Henry VIII’s dissolution enforcer stashed Catholic manuscript – its lost pages have just been rediscovered

University of Cambridge

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Dr Katie Walter and Dr James Wade in The Keep archive, Brighton, with the fragment of Nicholas Love’s early 15th-century Mirror of the Blessed Life of Jesus Christ.

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Credit: Courtesy of the University of Sussex

 

Sir John Gage, a key figure in Henry VIII’s dissolution of the monasteries, saved a dangerous Catholic book from likely destruction, a new study suggests. The identification of six lost pages of a medieval bestseller – illicitly prized by Catholics in the Reformation – as belonging to Gage, exposes the split loyalties of one of Tudor England’s great survivors.

 

Fans of Hilary Mantel’s Wolf Hall trilogy will recall John Gage appearing as a religious conservative and yet dependable enforcer for Henry VIII, as Constable of the Tower and Privy Counsellor. But new research suggests a bold act of subterfuge by Gage, in which he shielded a treasured Catholic text from the very destruction the king ordered him to enforce.

Archival sleuthing by researchers from the Universities of Sussex and Cambridge has reunited six fragile pages in The Keep archive, Brighton (UK) with a manuscript held 3,500 miles away at Yale University in the US: Nicholas Love’s early 15th-century Mirror of the Blessed Life of Jesus Christ.

Dr Katie Walter from the University of Sussex; and Dr James Wade, from Girton College, Cambridge overcame a cataloguing puzzle which had frustrated scholars for nearly a century, leaving the fragment ‘hiding in plain sight’. Their study is published today in the journal Notes and Queries.

A trail of clues left by various archivists and scholars eventually led Wade and Walter to a digitised manuscript known as ‘Takamiya MS 20’ held by the Beinecke Library at Yale University. Scrolling through it, they found the gap where The Keep pages belonged – just before a controversial passage on the importance of oral confession to a priest – and matched the scribe’s handwriting, and the content of the missing passage to prove the connection. On the final page of the Yale manuscript, among a list of names of likely owners, including those of two religious women, is the signature of John Gage.

Dr Katie Walter says: “The fact two possible owners before Gage were religious women suggests the manuscript might have been in a monastic house before it came into his possession. The dissolution of the monasteries led to the destruction of many books but others were taken and then circulated through informal networks. Considering Gage’s active role in the dissolution, it’s very possible he acquired the book during this chaos.”

Dr James Wade says: “One possibility is that John Gage went to a monastic library and brought it home. Another is that someone else smuggled it out, and it briefly circulated from hand to hand until Gage acquired it. The key thing is – he kept it safe when he was meant to destroy books precisely like this one.”

 

Love’s precious / deadly words

 

Nicholas Love’s Mirror of the Blessed Life of Jesus Christ went from being an approved, orthodox bestseller in the early 15th century to a ‘risk to life’ book in the English Reformation a century later.

Love completed his English translation and adaptation of an earlier Latin text around 1409, at a moment of intense anxiety about the rise and spread of heretical beliefs. The Lollards, a proto-Protestant religious movement, were boldly arguing people should have access to the Bible in English and challenging the role of the Pope and of priests. In 1401, an act was passed to suppress heresy, condemning seditious heretics, including the Lollards, to punishments that could include death by burning. 

“In the early 15th century, having bible translations in English could get you killed,” Katie Walter says. “Nicholas Love’s translation offered a safe alternative. It was considered orthodox and circulated with the seal of approval of Archbishop Arundel, the outspoken opponent of the Lollards.”

In the Reformation, however, some of Love’s words became toxic. Most problematically, he appended a treatise arguing for the real presence of the blood and body of Jesus in the sacrament. He also included passages about oral confession to a priest as well as other orthodox Catholic sacraments – all of which became hotly debated in Henry VIII’s reign and in the tumultuous years of Reformation and counter-Reformation which followed.

James Wade says: “65 copies of Love’s text survive today. That’s a lot for a 15th-century manuscript but so many could have been destroyed in the Reformation.  It shows how popular it was, but it also shows how a work that became suspicious and dangerous for some could also be valued and preserved by others.”

 

Who was John Gage (1479 – 1556)?

