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Preference: Infectious Diseases and Parasitology

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[Comment] The NCDs Cooperative: a call to action

Over the past 20 years, decision makers have largely stood impotent as non-communicable diseases (NCDs) have exploded around the world. Without a dramatic change in strategy, this resounding collective failure will persist. As I travelled the globe as one of three nominees for the Director-General of WHO, I met with 191 country delegations, including heads of state, foreign ministers, and health ministers. The good news on NCDs is that policy makers have both an awareness of the problem and an appetite for change.

[Comment] Potential efficacy of interleukin-1β inhibition in lung cancer

Over the past two decades, a wealth of experimental and clinical data have intimately linked dysregulated production of the potent proinflammatory cytokine interleukin 1β with several chronic inflammatory and autoimmune diseases, of which the most evidence is available for rheumatoid arthritis and cardiovascular disease (eg, atherosclerosis).1–3 Notably, these disease associations have provided the impetus to develop clinical grade inhibitors against interleukin 1β or its receptor, with the intereukin-1-receptor antagonist anakinra being the first such inhibitor approved for clinical use (in 2001).

Australia deepens its ties to World Health Organisation

 

A new era in relations between Australia and the World Health Organisation (WHO) is being ushered in with an agreement that will further deepen Australia’s involvement in the health of its region.

Signed last week at a WHO regional meeting in Brisbane, the agreement puts in place Australia’s first country cooperation strategy with the WHO. The plan is also the first of its type signed with a high-income country in the Western Pacific region.

It’s designed to leverage Australia’s expertise in healthcare to the benefit of less well developed countries in the region, while at the same time strengthening Australia’s own health security.

Health Minister Greg Hunt said the new partnership puts Australia at the forefront of international best practice in health policy.

“This strategy strengthens our systems to guard against emerging diseases at home and abroad, boosts our public health capacities and improves our already robust regulations to ensure we have safe and effective medicines and treatments,” he said.

The agreement outlines three strategic priorities:

  • Improving health security, with a focus on infectious diseases and emerging disease outbreaks;
  • Exchanging expertise and information in health systems policy;
  • Strengthening health regulations across the region.

Also at the Brisbane meeting of the WHO Regional Committee for the Western Pacific, Foreign Minister Julie Bishop launched a $300 million Indo-Pacific Health Security Initiative.

“In an interconnected world, diseases such as Ebola, MERS and the Zika Virus do not respect borders. A major epidemic could potentially disrupt tourism, trade, investment and people movement, setting back regional economic growth and development,” Minister Bishop said.

The $300 million will go to supporting efforts to prevent and contain disease outbreaks that could impact significantly on national, regional and global economies. The initial focus will be on drug-resistant tuberculosis and malaria in the Indo-Pacific region. These efforts will be led by the newly formed Indo-Pacific Centre for Health Security, a unit within the Department of Foreign Affairs and Trade.

As part of the fight against pandemics in the region, Greg Hunt has also announced that hospitals across the country will open their doors to a WHO-led team of auditors, who will look at local policies and plans for public health emergencies and antimicrobial resistance.

“I’m confident that our investments in pandemic preparedness, the national medical stockpile, biosecurity and vaccination supported by our people, systems and processes, will prove worthy,” he commented.

“We know there are gaps in our defences against global pandemics or potential epidemics, and antimicrobial resistance, and we need more, and better research to plug those gaps.”

Mr Hunt said the Pacific region is a known hotspot for emerging disease and increased resistance to conventional tuberculosis and malaria treatments.

“We are not alone in facing these health threats which have potentially disastrous social and economic impacts. While Australia recognises its privileged position in the world, we are not complacent about the risk that pandemics and other health threats pose to us.”

[Seminar] Polymyalgia rheumatica

Polymyalgia rheumatica is an inflammatory disease that affects the shoulder, the pelvic girdles, and the neck, usually in individuals older than 50 years. Increases in acute phase reactants are typical of polymyalgia rheumatica. The disorder might present as an isolated condition or in association with giant cell arteritis. Several diseases, including inflammatory rheumatic and autoimmune diseases, infections, and malignancies can mimic polymyalgia rheumatica. Imaging techniques have identified the presence of bursitis in more than half of patients with active disease.

The world is running out of antibiotics

The World Health Organization has confirmed in a new report that there is a serious lack of new antibiotics under development to combat the growing threat of antimicrobial resistance.

The report, Antibacterial agents in clinical development – an analysis of the antibacterial clinical development pipeline, including tuberculosis, reveals there is a serious lack of treatment options for multidrug- and extensively drug-resistant M. tuberculosis and gram-negative pathogens, including Acinetobacter and Enterobacteriaceae (such as Klebsiella and E.coli). 

