizes were used to assess mean differences for each variable before and after training within each group. Elliptical bike training was the only modality that improved FMS scores (d = 1.36) and RE before and after training (d = 0.48). All groups showed improvements in 3,000-m performance, but large effects were found only for the CYCLE (d = 1.50) and EBIKE (d = 1.41) groups. Running-only (d = 1.25), CYCLE (d = 1.17), and EBIKE (d = 0.82) groups showed improvements in maximal hip extensor strength. Outdoor cycling and EBIKE cross-training may be the most effective cross-training modalities to incorporate in early season training to improve running performance in high school runners.