Tag: 12/8/25

Categories : Diseases, Syndromes and ConditionsTags :

Bubonic Plague Treatment Proven Highly Effective and Safe in Global First

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Scanning electron micrograph of Yersinia pestis, which causes bubonic plague, on proventricular spines of a Xenopsylla cheopis flea. Credit: NIAID

Researchers from the UK and Madagascar, in collaboration with Madagascar’s health services and national plague programme, have conducted the world’s first rigorous clinical trial of treatments for bubonic plague.

The IMASOY trial provides the first robust evidence of the efficacy and safety of two treatment regimens. They also found that a ten-day course of an oral antibiotic (ciprofloxacin) is a highly effective and safe alternative to existing treatment with injectable antibiotic requiring hospitalisation.

Plague has scourged humanity for millennia. Though cases have been declining, it remains a high-threat pathogen of pandemic potential, due to its widespread animal reservoir and potential for being weaponised via deliberate release. Most continents see sporadic cases of bubonic plague every year, with Madagascar reporting approximately 80% of global cases. Bubonic plague is a life-threatening disease with mortality ranging from 15-25%.

The results from the trial, published in the New England Journal of Medicine, are the outcome of a hugely ambitious clinical trial conducted over the last five years in rural Madagascar.

With many cases occurring in remote villages and with outbreaks being unpredictable, the team deployed dozens of research assistants, and trained over 230 local doctors and nurses and 1300 village health workers. The trial was embedded within Madagascar’s national health service and was conducted with the support of the Ministry of Public Health.

Several treatment options are included in the current international and national guidelines, but none of them have been rigorously tested in humans. Regulatory approval has been based solely on data from animal studies and human safety data.

Researchers designed the IMASOY trial to test two treatments for plague. Patients were randomly allocated to receive either a ten-day oral regimen of ciprofloxacin (an antibiotic tablet which can be taken at home), or a regimen requiring three days’ injectable gentamicin followed by seven days’ ciprofloxacin, (with the intravenous (IV) therapy requiring patients to be hospitalised).

450 patients with clinically suspected bubonic plague were enrolled between 2020-2024 at 47 sites in 11 districts in Madagascar and treated with either regimen. Of these, 222 plague infections were confirmed by laboratory testing.

Key findings:
•    Both regimens were found to be highly effective and safe, with overall treatment success rates of about 90% and an overall mortality rate of about 4%.
•    A ten-day ciprofloxacin regimen has many advantages over a regimen requiring three days of injectable antibiotics. It alleviates bed space (particularly in health centres with minimal bed availability for the surrounding villages), reduces healthcare worker workload, and is much cheaper – costing about one-tenth of the current treatment regimen, depending on the route of administration.

With funding from Wellcome and the UK Foreign, Commonwealth, and Development Office, researchers from the University of Oxford, Institut Pasteur de Madagascar, Centre Hospitalier Universitaire Joseph Raseta Befelatanana, Centre d’Infectiologie Charles Mérieux, London School of Hygiene and Tropical Medicine, along with Madagascar’s health services and national plague programme, collaborated through the International Severe Acute Respiratory and emerging Infection Consortium (ISARIC) to fill this gap in knowledge.

Piero Olliaro, Professor at the Pandemic Science Institute, University of Oxford and senior author of the study said: ‘Despite its deadly history, we’ve had little clinical evidence on treating bubonic plague – until now. Thanks to the patients and healthcare workers in the trial, we now have real-world proof of effective, safe treatment. Ongoing data analysis will deepen our understanding of the disease, including risk factors, symptoms, and diagnostics.’

Mihaja Raberahona, physician at CHU Joseph Raseta Befelatanana and researcher at the Centre d’Infectiologie Charles Mérieux Madagascar said: ‘In Madagascar, where plague cases occur in remote rural locations with limited healthcare infrastructure, taking a straightforward oral antibiotic is vastly preferable to a treatment requiring injections. It alleviates healthcare worker workload and is also much cheaper – costing about one-tenth of the current treatment regimen.’

Rindra Vatosoa Randremanana, Medical epidemiologist at Institut Pasteur de Madagascar said: ‘The trial was a massive operational undertaking. Many patients were in remote villages and the unpredictable nature of the outbreaks made the research very challenging. Recruiting the 450 patients, of whom about half were confirmed with bubonic plague, took five plague transmission seasons and an army of research assistants, doctors and community health workers. We are hugely grateful to everyone who took part.’

The impact of this study is far-reaching. As a result of the trial, the researchers will be working with national and international bodies like the World Health Organization (WHO) to provide the evidence that may be required to update clinical guidelines, thereby translating the results into practice and saving lives.

The full paper, ‘Ciprofloxacin versus Aminoglycoside-Ciprofloxacin for Bubonic Plague‘, is published in the New England Journal of Medicine.

Source: University of Oxford

Categories : CancerTags :

When Should Preventive Mastectomy be Offered in High Breast Cancer Risk?

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Photo by National Cancer Institute on Unsplash

More women at higher risk of breast cancer should be offered a mastectomy, according to researchers at Queen Mary and London School of Hygiene and Tropical Medicine.

