Neurons in the brain of an Alzheimer’s patient, with plaques caused by tau proteins. Credit: NIH
People with multiple sclerosis (MS) are far less likely than those without the condition to have the molecular hallmarks of Alzheimer’s disease, according to a paper published in the Annals of Neurology.
The study from Washington University School of Medicine in St. Louis, suggests a new direction for researching Alzheimer’s treatments, said Matthew Brier, MD PhD, an assistant professor of neurology and radiology and the study’s first author.
“Our findings imply that some component of the biology of multiple sclerosis, or the genetics of MS patients, is protective against Alzheimer’s disease,” Brier said. “If we could identify what aspect is protective and apply it in a controlled way, that could inform therapeutic strategies for Alzheimer’s disease.”
A collaboration between WashU Medicine experts in Alzheimer’s and MS, the study was prompted by a suspicion Brier’s mentor and collaborator Anne Cross, MD, had developed over decades of treating patients with MS, an immune-mediated disease that attacks the central nervous system. Although her patients were living long enough to be at risk of Alzheimer’s or had a family history of the neurodegenerative disease, they weren’t developing the disease.
“I noticed that I couldn’t find a single MS patient of mine who had typical Alzheimer’s disease,” said Cross, the Manny and Rosalyn Rosenthal and Dr. John Trotter MS Center Chair in Neuroimmunology. “If they had cognitive problems, I would send them to the memory and aging specialists here at the School of Medicine for an Alzheimer’s assessment, and those doctors would always come back and tell me, ‘No, this is not due to Alzheimer’s disease.’”
Cognitive impairment caused by MS can be confused with symptoms of Alzheimer’s disease; Alzheimer’s can be confirmed with blood and other biological tests.
To confirm Cross’ observation, the research team used a new, FDA-approved blood test that was developed by Washington University researchers. Known as PrecivityAD2, the blood test is highly effective at predicting the presence of amyloid plaques in the brain. Such plaques are an indicator of Alzheimer’s disease and previously only could be verified with brain scans or spinal taps.
Brier, Cross and their colleagues recruited 100 patients with MS to take the blood test, 11 of whom also underwent PET scans at the School of Medicine’s Mallinckrodt Institute of Radiology. Their results were compared with the results from a control group of 300 individuals who did not have MS but were similar to those with MS in age, genetic risk for Alzheimer, and cognitive decline.
“We found that 50% fewer MS patients had amyloid pathology compared to their matched peers based on this blood test,” Brier said. This finding supported Cross’ observation that Alzheimer’s appeared to be less likely to develop among those with MS. It is not clear how amyloid accumulation is linked to the cognitive impairment typical of Alzheimer’s, but the accumulation of plaques is generally understood to be the first event in the biological cascade that leads to cognitive decline.
The researchers also found that the more typical the patient’s MS history was, in terms of age of onset, severity and overall disease progression, the less likely they were to have amyloid plaque accumulation in that patient’s brain compared with those with atypical presentations of MS. This suggests there is something about the nature of MS itself that is protective against Alzheimer’s disease, which Brier and Cross are planning to investigate.
MS patients generally have multiple flare-ups of the illness over the course of their lifetimes. During these flare-ups, the immune system attacks the central nervous system, including within the brain. It’s possible that this immune activity also reduces amyloid plaques, the researchers said.
“Perhaps when the Alzheimer’s disease amyloid pathology was developing, the patients with MS had some degree of inflammation in their brains that was spurred by their immune responses,” Brier said. Referring to work by co-author David M. Holtzman, MD, Brier noted that activated microglia, which are part of the brain’s immune response in MS, have been shown to clear amyloid from the brain in animal models.
Brier and Cross have begun the next steps of this research, both to tease out the possible human genetics involved, as well as to test amyloid plaque development in animal models representing MS.
New research published in Developmental Medicine & Child Neurology reveals that children born preterm are more likely to screen positive for autism than full-term children.
For the study, 9725 toddlers were screened at 15-, 18-, or 24-month well child visits using a test called the Modified Checklist for Autism in Toddlers, Revised.
Screening results that were positive for autism were most common among children born extremely preterm (51.35%) and least common among those born full-term (6.95%). Subsequent evaluations after positive screening revealed the following rates of autism diagnoses: 16.05% of extremely preterm, 2.00% of very preterm, 2.89% of moderately preterm, and 1.49% of full-term births.
