Research news in brief

Call for moratorium on human genome editing

Scientists and ethicists from seven countries have called for a global moratorium and an international governance framework for all clinical uses of human germline editing in an article published in Nature. The authors argued that various events over the past 3 years, including a scientist in China reportedly using germline editing to produce two babies in 2018, meant that a global moratorium and an international governance framework were now warranted. The authors emphasised that this moratorium would not cover germline editing for research purposes only or editing of somatic cells to treat diseases. Under the proposed scheme, after “an initial period of fixed duration during which no clinical uses of germline editing whatsoever should be allowed,” nations could then choose whether to permit specific applications. However, nations would proceed “openly and with due respect to the opinions of humankind on an issue that affects the human species” by agreeing not to approve applications without first meeting certain conditions. “The governance framework we are calling for will place major speed bumps in front of the most adventurous plans to re-engineer the human species,” but the “risks of the alternative — which include harming patients and eroding public trust — are far worse,” the authors concluded. Professor Peter Dearden, Vice-President of the Genetics Society of Australasia, responded that “most scientists believe that such a moratorium already exists”. “That gene-edited children have been born in China shows that moratoria are not effective to stop illegitimate behaviour. The scientist involved appears to have broken laws and regulations and behaved at the least unethically, at most illegally. That China has tightened its regulations and sanctioned the scientist is good news; clearly, they also recognise the need to think carefully about gene editing in humans,” he said. “I hope this moratorium is achieved and effective. Perhaps, however, we should be asking how it is a highly trained, internationally educated, scientist could feel that they have the right to ignore international opinion, ethical standards and law? Solving that problem may be one way to assure that this proposed moratorium is effective.”

Blood test used to spot heart attacks can lead to misdiagnosis

The blood test used to diagnose acute myocardial infarction in patients admitted to hospital can be misleading, warn researchers in a study published by The BMJ. Current guidelines recommend troponin tests to help exclude or diagnose a heart attack. Manufacturers of troponin tests provide a recommended level (known as the 99th percentile) based on values from a few hundred healthy individuals. This recommended level is used as the upper limit of normal. In other words, if the value of troponin is above the 99th percentile, it is considered to be abnormal and would indicate a heart attack in appropriate clinical circumstances. But little is known about the true distribution of the troponin level across a whole hospital population that includes inpatients, outpatients, patients undergoing surgery, patients in intensive care etc. The researchers measured levels of high-sensitivity cardiac troponin I (hs-cTnI) in 20 000 inpatients and outpatients undergoing blood tests for any reason at University Hospital Southampton between 29 June and 24 August 2017. The average age of participants was 61 years and 53% (10 580) were women. The researchers found that the 99th percentile of troponin for the whole study population was 296 ng/L compared with the manufacturer’s recommended level of 40 ng/L. One in 20 (1080; 5.4%) of all 20 000 patients had a troponin level greater than 40 ng/L, but in most of these patients there was no clinical suspicion of a heart attack. Overall, 39% of all patients from the critical care units, 14% of all medical inpatients, and 6% of all patients from the emergency department had a troponin concentration greater than the recommended upper limit of normal. This is an observational study, and as such, it can’t establish cause, and the researchers point to some limitations, such as relying on patient records for details about management and diagnoses and being unable to examine clinical outcomes. Nevertheless, the researchers say these results highlight the need for medical staff to interpret troponin levels carefully in order to avoid misdiagnosis of a heart attack and inappropriate treatment.

Dementia rates declining in older South Australians

Dementia rates among older Australians accessing home or long term care services may be declining according to a large-scale evaluation undertaken by the South Australian Health and Medical Research Institute (SAHMRI)-based Registry of Older South Australians, and published in the Journal of Gerontology: Medical Sciences. The researchers say the positive findings could be the result of national public health measures to improve the overall health of the population. The study of 348 311 older people receiving home care services found the prevalence of dementia was 26% in 2005 compared with 21% in 2014. For 188 846 older people starting long term care, the dementia rate was 50% in 2008 compared with 47% in 2014. There are currently estimated to be more than 436 000 Australians living with dementia. Those figures are predicted to rise above 589 000 people by 2028 and above 1 million people by 2058. “The overall number of older Australians with dementia and people accessing aged care will increase because of the ageing population,” the project’s lead author, SAHMRI Research Fellow Dr Stephanie Harrison, said. “But there could be a need to reassess current estimates as we should consider that the prevalence of dementia in Australia might be changing.”

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