We Could Soon Have a Cure for Every Form of Tuberculosis

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New Drug Therapies

Despite having been around for centuries now, tuberculosis (TB) remains one of the top 10 causes of death worldwide. According to a report by the World Health Organization (WHO): “In 2015, there were an estimated 10.4 million new (incident) TB cases worldwide, of which 5.9 million (56%) were among men, 3.5 million (34%) among women and 1.0 million (10%) among children.”

While there are existing drug treatments for both ordinary TB and its drug-resistant variants, these usually take months and include a barrage of tablets and injections. Two new drug therapies — called BPaMZ and BPaL — are currently in the development pipeline, and may be a match for all forms of TB including the drug-resistant ones which are most difficult to treat.

“We will have something to offer every single patient,” said Mel Spigelman, president of TB Alliance, which is coordinating the trials of both treatments. “We are on the brink of turning TB around.” Existing TB drug treatments require patients to take up to 20 tablets a day, coupled with a battery of injections. With treatment, it usually takes six months to cure ordinary TB, and could take up to two years for drug-resistant infections. On the other hand, BPaMZ involves taking just four drugs per day, while BPaL requires only three drugs a day.

Promising Trials

The TB Alliance found the results of the trials they conducted with BPaMZ and BPaL to be promising. BPaMZ was tested on 240 people from 10 African countries, and showed that it could cure almost all cases of ordinary TB in just four months, while curing drug-resistant TB cases in about six months. Furthermore, in most cases, traces of TB bacterium disappeared from sputum within two months. Likewise, BPaL was able to cure 40 of 60 patients with “extremely-drug-resistant TB” within just six months.

“The alliance has never before seen such rapid action against TB bacteria,” Spigelman said. These results results were presented in Seattle this week at the Conference on Retroviruses and Opportunistic Infections. BPaMZ could treat 99 percent of TB cases each year, while BPaL could treat the rest, the TB Alliance believes.

Larger trials are needed to confirm these findings, Spigelman said. This could mean three more years for BPaMZ, but sooner for BPaL. “The results are exciting and encouraging, but we must be cautious saying we can treat everyone with these regimes,” David Moore at the London School of Hygiene and Tropical Medicine said. “These are only preliminary data, so there’s a danger of jumping the gun.”

World Integrated Medicine Forum inaugurated

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Shripad Yesso Naik, the Minister of State for Ayush, has inaugurated the World Integrated Medicine Forum on regulation of homoeopathic medicinal products: National and global strategies in New Delhi. This is the first-of-its-kind Forum considering the increased perception of the international world towards India as a key player in the progress of the homoeopathy drug industry. Drug lawmakers, regulators, manufacturers and pharmacopoeial experts from various regulatory authorities, eminent scientific organisations and pharmaceutical industries from 25 countries, are expected to participate in two days Forum to strategise the actionable aspects in the homoeopathic drug industry, which, in turn, will promote global harmonisation in the sector.

The event is organised by ministry of Ayush (Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy) and Central Council for Research in Homoeopathy (CCRH) and supported by Pharmacopoeia Commission for Indian Medicine & Homoeopathy (PCIMH) & Central Drugs Standard Control Organization (CDSCO).

Major points of discussion will include current regulatory status in different countries; practices and possible trade opportunities in key countries worldwide; possible solutions to regulatory challenges; building knowledge and network to deal more efficiently with challenges at national and global level and a strategic perspective on the possibilities and limitations of what can be achieved at a national level via further international collaboration and harmonization. One of the highlights of the Forum will be exchange of MoU among homoeopathic pharmacopoeia convention of the US and Indian bodies – Pharmacopoeia Commission for Indian Medicine & Homoeopathy and Central Council for Research in Homoeopathy on cooperation in the field of homoeopathic medicine. It is hoped that this agreement will be a benchmark for many more agreements to follow with the aim to develop and harmonise homoeopathic pharmacopoeias and to strengthen regulatory provisions for homoeopathy in the whole world.

In India, homoeopathic medicines are regulated by D&C Act & Rules. All pharmaceutical industries are legally bound to comply with these Rules, which, in turn, assures safety and quality of homoeopathic medicines. Further, these industries adhere to GMP that further assure accredited production, packaging and distribution. In that sense, India has a relatively well-established regulatory framework for homoeopathy. However, the implementation of these Acts and Rules are sometimes challenging at the end of the pharmaceutical units, and despite their best efforts to comply, some practical challenges remain that come in their way.

