Anglia Ruskin University (ARU) researchers have found a to create a 3D ‘scaffold’ to grow cells from the retina -paving the way for potential new ways of treating a common cause of blindness. Their nanotechnology-based approached is detailed in the journal Materials & Design.
The researchers have been working on a way to successfully grow retinal pigment epithelial (RPE) cells that stay healthy and viable for up to 150 days. RPE cells sit just outside the neural part of the retina and, when damaged, can cause vision to deteriorate.
It is the first time this technology, called ‘electrospinning’, has been used to create a scaffold on which the RPE cells could grow, and could revolutionise treatment for one of age-related macular degeneration, one of the world’s most common vision complaints.
When the scaffold is treated with a steroid called fluocinolone acetonide, which protects against inflammation, the resilience of the cells appears to increase, promoting growth of eye cells. These findings are important in the future development of ocular tissue for transplantation into the patient’s eye.
Age-related macular degeneration (AMD) is a leading cause of blindness in the developed world and is expected to increase in the coming years due to an ageing population. Recent research predicted that 77 million people in Europe alone will have some form of AMD by 2050.
AMD can be caused by changes in the Bruch’s membrane, which supports the RPE cells, and breakdown of the choriocapillaris, the rich vascular bed that is adjacent to the other side of the Bruch’s membrane.
In Western populations, the most common way sight deteriorates is due to an accumulation of lipid deposits called drusen, and the subsequent degeneration of parts of the RPE, the choriocapillaris and outer retina. In the developing world, AMD tends to be caused by abnormal blood vessel growth in the choroid and their subsequent movement into the RPE cells, leading to haemorrhaging, RPE or retinal detachment and scar formation.
The replacement of the RPE cells is among several promising therapeutic options for effective treatment of sight conditions like AMD, and researchers have been working on efficient ways to transplant these cells into the eye.
Lead author Professor Barbara Pierscionek, Deputy Dean (Research and Innovation) at Anglia Ruskin University (ARU) said: “This research has demonstrated, for the first time, that nanofibre scaffolds treated with the anti-inflammatory substance such as fluocinolone acetonide can enhance the growth, differentiation, and functionality of RPE cells.
“In the past, scientists would grow cells on a flat surface, which is not biologically relevant. Using these new techniques. the cell line has been shown to thrive in the 3D environment provided by the scaffolds.
“This system shows great potential for development as a substitute Bruch’s membrane, providing a synthetic, non-toxic, biostable support for transplantation of the retinal pigment epithelial cells. Pathological changes in this membrane have been identified as a cause of eye diseases such as AMD, making this an exciting breakthrough that could potentially help millions of people worldwide.”
A US study shows that use of low-dose atropine eyedrops, commonly used in a higher dose to treat lazy eye, was no better than a placebo at slowing myopia progression and elongation of the eye among children treated for two years.
The first randomised controlled trial of its kind aimed at identifying an effective way to manage myopia was published last week in JAMA Ophthalmology. It was conducted by the Pediatric Eye Disease Investigator Group at at Vanderbilt University Medical Center (VUMC) and 11 other hospitals and practices across the United States and funded by the National Eye Institute (NEI).
“We found, interestingly, and honestly shockingly, that there was no difference in the use of 0.01% atropine and placebo in treating these children who ranged in age from 5 to 12,” said associate professor Lori Ann Kehler, OD, and the Vanderbilt site principal investigator for the study.
The onset of myopia usually occurs between the ages of 7 and 16 when developing eyes can start growing too long axially (from front to back). Instead of focusing images on the retina, images of distant objects are focused at a point in front of the retina which causes people to have poor distance vision while their near vision remains unchanged.
The condition results in the need for eyeglasses to improve distance vision, and it can also result in medical complications and serious uncorrectable vision loss later in life, like retinal detachments or myopic macular degeneration.
The study contradicts earlier studies from East Asia that showed the small dose of atropine is effective in slowing progression of myopia.
In 2017 the Academy of Ophthalmology endorsed the findings from East Asia saying that although the FDA had not approved atropine for this use, there was sufficient evidence for prescribing the low dose for myopia. Ophthalmologists across the country, including at VUMC, began to offer the prescription to young patients with myopia.
“That was a really exciting finding at the time because we had had no treatment options for many years,” Kehler said. The prescription of atropine for treating myopia is not covered by most insurance plans.
“The incidence of myopia is increasing worldwide,” Kehler said. “By 2030 it’s predicted that 39 million people in the US will have myopia. By 2050 that number is expected to increase to more than 44 million people in the US and to 50% of the global population. Once it’s detected in children, it tends to get worse every year,” she said. “Investigators all over the world have tried strategies to intervene, to either stop or slow the worsening of myopia.”
