Author: ModernMedia

Categories : General InterestTags :

Strength Looks Like Care: The Male Nurse Redefining South African Fatherhood

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For Bafana Manyisa, strength doesn’t look the way most men are taught it should. It’s not toughness or stoicism or an unshakeable composure. Strength, he says, looks like sitting with a patient who needs reassurance. It looks like supporting a new overwhelmed father navigating the parenting journey for the first time. It looks like simply being present for your family when they need you most.

As a registered nurse, Operational and Outreach Team Leader at Dis-Chem and Dis-Chem Baby City Clinics, husband and father, Manyisa has spent his career learning what few South African men are encouraged to admit: that care is one of the most demanding forms of strength there is.

From mechanics to healthcare

Raised in Mohlakeng on Johannesburg’s West Rand, Manyisa’s path to nursing was unconventional. His childhood dream was mechanical engineering. He spent his early years studying motor mechanics, working in workshops, enjoying the technical precision of the work. But something was missing.

“I realised that what fulfilled me most was helping people,” he explains.

It took his older sister, a primary healthcare nurse practitioner to recognise what he didn’t yet see in himself,  a natural capacity for compassion. She urged him to apply for the R425 nursing programme. “From the moment I started training, everything aligned,” he says. “I fell in love with nursing because it gave me the opportunity to make a real difference in people’s lives, especially during their most vulnerable moments.”

The values that shaped his approach to healthcare were rooted long before he entered any clinical setting. Growing up in Mohlakeng taught him resilience, humility, and the importance of community lessons he says no textbook could replicate. “Our community taught us to look out for one another,” he reflects. “Simple acts of kindness, respect for elders, and serving others became part of who I am.”

The weight of witnessing

Those values were tested most severely during his time at Eyethu Yarona Clinic under the Gauteng Department of Health. Faced with water shortages, electricity interruptions and stock limitations, the clinic ran on compassion and improvisation. It was difficult work in difficult conditions, yet it was there that Manyisa experienced one of the defining moments of his career.

After helping an elderly patient collect her chronic medication, she paused and told him something that has stayed with him ever since: “You make a difference in our lives. You don’t just give us medication, you treat us with care.”

That moment crystallised his understanding of nursing and later, fatherhood. “It’s not about treatment alone,” says the father of one. “It’s about dignity, empathy, and human connection.”

A different kind of strength

Working in healthcare has given Manyisa an intimate view of the pressures South African men carry in silence. Financial stress. The relentless expectation to provide. The demand to always appear strong. He sees men shoulder these burdens alone, asking for nothing, showing nothing.

His message to them is direct: asking for help is not weakness. Vulnerability is not failure.

“Too many men believe they have to carry everything on their own,” he says. “Real strength comes from being honest, seeking support when you need it, and taking care of yourself so that you can take care of those who depend on you.”

The qualities that make a good healthcare professional – empathy, resilience, patience, and care are, he believes, the very same qualities that make a good father. This Father’s Day, he’s actively encouraging more men to recognise this, to become more involved in their families’ health and wellbeing. To support partners during pregnancy. To take an active role in their children’s healthcare journeys. To show up.

The strongest thing

“People may forget what you said or what you did,” Bafana reflects. “But they never forget how you made them feel. Nursing teaches you resilience and compassion in ways no salary ever could.”

His story challenges a narrow version of masculinity that has done South African men no favours. Men can be leaders and caregivers. They can be strong and compassionate. They can provide and nurture.

Perhaps, he suggests, the strongest thing a man can do is simply care.

Categories : Expert Opinion IT in HealthcareTags :

Opinion Piece: Healthtech is Only as Strong as the Hands that Shape It

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By Vishal Barapatre, Group Chief Technology Officer at In2IT Technologies

| 17 June 2026

Healthcare is investing heavily in technology, but outcomes do not always improve at the same rate or deliver the desired effect. The issue is rarely a lack of tools. More often, it comes down to the way those tools are designed, connected, and maintained. Health technology, often referred to as Healthtech, delivers real value not just when systems exist, but also when expert IT partners shape them to turn health data into meaningful, useful intelligence throughout the entire care journey.

In many healthcare environments, technology has accelerated rapidly over the past decade. Hospitals and clinics have introduced electronic medical records, diagnostic platforms, and telehealth systems, with enormous potential, the benefits are often uneven when systems operate in isolation or fail to align with the realities of clinical workflows. The difference between technology investment and measurable clinical improvement often lies in the design and integration that happens behind the scenes.

