Month: December 2022

Extended Chemotherapy Slashes Childhood Leukaemia Recurrence

Photo by National Cancer Institute on Unsplash

Giving three years of chemotherapy to children with acute lymphoblastic leukaemia (ALL) instead of two years lowers the risk of their disease coming back after treatment by three times. The survival rate of all children with ALL, the most common form of childhood cancer, together has further increased to 94%. Less intensive therapy proved safe for three groups of children, resulting in a better quality of life. These findings on a large Dutch study into ALL were reported at the annual conference of the American Society of Hematology (ASH).

Many children with ALL have good outcomes. After two years of chemotherapy treatment, nine out of ten children are cured. But some children have a more aggressive disease, such as having the Ikaros mutation in their leukaemia cells, have a greater risk of recurrence after treatment. In order to improve the chances of survival and quality of life of all children with leukaemia, the treatment protocol has been continuously adapted over the years, based on the latest scientific insights.

Prof Rob Pieters, medical director and paediatric oncologist at the Princess Máxima Center for paediatric oncology in the Netherlands, presented the outcomes of the ALL-11 treatment protocol. The Dutch researchers tested the benefit of an adapted treatment in specific groups of children with leukaemia, including children with the Ikaros mutation. More than 800 children in the Netherlands were treated with this protocol between April 2012 and July 2020.

Threefold lower risk of recurrence

Children with Ikaros leukaemia received an extra year of chemotherapy in the ‘maintenance phase’ on top of the first two years of treatment. This change lowered the risk of their cancer coming back by threefold: this happened in only 9% of them, compared to 26% of the children in the previous treatment protocol.

87% of children with Ikaros leukaemia survived their disease for five years without their cancer coming back, an improvement on the 72% in the previous protocol. Because of the extra year of chemotherapy, this group of children had a slightly higher risk of infection, but these were treatable. The extended therapy did not lead to any additional side effects.

Analysis of data from all children with ALL, regardless of subtype, showed that the five-year survival rate has improved stepwise over the past 30 years from 80% to 94% under the ALL-11 protocol.

Safe reduction of treatment

In the ALL-11 protocol, doctors and researchers also looked at the benefit of a less intensive treatment plan for three groups of children. This included children with a leukaemia mutation linked to a very high chance of recovery, and children with Down syndrome who experience more severe side effects. These children received treatment without or with a lower dose of anthracyclines, a type of leukaemia drug that increases the risk of heart damage and infections. The reduced treatment proved successful: children had the same or even a better chance of survival, while their quality of life improved due to a lower risk of infections and damage to the heart.

Global interest

Globally, there is much interest in the Dutch research as it has been unclear how to improve therapy for children with Ikaros leukaemia. The results have now been presented for the first time at the largest blood cancer conference, and could lead to changes in treatment protocols for these children worldwide.

In the Netherlands, there are about 15 children with ALL each year for whom existing treatments stop working. Since 2019, they have been eligible for treatment with CAR T-cell therapy, a promising form of immunotherapy that now leads to a cure in 40% of these children.

Making a difference

Prof Monique den Boer, medical biologist and group leader at the Princess Máxima Center, played an important role in the adapted therapy for children with the Ikaros gene change. She says: ‘The Ikaros mutation was first discovered about 15 years ago in children with leukaemia who had a poor prognosis, partly thanks to the emergence of new DNA technologies. We saw that the cancer came back in many of these children shortly after the end of the two-year treatment plan. I am very proud that our lab findings have now found their way into the clinic and can make such a big difference for children with leukaemia.”

More cure with fewer side effects

Prof Pieters concludes: The five-year survival rate for children with acute lymphoblastic leukaemia has increased enormously since the 1960s, from zero to 94%, but the last steps are the most difficult. We are now one step closer to curing all children with ALL. We have also largely been able to remove a drug that poses a risk of heart damage from the treatment of children with a less aggressive form of the disease. The latest results for children with leukaemia therefore fit in perfectly with our mission: curing more children with cancer, with fewer side effects.”