A new analysis, published in JAMA Oncology, has found that the surgical technique was a cost-effective way of reducing the likelihood of developing breast cancer compared to breast screening and medication. Current guidelines on who is offered mastectomy may need to be revised to reflect these new findings. 

Clinicians currently use personalised risk prediction models which combine genetic and other data to identify those women who are at a higher risk of developing breast cancer (BC). Subsequent treatment options – including mammograms, MRI screening, surgery, and medication – are then offered dependent on each woman’s level of risk. 

Risk reducing mastectomy (RRM) is recommended for women at high risk, but in practice this surgery is only clinically offered to those carrying faults (called pathogenic variants) in genes that are known to increase the likelihood they will develop the disease (BRCA1/ BRCA2/ PALB2 PV). 

Professor Ranjit Manchanda from Queen Mary University of London, Dr Rosa Legood from London School of Hygiene and Tropical Medicine, along with colleagues from Manchester University and Peking University created a new economic evaluation model to accurately predict the level of risk that would make RRM a more cost-effective treatment. 

For their model, researchers used guidelines from the National Institute for Health and Care Excellence (NICE) to determine whether a treatment is considered cost-effective. Their model showed that mastectomy was a cost-effective treatment for women aged 30 or above who have a lifetime breast cancer risk greater than or equal to 35%. Offering RRM to women in this cohort could potentially prevent 6,500 of the 58,500 cases of breast cancer that are diagnosed every year in the UK. 

Professor Manchanda, Professor of Gynaecological Oncology at Queen Mary and  Consultant Gynaecological Oncologist, said: “We for the first time define the risk at which we should offer RRM. Our results could have significant clinical implications to expand access to mastectomy beyond those patients with known genetic susceptibility in high penetrance genes- BRCA1/ BRCA2/ PALB2 – who are traditionally offered this. This could potentially prevent can potentially prevent ~6500 breast cancer cases annually in UK women. We recommend that more research is carried out to evaluate the acceptability, uptake, and long-term outcomes of RRM among this group”.. 

Dr Legood, Associate Professor in health economics at the London School of Hygiene & Tropical Medicine, said: “Undergoing RRM is cost-effective for women 30-55 years with a lifetime breast cancer risk of 35% or more. These results can support additional management options for personalized breast cancer risk prediction enabling more women at increased risk to access prevention.”  

Dr Vineeth Rajkumar, Head of Research at Rosetrees, said: “Rosetrees is delighted to fund this truly groundbreaking research that could have a positive impact on women worldwide.” 

The researchers used data from women aged between 30 and 60 with varying lifetime breast cancer risks between 17% and 50%, and who were either undergoing RRM or receiving screening with medical prevention according to currently used predictive models. 

NICE deems a treatment cost-effective if it typically brings one additional year of health for no more than £20 000–£30 000 per patient (known as the ‘willingness to pay’ threshold, or WTP). The researchers’ model used a threshold of £30 000/Quality Adjusted Life Year. 

Source: Queen Mary University London

Categories : Respiratory DiseasesTags :

RSV Infection Significantly Affects Cardiac Risks of Older Adults

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Photo by Anna Shvets

Respiratory syncytial virus (RSV) is a well-known cause of infections in children, but it’s understudied in older individuals. In a retrospective study published in the Journal of the American Geriatrics Society, adults aged 65 and older hospitalised for RSV in Ontario, Canada experienced significantly higher rates of adverse outcomes such as longer length of hospital stay, transfer to intensive care, and 30-day mortality, compared with patients hospitalised with influenza, urinary tract infection, or fracture.

Interestingly, RSV hospitalisation was also associated with higher rates of heart failure and atrial fibrillation up to 1-year post-discharge, regardless of prior cardiovascular conditions.

“Unlike other respiratory viruses, immunity against RSV tends to decline relatively quickly. This means that a previous infection will not afford the same long-term protection as it might for influenza or COVID-19,” said corresponding author Chris Verschoor, PhD, HSN, Foundation Research Chair in Healthy Aging at Health Sciences North Research Institute. “Our findings reinforce the importance of RSV vaccination in older adults and suggest that monitoring for signs of heart disease following an RSV illness may be pragmatic.”

Source: Wiley

Categories : Metabolic Disorders Neurodegenerative DiseasesTags :

Does Metformin Possibly Help Prevent Dementia?

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Created with Gencraft. CC4.0

New research in Diabetes, Obesity and Metabolism reveals that metformin, a medication traditionally prescribed to treat diabetes, is linked to lower risks of dementia and early death.

In the study by investigators at Taipei Medical University that included 452,777 adults with varying degrees of overweight and obesity, 35,784 cases of dementia and 76,048 deaths occurred over 10 years. Metformin users exhibited significantly lower risks of both dementia and all-cause death than nonusers.

The benefits of metformin were seen across all categories of overweight, obesity, and severe obesity, with 8–12% lower risks of dementia and 26–28% lower risks of death.

