The latest survey from the European Centre for Disease Prevention and Control (ECDC), the fourth of its kind, confirms that Candidozyma auris (formerly Candida auris) continues to spread quickly across European hospitals, posing a serious threat to patients and healthcare systems. Case numbers are rising, outbreaks are growing in scale, and several countries report ongoing local transmission. The findings highlight the importance of early detection and control of transmission to avoid widespread rapid dissemination.
Candidozyma auris (C. auris) is a fungus that usually spreads within healthcare facilities, is often resistant to antifungal drugs, and can cause severe infections in seriously ill patients. Its ability to persist on different surfaces and medical equipment and to spread between patients makes it particularly challenging to control. Between 2013 and 2023, EU/EEA countries reported over 4 000 cases, with a significant jump to 1 346 cases reported by 18 countries in 2023 alone. Five countries – Spain, Greece, Italy, Romania, and Germany – have accounted for most of the cases over the decade.
“C. auris has spread within only a few years – from isolated cases to becoming widespread in some countries. This shows how rapidly it can establish itself in hospitals,” said Dr Diamantis Plachouras, Head of ECDC’s Antimicrobial Resistance and Healthcare-Associated Infections Section. “But this is not inevitable,” he added. “Early detection and rapid, coordinated infection control can still prevent further transmission.”
Recent outbreaks have been reported in Cyprus, France and Germany, while Greece, Italy, Romania and Spain have indicated they can no longer distinguish specific outbreaks due to widespread regional or national dissemination. In several of these countries, sustained local transmission has occurred within only a few years after the first documented case, highlighting a critical window for early interventions to stop its spread.
While some countries have showed positive results in limiting C. auris outbreaks, many are facing key gaps. Despite rising case numbers, only 17 of 36 participating countries currently have a national surveillance system in place for C. auris. Only 15 countries have developed specific national infection prevention and control guidance. Laboratory capacity is comparatively stronger, with 29 countries reporting access to a mycology reference or expert laboratory and 23 offering reference testing for hospitals.
While the number of C. auris infections is clearly rising, without systematic surveillance and mandatory reporting, the true scale of the problem is likely under-reported.
ECDC has regularly assessed the epidemiological situation, laboratory capacity and preparedness for C. auris in four surveys since 2018 and published rapid risk assessments including options for infection prevention and control. This is to support Member States in improving their preparedness and early response capacities to prevent or contain C. auris outbreaks in a timely manner and prevent further transmission.
Excessive amounts of visceral fat, the hidden fat surrounding organs, is linked with faster ageing of the heart, a new study has found. Ageing is the biggest risk factor for heart disease but why some people age faster than others isn’t fully understood.
The scientists leading the research, which is published in the European Heart Journal, say that visceral body fat could play an important role in accelerating ageing of the heart and blood vessels. This type of fat is known to be harmful to health and this study now links it to faster heart ageing.
Sex differences
The study, led by scientists from the Medical Research Council (MRC) Laboratory of Medical Sciences, also found differences between men and women. They discovered that fat around the hips and thighs could potentially slow heart ageing in women. The scientists analysed data from 21 241 participants in UK Biobank, which includes whole body imaging to map the amount of fat and where it is located in the body. The study was
Determining an individual’s ‘heart age’
The UK Biobank data also includes detailed imaging of the heart and blood vessels. Artificial intelligence (AI) was used to analyse these images to capture signs of organ ageing such as tissues becoming stiff and inflamed. An individual was given a ‘heart age’ which can be compared to their actual age at the time of the scan.
The risks of ‘hidden’ fat
The researchers found that faster heart ageing was linked to having more visceral adipose tissue. Visceral adipose tissue is fat found deep inside the abdomen around organs such as the stomach, intestines, and liver. This type of fat cannot be seen from the outside, and some people can have large amounts of visceral fat despite having a healthy weight.
Premature ageing
The researchers found signs on blood tests that visceral fat is linked to increased inflammation in the body, which is a potential cause of premature ageing. They also found differences between the sexes. Male-type fat distribution, which is fat around the belly and often called ‘apple-shaped’, was particularly predictive of early ageing in men.
