Antiviral drug, paxlovid, significantly reduced the likelihood of hospitalisation or death from COVID-19 in people at risk of severe illness during the Omicron wave, according to a study.
Antiviral drug, paxlovid, significantly reduced the likelihood of hospitalisation or death from COVID-19 in people at risk of severe illness during the Omicron wave, according to a study. The research, published in the Canadian Medical Association Journal, aimed to evaluate the effectiveness of paxlovid, a combiantion of nirmatrelvir and ritonavir drugs, in preventing severe illness during the emergence of the Omicron variant.
The researchers from Public Health Ontario looked at data on adults with mild disease in Ontario, Canada who tested positive for SARS-CoV-2 by polymerase chain reaction (PCR) test between April 4 and August 31, 2022.
They compared 8,876 patients treated with nirmatrelvir–ritonavir with 1,68, 669 who were not treated. Most patients were older than 70 years, were vaccinated and had potential drug–drug interactions.
A previous randomised controlled trial conducted before the emergence of the Omicron variant had found nirmatrelvir–ritonavir to be effective at treating patients.
However, that trial did not include people who had been vaccinated or who had potential drug–drug interactions.
“Our study, in conjunction with previous clinical trials and observational research, supports the effectiveness of nirmatrelvir–ritonavir at reducing hospital admission from COVID-19 and all-cause death,” said study lead author Kevin Schwartz from Public Health Ontario.
The researchers found that for every 62 people treated with nirmatrelvir–ritonavir, the medication prevented one case of severe COVID-19.
“This study highlights the importance of testing for SARS-CoV-2 if you have symptoms, and access to Paxlovid for those at risk for severe COVID-19,” Schwartz said.
“If you test positive for COVID-19, are over 60 years of age, or if you have other risk factors for severe infection, such as chronic medical conditions or are undervaccinated, contact your health care provider or pharmacy within 5 days of symptoms starting and ask about Paxlovid,” the scientist added.
Covid cases are declining across the country with daily and weekly positivity recorded at 0.08%.
India has reported 109 new covid cases in the last 24 hours, with active cases declining to 1,781, the union health ministry data on Thursday showed. ‘
The total number of covid cases has reached 4.47 crore, and covid related deaths stood at 530,748 since the onset of covid pandemic.
Covid cases are declining across the country with daily and weekly positivity recorded at 0.08%.
Karnataka reported 108 active cases while Kerala has 1218 active cases. Maharashtra has 83 active cases, Odisha 88 cases, Rajasthan 10 cases, Tamil Nadu 36 active cases, Uttar Pradesh 16 and West Bengal 43 cases.
Around 4,41,51,219 people have recovered from the infection with the current recovery rate touching 98.81%.
With the rapid decline in the trajectory of covid cases, scientists believe that Omicron and its sub-lineages will not affect India as large number of populations is already exposed to the virus and vaccinated. Scientists say that people in India have developed hybrid immunity (due to vaccination and natural infection). However, they suggest people wear masks in crowded places and complete their vaccination doses if not done yet.
At present, large number of cases are being reported in China and other countries as a result of which the government has tightened covid preparedness measures. The government has directed the INSACOG under the supervision of Department of Biotechnology (DBT) to keep a close watch on covid situation in the country and continue to do constant genome sequencing to track any new variant.
The government is conducting RT-PCR testing for people returning from China, Hong Kong, Japan, Singapore, Thailand, and South Korea and mandated the filling up of ‘Air Suvidha’ forms for travelers from six countries under which 72-hour prior RT-PCR testing is compulsory.
The country has conducted over 1,41,248 tests in the last 24 hours taking the total trajectory of covid testing to 91.67 crore so far.
Under the covid vaccination drive, more than 220.61 crore vaccine doses have been administered to the people across the country so far. In the last 24 hours, around 1,13,507 vaccine doses were administered.
Besides, surveillance at the hospital level is also going on to monitor lnfluenza-like illness (lLl) & SARI cases.
Multivitamins and minerals, probiotics and prebiotics and other botanical compounds and herbs can help in achieving a balanced intake of essential nutrients. Here’s how these supplements can help ward off common diseases and maintain a healthy lifestyle.
Insufficiencies in nutrition and nutritional deficiencies are universal issues that have a deleterious impact on health and well-being however, a variety of ailments that are now ubiquitous can be prevented by taking supplements as they are a great way to ensure that your body is getting the nutrients it needs to improve your diet and fend off common diseases. Incorporating a well-balanced diet along with the use of supplements are preventative measures that can lower your risk of developing various health problems.