Source: Princess Máxima Center

In-depth: ‘Access not Excess’ Key to Reducing Antibiotic Resistance in SA

By Tiyese Jeranji

Source: Danilo Alvesd on Unsplash

Antibiotics play a vital role in the management of bacterial infections, reducing morbidity, and preventing mortality. A 2011 report from the United Kingdom estimated that they have increased life expectancy by 20 years. However, the extensive use of antibiotics has resulted in drug resistance that threatens to reverse their life-saving power and if the situation is not reversed, it has been estimated that by 2050, 10 million people will die annually of drug-resistant infections.

Such estimates of future deaths are obviously uncertain, but there is strong evidence the problem is already very serious. A major study published earlier this year in the Lancet estimated that globally around 1.27 million deaths in 2019 were directly due to antibiotic resistance. The study identified sub-Saharan Africa as the hardest-hit region.

What is AMR?

Sham Moodley, a community pharmacist from Durban and the vice chairperson of the Independent Community Pharmacy Association (ICPA) explains that antimicrobial resistance (AMR) is the ability of microorganisms (bacteria, viruses, fungi, and protozoa) to withstand treatment with antimicrobial drugs. “It is vitally important as it directly impacts our ability to treat and cure common infectious diseases, including pneumonia, urinary tract infections, gonorrhoea and tuberculosis,” he says.

According to Professor Olga Perovic, Principal Pathologist at the National Institute of Communicable Diseases’ Centre for Healthcare-associated Infections, Antimicrobial Resistance and Mycoses (CHARM), there are six factors fuelling the AMR crisis. These are over-prescribing and dispensing of antibiotics by health workers, patients not finishing their full treatment course of antibiotics, poor infection control in hospitals and clinics, lack of hygiene and poor sanitisation in the community, lack of new antibiotics being developed, and the overuse of antibiotics in livestock and fish farming.

Under overuse, she stresses the misuse of antibiotics to treat upper respiratory tract infections, which are typically viral rather than bacterial. Antibiotics are powerless against viruses. Another driver of inappropriate or overprescribing of antibiotics, she says, may be the lack of testing of specimens for the presence of bacteria and their susceptibility to treatment.

How can we prevent AMR?

Dr Marc Mendelson, Professor of Infectious Diseases and Head of the Division of Infectious Diseases and HIV Medicine at Groote Schuur Hospital, the University of Cape Town as well as chairperson of the Ministerial Advisory Committee on Antimicrobial Resistance, says reducing the use of antibiotics is about preventing the need for prescription in the first place. (Mendelson’s recent SAMJ article provides excellent further reading on AMR in South Africa.)

“So, reducing the burden of infections through the provision of clean water and safe sanitation (reduces diarrhoeal diseases) and vaccination programmes (reduces diarrhoea and pneumonia for instance),” he says. “Education and awareness raising of the public and (sadly) healthcare professionals as to the correct use of antibiotics is also critical.”

Broadly speaking, all the experts we interviewed agreed that we should use far fewer antibiotics and only use them when they are absolutely necessary. But actually making this happen is surprisingly complex.

Part of the complexity, for example, is that resistance profiles and disease profiles are different in different places. Geraldine Turner, a pharmacist at Knysna Hospital in the Western Cape, says there is a need for guidelines tailored to the South African context or linked to the local epidemiology. This, she says, can play an important role in determining the correct antibiotics to be used.

It is also not just an issue of what antibiotics are prescribed for humans.

“A big driver of antimicrobial resistance is overuse in agriculture and collaboration with stakeholders in this regard is required,” says Turner. She says we need policies that facilitate improved integration among environmental, animal, and human sector interventions.

Moodley agrees that a multidisciplinary, One Health approach is needed at every level of care and in both human and animal health sectors.

“It is important we reinforce the principle that antimicrobial medicines for human use are only supplied on the authority of a healthcare professional and that antimicrobial medicines for either human or animal use are only supplied in accordance with country legislation and regulations,” he says.

The role of stewardship programmes

One response to the AMR crisis is antimicrobial stewardship programmes or ASPs. Moodley describes ASPs as a systematic approach used “to optimise appropriate use of all antimicrobials to improve patient outcome and limit the emergence of resistant pathogens whilst ensuring patient safety.”

