Leading Ebola researcher says there's an effective treatment for Ebola

A leading U.S. Ebola researcher from the University of Texas Medical Branch at Galveston has gone on record stating that a blend of three monoclonal antibodies can completely protect monkeys against a lethal dose of Ebola virus up to 5 days after infection, at a time when the disease is severe.

Thomas Geisbert, professor of microbiology and immunology, has written an editorial for Nature discussing advances in Ebola treatment research. The filoviruses known as Ebola virus and Marburg virus are among the most deadly of pathogens, with fatality rates of up to 90 percent.

Since the discovery of Ebola in 1976, researchers have been actively working on treatments to combat infection. Studies over the past decade have uncovered three treatments that offer partial protection for monkeys against Ebola when given within an hour of virus exposure. One of these treatments, a VSV-based vaccine was used in 2009 to treat a laboratory worker in Germany shortly after she was accidentally stuck with a needle possibly contaminated by an Ebola-infected animal.

Further advances have been made that can completely protect monkeys against Ebola using small 'interfering' RNAs and various combinations of antibodies. But these treatments need to be given within two days of Ebola exposure.

"So although these approaches are highly important and can be used to treat known exposures, the need for treatments that can protect at later times after infection was paramount," said Geisbert.
Further research led to a cocktail of monoclonal antibodies that protected 43% of monkeys when given as late as five days after Ebola exposure, at a time when the clinical signs of the disease are showing.

The new study from Qui and colleagues at MAPP Biopharmaceutical Inc. used ZMAPP to treat monkeys given a lethal dose of Ebola. All of the animals survived and did not show any evidence of the virus in their systems 21 days after infection, even after receiving the treatment 5 days after infection. They also showed that ZMAPP inhibits replication of the Ebola virus in cell culture.

ZMAPP has been used to treat several patients on compassionate grounds. Of these, two US healthcare workers have recovered, although but whether ZMAPP had any effect is unknown, as 45% of patients in this outbreak survive without treatment. There were also two patients treated with ZMAPP who did not survive, but this may be because the treatment was started too late in the disease course.

"The diversity of strains and species of the Ebola and Marburg filoviruses is an obstacle for all candidate treatments," said Geisbert. "Treatments that may protect against one species of Ebola will probably not protect against a different species of the virus, and may not protect against a different strain within the species."

Although we certainly need treatments for filovirus infections, the most effective way to manage and control future outbreaks might be through vaccines, some of which have been designed to protect against multiple species and strains. During outbreaks, single-injection vaccines are needed to ensure rapid use and protection. At least five preventative vaccines have been reported to completely protect monkeys against Ebola and Marburg infection. But only the VSV-based vaccines have been shown to complete protect monkeys against Ebola after a single injection.

"Antibody therapies and several other strategies should be included in the arsenal of interventions for controlling future Ebola outbreaks," said Geisbert. "Although ZMAPP in particular has been administered for compassionate use, the next crucial step will be to formally assess its safety and effectiveness."

Journal Reference:

1. Thomas W. Geisbert. Medical research: Ebola therapy protects severely ill monkeys. Nature, 2014; DOI: 10.1038/nature13746

Surprising discovery: HIV hides in gut, evading eradication

Researchers at UC Davis have made some surprising discoveries about the body's initial responses to HIV infection. Studying simian immunodeficiency virus (SIV), the team found that specialized cells in the intestine called Paneth cells are early responders to viral invasion and are the source of gut inflammation by producing a cytokine called interleukin-1 beta (IL-1β).

Though aimed at the presence of virus, IL-1β causes breakdown of the gut epithelium that provides a barrier to protect the body against pathogens. Importantly, this occurs prior to the wide spread viral infection and immune cell killing. But in an interesting twist, a beneficial bacterium, Lactobacillus plantarum, helps mitigate the virus-induced inflammatory response and protects gut epithelial barrier. The study was published in the journal PLoS Pathogens.

One of the biggest obstacles to complete viral eradication and immune recovery is the stable HIV reservoir in the gut. There is very little information about the early viral invasion and the establishment of the gut reservoir.

