Asthma, what is it and how do we treat it?Read More
Today, 2nd May 2017, is World Asthma Day, a day dedicated to asthma prevention, diagnosis and treatment.
What is asthma?
Asthma is a heterogeneous disease characterised by chronic airway inflammation and variable airway obstruction that is reversible, either spontaneously or after treatment. It affects people of all ages and often starts in childhood, although it can also appear for the first time in adults. The disease is long-term or chronic and the prevalence in different countries varies widely, but the disparity is narrowing due to rising prevalence in low and middle income countries and plateauing in high- income countries.
An estimated 300 million people worldwide suffer from asthma, with 250,000 annual deaths attributed to the disease. It is estimated that the number of people with asthma will grow by more than 100 million by 2025. Approximately 250,000 people die prematurely each year from asthma. Almost all of these deaths are avoidable.
There’s currently no cure for asthma, but there are simple treatments that can help keep the symptoms under control so it doesn’t have a significant impact on the patient´s life. Some people, particularly children, may eventually grow out of asthma, but for many it is a lifelong condition.
Treatment with inhaled corticosteroids is the dominating anti-inflammatory treatment during asthma and is recommended at all stages of the disease, except for the mildest. The inhaled corticosteroids can be combined with long-acting beta-2 agonists, these are symptom-controllers that are helpful in opening the airways. (Reference: http://www.aaaai.org/conditions-and-treatments/asthma)
In addition, leukotriene modifiers can further relieve symptoms for some patients, as leukotrienes are important mediators in asthma. Produced by eosinophils, mast cells and macrophages they contribute to chronic inflammation during asthma.
New drug treatments
In addition to traditional treatments, new drugs are being developed to relieve the different symptoms of asthma. One of them, anti-IL-5 (Mepolizumab) has recently been approved both in Sweden and the UK.
This drug is used to help patients with severe, difficult to treat asthma. Approximately five per cent of asthma patients fall within this category, but since asthma is such a prevalent disease, this proportion adds up to quite a few people.
Mepolizumab targets severe eosinophilic asthma – where the inflammation of the airways is linked to a particular type of white blood cell (eosinophils). It is a humanised monoclonal antibody that binds to interleukin-5 (IL-5) and hinders IL-5 from binding to its receptor on eosinophils, leading to a decrease of eosinophils in blood, tissue and sputum. It is believed that around 40% of people with severe asthma will have an eosinophilic phenotype – meaning that they may be able to benefit from the new treatment.
Mepolizumab is administered through sub-cutaneous injection every two to four weeks. Despite the high cost of the drug doctors are positive.
“A very badly affected group of patients can get help and if a few of these individuals can get a better control over their asthma, their need for healthcare would decrease and their ability to work would increase. This could mean economic benefits for both healthcare and the society,” says Christer Jansson, professor and consultant at the lung and allergy clinic at Akademiska sjukhuset, Uppsala, Sweden.
Benralizumab is another drug targeting eosinophilic asthma, that is undergoing testing right now. Unlike mepolizumab it uses a different pathway; targeting the IL-5 receptor, causing eosinophil apoptosis (cell death). One potential advantage of benralizumab is that it can be given less often, every two months instead of every two weeks, which may lower the cost of the treatment.
Into the future
Hopefully these drugs are just the first of a new line of treatments available targeted at severe asthma. Research is needed to help patients with other types of severe asthma and better diagnostic tests are needed to help ensure that people can have a confirmed diagnosis quickly. This will mean appropriate treatments can be offered, freeing people to go to work, school, raise families and live unrestricted lives that are not overshadowed by asthma.
What are your thoughts on future treatments and diagnostics for asthma? Let me know @fraidifrida
Are we the generation to eliminate one of the biggest killers in human history?Read More
April 25th marks World Malaria Day, a day dedicated to promoting the global efforts to understand and control Malaria – one of the biggest killers in human history. A disease so deadly, some researchers believe it may be responsible for the deaths of almost half of all people who have ever lived.
Caused by different forms of the Plasmodium parasite, there are four types of this life-threatening disease of varying severities. In its most serious form it can affect the kidneys and brain, causing anaemia, coma and death. Malaria is present in over 90 countries and roughly half of the population is currently at risk of catching the disease, with the greatest burden being in the least developed areas where there is very limited access to life-saving preventions, diagnoses and treatments.
How is malaria spread?
It is quite fitting that this lethal disease is transmitted to people through the deadliest animal on the planet – the mosquito. The Mosquito itself does not benefit from transmitting the malaria parasite, it is merely the disease vector – but, having survived for hundreds of millennia, with a population in the trillions and the ability to lay hundreds of eggs at a time, it’s an organism that certainly makes a very effective carrier.
A mosquito bite is simply the beginning of the process for the plasmodium sporozoites (an immature form of the parasite), which have accumulated in the mosquitos’ salivary glands, ready to be released into your body once your skin has been penetrated. This is where the human infection begins, and the sporozoites parasitize the liver, where they appear dormant as they mature and multiply to merozoites. The cells they inhabit eventually erupt and the merozoites are released into the bloodstream, cunningly disguising themselves with the liver cell membranes to avoid an immune attack. This is where they begin their second assault, causing red blood cells to erupt and release toxins that stimulate an immune response – it is this that leads you to experience flu-like symptoms such as fever. In severe cases, if the blood-brain barrier is breached, this can lead to a coma, neurological damage or even death.
The current situation
There have been large-scale efforts to eradicate malaria in the last 75 years. For example, during the WHO’s anti-malarial campaign in the 1950s and 60s DDT was used which, at the time, was hailed as kryptonite to mosquitoes. Bill Gates has famously stated that the world’s fight against malaria is one of the greatest success stories in the history of human health, and yes, over the last couple of decades there certainly has been a significant decline in the global burden of malaria. In fact, since 2000, almost 60 countries have seen a drop of at least 75% in new malaria cases, contributing to a 37% drop globally. However, the 2016 WHO report shows that in 2015 alone more than 400,000 people died of malaria and 214 million were infected. So, the job is far from finished.