Therefore, multivitamins and minerals, probiotics and prebiotics, and other botanical compounds and herbs can help in achieving a balanced intake of essential nutrients. Let’s discuss how these supplements can help ward off common diseases and maintain a healthy lifestyle.
Probiotics and prebiotics (microbes) for digestive health
Probiotics (microbes) are widely consumed dietary supplements for the purpose of promoting healthy digestion and improving the balance of good and bad bacteria in the gut. Good bacteria have the ability to reduce symptoms of irritable bowel syndrome and maintain a healthy digestive system.
One can include prebiotics in their diet to curb digestive issues, as probiotics and prebiotics provide the good bacteria with food that helps them grow and thrive in the gut.
Multivitamins and minerals for malabsorption
In addition to probiotics and prebiotics, multivitamins and mineral supplements are extensively beneficial, as the body needs certain vitamins and minerals to function properly. For those with malabsorption or difficulty absorbing nutrients, multivitamins provide an excellent way to ensure one is receiving the essential nutrients needed.
In this regard, salient multivitamins and minerals like vitamins A, C, D, E, K, B-complex and folic acid, along with other vitamins and minerals (including beta-carotene, copper, potassium, zinc, calcium, iodine and iron), are beneficial, as they help support healthy organ functioning, provide energy and regulate the immune system. Therefore, for those with malabsorption, taking a multivitamin supplement can help ensure that they are receiving the necessary nutrients and vitamins to maintain good health.
In an interview with HT Lifestyle, Dr Yogini Patil, BAMS and Nutritionist at LivLong, shared, “People who suffer greatly from malabsorption can benefit from adding supplements to their diets. If we talk in brief about why malabsorption occurs, it is caused by digestive issues such as colitis, gastritis, IBS, and IBD, among others. Therefore, adding supplements for those who suffer from malabsorption can be beneficial, as they provide essential nutrients to the body without any further burden on the digestive system.”
She added, “Supplements containing herbs and botanical compounds have anti-inflammatory and antioxidant properties that can boost the immune system and protect it against infectious agents. Ultimately, people can greatly benefit from dietary supplements, which are an excellent way to avoid nutrient deficiencies and support the immune system while ensuring that the digestive system is not overburdened.”
Botanical compounds and herbs for immunity
Combining a multivitamin supplement with botanical compounds and herbs is a great way to support the body’s immune system. One can incorporate herbs and botanical compounds like echinacea, ginger, caffeine, and curcumin to reduce inflammation and facilitate the body’s immune system.
To elaborate on specific botanical herbs and compounds, echinacea can be used to boost the immune system, ginger can help reduce inflammation, caffeine has antioxidant and energy-boosting properties and curcumin is a powerful anti-inflammatory agent. Kamayani Naresh, Health Expert and Founder of Zyropathy, revealed, “With a hectic lifestyle and sedentary habits, it becomes burdensome to meet nutrient requirements thus, supplements are an excellent way to avoid deficiencies and support the immune system.”
Believing that it is crucial to incorporate supplements into our diet regimen as sometimes we are unable to reap proper nutrients from our food, he said, “While it is mandatory to focus on eating whole foods and maintaining a balanced diet, supplements can be an integral player in improving our overall health routine. In the end, supplements are a great way to prevent nutrient deficiencies, support the immune system and keep the digestive system from becoming overworked.”
Foetuses and placentas of pregnant women, especially those infected with COVID-19 at earlier points in the pandemic, were found to bear a greater risk of experiencing growth impairment or vascular lesions in organs and brain, according to a new research.
Foetuses and placentas of pregnant women, especially those infected with COVID-19 at earlier points in the pandemic, were found to bear a greater risk of experiencing growth impairment or vascular lesions in organs and brain, according to a new research.
According to the research, results demonstrate that the different strains of the virus that emerged during the pandemic led to varying degrees of damage, which was especially higher by those involving pre-Omicron variants. The detected placental lesions could potentially harm both development and health in some of the affected unborn children, the study said.
Using prenatal magnetic resonance imaging, a group of Medical University of Vienna, Austria, researchers examined the placentas and foetuses of women who tested positive for SARS-CoV-2 during pregnancy, the study said.