"We want to understand what enables the virus to invade the gut, cause inflammation and kill the immune cells," said Satya Dandekar, lead author of the study and chair of the Department of Medical Microbiology and Immunology at UC Davis.

"Our study has identified Paneth cells as initial virus sensors in the gut that may induce early gut inflammation, cause tissue damage and help spread the viral infection. Our findings provide potential targets and new biomarkers for intervening or blocking early spread of viral infection," she said.

In the study, the researchers detected a very small number of SIV infected cells in the gut within initial 2.5 days of viral infection; however, the inflammatory response to the virus was playing havoc with the gut lining. IL-1β was reducing the production of tight-junction proteins, which are crucial to making the intestinal barrier impermeable to pathogens. As a result, the normally cohesive barrier was breaking down.

Digging deeper, the researchers found the inflammatory response through IL-1β production was initiated in Paneth cells, which are known to protect the intestinal stem cells to replenish the epithelial lining. This is the first report of Paneth cell sensing of SIV infection and IL-1β production that links to gut epithelial damage during early viral invasion. In turn, the epithelial breakdown underscores that there's more to the immune response than immune cells.

"The epithelium is more than a physical barrier," said first author Lauren Hirao. "It's providing support to immune cells in their defense against viruses and bacteria."

The researchers found that addition of a specific probiotic strain, Lactobacillus plantarum, to the gut reversed the damage by rapidly reducing IL-1β, resolving inflammation, and accelerating repair within hours. The study points to interesting possibilities of harnessing synergistic host-microbe interactions to intervene early viral spread and gut inflammation and to mitigate intestinal complications associated with HIV infection.

"Understanding the players in the immune response will be important to develop new therapies," said Hirao. "Seeing how these events play out can help us find the most opportune moments to intervene."

Journal Reference:

1. Lauren A. Hirao, Irina Grishina, Olivier Bourry, William K. Hu, Monsicha Somrit, Sumathi Sankaran-Walters, Chris A. Gaulke, Anne N. Fenton, Jay A. Li, Robert W. Crawford, Frank Chuang, Ross Tarara, Maria L. Marco, Andreas J. Bäumler, Holland Cheng, Satya Dandekar. Early Mucosal Sensing of SIV Infection by Paneth Cells Induces IL-1β Production and Initiates Gut Epithelial Disruption. PLoS Pathogens, 2014; 10 (8): e1004311 DOI: 10.1371/journal.ppat.1004311

New smartphone app can detect newborn jaundice in minutes

Newborn jaundice: It's one of the last things a parent wants to deal with, but it's unfortunately a common condition in babies less than a week old.

Skin that turns yellow can be a sure sign that a newborn is jaundiced and isn't adequately eliminating the chemical bilirubin. But that discoloration is sometimes hard to see, and severe jaundice left untreated can harm a baby.

University of Washington engineers and physicians have developed a smartphone application that checks for jaundice in newborns and can deliver results to parents and pediatricians within minutes. It could serve as a screening tool to determine whether a baby needs a blood test -- the gold standard for detecting high levels of bilirubin. 

"Virtually every baby gets jaundiced, and we're sending them home from the hospital even before bilirubin levels reach their peak," said James Taylor, a UW professor of pediatrics and medical director of the newborn nursery at UW Medical Center. "This smartphone test is really for babies in the first few days after they go home. A parent or health care provider can get an accurate picture of bilirubin to bridge the gap after leaving the hospital."

The research team will present its results at the Association for Computing Machinery's International Joint Conference on Pervasive and Ubiquitous Computing in September in Seattle.

The app, called BiliCam, uses a smartphone's camera and flash and a color calibration card the size of a business card. A parent or health care professional would download the app, place the card on her baby's belly, then take a picture with the card in view. The card calibrates and accounts for different lighting conditions and skin tones. Data from the photo are sent to the cloud and are analyzed by machine-learning algorithms, and a report on the newborn's bilirubin levels is sent almost instantly to the parent's phone.

"This is a way to provide peace of mind for the parents of newborns," said Shwetak Patel, a UW associate professor of computer science and engineering and of electrical engineering. "The advantage of doing the analysis in the cloud is that our algorithms can be improved over time."

