Healthcare

Healthcare Industry Should Flourish But Won't Allow Loot (The Economic

Times:20170921)

http://epaperbeta.timesofindia.com/Article.aspx?eid=31816&articlexml=ET-QA-Healthcare-

Industry-Should-Flourish-But-Wont-21092017023009

Companies and hospitals found overcharging on essential treatment may face penal action,

because the government will not be a mute spectator to unethical profiteering, Union Minister

for Chemicals and Fertilisers Ananth Kumar tells ET.Following price caps on coronary stents

and knee implants to increase access to affordable and quality healthcare, the minister says

the industry should flourish, but not through looting and exploitation . Edited excerpts:

This year, stents and knee implants were brought under price control. What impact did you

see as a result?

Prime minister told me in 2014 that we need to provide affordable medicines. Without

providing affordable medicines, without pharma security, you cannot have health security.

Pharma includes medical devices also. Therefore, what we did was, we took the review of

DPCO (Drug Prices Control Order, 2013), we took the review of NLEM (National List of

Essential Medicines) and we included medical devices also in it... The other day I was

verifying (and) there has been a savings of `5,500 crore for the consumers because of drug

price control. This is other than stents.

Regarding stents, we did a survey (that) told us we have six crore cardiac patients in the

country, and...not less than five lakh (of these patients) go for stents. Stent prices were

hovering around `1.5 lakh-2.5 lakh.

DAILY NEWS BULLETINLEADING HEALTH, POPULATION AND FAMILY WELFARE STORIES OF THE DayThursday 20170921

I told NPPA to scrutinise this--what is the landed cost? What is the ethical margin of profit?

After calculating all of that, (we capped prices of bare metal stents and drug-eluting

stents)...That has provided another `5,500 crore rupees (of saving)... If five lakh people have

gone through the procedure, I think by the end of this year, more than 1.5 lakh people will

take this treatment (additionally). It will benefit more people because of the capping of the

rates. Knee implants was hovering around `1.5 lakh-9 lakh rupees.

Hospitals are said to have increased other procedure-related costs following price caps on

stents. How is ministry dealing with this issue?

We have sent a request earlier and later also to ministry of health and family welfare and

they, in turn, have sent an advisory that the charges of procedure has to be kept the

same...You cannot revise the charges of the service.

There are two charges --one is for the device, one is for the services like nursing, pre-

operative, post-operative and procedure --the surgery itself.

These things cannot be tinkered with...

They (hospitals) tried to increase , but when NPPA and ministry of health and family welfare

have sent them notices and issued this advisory, by and large, they are behaving.

What is your message to hospitals and companies who are overcharging?

Only one strong message --if we get to know that you are overpricing or overcharging, then

we will not keep quiet. Government, pharma department, will not be a mute spectator. NPPA

will not be a mute spectator. We will give notice for overpricing and overcharging.

Not only that, we will take penal action and, if need be, we will cancel (their) licences also...

The message is loud and clear to the entire industry and to hospitals that the minister,

ministry and Modi government means business.

Once we say we have (capped) the (prices) of stents, we have capped (prices) of knee

implants, that means we have capped it. And that means that at that capped rate, the poor

patients are going to get that benefit. You cannot tinker with that.

Will any more devices or essential treatments face price caps as well?

I can say today only this much--that it is an ongoing process. There will be more, and much

more.

Industry should flourish, Make in India should flourish, but, at the same time, predatory

pricing is not acceptable. And, if somebody is making unethical profiteering...that will not be

allowed. Loot and exploitation will not be allowed. Therefore, I strongly urge pharma and

medical device industry to begin with fixing ethical margins.

Integrated Child Development Scheme

Govt hikes spend on nutrition at anganwadis (The Times of India:20170921)

http://epaperbeta.timesofindia.com/Article.aspx?eid=31808&articlexml=HEALTH-BOOST-

Govt-hikes-spend-on-nutrition-at-21092017018052

The cabinet committee on economic affairs (CCEA) chaired by Prime Minister Narendra

Modi on Wednesday approved an increase in cost norms for supplementary nutrition

provided at anganwadi centres to children, adolescent girls, pregnant women and lactating

mothers under the Integrated Child Development Scheme.

