Dietary potassium restriction is important for managing hyperkalaemia, or high blood potassium levels, in individuals on maintenance haemodialysis, but it imposes a substantial day-to-day burden. Results from a recent clinical trial indicate that adding the potassium binder sodium zirconium cyclosilicate (SZC) may help. The findings were published in BMC Nephrology and also presented at American Society of Nephrology (ASN) Kidney Week 2026 October 22–25.
In the multicentre, randomised, open-label, parallel-group trial, outpatients receiving thrice-weekly maintenance haemodialysis with pre-dialysis serum potassium of 5.5 to < 6.5 mEq/L were assigned to SZC plus standardised nutritional counselling or nutritional counselling alone for 8 weeks.
In the main analysis including 183 patients, those who received SZC plus standardised nutrition counselling had a greater improvement in quality of life related to dietary potassium restriction than those who received nutrition counselling alone. SZC also lowered pre-dialysis serum potassium more effectively. No patient in the SZC group needed rescue treatment during the 8-week study, compared with 25 of 92 patients in the control group. In exploratory analyses, the investigators also saw an increase in fruit intake without an increase in total dietary potassium intake, as well as improvements in several areas of kidney disease-related quality of life. There were no serious treatment-related adverse events or deaths.
“SZC may provide an important patient-centred benefit beyond lowering serum potassium. When added to standardised nutritional counselling and regular potassium monitoring, SZC reduced the day-to-day burden of dietary potassium restriction while also providing better potassium control,” said corresponding author Hiromichi Wakui, MD, PhD, of Yokohama City University Graduate School of Medicine. “Hyperkalaemia treatment should be judged not only by whether the potassium level falls, but also by whether treatment makes daily life less burdensome for patients.”
The investigators stressed that individualised dietary assessment, regular potassium monitoring, and attention to overall nutritional quality remain essential. When dietary restriction alone places a substantial burden on patients, potassium-binding therapy may support a safer and more patient-cantered management strategy.”
By Dr Veronica Netangaheni, Founder, Dr Vee’s Health and Wellness
South African men are taught to provide, protect, lead and carry the weight of their families, often at the expense of their own wellbeing. From a young age, many are conditioned to believe that strength means enduring pain, suppressing emotions and solving problems without asking for help. Yet one of the most important responsibilities of being a man is rarely discussed: taking responsibility for his own health.
As a general practitioner, I see the consequences of this mindset in my consulting room. Men often seek medical attention only when symptoms become unbearable, when their bodies can no longer accommodate neglect or when a manageable condition has progressed into something far more serious. They will make time for their families, businesses and responsibilities, but postpone the one appointment that could protect their own lives.
We have created a culture where men are expected to look after everyone, yet rarely encouraged to look after themselves.
Men service their cars. Why do they neglect themselves?
A man will take his vehicle for servicing when a warning light appears on the dashboard, understanding that ignoring a mechanical problem could eventually cost him more. Yet when his own body sends warning signs, he often dismisses them, hoping the discomfort will disappear without medical intervention.
The consequences are reflected in South Africa’s mortality figures. Statistics South Africa’s 2024 mortality report recorded 11 334 male deaths attributed to diabetes and 10 322 to hypertensive diseases. These conditions can develop silently, often without obvious symptoms, while gradually damaging vital organs and increasing the risk of life-threatening complications.
A blood pressure check, blood glucose test and cholesterol screening may take only minutes, but they can reveal risks that would otherwise go undetected. Feeling strong, looking healthy and being able to perform daily responsibilities do not necessarily mean that the body is functioning as it should. A man should not have to reach a medical emergency before his health becomes a priority.
Your sexual health may be warning you about your heart
Erectile dysfunction is another health concern that men often struggle to discuss, sometimes turning to unregulated medication rather than seeking professional advice. However, difficulties with sexual performance can be more than an embarrassing bedroom problem; they may signal underlying conditions such as diabetes, hypertension and cardiovascular disease.