A noninvasive jaundice screening tool is available in some hospitals and clinics, but the instrument costs several thousand dollars and isn't feasible for home use. Currently, both doctors and parents assess jaundice by looking for the yellow color in a newborn's skin, but this visual assessment is only moderately accurate. The UW team developed BiliCam to be easy to use and affordable for both clinicians and parents, especially during the first several days after birth when it's crucial to check for jaundice.

Jaundice, or the yellowing of the skin, can happen when an excess amount of bilirubin collects in the blood. Bilirubin is a natural byproduct of the breakdown of red blood cells, which the liver usually metabolizes. But newborns often metabolize bilirubin slower because their livers aren't yet fully functioning. If left untreated, severe jaundice can cause brain damage and a potentially fatal condition called kernicterus.

The UW team ran a clinical study with 100 newborns and their families at UW Medical Center. They used a blood test, the current screening tool used in hospitals, and BiliCam to test the babies when they were between two and five days old. They found that BiliCam performed as well as or better than the current screening tool. Though it wouldn't replace a blood test, BiliCam could let parents know if they should take that next step.

"BiliCam would be a significantly cheaper and more accessible option than the existing reliable screening methods," said Lilian de Greef, lead author and a UW doctoral student in computer science and engineering. "Lowering the access barrier to medical applications can have profound effects on patients, their caregivers and their doctors, especially for something as prevalent as newborn jaundice."

The researchers plan to test BiliCam on up to 1,000 additional newborns, especially those with darker skin pigments. The algorithms will then be robust enough to account for all ethnicities and skin colors. This could make BiliCam a useful tool for parents and health care workers in developing countries where jaundice accounts for many newborn deaths.

"We're really excited about the potential of this in resource-poor areas, something that can make a difference in places where there aren't tools to measure bilirubin but there's good infrastructure for mobile phones," Taylor said.

Within a year, the researchers say BiliCam could be used by doctors as an alternative to the current screening procedures for bilirubin. They have filed patents on the technology, and within a couple of years hope to have Federal Drug Administration approval for the BiliCam app that parents can use at home on their smartphones.

Related research paper can be found at: http://homes.cs.washington.edu/~mayank/BiliCam.pdf

source: www.sciencedaily.com 

Rapid Serological Assay Developed for Strongyloidiasis

Image: The adult free-living female Strongyloides stercoralis with a row of eggs within the body of the nematode (Photo courtesy of the CDC - Centers for Disease Control and Prevention).

Several imperfect methods exist for diagnosing strongyloidiasis and stool examination with microscopic identification of larvae considered the gold standard diagnostic procedure, showing good specificity with experienced staff.

Individuals with strongyloidiasis are typically asymptomatic, and the infection can persist for decades without detection. Problems arise when individuals with unrecognized Strongyloides stercoralis infection are immunosuppressed, which can lead to hyper-infection syndrome and disseminated disease with an associated high mortality if untreated.

An international team of scientists led by those at McGill University (Montreal, QC, Canada) obtained 54 positive serum samples that were confirmed by positive stool samples for S. stercoralis from multiple reference laboratories. There were 47 negative control samples consisted of sera obtained from healthy individuals residing in Canada with no prior history of travel outside of Canada and individuals with confirmed diagnosis of other parasitic infections, including trichinosis, and were negative for Strongyloides by an “in-house” enzyme-linked immunoassay (ELISA) (NRCP).

The team developed a rapid and sensitive serodiagnostic assay for strongyloidiasis based on a 31-kDa recombinant antigen from S. stercoralis (NIE) using a novel diffraction-based optical biosensor technology. The panelPlus oligonucleotide-based addressing system was used for NIE immobilization onto dotLab Sensors and All assays were performed on the dotLab mX System using panelPlus D Sensors (Axela, Inc.; Toronto, ON, Canada). All serum samples were also tested by an NIE ELISA that was developed and validated.

The assay readily differentiated S. stercoralis-infected patients from controls detecting 96.3% of the positive cases, and with no cross reactivity observed in the control group. These results were in excellent agreement with results obtained by an NIE-based ELISA. A further 44 sera from patients with suspected S. stercoralis infection were analyzed and showed 91% agreement with the NIE ELISA. The novel, high-sensitivity diffractive optics technology (dot) platform generated results in less than 30 minutes and is fully automated requiring minimal user intervention. This makes it potentially attractive for near-patient testing and for use in regions where technical expertise or adequate laboratory facilities may not be available.