Target Malaria – a new approach
There have been remarkable advances in gene-editing technologies in recent years, so one of the main focuses in malaria research lies in exploring different strategies to reduce or modify the populations of Anopheles mosquitoes; specifically, the three species in this genus that are responsible for most of the malaria transmission in Africa. Target Malaria is a not-for-profit research consortium that aims to develop and share technology for malaria control. Their focus is reducing the number of the deadliest malaria-transmitting mosquitoes in Africa – Anopheles gambiae. Specifically, they are interested in targeting female mosquitoes, as these are the only ones that bite, and this is an effective approach to control population size. Target Malaria are investigating the potential of using nuclease enzymes, that cut specific sequences of DNA, to modify mosquito genes. By changing certain genes, malarial resistance, female infertility and almost exclusively male offspring can be induced. The researchers are inserting genes that code for these enzymes into mosquito eggs, with the hope of affecting their reproduction. An example of this research involves nucleases that cut the X chromosome while males are making their sperm, resulting in mainly male offspring. Alongside this, researchers are also investigating how to disrupt the fertility of female mosquitoes to reduce the number of offspring, as well as engineering mosquitoes that are unable to transmit malaria.
These scientists are utilising a method called ‘gene drive’, a powerful emerging technology that is able to override genetic rules to ensure all offspring acquire a trait, as opposed to just, half as would normally be the case, allowing the trait to be spread extremely quickly.
Nowhere are the devastating effects of malaria as obvious as in sub-Saharan Africa, where hundreds of thousands fall victim each year, making up 90% of the total mortality count for the disease. Target Malaria researchers are currently working in Mali, Uganda and Burkina Faso with Bana, a small village in Burkina Faso, having the potential to be the site of a revolutionary genetic experiment. At Imperial College London, gene drive mosquitoes are being designed to have reduced female offspring or the inability to reproduce in general, and are then planned to be released into the wild in Bana. Their hope is that this would nearly eradicate Anopheles gambiae, to a point sufficient to prevent malaria transmission.
So what are we waiting for?
For one thing, the communities need to be prepared for the release. Firstly, there needs to be education, not just regarding genetic engineering and the impact the release will have, but also basic genetics – which may be a challenge in a community where there is no equivalent term, even for the word gene. Additionally, there are still years before scientists will be able to fully develop test gene drive mosquitoes in this manner.
If an experiment of this type is successful in the future, not only could this essentially eradicate malaria, but it could also pave the way for eliminating other mosquito-borne diseases such as dengue fever or even other insect-transmitted diseases like Lyme disease. However, humans have never before changed the genetic code of a free-living organism on this scale and released it into the wild. This genetic-engineering technology is very powerful and definitely needs to be treated as such. But, with millions dying and suffering at the hands of malaria each year, should we look to do this sooner rather than later?
What do you think? Could we be the generation that ends one of the oldest and deadliest diseases in human history? Tweet me your thoughts @PranikaAtNotch.
Progress for patients with Parkinson’s diseaseRead More
On April 11th this year, World Parkinson’s Day will mark 262 years since James Parkinson was born and 200 years since he published his essay ‘On the Shaking Palsy’, which led to an official recognition of Parkinson’s Disease (PD). Today, it’s estimated that over 10 million people worldwide have PD. Despite widespread awareness of PD and its most common symptoms, scientists don’t know why PD develops, and there is no cure. As a result, treatment has been restricted mostly to drugs that ease the symptoms, and physiotherapy.
Researchers have been exploring PD extensively over the decades and are closer to understanding its underlying biology. These studies are leading to promising new drug treatments that are now entering clinical trials, as well as new possibilities for reversing PD by repairing patients’ brains. Here’s a quick summary of a few recent developments.
What is Parkinson’s?
PD is a progressive neurodegenerative disease. It causes nerve cells in parts of the brain that control movement to stop working and die off. In healthy brains, these neurons rely on the brain chemical, dopamine, to communicate with one another. Replacing the lost dopamine in PD patients’ brains has therefore been the focus of many treatments over the decades.
Although PD is a degenerative disease that is more common in older people, we now know it is not specifically a disease of old age: around five to ten per cent of PD patients are aged under 50. Currently, there are no biochemical tests for PD; diagnosis depends on observation of the patient by a clinical and/or neurological specialist.
Every patient’s experience of PD can be different, but common symptoms include tremors – especially in hands or fingers when the limbs are at rest, slowness of movement and stiff, rigid muscles. These effects can be painful as well as debilitating, and become progressively worse.
It’s a challenging disease to diagnose, predict and treat for several reasons. The speed at which the disease progresses and symptoms develop can vary from one patient to the next. Sometimes Parkinson’s is hereditary, but most of the time it’s not. More recently, scientists have discovered that Parkinson’s can also affect parts of the brain that don’t control movement, resulting in a variety of ‘non-motor’ effects that include mental illness such as depression.
Since the 1960s, PD patients have been prescribed drugs such as levodopa that increase dopamine in the brain. Such drugs help to improve patients’ mobility but are associated with unpleasant side effects that typically get worse over time and can contribute to the patient’s illness. It’s also common for patients on these drugs to experience sudden “off periods” when the treatments just stop working. In the long term, the side effects can seriously outweigh the benefits of the treatment and there is an urgent need for more effective drugs.
Finding new drug treatments
In recent years, scientists have learned more about the biology of Parkinson’s and how it causes nerve cells to malfunction. Researchers have been particularly interested in Lewy bodies, which are clumps of proteins that typically appear in the affected brain cells of PD patients. One of the main components of Lewy bodies is alpha-synuclein, and a number of experiments have shown that alpha-synuclein could play a role in the development of PD. As a result, drug companies are now investigating whether new therapies targeting alpha-synuclein could prevent PD development, or at least slow down the disease progression in patients. Clinical trials have recently started for some of these potential new drugs and the Parkinson’s community is eagerly awaiting the results.
