Author: ModernMedia

Categories : Respiratory Diseases VaccinesTags :

The Hunt for a New TB Vaccine: Why We Are Now so Close, and Why it Matters

On By ModernMedia
Associate Professor Angelique Kany Kany Luabeya speaks about TB vaccine trials and the introduction of TB vaccines in South Africa. (Photo: Supplied)

By Angelique Kany Kany Luabeya

The only tuberculosis vaccine we have is a century old and offers only limited efficacy in children. With leading South African researchers involved in the pivotal clinical trials of three new tuberculosis vaccine candidates, we are on the verge of a major breakthrough, writes Associate Professor Angelique Kany Kany Luabeya.

My uncle died of abdominal TB a few days ago, after facing repeated challenges in getting an accurate diagnosis. For him, the treatment started much too late. To many in his community, my uncle was a respected teacher, a breadwinner, a pillar of support and strength.

In 2026, why are people still dying from a preventable disease that continues to cause unnecessary deaths and hardship?

Why we urgently need a new TB vaccine should be obvious. For the millions who are sick, and for families living with the catastrophic loss of a loved one, the need is painfully clear.

Prior to the emergence of the SARS-CoV-2 virus, TB was the world’s deadliest infectious disease, killing more than 1.5 million people every year. While COVID-19 has since shown an epidemic downturn, TB’s toll remains devastatingly high.

Globally, an estimated 2 billion people are infected with the Mycobacterium tuberculosis that causes TB in humans. In this state, also known as latent TB infection, they do not have TB symptoms and are non-infectious, but the bacteria remain dormant in their bodies. Of these people, about 5 to 10% will go on to develop active TB when their immune system is no longer able to contain the bacteria. This means that they now have TB disease, sometimes without noticeable symptoms, and risks passing it to others. This could be a family member, a friend, or a stranger who happens to be nearby.

TB bacteria have coexisted with humans for millions of years. There is a cure, but treatment alone is not enough to stop transmission. TB mostly affects countries with limited resources because patients struggle to access care or are unable to complete treatment due to side effects or a lack of food to support the rigorous regimen of drugs they must take to cure them. In addition, the rise of multidrug-resistant tuberculosis is now fueling a global health crisis.

In South Africa, recent data from the World Health Organization’s (WHO) Global TB Report indicate progress, with a 57% reduction in new TB cases since 2015. However, TB mortality is still high and is concentrated mainly in poor and vulnerable communities. According to the WHO, TB still claims over 50 000 lives in South Africa every year. The burden is also unevenly distributed, with some geographic areas affected more than others.

A vaccine which prevents TB

Our hopes are now pinned on developing an efficacious vaccine which prevents people from developing TB disease. WHO modelling suggests that a vaccine which prevents most people with latent TB infection from progressing to active disease would have the most rapid impact on the epidemic in high‑burden countries.

The most urgent priorities for protection would be people living with HIV, healthcare workers at risk of workplace exposure, adolescents and young adults who are driving transmission, as well as those with comorbidities such as diabetes that increase their risk of TB diseases and negatively affect treatment outcomes.

The COVID-19 pandemic proved that when human survival is threatened, the scientific community can respond with breathtaking speed, developing multiple effective vaccines in under a year. Sadly, the urgency and resources allocated to finding an effective TB vaccine do not match the scale of its devastation.

For more than a century (since 1921), we have had only one licensed TB jab, which is the bacillus Calmette-Guérin (BCG) vaccine that is given at birth. Despite its limitations in preventing TB that infects the lungs – the main route of transmission – BCG remains a critical tool because it protects millions of babies from more serious forms of TB that can spread through the blood to the brain. But, clearly, the BCG vaccine is not enough.

Hope is on the horizon though, with several novel TB vaccines now in late-stage clinical trials. New vaccines or drugs are evaluated clinically in humans in steps, or phases, for safety, immunogenicity, and efficacy.

  • The most advanced is M72/AS01E (M72 for short), which is an adjuvanted subunit vaccine under development by the Gates Medical Research Institute and GlaxoSmithKline. In a phase 2 trial, this vaccine showed close to 50% efficacy in preventing TB disease in TB-infected people—the first time a vaccine has achieved this level of efficacy. A pivotal phase 3 trial of this vaccine has now completed enrolment of 20 000 volunteers, including 13 000 people in South Africa, with results expected in 2028. Developers typically apply for registration with regulatory authorities after successful phase 3 trials – so this study is the last big hurdle for this vaccine.
  • Another promising candidate is the MTBVAC vaccine, a live, whole, attenuated Mycobacterium tuberculosis vaccine developed by Biofabri, in partnership with the University of Zaragoza and sponsored by the International AIDS Vaccine Initiative. It is in a multi-country phase 2b trial in adults and adolescents and a phase 3 trial in newborns, including in South Africa.
  • BioNTech’s mRNA TB vaccine is also being evaluated in a phase 2a study in South Africa. Funded by BioNTech, this vaccine candidate harnesses mRNA technology, which has proved successful in the COVID-19 response.

Paving the way for acceptance and use

South African researchers are at the forefront of these TB vaccine efforts. Our strengths lie in our robust clinical trial capacity, world-class institutions, commitment to equitable solutions, and regulatory expertise, all of which help accelerate vaccine licensure. As a global policy leader, South Africa co-chairs the Finance and Access Working Group at the WHO TB Vaccine Accelerator Council, advocating for fair distribution and sustainable financing, and has recently co-hosted a vaccine preparedness workshop to position the country for the emergence of late-stage TB vaccines.

But the most important aspect to consider is the vaccine’s acceptability and uptake by a myriad of population groups at risk of TB. We learned from COVID-19 how misinformation can devastate vaccine uptake, leading to unnecessary morbidity and mortality. Confidence in new TB vaccines must be built to maximise impact. The context may be different—TB is an old, well-known enemy that affects people close to us. By involving South African communities in the early stages of vaccine trials, we can ensure their priorities are part of the development agenda.