 

When the dissolution of the monasteries began in 1536, Sir John Gage was gaining influence at Henry VIII’s court. He was already vice-chamberlain of the royal household and was on the right side of Henry’s rising star: Thomas Cromwell.

Having already proven himself an effective administrator, Gage was tasked with organising the dissolution in Surrey, Kent, and Sussex. This involved taking stock of everything owned by monastic houses and working out how to dispose of those assets for the Crown.

As part of this role, Gage legitimately acquired items including the Battle Abbey sword, a treasure made for the Abbot in the early 15th century. Gage’s house, Firle Place, was even built with stones removed from the nearby Lewes Priory following its surrender to the Crown in 1537.

“Gage had a very long career in a highly turbulent court,” says James Wade. “He survived when many other very shrewd people did not. And he made a fortune in the process. But he's also this incredibly conflicted man, because he remained a Catholic throughout the Reformation. He’s got all this power and bureaucratic savvy combined with a risky conviction in his faith. Somehow he manages to reconcile these two things, and survive.”

Katie Walter says: “We often associate this period with book burning and destruction, so this manuscript’s story goes a bit against that grain. It reminds us that people were also rescuing, valuing and caring for books.”

William Caxton brought out a print edition of Nicholas Love's Mirror in 1486 and it stayed in print until publication abruptly halted at the start of the Reformation, after which point Catholics played an important role in safeguarding its contents for the future. “By keeping this book on his shelf, John Gage and his family were part of a much bigger secret effort to preserve Catholic literature and knowledge”, Katie Walter says.

James Wade says: “It makes us think about the integrity that underlies subterfuge. There was a lot at stake for John Gage to perform tasks at court, but then secretly preserve the very thing that he's meant to destroy.”

The researchers hope their findings will open up new opportunities to trace John Gage’s perilous steps through the dissolution and Reformation.

 

Notes to editors

 

A brief chronology

John’s Gage’s copy of Nicholas Love’s Mirror stays in the Gage family in Sussex until the 20th century. At some point between Gage’s acquisition and the manuscript’s re-binding in the nineteenth century, 6 pages, now known as ‘The Keep fragment’, become detached. In 1929, the family deposits 46 boxes of documents on loan with the Sussex Archaeological Society. One of these boxes contains the fragment but it is omitted from the box’s contents list. In 1982, the box is transferred to the East Sussex Record Office before moving to its current location in The Keep in 2013.

Meanwhile, in 1976, a collector in Tokyo, Japan, Professor Toshiyuki Takamiya, purchases the manuscript at a Christie’s sale of properties belonging to John Gage’s descendant, Viscount Gage of Firle. Then in 2017, it is transferred to the Beinecke Library at Yale University, where it remains.

 

References

 

K. Walter & J. Wade, Nicholas Love’s ‘Mirror of the Blessed Life of Jesus Christ: A missing fragment from Takamiya MS 20 in the holdings of The Keep’, Notes and Queries (2026). DOI: 10.1093/notesj/gjag103

 

‘Archive of the Gage Family of Firle, Viscounts Gage’, The Keep Catalogue.

 

Nicholas Love, Mirour of the Blessed Lyf of Jesu Christ (Takamiya MS 20). General Collection, Beinecke Rare Book and Manuscript Library, Yale University.

 

Media contacts

 

Tom Almeroth-Williams, Communications Manager (Research), University of Cambridge: tom.williams@admin.cam.ac.uk / tel: +44 (0) 7540 139 444

 

Dr Katie Walter, University of Sussex: K.L.Walter@sussex.ac.uk

 

Dr James Wade, Girton College, University of Cambridge: jpw49@cam.ac.uk

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Journal

Notes and Queries

DOI

10.1093/notesj/gjag103

Subject of Research

People

Article Title

Mirror of the Blessed Life of Jesus Christ: A missing fragment from Takamiya MS 20 in the holdings of The Keep

Article Publication Date

17-Sep-2026

Portrait (unattributed) of Sir John Gage.

First page of The Keep fragment of Nicholas Love’s early 15th-century Mirror of the Blessed Life of Jesus Christ. It shows the beginning of Chapter 34, on the Raising of Lazarus.