Replacing damaged brain cells
An alternative approach to PD treatment is to transplant new cells into the brain, to replace the dead cells. Several different methods have been tried over the past few decades, including transplants of dopamine-producing foetal cells and, more recently, stem cell grafts. In the late 1980s, researchers at Lund University in Sweden successfully transplanted dopaminergic foetal cells into the brains of 18 patients with Parkinson’s. The majority of the patients showed long-term improvements in their symptoms and some of them were able to stop taking levodopa.
One of the patients from the study died recently, 24 years after the transplant, and post-mortem analysis provided a detailed picture of what happened to the transplant in the patient’s brain. During his life, the patient had initially responded very well to the transplant: he was able to come off levodopa completely for a few years, then continued for ten years on a reduced drug dose. The patient then started to decline and, by 18 years after the transplant, the patient’s disease symptoms were similar to those shown before the study. In line with these behavioural observations, post-mortem analysis of the patient’s brain showed that the transplanted cells had grown into the damaged brain areas and successfully formed new nerve connections (re-innervation). However, signs of Parkinson’s disease, such as Lewy bodies, were found in a small proportion of the transplanted cells.
Further transplant studies have been carried out since the pioneering Lund study, but with mixed success. However, it has been generally accepted that cell replacement could be beneficial for PD, and researchers are now investigating modified approaches using stem cells that can develop into dopamine-producing neurons when transplanted into the brain.
Stem cells have attracted a lot of interest for repairing human brains and other organs in recent years. These immature cells have not yet differentiated into their final cell type (such as skin, muscle or brain cells) and, therefore, have important advantages for brain repair. Importantly, stem cells are much more widely available than foetal tissue because stem cells can come from a variety of sources, including adult humans, and can also be grown in the lab. A special type of inducible stem cell (iPSC) can be manipulated to grow into almost any type of cell that’s specialised for the brain or body region of interest. Scientists are now researching iPSCs as well as other types of stem cell for transplanting into Parkinson’s brains, and it’s expected that these will soon be ready for testing in PD patients.
Tailoring treatments to patients
Another area of research that could be beneficial for PD in the future is personalised medicine. This approach relies on collecting individual patients’ biological information and using that to decide the best course of treatment for the patient. For example, the data might include details about a patient’s immune system, their genes, and levels of hormones and other proteins or biomarkers. This can provide important information about the patient’s stage of disease and response to treatment. In turn, this helps with their prognosis and finding more tailored treatment regimes. Although much work has yet to be done before new Parkinson’s treatments become widely available, the personalised medicine approach could be particularly beneficial for PD given the variation seen in patients’ symptoms, disease progression and response to existing treatments.
What are your thoughts on future treatments for PD? Let me know Kate@Notch
Lindvall O, Rehncrona S, Brundin P et al. (1989). Arch Neurol 46(6): 615-631.
Lindvall O, Brundin P, Widner H et al. (1990). Science 247(4942): 574-577.
Stoker TB & Barker RA (2016). Regenerative Medicine 11(8): 778-786.
Parkinson’s Disease Foundation
The Michael J Fox Foundation
Revealing the mind of a synaestheteRead More
“Human life is but a series of footnotes to a vast obscure unfinished masterpiece” – Vladimir Nabokov, Lolita
Have you ever wondered if you’re not seeing the whole picture? Can science even define what the ‘whole picture is’ and categorise human sensation? What can we learn from the experiences of synaesthesia today?
Synaesthesia is one neurological example of how our brains truly do differentiate our senses from each other. There are many varied manifestations of synaesthesia, but they share the condition where one sense, such as hearing, triggers a sensation in another, such as taste.
Brain imaging studies have found that synaesthetic colour experience activates colour regions in the occipito-temporal cortex. Additionally, six brain regions are activated, these regions are in the motor and sensory regions as well as ‘higher level’ regions in the parietal and frontal lobe. This has led to scientific speculation that a synaesthete’s brain is wired differently or has extra connections.
Interestingly, this performs a spectrum of artistic characteristics in music, art and literature. I was first introduced to this phenomenon at a talk hosted by the Manchester Literary and Philosophical Society. It is studied with as much interest by the arts as it is by science.
Many music artists of today have claimed possession of synaesthetic senses, such as Pharrell, Kanye West, Billy Joel and Stevie Wonder. Pharrell describes his ‘Happy’ 2013 single as “yellow with accents of mustard and sherbet orange”. Synaesthesia almost neurologically embodies the idea that people can have different ‘taste’ in the arts.
My favourite example of synaesthesia at work is in Vladimir Nabokov’s masterpiece Lolita, where much of the language is chiastic (ABBA) to create alliterative and musical sounds. Nabokov himself had grapheme- colour synaesthesia, which is the association of colours with numbers and letters. Some synaesthetes say his prose reads as if it were meant to be visually pleasing, almost like a word painting.
“Lolita, light of my life, fire of my loins. My sin, my soul. Lo-lee-ta: the tip of the tongue taking a trip of three steps down the palate to tap, at three, on the teeth. Lo. Lee. Ta.”
Here, Nabokov imagines the syllables of Lolita walking in his ‘palate’ to ‘teeth’. It contends that his beautiful idea of Lolita does not come from a physical person but is created from the sensory feeling of her syllables inside his head. We could argue the narrator’s love for Lolita stems from a vivid synaesthetic experience.