Kehler said it is not known why the incidence of myopia is increasing. “There are several theories. Some believe it’s the increase in the use of screens and screen time, but myopia was increasing even before screens were part of children’s lives. Others think it has to do with industrialisation. We were an agricultural society. We were outside more. We weren’t reading. We weren’t looking up close all day. Really, the prevailing thought is whether we’re at a screen or looking at a math book or reading most of the day, we think the lack of sunlight and sustained near effort is what’s causing the increase of myopia.”
Kehler said the percentage of children with myopia using the atropine drop at VUMC is low and estimates fewer than 5% of children with myopia are using the drops nationally.
Going forward, eye specialists should have a frank discussion with parents of children with myopia about the conflicting data between the Asian studies and the new U.S. study.
“The absence of a treatment benefit in our US-based study, compared to East Asian studies, may reflect racial differences in atropine response. The study enrolled fewer Asian children, whose myopia progresses more quickly, and included Black children, whose myopia progresses less quickly compared with other races,” noted the study’s lead co-author, Michael X. Repka, MD, professor of Ophthalmology at Johns Hopkins University, in a news release from the NEI.
“All the studies have shown the drops are safe, so we aren’t putting children at risk if we continue to prescribe the 0.01%,” Kehler said. “But we are telling them there is a difference in these studies and it might have to do with your genetics; it might be that it’s more effective in children from Asia than in the U.S. population,” she said.
Further study is needed, Kehler said. The next step is likely to study a higher dose of atropine to see if children in the U.S. experience a benefit.
The LAMP study out of Hong Kong found that 0.05% might be more effective.
Kehler said other groups are studying the use of red-light therapy to slow the progression of myopia, and there are also new eyeglass lenses that have been developed to slow the progression of myopia, but they are not yet available in the U.S.
“It’s much harder to get drops in very young children,” Kehler said. “But if we had a spectacle option, that would open the door to treating our younger patients.”
Myopia usually stabilises in about half of children around 16 years of age and among an increasingly larger percentage as they get older. By their early 20s, about 10% of individuals with myopia will continue to grow more nearsighted, and by age 24 that percentage is 4%.
The Supreme Court of Appeal has dismissed an application for leave to appeal by Solidarity and Afriforum over a 2021 court case where they challenged a condition by South African Health Products Regulatory Authority (SAHPRA) that the Johnson & Johnson vaccine be restricted to the government. SAHPRA said that this was not a condition that they had imposed.
On 26 July 2023, the Supreme Court of Appeal (SCA) dismissed an application for leave to appeal filed by Solidarity and Afriforum (the Applicants) on the grounds that there is no reasonable prospect of success.
The Pretoria High Court struck Solidarity and AfriForum’s application from the court roll on the grounds of an alleged lack of urgency, and the court also ordered them to pay SAHPRA’s legal costs which was filed in June 2021 by the Applicants, wherein they alleged that when SAHPRA approved and registered the J&J vaccine, SAHPRA imposed a condition that the sale of the J&J vaccine is restricted to the National Government. The applicants argued that SAHPRA was not mandated to stipulate the condition that only the government may purchase the J&J vaccine and questioned the legality of such a condition.
SAHPRA refuted this claim because this is not a condition that SAHPRA had imposed. Subsequently, the applicants proceeded to lodge an application for leave to appeal with the SCA . SAHPRA CEO, Dr Boitumelo Semete-Makokotlela said, “This court ruling indicates that SAHPRA is judicious in adhering to its mandate responsibly. We welcome the outcome of this judgement.”
Following reports of healthcare workers who have been bitten, punched, hit in the face, robbed, assaulted, or even killed in healthcare facilities in Gauteng, the province’s health department announced that healthcare workers will now be trained in handling patients who become violent.
The initiative was recently announced by Motalatale Modiba, spokesperson for the Gauteng Department of Health, on social media.
A lack of security at public healthcare facilities is not a new problem. A previous series of Spotlight articles highlighted security challenges in public health facilities in several provinces – including Gauteng – and reports of robberies and assaults at some facilities. Last year, there was a fatal shooting of a nurse at Tembisa Hospital which sparked an outcry among health worker unions over the safety of their members.
The departments’ announcement prompted questions by organised labour and an opposition politician about whether the authorities have lost trust in the multi-million rand security measures already in place in health facilities to protect both workers and patients, with some arguing that security guards, rather than healthcare workers, should be responsible for safety.
However, according to Modiba, the training of staff has nothing to do with the security contracts of security companies.
“Security personnel are non-medical personnel, therefore, their presence in facilities does not substitute the need to ensure that our staff is empowered with techniques to know how to handle difficult patients,” he told Spotlight.
‘Just a tick-box exercise’
The training plans, however, have inspired little confidence among healthcare workers.