Pages 8-9 of The Keep fragment of Nicholas Love’s early 15th-century Mirror of the Blessed Life of Jesus Christ, from Chapter 34, on the Raising of Lazarus. Image shows the manuscript's thread binding.

Credit

Courtesy of The Trustees of the Firle Estate Settlement and the University of Sussex

New study sheds light on dementia among Indigenous Bolivians

The Tsimané and Mosetén communities, who live pre-industrial lifestyles in the Bolivian Amazon, experience modest rates of new dementia cases but shorter survival after diagnosis compared to other populations

University of Southern California

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Tsimane Health and Life History Project investigators interview a participant in Bolivia.

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Credit: USC Professor Margaret Gatz

In two Indigenous communities living pre-industrial lifestyles in the Bolivian Amazon, dementia is remarkably uncommon. However, a new longitudinal study reveals why earlier estimates told only part of the story.

Among the Tsimané and Mosetén communities, dementia incidence, or the rate of new cases, didn’t dramatically differ from rates in U.S. and northern European populations, especially for individuals under 80 years old. Shorter survival after dementia develops appears to play a significant role in why dementia prevalence – the total proportion of people living with the disease at a given time – in the Tsimané and Mosetén populations is unusually low.

“The surprising finding was that there weren’t big differences in dementia incidence,” said lead author Margaret Gatz, a professor of psychology and gerontology at USC and a senior scientist at the USC Center for Economic and Social Research. “That challenges us to identify the risk factors for developing dementia in the Tsimané population.”

Prevalence versus incidence

The study, published in Alzheimer's & Dementia: The Journal of the Alzheimer's Association, followed 730 adults who did not have dementia at their initial assessment and were revisited nearly five years later. Researchers identified 22 new dementia cases, an overall incidence of 7.40 cases per 1,000 person-years. At the follow-up assessments, dementia prevalence – the proportion of people living with the condition at a given time – remained below 2%.

Incidence counts new diagnoses within a given span of time, while prevalence includes everyone living with a disease, regardless of when it began. Because prevalence depends on how often a disease develops and how long people survive with it, repeated assessments revealed what a one-time snapshot could not.

Among the Tsimané and Mosetén communities, participants with dementia faced more than six times the mortality risk of those with normal cognition. Compared with U.S. studies, survival time following a dementia diagnosis appeared two to three times shorter on average.

The researchers point to the realities of life in remote communities, where families depend on members contributing to farming, hunting, fishing and food preparation. Previous research by the Tsimané Health and Life History Project (THLHP) found that the Tsimané and Mosetén experienced less brain atrophy and better cardiovascular health compared to industrialized populations in the U.S. and Europe, which at the time the authors hypothesized could be due in part to large amounts of physical activity and healthier food due to the groups’ subsistence lifestyle.

However, Gatz noted that disabilities may reduce a person’s ability to help obtain food while increasing pressure on the household. Limited medical care can also make treatable infections and other acute illnesses more deadly.

While the authors caution that 22 cases are too few to fully discern all of the factors behind low prevalence, the findings add rare incidence data to dementia research among Indigenous peoples. Some Indigenous communities report high dementia prevalence following disruptive integration into dominant societies and greater exposure to chronic disease risks. By contrast, several Indigenous and rural populations retaining subsistence lifestyles report low prevalence. The difference points to an important health-equity challenge, Gatz said.

Additional clues from biomarkers

The dementia observed in the Bolivian communities may also differ from prototypical Alzheimer’s disease. Many affected participants showed more difficulty with attention, reasoning and managing tasks than with memory, the hallmark challenge in Alzheimer’s.

Preliminary blood analyses found associations between the dementia cases and the amount of neurofilament light chain proteins in blood – a general indicator of neurodegeneration – but not with amyloid or phosphorylated tau protein profiles characteristic of Alzheimer’s. Imaging and vascular measures suggested contributions from blood-vessel disease.

“In most Tsimané with cognitive impairment or dementia, the pattern of atrophy in the brain is not typical of Alzheimer’s disease,” Gatz said. “Rather, there are changes indicative of vascular contributions to cognitive impairment and dementia.”