So are we non-synaesthetes missing out? Most synaesthetes claim that they feel sorry for those people without the condition. Yet, it’s not without its negatives too, such as feeling intensely disgusted by common sounds or words. Personally, I think synaesthesia is still relatable to those without the condition. Nabokov reiterates this idea that synaesthesia is an extrapolation of taste, and allows one to experience the world more intensely:
“I am therefore inclined to think of my synaesthesia as an extension of the typical writer’s overinvestment in words: an extension…”
What are your thoughts on taste and synaesthesia? Do you think science can understand it better by analysing art? Send me your Qs via Twitter @ZaraAtNotch
Gaby’s Top 5 Science moments 2016Read More
This year for my top 5 science moments, I have taken a different tactic to past yearly reviews. I have resisted the temptations to choose a discovery from each discipline of science for the sake of balance and, instead, have included the stories that spoke to me. So, if you are looking for a wide-reaching view of the science of 2016, then this may not be for you. But if you are interested in the science discoveries that captured the imaginations and hopes of this geneticist then grab a cuppa. Here is my top 5 moments from 2016.
5. Pocket-sized DNA sequencer
The ability to sequence a genome and read the code to life is arguably one of the greatest breakthroughs in the history of modern science. However, the hardware involved is normally at least the size of a microwave oven and can be very fragile. This year, a biotechnology company made a significant breakthrough with a sequencing machine, the MinION. This sequencer is only 86 grams and is small enough to be forgotten in a pocket! This year however, it was proven to be not only functional but has also been shown to work in microgravity.
In June this year the MinION was sent to the International Space Station to be tested on board. The future holds great things for this technology and space exploration. In theory, the crew could use it to quickly identify the precise cause of any illness to ensure that it is treated effectively. This type of diagnosis is imperative for future missions to Mars and beyond when there is no possibility to restock the limited supply of antibiotics.
However, it is not only for space travel that this development will be useful. Reducing DNA sequencing to a small size means it could be combined with other technologies to allow patients to monitor levels of certain DNA sequences at home. In theory, cancer patients could track the progress of their disease by the level of fusion chromosomes and HIV patients could monitor viral levels as easily as diabetics can monitor their blood sugar.
Whatever the future uses are, the pocket-sized DNA sequencing technology opens new doors for genomics, therapeutics and disease management.
4. Promising results from stem cell treatments for stroke
Stroke research, especially developing therapies, is a complex field that is subject to many challenges. For a long time, the industry belief was that the most effective treatment for stroke would be one that can be administered to patients as soon as possible after the fact, even in the back of an ambulance.
However, new research from Stanford University has broken new ground with a treatment that can be administered 3 years after a stroke. Adult mesenchymal stem cells were injected into the brain of volunteer stroke victims between 6 months and 3 years after the stroke had occurred. Normally, after 6 months doctors would expect no future improvement to occur. However, after the procedure, one patient regained movement in her right arm and right leg even after being confined to a wheelchair for the previous few years.
Mesenchymal stem cells have interesting therapeutic potential as they have been shown to repress the immune system which may have contributed to the high success rate and low number of side effects observed in this trial.
Whatever the theory and the reason behind the success, this trial has paved the way for more successful therapies for stroke victims and has given hope to those that currently live with a disability as a result.
3. Progress in the field of human CRISPR research
2015 was undoubtedly the year of gene editing. As Science’s breakthrough of the year and with multiple advances, it was the beginning of the gene editing revolution. As a result, this year was expected to be when all of that research and progress was finally applied and the true value of CRISPR was revealed. It did not disappoint.
2016 saw the first human trial in China using CRISPR-Cas9 in an experimental therapy for a patient with advanced lung cancer. In this trial, CRISPR was targeted to PD-1 in the targeted cells, which aimed to induce cell death and halt the growth of the cancer.
Equally notable progress was made closer to home in the USA with the start of a safety test of CRISPR for human use. The safety test is administering CRISPR to 18 patients with various cancers but will not be assessed for efficacy. The completion of this safety screen should allow the development of CRISPR therapeutics in the USA and encourage investment into applying CRISPR to proven gene editing based therapies. Such proven techniques include the removal of rejection genes with TALENS by Great Ormond Street Hospital or the addition of HIV resistance genes to patients using techniques done with ZFNs.
The approval of these trials is a big moment for gene editing based therapeutics. After the death of Jesse Gelsinger in 1999, the industry is understandably cautious surrounding these techniques. However, recent developments, improvements and precautions for conflict-of-interest all contribute to making CRISPR-based therapeutics that little bit closer.
2. The continued race for a Zika vaccine
Two years ago, the first reports began to surface about the outbreaks of microcephaly in South America. Quickly, research abounded into the detection of the cause and the Zika virus made headlines worldwide. Reminiscent of the Ebola outbreak, a known virus became more dangerous and was posing a real threat to millions of people.
The response was instant. Never before have so many corporations, research groups and academics reacted so quickly to develop a vaccine for an outbreak. Some vaccines are on track to finish development in a remarkable and record-breaking 2-year turnaround. Lessons have obviously been learned from the Ebola outbreak and teams are reacting quickly to not miss the critical window for a vaccine.
Many have taken the opportunity of the outbreak to develop innovative vaccine technologies. One such technique involves administering spliced viral DNA. The DNA enters the nuclei of cells and is synthesized into partial viral particles. Antibodies can then be created in response so the body is prepared for a future infection. To improve the vaccine, some manufacturers are using RNA as a more flexible alternative to enter the nucleus.
The development of the Zika vaccines has made it into my top 5, not only because new and innovative techniques are being used. The response by the science industry has given me a lot of hope for the future of science. In the face of the crisis, the industry has shown how teams from across the world can work together to create solutions.
1. Discovery of a key moment in evolutionary history
Few moments in evolutionary history can be argued to be as impactful as the point where life transitioned from single-celled amoeba to complex multicellular organisms. The ability to form a multicellular organism is the point at which life, as we know it, became possible. This year it was revealed that this breakthrough in evolution might have been the result of a single mutation and the consequence of simple dumb luck.
For the formation of multicellular organisms, communication between cells is imperative and a failure to communicate, can lead to cancer, developmental abnormalities and death. Researchers found that, approximately one billion years ago, a single mutation occurred in the gene GK-PID.