The role of hormones
In contrast, a genetic predisposition to female-type fat, primarily fat on the hips and thighs, often called ‘pear-shaped’, was protective against heart ageing in women. The researchers also found a link between higher oestrogen levels in pre-menopausal women and a slowing of heart ageing. They suggested that this could indicate a role for hormones in protecting against heart ageing.
Increasing healthy lifespan
Professor Declan O’Regan, who led the research at the MRC Laboratory of Medical Sciences and Imperial College London, said:
We have known about the apple and pear distinction in body fat, but it hasn’t been clear how it leads to poor health outcomes. Our research shows that ‘bad’ fat, hidden deep around the organs, accelerates ageing of the heart.
But some types of fat could protect against ageing, specifically fat around the hips and thighs in women.
We also showed that body mass index wasn’t a good way of predicting heart age which underscores the importance of knowing where fat is stored in the body and not just total body weight.
The goal of our research is to find ways to increase healthy lifespan. While being active is important, we found that hidden fat could still be harmful even in fit people.
In the future, we plan to investigate how drug therapies, such as GLP-1 inhibitors (for example, Ozempic) could improve not just diabetes and obesity but target the ageing effects of hidden visceral fat.
Could a keto diet affect males differently from females? A study from The University of Texas Health Science at San Antonio (UT Health San Antonio) suggests so, and oestrogen could promote different protections against adverse effects of the diet like the accumulation of cells expressing markers of age, or senescence.
The study, published Aug. 26 in the journal Cell Reports, found that male, but not female, mice on a ketogenic diet showed the accumulation of cells in organs expressing markers of cellular senescence. A keto diet is a popular low-carbohydrate, high-fat regimen that can help some Type 2 diabetes patients control blood sugar and those with epilepsy manage seizures. Cells expressing senescence markers can contribute to age-related declines in overall bodily function.
“These results suggest sex specificity alters the effects of a ketogenic diet, with important clinical implications,” said David Gius, MD, PhD, assistant dean of research and professor with the Department of Radiation Oncology at UT Health San Antonio, associate cancer director for translational research at the institution’s Mays Cancer Center and investigator for its Barshop Institute for Longevity and Aging Studies.
He is lead author of the study, titled, “Divergent sex-specific effects on a ketogenic diet: Male, but not female, mice exhibit oxidative stress and cellular senescence.”
Ketogenic diets induce ketogenesis, the generation of ketone bodies or water-soluble molecules from fat for use as fuel in place of glucose. They have shown benefits in controlling refractory epilepsy and are being investigated as potential therapies for other health conditions.
In the past decades, keto diets also have become popular in North America and Europe for weight loss.
While the diets can improve certain health parameters, evidence from mice and clinical studies suggest the effects may be dependent on multiple variables, including adherence, metabolism and, importantly, sex, suggesting that hormone status may impact response.
Gius says the role of gender in the response to keto diets has been understudied. One reason is that male mice have been used extensively for in vivo basic and translational research because it was assumed that females would give less consistent results due to variability from the oestrous cycle. Recent studies, however, suggest that largely is unfounded.
In the new study, Gius’ team observed a keto-diet-induced increase in cellular senescence only in male mice, except when they were given the female hormone oestrogen. Male mice on a keto diet also exhibited an increase in markers of oxidative stress, which is known to contribute to senescence in cells.
Notably, the researchers found, estrogen or estradiol treatment prevented increases in cell senescence and oxidated stress in male mice on a keto diet, as did several established antioxidants.
They also observed that when females were administered tamoxifen, a “selective oestrogen receptor inhibitor” that blocks the effects of oestrogen, they then exhibited an increase in oxidative stress and cells expressing senescence markers, the same as male mice. “These results strongly suggest that oestrogen is an important variable in the response to a ketogenic diet,” Gius said.
The researchers also found that a high-fat diet – comprising more carbohydrates than a keto diet – also induces cellular senescence in male, but not female, mice.
Sceletiumtortuosum is a little succulent plant that grows in the semi-arid Karoo and Namaqualand regions of South Africa. It has a long history of traditional use among the hunter-gatherers of the region.