Perovic says, “In healthcare institutions, resistant bacteria can spread easily within and from patient to patient. That is why there are guidelines, which we call ASPs in the medical and veterinary fields, on how and when antibiotics are prescribed as well as how to implement infection prevention and control measures, particularly for patients with health risks such as diabetes, high blood pressure, and cancer.”

“In hospitals,” explains Mendelson, “ASPs will consist of a governance body such as an AS Committee that directs a work programme of stewardship, often with AS teams as the implementers of policy. AS teams can involve anything from single pharmacists or physicians, through one to two dedicated individuals, through to all-singing all-dancing multi-disciplinary teams in academic teaching hospitals, comprising infectious diseases specialists, microbiologists, pharmacists, [and] infection prevention and control nurses.”

ASPs are not only important at institutional levels, adds Moodley, but imperative for every individual prescriber/practitioner to implement to reduce AMR in our population.

Critical role for pharmacists

Mendelson stresses that pharmacists are integral to antibiotic stewardship in South Africa and globally. “Community pharmacists give advice to patients seeking symptomatic relief and reduce doctors’ visits, which can result in antibiotic prescriptions when not needed,” he says. In hospitals, dispensing pharmacists help optimise the antibiotics prescribed to patients by checking indication for the antibiotic, dose, dosing frequency, and duration. “Some hospitals have pharmacists on the wards, again, checking and helping to optimise the use of antibiotics,” he says.

“Pharmacists play an important role in recommending symptomatic treatments for non-specific symptoms and particularly, the common cold, which is a major cause of inappropriate antibiotic prescribing, requiring simple paracetamol with or without decongestants. Unfortunately, a recent pilot study suggests that a small number of community pharmacies are dispensing antibiotics without a prescription, which is not allowed in South Africa,” says Mendelson.

Turner concurs that pharmacists play a crucial role in ensuring that the correct antibiotics are used appropriately and only if indicated. She says pharmacists are also in a good position to counsel and advise patients on the correct use of antibiotics.

Strategy framework

The key policy document setting out South Africa’s response to AMR is the South Africa Antimicrobial Resistance Strategy Framework of 2018-2024. The framework outlines nine strategic objectives – they include improving the appropriate use of diagnostic investigations to identify pathogens, guiding patient and animal management and ensuring good quality laboratory, enhancing infection prevention and control, promoting appropriate use of antimicrobials in humans and animals as well as legislative and policy reform for health systems strengthening.

Mendelson is positive about what has been achieved so far. “There have been major improvements to the surveillance and reporting of antibiotic resistance and antibiotic use in humans and animals, development of a greater one health (human, animal, and environmental health) response. There was a formation of national training centres for antibiotic stewardship and empowerment of under-resourced provinces to train and develop Antimicrobial Stewardship programmes and there have been improvements in governance and delivery of infection prevention and control measures in hospitals and development of education programmes for healthcare workers in South Africa,” he says.

But Mendelson also says that challenges remain in promoting prescribing behaviour change amongst the health workforce in SA and the expectations and social position that antibiotics hold in society.

As with several other health policies, there are questions on whether the plan has been backed up with funding.

“The national strategic framework remains largely unfunded (shared by most low- and middle-income countries) but this does hamper progress in developing programmes of interventions,” says Mendelson. “In food production, reducing [the] use of antibiotics is an important goal but will require investment in reducing drivers of infection in the animals that produce food. Legislation to bring all antibiotic prescribing in food production under veterinarian control will be an important intervention,” says Mendelson.

Source: Spotlight

Antibody Discovery Suggests a Possible New Vaccine for Strep A

Streptococcus pyrogenese bound to human neutrophil
Streptococcus pyogenese bound to a human neutrophil. Credit: National Institute of Allergy and Infectious Diseases, National Institutes of Health

Researchers at Lund University in Sweden have discovered an antibody that could potentially protect against Strep A infection, as well as a rare form of antibody binding, that leads to an effective immune response against bacteria. The discovery could explain why so many Group A strep vaccines have failed.

The results are published in EMBO Molecular Medicine.