While we continue to improve TB diagnosis and treatment, the hunt for an effective vaccine continues. After a century of fighting TB with only one vaccine and several antibiotics, we might be on the verge of a breakthrough that could finally shift the trajectory of this ancient and deadly disease.

*Associate Professor Angelique Kany Kany Luabeya is the clinical investigator on the M72 TB vaccine trials being conducted at the South African Tuberculosis Vaccine Initiative based at the University of Cape Town.

Disclosure: The Gates Medical Research Institute mentioned in this article is a non-profit organisation and subsidiary of the Gates Foundation. Spotlight receives funding from the Gates Foundation but is editorially independent – an independence that the editors guard jealously. Spotlight is a member of the South African Press Council.

Note: Spotlight aims to deepen public understanding of important health issues by publishing a variety of views on its opinion pages. The views expressed in this article are not necessarily shared by the Spotlight editors.

Republished from Spotlight under a Creative Commons licence.

Read the original article.

Categories : CancerTags :

New Trial Tests Lower Dose Treatments for Prostate Cancer

On By ModernMedia
Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health

A major UK clinical trial co-led by researchers at UCL will test whether lower doses of common hormone therapies can treat advanced prostate cancer while reducing the severe side effects many patients experience.

The ENHANCE trial, jointly funded by Cancer Research UK and Prostate Cancer UK, will recruit 1,500 men with advanced prostate cancer from hospitals across the UK to compare standard and half-dose treatment using four commonly prescribed hormone drugs. UCL is sponsoring the trial and Professor Allan Hackshaw (Director of CRUK & UCL Cancer Trials Centre, UCL Cancer Institute) is joint-lead investigator, alongside Professors Ananya Choudhury and Peter Hoskin at the University of Manchester.

Men diagnosed with advanced prostate cancer, where the disease has spread beyond the prostate, are typically treated with powerful hormone therapies that slow tumour growth. While these drugs can extend life, they can also cause debilitating side effects such as extreme fatigue, hot flushes and high blood pressure, which can make it difficult for some patients to remain on treatment.

Researchers hope the £3.2 million ENHANCE trial will show that lower doses of these drugs can be just as effective while improving patients’ quality of life. The trial has not yet been launched and is awaiting the relevant regulatory and ethics approvals.

Professor Allan Hackshaw said: “Although focus is often on cancer trials to improve survival, we also need to find more tolerable ways of treating cancer without compromising survival. Side effects of cancer therapies matter a lot to patients, especially when they are frequent.

“We believe that several modern cancer drugs can be given at a much lower dose than what they were licensed for. Not only would this improve patient’s quality of life, but healthcare costs would be lower allowing more access especially in countries that cannot afford these drugs at their current high dose. The ENHANCE study can therefore influence clinical practice worldwide.

“Furthermore, Black men are more likely to get prostate cancer, and they too suffer from the same side effects of hormone treatment. They are often under-represented in clinical trials, so the ENHANCE study is a good opportunity to show that they get the same benefits from lowering the treatment dose as other ethnic groups.”

ENHANCE will compare full and half-dose treatment across four hormone therapies widely used for advanced prostate cancer: abiraterone, enzalutamide, darolutamide and apalutamide. If successful, the findings could influence prostate cancer treatment guidelines in the UK and internationally as early as 2030, improving care for thousands of men and reducing costs for the NHS.

Dr Ian Walker, Executive Director of Policy at Cancer Research UK, said: “Thanks to research, there’s been huge progress in prostate cancer treatments. Today, more than 8 in 10 men diagnosed with the disease in the UK will survive for 10 years or more. There’s more that can be done to save even more lives though, and in addition to finding more effective treatments, we need to find kinder ones too. The ENHANCE trial is looking to do just that and could mean that men affected by prostate cancer live not just longer lives but have a better quality of life.”

Dr Matthew Hobbs, Director of Research at Prostate Cancer UK, said: “No man should be forced to compromise between survival and their day-to-day wellbeing. This is a crucial issue for men with prostate cancer. That’s why Prostate Cancer UK is thrilled to be working alongside Cancer Research UK, pooling our resources and expertise to deliver the impact men need by funding this bold new trial that puts men’s wellbeing at its centre.”

Prostate cancer is now the most common cancer in UK men. Around 55 900* men are diagnosed each year. While survival rates have tripled since the 1970s, many men still face difficult side effects from treatment.

Retired solicitor Jonathan Edwards, 80, from Cheshire, experienced severe side effects after starting the hormone-blocking drug enzalutamide following his prostate cancer diagnosis in 2024, but when his nurse reduced the dose, his cancer remained under control and his quality of life improved dramatically.

Jonathan said: “It was such a shock when I was diagnosed. I had several health issues and after many tests was eventually told that I was suffering from prostate cancer and that it had spread beyond the prostate wall to my bones. I was referred to The Christie Hospital for treatment and was prescribed hormone blockers. The side effects made me extremely tired; I was sleeping through the day on and off and I had frequent hot flushes and generally felt weak.

“When the nurse suggested lowering the dose I was not sure what to expect. The difference soon became apparent and I felt normal again. I know that I will stay on the medication for as long as it is effective but, in the meantime, I am able to live a pretty normal life. I now exercise more and do not usually need an afternoon sleep. Happily, my PSA level started to go down until, after a few months, it was undetectable and has so far remained undetectable.

“My life has been transformed by the medication, my energy levels are higher, and I can socialise as normal. Traveling was a problem but now I can plan trips as long as I work around the 12-week cycle of injections and consultations. I am delighted that this trial has the potential to help other men going through the same thing in the future by enabling them to be treated for prostate cancer with their quality of life still largely intact.”