The promise of healthtech lives in the data

At its core, healthtech is about data. This includes how data is captured, stored, presented, and analysed to support better patient care. Every interaction between a patient and the healthcare system generates information that can guide more informed decisions. From recognising early signals for preventive care, tracking progress during rehabilitation, to ensuring complete and accurate information during operative procedures, effective use of data underpins every stage of the healthcare journey.

Yet data alone is not enough. Without systems designed to bring clarity to complexity, information becomes fragmented, inconsistent, and largely underused. This is where expert IT partners are essential. They do not just implement platforms; they create the right conditions for data to support better patient care.

Another challenge lies in the diversity of healthcare data sources. Clinical records, laboratory results, imaging systems, wearable devices, and patient engagement platforms, all generate valuable information. However, without thoughtful integration and governance, these data streams can quickly become disconnected. When aligned, they allow clinicians to see a more complete picture of a patient’s health, enabling earlier intervention and more personalised treatment decisions.

Intuition does not happen by accident

There is a growing expectation that healthtech should feel intuitive, where insights emerge naturally without creating additional friction in already demanding clinical environments. However, intuitive technology does not happen by chance. It results from thoughtful choices about structure, integration, and user experience.

What needs to be understood is that a system’s value is not determined by its technical features but by how well it fits into clinical workflows. The data must be available at the right time, in the right context, and in a way that supports judgment instead of overwhelming it. Without this insight and expertise, even the most advanced systems may become obstacles instead of assets.

This is particularly important in high-pressure healthcare environments where time is limited, and decisions are critical. If systems require excessive navigation, duplicate data entry, or complicated interfaces, clinicians may spend more time interacting with technology than with the patients. Well-designed systems quietly support decision-making rather than compete for attention, ensuring that technology strengthens clinical practice of disrupting it.

Continuity of care requires continuity of systems

To add, preventive, rehabilitative, and operative care are often treated as separate areas, yet they are part of a single patient journey. The true value of healthtech emerges when data flows smoothly across these stages, creating continuity instead of hand-offs.

This continuity does not happen on its own. It relies on systems that preserve data integrity over time, integrate seamlessly across different care settings, and evolve as patient needs evolve. Without it, technology investments risk becoming isolated solutions rather than truly transformative tools.

When healthcare providers can access consistent patient information across departments and care phases, they gain a more holistic understanding of health outcomes. This continuity helps reduce redundant tests, prevent information gaps, and support coordinated treatment plans. Over time, it contributes to a healthcare environment where patients’ experiences feel more connected and less fragmented.

Trust is built behind the scenes

To truly be transformative, healthcare must rely on trust between patients and clinicians, as well as between clinicians and the systems they depend on. Yet, this trust is fragile, as a single system failure, data inconsistency, or security issue can erode confidence across a healthcare facility.

Trust is built on reliability, resilience, and strong governance. Systems must perform well under pressure, safeguard sensitive information, and evolve safely over time. Although this foundation work often goes unnoticed, its impact is felt every time clinicians use technology with confidence and ease.

The growing digitisation of healthcare has also made cybersecurity and data protection essential pillars of trust. Healthcare data is among the most sensitive information an organisation can manage. Protecting it requires robust security architecture, continuous monitoring, and governance practices that evolve as threats emerge. When these safeguards are embedded into the system architecture, healthcare organisations can innovate confidently without compromising patient privacy.

The real differentiator is partnership, not platforms

As healthtech continues to evolve, access to tools will be less of a significant differentiator. What will matter more is how those tools are shaped, connected, and sustained. Technology alone cannot provide better care. It requires partners who understand both the technical and human aspects of healthcare.

This is where an IT partner can navigate and guide healthcare organisations through complexity, turning possibilities into practice and ambitions into results. Their role is not just supportive but foundational in demonstrating the true value of healthtech. The future of healthcare will belong not to those who adopt the most technology, but to those who build it wisely.

Categories : Mental HealthTags :

Repurposing a Parkinson’s Drug for Treatment-resistant Depression Appears Promising

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Photo by Sydney Sims on Unsplash

For many people who suffer from depression, the condition is not just about feeling down, but also about a loss of motivation and difficulty finding pleasure in activities they used to enjoy. A study conducted in Sweden at Lund University and Region Skåne shows that a medicine used to treat Parkinson’s disease can be used as an add-on therapy to alleviate these symptoms in some patients with treatment-resistant depression.


The study has been published in Nature Medicine.