The CCEA has approved an increase in the per day cost per beneficiary from Rs 6 to Rs 8 for

children between six months to three years and from Rs 7 to Rs 9.5 for pregnant women and

lactating mothers. For severely malnourished children, the cost has been revised from Rs 9 to

Rs 12.5.

Meanwhile, the ministry of women and child development is also studying the feasibility of

shift ing to direct benefit transfers for supplementary nutrition for children under three in

place of feeding them at anganwadis as the current practice is.

Asked if there was such a plan, WCD secretary Rakesh Srivastava at a press briefing after the

Cabinet meet said, The matter is under consideration of the ministry but no decision has

been taken yet. A decision will be taken soon.

Under the Integrated Child Development Scheme (ICDS), children between six months to

three years are supposed to get a nutritious morning snack as well as a hotcooked meal at an

anganwadi centre, while pregnant women, lactating mothers and severely malnourished

children are entitled to take home rations.

As per the Cabinet de cision on Wednesday there is also a revision in cost norms for nutrition

provided to adolescent girls between the age of 11-14 years from Rs 5 to Rs 9.5 under the

Sabla scheme. The scheme targets adolescent girls and provides them nutrition as well as

education in life skills.

The rates were fixed in 2012 but since then the consumer price index has increased. The

revision in costs will make it easier for us to provide food as the prices of raw materials have

increased, the WCD secretary said. The revision of rates will lead to an additional

expenditure of Rs 12,000 crore over the next three years. The Cabinet also approved an

annual cost indexation for increase in rates in the future.

There are 13.55 lakh centres across the country and 983.42 lakh beneficiaries.

Public health statistics

Indian data ecosystem needs an overhaul (Hindustan Times:20170921)

http://paper.hindustantimes.com/epaper/viewer.aspx

Either there isnt enough data available or the one that exists is sometimes unreliable but is

used anyway because there is no alternative

Every data set comes with caveats that must be considered when making interpretations. But

some failings appear to be a standard characteristic of indian data sets. Several data sets are

released with a huge time lag

NEWDELHI: In July, in front of a roomful of policy wonks, government officials and

journalists, Union health secretary CK Mishra made an honest acknowledgement there are

serious problems with Indias public health statistics.

For one, he said, data from the latest round of the National Family Health Survey (NFHS-4)

the major source for detailed health statistics in India, conducted under the aegis of the

ministry of health and family welfare (MoHFW) itself is unreliable for certain states.

On top of that, the Health Management Information System (HMIS), which Mishra called a

data mine, is not effectively used. We use very little of it in the planning process due to

lack of expertise to read and understand the data, he said.

The health secretarys statement raises concerns: how can the country formulate evidence-

based policy or plan wisely for the future without credible data? And Mishra, a 34-year

veteran of the Indian Administrative Service who was appointed to head the MoHFW last

year, is not alone. A recent paper by the Health Team of the National Institute of Public

Finance and Policy, New Delhi, found that the countrys health data was unreliable,

irregularly published, and failed to cover a broad-enough population.

PROBLEMS GALORE

And such problems are not restricted to the health sector alone. The entire Indian data

ecosystem needs improvement. Former RBI governor Duvvuri Subbarao has stated that

monetary policy decisions often go astray because of erroneous data provided by the

government. The debate on the reliability of Indias macroeconomic data, GDP and IIP

numbers, for instance, remains unsettled. At a time when unemployment or rather,

underemployment is a key socio-economic concern, economists cannot measure the

problems magnitude because they do not have credible figures and surveys. Indias

agricultural statistics have also come under the scanner. Talk about crime, and all you have is

aggregated data from FIRs no official crime victimisation surveys have been instituted yet.

To be sure, every data set comes with caveats that must be considered when making

interpretations. But some failings appear to be a standard characteristic of Indian data sets.