At least 10 per cent of trial participants will be Black men. Historically under-represented in clinical trials, Black men are often treated based on data that may be less applicable to them. Although data shows Black men are more likely to develop prostate cancer, more evidence is needed to understand their risk of aggressive disease and the role of overdiagnosis.

Alongside testing lower doses, the trial will collect tissue, blood and urine samples to identify biomarkers that could help determine which men are most suitable for reduced-dose treatment, shaping more personalised care in the future.

*Based on the average annual number of new cases of prostate cancer (ICD10 C61) diagnosed in the UK in the years 2018-2019, 2021.

Source: University College London

Categories : NeurologyTags :

Mechanoreceptors Set off Cascade of Damage Milliseconds After Spinal Trauma

On By ModernMedia
View of the spinal cord. Credit: Scientific Animations CC4.0

Mechanoreceptors are present in the spinal cord from birth, are sensitive to mechanical stimuli, and play an important role in triggering the pathological events that follow trauma. What happens if they are blocked? The extent of the damage decreases. This is the finding of a new study published in The Journal of Physiology and conducted by a team at Scuola Internazionale Superiore di Studi Avanzati (SISSA), led by Professor Giuliano Taccola, with Atiyeh Mohammadshirazi as first author.

Everything happens within the very first milliseconds after the trauma, the scientists explained. It is during this brief time window that these spinal mechanoreceptors become active, triggering an impairment of the electrical signals that underlies normal neural communication. This initial event sets off a cascade of neurotoxic factors known as secondary damage, which amplifies and spreads the original traumatic lesion over the following hours and days.

Understanding the role of these receptors, according to the authors, is important not only for clarifying what happens during spinal shock. As demonstrated in the experiments, when their activity is blocked, the functional damage is also reduced. For this reason, spinal mechanoreceptors may represent a potential target for strategies aimed at reducing the disabling consequences of spinal cord injury.

Physical trauma disrupts electrical signaling

“It is well known that physical trauma to the spinal cord disrupts the flow of electrical signals that underlie the functioning of our nerve fibers. This phenomenon is known as DIP (Depolarizing Injury Potential). It begins almost immediately after trauma and continues propagating the primary damage over the following weeks, progressively worsening the lesion,” explain Atiyeh Mohammadshirazi and Giuliano Taccola. “However, the origins of this phenomenon are not yet fully understood.”

Yet, thanks to experiments carried out using highly sophisticated instrumentation invented by Professor Taccola and John Fischetti, the two scientists say, “we were able to discover something truly new.”

Mechanoreceptors and their role in the spread of damage

Receptors are cellular structures that respond to specific signals. Among them are mechanoreceptors, specialized proteins located on the cell membrane of sensitive cells that act as sensors for mechanical forces such as compression. Mechanoreceptors are found throughout the body, including around the spinal cord and within its central canal. In this environment, according to the SISSA research, they appear to play an important role in the propagation of injury.

The two authors explain, “In the progression of damage, depolarization precedes other well-known events such as the release of neurotoxic agents, and the inflammatory response that ultimately leads to cell death, the transient spinal hypoxia, and the rapid cell neuronal loss in the area of the primary lesion.” In this context, mechanoreceptors seem to contribute to initiating the depolarization process.

Mohammadshirazi and Taccola confirm: “When we blocked their activity in our experiments, we observed that the functional damage was significantly contained and limited.”

A possible avenue for reducing trauma-induced damage

“Our work,” conclude Giuliano Taccola and Carmen Falcone, who contributed to the histological analysis of the study, “explored what happens at the cellular level immediately after spinal trauma. As we explained, these injuries do not only involve the initial mechanical damage; they also trigger a cascade of complex neurotoxic events that amplify and worsen cellular damage and disrupt communication between neurons.”

They conclude: “With our laboratory model experiments, we demonstrated that blocking mechanosensitive receptors can effectively reduce the immediate pathological effects of spinal trauma. Our research is basic research, of course, and practical applications are still far away. Nevertheless, it may open a promising path to explore in the future to reduce spinal shock and the damage that follows trauma.”

Categories : IT in HealthcareTags :

Healthcare Under Attack: Why Cybersecurity is now Critical Care

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Photo by Nahel Abdul on Unsplash

By Kerissa Varma, Microsoft Chief Security Advisor, Africa

Africa’s healthcare sector is facing a silent emergency. Many healthcare operators, facilities and doctors across Africa already grapple with the challenges of under-resourced environments, an uneven distribution of resources and massive demand for services. Now, healthcare administrators must turn their attention to a relatively new and extremely urgent concern. While doctors fight to save lives, cybercriminals are infiltrating hospitals, laboratories, and clinics, turning life-saving environments into digital battlegrounds.

A growing epidemic

World Health Organization director-general Tedros Adhanom Ghebreyesus noted that the digital transformation of healthcare, combined with the high value of health data, has made the sector a prime target for cybercriminals, commenting that “At best, these attacks cause disruption and financial loss. At worst, they undermine trust in the health systems on which people depend, and even cause patient harm and death.”

Recent attacks have exposed the fragility of Africa’s medical infrastructure. In May 2025, Mediclinic Southern Africa was hit by a cyber extortion attack, compromising sensitive HR data. Later in 2025, Lancet Laboratories faced a regulatory penalty for failing to notify patients about data breaches under South Africa’s POPIA law, while a ransomware strike on the National Health Laboratory Service disrupted blood test processing nationwide, delaying critical care for millions.

M-Tiba, a Kenyan digital health platform managed by CarePay and backed by Safaricom, suffered a significant cyberattack and data breach in late 2025, while earlier this year Pharmacie.ma, a Moroccan pharmaceutical platform, was reportedly the target of an alleged data leak incident that allegedly involved the unauthorised export of a customer database. And recent research indicates that Nigeria’s private healthcare sector is now one of the most targeted on the African continent, with attacks increasing at an alarming rate.

