Researchers screening more than 1000 potential drugs for spinal cord injury treatment identified an existing one – cimetidine – that improved spinal repair in zebrafish. The results, published in the journal Theranostics, showed that the drug also helped improve recovery of movement and reduce the extent of spinal cord damage when tested in spinal-injured mice.
Healing of spinal cord injuries can be inefficient due to inflammation caused by an overreaction of the immune system. Anti-inflammatories that suppress the whole immune response also inhibit the immune cells which promote repair.
The University of Edinburgh-led study tested multiple drugs in zebrafish larvae for their ability to prevent excessive inflammation during an immune response. Scientists discovered that cimetidine acts by helping to regulate histamine levels.
The findings have enabled the team to pinpoint a specific signalling pathway that moderates the immune response after spinal injury to support repair.
The investigators say that other drugs that work in a similar way could also be tested for their ability to support recovery from spinal injury. They caution that further studies are needed to investigate their impact in human clinical trials. The researchers add that the study highlights the usefulness of zebrafish in the drug discovery process.
The research team included scientists from the University of Edinburgh, the Research Institute of the McGill University Health Centre and Technische Universität Dresden.
Scientists studying gene activity data of the early human embryo have discovered an overlooked type of cell which self-destructs within days of forming, as part of a quality control process to protect the developing foetus. The findings, published in PLoS Biology, give insights on what happens at the very first stages of life after fertilisation which could in the future help improve IVF or regenerative medicine treatments.
Self-destructing embryonic cell
As a zygote develops, cells start to specialise, and like trains sent to different end stations, some will be shunted off to become the placenta while others will become the embryo.
The team of scientists analysed previously published data on gene activity of each individual cell from 5-day old embryos and discovered around a quarter of the cells didn’t fit the profile of any of the known cell types (pre-embryo, pre-placenta etc).
Investigating further, they discovered that these cells contained so-called “Young transposable elements” or “jumping genes.” These are rogue elements of DNA that can copy themselves and insert themselves back into our DNA, often causing damage in the process.
Staining of embryos by project collaborators in Spain confirmed the existence of the cells with proteins derived from the jumping genes.
Looking a little further forward in time, the team found their descendants both have DNA damage and undergo a process of programmed cell death.
Quality control mechanism
This process, the researchers suggest, looks like a form of quality control: selection between cells in favour of the good ones.
Dr Zsuzsanna Izsva?k, co-senior author from the Max Delbrück Center and an expert on mobile DNA, said: “Humans, like all organisms, fight a never-ending game of cat and mouse with these harmful jumping genes.
“While we try and suppress these jumping genes by any means possible, very early in development they are active in some cells, probably because we cannot get our genetic defences in place fast enough.”
Co-lead author Professor Laurence Hurst, from the Milner Centre for Evolution at the University of Bath, said: “If a cell is damaged by the jumping genes – or any other sort of error such as having too few or too many chromosomes – then the embryo is better off removing these cells and not allowing them to become part of the developing baby.
“We are used to the idea of natural selection favouring one organism over another. What we are seeing within embryos also looks like survival of the fittest but this time between almost identical cells. It looks like we’ve uncovered a novel part of our arsenal against these harmful genetic components.”
Using old genetic enemies to fight new ones
Conversely, the single-cell data showed that the key cells that will become the embryo (the inner cell mass or ICM) don’t contain jumping genes but instead express a virus-like gene called human endogenous virus H. This helps suppress the young jumping genes in the inner cell mass, fitting with an emerging pattern that we use our old genetic enemies to fight our new ones.
The authors suggest that if the quality control process is too sensitive, the embryo as a whole may die. This might explain why some mutations in our system to detect damage in early embryos are also associated with infertility.
A new study analysing data from the landmark ASPREE trial has found that long-term daily aspirin use increases the risk of anaemia by 20% in people mostly aged 70 and over. The results, which are published in Annals of Internal Medicine, have prompted researchers to suggest considering regular monitoring for anaemia in older adults taking low-dose aspirin. In addition, they should discuss any concerns about their health or medications with their GP.
Anaemia is commonly experienced by older adults, potentially affecting overall function and increasing fatigue, disabilities, depressive symptoms and cognitive problems.
The Monash University-led study followed 18 153 initially healthy older adults in Australia and the USA and recorded incidents of anaemia over an average 4.7 years.
It was the largest study to investigate anaemia in older people as part of a randomised controlled trial, ASPREE (ASPirin in Reducing Events in the Elderly) – with half the participants taking a placebo and the other half a daily low dose (100mg) of aspirin.
The risk of developing anaemia was found to be 20% higher in the aspirin group compared to those in the placebo group.
In addition to a higher risk of anaemia, blood tests revealed a faster decline of haemoglobin and reduced ferritin (a protein that carries iron) levels in the aspirin group compared to the placebo group.
Lead author, Associate Professor Zoe McQuilten from Monash University, said that while bleeding was a known side-effect of aspirin, few previous studies had looked at the effect of prolonged aspirin use on the progressive development of anaemia in older adults.
“This study gives a clearer picture of the additional risk of becoming anaemic with aspirin use and the impact is likely to be greater in older adults with underlying diseases, such as kidney disease,” Associate Professor McQuilten said.
Associate Professor McQuilten said the new data gave doctors insight into the risk of anaemia from prolonged aspirin use by their older patients. “Older adults are more likely to become anaemic generally and now doctors can potentially identify patients at higher risk of developing anaemia,” she said.