To begin with, there isnt enough data. The data that does exists is sometimes unreliable but

is used anyway because there is no alternative. Several important data sets are released with a

huge time lag. Others are missing granular districtlevel estimates. If such estimates are

present, they are not always used for policy making or governance. And even when data sets

are good and people want to use them, there may be too few who understand how to work

with them, as Mishra said about HIMS.

Taken together, these shortcomings amount to an Indian statistical ecosystem that falls short

of the needs of the worlds largest democracy.

MODES OF DATA COLLECTION

There are two major modes of data collection: administrative, which refers to data collected

as a result of an organisations daily operations (think of patient registrations at a hospital or

new accounts opened at a bank); and surveys, which are based on how a part of a population

(what statisticians call a sample) responds to a set of questions.

P.C. Mahalanobis, the statistician credited for laying the foundations of the data systems of

independent India, focused on creating credible data sets from representative sample

surveys, says a Mint essay which traced the history of Indian statistical system.

But Mahalanobiss preference for surveys came at the expense of data collection at the

administrative level, the essay argued, and may have undermined the governments ability to

collect regular, reliable data.

Instead of being sparingly used for purposes where there was no alternative to sampling,

sampling became the first choice of technique for collecting data. Sometimes, surveys are

the only way to capture data. Economic statistics, for example, cannot be collected at the

administrative level because of the huge size of the Indian economys informal sector, which

employs around 90% of the countrys workforce, says Pronab Sen, former chief statistician of

India.

Yet India faces challenges to conducting good surveys a population of more than a billion

people, relatively high rates of illiteracy, and dependence on the informal economy that

simply do not exist in much of the rest of the world, says Sen.

VACANCY ISSUES

The government also employs too few people to carry out regular and robust surveys. The

National Sample Survey Offices (NSSO) field operations division, which is responsible for

collecting primary socio-economic data, has around 24% of positions vacant for the posts of

junior and senior statistical officers.

The NSSOs critics do not realise how hard it is to undertake actual data collection on the

ground, Sonalde Desai, professor of sociology at the University of Maryland who also

conducts the India Human Development Survey (IHDS), said in an email. Without adequate

internal staff, the agency must contract with outside agencies.

This is what both IHDS and NFHS do, and only we know how difficult it is to maintain

quality. Some of the agencies we work with are fantastic, and some are struggling

themselves. This requires enormous supervision, and if one slips there, the data can be highly

questionable, Desai said.

This hit-and-miss approach is not acceptable for data that form the core of our policy-

building process.

Experts say that technology can be leveraged to improve data collection systems. Private data

collection agencies are already making use of apps and tools to conduct surveys

electronically, rather than on paper. But that comes with its own challenges. Richa Verma,

who leads the research and analysis team at Social Cops, a data intelligence company, says

that better design is key to make it easier for people to adopt technology.

While working with the government and various non-profits, Verma found that many of its

trainees have never used a smartphone. Data collection technology must be made simple, and

appropriate training must be conducted, so that anyone can be trained to use it.

Urinary infections

Cranberries fight urinary infections (The Hindu:20170921)

http://www.thehindu.com/sci-tech/health/cranberries-fight-urinary-

infections/article19722317.ece

Fruit helps against bacteria: study

Consuming cranberry products may be a low risk, cheap and effective way to prevent

recurrent urinary tract infections (UTIs), a study claims.

The study, published in The Journal of Urology, suggests that doctors may recommend

cranberry products as first line of defence against the disease.

Researchers conducted a comprehensive meta-analysis and assessment of human clinical

trials and 28 studies on nearly 5,000 patients. They found that overall, the use of cranberry

products led to a statistically significant risk reduction in repeat UTIs.

The medicinal properties of cranberries may be attributed to their unique polyphenol,

proanthocyanidins, researchers said.

Their ability to keep infection-causing bacteria from sticking to the urinary tract walls may be

the major reason for their effectiveness in limiting infection growth and recurrence, they

added.