The authors concluded that with the ability to create custom multiplex assays using the panelPlus oligonucleotide-based addressing system, the dotLab mX System could also be used further to improve Strongyloides serodiagnostics by incorporating multiple recombinant antigens in a multiplex format or by simultaneously screening for clinically relevant co-infections such as Human T-cell lymphotropic virus type 1 (HTLV-1).

The study was published on August 7, 2014, in the journal Public Library of Science Neglected Tropical Diseases.

source : www.labmedica.com

Amount, types of fat we eat affect health, risk of disease

Healthy adults should consume between 20 percent and 35 percent of their calories from dietary fat, increase their consumption of omega-3 fatty acids, and limit their intake of saturated and trans fats, according to an updated position paper from the Academy of Nutrition and Dietetics.

The position paper "Dietary Fatty Acids for Healthy Adults" has been published in the January issue of the Journal of the Academy of Nutrition and Dietetics. The position paper provides guidance for registered dietitian nutritionists and dietetic technicians, registered to translate research on fat and fatty acids into practical dietary recommendations for consumers.

The Academy's updated position is: It is the position of the Academy of Nutrition and Dietetics that dietary fat for the healthy adult population should provide 20 percent to 35 percent of energy, with an increased consumption of n-3 polyunsaturated fatty acids and limited intake of saturated and trans fats. The Academy recommends a food-based approach through a diet that includes regular consumption of fatty fish, nuts and seeds, lean meats and poultry, low-fat dairy products, vegetables, fruits, whole grains and legumes.

Registered dietitian nutritionists can help consumers understand that a total diet approach is more beneficial than simply reducing dietary fat and replacing it with carbohydrates, as a high intake of refined carbohydrate can also negatively affect health.

The Academy's position paper can be translated into healthful eating messages for the public:

• A simple and effective way to improve health is to eat more fish, nuts and seeds and to consume fewer desserts and convenience foods.

• Fat is a critical nutrient, and certain types of fat, such as omega-3s and omega-6s, are needed for good health. For this and other health reasons, a fat-free diet is not recommended.

• Fish is an excellent source of the omega-3s EPA and DHA; flax, walnuts and canola oil are good sources of ALA omega-3.

• Both the amount of fat (how much) and the type of fat (what foods) in the diet can affect health and risk of disease.

• Different foods provide different types of fat. Some fats improve your health (omega-3s help your heart and brain) while some are detrimental to your health (trans fat increases heart disease risk factors).

Journal Reference:

1. Gretchen Vannice, Heather Rasmussen. Position of the Academy of Nutrition and Dietetics: Dietary Fatty Acids for Healthy Adults. Journal of the Academy of Nutrition and Dietetics, 2014; 114 (1): 136 DOI: 10.1016/j.jand.2013.11.001

Low birth weight linked to higher incidence of type 2 diabetes in African American women

African American women born at a low or very low birth weight may be at a higher risk for developing type 2 diabetes. The findings, which appear in Diabetes Care, may explain in part the higher occurrence of type 2 diabetes in African American populations, which has a high prevalence of low birth weight.

Researchers from Boston University's Slone Epidemiology Center followed more than 21,000 women enrolled in the Black Women's Health Study over the course of 16 years, analyzing characteristics such as birth weight, current age, family history of diabetes, body mass index, physical activity and socioeconomic status.

The study results indicate that women with low birth weight had a 13 percent higher chance of developing type 2 diabetes than those with normal birth weight, and those with very low birth weight had a 40 percent higher chance of developing the disease. Low birth weight was defined as less than 2.5 kg, and very low birth weight as less than 1.5 kg. It appeared that body size did not play a role in this relationship as there was a clear association between birth weight and diabetes even for women who were not obese.

Although previous studies have shown that birth characteristics such as birth weight can have a major impact on adult health, this is the first large-scale study to demonstrate this effect in an African American population.