According to the nurses’ union Denosa’s Gauteng Provincial Secretary, Bongani Mazibuko, the training does not address the safety concerns that exist in the facilities. “It’s just a tick-box exercise to say the employer is trying to do something. The root cause of these attacks is the influx of mental health patients and the mixing of mental health patients with medical patients,” he told Spotlight.
The department in a statement in April said many of the incidents were reported at Weskoppies Psychiatric Hospital with 21 cases since January last year. At Carletonville Hospital there were nine safety incidents, nine incidents at the Far East Rand Hospital, seven at Chris Hani Baragwanath Academic Hospital, four at Thelle Mogoerane Hospital, and three at Kopanong Hospital. There were also reports of some isolated incidents at other facilities.
Mazibuko said that from the reports they received from their members working in Gauteng public health facilities, the training has also not yet taken place. “We would like the department to tell us which institutions they have provided the training to so that we can confirm with our members if they received the training or not.”
Modiba, however, did not respond to Spotlight’s questions about where training had taken place so far, how many healthcare workers have been trained, or the impact this is having.
Explaining aspects of the plan, however, Modiba said that the department training staff to know how to protect themselves is a practical step that shows that they are conscious of the environment they operate in. According to him, training on how to manage a violent mental healthcare user is generic to the training of doctors and psychiatric nurses as regulated by the Health Professions Council of South Africa, which is a statutory body established in terms of the Health Professions Act. “A special course on management of violent mental healthcare users is planned to be rolled out from the second quarter of the 2023-2024 financial year. It is based on a similar course attended by one of the healthcare workers in the UK. He will be working in one of our Specialist Psychiatric hospitals, Sterkfontein Hospital. He will be the main facilitator and will be working with other employees from the Regional Training Centres, the Office of Health Standards Compliance (OHSC), and Wellness Practitioners,” said Modiba. He said the department is also working with the police.
But Mazibuko said Denosa has had many talks with the department on healthcare workers’ safety concerns and the need to create a safe working environment. “This was part of our demands when we marched last year. Even on International Nurses Day, we were vocal about our concerns about the safety of our members at the workplace.”
He said the union had previously presented its safety campaign to the department.
SAMA ‘deeply concerned’
Meanwhile, following a scoping review study, the South African Medical Association (SAMA) recently published a report outlining the nature and extent of violence against healthcare workers between 2012 and 2022. The study found an increase in violent acts targeting healthcare workers, with the most affected being doctors, nurses, and paramedics. The study found that female healthcare workers were disproportionately affected compared to their male counterparts and most of the incidents were reported in Gauteng.
In an interview with Spotlight, SAMA Chairperson Dr Mvuyisi Mzukwa said they are “deeply concerned” about the safety of healthcare professionals. He said they appreciate efforts that can realistically improve the safety of healthcare workers in the workplace.
“SAMA has shared an interim report [based on the study findings] on violence targeting healthcare workers with DENOSA and the media. This report was designed to sensitise all stakeholders about crime targeting healthcare workers and to prime the stakeholders, including the National Department of Health, to initiate intersectoral solutions to limit and prevent safety threats in the workplace against all healthcare workers in the country,” Mzukwa said.
SAMA’s report found eight murders of healthcare workers reported in the media, “with six of the deaths (or 75%) occurring among doctors”. One nurse and one paramedic were also murdered in the set period the report found. “Of all the 45 media reports examined, only 17 arrests (38%) were reported, with only two resulting in successful prosecution.”
According to Mzukwa, SAMA had recommended that a multi-sectorial strategy for the security of healthcare workers to protect them from targeted crime be developed and implemented.
“Without this intervention, healthcare in itself continues being further jeopardised and more doctors will feel threatened and seek safer refuge in foreign countries, taking with them critical skills and expertise that are in dire need locally. Law enforcement agencies should also act swiftly in dealing with crime and to ensure the safety of both patients and healthcare providers,” Mzukwa said.
61 safety incidents
Speaking in the Gauteng Legislature in April, MEC for Health and Wellness, Nomantu Nkomo-Ralehoko said there were 61 incidents reported in health facilities between January 2022 and April 2023. She told MPLs that most of these incidents were attributed to mental healthcare users, while others relate to patients’ anger towards staff for various reasons, such as refusal to buy them items or patients trying to escape, as well as angry relatives and patients linked to criminal activities.
Nkomo-Ralehoko said that staff training in responding to aggression and violence in the affected institutions is one element of their intervention. She said the department will be installing CCTV cameras at strategic locations for monitoring purposes.
“Our goal is to minimise – if not eradicate – such incidents in our facilities. We have to work with healthcare workers and other stakeholders such as hospital boards, clinic committees, and the patients themselves to curb incidents of attacks inside our facilities,” she said.