The APOE e4 gene variant, the best-known genetic risk factor for Alzheimer’s, was associated with dementia in the study. However, Gatz noted that APOE4 also affects lipid transport and immune response, so the association doesn’t necessarily establish Alzheimer’s pathology.

“We need far more data before we can address the balance between lifestyle and genetic factors,” she said. “Generally, it is believed that the two have complementary roles.”

Researchers adapted clinical interviews and cognitive tests for language, culture and limited literacy, conducting assessments in Tsimané or Spanish. The THLHP teams also provide medical exams and help coordinate care. Future phases will use improved brain imaging and additional blood biomarkers to investigate vascular injury and Alzheimer’s pathology.

“The research is both immensely challenging and highly rewarding,” Gatz said. “We are grateful for their participation and try to assure that the research is helpful to them.”

These latest findings not only provide more information on how dementia affects the Tsimané and Mosetén communities but also raise new questions about the factors contributing to dementia risk, said Professor Hillard Kaplan, a health economist at Chapman University and THLHP principal investigator.

“While healthy hearts are generally associated with healthy brains, these new findings indicate that brain aging occurs without significant heart disease and that there is much more to be learned about the pathways leading to dementia,” he said.

About the study

Gatz’s and Kaplan’s coauthors include Wendy Mack, Helena Chui, Caleb Finch and Ellen Walters of USC; Daniel Eid Rodriguez of Universidad Mayor de San Simon (Bolivia); Raul Quispe Gutierrez and Jesus Bani Cuata of the Tsimane Health and Life History Project (Bolivia); Daniel K. Cummings of Chapman University; Paul L. Hooper of the University of New Mexico; Henrik Zetterberg of University of Wisconsin–Madison; Benjamin C. Trumble of Arizona State University; Jonathan Stieglitz of Université Toulouse Capitole (France); Michael D. Gurven of UC Santa Barbara; Randall C. Thompson of University of Missouri–Kansas City and Gregory S. Thomas of UC Irvine. The research was supported by the National Institute on Aging, the National Science Foundation and the French National Research Agency.

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DOI

10.1002/alz.71750

Method of Research

Observational study

Subject of Research

People

Article Title

Incidence of dementia and mild cognitive impairment in two Indigenous Bolivian cohorts

Article Publication Date

15-Sep-2026

 

Bacteria in airway shape air pollution health risk

Wellcome Trust Sanger Institute

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Air pollution leads to different risk of bacterial pneumonia, sepsis, and meningitis, depending on the subtype of bacteria a person has, new research suggests.

The new study comes from the Wellcome Sanger Institute, the National Institute for Communicable Diseases in Johannesburg, South Africa, the Barcelona Supercomputing Center – Centro Nacional de Supercomputación (BSC-CNS), and collaborators. The team suggests that the subtype of the bacterium, Streptococcus pneumoniae (S. pneumoniae), together with air pollution exposure impacts the rate and timing of invasive disease — with some strains linked to immediate infection after air pollution exposure, and some taking several weeks.

Published today (14 September) in Nature Microbiology, the researchers also found that older adults and young children are more vulnerable during periods of high air pollution, and that improving air quality could lower disease risk. They also suggest that understanding what type of bacterial strains are circulating and how environmental factors shape infection rates could inform future public health policies, protect those most at risk, and prepare hospitals for outbreaks.  

S. pneumoniae is found in the respiratory microbiome, the collection of microbes that live in the human nose and throat, in almost 20 per cent of adults globally1. While many adults and children carry the bacteria without any symptoms, when S. pneumoniae gets into the lower respiratory tract, or blood stream, it can lead to invasive pneumococcal disease (IPD)2.

IPD includes bacterial sepsis, pneumonia and meningitis. It is a major cause of disease and death globally and often peaks during colder months2. In South Africa, there were over 1,800 reported cases of IPD in 20223. In England, the UK Health Security Agency reports that there are more than 5,000 cases per year, particularly impacting children under the age of five, people over 65 years old, and those with underlying conditions2. There are currently over 100 different serotypes, which are specific subtypes of S. pneumoniae4.