Utilising the screening test at ages unadjusted for early birth was effective for identifying autism, as only a small number of preterm children (1.90%) who screened positive with the test did not receive a diagnosis of autism or other developmental delay following evaluation.
“With this research, we are hoping to help dissipate doubts that clinicians might have about the utility of screening for autism in toddlers born preterm,” said corresponding author Georgina Perez Liz, MD, of the AJ Drexel Autism Institute. “Low-cost, universal public health strategies such as screening can lead to less disparity in autism detection and help children on the spectrum start specific intervention and supports earlier in life.”
Myocardial infarction, stroke, neuropathy: when a person has any of these chronic diabetes complications, they are more likely to have a mental health disorder, and vice versa, according to a University of Michigan-led study.
“We wanted to see if chronic diabetes complications led to mental health disorders or if mental health disorders led to those diabetes complications – but we found that both relationships are true,” said Brian Callaghan, MD, MS, senior author of the study published in Diabetes Care.
“The findings highlight a need for clinicians to actively screen for mental health disorders in patients with diabetes in addition to screening for chronic complications, which is the recommended standard of care in diabetes.”
Three-times greater risk
The research team, led by Michigan Medicine and the Department of Biostatistics at the U-M School of Public Health, examined insurance claims data from over 500 000 individuals with type 1 or type 2 diabetes and 350 000 people without diabetes.
The results reveal that people with chronic diabetes complications had up to a three-times greater risk of having a mental health condition, such as anxiety or depression. This effect increased as adults got older.
Those with mental health disorders were up to 2.5 times more likely to experience sustained diabetes complications.
In adults younger than 60 years old, having type 1 diabetes was more associated with chronic complications. People with the more common type 2 diabetes were more likely to experience mental health difficulties.
A possible reason for this bi-directional relationship, researchers say, may be that having a diabetes complication or mental health condition has direct effects on developing the other complication.
“For instance, a stroke causes detrimental effects on the brain, which may directly lead to depression,” Callaghan said.
“And having a mental health condition and diabetes may affect a person’s self-management of their condition – like poor glycaemic control or not taking medications – which, in turn, may increase their risk of diabetes complications.”
Common risk factors
The relationship may also be less direct. Diabetes complications and mental health conditions share common risk factors; obesity, issues with glycaemic control and social determinants of health can all increase the likelihood of developing both comorbidities.
“Most likely, a combination of direct and indirect effects and shared risk factors drive the association we are seeing,” said first author Maya Watanabe, MS, a biostatistician at the Harvard T.H. Chan School of Public Health and former graduate student research assistant at U-M.
“Diabetes care providers may be able to simultaneously prevent the risk of multiple complications by providing interventions to treat these shared risk factors.”
In South Africa’s ever-evolving healthcare landscape, women are not just participants—they are pioneers, breaking barriers and driving transformative change. With women making up approximately 51.1% of South Africa’s population and over 50% of the African continent’s population of more than 1.4 billion people, their contributions are integral to the region’s progress. In the healthcare sector, women form the backbone of the workforce, representing a significant majority in roles ranging from frontline patient care to high-level decision-making.
writes Ms Nokuzola Mtshiya, Head: Stakeholder Relations and Business Development, Board of Healthcare Funders
The Board of Healthcare Funders (BHF) celebrates the incredible women who are leading the charge, advocating for equity, fostering innovation, and ensuring inclusivity at every level of the system. As trailblazers, they are not only providing essential frontline care but are also shaping strategies that will influence the future of healthcare in South Africa and beyond. This moment calls for even more women to step into leadership roles, to amplify their impact and continue to reshape the future of healthcare across the continent. Among the many remarkable women making a difference, we celebrate a few who are setting the standard for excellence and progress in the sector.
Professor Deborah Glencross: Revolutionising HIV diagnostic immunology
Professor Deborah Glencross’s journey from childhood, which was marked by frequent hospital visits, to becoming a leading expert in haematology and molecular medicine. is nothing short of extraordinary. Initially aspiring to be a paediatrician, her path changed due to health challenges. This shift led her to a groundbreaking career at the National Health Laboratory Service, where she has made a significant impact in the field of HIV care.