Researchers at Lund University and the psychiatric services in Region Skåne have identified a potential new therapy for the condition associated with depression that involves a reduced ability to feel joy, pleasure or motivation – known as anhedonia. Those affected may lose interest in things that they previously found meaningful or rewarding. 
 
The study is an example of what is known as drug repurposing, whereby an already approved medicine is used to treat a different condition. In this study, the researchers investigated pramipexole, which has long been used to treat Parkinson’s disease, as an add-on therapy for depression with marked anhedonia. 
 
“Anhedonia is one of the most debilitating symptoms of depression, and something on which current antidepressant therapies often have only a limited effect. Our findings suggest that pramipexole could be an important new therapy option for this patient group,” says Daniel Lindqvist, a researcher at Lund University and senior consultant in psychiatry at Region Skåne. 

All participants in the study had marked anhedonia. Patients were given either pramipexole or a placebo as an add-on to their ongoing medication for nine weeks.
 
“Those treated with pramipexole for anhedonia showed a more pronounced improvement compared with the placebo group. The effect persisted during a six-month follow-up period among those patients who chose to continue treatment,” says Daniel Lindqvist.
 
The researchers used advanced brain imaging techniques (7 Tesla fMRI) to investigate the possible biological mechanisms underlying the effect, and activity monitors to assess whether the therapy affected patients’ everyday movement and activity levels. 


“We found that pramipexole was linked to a positive effect on the brain’s reward system and increased physical activity in everyday life. This supports the theory that the drug affects the dopamine system, which plays a key role in motivation and reward processing,” says Filip Ventorp, a postdoc at Lund University and resident physician at Region Skåne.
 
Most patients experienced no major issues with the treatment, and few patients dropped out during the randomized controlled trial. Common side effects included sleep problems, nausea and dizziness, but these could usually be managed by adjusting the dose. Even those who chose to continue with the follow-up phase of the study for a further six months generally responded well to the therapy.
 
“Efficacy and safety were maintained over time during the follow-up phase, which is particularly relevant in cases of long-term and treatment-resistant depression. Although most participants in our study tolerated the drug well, it is important to monitor any side effects, such as impaired impulse control and daytime fatigue,” says Marie Asp, a psychiatric researcher at Lund University and senior consultant in psychiatry at Region Skåne.

 På svenska

By Tove Smeds – published 12 June 2026

Categories : PaediatricsTags :

Study Finds No Link Between Newborn Upper Lip Frenulum and Breastfeeding Difficulties

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Photo by Tim Bish on Unsplash

A joint study by the University of Oulu and Oulu University Hospital in Finland suggests that a newborn’s upper lip frenulum is unlikely to be a major cause of breastfeeding difficulties.

The study, published in JAMA Network Open, followed 264 mother–infant pairs at Oulu University Hospital between 2023 and 2024. Researchers assessed the anatomy and mobility of the upper lip frenulum in healthy, full-term infants and compared the findings with mothers’ reported breastfeeding experiences.

Overall, 86% of mothers reported experiencing breastfeeding difficulties during the first days of breastfeeding. However, based on data collected in the six-month follow-up questionnaire, the researchers found no association between the anatomical characteristics of the upper lip frenulum and breastfeeding problems. The thickness of the frenulum, its attachment site, or other structural features did not increase the risk of breastfeeding difficulties.

Instead, previous breastfeeding experience appeared to be beneficial for breastfeeding. Breastfeeding problems were reported less frequently among mothers with experience of breastfeeding previous children.

According to the researchers, an upper lip frenulum that interferes with breastfeeding is a rare finding. Nevertheless, the number of lip-tie release procedures has increased in several countries in recent years, despite limited evidence supporting their benefits.

“Breastfeeding difficulties in newborns should always be assessed comprehensively,” said paediatrician and neonatologist Outi Aikio. “Based on our findings, we found no evidence to support upper lip frenulum surgery in healthy, full-term infants. Instead, I would emphasise the importance of high-quality breastfeeding support, particularly in the early weeks after birth, when breastfeeding challenges are common.”

Source: University of Oulo

Research article: Niemelä L, Lohi V, Aitamurto S, Lehtinen A, Aikio O. Upper Lip Frenulum Findings and Breastfeeding Problems in Healthy Newborns. JAMA Netw Open. 2026;9(5):e2613308.