Group A streptococci have several ways in which they evade the body’s immune system and, when they infect us, can cause both common throat infections (strep throat), scarlet fever, sepsis, swine pox and skin infections. So far, antibiotics work against these bacteria, but should they become resistant, they will pose a major public health threat.

One strategy that the scientific community uses to find new ways of fighting bacterial infections is to create target-seeking antibodies. First, the antibodies that the body’s immune system produces in the event of an infection are mapped, and then their effect on the immune system is studied. In this way, antibodies can be identified that can be used both for preventive treatment and for treatment during an ongoing infection. It is a difficult process, though, with many attempts to develop antibody-based treatments against Strep A ending in failure.

The current study shows an unexpected way that antibodies interact with group A streptococci and, more specifically, how they hook onto the probably most important bacterial protein, the M protein, on the cell surface.

“We found that it happens in a way that has never been described before. Normally, an antibody binds via one of its two Y arms to its target protein at a single site, regardless of which of the two arms is used for binding. But what we have seen- and this is vital information – is that the two Y arms can recognise and hook on to two different places on the same target protein,” explains study author Pontus Nordenfelt.

This means that the two arms of the antibody – which are identical – can bind to two different sites on a target protein. It turns out that it is precisely this type of binding that is required for effective protection, and since it is probably rare, the researchers believe, it could explain why so many vaccine attempts have been unsuccessful. It could also be a reason why the bacteria manage to escape the immune system.

It has long been known that the streptococcal bacteria’s M protein is of great importance for how disease occurs and develops in the body. Finding an antibody that attaches to this protein, thereby flagging it up to the immune system, can prevent the bacteria from infecting the body’s cells. Since we know that the human body can fight the infection, such antibodies exist, but it is hard to locate them.

The researchers therefore focused on examining antibodies in patients who had recovered from group A streptococcal infection. They managed to identify three so-called monoclonal antibodies from a patient who recovered from a Strep A infection. Monoclonal antibodies are identical copies of each other, and in this case target a single protein (the M protein) of the group A streptococci. The researchers then investigated in animal studies whether it is possible to use the antibodies to strengthen the immune system in its fight against group A streptococcus. It turned out that the antibody with the newly discovered binding mechanism produced a strong immune response against the bacteria. The researchers have now applied for a patent based on the findings in the article, and will continue to study the antibody.

“This opens up possibilities where previous vaccine attempts have failed and means that the monoclonal antibody we used has the potential to protect against infection,” concludes study author Wael Bahnan.

Source: Lund University

Online Anger Management Therapy can be Effective

Photo by Yogendra Singh on Unsplash

Problems with managing anger can have severe consequences for the afflicted individual and their loved ones. A new study from Karolinska Institutet shows a four-week therapy course delivered over the internet can help people to deal with their anger and aggression. The results have been published in the Journal of Consulting and Clinical Psychology.

The study, which the researchers have chosen to call the “anger study”, is the first to compare different internet-mediated emotion regulation strategies against anger. The results are expected to be important for understanding emotion regulation and for the dissemination of evidence-based methods.

Easy to recruit participants

“It is usually very difficult to recruit participants for treatment studies. For the anger study, however, it was very easy, and we had to close the recruitment site after a few weeks due to the high number of applicants. This suggests that there is a pent-up need for the psychological treatment of anger. Many people who have problems with anger feel ashamed, and we think the internet format suits this group particularly well because they don’t have to wait in a reception room or sit face-to-face with a therapist and talk about their anger,” says lead researcher Johan Bjureberg, assistant professor at Karolinska Institutet.

The anger study evaluated the effect of two emotion regulation strategies: mindful emotion awareness; and cognitive reappraisal. Mindful emotion awareness focuses on the ability to notice and accept one’s feelings and thoughts without judging or acting on them. Cognitive reappraisal, on the other hand, focuses on the ability to reinterpret thoughts and situations and identify alternative thoughts that do not trigger difficult feelings.

The 234 participants, all with significant anger problems, were randomly assigned to four weeks of either mindful emotion awareness, cognitive reappraisal, or a combination of these two strategies. All treatments were of approximately the same length and were associated with decreased self-reported anger and aggressiveness at the end of the treatment.