On the other hand, the international scenario of regulations of homoeopathic medicinal products is also varied and in many countries, the regulatory provisions are either non-existent or minimalist, thereby advocating reforms in policies for wider accessibility of quality homoeopathic products.

Homoeopathy is one of the most followed medical systems in India and its strength lies in the fact that its medicines are gentle, safe as well as cost-effective. In the era of growing adverse drug reactions and auto-immune and lifestyle-related illnesses, homoeopathy has a crucial role to play in the well-being of mankind. The use of homoeopathy is steadily growing in India and as per an analysis by Ayush ministry, this sector exhibited an annual growth rate of 26.3 per cent in the past year, the highest among the other Ayush modalities.

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Doctors 3D Printed a Replacement for This Woman’s Damaged Spine

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From a Disease to a Disability

Human innovation continues to push forward in so many directions. In all walks of science, researchers are achieving new “firsts” in the pursuit of a better life for the people of the world. Now, doctors in India, a country that has been basking in its recent record-breaking satellite launch, have completed the nation’s first 3D-printed spinal restoration surgery.

The patient, a 32-year-old Indian woman, lost her ability to walk due to a severe case of tuberculosis. The disease commonly affects the lungs, but it traveled to the woman’s spinal cord when her immune system was particularly weakened by drugs she was prescribed for infertility. The tuberculosis compromised her first, second, and third cervical vertebrae, removing support for both her skull and lower spine.

The damaged spinal cord resulted in a curved posture, weakness in her limbs, and an involuntarily sliding of the head. If left untreated, her condition would have been essentially a death sentence. However, a team of surgeons at Gurgaon Hospital had an interesting solution.

To Print a Spine

A team of surgeons led by Dr. V Anand Naik, a senior consultant of spine surgery from the Medanta Bone and Joint Institute, replaced the damaged vertebrae with a 3D-printed titanium copy. Using CT and MRI scans as reference, they first 3D printed a dummy spine that was perfectly sized for the patient’s needs. After much testing by design teams from India, the U.S., and Sweden for biomechanics and stress resistance, the final titanium implant was created.

Photo Credit: Sanjay Kumar Pathak
Photo Credit: Sanjay Kumar Pathak

Naik and his team then inserted the replacement between the first and fourth vertebrae, bridging the gap within the damaged spine. The surgery was completed over an intense 10-hour period, and afterward, Dr.Naik told the Hindustan Times, “It was a very complex surgery and the patient’s condition was deteriorating by the day. It would not have been possible to do it without 3D-printing technology.”

The woman is expected to recover fully in two weeks and live a normal life. Her journey is truly one for the history books. What seemed like an impossible case was resolved with multinational efforts that went beyond traditional medical thinking. Today’s “first” in a field could eventually become a common practice that saves many lives, but for now, just saving one is enough.

Sea Snail Venom Could Provide a New, Long-Lasting Alternative to Opioid Painkillers

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A compound found in the venom of sea snails has been discovered to block pain, and does so by targeting a different molecular pathway to that used by opioid painkillers.

With estimates that more than 90 Americans die every day from an opioid overdose, a new treatment formulated from the venom compound could provide an alternative to overused opioid medications – a crisis that’s been described as the worst drug epidemic in American history.

The pain-killing compound, called RgIA, is a peptide that naturally occurs in the venom of Conus regius, a small sea snail species with a cone-shaped shell, which is common in the Caribbean Sea.

“Nature has evolved molecules that are extremely sophisticated, and can have unexpected applications,” says biologist Baldomero Olivera from the University of Utah.

“We were interested in using venoms to understand different pathways in the nervous system.”

16004640459 264032fffd h-2Conus regius. Credit: My Huynh

Previous research looking into the effects of RgIA had examined its potential for pain relief in rodents, but the basis by which the compound acted was unclear.

To find out what was going on, Olivera’s team used synthetic chemistry to engineer 20 analogues of the RgIA compound, each with a slightly different molecular configuration.

Using computer modelling, they found that RgIA provides a molecular fit with a pain pathway in rats called α9α10 nicotinic acetylcholine receptors (nAChRs), which suggested it could be blocking the receptor when it binds.