"African American women are at increased risk of developing type 2 diabetes, and also have higher rates of low birth weight than white women," said Edward Ruiz-Narváez, ScD, assistant professor of epidemiology at Boston University School of Public Health. "Our study shows a clear relationship between birth weight and diabetes that highlights the importance of further research for this at-risk group."

According to the researchers, there are two leading hypotheses for the phenomenon. The first, known as the "thrifty phenotype hypothesis," states that once the newborn body perceives that it lacks nutrition, it reprograms itself to absorb more nutrition, causing an imbalance in metabolism that eventually leads to type 2 diabetes. The second, known as the "fetal insulin hypothesis," states that genes that are responsible for impaired insulin secretion also have a negative effect on birth weight. Some of these genes have been discovered in recent studies, supporting the latter hypothesis.

Journal Reference:

1. E. A. Ruiz-Narvaez, J. R. Palmer, H. Gerlovin, L. A. Wise, V. G. Vimalananda, J. L. Rosenzweig, L. Rosenberg. Birth Weight and Risk of Type 2 Diabetes in the Black Women's Health Study: Does Adult BMI Play a Mediating Role? Diabetes Care, 2014; 37 (9): 2572 DOI: 10.2337/dc14-0731

Overweight and obesity linked to 10 common cancers, over 12,000 cases every year in UK

A higher body mass index (BMI) increases the risk of developing 10 of the most common cancers, the largest study of its kind on BMI and cancer shows.

 UK researchers at the London School of Hygiene &Tropical Medicine and the Farr Institute of Health Informatics estimate that over 12,000 cases of these 10 cancers each year are attributable to being overweight or obese, and calculate that if average BMI in the population continues to increase, there could be over 3500 extra cancers every year as a result.

"The number of people who are overweight or obese is rapidly increasing both in the UK and worldwide. It is well recognised that this is likely to cause more diabetes and cardiovascular disease. Our results show that if these trends continue, we can also expect to see substantially more cancers as a result"*, said study leader Dr Krishnan Bhaskaran, National Institute for Health Research Postdoctoral Fellow, from the London School of Hygiene & Tropical Medicine, London, UK.

Using data from general practitioner records in the UK's Clinical Practice Research Datalink (CPRD), the researchers identified 5·24 million individuals aged 16 and older who were cancer-free and had been followed for an average of 7·5 years. The risk of developing 22 of the most common cancers, which represent 90% of the cancers diagnosed in the UK, was measured according to BMI after adjusting for individual factors such as age, sex, smoking status, and socioeconomic status.

A total of 166 955 people developed one of the 22 cancers studied over the follow-up period. BMI was associated with 17 out of the 22 specific types of cancer examined.

Each 5 kg/m² increase in BMI was clearly linked with higher risk of cancers of the uterus (62% increase), gallbladder (31%), kidney (25%), cervix (10%), thyroid (9%), and leukemia (9%). Higher BMI also increased the overall risk of liver (19% increase), colon (10%), ovarian (9%), and breast cancers (5%), but the effects on these cancers varied by underlying BMI and by individual-level factors such as sex and menopausal status. Even within normal BMI ranges, higher BMI was associated with increased risk of some cancers.

There was some evidence that those with high BMI were at a slightly reduced risk of prostate cancer and premenopausal breast cancer.

Dr Bhaskaran explained, "There was a lot of variation in the effects of BMI on different cancers. For example, risk of cancer of the uterus increased substantially at higher body mass index; for other cancers, we saw more modest increases in risk, or no effect at all. For some cancers like breast cancer occurring in younger women before the menopause, there even seemed to be a lower risk at higher BMI. This variation tells us that BMI must affect cancer risk through a number of different processes, depending on the cancer type."

Based on the results, the researchers estimate that excess weight could account for 41% of uterine and 10% or more of gallbladder, kidney, liver, and colon cancers in the UK. They also estimate that a population-wide 1 kg/m² increase in average BMI (roughly an extra 3 to 4 kg, or 8 to 10 pounds, per adult), which would occur every 12 years or so based on recent trends, would result in an additional 3790 cases of these 10 cancers in the UK each year.