Categories : AgeingTags :

‘Wait and See’: Three Words Costing Postmenopausal Women Their Hair

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More than half of postmenopausal women have clinically measurable hair loss. The most common response is to tell them to do nothing

Photo by Kateryna Hliznitsova on Unsplash

52% of postmenopausal women experience female-pattern hair loss, according to peer-reviewed research published in Menopause, the journal of the North American Menopause Society. Hot flushes – one of the symptoms that owns many public conversations about menopause – affect a larger proportion of women, but the disparity is not in the data. It is in how medicine responds to them. At more than one in two women, female-pattern hair loss is routinely absent from clinical consultations, rarely investigated at first presentation, and almost universally met with the same advice: give it time.

Why timing matters

During and after menopause, declining oestrogen levels and shifts in androgen balance cause susceptible hair follicles to gradually shrink. Each hair grows finer and shorter, with a briefer growth period per cycle. Left long enough without intervention, some follicles reach a point of no return, and the damage becomes irreversible.

“When we say irreversible, we mean that the follicle has become so damaged or inactive that it can no longer reliably regenerate a healthy terminal hair on its own,” says Dr Kashmal Kalan, Medical Director at Alvi Armani South Africa. “Medical therapies may help stabilise surrounding hair at that stage, but they may not recover what has already been lost,” says Dr Kalan.

For many women, that window closes not because they made an informed decision, but because nobody told them they had options. The advice they received – that gradual thinning is normal, that stress is a likely factor, that it may settle with time – sounded measured.

The cost of being dismissed

When the condition is classified as cosmetic, clinical urgency disappears. The patient is reassured rather than assessed, even though menopausal thinning is frequently a visible signal of systemic change. Hormonal shifts, nutritional deficiencies, thyroid dysfunction, and inflammatory or metabolic factors are all documented contributors, and none of them are cosmetic.

The consequences reach well beyond the scalp. Research published in the British Journal of Dermatology found that over 60% of women with hair loss actively avoided social interactions because of it. A separate study in the Journal of Cosmetic Dermatology found that affected women reported significantly higher social anxiety, lower self-esteem, and reduced life satisfaction compared to men experiencing the same condition. What begins on the scalp moves into how a woman presents professionally, how she engages socially, and how she sees herself.

A clinical framework built for men, applied to women

The protocols widely used to assess and treat this condition were largely developed around male patients. Defined hairline recession, concentrated donor areas, and linear progression are all considered male presentations. As a result, women have largely been assessed within a framework built for someone else.

“Applying male-based protocols to women can absolutely compromise outcomes. Female hair restoration requires an understanding of female-specific patterns of loss, progression risk, and the long-term hormonal picture. Preservation of softness, natural density gradients, and age-appropriate framing are considerations with no real equivalent in the male framework. In experienced hands, those distinctions are built into every stage of assessment and planning – not treated as secondary.”

What rigorous care looks like

At Alvi Armani, the first step is not a treatment recommendation – it is a diagnosis. A comprehensive workup, including blood investigations, is conducted before any intervention is discussed, because in menopausal women the drivers are rarely singular and what is visible on the scalp is seldom the whole picture.

“Not every patient is an immediate candidate for surgical restoration and recognising this is itself part of responsible practice. Medical stabilisation, non-surgical therapies, and hormonal management in collaboration with relevant specialists all form part of the treatment landscape – guided by individual diagnosis, not assumption,” Dr Kalan concludes.

“If any of this sounds familiar – the gradual changes, the concerns dismissed, the years of quietly adapting – it is worth knowing that the window is not necessarily closed. But it is also not standing still. Hair loss during menopause is extremely common – but common does not mean insignificant, and it does not mean inevitable.”

Categories : Obstetrics & Gynaecology Pain ManagementTags :

Supermarket Receipts Show Trends in Menstrual Pain Relief

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An analysis of 211 million supermarket transactions found that more than a quarter of customers buying menstrual products bought pain relief at the same time.

Photo by Sora Shimazaki on Pexels

More than a quarter of women buying menstrual products also purchase pain relief at the same time – and those in lower-income areas are significantly less likely to do so – according to a new study published this week in the open-access journal PLOS Digital Health by Dr. Victoria Sivill of the University of Bristol, UK, and colleagues, which used supermarket loyalty card data to map menstrual pain disparities across England.

Menstrual pain is a common concern affecting many individuals globally. Existing research highlights its negative impact on daily activities, including school and work attendance.

In the new study, researchers analysed anonymised loyalty card data from a major UK health and beauty retailer, encompassing 211 million transactions by 3.4 million individuals between 2006 and 2015. They analysed how often shoppers purchased menstrual products at the same time as pain relief, and how that compared to a customer’s baseline rate of buying pain relief.