But security concerns in Gauteng’s public health facilities are also fuelled by systemic and contract management issues – something the MEC vowed to address. In March, responding to concerns over these multi-million rand security contracts that are rolled over year on year without a proper tender, Nkomo-Ralehoko acknowledged that the situation is unacceptable. The department is spending over R59 million on month-to-month security contracts at its facilities.
“The security contracts are rolled over irregularly as there is currently no contract in place; only service level agreements are used to manage the contracts,” she said.
Responding to a question from Spotlight on the progress with the new security tender, Modiba said that the tender was advertised and has since closed. “The evaluation committee has been appointed and will now go through the evaluation process to assess the various bids that have been received. We are still on course to complete the process within this financial year,” Modiba said.
But according to Denosa’s Mazibuko, in-sourcing security services, separating mental health patients from other patients, and ensuring that mental health patients are only admitted to where the institutions can commit them, will help the department and the healthcare workers work in a safe space.
He said that the fact that there have been years of year-on-year security contracts, shows that the department is not in touch with the challenges on the ground. “In-sourcing of security will help as well since it will address the issue of security withholding their services as they have not been paid and security being given proper gear for work,” he said.
According to Jack Bloom, the Democratic Alliance’s health spokesperson in Gauteng, the department is failing in its basic responsibility to provide a safe working environment for staff and patients in public hospitals.
“A huge amount of money is spent on security companies that don’t do their job, and it is high time that new security contracts are awarded to competent providers,” he said.
Bloom said that healthcare providers should not have to defend themselves against attacks because that is what security guards are supposed to do. “There needs to be a complete overhaul of security arrangements at our hospitals, with a professional assessment of what should be provided at a reasonable cost,” he said.
When a fragrance wafted through the bedrooms of older adults for two hours every night for six months, memory recall skyrocketed. Participants in this study experienced a 226% increase in cognitive capacity compared to controls. The researchers say the finding transforms the long-known tie between smell and memory into an easy, non-invasive technique for strengthening memory and potentially deterring dementia. The findings, which appear to pass the ‘sniff test’, are published in the open-access journal Frontiers in Neuroscience.
The project was conducted University of California, Irvine neuroscientists, involving men and women aged 60 to 85 without memory impairment. All were given a diffuser and seven cartridges, each containing a single and different natural oil. People in the enriched group received full-strength cartridges. Control group participants were given the oils in tiny amounts. Participants put a different cartridge into their diffuser each evening prior to going to bed, and it activated for two hours as they slept.
People in the enriched group showed a 226% increase in cognitive performance compared to the control group, as measured by a word list test commonly used to evaluate memory. Imaging revealed better integrity in the brain pathway called the left uncinate fasciculus. This pathway, which connects the medial temporal lobe to the decision-making prefrontal cortex, becomes less robust with age. Participants also reported sleeping more soundly.
Scientists have long known that the loss of olfactory capacity, or ability to smell, can predict development of nearly 70 neurological and psychiatric diseases. These include Alzheimer’s and other dementias, Parkinson’s, schizophrenia and alcoholism. Evidence is emerging about a link between smell loss due to COVID and ensuing cognitive decrease. Researchers have previously found that exposing people with moderate dementia to up to 40 different odours twice a day over a period of time boosted their memories and language skills, eased depression and improved their olfactory capacities. The UCI team decided to try turning this knowledge into an easy and non-invasive dementia-fighting tool.
“The reality is that over the age of 60, the olfactory sense and cognition starts to fall off a cliff,” said Michael Leon, professor of neurobiology & behaviour and a CNLM fellow. “But it’s not realistic to think people with cognitive impairment could open, sniff and close 80 odorant bottles daily. This would be difficult even for those without dementia.”
The study’s first author, project scientist Cynthia Woo, said: “That’s why we reduced the number of scents to just seven, exposing participants to just one each time, rather than the multiple aromas used simultaneously in previous research projects. By making it possible for people to experience the odors while sleeping, we eliminated the need to set aside time for this during waking hours every day.”
The researchers say the results from their study bear out what scientists learned about the connection between smell and memory.
“The olfactory sense has the special privilege of being directly connected to the brain’s memory circuits,” said collaborating investigator Michael Yassa, professor and director of CNLM. “All the other senses are routed first through the thalamus. Everyone has experienced how powerful aromas are in evoking recollections, even from very long ago. However, unlike with vision changes that we treat with glasses and hearing aids for hearing impairment, there has been no intervention for the loss of smell.”
The team would next like to study the technique’s impact on people with diagnosed cognitive loss. The researchers also say they hope the finding will lead to more investigations into olfactory therapies for memory impairment. A product based on their study and designed for people to use at home is expected to come onto the market later this year.