Writing in a linked Comment, Dr Peter Campbell from the American Cancer Society, Atlanta, USA, says, "We have sufficient evidence that obesity is an important cause of unnecessary suffering and death from many forms of cancer…More research is not needed to justify, or even demand, policy changes aimed at curbing overweight and obesity. Some of these policy strategies have been enumerated recently, all of which focus on reducing caloric intake or increasing physical activity, and include taxes on calorically dense, nutritionally sparse foods (eg, sugar-sweetened beverages); subsidies for healthier foods, especially in economically disadvantaged groups; agricultural policy changes; and urban planning aimed at encouraging walking and other modes of physical activity. Research strategies that identify population-wide or community-based interventions and policies that effectively reduce overweight and obesity should be particularly encouraged and supported. Moreover, we need a political environment, and politicians with sufficient courage, to implement such policies effectively.

Journal Reference:

1. Krishnan Bhaskaran, Ian Douglas, Harriet Forbes, Isabel dos-Santos-Silva, David A Leon, Liam Smeeth. Body-mass index and risk of 22 specific cancers: a population-based cohort study of 5·24 million UK adults. The Lancet, 2014; DOI: 10.1016/S0140-6736(14)60892-8

Malaria vaccine shows continued protection during 18 months of follow-up

A vaccine previously shown to reduce malaria in young infants and children reduces larger numbers of malaria cases in areas of higher malaria transmission, according to results from an ongoing clinical trial published in PLOS Medicine. The effect of vaccination diminished over time, but protection against clinical malaria remained evident 18 months after vaccination.

In the new report, the RTS,S Clinical Trials Partnership update estimates of vaccine efficacy (the reduction in the risk of malaria in participants who received the vaccine compared to those who received a comparator vaccine) and calculate the number of cases of malaria that the vaccine prevented in a phase 3, randomized, controlled clinical trial of the malaria vaccine RTS,S/AS01 given to young infants and children in Africa.

The study included 6,537 infants aged 6-12 weeks and 8,923 children aged 5-17 months who were randomly assigned to receive three doses of RTS,S/AS01 or comparator vaccine. During 18 months following vaccination, the researchers report vaccine efficacy of 45% [95% confidence interval (CI): 41%-49%, intention-to-treat analysis] in children age 5-17 months, and 27% vaccine efficiency [95% CI: 21%-33%, intention-to-treat analysis] in infants age 6-12 weeks. In both age groups, vaccine efficacy was highest in the first 6 months after vaccination. Across all 11 study sites, RTS,S/AS01 averted an average of 829 (range 37 to 2365) cases of clinical malaria per 1,000 children vaccinated, and 449 (Range -10 to 1402) cases in infants vaccinated, over 18 months following vaccination.

Safety analyses found overall serious adverse events (SAE) to occur less often in children age 5-17 months who received the vaccine [18.6% (95% confidence interval 17.6%-19.6%), compared with 22.7% (95% CI 21.2%-24.3%) in children who received a comparator vaccine]. In infants age 6-12 weeks overall SAE were not found to differ significantly with immunization. As noted in earlier reports, more meningitis cases were reported as SAE in participants who received the malaria vaccine than in those who received a comparator immunization (16 cases among the 5,949 children in the RTS,S/AS01 vaccine group and one case among the 2,974 children in the control group; and nine cases among 4,358 young infants in the RTS,S/AS01 group and three among 2,179 young infants in the control group) and no causal relationship to the vaccine has been established.

Going forward the study will analyze further efficacy and safety results following administration of a booster immunization given to study participants just after the time period analyzed in the current report. The authors note that "Translated to the population at risk of malaria, reductions in clinical cases on this scale as a result of vaccination with RTS,S/AS01 would have a major public health impact."

Journal Reference:

1. The RTS,S Clinical Trials Partnership. Efficacy and Safety of the RTS,S/AS01 Malaria Vaccine during 18 Months after Vaccination: A Phase 3 Randomized, Controlled Trial in Children and Young Infants at 11 African Sites. PLOS Medicine, 2014 DOI: 10.1371/journal.pmed.1001685

New malaria vaccine candidates identified

Children and guardians present to a local dispensary for sampling for the detection of anti-malarial antibodies.

Researchers have discovered new vaccine targets that could help in the battle against malaria. Taking a new, large-scale approach to this search, researchers tested a library of proteins from the Plasmodium falciparum parasite with antibodies produced by the immune systems of a group of infected children.