Our investigation supports that cranberry products can be a powerful tool to fight off

frequent UTIs, said Angelo Luis, from the Universidade da Beira Interior in Portugal.

Dengue

Milder form of dengue dominant this year: AIIMS (The Indian Express:20170921)

http://indianexpress.com/article/cities/delhi/milder-form-of-dengue-dominant-this-year-

aiims-4853656/

The latest MCD data reveals that 2,215 cases of dengue have been reported in the capital this

year a 60 per cent increase as compared to last year. According to MCD data, 1,177 cases

of dengue have been reported in the city and 1,038 cases have been reported, where the

infection has been acquired from outside the city.

AIIMS fellowship programme 2017: Apply for 45 seats in 21 courses at

aiimsexams.orgAIIMS fellowship programme 2017: Apply for 45 seats in 21 courses at

aiimsexams.org

Mumbai sees sharp increase in dengue cases after August delugeMumbai sees sharp increase

in dengue cases after August deluge

46% jump in dengue cases in a week; malaria cases toll crosses 60046% jump in dengue

cases in a week; malaria cases toll crosses 600

Even as the capital this week crossed the 2,000 mark of patients who tested positive for

dengue, the All India Institute of Medical Sciences (AIIMS) has identified the relatively less

virulent DEN 3 (dengue strain type 3) as the dominating strain circulating this year. Type

3 strain, considered to be a relatively mild strain, has been the most common strain in Delhi

since 1960.

According to the virology laboratory at the department of microbiology, preliminary data on

dengue serotypes during the ongoing season is predominately type 3, senior AIIMS officials

told The Indian Express. The laboratory is an apex one for the National Vector-Borne

Disease Control Programme for dengue and chikungunya.

Dengue has been the dominant vector-borne infection circulating this year. Cases of

chikungunya have been fewer this year as compared to dengue. As far dengue is concerned,

DEN 3 has been the dominating strain circulating this year. It is the milder strain compared to

Type 2 and 1; and Type 4 is the rare strain and has not shown a significant presence, Dr

Lalit Dar, professor, Department of Microbiology, AIIMS, said.

The dengue virus has four distinct but closely related serotypes depending on the antigens

that make it. Also, each serotype has its characteristic symptoms. In case of Type 1, the

symptom is classic dengue fever; Type 3 causes high grade fever without shock. These two

are considered relatively mild serotypes. The severe strains are Type 4, which leads to fever

with shock, and Type 2, which causes thrombocytopenia or a drop in platelets, haemorrhagic

fever, organ failure and Dengue Shock Syndrome (DSS). Globally, Type 2 has been

identified as the most common cause of Dengue Haemorrhagic Fever (DHF).

The latest MCD data reveals that 2,215 cases of dengue have been reported in the capital this

year a 60 per cent increase as compared to last year. According to MCD data, 1,177 cases

of dengue have been reported in the city and 1,038 cases have been reported, where the

infection has been acquired from outside the city.

In 2016, AIIMS had confirmed that Type 2 strain, the less virulent one, was the most

dominant strain circulating in the city. In 2015, when the capital witnessed its worst outbreak,

Type 2 and 4 strains of the virus, both strong strains, emerged as the dominant ones. Type 4

is especially rare in the capital. Barring stray cases in 2003, the Type 4 strain has never been

recorded in Delhi.

Recovery from dengue by one provides life-time immunity against that particular serotype.

However, cross-immunity to other serotypes after recovery is only partial and temporary.

Also, subsequent infections from other serotypes increase the risk of developing severe

dengue.

Child Mortality

India averted 10 lakh child deaths since 2005 (The Tribune:20170921)

http://www.tribuneindia.com/news/nation/india-averted-10-lakh-child-deaths-since-

2005/470509.html

Govts financial push to child health reduced mortality from pneumonia, diarrhoea, tetanus &

measles: Study

India has prevented 10 lakh deaths of children under age five since 2005 by reducing

mortality from pneumonia, diarrhoea, tetanus and measles.