Many incidents also go unreported, as hospitals and healthcare facilities rarely disclose them publicly, yet these incidents are not isolated, with ransomware dominating the threat landscape. Africa’s healthcare sector is heavily targeted by cybercriminals, with healthcare organisations facing an average of 3575 weekly attacks in 2025, a 38% surge from the previous year, with encryption of patient data, temporary loss of access to hospital systems and the risk of data appearing on the dark web cited as potential impacts.

Why healthcare is a prime target

The healthcare industry in Africa, particularly in the public sector, is working with legacy systems, fragmented infrastructure, and underfunded IT teams, all of which combine to make the sector an easy target for unscrupulous bad actors.

Many medical institutions are adopting open-source AI tools for diagnostics and patient management. While cost-effective, these platforms often lack enterprise-grade security, leaving sensitive data exposed. Combined with fragmented storage of paper and electronic patient records – often unencrypted and scattered across multiple systems – the risk of breaches multiplies.

Hospitals and healthcare facilities cannot afford downtime. Every minute offline risks lives, making them more likely to pay ransoms in an attempt to regain control of their systems. Cyber insurers  indicate that in 2 of 5 cases of a ransom being paid, data and operations still cannot be recovered. Additionally, in instances where some or all of the seized data is recovered after paying a ransom, the attacker goes on to request further payments.

Medical records are also a premium target for cybercriminals. In the USA, researchers found that patient records, insurance details, and research data fetch premium prices on the dark web – up to 10 times higher than financial data, according to cybersecurity analysts. A single stolen medical record can sell for $260–$310, compared to $30–$50 for a credit card, because unlike credit cards, medical records never expire and medical information cannot be easily changed, making it useful for years. Medical records frequently include personal identifiers, insurance details, and sometimes biometric data, enabling identity theft and fraud, while criminals use medical data for fake insurance claims, prescription fraud, and targeted scams. Microsoft believes cybersecurity needs to be embedded into every technology implementation. This should be a key priority, especially with sensitive medical data and operations.

How healthcare can use modern technology safely

As Africa’s healthcare systems digitise and embrace AI, protecting the digital lifeline must become as critical as protecting the physical one. Key steps can secure healthcare organisations and facilities like laboratories and diagnostic services’ systems.

Include cybersecurity in your resilience planning

Medical professionals and healthcare facilities often prioritise the resilience of physical capabilities. Power backups, multiple devices should equipment fail, and a standby roster in the event of a practitioner being unavailable are all practices that save lives. Equally cybersecurity and safeguarding online systems needs to be built into the overall resilience planning of medical facilities and services.

Investing in cybersecurity technology that can quickly identify and contain attacker activity before it leads to system downtime or data theft can save lives. Having a response plan that is practiced and maintained in the event of a cyber breach and ensuring strong data backups could mean the difference between a total failure of health services or a minor incident. Ensuring incident response plans are aligned with local compliance laws such as South Africa’s POPIA, and Kenya and Nigeria’s Data Protection Acts is critical for healthcare providers to meet both their resilience and compliance objectives.

Prepare for AI-driven attacks that are going to increase attacker speed and success

Threat actors are increasingly exploiting the interconnectedness of modern software ecosystems and operational structures to conduct malicious activity, so regular auditing of third-party integrations, especially those involving AI or cloud services, is critical.

Adversaries are using AI to scale and tailor operations, with AI-driven phishing being 4.5x more effective than traditional phishing. However, in equal measure, AI is transforming cyber defence – it automates response and containment, detects threats faster and more accurately, and identifies detection gaps and adapts to attacker behaviour. Healthcare organisations should invest in AI-driven threat detection for faster response and anomaly detection and must also take steps to secure AI models and data pipelines by implementing robust access controls, vulnerability scanning, and regular patching for open-source tools.

Remote and wider access to patient records requires strong identity practices

As both patients and medical professionals start accessing patient records digitally, strong means of identification, verification and authentication are critical. The Microsoft Digital Defense Report 2025 notes that the abuse of valid accounts is a frequent occurrence, with malicious actors gaining access to user credentials (usernames and passwords) and using them to infiltrate systems without triggering traditional security alerts. Therefore, organisations must deploy phishing-resistant multifactor authentication (MFA) and conditional access to strengthen user defences.

Invest in people and skills

People are at the heart of robust cybersecurity measures, so it is vital to train staff against common tactics such as phishing, which is the most common entry point for attackers, and apply role-based access controls for both clinical and research data to prevent privilege misuse.

Cybersecurity is no longer an IT issue – it’s a patient safety issue. Healthcare services and providers must treat digital resilience with the same urgency as infection control. By investing in comprehensive cybersecurity strategies and leveraging AI-powered defences, Africa’s healthcare sector can position itself as a crucial front line against emerging threats and help build stronger, more resilient digital ecosystems.

Categories : Diet and Nutrition Neurodegenerative DiseasesTags :

High Meat Intake Linked to Lower Dementia Risk in APOE4

On By ModernMedia
Photo by Jose Ignacio Pompe on Unsplash

Older people with a genetic risk of Alzheimer’s disease did not experience the expected increase in cognitive decline and dementia risk if they consumed relatively large amounts of meat. This is shown in a new study from Karolinska Institutet published in JAMA Network Open. The results may contribute to the development of more individually tailored dietary advice.

APOE is a gene that affects the risk of Alzheimer’s disease. In Sweden, approximately 30 per cent of the population are carriers of the gene combinations APOE 3/4 or APOE 4/4. Among people with Alzheimer’s disease, those with these genotypes account for nearly 70 per cent.

When the Swedish Food Agency presented an overview of research on the link between diet and dementia last year, more research was requested to assess a possible link between meat consumption and the development of dementia.