While it is known that different subtypes of S. pneumoniae can lead to varying infection rates in different populations, important gaps remain in our collective understanding of how things such as humidity, temperature, and air pollution impact the timing of disease, and how risks vary by individual age and bacterial subtype.

This new study examined around 59,000 cases of IPD across 19 years from South Africa’s national GERMS-SA surveillance programme.  In South Africa, between 40-60 per cent of children carry S. pneumoniae,5,6.

The researchers found that different subtypes of S. pneumoniae responded differently to higher air pollution exposure, noting three subtypes (14, 19A, and 8) were linked to the greatest risk of IPD following exposure.  

Additionally, they found that different subtypes were linked to differences in the timing of disease risk. While the highest risk of IPD peaked roughly two weeks after air pollution exposure, in areas where subtypes 4, 8, 23F, and 19F were common, there was an immediate increase in disease risk, occurring within the same week.

Importantly, the team accounted for other factors including temperature, humidity, and population density to ensure that the effects were measured as accurately as possible. They also noted that high temperatures were associated with an immediate increase in disease risk, and cold temperatures led to a delayed rise in cases. The team suggests that cold weather slows bacterial transmission or that damage from seasonal viruses could make it easier for bacterial infections to follow.  

The authors suggest that integrating environmental monitoring with genomic surveillance of S. pneumoniae could help predict infection spikes, inform vaccination strategies, and support healthcare providers prepare during periods of poor air quality. The study also provides further evidence that reducing air pollution may yield important benefits for infectious disease prevention, particularly in areas with high levels of exposure, such as cities.

Professor Anne von Gottberg, co-senior author at the National Institute for Communicable Diseases in Johannesburg, South Africa, said: “Invasive pneumococcal diseases are a significant public health issue in South Africa and globally. This research adds to the ongoing evidence that air quality greatly impacts our health and shows that it has different effects depending on the strain of bacteria that is found in an area. We need to focus on monitoring and improving air quality in areas with high disease risk to prevent or reduce some of these infections.”

Professor Rachel Lowe, co-senior author at the Barcelona Supercomputing Center and the Catalan Institution for Research & Advanced Studies, said: “Climate change and rapid urbanisation are fundamentally altering the environmental conditions that influence risk of infectious disease. By linking long-term climate and air quality monitoring with health outcomes, this work highlights how shifting environmental patterns can amplify public health risks. Protecting communities most at risk will require cross-sector collaboration and adaptive health strategies that can keep pace with a changing environment.” 

Dr Sophie Belman, first author previously at the Wellcome Sanger Institute, and Barcelona Supercomputing Center, currently Assistant Professor at Yale School of Public Health, said: “While we found that temperature and air pollution generally increase the risk of invasive pneumococcal diseases, such as bacterial meningitis, our research also suggests that it is the bacterial subtypes a person is carrying that modulate infection rates. The strain of bacteria impacts the timing of disease and who might be more at risk depending on their respiratory microbiome, meaning that the risk is not the same in every situation or for every person. By extending our findings to other parts of the globe, we will better understand who has the highest health risk from environmental exposures, and what factors need to be addressed in different regions, such as improving air quality in cities."

ENDS

Contact details:

Rachael Smith

Press Office

Wellcome Sanger Institute

Cambridge, CB10 1SA

07827979492

Email: press.office@sanger.ac.uk

Notes to Editors:

1. D. Rosdiana, AM. Simanjuntak, NC. Ediwi, et al. (2025) Prevalence of Streptococcus pneumoniae carriage among adults: Should we raise a concern? A systematic review and meta-analysis with geospatial analysis. Exploration of Medicine. DOI:  10.37349/emed.2025.1001354
2. Pneumococcal disease: guidance, data and analysis. UK Health Security Agency. Available at: https://www.gov.uk/government/collections/pneumococcal-disease-guidance-data-and-analysis [Accessed August 2026]
3. C. Lekhuleni, K. Ndlangisa, R.A. Gladstone, et al.(2024) Impact of pneumococcal conjugate vaccines on invasive pneumococcal disease-causing lineages among South African children. Nature Communications. DOI: 10.1038/s41467-024-52459-3
4. F. Ganaie, et al. (2020) A New Pneumococcal Capsule Type, 10D, is the 100th Serotype and Has a Large cps Fragment from an Oral Streptococcus. mBio. DOI: 10.1128/mbio.00937-20
5. F. S. Dube, et al. (2018) Longitudinal characterization of nasopharyngeal colonization with Streptococcus pneumoniae in a South African birth cohort post 13-valent pneumococcal conjugate vaccine implementation. Scientific Reports. DOI: 10.1038/s41598-018-30345-5
6. S.L. Downs, et al. (2023) Streptococcus pneumoniae and other bacterial nasopharyngeal colonization seven years post-introduction of 13-valent pneumococcal conjugate vaccine in South African children. International Journal of Infectious Diseases. DOI: 10.1016/j.ijid.2023.05.016