This mutation allowed the protein to orient the divisional direction of cells by dictating the position of the mitotic spindle in the cell. However this mutation has an intriguing history when you consider how it functions. The mutation gave GK-PID the ability to link an anchor in the cell membrane to the mitotic spindle. The intriguing point is that, at the time of GK-PID’s mutation, the anchor had not yet evolved!
The reason that this discovery is my number 1 of the year is simple. As a geneticist, I enjoy how this discovery reveals the seldom-admitted secret of biology. Life as we know it, and the key moments of evolution, all came down to plain, old, boring, dumb luck!
So, which of my top 5 got you excited about what science has to offer in 2017? Do you agree with my list? Is there something missing?
Let me know on Twitter @GabyAtNotch
Phantom Limbs and Virtual RealityRead More
After watching the inspirational Paralympic games this September, it got me thinking about amputees and the challenges they face. As a neuroscientist, my immediate thoughts went to a condition called Phantom Limb Syndrome, a very peculiar sensation that occurs in around 90% of amputees. It made me wonder how on earth does this happen! It didn’t seem logical, so I looked into the background and causes of the syndrome and that led me to some very interesting treatments for patients – spanning a period of over 450 years!
What is a Phantom Limb?
Firstly, let’s get a little bit of background on the term Phantom Limb Syndrome. It is the sensation or feeling that a limb is still part of a person after that particular limb has been amputated. The feeling can be characterised into both painful and non-painful sensations. Non-painful sensations include the feelings of touch, temperature, pressure and often itching, whilst the painful sensations usually come in the form of burning and shooting pains. This phantom limb pain does not originate from the site of amputation; it is a completely separate experience. But for me it begs the question, how can you ‘feel’ anything in a limb that doesn’t physically exist?
Why does it occur?
This question has had scientists baffled since 1552 when the syndrome was first described, but to this day the exact causes still remain unclear. A little more recently, research using Magnetic Resonance Imaging (MRI) and Positron Emission Tomography (PET) scans has led current thinking to believe the feelings originate in the brain and spinal cord. It was found that the portions of the brain that had once been neurologically connected to the nerves in the amputated limb showed activity in the scans when the patient was experiencing their phantom pain. The patient was experiencing the genuine sensation of pain in a limb that shouldn’t be able to feel anything, a slightly confusing concept right? The explanation for this baffling condition is by no means set in stone, but it is mostly thought to occur due to a lack of sensory input from the missing limb. In everyday life when you produce movement via your limbs, the brain is constantly receiving sensory feedback from that moving limb. In a phantom limb patient, after the limb is amputated, comprehensive sensory input from the limb ceases to be sent; the brain becomes confused and so triggers the body’s most rudimentary response of pain. A different example is the noise heard by people suffering from tinnitus – individuals hear a high-pitched noise that doesn’t actually exist as no-one else can hear it – and current theory is that this is also caused by an anomaly in the brain and spinal cord.
Phantom limb pain is extremely prolific in amputees but varies in duration and seriousness between patients. Phantom pain is a type of nerve pain and can be extremely severe and debilitating. It is extremely common for phantom pain to severely affect patients quality-of-life with many people being driven to near madness from the constant pain. The condition is usually treated via drugs such as painkillers, sedative-hypnotics and anticonvulsants but sadly without much success, often leaving patients still having to cope with their chronic pain. An effective form of treatment is therefore very much in need. But what would happen if we could trick the brain into thinking the limb still existed? This concept was first used by neuroscientist Ramachandran in the 1990s whereby he placed a mirror between a patient’s limbs and asked the patient to move their healthy limb and phantom limb whilst looking at the mirror. This could effectively trick the brain into thinking that the phantom limb was moving, removing some of the discordance in brain signals and relieving the patient of pain.
Cutting edge treatments
Now usually, when thinking of the term ‘Virtual Reality’ (VR) I would immediately think of state-of-the-art video games, where users are completely immersed to the point where they think they are in the game. A recent study has allowed this technology to be used to help sufferers of phantom limb pain. Through VR, users are able to see an image of their moving (phantom) limb in their minds. The technology allows the virtual image to move in accordance with the intact parts of the limb creating a life-like and extremely believable sensation of an intact limb. This then tricks the brain, stops the confusion and therefore reduces the patients’ pain. It’s a more modern take on Ramachandran’s mirror therapy concept and has proven to be even more effective. It’s exciting to see how technology can improve people’s lives, what are your predictions for the future?
Tweet me your thoughts to @MegAtNotch
Removing Barriers to Technology InnovationRead More
Science, technology and healthcare have advanced dramatically over the past few decades, but there is still great scope for new innovation as technologies continue to develop. True innovation requires stepping into the unknown, and this is often limited by perceived hurdles – including tangible barriers, such as lack of resources, and emotional barriers such as fear. What can be done to help drive innovation forwards? Aside from the obvious factors, such as time, money and fresh ideas, I’d like to consider some of the influences that societal and workplace cultures can have on promoting or preventing progression. I’ve classed them into three broad areas of relevance for the life sciences and pharmaceutical industries.
Collaboration vs Competition
Many industries are moving away from closed, secretive cultures towards more open approaches that allow collaboration and sharing of information between organisations, including private companies. The common aim is to accelerate progress, such as finding new therapies more quickly through sharing academic and industrial scientific research data (eg, Cancer Research Technology’s various programmes). In software, there have been attempts to pool technical expertise across groups of developers and across industries for rapid creation of new software tools and platforms, notably the well-established Linux community and, more recently, the Open Compute Project.
This movement towards greater collaboration could be seen as very risky. It is driven by urgent consumer or end-user needs – conflicting with the usual corporate drivers of increased profit and gain of market share. Furthermore, collaboration between academics and/or companies requires sharing of data that not only gives away perceived knowledge advantages to potential competitors, but ultimately risks losing ownership of intellectual property. Why, then, does it occur? Is it the result of a philanthropic urge, or could there be advantages for participating organisations in addition to producing end-user benefits?