‘This study tested the hypothesis that people with APOE 3/4 and 4/4 would have a reduced risk of cognitive decline and dementia with higher meat intake, based on the fact that APOE4 is the evolutionarily oldest variant of the APOE gene and may have arisen during a period when our evolutionary ancestors ate a more animal-based diet,’ says first author Jakob Norgren, researcher at the Department of Neurobiology, Care Sciences and Society, Karolinska Institutet.

The study followed more than 2100 participants in the Swedish National Study on Aging and Care, Kungsholmen (SNAC-K) for up to 15 years. All were aged 60 or older and had no diagnosis of dementia at the start of the study. The association between self-reported diet and cognitive health measures was analysed, adjusting for age, sex, education and lifestyle factors.

Twice the risk of dementia

At lower meat intake, the group with APOE 3/4 and 4/4 had more than twice the risk of dementia than people without these gene variants. However, the increased risk of cognitive decline and dementia in the risk groups was not seen in the fifth of participants who consumed the most meat. Their median consumption is estimated at approximately 870 grams of meat per week, standardised to a daily energy intake of 2,000 calories.

‘Those who ate more meat overall had significantly slower cognitive decline and a lower risk of dementia, but only if they had the APOE 3/4 or 4/4 gene variants,’ says Jakob Norgren. He continues: 

‘There is a lack of dietary research into brain health, and our findings suggest that conventional dietary advice may be unfavourable to a genetically defined subgroup of the population. For those who are aware that they belong to this genetic risk group, the findings offer hope; the risk may be modifiable through lifestyle changes. ‘

The study also shows that the type of meat is important.

‘A lower proportion of processed meat in total meat consumption was associated with a lower risk of dementia regardless of APOE genotype,’ says Sara Garcia-Ptacek, assistant professor at the same department, who together with senior lecturer Erika J Laukka is the study’s last author.

The findings also extend beyond brain health. In a follow-up analysis, the researchers observed a significant reduction in all-cause-mortality in carriers of APOE 3/4 and 4/4 with higher consumption of unprocessed meat.

However, the study is observational and needs to be followed up with intervention studies that can better demonstrate causal relationships.

‘Clinical trials are now needed to develop dietary recommendations tailored to APOE genotype,’ says Jakob Norgren. He continues:

‘Since the prevalence of APOE4 is about twice as high in the Nordic countries as in the Mediterranean countries, we are particularly well suited to conduct research on tailored dietary recommendations for this risk group.’

The research was funded by, among others, the Swedish Alzheimer’s Foundation, the Swedish Dementia Foundation, the Emil and Wera Cornell Foundation, the Leif Lundblad family and other philanthropists, the Swedish Research Council and FORTE. The researchers state that they have no related conflicts of interest.

APOE Gene Facts:

Apolipoprotein E plays a central role in the transport of cholesterol and fats in the brain and blood. The protein is encoded by the APOE gene, which exists in three main variants: epsilon 2, 3 and 4. These variants affect the risk of developing Alzheimer’s disease and cardiovascular disease. Each person inherits two APOE genes, one from each parent, giving six possible combinations (genotypes): 2/2, 2/3, 2/4, 3/3, 3/4 and 4/4.

Compared to the most common genotype 3/3, one 4 variant increases the risk of Alzheimer’s disease by about three to four times and two 4 variants by about ten to fifteen times, while the 2 variant is associated with a lower risk. However, the increase in risk varies between different ethnic groups.

Source: Belloy et al., JAMA Neurology, 2023

Source: Karolinska Institutet

Categories : OphthalmologyTags :

Closing the Gap on Eye Care Through Early Detection this World Optometry Week

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Uneven access to optometry services in South Africa puts pressure on prevention, but collaboration and technology are helping shift the dial.

Photo by Hush Naidoo Jade Photography on Unsplash

Access to good eye care in South Africa remains uneven, resulting in many conditions being diagnosed too late. World Optometry Week, observed from 22 to 28 March, shines a light on this reality, where one in 10 South Africans suffers from some form of vision loss, highlighting the importance of eye health and the role early detection plays in preventing avoidable vision loss.

This challenge is exacerbated by the fact that, while there are approximately 4 200 registered optometrists in South Africa, only a small proportion practise in the public sector. This limits access to care for many communities and delays diagnosis, particularly in under-resourced areas. As a result, prevention remains one of the most important, yet underutilised, tools in protecting eye health.

“The reality is that many serious eye conditions develop without noticeable symptoms early on,” says Dr Themba Hadebe, Clinical Executive at Bonitas. “By the time vision is affected, the condition may already be advanced. Regular eye tests are critical in detecting issues early and preventing avoidable vision loss.”

This year’s World Optometry Week theme, “A Shared Vision: Collaboration in Global Eye Care”, underscores the need for a coordinated approach to improve access, strengthen prevention and enable early diagnosis. This is one way to ease pressure on the broader healthcare system, since identifying conditions earlier reduces the likelihood of more complex interventions later, benefiting both patients and providers.

Why early detection matters

Conditions linked to chronic illnesses, particularly diabetes, remain a significant contributor to vision loss in South Africa. Diabetic retinopathy is among the leading causes of blindness in working-age adults, yet it often develops without pain or early warning signs.

Advances in optometric technology are beginning to shift how the risks of permanent damage are identified and managed. Developments highlighted by the American Optometric Association point to a growing role for AI-assisted diagnostics and enhanced imaging in improving both the speed and accuracy of screening. These tools support clinicians by flagging potential abnormalities during routine eye tests, enabling earlier referral for further assessment where needed.

Within this context, collaboration between medical schemes and provider networks plays a role in strengthening preventative care. Through its partnership with PPN, Bonitas provides members with access to diabetic retinopathy screening as part of the eye testing process at participating network practices.