Prof Glencross’s development of the PanLeucogated (PLG) CD4 assay has been pivotal in improving the quality and affordability of CD4 testing, a crucial aspect of HIV care. Her innovation has saved South Africa approximately R12 billion, reflecting her ability to drive significant advancements despite resource limitations. This achievement underscores the potential for local insights and creativity to lead to profound healthcare improvements.
Throughout her career, Prof Glencross has been deeply involved in flow cytometry technology, which contributed to her pioneering work in HIV diagnostics. Her success is also attributed to the mentorship she received from influential figures such as Prof Barry Mendelow and Prof Ruben Sher. Their support helped shape her research focus and contributed to her international recognition.
Prof Glencross’s career highlights the importance of persistence and effective management of both professional and personal responsibilities. She advises young women in healthcare to seek support and let go of guilt, emphasising the need for better support systems such as on-site childcare and flexible work hours. Her vision for the future includes driving impactful solutions through local knowledge and creativity rather than relying solely on large grants.
This driven and caring healthcare professional’s legacy is testimony to the significant impact that dedicated individuals can have on transforming healthcare and improving lives.
Dr Gloria Tshukudu: Innovator in plasticand reconstructive surgery
Dr Gloria Tshukudu’s career in healthcare is a powerful example of dedication and resilience. From a young age, influenced by her mother’s career as a nurse, Dr Tshukudu knew she wanted to be a doctor. Despite facing numerous challenges, including struggles with specialisation and balancing professional demands with personal responsibilities, she remained steadfast in her commitment to medicine.
Dr Tshukudu has achieved notable milestones in her career, including becoming the first South African woman to qualify as a plastic surgeon in 2013, pioneering research on chemical peels for ethnic skin and making significant advancements in plastic surgery. Her contributions have not only advanced her field but have also helped address issues related to gender dynamics and representation within healthcare.
Navigating the complex interplay between work, family responsibilities and societal expectations has been a significant part of Dr Tshukudu’s career. She has advocated for improved support systems, including better maternity leave and access to childcare, to enhance the working conditions for women in healthcare. Her leadership style emphasises empathy, support, and perseverance, reflecting her belief in fostering an inclusive and supportive environment.
Dr Tshukudu’s efforts have significantly increased the representation of women and marginalised groups in healthcare. Through mentoring and supporting younger professionals, she has contributed to the evolution of the healthcare sector, ensuring that future generations benefit from the advancements and opportunities she has championed.
Melanie Da Costa: A visionary in healthcare strategy and policy
Melanie Da Costa is a trailblazer in healthcare strategy and policy. She combines her expertise as a Chartered Financial Analyst (CFA) and a Master of Commerce (MCom) to make a profound impact on the healthcare sector. Her career began in the investment world, where she distinguished herself as a healthcare investment analyst and fund manager. Notably, she served as the Head of Equity Research for HSBC’s South African office, showcasing her deep understanding of financial dynamics and strategic insight.
In May 2006, Da Costa transitioned to Netcare, where she has been instrumental in the organisation’s strategic evolution. Her role in founding the Health Policy Unit has been crucial in shaping national health policy. Her responsibilities at Netcare include overseeing health policy, funder contracting and strategic initiatives, with a focus on international opportunities until 2018.
Da Costa’s influence extends beyond South Africa. She has played a key role in global healthcare policy discussions, leading Netcare’s participation in the South African Competition Commission Healthcare Market Inquiry and serving as the Board lead in the UK’s Competition Markets Authority Healthcare Inquiry. Her strategic acumen was further demonstrated during her tenure on the Board of BMI Healthcare in the United Kingdom, where she contributed until the group’s change of control in 2018.
Currently serving as the Managing Director of Netcare Akeso, Da Costa continues to drive strategic growth and innovation. Her leadership during the government-led pandemic response, including the vaccine rollout, was recognised with a Lifetime Achievement Award in 2022 from the Hospital Association of South Africa (HASA), honouring her contributions to health policy and unwavering commitment to improving healthcare systems.
Dr Keo Tabane: Shaping the future of oncology care
Dr Keo Tabane’s journey into oncology bears witness to her unwavering commitment to service and excellence. Raised by an Anglican priest, her formative years instilled in her a profound sense of purpose, steering her toward a career where she could make a meaningful impact.
After completing her undergraduate training in 1999, Dr Tabane embarked on her medical career with an internship at Kalafong Hospital, followed by community service in Makopane.