The analysis found that 26.7% of customers who purchased menstrual products also bought pain relief in the same transaction. These customers were nearly four times more likely to buy pain relief while buying menstrual products compared to other shopping trips. As a validation of the approach, the most common interval between consecutive menstrual purchases across the dataset was exactly 28 days – consistent with the average menstrual cycle.

Regional income emerged as the strongest predictor of menstrual pain purchases: customers in the lowest-income areas were 32% less likely to purchase pain relief at the same time as menstrual products compared to those in the highest-income areas. The authors note that lower rates of pain relief purchases in deprived areas likely reflect an inability to afford over-the-counter medication rather than lower rates of menstrual pain itself

“The study highlights the need for greater awareness and policy interventions to address the high prevalence of menstrual pain as well as socioeconomic dimensions of menstrual pain,” the authors say. “Public health initiatives should incorporate menstrual pain relief as part of broader efforts to improve health equity.”

 Co-author Dr James Goulding notes: “It is wonderful that smart data research in the UK is able to bring issues which may have once been overlooked in scientific settings – such as the sheer scale and impact of menstrual pain – to light. This is well overdue.”

Co-author Dr Anya Skatova adds: “Like many women, I was aware of how common menstrual pain is, but the scale of painkiller purchases alongside menstrual products was still striking. Using shopping data, we can see just how widespread the need for pain relief really is. This kind of evidence helps make menstrual pain visible at a population level and provides a strong foundation for systemic change in how it is recognised, treated, and prioritised in public health.” 

Provided by PLOS

Press Preview: https://plos.io/42wSl1W

In your coverage please use this URL to provide access to the freely available article in PLOS Digital Health: https://plos.io/4wzrwbh

Contact: Anya Skatova, anya.skatova@bristol.ac.uk; James Goulding, james.goulding@nottingham.ac.uk 

Image Caption: Fig 1. Average (mean) individual summary statistics for Menstrual, Pain and Menstrual Pain customer sets via analysis of transactional logs between 30th April 2006 to 16th April 2015. 

Image Credit: Sivill et al, PLOS Digital Health, 2026

High-Resolution Image Link: https://plos.io/4ujYPxl

Citation: Sivill V, Ljevar V, Goulding J, Skatova A (2026) What can shopping transactional data reveal about relative prevalence of menstrual pain and period poverty in England? PLOS Digit Health 5(5): e0001308. https://doi.org/10.1371/journal.pdig.0001308 

Categories : TransplantsTags :

New Liver Perfusion Technology Marks a Breakthrough for Transplant Care in South Africa at Wits Donald Gordon Medical Centre

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L-R – Dr Bilal Bobat, Professor Jerome Loveland, Dr Sharan Rambarran and Dr Dinen Parbhoo, the transplant team at Wits Donald Gordon Medical Centre alongside the liver perfusion machine, the first of its kind to be implemented on the African continent.

Johannesburg, 12 June 2026: For a patient waiting for a liver transplant in South Africa, the hardest part is not the surgery. It is the wait and the knowledge that an organ may never come. In a country facing severe organ shortages, every decision to accept or decline a donor liver carries immense weight and every viable organ that goes unused represents a lost opportunity to save a life.

At the centre of changing this reality is the Wits Donald Gordon Medical Centre (WDGMC), home to one of the leading liver transplant programmes in Africa and a unit internationally recognised for its contribution to specialised transplant care, research and surgical training. Having performed over 1 000 liver transplants, the programme represents decades of expertise, innovation and collaboration.

Now, WDGMC, in partnership with Surgeons for Little Lives and with support from key corporate sponsor Weelee, has introduced a state-of-the-art liver perfusion machine, becoming the first transplant centre on the African continent to implement this technology for liver transplantation.

This technology keeps donor livers viable outside the body while clinicians assess, monitor and actively improve the condition of the organ before transplantation. By allowing transplant teams to better maintain organ viability, the machine has the potential to increase organ utilisation, reduce complications and improve transplant outcomes for patients who may otherwise not survive the wait.

“As a transplant programme, our responsibility extends far beyond the operating theatre,” says Professor Jerome Loveland, Head of Solid Organ Transplantation at WDGMC. “This technology will help us better assess donor organs and increase the number of livers that can safely be transplanted, whilst simultaneously improving results. In a country where every donor organ matters, this will have a significant impact on organ utility and patient outcomes.”

South Africa’s transplant programmes continue to achieve strong outcomes despite operating within a severely resource-constrained environment and against the backdrop of ongoing organ shortages. As a result, transplant teams are often required to make difficult decisions under significant pressure.