The blood vessels responsible for achieving an erection are also connected to the wider cardiovascular system. Damage caused by these conditions can affect sexual function and may provide an early indication of broader vascular problems. Men must therefore understand that discussing changes in their sexual health with a doctor is not an admission of weakness, but an opportunity to identify potentially serious health concerns before they become life-threatening.
Silence is not strength
The crisis extends beyond physical health. The Commission for Gender Equality highlighted in 2026 that approximately 80% of suicide deaths in South Africa are among men. This should force us to question the expectations we place on men and the limited space we give them to acknowledge emotional distress.
We expect men to carry financial pressure, unemployment, family responsibilities and relationship difficulties while maintaining the appearance that everything is under control. We discourage boys from crying, teach men to suppress vulnerability and then wonder why so many struggle to ask for help when life becomes overwhelming.
We cannot continue confusing emotional silence with resilience. A man who admits that he is struggling has not failed his family or his responsibilities. He is recognising that his wellbeing matters and that some challenges require support beyond what he can manage alone.
Medical progress means nothing if men stay away
South Africa has made significant progress in HIV prevention and treatment, with access to PrEP, PEP and newer prevention options such as twice-yearly injectable lenacapavir. Effective treatment also means that people living with HIV who maintain an undetectable viral load cannot sexually transmit the virus.
Yet medical progress means little if fear, stigma and outdated ideas about masculinity continue keeping men away from testing and treatment. Knowing your HIV status is not a sentence; it is an opportunity to make informed decisions, protect your health and take control of your future.
We must also recognise that raising healthy men starts with raising boys differently. Boys need mentors who teach them that accountability, compassion and emotional intelligence are essential parts of manhood, not qualities that diminish it.
It is time to make men’s health a priority
My message to men is simple: book the appointment before your body makes the decision for you. Check your blood pressure, blood sugar and cholesterol, get tested for HIV, discuss appropriate cancer screenings and seek professional support when your mental health begins to suffer.
Families, employers, healthcare professionals and communities also have a responsibility to create environments where men can seek help without ridicule or judgement.
For generations, we have told men to provide, protect and lead. But we cannot keep expecting them to fulfil these responsibilities while overlooking the importance of their own survival.
The strongest thing a man can do is not pretend he is invincible. It is recognise that his health matters, ask for help when necessary and take action before it is too late.
Dr Veronica Netangaheni is a general practitioner.
New research indicates that commonly used measures of kidney function largely underestimate the prevalence of chronic kidney disease (CKD) in patients with cancer. The findings were presented at American Society of Nephrology (ASN) Kidney Week 2026 October 22–25.
In 1200 adults with solid tumours, investigators compared measured glomerular filtration rate (mGFR), which directly measures kidney filtration rate using a specialised clearance marker, with commonly used estimated GFR (eGFR) values based on the blood proteins cystatin C and creatinine.
CKD prevalence rates based on mGFR, eGFR based on creatinine, and eGFR based on both creatinine and cystatin C were 18.9%, 10.2%, and 15.7%, respectively. Among those with mGFR of 45–59 ml/min/1.73 m² (indicating mild to moderate CKD), 72.1% had creatinine-based eGFR >60, suggesting that they had normal kidney function. Among those with mGFR <45 (indicating more advanced CKD), 52.5% had creatinine-based eGFR >45. Adding cystatin C to creatinine improved GFR discrepancy, but concordance remained poor.
These thresholds are especially important for decisions about drug eligibility and dose adjustments, as drug clearance rates often drop as kidney function declines. “The results suggest that errors in GFR estimation may contribute to exceeding toxicity in patients with cancer receiving anticancer therapy,” said corresponding author Veronica Torres Costa e Silva, MD, PhD, of the University of São Paulo Medical School, in Brazil. “I’ll give the example of cisplatin. Most recommendations state that patients with GFR of 45–60 ml/min/1.73m² should have a dose reduction of 25–50%, and those with GFR below 45 ml/min/1.73m² should not be considered eligible. This means that our patients are receiving exceedingly higher doses and having a higher frequency of toxicity because we are not capable of accurately assessing GFR and making accurate dose adjustments.”