Had the rate of child death reduction stagnated at 2000 to 2005 levels, India would have seen

30 million under-five child deaths between 2005 and 2015. It actually saw 29 million, says a

new study published in The Lancet today and authored by Dr Prabhat Jha, Head, Centre for

Global Health Research of St. Michaels Hospital in Toronto and Dr Rajesh Kumar of PGI,

Chandigarh.

The study shows that neonatal (first 28 days of birth) mortality rate (deaths of children per

1,000 lives) in India fell from 45 in 2000 to 27 in 2015. Mortality in 1 to 59 month olds fell

from 45.2 per 1,000 live births in 2000 to 19.6 in 2015.

Girl deaths among 1 to 59 month olds fell particularly fast with an equal number of under-

five boy and girl deaths now, Jha said. The study is part of Registrar General of Indias

Million Death Study (MDS) in which health workers physically visited 1.3 million homes

over the past decade to ask parents what caused their childs death.

The research showed the child mortality reduced as neonatal infections fell by 66%; birth

asphyxia fell by 76%, tetanus fell by over 90%.

Among children aged 1 to 59 months, largest reduction in mortality came as pneumonia fell

by 63%, diarrhea by 66% and measles by 90%, Dr Kumar said. Despite gains, one in five

global child deaths still happens in India which contributes 22% of the worlds 6.3 million

annual under-five deaths.

India will achieve UN Sustainable Development Goals on child health only if it maintains

current declines in 1-59 month mortality and accelerates declines in neonatal mortality to

over 5% as against 3.3% annually. Low birth weight and malaria deaths need to be urgently

addressed, Jha said.

SDGs urge nations to reduce infant mortality to at least 25 per 1,000 live births by 2030.

Indias infant mortality rate is 39 deaths and under five mortality rate is 43.

UN health goals achieved: Nadda

Presenting the annual National Health Mission report card to the Cabinet, Health Minister JP

Nadda on Wednesday said India had achieved Millennium Development Goals on infant

mortality, under five-mortality and maternal mortality

Our total fertility rate is 2.2. It will be reduced to 2.1 by 2017 end. We have also achieved

MDG 6 by reversing the epidemic of malaria, TB and HIV epidemic, the Health Minister

said

Child Mortality (Hindustan:20170921)

http://epaper.livehindustan.com/story.aspx?id=2223231&boxid=70493602&ed_date=2017-

09-21&ed_code=1&ed_page=12

Alzheimer's disease

Alzheimer's: Targeting ApoE gene may 'stop the disease' (Medical News

Today:20170921)

https://www.medicalnewstoday.com/articles/319492.php

New research suggests that reducing the expression of the ApoE gene may stop the brain

damage associated with Alzheimer's disease.

A new study published in the journal Nature has uncovered a new role for a gene known to be

key in the development of Alzheimer's disease: ApoE. This newly gained understanding

gives researchers a novel therapeutic target, which, they hope, will soon enable them to cure

the condition.

The senior author of the new study is Dr. David Holtzman, head of the Department of

Neurology at the Washington University School of Medicine in St. Louis, MO. The team -

led by Dr. Holtzman - investigated the effect of the ApoE4 gene variant in the development

of Alzheimer's disease.

ApoE is a gene responsible for creating the protein apolipoprotein E, which - in combination

with fats - forms lipoproteins. The latter carry cholesterol through the bloodstream.

ApoE has different variants, or alleles: e2, e3, and e4. Studies have shown that ApoE e4

(ApoE4) puts carriers at a dramatic risk of developing Alzheimer's disease.

In fact, people with one copy of the gene are two to three times more likely to develop this

kind of dementia, while those with both copies of the gene are 12 times more likely to have

the disease.

Additionally, studies of brain pathology have shown that people with ApoE4 have more of

the amyloid beta plaques accumulated in the brain. Beta-amyloid is a sticky protein that

clumps together, blocking neuron-to-neuron signaling in Alzheimer's patients.

So, while it is known that ApoE4 is somehow crucial in Alzheimer's disease, the mechanism

whereby this gene contributes to disease formation remains unclear.