Combination therapy most effective

The combined treatment resulted in significantly lower levels of outward anger expression, aggression, and anger rumination, but not anger suppression, compared to mindful emotion awareness or cognitive reappraisal alone. The combination was particularly effective for participants who were experiencing very high levels of anger at the start of the study. The results strengthen research and theories suggesting that difficulties in regulating emotions and interpreting events and situations can be a major contributing factor to problems in managing anger.

“Our results suggest that a very short treatment of only four weeks administered over the internet with minimal therapist support is effective in reducing anger problems. Our hope is that follow-up studies support this finding and that the treatment can be offered broadly within regular care,” explains Johan Bjureberg.

Source: Karolinska Institutet

Pregnant Women Over 4 Times as Likely to Use Cannabis if it is Legal

Photo by Thought Catalog on Unsplash

US scientists conducting a nationwide study found that pregnant women living in states where cannabis is legally available are far more likely to use the substance, prompting a call for pregnant women to be screened for the drug.

Published in The American Journal of Drug and Alcohol Abuse, the findings show that pregnant women were around 4.6 times more likely to report using cannabis in states where it is legal for medical and recreational purposes, compared to where only CBD oil is allowed.

A large proportion of women reported using the drug for medical purposes, which is in keeping with “a growing body of evidence” that suggests in order to alleviate pregnancy symptoms cannabis is being used as a substitute for medical drugs in legalised areas.

“Therefore it is increasingly important to evaluate the risk-benefit profile of cannabis as compared to other medical treatments to understand any potential therapeutic indications for cannabis use in pregnancy,” says lead author Kathak Vachhani.

The team is calling for prenatal and primary care providers to screen and counsel patients regarding cannabis use in pregnancy, particularly in states where it is legal, for the potential effects on foetal development.

They also state public messaging “around the risks” of cannabis in pregnancy is “particularly relevant now,” as many states have recently implemented cannabis laws and established cannabis markets.

The legalisation of cannabis products has increased exponentially in the last decade in the United States. The legalisation has been piecemeal, as some states allow CBD oil, or marijuana for medical or recreational purposes. Use of these products has risen among all demographics.

Among the least studied are pregnant women. Because cannabis has been known to be used to treat some symptoms associated with pregnancy—notably nausea and vomiting.

Here, the team used data from the Behavioral Risk Factor Surveillance System compiled by the Centers for Disease Control and Prevention (CDC) between 2017 to 2020 to analyse the consumption of cannabis by 1,992 pregnant women.

While previous studies have examined the use of cannabis by pregnant women in restricted geographic areas and under particular legislative parameters, this study used a broader dataset to compare use across legalisation frameworks in 27 states.

Self-reported use was found to be “significantly higher” in pregnant women residing in states that allow medical and adult use, compared to those residing in states with restricted use.

“The unweighted dataset consisted of 426 CBD-only, 1114 medical, and 394 reactional group respondents,” the authors wrote claim. Weights were applied to each datapoint to obtain the population they represented. Of this weighted data, 2.4% from CBD-only regions reported cannabis use, while 7.1% from medical regions and 6.9% from adult-use regions reported the same. Respondents from the medical and recreational areas were 4.5 and 4.7 times more likely to use cannabis than those in CBD-only areas.

Most respondents who reported cannabis use smoked it partially or mostly for recreational purposes. “Mode of intake and reason for consumption did not differ between state groups,” the authors observe.

But what impact is this having on the mother or the foetus?

Previous studies have shown that medical cannabis usage during pregnancy can be effective for nausea and vomiting. Medical cannabis may be suitable to treat pregnancy-specific conditions which, if untreated, could be more harmful to the foetus than cannabis.

However, safe usage depends on having a comprehensive understanding of the benefits and risks of cannabis when weighed against the risks of untreated or refractory conditions such as hyperemesis gravidarum.

Therefore, more research is needed, states Vachhani, who is also from the University of Toronto Temerty Faculty of Medicine.

“Cannabis is a complex substance and its use is further complicated by factors such as the form of intake and frequency of use.

“From the mother’s health standpoint, our current understanding is rudimentary regarding the complex interplay between use (whether CBD or THC-based) and long-term health outcomes for the mother.

