[Vol 33] Medi-Scene: Your Weekly Health News Update

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MediScene Vol 331. Doctors talk about importance of clean air

To celebrate the First International Day of Clean Air for Blue Skies on September 7, doctors from various disciplines from across the globe participated in a first-of-its-kind virtual event on September 6, called Doctors for Clean Air Conclave. Seven national medical associations that joined hands to make it happen included the Federation of Obstetric and Gynaecological Societies of India (FOGSI), the Indian Academy of Pediatrics (IAP), the Cardiological Society of India (CSI), the Indian Chest Society (ICS), the Indian Academy of Neurology (IAN), the Association of Surgeons of India (ASI) and the Medical Students Association of India (MSAI). Dr H. Paramesh, a member of the IAP, highlighted the importance of creating awareness about the depleting levels of clean air by stating, “Delhi has gone from having 10 trees per person to now having just one tree per person.” Dr Alok Gupta during the session said that, “Not even the air within homes is safe. Cooking using biomass and kerosene leads to the open fire in homes becoming a direct pollutant which causes non-communicable diseases, chronic heart diseases and chronic pulmonary and respiratory diseases.” The conclave was an initiative to bring together doctors from all over the country to try and turn the awareness campaign to attain clean air into a people’s movement.

2. Early combination therapy for type 2 diabetes: New Guidelines

The 2020 American Diabetes Association (ADA) clinical guideline stresses the importance of considering early combination therapy in patients with type 2 diabetes. Kacie Doyle-Delgado of St. Mark’s Hospital and St. Mark’s Diabetes Center, in Salt Lake City, told Reuters Health by email said, “While metformin and therapeutic lifestyle change remain the standard for new-onset diabetes diagnoses, initial combination therapy should be considered in patients presenting with hemoglobin (Hb)A1c levels >1.5 to 2 percentage points above target, as most singular medications rarely decrease HbA1c concentrations by more than 1 percentage point.” According to the guideline, metformin remains the preferred initial pharmacologic agent for the treatment of type 2 diabetes, but early combination therapy should be considered in some patients at treatment initiation as a strategy for extending the time to treatment failure. Treatment selection should be based on individual patient factors, such as cardiovascular comorbid conditions, hypoglycemia risk, impact on weight, cost, risk for side effects and patient preferences, the authors say. Medication regimens and medication-taking behavior should be reevaluated every three to six months and adjusted as needed to incorporate these specific factors. Although the guideline focuses on pharmacologic treatments, it emphasizes that the mainstay for initial treatment of type-2 diabetes includes therapeutic lifestyle change.

3. Cardiovascular disease and other health condition linked to gut bacteria

Microorganisms in the human digestive tract are linked to 29 specific health conditions, including chronic obstructive pulmonary disease, high blood pressure, and type 2 diabetes, according to a genome analysis in more than 400,000 individuals. Hilde E. Groot, MD, of the University of Groningen (The Netherlands), said in a presentation at the virtual annual congress of the European Society of Cardiology, “The extent to which the human gut microbiome can be considered a determinant of disease and healthy aging remains unknown. Over the past few years, the amount of research concerning the human gut microbiome and the associations with health and disease has tremendously increased. However, most studies investigated one or a few traits. The strength of our study is the possibility to cover a wide range of traits simultaneously within one population. Our data support the hypothesis that the human gut microbiome is a complex system, involved in many pathophysiological mechanisms in the human body. So, our results are additional to earlier research and strengthen this hypothesis. Microbiota and their metabolites might be of importance in the interplay between overlapping pathophysiological processes, and could serve as potential therapeutic targets for the maintenance of health and prevention and treatment of cardiovascular diseases. However, before it is possible to give advice for the public and medical practice, further research is needed to study causality. Currently, it is too soon to advise patients concerning their microbiome. However, genetic studies like ours might help other researchers to study causality between the gut microbiome and particular traits, which might potentially lead to new therapeutic targets. Next to genetic variants as a proxy, we’re currently studying the gut microbiome composition in myocardial infarction patients and healthy controls in a longitudinal setting.” Carol Ann Remme, MD, of the Amsterdam University Medical Center, said in an interview, “Previous studies have suggested a potential link between the gut microbiome and the development of cardiovascular disease, type 2 diabetes mellitus, and other chronic disorders. However, it is challenging to study the effect of gut microbiome composition in large patient cohorts. As an alternative approach, the study authors showed in a very large population that genetic variants previously shown to influence gut microbiome composition were significantly associated with conditions such as hypertension, type 2 diabetes, hypercholesterolemia, and heart failure.”