Publication:

S. Belman, C. Lekhuleni, J. Kleynhans, et al. (2026) ‘Pneumococcal population structure influences the effects of air pollution on invasive disease risk in South Africa’. Nature Microbiology. DOI: 10.1038/s41564-026-02458-5

Funding:

Sophie Belman conducted this research as part of her Schmidt Science Fellowship at Barcelona Supercomputing Center (BSC). Surveillance for IPD in South Africa is funded by the National Institute for Communicable Diseases (NICD), a division of the National Health Laboratory Service, Johannesburg, South Africa. This research was supported in part by the Fogarty International Center, the Gates Foundation, Wellcome, and the Department of Health and Social Care. A full acknowledgement list can be found in the publication.  

Selected websites:

The Wellcome Sanger Institute

The Wellcome Sanger Institute is a world leader in genomics research. We apply and explore genomic technologies at scale to advance understanding of biology and improve health. Making discoveries not easily made elsewhere, our research delivers insights across health, disease, evolution and pathogen biology. We are open and collaborative; our data, results, tools, technologies and training are freely shared across the globe to advance science.

Funded by Wellcome, we have the freedom to think long-term and push the boundaries of genomics. We take on the challenges of applying our research to the real world, where we aim to bring benefit to people and society.

Find out more at www.sanger.ac.uk or follow us on Bluesky, X, Instagram, Facebook, LinkedIn and on our Blog.

About Wellcome

Wellcome supports science to solve the urgent health challenges facing everyone. We support discovery research into life, health and wellbeing, and we’re taking on three worldwide health challenges: mental health, infectious disease and climate and health. https://wellcome.org/

National Institute for Communicable Diseases

The National Institute for Communicable Diseases (NICD) is South Africa’s leading public health institute responsible for disease surveillance, outbreak response, reference laboratory services, and public health research. GERMS-SA is its national laboratory-based surveillance programme that monitors invasive bacterial diseases, including invasive pneumococcal disease across South Africa. More information: https://www.nicd.ac.za

Barcelona Supercomputing Center
Barcelona Supercomputing Center (BSC) is one of the leading supercomputing centers in Europe and houses one of the most powerful supercomputers in the world, MareNostrum 5. The center specializes in High Performance Computing (HPC) and artificial intelligence (AI), serving a dual purpose: providing supercomputing infrastructure and services to Spanish and European scientists, and generating knowledge and technology to transfer to society.

BSC’s research focuses on the fields of computer science, life sciences, Earth sciences, computer applications in science and engineering, and computational social sciences and humanities.

Within BSC’s Earth Sciences Department, the Global Health Resilience (GHR) group works to strengthen preparedness for and response to emerging climate-sensitive health threats worldwide. GHR develops approaches to anticipate how climate extremes, environmental degradation and social inequalities interact to shape disease risk across regions and populations. More information: https://www.bsc.es/discover-bsc/organisation/research-departments/global-health-resilience 

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Journal

Nature Microbiology

DOI

10.1038/s41564-026-02458-5

Article Title

Pneumococcal population structure influences the effects of air pollution on invasive disease risk in South Africa

Article Publication Date

14-Sep-2026

Sleep app tracks link between air pollution and a bad night’s sleep

University of Cambridge

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Has your partner ever woken you up at night with their coughing? Has your coughing ever woken them up? New research suggests it could be due to air pollution levels in your area, even if those levels are low.