“There is currently no accepted therapeutic indication or safe amount of cannabis that may be consumed during pregnancy.

“Although further studies may lead to an accepted therapeutic indication, based on the current consensus the positive association between cannabis use and legalisation found in our study warrants further inquiry.”

The analysis carried out here was limited by a relatively small sample size, a lack of information regarding timing of use in pregnancy, lack of information about the chemical composition of cannabis consumed, and the potential for self-reporting biases.

Source: Taylor & Francis

Why do Humans Catch Diseases from Rodents?

Photo by Kanasi on Unsplash

A need to better understand zoonotic transmission was highlighted by the COVID pandemic. In a global study published in Nature Communications, researchers have identified that most reservoirs of rodent-borne diseases tend to live exclusively or occasionally in or near human dwellings, show large fluctuations in their numbers, and/or are hunted for meat or fur.

Rodents’ ‘fast life’ with sexual maturity at early age, many litters per year and numerous young per litter is an important explanation why rodents are important reservoirs for pathogens. But why do humans get infected by rodent-borne pathogens?

“Most rodents that spread zoonotic pathogens, meaning pathogens spreading between animals and humans, show large population fluctuations, move at least occasionally indoors, or are hunted for meat or fur. Our results were consistent among pathogen types ie, virus, bacteria, fungi, and parasites. And with transmission modes, ie, intermediate, involvement of vectors or non-close and close contact, with close contact including inhalation of contaminated aerosols,” says Frauke Ecke, project leader and Professor at University of Helsinki, Finland and senior lecturer at Swedish University of Agricultural Sciences (SLU).

Global study on 436 rodent species

In the study, researchers from SLU, University of Helsinki and Cary Institute of Ecosystem Studies, USA, performed a global quantitative study based on data collected from research papers and databases. The study includes 436 rodent species of which 282 are all known reservoirs of zoonotic pathogens. The researchers studied the linkage among the rodents’ choice of environment, variation in numbers i.e., population fluctuations, humans’ hunting of rodents, and the status of rodents as reservoirs.

“It is remarkable how consistent the results are among continents, disease systems and rodent species,” says Rick Ostfeld, co-leader of the study.

Greater risk of rodent zoonotic transmission in some parts of the world

In addition, the researchers have identified regions where transmission risk between rodents and humans is high. Large parts of Europe, especially central and northern Europe, a wide stretch extending from eastern Europe to eastern Asia, eastern China, parts of South America, south-east Australia, and eastern regions in North America are at high risk.

“If people encounter a rodent in these regions, there is a high risk that this rodent carries zoonotic pathogens,” says Ecke.

Examples of such pathogen carrying rodents include the bank vole in Europe, the North American deer mouse, and Azara’s Grass Mouse in South America. These species show large population fluctuations and can also move indoors.

“It is especially the large population fluctuations together with the disturbance of the rodents’ natural habitat that can explain why rodents move nearby and into human dwellings. This movement behaviour is typical for so-called generalists, which are species that can cope with many different environments. These generalists are the most important reservoirs of pathogens,” explains Ecke.

Source: University of Helsinki

Study Identifies Risk Factors for CVD among Young Cancer Survivors

Source: Pixabay CC0

Adolescent and young adult (AYA) cancer survivors are at risk of experiencing treatment-related effects later in life, including cardiac damage. New research published in in CANCER has identified a number of sociodemographic and modifiable risk factors linked to these patients’ risk of developing cardiovascular disease (CVD).

The study by investigators at Duke University and The University of Texas MD Anderson Cancer Center relied on 2009–2018 data from the National Health Interview Survey, which collects information on a broad range of health topics through personal interviews of US households. Responses from 4766 AYA cancer survivors and 47 660 controls (without a history of cancer) were included. 

The risk of CVD was significantly higher in survivors than controls by sex, race/ethnicity, income, education, smoking status, and physical activity.

In the AYA survivor population, male sex, Black race, household income under $50 000 a year, and current or former smoking were all associated with higher odds of CVD. Household income < $50 000 a year disproportionately increased the odds of CVD in survivors compared with controls.  Performing any moderate to vigorous intensity physical activity was associated with lower CVD odds.  