Study reveals differences by income level, travel distance, and trial phase
Photo by Tima Miroshnichenko on Pexels
New research reveals that participating in cancer clinical trials can cause financial burdens that are shaped by both socioeconomic and logistical factors. The analysis published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society, indicates the need for better reimbursement programs to improve equitable access to, and retention in, cancer clinical trials.
For adults with cancer, participating in clinical trials can carry costs related to travel, lodging, meals, internet access, missed work, and greater need for childcare/eldercare. In the United States, federal legislation addressing financial support for clinical trial participants is currently under consideration. Recognising the need for financial support for participation in trials, the Lazarex Cancer Foundation reimbursed out-of-pocket non-medical costs from 2006–2024 for patients enrolled in therapeutic cancer clinical trials across multiple US sites.
When investigators examined the types and amounts of expenses faced by trial participants, they found that among 2826 individuals who received at least one reimbursement, median total per-patient reimbursement was $2128, median trial participation duration was 4.3 months, and monthly reimbursed amounts declined substantially throughout trial participation (with monthly reimbursements falling to 60% of initial levels by 3 months into trial participation).
Importantly, the program reimbursed expenses only if there were no other sources of financial support from the trial sponsor or site.
Types of reimbursement varied by patient income: internet, ground transportation, and childcare/eldercare were more common at lower income levels, while lodging and airfare were more common for higher income. After adjustments, monthly reimbursed amount was greater among middle-tier household income quartiles, greater distance to trial site, and phase 1 trials.
“When we consider the overall cost of running cancer clinical trials, covering patients’ travel, lodging, and other non-medical expenses represents a relatively small investment. Our findings suggest that these costs are modest compared with what sponsors already spend per participant and decline substantially over time,” said lead author Sukh Makhnoon, PhD, an assistant professor in the O’Donnell School of Public Health and Simmons Comprehensive Cancer Center at UT Southwestern Medical Center. “Reimbursing patients for these expenses could be a practical and relatively inexpensive way to reduce financial barriers and make cancer clinical trials more accessible.”
A pair of phase 3 trials of the investigational triple agonist retatrutide showed a mean weight loss of up to ~25% and clinically meaningful pain reduction versus placebo in people with obesity and osteoarthritis.
Compared to currently available GLP-1 (glucagon-like peptide-1) drugs like semaglutide or tirzepatide, which target one or two receptors and typically result in 10%-20% weight loss, retatrutide, a once-weekly injectable, targets three hormone receptors: GLP-1, GIP (glucose-dependent insulinotropic polypeptide), and glucagon (GIP/GLP-1/glucagon).
The two trials, TRIUMPH-4 and TRIUMPH-1-OA, found that the highest doses produced average body-weight reductions of 20–25%. In a pooled analysis, roughly two-thirds of retatrutide recipients achieved ≥ 50% reduction in pain scores, compared with 38% on placebo. Additional benefits included lower blood pressure, improved lipids, and reduced systemic inflammation. The results of the Northwestern University-led trials were published in the New England Journal of Medicine.
Current knee-OA options (intra-articular corticosteroids, physiotherapy, topical agents, NSAIDs, opioids) offer only limited or short-term relief. Modest (5–10%) weight loss via diet and exercise can help but is hard to sustain, particularly when pain limits activity. Retatrutide’s three-receptor mechanism produced greater weight loss than dual or single agonists typically achieve.
Dr Thomas Schnitzer, corresponding author at Northwestern, said: “Participants had remarkable responses. Many of the people in this study lost considerable amounts of weight, with a few losing up to a hundred pounds or more.”
People who need a knee replacement were excluded from the trial. The biggest unknown from the study, Schnitzer said, is whether retatrutide slows the progression of knee OA enough to reduce the need for total joint replacement.
“That would be the goal here to say you can reduce people’s pain, and you can stop the progression of their osteoarthritis,” Schnitzer said.
The other area of this research that needs further investigation is whether the drug can reduce painful knee OA in people who are not overweight, as they were not included in the study.