This is alarming because these pathogens can cause severe and often deadly infections that pose a particular threat in hospitals and nursing homes.

Most of the drugs currently being developed are modifications of existing classes of antibiotics and are only short-term solutions. The report found very few potential treatment options for those antibiotic-resistant infections. This includes drug-resistant tuberculosis which kills around 250,000 people each year.

Dr Tedros Adhanom Ghebreyesus, Director-General of WHO, believes antimicrobial resistance is a global health emergency.

“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 cautioned.

WHO has also identified 12 classes of priority pathogens which can cause common infections such as pneumonia or urinary tract infections but are increasingly resistant to existing antibiotics and urgently in need of new treatments.

The report identifies 51 new antibiotics and biologicals in clinical development to treat priority antibiotic-resistant pathogens, as well as tuberculosis and the sometimes deadly diarrhoeal infection Clostridium difficile.

Among all these candidate medicines, however, only eight are classed by WHO as innovative treatments. There are also very few new oral antibiotics being developed, despite these being essential formulations for treating infections outside hospitals or in resource-limited settings.

“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 defence,” explained Dr Suzanne Hill, Director of the Department of Essential Medicines at WHO.

To counter this threat, WHO and the Drugs for Neglected Diseases Initiative (DNDi) have set up the Global Antibiotic Research and Development Partnership (known as GARDP), with Germany, Luxembourg, the Netherlands, South Africa, Switzerland and the United Kingdom of Great Britain and Northern Ireland and the Wellcome Trust recently pledging more than €56 million.

“Research for tuberculosis is seriously underfunded, with only two new antibiotics for treatment of drug-resistant tuberculosis having reached the market in over 70 years,” Dr Mario Raviglione, Director of the WHO Global Tuberculosis Programme said.

WHO believes that new treatments alone will not be sufficient to combat the threat of antimicrobial resistance, and is developing guidance for the responsible use of antibiotics in the human, animal and agricultural sectors.

The AMA believes the over-prescribing of antibiotics is a threat to the wellbeing of Australians as we remain one of the highest consumers of antibiotics in the industrialised world. The AMA also encourages antibiotics to be responsibly prescribed.

MEREDITH HORNE

[Editorial] Systemic sclerosis: advances and prospects

Of all the rheumatological diseases, systemic sclerosis (scleroderma) has the highest case-specific mortality and substantial non-lethal complications. It is a rare multisystem autoimmune disease of the connective tissue, distinguished by prominent fibrosis and vasculopathy of the skin and internal organs. A Seminar by Christopher Denton and Dinesh Khanna is the first comprehensive clinical review on systemic sclerosis since a formal evidence-based management guideline in 2016 and the results of key trials of stem-cell therapy and immunosuppression were published.

[Articles] Population health and regional variations of disease burden in Japan, 1990–2015: a systematic subnational analysis for the Global Burden of Disease Study 2015

Japan has been successful overall in reducing mortality and disability from most major diseases. However, progress has slowed down and health variations between prefectures is growing. In view of the limited association between the prefecture-level health system inputs and health outcomes, the potential sources of regional variations, including subnational health system performance, urgently need assessment.

Genetic program helps with understanding brain disease

Research results recently published in the journal eLife explain a genetic program that controls how and when brain genes are expressed at different times in a person’s life to perform a range of functions.

Researchers say the timing of the genetic program is so precise they can tell the age of a person by looking at the genes that are expressed in a sample of brain tissue.

The study was funded by the Medical Research Council, Wellcome Trust and the European Union Seventh Framework Program.

Scientists analysed existing data that measured gene expression in brain tissue samples from across the human lifespan – from development in the womb up to 78 years of age.

They found the timing of when different genes are expressed follows a strict pattern across the lifespan.

Most of the changes in gene expression in the brain were completed by middle-age.

The gene program is delayed slightly in women compared with men, the study found, suggesting the female brain ages more slowly than the male.

The biggest reorganisation of genes occurs during young adulthood, peaking around age 26. These changes affected the same genes that are associated with schizophrenia.

The research team said that finding could explain why people with schizophrenia do not show symptoms until young adulthood, even though the genetic changes responsible for the condition are present from birth.

The findings could hold clues to new treatments for schizophrenia and other mental health problems in young adults. The next step for the researchers is to study how the genetic program is controlled, which could potentially lead to therapies that alter the course of brain aging.

Professor Seth Grant, Head of the Genes to Cognition Laboratory at the University of Edinburgh, said: “The discovery of this genetic program opens up a completely new way to understand behaviour and brain diseases throughout life.”

Dr Nathan Skene, Research Scientist at the University of Edinburgh’s Centre for Clinical Brain Sciences, said: “Many people believe our brain simply wears out as we age. But our study suggests that brain aging is strictly controlled by our genes.”

CHRIS JOHNSON