“This technology changes the level of information we have available before transplantation. Traditionally, organs are preserved on ice and assessment is limited. Machine perfusion allows us to monitor how the liver is functioning outside the body. Beyond the valuable information it provides, the machine has the ability to resuscitate the liver by delivering oxygen to the liver cells, creating the best metabolic environment outside the body. This helps us make more informed clinical decisions and potentially increases the number of organs that can safely be transplanted,” says Dr Sharan Rambarran, Transplant Surgeon at WDGMC.

The introduction of the machine is also expected to contribute to reduced post-operative complications, shorter hospital stays and improved recovery outcomes.

“Too many patients in South Africa deteriorate while waiting for a transplant because there are simply not enough donor organs available,” says Dr Bilal Bobat, Transplant Hepatologist at WDGMC. “Anything that helps us safely expand organ utilisation has the potential to directly impact survival and quality of life for patients and families facing end-stage liver disease.”

“Weelee is always looking for opportunities to contribute to causes that create real and lasting impact,” says Errol Levin, CEO of Weelee. “Supporting advancements in liver perfusion technology aligns perfectly with our commitment to innovation that improves lives. This ground-breaking initiative has the potential to save countless lives and we are proud to be associated with a project of such significance.”

WDGMC plays a unique role within South Africa’s healthcare system. As a private academic hospital affiliated with the University of the Witwatersrand, the Centre combines highly specialised clinical care with academic medicine and collaboration across both the private and public healthcare sectors.

While the technology represents an important advancement in liver transplantation, clinicians stress that increasing organ donation awareness remains critical to improving access to life saving transplants in South Africa.

For the transplant teams, this marks not only a clinical advancement but the beginning of a broader effort to continue strengthening transplant medicine in South Africa.

Categories : CancerTags :

Irradiation May Help CAR-T Cell Therapy Work Better Against Solid Tumours

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New study shows focused irradiation helps immune cells keep cancer-fighting CAR T cells active and contained inside tumours

CAR-T cells (brown, arrowheads) infiltrating solid tumours. Left: unirradiated (0 Gy). Right: after focal irradiation (8 Gy).

Researchers from the Icahn School of Medicine at Mount Sinai have discovered a promising new way to improve CAR-T cell therapy for solid tumours such as lung cancer and melanoma. The study, published in Nature Cancer, found that focused irradiation, a targeted therapy that delivers high-energy beams to stun rapidly growing cells such as cancer, can help CAR-T cells survive longer and work more effectively inside tumours. 

CAR-T cell therapy involves removing the patient’s T cells (a type of immune cell), reprogramming them in the lab to fight cancer, and then infusing them back into the patient. It has transformed treatment for some blood cancers, but has not worked as well for solid tumours such as lung cancer and melanoma. Patients with solid tumours typically have bulky, treatment-resistant disease, and one of the central reasons CAR-T cells fail in this setting is that they do not persist or expand at the tumour long enough to eliminate it. Even when CAR-T cells initially reach the tumour, their numbers dwindle before they can finish the job. 

The research team discovered that tumour irradiation does something unexpected: it turns dendritic cells, the immune system’s most powerful antigen-presenting cells, into a local source of stimulation for CAR-T cells inside the tumour.  

In mouse models of advanced lung cancer and melanoma, irradiation promoted dendritic cells to capture intact tumour surface proteins and display them on their own membranes, a process called “antigen dressing.” These antigen-dressed dendritic cells then engaged the chimeric receptor on the CAR-T cells – the laboratory-engineered protein that gives these cells the ability to target specific proteins – keeping them alive and multiplying within the tumour over several weeks.  

The result was durable control of advanced lung tumors that CAR-T cells alone could not eliminate.  

“This study shows that irradiation can do more than kill cancer cells; it can enhance cell therapy,” said corresponding author Jalal Ahmed, MD, PhD, who led the study and is Assistant Professor of Immunology and Immunotherapy, and Radiation Oncology, at the Icahn School of Medicine at Mount Sinai. “We found that dendritic cells can dress themselves in tumor proteins and use them to directly expand CAR-T cells through the engineered receptor. This was completely unexpected – dendritic cells normally engage T cells through an entirely different mechanism.” 

A second finding addresses one of the most pressing safety challenges in the field. The researchers found that the CAR-T cell response stayed largely confined to the irradiated tumour. CAR-T cells expanded within the tumour but did not become more active in nearby healthy tissues, even when those tissues expressed the same protein targeted by the CAR-T cells. On-target activity against healthy organs has been one of the most serious safety barriers in solid tumour CAR-T cell therapy and has led to the termination of clinical trials. By selectively concentrating CAR-T cell activity at the tumour, focused irradiation may allow treatment of advanced tumours at lower and safer CAR-T cell doses.  