“These drugs are believed to have significant anti-inflammatory activity, but the mechanism is not entirely known,” Schnitzer said. “Whether cutting down inflammation in the joint is also important in addition to reducing load needs more research, so this is still a first step, in my view. I’ve been working in the OA field for a long time, and I think this opens up opportunities to do a lot more studies to understand the condition better.”
Dr Philip Conaghan (University of Leeds) presented TRIUMPH-4 results at the American College of Rheumatology meeting.
An illustration of blood glucose monitoring, an important aspect of diabetes management and the prevention of complications. Source: Pixabay CC0
PRETORIA – Diabetes has remained South Africa’s leading underlying natural cause of death for three consecutive years, claiming nearly 29 000 lives in 2024 alone. A University of Pretoria (UP) public health expert is calling for urgent action to strengthen healthcare and prevent avoidable deaths.
According to the latest Statistics South Africa mortality report, 28 767 South Africans died from diabetes-related complications in 2024. This represents 6.1% of all recorded deaths, or about 79 people every day.
Diabetes was also the leading underlying natural cause of death in 2022 and 2023, with 33 126 and 27 967 deaths, respectively.
“These numbers cannot be accepted as South Africa’s new normal,” he says. “Diabetes is mostly preventable and manageable. With timely support, people can lead long, healthy lives free from preventable complications.”
Diabetes is a chronic condition in which the body cannot properly regulate blood sugar levels. Without appropriate treatment, it can cause life-threatening complications affecting the heart, kidneys, eyes, and blood vessels.
Women and working-age adults are most at risk
The national statistics reveal significant inequalities in the burden of diabetes.
In 2024, diabetes claimed 17 429 women’s lives, accounting for 7.9% of all recorded female deaths. Among men, it caused 11 334 deaths, representing 4.5% of male deaths.
Working-age South Africans are also particularly vulnerable. Diabetes was the leading natural cause of death among people aged 45 to 64, accounting for 9 364 deaths, or 7.9% of deaths in this age group.
It also ranked as the leading natural cause of death in five provinces: Gauteng, KwaZulu-Natal, Western Cape, Eastern Cape, and Limpopo.
The findings reflect a broader national health challenge, with noncommunicable diseases, including diabetes and cardiovascular conditions, accounting for 60.7% of all recorded deaths in 2024.
Why better healthcare could save lives
Dr Ngassa Piotie argues that mortality statistics tell us how many lives have been lost to diabetes, but reveal little about the circumstances surrounding those deaths, including whether they could have been prevented through earlier diagnosis, timely treatment, and better-quality care.
“We should not wait until people die to identify where our health system is failing them,” he says. “We must use the evidence available today to improve care, prevent avoidable complications, and save lives.”
Death certificates cannot reveal whether patients received timely diagnoses, had reliable access to medication, or were regularly monitored for complications.
Through UP’s Tshwane Insulin Project, researchers have demonstrated how nurse-led care can help patients with type 2 diabetes start and adjust insulin treatment at primary healthcare facilities, supported by follow-up care at home.
“Survival rarely hinges on high-tech interventions,” Dr Ngassa Piotie says.
Instead, effective diabetes care depends on trained healthcare workers, reliable medicine supplies, regular screening, continuous monitoring, and support that accommodates patients’ everyday circumstances.
From policy to action: Preventing avoidable deaths
South Africa’s National Strategic Plan for Non-Communicable Diseases includes targets known as 90-60-50. These aim to ensure that 90% of adults know their blood pressure and blood glucose status, 60% of those with elevated levels receive treatment, and 50% of those receiving care achieve clinical control.
However, translating these commitments into effective healthcare remains a challenge.
Dr Ngassa Piotie advocates for the establishment of a national diabetes registry and the integration of digital health systems to track patients from diagnosis through treatment, identify those who discontinue care, and monitor complications.
He identifies three immediate priorities: connecting early diagnosis to sustained treatment, measuring healthcare outcomes across districts and provinces, and addressing socio-economic barriers such as food insecurity, transport costs, and limited healthcare access.