It seems there are potential advantages and these are emerging due to recent economic shifts. The life sciences industry, and particularly pharmaceuticals, remains permanently changed by recent recessions that have resulted in significant layoffs within numerous R&D departments, and many ongoing mergers and acquisitions. There’s less funding available for fundamental academic research and more emphasis on grants with tangible outputs. The industry as a whole is facing greater requirements for accountability, with justification of budgets through demonstrating return on investment.
As a result, many organisations lack the internal resources and expertise they need for scientific discoveries or innovative product development, which are essential to remain successful in the life sciences. Some companies can outsource or insource certain R&D projects and niche expertise, but this still requires budget, project management and building trust with third parties. The alternative is to form true collaborations that rely on different capabilities from each party to achieve the desired goals. There is no client-supplier relationship in such arrangements, and the investment can often be jointly managed, typically requiring time and internal resources as opposed to significant cash budgets. Importantly, the risks can be shared by all contributing parties.
To be successful, this model requires truly equal commitment to the project from all parties and total agreement on the desired outcomes. The priority has to be the success of the project, and this necessitates a change in employee mentality and business cultures.
Whether or not this can be sustained in the long-term remains questionable. Firstly, products arising from inter-organisational collaborations may be innovative but their profits would be diluted across different contributing parties or, in some cases, non-existent: collaborative efforts in the software industry usually aim for open-source software. Secondly, it would have the effect of reducing competition, which would not only be damaging to the economy and reduce consumer choice, but ultimately would take away the need for companies to innovate. Allowing more collaboration between organisations can be beneficial for innovation, but only when it enables true synergy.
Progression vs Privacy
The arrival of smart phones, along with improvements in wireless technologies and mobile data collection, has led to significant changes in the way we make purchases, consume entertainment, and read and engage with media. In turn this has led to large-scale developments in rapid data collection and analysis that have allowed major innovations to emerge, such as fitness bands and other wearable technologies.
These changes also offer great advantages for healthcare, opening new possibilities for automatic submission and monitoring of live outpatient data via smart phone apps. One example is monitoring blood glucose levels in people with diabetes, where digital collection and submission of patient data provides a more accurate, reliable and traceable approach than current self-monitoring methods. Similarly, these technologies hold the key to improved collection and submission of data for clinical trials, which could greatly enhance the quality of trials data as well as reducing the economic and labour burden of current data collection methods.
In countries such as Sweden, where healthcare records and drug dispensation are fully digitalised and linked with every citizen’s personal ID number, these emerging developments are becoming a real possibility. A compulsory ID card system has numerous advantages because the personal ID number can be used for storing almost all personal data. This allows reliable keeping of electronic medical records, as well as instant and hassle-free systems for numerous daily activities, from collecting loyalty points when shopping to receiving parcels, borrowing library books or hiring a car.
However, these ID numbers also hold the key to vital information such as the individual’s address, mobile phone number and even their income and tax returns. In some populations there remains a general aversion to sharing of personal data, despite the widespread embracement of smart phone technologies, and self-submission of data and content to all kinds of apps and platforms. Polling in the UK has established that the majority of Brits are strongly against compulsory ID cards, which are perceived as representing an invasion of privacy. The UK is also relatively over-populated and vital changes – such as an electronic medical records system – that would be necessary to underpin revolutionary digital healthcare innovations remain exceptionally difficult to implement. Furthermore, the country’s over-burdened mobile phone network still can’t guarantee even 3G networks nationwide, which removes the practicality of many new data-collecting technology developments. By contrast, less populated countries, such as Sweden and Finland, that are leading digitalisation of healthcare are also implementing 5G.
Digitalisation of healthcare has great potential to change the lives of patients and healthcare providers, but in some countries the decaying infrastructure combined with societal privacy concerns are impeding implementation of such innovative, life-changing technologies.
Democracy vs Decisiveness
Successful innovation across the life science and pharmaceutical sectors also depends on agility. This is essential for allowing businesses or researchers to respond to new developments, to rethink their strategies and to reshape their ideas accordingly.
Although few business decisions are made by a single person, the way in which decisions are made and information is handled varies from one organisation to the next. This is strongly related to the organisation’s degree of democracy and culture of equality. In the corporate world, it has been traditional to empower small groups with appropriate decision-making responsibilities. These groups may report directly to the senior management and the outcomes of their decisions are fed downwards through the organisation in a single-minded and relatively autocratic manner. This approach is effective and decisive, setting clear boundaries within the work environment. However, it is not particularly open or flexible for accommodating differences of opinion and, in larger organisations with long chains of command and reporting, this can become a very slow-moving and cumbersome process. Furthermore, a rigid and procedural-based mentality is not conducive to developing a creative and innovative working environment.
In some organisations, there is greater emphasis on involving wider groups in decisions. This ensures that many individual voices are heard across different areas of an organisation, and large teams can be used to discuss and finalise the outcomes. This creates a more open, democratic and transparent culture, that’s often assumed to be more conducive to creativity. In reality, too many decision makers can result in extremely prolonged decision-making that requires significant time and resources. In some cases this time and resource may be better spent simply taking the action, rather than discussing what actions to take. An agile workplace culture is vitally important for innovation and creativity, regardless of how many decision-makers are needed to purchase a new light bulb.
What other influences affect innovation and how can we remove these barriers? Contact me @kateatnoch
World Malaria Day, 25th April 2016Read More
It’s World Malaria Day! Today is an international campaign day dedicated to raising awareness of one of the most prevalent and deadly parasitic diseases on the planet.
Malaria is one of the leading causes of child deaths in Africa. Symptoms include high fevers, chills and muscle pains, and often occur in cycles. Occasionally the malaria parasites can cause extreme forms that affect the brain, lungs, heart or kidney. Malarial deaths are often caused by the development of secondary health issues that may not have occurred had the person not contracted malaria in the first place. These include anaemia, an enlarged spleen or other nutrition-deficiency-related indicators.