“These results highlight the importance of long-term surveillance of AYAs after cancer treatment to ensure that appropriate screenings are initiated to reduce the risk of CVD and to promote healthy behavioural changes, such as physical activity, which impact long-term CVD outcomes,” said lead author Amy Berkman, MD, of the Duke University School of Medicine. 

Source: Wiley

In Some Diabetes Patients, Intermittent Fasting Induces Remission

Photo by Towfiqu Barbhuiya on Unsplash

After an intermittent fasting diet intervention, patients achieved complete diabetes remission, defined as an HbA1c level of < 6.5% at least one year after stopping diabetes medication, according to a new study published in the Journal of Clinical Endocrinology & Metabolism.

Intermittent fasting diets, which involve restricting eating to a specific window of time, have become popular in recent years as an effective weight loss method. Previous studies have shown that intermittent fasting can lower the risk of diabetes and heart disease.

“Type 2 diabetes is not necessarily a permanent, lifelong disease. Diabetes remission is possible if patients lose weight by changing their diet and exercise habits,” said Dongbo Liu, PhD, of Hunan Agricultural University in China. “Our research shows an intermittent fasting, Chinese Medical Nutrition Therapy (CMNT), can lead to diabetes remission in people with type 2 diabetes, and these findings could have a major impact on the over 537 million adults worldwide who suffer from the disease.”

The researchers conducted a 3-month intermittent fasting diet intervention among 36 people with diabetes and found almost 90% of participants, including those who took blood sugar-lowering agents and insulin, reduced their diabetes medication intake after intermittent fasting. Fifty-five percent of these people experienced diabetes remission, discontinued their diabetes medication and maintained it for at least one year.

The study challenges the conventional view that diabetes remission can only be achieved in those with a shorter diabetes duration (0–6 years). Sixty-five percent of the study participants who achieved diabetes remission had a diabetes duration of more than six years (6–11 years).

“Diabetes medications are costly and a barrier for many patients who are trying to effectively manage their diabetes. Our study saw medication costs decrease by 77% in people with diabetes after intermittent fasting,” Liu said.

Source: The Endocrine Society

Longevity Treatments Fail to Turn Back the Clock

In a new study published in the journal Nature Communications, researchers have taken a close look at three treatment approaches that have been widely believed to slow the ageing process. However, when tested in mice, these treatments proved largely ineffective in their supposed impact on ageing.

“There is no internal clock of ageing that you can regulate with a simple switch – at least not in the form of the treatments studied here,” concludes Dr Dan Ehninger of the German Centre for Neurodegenerative Diseases (DZNE), the initiator of the study. The team has developed a new analytical approach to make influences on ageing processes measurable.

“We chose three regulators for our interventions that many experts believe slow down aging,” explains Prof Martin Hrab de Angelis, who also drove the project with his team. One of them is intermittent fasting, in which the calories consumed are reduced. Number two targets a central node of cell metabolism (mTOR), which is also the target of the supposed “anti-ageing drug” rapamycin. Number three, in turn, interferes with the release of growth hormone. Similar treatments are also used by humans, although their efficacy with regard to ageing has not been sufficiently proven.

For the assessment in mice, the scientists developed a new answer to the question of how to measure ageing. “Many researchers in recent decades have used lifespan as an indirect measure of ageing,” explains Dan Ehninger, who is a senior scientist at DZNE. So, for example, how old do mice get – and how can that lifespan be extended? “It is often assumed that if they just live longer, they will also age more slowly. But the problem is that mice, like many other organisms, do not die from general old age, but from very specific diseases,” says Ehninger. For example, up to 90 percent of mice die from tumors that form in their bodies at an advanced age. “So, if you were to look at the whole genome for factors that make mice become long-lived, you would like find many genes that suppress tumor development – and not necessarily genes that play a general role in aging.”