The tests measured which proteins the children’s immune systems responded to, revealing antigens that had not previously been identified as possible vaccine targets and new insights into the ways antigens could be used in combination to increase protection.

“Resistance to malaria drugs is an increasing problem so vaccines are desperately needed to battle the Plasmodium falciparum parasite before it has a chance to make people sick,” says Dr Faith Osier, first author from the Kenya Medical Research Institute. “This study presents us with a large number of new vaccine candidates that offer real hope for the future.”

A group of children infected with malaria were followed over a six-month period by scientists at the Kenya Medical Research Institute (KEMRI). While some patients became sick, others were protected by naturally occurring antibodies that stopped the malaria parasite from penetrating their red blood cells during the blood stage of the disease, which produces severe symptoms such as fever and anaemia. Researchers used samples taken from these children to identify combinations of antibodies that provided up to 100 per cent protection against clinical episodes of malaria.

The study used a library of parasite proteins that was generated using an approach developed at the Wellcome Trust Sanger Institute by Dr Gavin Wright and Dr Julian Rayner. These researchers had previously developed a new approach to express large panels of correctly folded, full-length proteins from the Plasmodium falciparum parasite, targeting proteins involved in the invasion of human red blood cells. In this study, Sanger Institute scientists collaborated with colleagues in Kenya to see which of them the children’s immune systems had developed antibodies against.

“The use of these proteins by the Sanger Institute’s Malaria Programme is helping to zero in on and exploit the weakest point in the malaria parasite’s life cycle,” says Dr Julian Rayner, an author from the Sanger Institute. “Trials for vaccines in the past have focussed on one target at a time and have had limited success; with this approach, we can systematically test larger numbers of targets and identify targets that might work in combination.”

The findings of this research add further weight to the theory that a successful blood-stage vaccine needs to target multiple antigens. The next step in this research will be to generate antibodies against all of the proteins in the library and test them in the laboratory in different combinations to see whether combinations that appear to protect individuals in the field are able to directly prevent parasite invasion. Such studies are now underway at the Sanger Institute. At KEMRI, Dr Faith Osier’s team is working on validating these findings in other African countries.

“Each year, hundreds of thousands of people die from malaria; but hundreds of millions are infected, many of whom are protected from severe symptoms by their immune response,” says Dr Kevin Marsh, Director of the KEMRI Wellcome Trust Research Programme at the Kenya Medical Research Institute. “Collaborating with our colleagues at the Sanger Institute helps to bring the latest technological advances to the field, which in this case has highlighted combinations of naturally occurring antibodies that could contribute to the design of new vaccines.”

Journal Reference:

1. Osier, F et al. New antigens for a multicomponent blood-stage malaria vaccine. Science Translational Medicine, 2014 DOI: 10.1126/scitranslmed.3008705

Erectile dysfunction can be reversed without medication

Men suffering from sexual dysfunction can be successful at reversing their problem, by focusing on lifestyle factors and not just relying on medication, according to research at the University of Adelaide.

In a new paper published in the Journal of Sexual Medicine, researchers highlight the incidence of erectile dysfunction and lack of sexual desire among Australian men aged 35-80 years.

Over a five-year period, 31% of the 810 men involved in the study developed some form of erectile dysfunction.

"Sexual relations are not only an important part of people's wellbeing. From a clinical point of view, the inability of some men to perform sexually can also be linked to a range of other health problems, many of which can be debilitating or potentially fatal," says Professor Gary Wittert, Head of the Discipline of Medicine at the University of Adelaide and Director of the University's Freemasons Foundation Centre for Men's Health.

"Our study saw a large proportion of men suffering from some form of erectile dysfunction, which is a concern. The major risk factors for this are typically physical conditions rather than psychological ones, such as being overweight or obese, a higher level of alcohol intake, having sleeping difficulties or obstructive sleep apnoea, and age.

"The good news is, our study also found that a large proportion of men were naturally overcoming erectile dysfunction issues. The remission rate of those with erectile dysfunction was 29%, which is very high. This shows that many of these factors affecting men are modifiable, offering them an opportunity to do something about their condition," Professor Wittert says.