The screening process uses AI-assisted technology to evaluate retinal images in real time, flagging any irregularities that could indicate early-stage disease. This allows clinicians to identify potential issues ranging from diabetic retinopathy to glaucoma or macular degeneration before they progress to more serious stages. Patients who require further assessment are referred for secondary care, ensuring timely intervention and reducing the risk of irreversible vision loss.

“This approach extends the reach of early detection by combining advanced technology with coordinated care and helps make the most of the limited number of specialists available,” says Hadebe. “Spotting problems early dramatically improves outcomes while reducing pressure on our healthcare system. In practice, it means a member could walk into a routine check-up and leave with peace of mind, or if something is flagged, a clear path to treatment.”

As World Optometry Week highlights, awareness must translate into action. In a healthcare environment where access is not equal, regular eye tests, particularly for those at higher risk, remain essential to safeguarding vision and improving long-term health outcomes.

Categories : CancerTags :

Treatment Combo Benefits Patients with Leptomeningeal Metastasis

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Photo by Anna Shvets on Pexels

Patients with leptomeningeal metastasis (LM) have historically had few treatment options. Now, researchers from The University of Texas MD Anderson Cancer Center have found a combination of targeted therapies, tucatinib and trastuzumab, plus the  chemotherapy drug, capecitabine, may improve symptoms and extend survival in some breast cancer patients with LM. 

The Phase II study, published in Nature Cancer, included 17 female patients with newly diagnosed LM and HER2+ breast cancer. Median overall survival (OS) in those treated with the combination therapy increased from a historical average of 4.4 months to 10 months. At the 18-month mark, 41% of patients were still alive. Under the combination treatment, disease progression also stalled, with a median of seven months before central nervous system progression, and seven of 12 evaluable patients also had improved neurologic deficits.

“The combination achieved a clinically meaningful improvement in overall survival compared to historical controls,” said lead author Rashmi Murthy, MD, associate professor of Breast Medical Oncology. “For these patients, who often face limited treatment options, our results represent a step forward, offering new hope in how we treat and manage leptomeningeal metastasis.”

Why are there limited treatments for patients with leptomeningeal metastasis?

Leptomeningeal metastasis is difficult to treat primarily because the blood-brain barrier may block drugs from reaching the spinal fluid, where the metastatic cells are found. Additionally, LM is not a solid tumor but is made up of metastatic cells living in fluid, making them more difficult to target. Historically, there also are few studies about this specific disease. 

“In addition to encouraging survival outcomes, throughout this study we observed improvements in neurologic symptoms,” said co-lead author Barbara O’Brien, MD, associate professor of Neuro-Oncology. “Treatments for breast cancer leptomeningeal metastasis have historically focused on stabilising disease rather than improving symptoms, making these findings particularly meaningful and encouraging.” 

How do the treatments in this combination therapy work?

Tucatinib is a targeted therapy pill that blocks the HER2 protein, which helps some breast cancers grow. Trastuzumab is a targeted antibody that attaches to the HER2 protein on cancer cells and helps the immune system destroy them. Finally, capecitabine is a chemotherapy pill that turns into 5-fluorouracil (5-FU) in the body to eliminate fast-growing cancer cells.

The single arm, non-randomised, multi-phase study enrolled patients at four sites in the U.S., including UT MD Anderson. Eligible patients were at least 18 years old with histologically proven metastatic HER2+ breast carcinoma. These patients were treated with 21-day cycles of oral tucatinib (300 mg) twice daily, plus oral capecitabine (1000 mg/m2) twice daily on days 1-14 and intravenous trastuzumab (6 mg/kg) on day 21. 

What are other key findings of the study?

Side effects included diarrhoea, nausea, vomiting, hand-foot syndrome, and liver function test elevation. Most adverse effects improved or resolved with appropriate care and dose modifications. One patient saw alanine aminotransferase elevation after one cycle, which led to discontinuation of the combination, and symptoms resolved after one month.

Study limitations include early termination due to slow accrual following Food & Drug Administration (FDA) approval of the combination therapy. Additionally, LM from HER2+ metastatic breast cancer is rare, resulting in limited published data. As a result, the study design was informed by the small amount of available retrospective evidence.

Source: UT MD Anderson Cancer Center

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Rapid Diagnostics Alone Do Not Cut Antibiotic Prescribing for Respiratory Infections

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Credit: Scientific Animations CC4.0

Two international studies, a clinical trial led by the University of Oxford and University of Utrecht, and a qualitative study led by the University of Oxford and University of Antwerp, report that point-of-care diagnostic testing, when used alone is unlikely to reduce antibiotic prescribing for respiratory tract infections in primary care. The findings indicate that testing must be embedded within broader antimicrobial stewardship strategies to be effective.

The results of the PRUDENCE trial, published in The Lancet Primary Care took place in 13 European countries. Part of the randomised controlled trial with 2639 patients in all 13 countries was an in-depth qualitative evaluation involving clinicians and patients in six countries.

Together, the studies provide the most comprehensive evaluation to date of whether rapid diagnostic testing can meaningfully decrease antibiotic use in real-world primary care settings without having a negative impact on patient recovery.

Around 90% of antibiotics are prescribed by GPs in primary care, and most of these prescriptions are for respiratory infections such as sore throats and coughs, which are usually caused by viruses and do not need antibiotics.

Point-of-care tests have been widely promoted as a diagnostic tools to help clinicians in treatment decision making, thereby reducing unnecessary prescriptions.

Clinical trial across 13 countries shows no overall reduction in antibiotic prescribing

The clinical trial ran from December 2021 to January 2024. The trial enrolled 2,639 patients aged one year and older who presented with a cough or sore throat. All participants were included because their clinician was considering to prescribe antibiotics.

Participants were randomly assigned to usual care alone or to usual care plus a point-of-care testing strategy. Depending on symptoms and season, testing could include a CRP test (a blood test measuring inflammation), a group A streptococcus test (a rapid throat swab), an influenza A and B test, or a combination of these tests depending on clinical presentation and influenza season.