“What is striking is that irradiation does not just amplify the immune response – it tells the immune system where to act,” said study co-author Miriam Merad, MD, PhD, Robin Chemers Neustein Professor of Immunology and Chair of Immunology and Immunotherapy at the Icahn School of Medicine at Mount Sinai. “Confining CAR-T cell expansion to the tumour could open up a new generation of safer cell therapies for solid cancers.” 

This approach is particularly relevant for patients with metastatic solid tumours, who currently have few options. The irradiation treatment used in the study is available in cancer care centres around the world. This means the strategy could be tested in clinical trials without requiring new equipment, new drugs, or new infrastructure.  

“This work suggests that preparing the tumour environment is important to optimise the efficacy of CAR-T cells,” said study co-author Michel Sadelain, MD, PhD, who was previously at Memorial Sloan Kettering Cancer Center and is currently the founding director of Columbia University’s Institute for Cell Engineering and Therapy. “Irradiation may provide a practical way to help CAR-T cells succeed in solid tumours.” 

The researchers caution that the findings are still preclinical and must be tested in human clinical trials. The team is now working to define the molecular mechanism of antigen dressing, identify the signals dendritic cells use to sustain CAR-T cells, and translate the approach into trials for patients with advanced solid tumours. 

Source: Mount Sinai

Categories : Mental Health NeurologyTags :

Brain Region Linked to Transcranial Magnetic Stimulation’s Antidepressant Effects

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Source: Pixabay

A circuit that runs from the prefrontal cortex near the front of the brain to a deeper brain structure called the insular cortex appears to mediate the antidepressant effects of a newer form of transcranial magnetic stimulation (TMS), according to a study led by Weill Cornell Medicine investigators. The discovery could lead to more effective TMS treatment of depression.

In the study, published May 7 in Cell, the researchers developed mice whose brains can be stimulated artificially in a prefrontal region to mimic the antidepressant effect of a widely used—but not well understood—TMS technique. The researchers showed that this antidepressant effect in the mice depends heavily on the indirect stimulation of a connected region, the insular cortex.

“We’re excited about this work because it advances our understanding of the antidepressant effects of TMS, and points to more effective ways of delivering this therapy,” said study senior author Dr. Conor Liston, the Robert Michels, M.D. Professor of Psychiatry in the Department of Psychiatry and a professor of neuroscience in the Feil Family Brain and Mind Research Institute at Weill Cornell Medicine. Dr. Shane B. Johnson, Dr. Devin Rocks and Dr. Laura Chalencon, postdoctoral associates in psychiatry at the time of the study, were co-first authors of the study.

Depression is one of the most commonly diagnosed illnesses in the modern world, and its prevalence has been increasing in recent decades. In the United States alone, tens of millions of people are treated for depression annually, according to the National Institute of Mental Health. Antidepressant drugs called selective serotonin reuptake inhibitors are the most common treatments but can take weeks to work and frequently have side effects.

TMS treatments, though they involve clinic visits, have the advantage of being more targeted, with few if any side effects, and are increasingly used for patients who do not respond to drug therapy. One new TMS protocol called accelerated intermittent theta-burst stimulation (aiTBS) has been found to reduce or abolish depression symptoms in many patients after only a few days of treatment. But exactly how TMS works and how it could be optimized have been notoriously difficult to study.

“There’s a lot of variation in how you can deliver TMS, which makes it very hard to test systematically in humans,” said Dr. Liston, who is also a psychiatrist at NewYork-Presbyterian/Weill Cornell Medical Center. “The variables include the duration of treatment in each session, the specific pulse rhythm, the interval between sessions and the specific brain area targeted, among others.”

The researchers developed a mouse model to explore and optimize aiTBS. The optogenetic mouse model allows the researchers to use light pulses to stimulate specific groups of neurons, with the same rhythms used in aiTBS. The team showed that stimulating the same prefrontal region targeted by aiTBS reverses stress-induced, depression-like behaviors in the mice.

Next, the scientists identified the specific prefrontal neurons that mediate this effect, and revealed changes that occur in these neurons, including denser growths of connections between brain cells in response to the stimulation. They then traced these neurons’ connections, finding that a connection to the insular cortex is necessary for the antidepressant effect.