For Dr Ngassa Piotie, preventing avoidable diabetes-related deaths requires more than awareness campaigns. It demands a coordinated national response that ensures patients receive the continuous care they need.
“People living with diabetes must help define what quality care looks like,” he says.
There is not enough evidence to determine whether testosterone helps with thinking and memory in midlife women, even though it is often prescribed in the UK, according to a UCL study.
Published in Reproduction and Fertility, the review examined five existing studies of women aged 41 to 65 to understand whether testosterone treatment improves thinking and memory in women during and after menopause.
Senior author and Director of the UCL Menopause Mind Lab Professor Aimee Spector (UCL Psychology and Language Sciences) said: “Social media is flooded with claims that testosterone improves memory and brain fog, and we hear of many women taking testosterone specifically to manage these symptoms during the menopause. While there may be some anecdotal evidence for this in perimenopausal women (who are missing from these trials), we cannot claim testosterone improves cognition during menopause without further evidence.
“More research is needed to understand any links between testosterone and brain health.”
The menopause is when a woman’s periods stop due to lower hormone levels. This usually happens between the ages of 45 and 55. Post menopause is the stage of life that begins 12 consecutive months after a woman’s final menstrual period and lasts for the rest of her life.
The menopause transition and post menopause have been associated with cognitive complaints, often described as ‘brain fog’. This includes difficulties recalling words and numbers, misplacing items, trouble concentrating and forgetfulness. It is thought that testosterone levels do not acutely change during menopause but instead begin to decline from a woman’s mid-20s to early 30s.
Researchers reviewed five different studies to determine whether testosterone improved executive function, verbal learning and memory, and visuospatial learning and memory in post-menopausal women.
Many of the study participants were given testosterone while most of the other participants were given a placebo, administered on a daily, weekly or monthly basis for periods ranging between four to 26 weeks. Researchers then compared the effects of cognition between testosterone and the placebo.
The authors conducted a meta-analysis on the results of three of the five studies, which examined a total of 244 women in randomised controlled trials, and they did not find any statistically significant improvements for cognitive function among participants taking testosterone.
Hormone treatments are often used to manage menopause symptoms, but it is unclear whether they help with brain fog. Current guidance from the British Menopause Society and the International Menopause Society only supports testosterone therapy for low libido, and the researchers note its effects on thinking and memory are not well understood.
The researchers say that testosterone prescribing has anecdotally increased across NHS and private clinics in the UK, reflecting growing interest in its role during menopause.
Corresponding author Dr Alexandra Faulkner (UCL Psychology and Language Sciences) said: “Our review found that the available evidence is limited and insufficient to determine the effect of testosterone therapy on cognition in women during the menopause transition and post menopause. This reflects a lack of sufficient evidence rather than evidence of no effect.”
Further research is needed to guide treatment decisions and support women in making informed choices about their care, particularly in women going through the menopause. Future research should also explore how women perceive changes in their thought processes and memory.
Data was included from Australia, Canada, the USA and Sweden to complete this review.
The researchers note that the studies available were limited in number and sample size, with the existing evidence base too small to draw firm conclusions about whether testosterone therapy helps cognitive symptoms during menopause. The findings should not be interpreted as proof that testosterone has no effect on cognition.
But nightly prenatal sleep length may modify this association, exploratory findings suggest
Working night shifts during pregnancy is linked to a heightened risk of neurodevelopmental abnormalities detected by screening in the child by the age of 4, finds research published online in Occupational & Environmental Medicine.
But nightly prenatal sleep length during this period may modify this observed association, exploratory findings suggest.
Night shift work during pregnancy has been associated with unfavourable health outcomes for both mother and child, including neurodevelopmental issues, potentially related to body clock and sleep disturbances, note the researchers.
They therefore wanted to explore the associations between mums’ night shift work and their children’s neurodevelopment and to find out if there are potentially modifiable prenatal factors, such as changes in night shift patterns and sleep duration.
They drew on nationwide survey data for around 100 000 pregnant women from the Japan Environment and Children’sStudy (JECS) who were enrolled between January 2011 and March 2014.