Antibiotics were prescribed to 45.7% of patients in the point-of-care testing group and 47.1% in the usual care group, a difference that is not statistically significant. Both groups recovered at the same rate, taking an average of four days to return to their usual daily activities. The study also found no increase in complications or serious adverse events linked to the testing strategy.

The trial concludes that point-of-care testing, when introduced as a standalone strategy in situations where clinicians are already inclined to prescribe antibiotics, does not substantially reduce antibiotic prescribing.

Qualitative study reveals why testing alone is insufficient

The qualitative study embedded within the trial explored how clinicians and patients experienced and used point-of-care testing. Researchers conducted in-depth interviews with 56 patients and 33 clinicians across six countries.

The findings from this study help explain why the trial did not lead to a reduction in prescribing rates.

Clinicians often used test results to confirm decisions they had already made, rather than to change them. When the initial clinical assessment strongly suggested a bacterial infection, clinicians frequently prioritised clinical judgement over test results. They also highlighted importance of relying on clinical intuition, and questioned the accuracy of the test rather than revising their prescribing decision.

Point of care tests were more effective in cases of genuine diagnostic uncertainty, when symptoms were non-specific or when it was difficult to distinguish a bacterial from a viral infection. In these cases, a test result could change the prescribing decision in either direction. However, perceived patient expectations, perceived severity of illness, timing of presentation, and cultural norms around antibiotics often outweighed test results.

The question is no longer whether point of care tests work in primary care, but under what conditions they can function optimally and how policy and medical practice can actively create those conditions.

Professor Sarah Tonkin-Crine at the Nuffield Department of Primary Care Health Sciences and senior co-author of the qualitative study, said: ‘The results of our study suggest that diagnostic tests alone are not sufficient. Clinicians across six very different countries and health systems described the same patterns; the primacy of clinical intuition, the pressure of perceived patient expectations and the difficulty of acting on a test result those conflicts with your own assessment. are fundamental to how clinical decisions. This tells us that point-of-care testing needs to be part of a broader strategy, one that includes clinician training, communication support, and clear guidance on how to act safely on test results.’

Professor Chris Butler, Associate Head for Research at the Nuffield Department of Primary Health Care Sciences and lead author of the trial, said: ‘Point-of-care tests have real potential, but our study shows that diagnostics on their own do not inevitably change prescribing decisions. When clinicians are already leaning towards antibiotics, test results often reinforce that choice. To make a meaningful difference, rapid testing must be combined with clear guidance, clinician training, and support to manage patient expectations. In addition, we need better evidence about the safety of following the prescribing implications of tests.’

Diagnostic testing has been widely promoted in national and international action plans as a key mechanism to reduce inappropriate antibiotic use. The results of these studies suggest that diagnostics tests alone are not sufficient to reduce antibiotic prescribing. They must be combined with structured clinician training, clear guidance on the safety of following test results, and strategies to address the cognitive dissonance- the discomfort of holding conflicting information that arises when test results challenge a clinician’s initial assessment.

The paper, ‘Point-of-care testing strategy versus usual care to safely reduce antibiotic prescribing for acute respiratory tract infections in primary care (PRUDENCE): a pragmatic, randomised controlled trial in 13 countries‘, is published in The Lancet Primary Care.

Source: Oxford University

Categories : Ageing NeurologyTags :

Popular Anti-ageing Compound Causes Callosal Brain Damage

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Part of the brain disappears in mice treated with dasatinib and quercetin

The image shows a section of the brain of a mouse treated with dasatinib and quercetin. The bluish area is the corpus collosum. The dotted outline shows the part of the corpus collosum that is affected by the medication. (Image courtesy of Crocker Lab/UConn School of Medicine)

A two-drug combination frequently used in anti-ageing research causes brain damage in mice, University of Connecticut researchers report in the March 16 issue of PNAS. The findings should make doctors cautious about prescribing the drug combo prophylactically, but also suggest new ways to understand multiple sclerosis.

“When you administer this cocktail to an animal, young or old, the myelin is damaged, which makes it disappear. Even worse in the young animals” than in the aged ones, says UConn School of Medicine immunologist Stephen Crocker.

Myelin is the insulation around the nerves. When it disappears, nerves don’t work as well, and people can develop numbness, pain, and lose the ability to walk. They can also have problems thinking and remembering. Missing myelin is the primary cause of multiple sclerosis. And Crocker and his colleagues saw it happen to mice when treated with dasatinib+quercetin (D+Q) at doses often used to treat ageing-related inflammation and metabolic disorders.

D+Q is a popular combination of medicines in anti-ageing research. Many studies have shown it works to eliminate aged cells that contribute to inflammation and other age-related symptoms. It is being tested for a range of diseases, from type II diabetes to Alzheimer’s. People in the anti-ageing scene sometimes even use it off-label, though the medical community discourages this. Very few studies have looked at its effect on the brain.

Evan Lombardo ’23 (CLAS), currently a Dartmouth neuroscience graduate student, and Robert Pijewski ’21 PhD, now at Anna Maria College, were working in Crocker’s lab when they wondered if it was possible to rejuvenate the brains of people with multiple sclerosis, and potentially heal their symptoms, using D+Q. They tried it on mice, both young (6 to 9 months) and old (22 months), as well as on brain cells cultured in a dish in the lab. The brain cells were oligodendrocytes, the cells that are supposed to grow and maintain myelin.

The results were dramatic. Healthy mice have myelin surrounding the axons (nerve cells) in the brain. It looks like dark rings around the lighter axon (see figure 1, the left panel.) But the mice treated with D+Q had much less myelin around their axons after the treatment, and the damage was worse in the younger mice. The corpus callosum, a region that connects the cerebral cortex to other parts of the brain and is associated with a range of important functions, also disappeared in mice treated with D+Q. This is known to happen sometimes to people who received chemotherapy, and causes the symptoms sometimes referred to as “chemo brain.”