Researchers from the University of Cambridge, Tsinghua University and the sleep technology company Sleep Cycle analysed coughing sounds from 32 cities in 12 countries over 500 days, and found that higher daily air pollution levels were strongly linked to nighttime coughing levels, even where local pollution levels were below the World Health Organization’s recommended daily exposure limit.

The researchers used cough sounds passively recorded by the mobile app via the phone’s microphone. Cough sounds were counted on individual devices and pooled by city to build an unprecedented dataset of this kind. The researchers accounted for external factors that could lead to an increase in coughing levels, such as weather conditions or influenza levels.

Analysis of the data, which was anonymised, also found that when pollution levels rose by 10 micrograms of particulate matter per metre cubed, there was a 2.4% rise in coughing levels.

In Los Angeles, one of the cities included in the dataset, coughing levels spiked at the same time as the January 2025 wildfires, acting as a quasi-natural experiment that further supported the short-term association between daytime pollution and nighttime coughing. The results are reported in the journal Communications Health.

Air pollution is a leading environmental risk for human health, leading to an estimated seven million premature deaths per year. Among airborne pollutants, tiny particles of less than 2.5 micrometres (PM2.5) are particularly dangerous, as they can penetrate deep into the lungs and into the bloodstream, potentially leading to inflammation throughout the body, heart disease or respiratory conditions such as asthma or chronic obstructive pulmonary disease (COPD).

“Everyone coughs from time to time, but coughing, whether it’s a one-off or more persistent, is a sign of irritation or inflammation in the lungs,” said lead author Dr Tong Xia from Tsinghua University. “A cough could be a sign of something that hasn’t become chronic yet, but might in future.”

Sleep Cycle is a mobile app that uses sounds – such as breathing, snoring or coughing – to track sleep quality. These sounds are recorded locally and analysed by an AI algorithm. The company’s technology has analysed more than four billion sleep sessions, making it a useful complement to traditional public health surveillance and epidemiological research.

“The dataset from Sleep Cycle is really valuable, because the app is widely used worldwide,” said Professor Cecilia Mascolo from Cambridge’s Department of Computer Science and Technology, who led the research. “Most public health studies only have data from one country, so having a dataset of this size gives it much more power.”

“Every night, Sleep Cycle’s technology turns millions of smartphones into precise sound analysis instruments,” said co-author Dr Mikael Kågebäck from Sleep Cycle. “Coughs are detected and counted directly on each user’s device, so no audio ever leaves the phone. The combination of scale and privacy lets researchers see the health effects of air pollution city by city, night by night, at a scale no sleep lab could match.”

The dataset – which included no personal identifiers – contained information on cough sounds from tens of thousands of users over 18 months. The researchers used data from the 32 cities worldwide where usage rates of the app were highest. The cities were from 12 countries: Australia, Brazil, Chile, China, France, Germany, Italy, Japan, South Africa, Sweden, the United Kingdom and the United States.

The researchers linked the cough data with city-level PM2.5 concentrations, meteorological variables and influenza surveillance data over a period of 18 months. Analysis of the data, even when accounting for the annual flu season when cough rates would normally be higher, showed a strong link between daytime pollution levels and nighttime cough frequency.

“I was surprised we could still see the signal at all,” said Tong, who was formerly a PhD student in Mascolo’s group. “I thought that adding in the confounding factor of flu season would make the link in the data disappear, but it didn’t.”

The link between pollution and coughing persisted in the data, even when pollution levels were below the WHO’s recommended safe daily exposure limit.

“This suggests that there may be no such thing as a safe threshold for exposure to air pollution, although our research is purely observational,” said Mascolo. “However, people may wish to consider how they might mitigate their own exposure to air pollution, by using masks or air filters, for example.”

The research was supported by the European Research Council, the Tsinghua University Vanke School of Public Health Fund, and the Engineering and Physical Sciences Research Council (EPSRC), part of UK Research and Innovation (UKRI). Cecilia Mascolo is a Fellow of Jesus College, Cambridge.

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DOI

10.1038/s44528-026-00030-5

Article Title

Short-term associations between air pollutions and nocturnal cough frequency

Article Publication Date

15-Sep-2026