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Wellcome Trust Research Round-Up: 25.01.16

25 Jan, 2016

Our fortnightly round-up of news from the Wellcome Trust community…

Drug-resistant typhoid

B0008378 Salmonella Typhimurium

Credit: David Goulding, Wellcome Trust Sanger Institute.

The frontline treatment for typhoid is no longer effective due to drug resistance, according to a Wellcome Trust-funded study published in The Lancet Infectious Diseases.

The research revealed that fluoroquinolone antibiotics, which have commonly been used to treat typhoid for many years, have been over-prescribed and are no longer the recommended treatment for individuals with typhoid fever in Nepal, and possibly in the rest of South Asia.

The study found that – for the first time – the bacteria Salmonella Typhi has become resistant to advanced fluoroquinolones, making the treatment ineffective.

Conducted in Nepal, the trial had to be stopped early due to concerns over safety, as there was a high clinical failure rate of some antibiotics in patients with typhoid.

The researchers also discovered that a large proportion of individuals who have symptoms indicating they have uncomplicated typhoid fever are actually likely to have an alternative diagnosis.

Dr Buddha Basnyat, senior author of the study and head of the Oxford University Clinical Research Unit in Nepal said, “The findings from this study are sobering. Typhoid is becoming more difficult and  confusing to treat and we must now more seriously consider public health measures such as vaccination to protect against typhoid.”

Wake up call for deadly disease

meliodiosis credit ADC

Credit: ADC

A deadly bacterial disease called melioidosis may be present in many more countries than previously thought, according to new research published in Nature Microbiology.

The study, funded by the Wellcome Trust and conducted by the Mahidol Oxford Tropical Medicine Research Unit, is the first to provide an evidence-based estimate of the global extent of melioidosis, which is caused by a bacterium found in soil and water in South and Southeast Asia and northern Australia.

Researchers predict that melioidosis is present in almost 80 countries, including 34 that have never reported the disease. Health workers and policy makers are encouraged to give the disease a higher priority as the spread of melioidosis is on the rise.

Melioidosis – which is contracted through the skin, lungs or by drinking contaminated water – is difficult to diagnose since it mimics other diseases. High-risk groups for the disease include patients with diabetes mellitus, chronic kidney disease and excessive alcohol intake. The bacterium is also resistant to many antimicrobials, and insufficient treatment could lead to fatality rates of over 70%.

Dr Direk Limmathurotsakul, study co-author and Head of Microbiology at MORU said, “Although melioidosis has been recognised for more than 100 years, awareness of it is still low even among medical and laboratory staff in confirmed endemic areas. We predict that the burden of this disease is likely to increase in the future because the incidence of diabetes mellitus is increasing and the movements of people and animals could lead to the establishment of new endemic areas.”

Predicting cancer’s growth

stomach cancer.jpgA mathematical rule may predict how a cancer will grow, according to researchers at The Institute of Cancer Research.

The study, published in Nature Genetics, suggests that by applying mathematical formulas to tumour biopsies, doctors could make clinical decisions about how an individual patient’s cancer will change and what treatments should be used.

The mathematical model predicted that in many tumours, all important cancer genes were already present early on, and any new mutations inside the tumour act as ‘passengers’ with no additional effect.

While the model indicated bowel, stomach and some lung cancers closely followed a path set out by a theoretical model, it could not as accurately predict the path of some other cancers like brain and pancreatic tumours. Scientists suggest that in these cases, pressures on resource and space might lead to natural selection playing a greater role in the spread of mutations.

Study co-leader Dr Trevor Graham, Head of the Evolution and Cancer laboratory at the Barts Cancer Institute at QMUL, said, “We often think of cancers as being the chaotic and uncontrolled growth of cells within the body.  But counter to this intuition, our study shows how cancer evolution is in fact often highly ordered and can even be explained by a straightforward mathematical rule.  We can attempt to bend it in our favour to improve patient outcomes.”

In other news…

An Ebola legacy lab has been set legacy lab cropup in Sierra Leone to improve resilience to future epidemics. The lab is a collaboration between the University of Makeni and the University of Cambridge, with funding from the Wellcome Trust.

Mosquito, Anopheles stephensi in flight

Credit: Hugh Sturrock.

Congratulations to Professor Francois Nosten, Head of the Shoklo Malaria Research Unit at the Wellcome Trust’s major overseas programme in Thailand, who was awarded l’Orde de la Légion d’honneur (Legion of Honour) for his work fighting malaria for over three decades. You can read about his work in our long-form online publication, Mosaic.

The House of Commons International Development Committee has published a report on ‘Ebola: Responses to a public health emergency’. Jeremy Farrar was a witness and gave evidence at the committee session.

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