The pathway works as part of the central nervous system, responding to the neurotransmitter chemical acetylcholine, in addition to the drug nicotine.

One of the analogues they came up with, called RgIA4, also appeared to bind tightly with the human version of this pain receptor.

To see whether RgIA4 was effective for pain relief, the researchers administered the compound to rats and mice that had been given a chemotherapy drug that causes extreme sensitivity to cold and touch.

“Interactions that are not normally painful, like sheets rubbing against the body or pants against the leg, become painful,” explains one of the team, J. Michael McIntosh.

The rodents given RgIA4 did not experience pain, but untreated animals did when given the chemotherapy medication. In addition, genetically altered rodents that had their α9α10 receptor removed also did not experience pain.

The researchers suggest the results are evidence that they’ve isolated the molecular target that the venom compound acts upon – but of course, it’s still early days for the analogue.

There are no guarantees that just because RgIA4 blocked the pain pathway in rodents that it will do the same in people – despite the molecular modelling.

But the researchers are hopeful that future studies will show that we’ve got a new mechanism for pain relief here, and one which could provide a much-needed alternative to opioids.

If that’s the case, another promising thing about the synthesised compound is how long-lasting it seems to be. While RgIA4 worked its way out of the rodents’ bodies in about 4 hours, the painkilling effects persisted long after.

“We found that the compound was still working 72 hours after the injection, still preventing pain,” says McIntosh.

We’ll have to wait and see if future research with RgIA4 backs up this positive beginning. The researchers are currently laying the groundwork for a pre-clinical trial, and if that succeeds, clinical trials with human subjects could be the next step.

“What is particularly exciting about these results is the aspect of prevention,” says McIntosh.

“Once chronic pain has developed, it is difficult to treat. This compound offers a potential new pathway to prevent chronic pain from developing in the first place and also offers a new therapy to patients with established pain who have run out of options.”

The findings are reported in Proceedings of the National Academy of Sciences.

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We May Have Found a Way to Detect Autism Before Symptoms Show

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Uncovering Autism

Some parents first notice that their child could be on the autism spectrum when certain symptoms arise at around 12 to 18 months of age. Perhaps the children don’t make eye contact with others or aren’t smiling when their parent walks through the door. Their social interactions aren’t considered “normal,” and some children show challenges in communication.

Now, a new study suggests that we might be able to detect autism even before its visible onset. Researchers took magnetic resonance imaging (MRI) scans of 150 children three times: the first at six months, the second at one year, and the last at two years of age. Around 100 of the children imaged had siblings that were previously diagnosed with autism spectrum disorder, placing them at a higher risk of being susceptible.

autism autism spectrum genetics mri children with autism developmental disorder
(The colored regions show the parts of the brain that enlarged more quickly in children later diagnosed with autism). Credit: Hazlett et al., Nature 2017; 10.1038/nature21369

What the researchers found was that the enlargement of a child’s brain correlated with the future onset of symptoms. In fact, a faster growth rate of the brain’s surface areas predicted the arrival of symptoms in 8 out of 10 of the high-risk children tested.

“We’re learning that there are biological changes that occur at [the time] or before the symptoms start to emerge,” Geraldine Dawson, a clinical psychologist and autism researcher at Duke University, told Scientific American. “It’s the ability to detect autism at its very early stages that’s going to allow us to intervene before the full syndrome is manifest.”

The study is published in the journal Nature.

One (Slight) Step Closer to Understanding

Although the study sounds promising, the sample size was deemed too small to have external validity for use in other research. Also, the scientists aren’t sure whether or not autism is different in families that already have a child with the condition and those with no known genetic link.

The younger siblings of children with autism, “baby sibs,” are more likely to develop the condition, but researchers aren’t sure it they are categorically different from others with autism, which confuses the validity of the study even further.

Regardless, the ability for scientists to see just how the brain develops prior to diagnosis could help in demonstrating autism’s relation to genetics. This study can be used to spark future research, allowing researchers to develop plans on when treatment would be most effective for children with autism spectrum disorder.

With autism being one of the fastest-growing developmental disorders in the U.S. and one with no proven detection method or treatment, this study gives us much needed extra insight into its manifestation. Since brain development is so critical during a child’s first year of life, early detection of symptoms could be our window into developing future treatments.

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