The women were surveyed in the first and second/third trimesters and answered questions about the number of night shifts they worked in a month.
Their responses were divided into 3 groups: no night shifts reported in either survey (27 655 women); night shifts in the first, but not second survey (‘discontinued night shifts’, 1779 women); and night shifts in both surveys (‘continued night shifts’, 2084 women).
Prenatal sleep length was calculated from self-reported bedtime and wake-up times in the second/third trimester. Sleep length was categorised as short if less than 6 hours; moderate if 6–9 hours; and long if 10 or more hours.
Child neurodevelopmental abnormalities at the age of 4 were assessed using a developmental screening tool—the Japanese version of the Ages and Stages Questionnaire, Third Edition (J-ASQ-3).
This is made up of 5 domains: communication; gross motor skills; fine motor skills (ability to make small, precise, deliberate movements); problem solving; and personal–social functioning (interpersonal skills, emotional/behavioural development, and awareness of personal boundary/space).
In all, 31,528 mothers who worked in the first trimester and completed the child development questionnaire when their children were 4 years old were included in the analysis.
Some 4189 (just over 13%) of the 4 year olds were classified as high risk of an abnormality in at least one of the five J-ASQ-3 domains: 1210 (4%) for communication; 1599 (5%) for gross motor skills; 1906 (6%) for fine motor skills; 913 (3%) for problem solving; and 1495 (5%) for personal–social functioning.
Compared with the children of mothers who didn’t work night shifts, the children of those who discontinued night shift work were more likely to have developmental screening abnormalities, but only in the fine motor skills domain (24% higher risk).
But the children of mothers who continued night shifts during their pregnancy had higher risks of developmental abnormalities in 3 domains compared with children whose mothers didn’t work night shifts.
These were in the domains of communication skills (29% higher risk); fine motor skills (34% higher risk); and personal–social functioning (31% higher risk).
Only the fine motor skills domain showed a significant association, regardless of whether night shifts were continued or discontinued.
“One possible explanation is that maternal inflammation associated with persistent night work may preferentially affect neural pathways involved in fine motor function,” suggest the researchers.
A separate exploratory analysis showed that the observed association between night shift pattern and the child’s neurodevelopmental risk differed according to how long the mothers slept.
Prenatal sleep duration of 10 or more hours was associated with an 80% heightened risk of abnormalities in any of the 5 domains compared with prenatal sleep length of 6-9 hours.
Long prenatal sleep duration may also reflect underlying fatigue, subclinical depression, inflammation, or anaemia, rather than representing a harmful exposure in itself, suggest the researchers.
This is an observational study, and as such, can’t establish cause and effect. And the researchers acknowledge that they weren’t able to account for shift rotation systems, individual chronotype, workload, exposure to light, or the timing of night shift discontinuation, all of which might have influenced the findings.
But in light of the findings, it may be worth employers considering flexible work schedules for pregnant night shift workers, they say.
Dialysis should not necessarily be regarded as the default option for older people with kidney failure, a major study led by Bristol NHS Foundation Trust and the University of Bristol has found.
The findings are from the Prepare for Kidney Care trial, the first randomised study of its kind in the world, published in The Lancet on 5 November. The study suggests a structured, less medicalised approach without dialysis may offer an alternative without compromising a person’s overall length and quality of life.
The trial investigated whether older people living with kidney failure and multiple health conditions or frailty would benefit more from dialysis or a structured programme of care that does not include dialysis. It looked at both quality of life and survival.
The researchers aim to help patients and their families reach the best decision for them, offering by far the best evidence on this issue. They also want to influence NHS policy on care for this group of patients.
Around 75% of participants were aged 80 or over. The remaining 25% were aged 65–79 and had additional health problems.
Participants were randomly allocated to one of two approaches: prepare for renal dialysis or prepare for responsive management (a form of conservative kidney management). The study took nine years to complete, including seven years to recruit, and participants could choose to withdraw at any time.
Over an average follow-up period of 4.5 years, the team found neither approach resulted in better outcomes when length and quality of life were considered together.