“Although our study results are promising for metformin’s effects on dementia and mortality, further research is required to explore the mechanisms involved,” said co-corresponding author Chiehfeng Chen, MD, PhD, MPH.

Source: Wiley

Categories : Dermatology Injury & TraumaTags :

“Skin in a Syringe” a Step Towards a New Way to Heal Burns

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Researchers in fields such as regenerative medicine and materials science have collaborated to develop a gel containing living cells that can be 3D-printed into a transplant. Photographer: Magnus Johansson

Finding a way to replicate the skin’s complicated dermis layer has long been a goal of healing burn wounds, as it would greatly reduce scarring and restore functionality. Researchers at Linköping University have developed a gel containing living cells that can be 3D-printed onto a transplant, which then sticks to the wound and creates a scaffold for the dermis to grow.

Large burns are often treated by transplanting a thin layer of the top part of the skin, the epidermis, which is basically composed of a single cell type. Transplanting only this part of the skin leads to severe scarring.

“Skin in a syringe”

Beneath the epidermis is the dermis, which has the blood vessels, nerves, hair follicles and other structures necessary for skin function and elasticity. However, transplanting also the dermis is rarely an option, as the procedure leaves a wound as large as the wound to be healed. The trick is to create new skin that does not become scar tissue but a functioning dermis.

“The dermis is so complicated that we can’t grow it in a lab. We don’t even know what all its components are. That’s why we, and many others, think that we could possibly transplant the building blocks and then let the body make the dermis itself,” says Johan Junker, researcher at the Swedish Center for Disaster Medicine and Traumatology and docent in plastic surgery at Linköping University, who led the study published in Advanced Healthcare Materials.

The most common cell type in the dermis, the connective tissue cell or fibroblast, is easy to remove from the body and grow in a lab. The connective tissue cell also has the advantage of being able to develop into more specialised cell types depending on what is needed. The researchers behind the study provide a scaffold by having the cells grow on tiny, porous beads of gelatine, a substance similar to skin collagen. But a liquid containing these beads poured on a wound will not stay there.

The researchers’ solution to the problem is mixing the gelatine beads with a gel consisting of another body-specific substance, hyaluronic acid. When the beads and gel are mixed, they are connected using what is known as click chemistry. The result is a gel that, somewhat simplified, can be called skin in a syringe.

“The gel has a special feature that means that it becomes liquid when exposed to light pressure. You can use a syringe to apply it to a wound, for example, and once applied it becomes gel-like again. This also makes it possible to 3D print the gel with the cells in it,” says Daniel Aili, professor of molecular physics at Linköping University, who led the study together with Johan Junker.

3D-printed transplant

In the current study, the researchers 3D-printed small pucks that were placed under the skin of mice. The results point to the potential of this technology to be used to grow the patient’s own cells from a minimal skin biopsy, which are then 3D-printed into a graft and applied to the wound.

“We see that the cells survive and it’s clear that they produce different substances that are needed to create new dermis. In addition, blood vessels are formed in the grafts, which is important for the tissue to survive in the body. We find this material very promising,” says Johan Junker.

Blood vessels are key to a variety of applications for engineered tissue-like materials. Scientists can grow cells in three-dimensional materials that can be used to build organoids. But there is a bottleneck as concerns these tissue models; they lack blood vessels to transport oxygen and nutrients to the cells. This means that there is a limit to how large the structures can get before the cells at the centre die from oxygen and nutrient deficiency.

Step towards labgrown blood vessels

The LiU researchers may be one step closer to solving the problem of blood vessel supply. In another article, also published in Advanced Healthcare Materials, the researchers describe a method for making threads from materials consisting of 98 per cent water, known as hydrogels.

“The hydrogel threads become quite elastic, so we can tie knots on them. We also show that they can be formed into mini-tubes, which we can pump fluid through or have blood vessel cells grow in,” says Daniel Aili.

The mini-tubes, or the perfusable channels as the researchers also call them, open up new possibilities for the development of blood vessels for eg, organoids.

Source: Linköping University

Categories : Medical Research & TechnologyTags :

Podcast: Could Infrared Light Have Deeper Biological Effects than Believed?

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Light transmission through the hand from an 850nm LED source. Because the tissues are relatively
thin compared with the thorax it was possible to map the spectrum here against known biological absorbers.
The images clearly show that deoxygenated blood is a key absorber. Also, bone can not be seen and hence is
relatively transparent at these longer wavelengths. Source: Jeffery et al., Scientific Reports, 2025.

In this podcast, we explore how some infrared wavelengths of sunlight can penetrate the human body – even through clothing – and have a systemic positive impact on physiological functions. Sounds like something out of science fiction, but a recent article published in Scientific Reports has demonstrated this effect in humans.

In this study, exposing the torsos of human participants to 830–860nm infrared light was found to boost mitochondrial function and ATP production. There were notable improvements in vision, despite the eyes being shielded from the infrared light. If infrared light is indeed beneficial, what does this mean for our current way of life, indoors and illuminated by LED lights – which notably lack infrared light?