It is thought that around half of the world’s population lives in areas that are at risk of malaria transmission and that 91% of malarial deaths in 2010 occurred in Africa. The map below highlights the areas where malaria transmission occurs throughout, only in some parts or does not occur in the region at all.
What Happens on World Malaria Day?
The purpose of World Malaria Day is to encourage activities across various platforms, demonstrating global support for communities affected by the disease and to researchers who are helping to bring new treatments and preventative measures to those affected. Events are being held across the world, including the World Malaria Day Reception in Washington DC and various workshops on malaria, as well as free malaria testing at hospitals in countries such as Uganda. If you are not attending any events then you can get involved on social media by using the hashtags #EndMalaria and #WorldMalariaDay.
Each World Malaria Day focuses around a theme. Previous years have included themes such as ‘Malaria – a disease without borders’, ‘Counting malaria out’ and for the past two years: ‘Invest in the future: defeat malaria’. This year the focus of the day will be ‘End malaria for good’. This campaign seems to bear an element of finality compared to previous years, and this could be due to the significant decrease in malaria deaths by 60% since 2000. This statistic has given many people real hope of seeing an end to malaria – is the elimination and eradication of this disease finally on the horizon?
The Basics: The Parasite
Now you know a bit about World Malaria Day, let’s explore the basics of the disease. Malaria is a single-celled microorganism from the genus Plasmodium. There are five species within this genus that can infect humans: P. falciparum, P. vivax, P. ovale, P.malariae and P. knowlesi. The most virulent and dangerous of these species is P. falciparum. The World Health Organisation reports that 91% of malarial deaths is from P. falciparum infections. Milder forms of malaria are usually caused by the P. vivax, P. ovale and P. malariae species, hence death tolls from these infections are typically lower. The P. knowlesi strain is not strictly a threat to humans as it is mainly infects only long-tailed and pig-tailed macaques – being transferred to humans when this bush meat is consumed.
The Basics: The Vector
Malaria is a mosquito-borne disease. The mosquito acts as a carrier, or vector, that allows the parasite to infect humans. The genus of mosquito that carries the malaria parasite is known as the Anopheles mosquito. There are a huge number of species within this genus that act as malaria vectors, see the map below. It is the female insect that carries the parasite and transmits Plasmodium to a human host in its saliva. It’s specifically the female mosquito that transmits the disease because they require a blood meal to help with the production of a clutch of eggs.
The Basics: Malaria Lifecycle
As the mosquito penetrates the skin of a human to take a blood meal, it injects saliva to aid feeding, and this saliva contains the malaria parasite. The malaria parasite migrates through the bloodstream of the human to the liver. It infects liver cells and multiplies within the cells. P. vivax and P. ovale are able to lie dormant within the cells of the liver and cause relapses weeks or years later. Eventually, the liver cells rupture and malaria parasites are released into the bloodstream to infect red blood cells (also known as erythrocytes). They can then enter one of two stages: the Erythrocytic Cycle or the Sexual Erythrocytic Cycle.
The Erythrocytic Cycle is when the parasites multiply within the red blood cell and rupture to release even more parasites into the blood stream, allowing infection of even more red blood cells. The Sexual Erythrocytic Cycle is when the parasites differentiate into male or female gametes within the red blood cells. It is these gamete-containing cells that are taken up by a mosquito during feeding. Within the mosquito the parasite gametes form zygotes, and eventually infective malaria parasites form within the mosquito’s midgut. The parasite then migrates to the mosquito’s salivary glands, ready to be injected into another human host.
The Basics: Vector Control and Treatment
Vector control has played a big part in helping to reduce the number of infections and deaths from malaria. One of the most effective tools in vector control so far has been the implementation of insecticide-treated bed nets. These act as a physical and chemical barrier between humans and the malaria-carrying mosquitoes. These bed nets are designed to last for up to 3 years before they will need to be replaced, to ensure that they maintain a steady defence against the insects. According to the WHO, between 2000 and 2015 over a billion insecticide-treated nets were delivered to communities in need. This has meant that from 2000-2015, the number of children under the age of 5 living in sub-Saharan Africa and sleeping under bed nets has increased from 2% to 68%! Having said this, the number of other age groups sleeping under these nets has fallen below that of the children under 5. This is because, in 2013, it was found that only around 29% of households that had access to bed nets had enough to protect all members of that household. Additionally, mosquitos developing insecticide resistance is becoming an ever-increasing problem, contributing to the difficulties faced when tackling this disease.
Malaria is an entirely preventable and treatable disease. The drugs given to treat the disease have to be meticulously researched and specifically designed to combat weaknesses of the parasite. Therefore, the WHO recommends therapies that use a combination of mechanisms to attack the parasite; these are usually artemisinin-based combination therapies (ACTs). The WHO recommends 5 different ACTs, with these being the most effective anti-malarial treatments on the market today. The therapy administered will be based on results of studies conducted in the patient’s local area that assessed the strain of Plasmodium falciparum parasite in that region. Due to the combination of drug actions within these therapies, it means that resistance to the drugs from the parasites is very slow. However, much like insecticide resistance, this is also a real issue in the fight against malaria.
It seems like, so far, real progress has been made towards the elimination of malaria. One of the most powerful ways to help fight malaria is by sharing knowledge of the disease through scientific research and educating those affected by the disease. This is why World Malaria Day is such an important tool for raising awareness of the disease. It is a global effort to share resources and focus on the future goals of malaria elimination.
What will you be doing for World Malaria Day?
Why not show your support using the hashtags #WorldMalariaDay and #EndMalaria
Zika Virus: who, what, when, where, how?Read More
Over the past weeks and months you will have undoubtedly seen headlines or heard news reports about Zika virus. The World Health Organization (WHO) has now declared the Zika virus an international public health emergency due to the threat it poses to pregnant women and babies. In this short blog I will aim to cover the basics of the virus: what it is, how it’s spread, who it affects, where it’s affecting and also why it’s suddenly become a global emergency despite being identified over 60 years ago.