A defining moment in Dr Tabane’s career came early on during her internship when she faced prejudices as a young black woman. Instead of being deterred, she used this challenge as fuel for her drive, leading to her success and subsequent invitation to return as a specialist.
Her dedication and expertise earned her the prestigious Charlotte MacLeachy Award for medical excellence in 2019. By 2002, she returned to Johannesburg, becoming a specialist in internal medicine and later a pioneering force in medical oncology.
Dr Tabane attributes much of her success to the mentorship of Dr Daniel Vorobyov, whose guidance profoundly influenced her patient-centred approach. Balancing the demands of a high-stakes career with personal life has not been without its challenges. She views work-life integration as a dynamic dance rather than a static balance, blending her professional and personal spheres to enhance both.
Her advice to aspiring women in healthcare emphasises the importance of self-care and respecting personal boundaries. Dr Tabane envisions her legacy as one defined by a focus on patient-centred care, advocating for initiatives to tackle burnout and promote value-based care that keeps pace with medical innovation. Her vision for the future of healthcare is one where progress and patient welfare are intertwined, ensuring that every advancement serves to enhance the quality of care.
These women exemplify leadership and innovation in South Africa’s healthcare sector, making significant contributions that drive progress and equity. From advancing diagnostics and pioneering new treatments to shaping policy and driving strategic growth, their diverse achievements highlight the transformative power of women in healthcare.
Their dedication and impact ensure that adequate healthcare reaches every corner of the nation, inspiring future generations to continue their legacy of excellence and service.
Credit: Darryl Leja National Human Genome Research Institute National Institutes Of Health
Men with metastatic castration-resistant prostate cancer should be treated primarily with second-generation hormone drugs, which offer better treatment response and longer life expectancy than chemotherapy. But the effect depends on which mutations the patient’s tumour carries. This is shown by results from the ProBio study, led by researchers at Karolinska Institutet in Sweden. The findings are published in Nature Medicine.
Every year, around 2500 men in Sweden are diagnosed with metastatic prostate cancer. Initially, all are treated with testosterone blockade to prevent testosterone from activating the androgen receptor, the gene that mainly fuels the growth of cancer cells. Over time, the cancer cells develop resistance and become so-called castration-resistant. This requires the use of new drugs – usually chemotherapy or second-generation hormone drugs (abiraterone/enzalutamide) that inhibit the androgen receptor. These are called Androgen Receptor Pathway inhibitors, or ARPi. Although these drugs have been available for over a decade, there is no direct comparison from a randomised trial until now.
Personalised treatment
“For the first time, we have compared these treatments with each other and also analysed the DNA of the cancer cells to find out which drug that works best for different individuals,” says Johan Lindberg, senior researcher at the Department of Medical Epidemiology and Biostatistics (MEB), Karolinska Institutet.
The bloodstream contains so-called cell-free DNA from cells that have died, something that happens all the time in healthy individuals and is perfectly normal. In patients with cancer, a fraction of the cell-free DNA originates from the cancer cells and is called circulating tumour DNA (ctDNA). By analysing ctDNA, it is possible to see what changes, or mutations, are present in a person’s tumour. The ProBio study aims to use knowledge of the tumour’s genetic signature to provide the best treatment. The idea is to be able to identify patients whose tumours are particularly sensitive or resistant to certain treatments through ongoing analyses.
“It creates a self-learning system to continuously improve treatment for men with metastatic prostate cancer,” says Martin Eklund, Professor of Epidemiology at the same department. “We are also gathering knowledge about which regions of the genome are important in prostate cancer.”
Longer life expectancy
The current sub-study included 193 patients with metastatic castration-resistant prostate cancer. They were randomly chosen to receive either chemotherapy or ARPi, which was compared to a control group where the doctor decided on the best treatment. The ARPi group responded the longest to treatment (a median of 11.1 months compared with 6.9 for chemotherapy and 7.4 for the control group). Survival for the ARPi group was also significantly longer – a median of 38.7 months compared with 21.7 months and 21.8 months respectively.
The effectiveness of ARPi varied depending on the patient’s genetic profile. For example, there was no significant difference between the treatments in the short term in patients whose tumours had mutations in the p53 gene, which occurs in around 45% of men with metastatic prostate cancer. However, data from the study suggest that also this group may have better survival if they receive ARPi rather than chemotherapy.