The new research by Dr. Holtzman and his colleagues sheds some light on this mechanism.

Their findings suggest that ApoE4 may "work" by exacerbating the damage done by a

different protein associated with Alzheimer's: tau.

ApoE amplifies tau damage in mice

In a healthy brain, the tau protein helps to transport nutrients and other supplies to neurons.

But, in a brain affected by Alzheimer's disease, tau forms tangles, which break down this

essential transport system.

Dr. Holtzman and team designed a mouse model in which the rodents had a modified form of

human tau, predisposing them to tangle formation.

Alzheimer's disease: New genetic culprit found

Can this newly discovered gene be the actual "mastermind" behind the illness?

They genetically engineered the mice to carry human versions of the ApoE gene - namely,

e2, e3, and e4 - instead of their mouse-specific ApoE.

The researchers followed the mice for 9 months. By this time, the mice that had the e4 allele

showed the most neurodegeneration, while those with e2 had the least.

In the mice with ApoE variations, the hippocampus and entorhinal cortex - which are both

brain regions important for memory - had atrophied. These mice also exhibited brain damage,

with numerous brain cells having died.

The study found that when ApoE was not present, tau tangles were not as harmful. In fact,

mice that lacked ApoE altogether did not exhibit any brain damage.

The team also found that the immune cells in the brains of mice with ApoE4 were activated,

suggesting a strong inflammatory response. By contrast, mice lacking ApoE4 did not show

immune cell activation.

"ApoE4 seems to be causing more damage than the other variants because it is instigating a

much higher inflammatory response, and it is likely the inflammation that is causing injury,"

explains Dr. Holtzman.

"But all forms of ApoE - even ApoE2 - are harmful to some extent when tau is aggregating

and accumulating. The best thing seems to be in this setting to have no ApoE at all in the

brain," he adds.

Reducing ApoE may block disease

To examine whether or not ApoE has the same role in human brains, the researchers

examined autopsy samples from 79 people who had died from tau pathologies and

inventoried the ApoE variants that these people had.

The analysis revealed that the brains of those with the e4 variant of ApoE exhibited more

severe damage than those without the variant.

"Assuming that our findings are replicated by others, I think that reducing ApoE in the brain

in people who are in the earliest stages of disease could prevent further neurodegeneration,"

Dr. Holtzman says.

He explains that because ApoE is important for transporting cholesterol, the few people who

lack the gene entirely develop cardiovascular disease as a result of cholesterol buildup.

Cognitively, however, there seems to be no obvious role for the protein. "There are people

walking around who have no ApoE and they're fine cognitively," Dr. Holtzman says. "It

doesn't appear to be required for normal brain function."

He notes that so far, research has focused on reducing either tau or beta-amyloid, but ApoE

has not yet been targeted.

"Once tau accumulates, the brain degenerates [...] What we found was that when ApoE is

there, it amplifies the toxic function of tau, which means that if we can reduce ApoE levels,

we may be able to stop the disease process."

Dr. David Holtzman

Alzheimer's disease (Hindustan:20170921)

http://epaper.livehindustan.com/story.aspx?id=2223243&boxid=70848746&ed_date=2017-

09-21&ed_code=1&ed_page=24

Drug resistance

Drug resistance: WHO report 'serious lack of new antibiotics' (Medical News

Today:20170921)

https://www.medicalnewstoday.com/articles/319493.php

The WHO say that there are not enough new drugs in the pipeline to help combat

antimicrobial resistance.

A new report from the World Health Organization confirms that, worryingly, there are now

limited treatment options for some of the most common drug-resistant infections, which

highlights the desperate need for new antibiotics.

But despite this need, the report reveals that there are very few antibiotics in development

that could effectively combat drug resistance.

"Pharmaceutical companies and researchers must urgently focus on new antibiotics against

certain types of extremely serious infections that can kill patients in a matter of days because

we have no line of defense," says Dr. Suzanne Hill, director of the Department of Essential

Medicines at the World Health Organization (WHO).