Only one in four people (28%) who were preparing for dialysis went on to start treatment. Participants in both groups were more likely to die from other causes than to require dialysis, reflecting the vulnerability and complex health needs of this population.
The results do not apply to people already receiving dialysis, or to younger and fitter patients, for whom dialysis and transplantation remain standard care.
Fergus Caskey, Professor of Renal Medicine in Bristol Medical School, Consultant Nephrologist at Bristol NHS Foundation Trust and project lead, said:
“Our findings could have global implications for how kidney failure is discussed and managed in older patients living with multiple health conditions or frailty. Conservative kidney management is an active treatment that does not include dialysis. It is increasingly recognised around the world, but until now there has been limited evidence to compare both approaches.
“This trial establishes that if you are an older person with failing kidneys and other health problems, both preparing for dialysis and conservative kidney management are worth considering. Both have pros and cons. They result in similar overall length and quality of life. Neither should be the default.
“Carrying out a trial like this presented significant ethical challenges, but we worked hard to develop a trial where all participants retained their choice about taking part and could change their treatment pathway at any point.”
Dialysis can place a considerable burden on patients and families, often requiring frequent travel, regular treatments and medical procedures. It also carries the risk of complications. With costs estimated at around £35 000 per patient each year, dialysis also represents a significant commitment of NHS resources.
The trial was co-designed with patients and kidney specialists and included interviews with participants and their families to better understand their experience of the treatments.
The research team recommend that dialysis preparation should no longer be the default pathway for older people living with kidney failure and multiple other health problems or frailty. Instead, both treatment approaches should be presented as equally valid options, with decisions made jointly by patients and their healthcare teams.
For the first time, researchers have successfully measured antibodies against specific respiratory viruses in exhaled air. This is shown in a new study involving, amongst others, the Karolinska Institutet, published in eBioMedicine. The method may make it easier to study the immune system in the small airways of the lungs.
Antibodies in the mucosal lining of the respiratory tract play an important role in protecting against respiratory viruses such as influenza virus, SARS-CoV-2 and respiratory syncytial virus (RSV). While antibodies in the upper airways are relatively easy to measure, sampling from the lower airways has previously required invasive procedures such as bronchoscopy.
In the new study, researchers used a non-invasive method called PExA (Particles in Exhaled Air). By breathing into a specially designed instrument, participants generated tiny exhaled particles originating from the respiratory tract lining fluid of the small airways. These particles were collected and analysed for virus-specific antibodies.
“Antibodies in the nasal mucosa are important for protection against respiratory infections, but immune responses further down the lungs are also crucial, particularly for preventing severe disease such as pneumonia. This method opens up new possibilities for understanding how immunity differs between the upper and lower airways,” says Charlotte Thålin, adjunct professor at the Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, and co-last author of the study.
The study included 28 participants in the COMMUNITY cohort at Danderyd Hospital, 18 of whom had recently experienced a respiratory tract infection. The researchers analysed paired samples from blood, nasal secretions and exhaled breath.
In the exhaled breath samples, the researchers successfully detected IgA and IgG antibodies directed against SARS-CoV-2, influenza virus and RSV. Virus-specific IgG levels in the lower airway samples largely mirrored those observed in blood, whereas IgA showed a different pattern, consistent with a greater contribution from local mucosal antibody responses.
“Sampling is relatively simple, as participants simply need to breathe into a device. This enables us to collect samples from the small airways without invasive procedures, which is particularly valuable if we wish to take repeated samples and monitor the immune system over time,” says Katherina Aguilera, a PhD student at the same department, and the study’s first author.
In the future, the method could help researchers investigate how immune responses in the lower airways change following respiratory infections or vaccinations, and and support the evaluation of preventive treatments. The researchers emphasise that this was an initial methodological study involving a limited number of participants and that further validation in larger studies is needed.
The study was conducted in collaboration between Karolinska Institutet, Danderyd Hospital, Uppsala University, and SciLifeLab. Funding was provided by the European Research Council (ERC), the Knut and Alice Wallenberg Foundation and the Swedish Society for Medical Research (SSMF).