Surprisingly to some, Zika is not a new virus and it was in fact first recorded in 1947 in rhesus monkeys in Uganda. It was later identified in humans in 1952, again in Uganda and the United Republic of Tanzania. Since then it has been reported in the Americas, Asia, other parts of Africa and the Pacific. See map below to understand how the virus has travelled.
Zika virus is transmitted by mosquitos, specifically Aedes aegypti, which carry the virus and bite humans causing them to become infected. This type of mosquito is particularly effective at carrying this virus and it’s also the primary vector of the yellow fever, dengue, and chikungunya viruses. This genus of mosquitos is also better adapted to live amongst humans compared to others as they are able to thrive in smaller bodies of water, even as small as a bottle cap, making them very difficult to avoid.
The best way to prevent the spread of the virus is by minimising exposure to mosquitos by removing their source or avoiding contact. This can be done using insect repellent, covering up small bodies of water, keeping doors and windows closed and sleeping with mosquito nets.
What’s interesting about Zika is that in many instances it remains undiagnosed as symptoms are very subtle and in 80% of cases there are no symptoms at all. If a patient does display symptoms, they usually manifest as minor fever, headache and a body rash. The most worrying thing about Zika, though, is the links that have been drawn in more recent years. Researchers noted that many people infected during the Brazil and French Polynesia outbreaks later developed Guillain-Barré syndrome, a rare and serious condition of the peripheral nervous system. Zika virus has also been linked with microcephaly, a rare neurological condition in which an infant’s head and brain are significantly smaller than they should be. Since the outbreak in Brazil in 2015 there has been a 20-fold increase in the number of cases of microcephaly. For this reason, pregnant women are being discouraged from travelling to regions affected by the virus, and those planning to get pregnant should delay it if possible. It’s worth noting, though, that if you’ve had the virus it is perfectly safe to have a child in the future as the virus leaves the blood system after a few weeks.
As the symptoms of Zika itself are relatively minor, there are no specific treatments for it other than rest and staying well hydrated.
The reason Zika virus has begun to spread so fast across South America at the moment is due to a lack of background immunity within the populations there. Added to this is the fact that Aedes aegypti mosquitoes are densely populated in this region and the environment is perfect for them to thrive. This combination has resulted in a rapid spread of the virus within the last year in South America.
With 16,000 athletes and 600,000 spectators due to arrive in Rio this August for the 2016 Olympic games, this outbreak has come at a very critical time for Brazil. Some countries and athletes are beginning to discuss whether they will be attending due to the risk of Zika virus. Some are calling for the Games to be cancelled or postponed, but the spokesman of the Rio Olympics said that cancellation “has never been mentioned”. Experts of infectious disease believe that Brazil is making a huge effort to tackle the virus and that factors such as it being held in one city and within colder months should be able to reduce the risk of Zika to an acceptable level. At the moment no countries or athletes have officially pulled out, although many will continue to assess the risk up until August.
Scientists have still not been able to prove a definitive link between Zika and microcephaly so this remains the biggest focus of their research. The WHO recommends all people to avoid travel to affected regions and delay pregnancies where possible. If you’d like to find out more information about this virus head to the WHO website: http://www.who.int/mediacentre/factsheets/zika/en/.
Have you got any questions about Zika? Tweet them to me at @EmilyAtNotch!
World Cancer DayRead More
Today, 4th February 2016, is World Cancer Day. Taking place under the tagline ‘We can. I can,’ World Cancer Day is the chance for the entire world to unite in the fight against the global epidemic – cancer. This day aims to save millions of preventable deaths each year by raising awareness and education about cancer as well as pressing governments and individuals across the world to take action against the disease. The goal is to ensure fewer people develop cancer, more people are cured and there is better quality of life for people undergoing treatment.
Currently, 8.2 million people die from cancer worldwide every year, out of which 4 million people die prematurely (aged 30 to 69 years). However, death rates for the disease are declining in the UK thanks to some of the amazing research that is being carried out in the fight against cancer. For example, cancer death rates in the UK have fallen by 10% in the past 10 years, according to a report released today by Cancer Research UK. Unfortunately though, this is not the case worldwide, with cancer incidence and mortality predicted to continue rising as people in developing countries start living longer and the world population continues to grow.
Efforts are currently focused on, but not limited to, early diagnosis and how to manage hard-to-treat cancers. Cancer Research UK’s chief executive said: “Today, one in two of all people diagnosed with cancer survive their disease for at least 10 years. Cancer Research UK’s ambition is to accelerate progress so that three in four survive cancer by 2034”. The current World Cancer Declaration, put together in 2013 by world cancer leaders at a summit in Cape Town, has an overarching goal:
“There will be major reductions in premature deaths from cancer, and improvements in quality of life and cancer survival rates.”
To achieve this, the Summit’s World Cancer Leaders have put together 10 targets that you can read here.
There are lots of different ways that you can get involved in World Cancer Day. You can see a range of ways you could get involved here; it could be as simple as sharing a message on social media or donating money. For instance, you may have noticed people wearing Unity Bands today and sharing their photos on social media. For this year’s campaign, Cancer Research UK is selling Unity Bands and encouraging people to write the names of their loved one who are or have suffered from cancer on their hands. The hashtag #ADayToUnite is being used widely across Twitter today to help everyone get involved. The focus of World Cancer Day this year is to get as many people as possible to join together to help raise funds to continue vital research in the UK. You can purchase a Unity Band and support the work of Cancer Research UK here. Charities like Cancer Research UK rely on donations to keep this vital research going; your donations make a huge difference.
Join the conversation on Twitter using the hashtags #ADayToUnite, #WeCanICan and #WorldCancerDay.