Drug resistance, or antimicrobial resistance, arises when pathogens evolve to evade the harms

of antimicrobial therapeutics, such as antibiotics. This reduces the efficacy of these

medications against infections caused by such pathogens.

According to the Centers for Disease Control and Prevention (CDC), around 2 million people

in the United States are infected with drug-resistant bacteria every year, and more than

23,000 people die as a result.

Clostridium difficile is among the most deadly drug-resistant infections in the U.S.,

responsible for around 250,000 illnesses and 14,000 deaths in the country annually.

Worldwide, drug-resistant tuberculosis (TB) is one of the biggest threats, causing around

480,000 deaths every year.

Plans to tackle the priority pathogens

In 2015, the WHO set out a Global Action Plan on Antimicrobial Resistance, with the aim "to

ensure, for as long as possible, continuity of successful treatment and prevention of infectious

diseases with effective and safe medicines that are quality-assured, used in a responsible way,

and accessible to all who need them."

Earlier this year, the organization put together a list of antibiotic-resistant bacteria that pose

the biggest threat to health across the globe, in order to help guide the development of new

antibiotics.

As well as drug-resistant TB, the WHO identified a further 12 pathogens that are becoming

increasingly resistant to current classes of antibiotics.

For their latest report, the WHO conducted a review of global public data to determine how

many new antibiotics are being developed to help tackle these priority pathogens. The

findings are a concern.

Current drug pipeline 'insufficient'

The report revealed that 51 new classes of medications - including 33 antibiotics - are in the

pipeline for the treatment of priority drug-resistant pathogens.

However, only eight of these drugs meet at least one of the WHO's criteria for "innovative

treatments" that are likely to help overturn drug resistance. These criteria include a new

mechanism of action and a lack of cross-resistance to existing antibiotics.

Furthermore, the WHO found that there are few new antibiotics in development for the

treatment of drug-resistant TB, which, as mentioned above, is one of the world's biggest

public health threats.

Drug resistance 'could kill 10 million people annually'

A review suggests that drug resistance could kill 10 million people per year by 2050.

The report authors note that the current scope of new antibiotic development could yield 10

new drug approvals over the next 5 years.

"However," they write, "these new treatments will add little to the already existing arsenal

and will not be sufficient to tackle the impending AMR [antimicrobial resistance] threat."

An 'urgent need for more investment'

Based on the report findings, the WHO conclude that the "current clinical pipeline is still

insufficient to mitigate the threat of antimicrobial resistance," and that more work needs to be

done to develop new, effective antimicrobial medications.

"Antimicrobial resistance is a global health emergency that will seriously jeopardize progress

in modern medicine," says Dr. Tedros Adhanom Ghebreyesus, director-general of the WHO.

"There is an urgent need for more investment in research and development for antibiotic-

resistant infections including TB, otherwise we will be forced back to a time when people

feared common infections and risked their lives from minor surgery."

Dr. Tedros Adhanom Ghebreyesus

However, the WHO caution that creating new antibiotics is not enough by itself to combat

drug resistance.

"Antibiotic development must go hand in hand with efforts to foster appropriate use of

existing and future antibiotics," write the report's authors.

Cancer

Boosting cancer-killing cells through oxygen starvation (Medical News

Today:20170921)

https://www.medicalnewstoday.com/articles/319482.php

The results of a new study suggest that killer T cells - which work to destroy cancer - could

be made more effective if grown in a low-oxygen environment.

New research has suggested that an immunotherapy type that cultures patients' killer T cells

in a laboratory before fine-tuning their cancer-destructive powers and returning them could

be made more effective by growing the killer T cells in a low-oxygen culture.

Writing in the journal Cell Reports, researchers from the Weizmann Institute of Science in

Israel suggest that their finding could increase the power of immunotherapy to fight solid

tumors, which pose a particular challenge to killer T cells.