For their study, the scientists therefore chose an approach that does not emphasize lifespan, but rather focused on a comprehensive investigation of age-related changes in a wide range of bodily functions. “You can think of it as a complete health status survey,” says Martin Hrab de Angelis: “The health check results in a compendium of hundreds of factors covering many areas of physiology” – an exact description of the state of the animal at the moment of examination. That’s exactly the approach the researchers applied to the animals subjected to one of the three treatment approaches that supposedly slow ageing. Across different life stages, they were analysed and compared: How much does each parameter typically change at a given stage of life? And, do parameters change more slowly when the mice are given one of the three treatments? This study design makes it possible to determine precisely whether the natural aging process can be slowed, and with it the deterioration of important physiological functions.

The results were unambiguous: Although the researchers were able to identify individual cases in which old mice looked younger than they actually were, it was clear that “this effect was not due to slowing down aging, but rather due to age-independent factors,” says Dan Ehninger. “The fact that a treatment already has its effect in young mice – prior to the appearance of age-dependent change in health measures – proves that these are compensatory, general health-promoting effects, not a targeting of aging mechanisms.”

The DZNE and Helmholtz Diabetes Center teams have now set their sights on the next goal: They want to investigate other treatment approaches that experts believe can slow aging. The researchers hope that the new research method will provide a more comprehensive picture of possible treatment approaches and their effectiveness.

Source: DZNE – German Center for Neurodegenerative Diseases

Looking Back at 2022: Pandemic Fades but Other Challenges Remain

Photo by Joshua Hoehne on Unsplash

The year 2022 finally saw the COVID pandemic petering out, largely through the less-lethal but still highly contagious Omicron variant. Significant strides were made in cancer and Alzheimer’s research, although not without controversy. Amid growing public healthcare challenges in South Africa, the NHI Bill advanced closer to reality.

As Omicron displayed greatly reduced severity compared to prior strains, South African medical experts were some of the first to justify no longer being at ‘code red’. This brought an end to the cycles of lockdowns and travel restrictions characterised by the two previous years.

It even saw the lifting of some aspects of China’s ultra-strict ‘zero-COVID’ policy, with citizens paying online tribute to the memory of the heroic doctor who defied government censorship to warn the world. However, the pandemic’s true cost became apparent as the World Health Organization put global excess deaths for the pandemic at almost 15 million.

A number of key medical advances were made during the year for a variety of conditions. Studies showed that administering steroids after COVID hospitalisation with severe inflammation reduced mortality up to one year post-infection.

COVID was found to be linked to a spate of new-onset Type 1 diabetes, but this may just have been due to medical checkups as a result of developing COVID. The rheumatoid arthritis drug auranofin was found to relieve diabetes symptoms. And research suggested a possible way to deliver insulin and cancer drugs orally, by adding a ‘tag’ that lets them enter the bloodstream through the intestines.

The fields of cancer and Alzheimer’s research was rocked by findings of numerous red flags. This controversy did not stop real progress: the first new drug that had any real effectiveness against Alzheimer’s disease was confirmed in a historic trial. Fortunately, the flu jab also seems to protect against developing the disease. Indeed, serious infections appear to increase the risk of both Alzheimer’s and Parkinson’s.

In advanced ER-positive, HER-2 negative breast cancers, the new drug capivasertib halved the rate of progression.

It was also revealed that humans are paying through the nose for common medications compared to those that animals receive. Antimicrobial resistance also remains a growing problem, causing an estimated 1.2 million deaths in 2019.

A major South African Medical Research Council (SMARC) study told a familiar story: unsafe sex, interpersonal violence, obesity, hypertension, and alcohol consumption are the top risk factors for disease and death in South Africa.

Despite lessons learned in the COVID pandemic, South Africa saw the progression of systemic problems in healthcare such as a critical shortage of nurses. Dr Tim de Maayer’s open letter on appalling conditions at Rahima Moosa exposed deep-seated problems in Gauteng’s public healthcare system. This was followed by the shock resignation of top cancer surgeon Professor Carol-Ann Benn. The appointment of Nomantu Nkomo-Ralehoko as Gauteng Health MEC should hopefully change the province’s situation.

As for the National Health Insurance (NHI) Bill, medical aids have aimed to reposition themselves in the new uncertain paradigm while the threat of a mass exodus of healthcare professionals from the country still hangs in the air. A slew of legal challenges now await the Bill, which still has no details on how it will be financed.