The lead author of the paper, Dr Sean Martin from the University of Adelaide's Freemasons Foundation Centre for Men's Health, says: "Even when medication to help with erectile function is required, it is likely to be considerably more effective if lifestyle factors are also addressed.

"Erectile dysfunction can be a very serious issue because it's a marker of underlying cardiovascular disease, and it often occurs before heart conditions become apparent. Therefore, men should consider improving their weight and overall nutrition, exercise more, drink less alcohol and have a better night's sleep, as well as address risk factors such as diabetes, high blood pressure and cholesterol.

"This is not only likely to improve their sexual ability, but will be improve their cardiovascular health and reduce the risk of developing diabetes if they don't already have it."

Journal Reference:

1. Sean A. Martin, Evan Atlantis, Kylie Lange, Anne W. Taylor, Peter O'Loughlin, Gary A. Wittert. Predictors of Sexual Dysfunction Incidence and Remission in Men. The Journal of Sexual Medicine, 2014; DOI: 10.1111/jsm.12483

One in four patients with newly-diagnosed erectile dysfunction is a young man

In a recent analysis of one outpatient clinic, one in four men seeking medical help for newly-developed erectile dysfunction (ED) was younger than 40 years, and nearly half of young men with the condition had severe ED. While larger population-based studies are needed, the findings, which were published in The Journal of Sexual Medicine, suggest that erectile dysfunction in young men may be more prevalent and more serious than previously thought.

Erectile dysfunction is a common complaint in men over 40 years of age. Prevalence increases with age, but the prevalence and risk factors of erectile dysfunction among younger men have been scantly analyzed. The research that has been done paints a vague picture, reporting prevalence rates ranging between two percent and nearly 40 percent.

To provide more clarity, Paolo Capogrosso, MD, of the University Vita-Salute San Raffaele, in Milan, Italy, and his colleagues assessed the sociodemographic and clinical characteristics of 439 men seeking medical help for newly-developed erectile dysfunction between January 2010 and June 2012 at a single academic outpatient clinic. Of the 439 patients, 114 (26 percent) were aged 40 years or younger. Compared with older patients, younger patients had a lower average body mass index, a higher average level of testosterone in the blood, and a lower rate of other medical conditions. (Only 9.6 percent of younger patients had one or more concomitant medical conditions compared with 41.7 percent among older patients.) Younger ED patients smoked cigarettes and used illicit drugs more frequently than older patients. Premature ejaculation was more common in younger men, whereas Peyronie's disease (bent erection from scar tissue) was more prevalent in older patients. Severe erectile dysfunction was found in 48.8 percent of younger patients and 40 percent of older patients while the rates of mild, mild-to-moderate, and moderate erectile dysfunction were not significantly different between the two groups.

"These findings, taken together with those of other studies showing the importance of erectile dysfunction as a potential "sentinel marker" of major diseases, outline the importance of taking a comprehensive medical and sexual history and to perform a thorough physical examination in all men with erectile dysfunction, irrespective of their age," said Dr. Capogrosso.

"Erectile function, in general, is a marker for overall cardiovascular function -- this is the first research showing evidence of severe erectile dysfunction in a population of men 40 years of age or younger" stated Irwin Goldstein, editor-in-chief of The Journal of Sexual Medicine. "Clinically, when younger patients have presented with erectile dysfunction, we have in the past had a bias that their ED was primarily psychologic-based and vascular testing was not needed. We now need to consider regularly assessing the integrity of arterial inflow in young patients -- identifying arterial pathology in such patients may be very relevant to their overall long-term health."

Journal Reference:

1. Paolo Capogrosso, Michele Colicchia, Eugenio Ventimiglia, Giulia Castagna, Maria Chiara Clementi, Nazareno Suardi, Fabio Castiglione, Alberto Briganti, Francesco Cantiello, Rocco Damiano, Francesco Montorsi, Andrea Salonia. One Patient Out of Four with Newly Diagnosed Erectile Dysfunction Is a Young Man-Worrisome Picture from the Everyday Clinical Practice. The Journal of Sexual Medicine, 2013; DOI: 10.1111/jsm.12179