The plant, known as kanna or kougoed by the San and Khoikhoi people, was mainly chewed or smoked to stay alert and suppress appetite during long hunts. The San were traditionally hunter-gatherers, while the Khoikhoi were pastoralists who herded livestock.
The name kanna (meaning “eland” in the click language of the San), has a symbolic reference to this large antelope, as the “trance animal”, which was called upon during religious and spiritual gatherings. Kougoed is Afrikaans for “something to chew”. The plant can be chewed after being dried and fermented, which is believed to intensify its effects.
The first colonial governor of the Cape colony, Simon van der Stel, in 1685 wrote about kanna in his journal:
They chew mostly a certain plant which they call Canna and which they bruise, roots as well as the stem, between the stones and store and preserve in sewn-up sheepskins.
I’m part of a group of scientists from different disciplines with an interest in this plant and we pooled our expertise to understand its effects on neurochemical concentrations in different parts of the brain.
Our studies were done in mice, so there is caution about establishing effectiveness on humans. Still, the results are striking.
As a chemist with an interest in natural products, I wanted to know which alkaloids in the plant were important in bringing about these effects.
Our latest study explored the effects of Sceletiumtortuosum extracts on mouse brain chemistry.
We found that Sceletium increased the levels of certain brain chemicals which may balance mood and reduce stress. These findings lend support to the calming and mood-enhancing use of this plant in traditional medicine.
Plant chemistry
Our study examined how extracts from different chemotypes of Sceletiumtortuosum can have different effects on brain chemistry. Chemotypes are groups of the same plant species that differ in the alkaloids they produce. This is because plants often produce alkaloids in response to external cues such as the weather or the presence of a plant-eating animal or pathogen.
Alkaloids are carbon-based compounds produced by plants. They are often toxic or taste bitter, making the plants less appealing or even harmful to the predators or invaders that want to eat or inhabit them. Alkaloids generally have physiological effects of use to humans. Some commonly used ones include caffeine, morphine and quinine.
We harvested two chemotypes of kanna from the Touwsrivier and De Rust regions of South Africa. These areas were chosen because of their interesting and unusual alkaloid profiles. The chemotypes were given to healthy mice as a supplement once a day for one month. The mice were monitored every day for behavioural or unexpected adverse reactions but none were noted.
At the end of the month, the levels of chemicals in the mouse brain were measured. Both the chemotypes were found to cause a marked increase in noradrenaline and a decrease in GABA in all brain regions studied. Both molecules are neurotransmitters that transmit nerve signals in the brain affecting memory, mood, attention and sleep.
This effect on noradrenaline supports kanna’s traditional use as an appetite suppressing drug. Increased noradrenergic stimulation is also the basis of many anti-depressants as well as drugs that improve attention and alertness.
We also found an impact on the brain chemicals serotonin and dopamine which may act together to balance mood and reduce stress. Serotonin affects emotional well-being and mood; dopamine motivates feelings of pleasure and satisfaction. These findings lend support to the calming and mood-enhancing use of this plant in traditional medicine.
Importantly, the control kanna extracts that did not have the interesting alkaloid profiles did not cause any of these chemical changes in the mouse brain.
Most studies on kanna have focused on the alkaloid mesembrine. The two specific chemotypes of kanna harvested from the Touwsrivier and De Rust regions of South Africa do have the mesembrine, but they are also packed with some other lesser-known or “minor” alkaloids. These differences in alkaloids may arise from a combination of geographic, environmental and inherent genetic factors found in a particular subset of plants.
Both the Touwsrivier and De Rust plants contained higher levels of alkaloids called mesembrine alcohols, which are different from mesembrine, and were barely present in the control extract. Another minor alkaloid, known as sceletium A4, was also identified as possibly being important. Mesembrine alcohols and sceletium A4 may be the ones responsible for the activity.
This suggests that the source of the plant, and the area in which it is grown, can influence its potential as a natural treatment for mood disorders and sleep.
What the results tell us
Stress, anxiety and depression pose a risk to the ability to lead a meaningful life. The World Health Organization has reported a 25% increase in anxiety and depression worldwide since the emergence of COVID-19.