4. New therapy developed to detect lung cancer at an early stage

The researchers from Jawaharlal Nehru Centre for Advanced Scientific Research (JNCASR) have developed a diagnostic therapy for lung cancer that can detect the disease at an early stage paving the way for personalized medicine, said the Ministry of Science and Technology on Sunday. Govindaraju and his team have developed a small molecule for selective recognition of BCL-2 GQ through unique hybrid loop stacking and groove binding mode with turn on far-red fluorescence response and anticancer activity demonstrating the potential as GQ-targeted lung cancer theranostics. The research showed that, “Their strategy of specific topology recognition through hybrid binding mode led to capitalize on the gains of oxidative stress and genome instability to kill lung cancer cellsAin vivo. In addition, TGP18 with turn on emission band at the lower edge of far-red to NIR spectroscopic window proved to be a viable probe for tumor tissue imaging. Collectively, the theranostic agent TGP18 with outstanding biocompatibility showed in vivo tumor inhibition and tissue imaging, indicating excellent clinical translational potential. The selective recognition and imaging of oncogene specific non-canonical DNA secondary structures (G-quadruplex-GQ structures) holds great promise in the development of diagnostic therapy (theranostics) for cancer and has been challenging due to their structural dynamics and diversity. TGP18 binding to anti-apoptotic BCL-2 GQ ablates the pro-survival function and elicits anti-cancer activity by inducing death in cancer cells. The JNCASR team deciphered that inhibition of BCL-2 transcription synergized with signaling cascade of nucleolar stress, DNA damage, and oxidative stress in triggering the apoptosis signaling pathway. The intervention of GQ mediated lethality by TGP18 translated into anti-cancer activity in both in vitro 3D spheroid culture and in vivo xenograft models of lung and breast cancer with superior efficacy for the former. In vivo therapeutic efficacy, supplemented with tumor 3D spheroid and tissue imaging potential, define the role of TGP18 in GQ-targeted cancer theranostic.”

5. Study suggests gene test can predict medication risk causing liver injury

Scientists who were working on a way to determine the viability of batches of tiny liver organoids have discovered a testing method that may have far broader implications. They discovered a gene test that can possibly predict the risk of medications that cause liver injury. Their study published in the journal Nature Medicine reports identifying a “polygenic risk score” that shows when a drug, be it an approved medication or an experimental one, poses a risk of drug-induced liver injury (DILI). Jorge Bezerra, MD, Director, Division of Gastroenterology, Hepatology and Nutrition at Cincinnati Children’s said, “So far we have had no reliable way of determining in advance whether a medication that usually works well in most people might cause liver injury among a few. That has caused a number of promising medications to fail during clinical trials, and in rare cases, also can cause serious injury from approved medications. If we could predict which individuals would be most at-risk, we could prescribe more medications with more confidence.” Corresponding author Takanori Takebe, MD, an organoid expert at Cincinnati Children’s who has been studying ways to grow liver “buds” for large-scale use in research said, “Our genetic score will potentially benefit people directly as a consumer diagnostic-like application, such as 23andMe and others. People could take the genetic test and know their risk of developing DILI.” For clinicians, this would allow them to run a quick genetic test to identify patients at higher risk of liver injury before prescribing medications. The results might prompt a doctor to change the dosage, order more frequent follow-up tests to catch early signs of liver damage, or switch medications entirely. For drug research, the test could help exclude people of the high risk of liver injury from a clinical trial so that the benefits of a medication can be more accurately assessed.

6. Antibiotics affect breast milk microbiota in mothers of preterm infants: Study

The study led by researchers from the University of Toronto and The Hospital for Sick Children was published in the journal Cell Host and Microbe. The study is the largest to date of breast milk microbiota in mothers of preterm infants, and it is the first to show that antibiotic class, timing and duration of exposure have particular effects on the most common microbes in breast milk — many of which have the potential to influence growth and immunity to disease in new-borns. Deborah O’Connor, who is a professor and chair of nutritional sciences at U of T and a senior associate scientist at SickKids said, “It came as quite a shock to us that even one day of antibiotics was associated with profound changes in the microbiota of breast milk. I think the take-home is that while antibiotics are often an essential treatment for mothers of preterm infants, clinicians and patients should be judicious in their use.” Michelle Asbury, a doctoral student in O’Connor’s lab and lead author on the paper said, “Overall we saw a decrease in metabolic pathways, and increase in more pathogenic pathways in bacteria over time. Of particular concern was an association between antibiotics and a member of the Proteobacteria phylum called Pseudomonas. When elevated, Proteobacteria in a preterm infant’s gut can precede necrotizing enterocolitis. Sharon Unger is a co-author on the study and a professor of paediatrics at U of T, as well as a scientist and neonatologist at Sinai Health and SickKids says that, “The benefits of breastfeeding far outweigh the risk that antibiotics can disrupt the breast milk microbiome, and that mothers should without question continue to provide their own milk when possible. But I think we can look to narrow the spectrum of antibiotics we use and to shorten the duration when possible. Clearly the microbiome is important for their metabolism, growth and immunity. But emerging evidence on the gut-brain axis and its potential to further improve neurodevelopment for these babies over the long term warps my mind.”

Reference links: 

  1. https://health.economictimes.indiatimes.com/news/industry/doctors-come-together-to-talk-about-the-importance-of-clean-air/77972269
  2. https://www.medscape.com/viewarticle/936669
  3. https://www.medscape.com/viewarticle/936649
  4. https://health.economictimes.indiatimes.com/news/diagnostics/researchers-develop-therapy-that-can-detect-lung-cancer-at-early-stage/77972129
  5. https://health.economictimes.indiatimes.com/news/diagnostics/gene-test-can-predict-risk-of-medications-causing-liver-injury-study/77995809
  6. https://health.economictimes.indiatimes.com/news/diagnostics/study-finds-antibiotics-affect-breast-milk-microbiota-in-mothers-of-preterm-infants/77928419

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