Killer T cells, which are also known as cytotoxic T lymphocytes (CTLs), are a specialized

type of white blood cell called CD8+ T cells that are considered to be the "foot soldiers of the

immune system."

CTLs directly kill damaged cells, cancer cells, and cells infected with viruses and other

pathogens.

Senior author Guy Shakhar, who is a professor at the Weizmann Institute, explains that while

killer T cells are the main agents of cancer immunotherapy, "they don't always manage to

eliminate the malignancy."

However, he says that "by growing these T cells in an oxygen-poor environment, we can turn

them into more effective killers."

Tumor cells can withstand low oxygen

At present, cancer immunotherapy that boosts patients' own killer T cells works best against

certain leukemias and lymphomas. However, it is less effective at eliminating solid tumors, in

which oxygen levels are very low.

Oxygen levels inside solid tumors, expressed as a percentage of gas dissolved in the fluid

surrounding cells, range from 0.5 to 5 percent. This is lower than in most healthy organs and

considerably lower than the 20 percent normally set for growing cells in the laboratory

incubator.

Low oxygen does not appear to hamper tumor cells - for example, it does not stop them from

taking in and metabolizing glucose, which is their main source of fuel.

But the low-oxygen environment of the tumor is not favorable to killer T cells. The

researchers refer to several studies that offer evidence of this.

Advanced melanoma: Groundbreaking trials could transform treatment

For example, it appears that tumor areas with low oxygen attract other cells, such as "M2-like

tumor-associated macrophages" and "regulatory T cells," that can disrupt the function of

killer T cells.

In addition, low-oxygen pockets in tumors favor anerobic metabolism of glucose, resulting in

an acid environment that dampens killer T cell activity.

'Better tumor rejection and survival'

Previous studies have shown that growing killer T cells under conditions of low oxygen

enhances their ability to kill other cells in the laboratory. But until this new work in Prof.

Shakhar's laboratory, their ability to kill cancer had not been studied.

Thus, for their own investigation, the team experimented with growing killer T cells in

culture in the laboratory at just 1 percent oxygen and compared them with cells grown at 20

percent, as before.

They found that the oxygen-starved killer T cells were more effective at attacking cultured

melanoma cancer cells than killer T cells grown under the usual oxygen conditions.

In the meantime, the team implanted mice with tumor cells under their skin. Then, once

tumors had formed 7 days layer, they injected some of the mice with oxygen-starved killer T

cells, some with killer T cells grown under the usual conditions, and left the rest untreated.

They found that the mice treated with oxygen-starved killer T cells, or "hypoxic CTLs,"

showed "better tumor rejection and survival" than any of the others.

Low oxygen deals deadlier punches

When the researchers looked more closely at the oxygen-starved killer T cells, they found

that they were not necessarily penetrating the tumors more deeply, but they had better

weaponry for killing the tumor cells.

Killer T cells have a number of weapons for attacking cancer cells. One of these is a

destructive enzyme called granzyme-B that they package into "granules." They release the

granules into the cancer cells after they have punched holes in them using a protein named

"perforin."

The team found that while the oxygen-starved killer T cells contained the same number of

granules as the non-starved cells and released them as efficiently, they "packaged more

granzyme-B in each granule without producing more perforin."

In other words, although the oxygen-starved killer T cells delivered the same number of

punches as non-starved cells, each punch was deadlier.

Prof. Shakhar likens the oxygen-starved killer T cells to mountaineers who become

acclimatized to lower oxygen levels. "Just as altitude training increases endurance in humans,

so putting killer T cells through a 'fitness regimen' apparently toughens them up," he explains.

He and his colleagues point out that their method now needs to be confirmed in humans. If it

is, then it offers an immediate way to improve the effectiveness of immunotherapy for solid

tumors.

"In cellular immunotherapy, T cells need to be removed and grown outside the body in any

event. Growing them under low oxygen pressure is relatively simple, but this small

adjustment to existing clinical protocols may significantly improve the therapy's

effectiveness."

Prof. Guy Shakhar

Antibiotic Drugs (Hindustan:20170921)

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