When the researchers looked closely at the damaged brain tissue, they found clues as to why the myelin had disappeared. The myelinating cells – oligodendrocytes – hadn’t died. They’d regressed into a juvenile form of themselves. And the metabolism of the cells was abnormal, too.

“We suspect the drugs are choking off energy the cells need, and the cells respond by reducing complexity, reverting to a younger state, but less functional,” Crocker says.

Interestingly, these cells that have reverted look very much like a distinct population of cells found in people with multiple sclerosis. It suggests that in multiple sclerosis, myelinating cells might come under stress and revert to a younger stage. It also means those cells might be able to recover. And that is what the researchers are working on now.

“If we can mimic this, we have an amazing opportunity to see if the cells can recover and repair the brain,” Crocker says.

Source: University of Connecticut

Categories : Lab Tests and Imaging Respiratory DiseasesTags :

UP Researchers Innovate Handheld Detection Device that Could Transform TB Screening

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The new MARTI TB screening device

With their innovation of a small but powerful handheld device, researchers at the University of Pretoria (UP) are on course to redefine the tuberculosis (TB) screening process, which could ultimately help to combat the TB pandemic more effectively. TB is one of the deadliest infectious diseases worldwide, claiming more than 1.25 million lives each year, of which about 50 000 deaths occur in South Africa. It is the leading cause of death among people with HIV.

MARTI (mycolate antibody real-time immunoassay) is the name of the handheld device that can provide very high certainty that a person at risk does not have TB. Using just one drop of blood – and no laboratory – it is set to change the way TB is detected. It may even be adapted for use in both human and veterinary healthcare. The diagnostic is fast, accurate, affordable and – the intellectual part of it – proudly South African.

An internal validation trial was recently completed to confirm the accuracy of the test. These trial results show remarkable promise in terms of the specificity, sensitivity and accuracy of the diagnostic test, coming close to the range of targets set by the World Health Organization for the “perfect” test, making MARTI an ideal screening and diagnostic tool. An earlier trial demonstrated great potential in using this test to monitor TB treatment; these results were published in the journal Biomarkers in Medicine.

“Many people aren’t aware that TB doesn’t always sit in the lungs – it can be present in bones, joints and the brain,” says Professor Jan Verschoor, former research leader of UP’s Tuberculosis Research Group in the Department of Biochemistry, Genetics and Microbiology and now an emeritus professor of biochemistry who has been leading this discovery. “The ‘gold standard’ TB test that involves growing cultures from lung sputum can take about six weeks, by which time, many more people could have been infected by the patient or the patient’s health could have deteriorated beyond the prospect of cure. From a simple finger-prick blood sample, the MARTI test gives us a result in 30 minutes. This has profound cost and public health implications in a country like South Africa, where we conduct three to five million TB tests a year.

Tuberculosis bacteria. Credit: CDC

Caused by Mycobacterium tuberculosis, this resilient bacterium has long evaded simple detection methods, particularly in regions where healthcare infrastructure is limited. But now, an unexpected hero has emerged in the war on TB: a molecule in the bacterium’s waxy coat – specifically its mycolic acid (MA) – holds the key. These wax-like substances form a nearly impenetrable barrier, making the bacterium both drug-resistant and difficult to detect.

But while other scientists focused on breaking through this barrier, Prof Verschoor took a different approach: what if the wax itself could be used to detect the disease? He was the first to demonstrate that antibodies to the waxes are reliable indicators of active TB, irrespective of whether someone had been vaccinated or was coinfected with HIV.

A key aspect of the innovation came from Carl Baumeister, a PhD candidate under Prof Verschoor. He made the leap from slow laboratory-based biosensing to a handheld device that detects anti-MA antibodies accurately and affordably in less than 30 minutes. The result is a test that’s as clever as it is simple and cost-effective.

Detecting these anti-MA antibodies requires sophisticated sensing technology: the surface of a screen-printed carbon electrode is pre-coated with a thin layer of MA. MARTI works by flowing a drop of blood over this electrode. If a patient has TB, the sensor detects these antibodies in the blood sample; if a patient does not have TB, no signal would be generated since there are no anti-MA antibodies in the blood sample.

“The device fits in the palm of your hand and requires only a single drop of blood – no sputum, no needles, no laboratory,” says Carl Baumeister, Head of Operations of the UP spin-off company MARTI TB Diagnostics. “This may become a game-changer to diagnose TB in paediatric and HIV-positive patients, where obtaining sputum samples is often neither feasible nor safe. The same could apply to the 20% of all extra-pulmonary cases.”

“If MARTI says you don’t have TB, you can trust it,” Baumeister says. “That’s a critical trait when trying to rule out cases during an outbreak or in mass screening campaigns, much like what was needed during the COVID-19 pandemic.

Unlike other TB diagnostics, MARTI offers something rare and powerful: near-perfect negative predictive value in typical screening applications.

The internal validation trial across six healthcare facilities in Tshwane was led by Prof Veronica Ueckermann, Head of Infectious Diseases at Steve Biko Academic Hospital and UP’s Faculty of Health Sciences.

“Collecting, transporting, processing and analysing the samples from the various sites within the temperature and time constraints of the validation trial protocol posed a significant logistical challenge – but we succeeded,” says Mosa Molatseli, a senior research scientist who heads up the MARTI laboratory.

Recognising its potential, UP established the start-up company MARTI TB Diagnostics (Pty) Ltd to develop and eventually commercialise MARTI.

“This is designed to ensure that the technology remains in South African hands while attracting investment and serving global needs,” says Gerrie Mostert, interim CEO of the company. “The next steps are to get investors, funding and partner organisations on board, obtain regulatory approval and start manufacturing the kit. Ultimately, MARTI should be rolled out to clinics worldwide.”