Our study showed that the plant extracts had a broad noradrenergic effect in mice. But we have to be careful about making connections between results in mice and in humans. We need to explore the behavioural impact of these extracts in both mice and humans, especially in relation to sleep, alertness and mood.
The results also highlighted that without understanding the complex chemical composition of these plants, we risk overgeneralising their benefits, or worse, using them inappropriately.
Our findings have two implications.
First, they point towards a future of precision phytotherapy (use of plants for medicinal purposes), where natural remedies are tailored not just to individuals but to selecting certain plant chemotypes that produce certain combinations of alkaloids. Manipulating the growing conditions and genetic make-up of plants to optimise for alkaloid content is an age-old art.
Second, they remind us of the enormous, still largely untapped potential of African medicinal plants in global health innovation if we invest in research that honours both indigenous knowledge and scientific rigour.
As the world searches for safer, more sustainable ways to treat mental health conditions, South Africa’s kanna plant may hold secrets worth rediscovering.
Graphical abstract. Credit: Device / Jeon et al. CC BY-SA
Scientists have developed a tool made from a modified glue gun that can 3D print bone grafts directly onto fractures and defects during surgery. The tool, described September 5th in the Cell Press journal Device, has been tested in rabbits to quickly create complex bone implants without the need for prefabricating in advance. What’s more, the team optimised the 3D-printed grafts for high structural flexibility, release of anti-inflammatory antibiotics, and promotion of natural bone regrowth at the grafting site.
Historically, bone implants have been made of metal, donor bone, or even more recently 3D-printed material. However, in cases involving irregular bone breaks, these implants must be designed and produced prior to surgery to allow for appropriate fitting.
“Our proposed technology offers a distinct approach by developing an in situ printing system that enables a real-time fabrication and application of a scaffold directly at the surgical site,” says Jung Seung Lee, co-author and associate professor of biomedical engineering at Sungkyunkwan University. “This allows for highly accurate anatomical matching even in irregular or complex defects without the need for preoperative preparation such as imaging, modelling, and trimming processes.”
The material fed into the glue gun is a filament comprised of two major components: a feature of natural bone known to promote healing called hydroxyapatite (HA) and a biocompatible thermoplastic called polycaprolactone (PCL). PCL can liquify in temperatures as low as 60°C, which when applied with a heat-modified glue gun, is cool enough to prevent tissue damage during surgical application while being able to conform to the jagged grooves of fractured bone. By adjusting the proportion of HA to PCL within the filament, the team can customise the hardness and strength of the grafts to fit different anatomical needs.
“Because the device is compact and manually operated, the surgeon can adjust the printing direction, angle, and depth during the procedure in real time,” says Lee. “Also, we demonstrated that this process could be completed in a matter of minutes. This highlights a significant advantage in terms of reducing operative time and improving procedural efficiency under real surgical conditions.”
Since infection is a common concern with surgical implants, the researchers incorporated vancomycin and gentamicin, two anti-bacterial compounds, into the filament. In both petri dish culture and liquid medium, the filament scaffold successfully inhibited the growth of E. coli and S. aureas, two common bacteria prone to cause infection post-surgery. Due to physical properties of HA and PCL within the filament, the drugs are released slowly and are able to diffuse directly onto the surgical site over several weeks.
“This localised delivery approach offers meaningful clinical advantages over systemic antibiotic administration by potentially reducing side effects and limiting the development of antibiotic resistance, while still effectively protecting against postoperative infection,” says Lee.
As a proof of concept, the device was tested on severe femoral bone fractures in rabbits. Within 12 weeks after surgery, the team found no signs of infection or necrosis and greater bone regeneration outcomes when compared to rabbits grafted with bone cement – a sealing compound commonly used for treating bone defects.
“The scaffold was designed not only to integrate biologically with surrounding bone tissue but also to gradually degrade over time and be replaced by newly formed bone,” says Lee. “The results showed that the printing group exhibited superior outcomes in key structural parameters such as bone surface area, cortical thickness, and polar moment of inertia, suggesting more effective bone healing and integration.”
Next, the team is setting their sights on optimising the anti-bacterial potential of the scaffold even further and preparing the procedure for human trials.