The functions of the insular cortex, or ‘insula’, are complex and not completely understood; but they include processing bodily sensations – such as hunger and pain – and integrating them with emotion-related signals.

“The insula hasn’t been covered much in TMS research, in part because it is too deep in the brain to reach with ordinary TMS protocols, but it is one of the most consistently altered brain regions in studies of patients with depression,” Dr. Liston said.

Experiments in mice don’t always translate to humans. So, the researchers used functional magnetic resonance imaging to map brain connections and electroencephalography to measure neuronal responses in consented patients receiving TMS. They found that TMS stimulation of the prefrontal cortex does have a downstream effect on the insula in these patients.

The results overall suggest that aiTBS’s antidepressant effect might be improved by maximising its downstream stimulation of the insula – a prospect that Dr Liston and his colleagues now plan to investigate further using their mouse model and in future clinical trials.

The identification of the neurons that are important for aiTBS’s effects and the changes that occur in them could also lead to new drug therapies targeting those neurons, Dr Liston said.

“In the meantime, another exciting strategy with great potential is to pair drug treatment with TMS to accelerate the antidepressant response,” he said.

Source: Weill Cornell Medicine

Categories : TransplantsTags :

Can an Organ Transplant Really Change Someone’s Personality?

On By ModernMedia
Photo by Seb [ P34K ] Hamel on Unsplash

Adam Taylor, Lancaster University

Changes in personality following a heart transplant have been noted pretty much ever since transplants began. In one case, a person who hated classical music developed a passion for the genre after receiving a musician’s heart. The recipient later died holding a violin case.

In another case, a 45-year-old man remarked how, since receiving the heart of a 17-year-old boy, he loves to put on headphones and listen to loud music – something he had never done before the transplant.

A recent study suggests that heart transplant recipients may not be unique in experiencing personality changes. These changes can occur following the transplantation of any organ.

What might explain this? One suggestion could be that this is a placebo effect where the overwhelming joy of receiving a new lease on life gives the person a sunnier disposition. Other transplant recipients suffer from guilt and bouts of depression and other psychological issues that might also be seen as personality changes.

However, there is some evidence to suggest that these personality changes aren’t all psychological. Biology may play a role, too.

The cells of the transplanted organ will perform their expected function – heart cells will beat, kidney cells will filter and liver cells will metabolise – but they also play a role elsewhere in the body. Many organs and their cells release hormones or signalling molecules that have an effect locally and elsewhere in the body.

The heart seems to be most commonly associated with personality changes. The chambers release peptide hormones, including “atrial natriuretic peptide” and “brain natriuretic peptide”, which help regulate the balance of fluid in the body by affecting the kidneys.

Around two hundred heart transplants are performed in the UK each year. VesnaArt/Shutterstock

They also play a role in electrolyte balance and inhibiting the activity of the part of our nervous system responsible for the fight-or-flight response. The cells in charge of this are in the hypothalamus – a part of the brain that plays a role in everything from homeostasis (balancing biological systems) to mood.

So the donor organ, which may have a different base level of hormones and peptide production from the original organ, could change the recipient’s mood and personality through the substances it releases.

It has been shown that natriuretic peptide levels are higher following transplantation – and never return to normal. Although some of the elevation is probably a response to the trauma of surgery, it may not account for everything.

Memories stored outside the brain

The body stores memories in the brain. We access them when thinking or they can be triggered by sight or smell. But memories are basically neurochemical processes where nerves convey impulses to each other and exchange specialised chemicals (neurotransmitters) at the interface between them.

While in transplant surgery, many of the nerves that govern the function of the organ are cut and are not able to be reattached, this doesn’t mean that the nerves within the organ do not still function. In fact, there is evidence that they may be partially restored a year after surgery.

These neurochemical actions and interactions could feed into the nervous system of the recipient, enacting a physiological response that then affects the recipient’s personality according to memories from the donor.

We know that cells from the donor are found circulating in the recipient’s body and donor DNA is seen in the recipient’s body two years after the transplant. This again poses the question of where the DNA goes and what actions it may have.

One thing it does is stimulate immune responses. These immune responses may be enough to trigger personality changes as long-term, low-level inflammation is known to be able to change personality traits, such as extroversion and conscientiousness.

Whichever mechanism, or combination of mechanisms, is responsible, this area of research warrants further investigation so that recipients can understand the physical and psychological changes that could occur following surgery.

Adam Taylor, Professor and Director of the Clinical Anatomy Learning Centre, Lancaster University

This article is republished from The Conversation under a Creative Commons license. Read the original article.