Associate Professor McQuilten urged patients to follow the advice of their doctor about their daily use of aspirin. She cautioned that for some older adults, aspirin was recommended as a valuable therapy to prevent recurring heart attacks or stroke. “Patients should not change their aspirin regimen without speaking to their GP,” she said.
Researchers have identified how pathogenic genes in some Providencia spp., which have gained attention as causes of food poisoning as well as enterohaemorrhagic Escherichia coli. O157 and Salmonella, are transferred within bacterial cells. Their findings are expected to provide new insights into the identification of infection routes of Providencia spp. and the establishment of preventive methods for food poisoning.
Recently, Providencia spp. which have been detected in patients with gastroenteritis, and similar to enterohemorrhagic Escherichia coli. O157 and Salmonella spp., have been attracting attention as causative agents of food poisoning. For children with low immunity, food poisoning can be lethal as it causes severe symptoms such as diarrhoea and dehydration, so clarifying the source of infection and pathogenic factors of Providencia spp., and establishing preventive methods are urgent issues worldwide.
A joint research group led by Professor Shinji Yamasaki, Dr Sharda Prasad Awasthi, a Specially Appointed Lecturer, and graduate student Jayedul Hassan from the Graduate School of Veterinary Science, Osaka Metropolitan University, determined how the pathogenic genes in some Providencia spp. such as Providencia alcalifaciens and Providencia rustigianii are transferred within bacterial cells of genus Providencia. The group has also elucidated that the pathogenic genes of Providencia rustigianii are also transferred to other bacterial cells belonging to Enterobacteriaceae.
Professor Yamasaki concluded, “This achievement is expected to provide new insights into the identification of infection routes of Providencia spp. and the establishment of preventive methods for food poisoning.”
Amid skyrocketing youth unemployment, healthcare, a vast sector which touches all of our lives at some point, seems a sensible space for young people to set their sights on for opportunities. From clinical sciences to pharmacy, there is a myriad of careers in the healthcare ecosystem, but there are also factors preventing this potential from being unleashed, writes Bada Pharasi, CEO of The Innovative Pharmaceutical Association South Africa (IPASA).
A career in health has long been seen as a symbol of success in South Africa. The no-nonsense nurses in our communities, the hard-working doctors and the knowledgeable pharmacists have long represented those who had “made it”.
For many of us, these were the lucky ones who had found a career path that was both rewarding and respected. This has also been the way that South Africans view the myriad of the less visible jobs in healthcare (lab technicians, pharmacist assistants, dieticians, the list is endless).
Bada Pharasi, Chief Executive Officer of IPASA
As South Africa grapples with the highest unemployment rate1 in the world, with youth unemployment being the biggest concern (currently at more than 60%2), it’s not difficult to see why the healthcare system with its vast range of careers would present a solution. Careers in health not only benefit young people looking for a start in life, but they also build South Africa’s capacity to provide care for millions who desperately need it.
As young people search for the stepping stones to long, rewarding careers, many will be advised by well-intentioned family and friends to seek a future in healthcare. And it’s not bad advice.
As a sector that can generate employment opportunities at both ends of the value chain – from highly skilled specialists in technology and research to those who operate in palliative or frail care environments2 – the recent effects of the Covid-19 pandemic underscored the essential value and role that healthcare workers play in bolstering South Africa’s socio-economic and overall health resilience.
Human resource gaps in healthcare are clear
In 2020, the Hospital Association of South Africa suggested that there was a shortage of between 26 000 and 62 000 professional nurses and this shortage is expected to increase to between 305 000 and 340 000 by 2030 as the country’s population continues to grow. Alarmingly, estimates suggest that only 26 ,000 will be trained by then3.
South Africa also has less than one doctor per 1000 patients4. In a country with serious disease burdens, the situation is far from ideal.
The need for long-term planning
A challenge often cited when posts are frozen in healthcare is funding. While there are undoubtedly funding constraints in the healthcare system, it seems unlikely that the addition of funds will solve the challenge. It’s worth rethinking the way the human resources pipeline in South Africa is structured and where the bottlenecks lie.
South Africa’s history of inequality, which is deeply entrenched in the country’s healthcare system, has created the twin challenge of a shortage of skills and inadequate capacity to manage and distribute those skills to where they’re most needed. There are also policy bottlenecks that can hinder progress.
For instance, while complementing the qualification with some kind of work experience and community service spent in the public sector is an applaudable initiative, it becomes counterproductive when there aren’t enough posts in the public sector to place people coming out of training institutions. This, in turn, limits the number of professionals who can qualify, adding incrementally to the shortage of personnel every year.
Similarly, the cap on the number of personnel that the Nursing Council can accredit per year may limit the number of posts needed, but it doesn’t help address the shortage of nurses in South Africa.
The burden of disease in South Africa, coupled with the uneven spread of healthcare facilities means that it’s also a singularly challenging environment to work in. This means that retention policies, and initiatives that prioritise the well-being of healthcare workers are also important considerations.
It’s worth noting that over the past few decades, there have been a number of well-considered human resources strategies for the healthcare system in South Africa5. Unfortunately, these have suffered from inadequate implementation. This long-term planning and implementation is critical.
Ultimately, it means ensuring that we’re able to encourage young people to take up these worthy careers with the guarantee that once they qualify, their skills will be put to good use.
As the National Department of Health prepares to move South Africa toward the National Health Insurance scheme, the question of staffing becomes even more critical. It’s going to call for long-term strategies that will need to be implemented over generations.