The research was published in the journal The Lancet Regional Health – Europe. While such damage occurs more infrequently and is less severe with the currently circulating Omicron sub-lineages, the study authors still advocate early detection measures for pregnant women who test positive for coronavirus.
Contrary to previous studies, in which SARS-CoV-2-related abnormalities were only identified postnatally and/or through histopathological procedures, the research team focused on prenatal imaging findings, the study said.
Using prenatal magnetic resonance imaging (MRI), 76 scans of placentas and foetuses of pregnant women were performed in the study: 38 following a confirmed SARS-CoV-2 infection (pre-Omicron or Omicron variants) and 38 in healthy control cases, the study said.
The study found that the placentas in both the pre-Omicron and the Omicron groups revealed abnormalities.
“Infections with pre-Omicron variants, such as Delta, led to significantly greater damage in the form of vascular events such as blood clots or bleeding than with the Omicron subvariants currently circulating through the population,” noted lead author Patric Kienast, outlining a key finding of the study.
The researchers attribute the varying extent of damage to the placenta caused by different virus strains to the fact that Omicron sub-lineages are less likely than their predecessors to result in severe cases, and to higher vaccination rates as the pandemic has progressed, the study said.
“In any case, our results showed that the two non-vaccinated study participants developed placental abnormalities following infection with SARS-CoV-2 Omicron, compared with just one out of six of the women who had received three doses of the vaccine,” confirmed senior author Gregor Kasprian.
Oxygen, nutrients and metabolic products are exchanged between mother and child in the placenta. Attached to the uterine wall, this organ forms such a strong barrier against the coronavirus that only 3 per cent or fewer of foetuses whose mothers test positive for SARS-CoV-2 are also infected, the study said.
But as the study shows, the placenta itself is not spared from complications caused by Covid-19. Subsequently, some unborn babies experience stunted growth or bleeding in the brain, the study said.
“This is why the placentas of pregnant women who have been infected with SARS-CoV-2 should be examined as soon as possible after testing positive using prenatal imaging techniques,” advised Daniela Prayer from Medical University of Vienna, citing the importance of scanning, particularly in the case of possible future coronavirus variants with mechanisms similar to Delta, for example.
By doing so, there is a chance to take measures to safeguard the health of the foetus in a worst case scenario, the study said.
Nearly 100,000 people die every year in U.S. hospitals of infections they develop after being admitted. But despite intense infection-control efforts, new strains of bacteria keep on emerging, seemingly out of nowhere, to sicken people in hospitals worldwide.
Hospitals have strict hygiene and sanitation protocols to protect patients from bacteria that rarely sicken healthy people but can be deadly for vulnerable patients already hospitalized with serious illnesses.
Nearly 100,000 people die every year in U.S. hospitals of infections they develop after being admitted. But despite intense infection-control efforts, new strains of bacteria keep on emerging, seemingly out of nowhere, to sicken people in hospitals worldwide.
Researchers at Washington University School of Medicine in St. Louis have found evidence pointing to an unexpected source of such bacteria: the hospitalized patients themselves. Studying mice, the researchers discovered that urinary tract infections (UTIs) can arise after sterile tubes, called catheters, are inserted into the urinary tract, even when no bacteria are detectable in the bladder beforehand. Such tubes are commonly used in hospitals to empty the bladders of people undergoing surgery. In the mice, inserting the tubes activated dormant Acinetobacter baumannii (A. baumannii)bacteria hidden in bladder cells, triggering them to emerge, multiply and cause UTIs, the researchers said.
The findings, published January 11 in Science Translational Medicine, suggest that screening patients for hidden reservoirs of dangerous bacteria could supplement infection-control efforts and help prevent deadly infections.
“You could sterilize the whole hospital, and you would still have new strains of A. baumannii popping up,” said co-senior author Mario Feldman, PhD, a professor of molecular microbiology. “Cleaning is just not enough, and nobody really knows why. This study shows that patients may be unwittingly carrying the bacteria into the hospital themselves, and that has implications for infection control. If someone has a planned surgery and is going to be catheterized, we could try to determine whether the patient is carrying the bacteria and cure that person of it before the surgery. Ideally, that would reduce the chances of developing one of these life-threatening infections.”
The findings, published January 11 in Science Translational Medicine, suggest that screening patients for hidden reservoirs of dangerous bacteria could supplement infection-control efforts and help prevent deadly infections.
“You could sterilize the whole hospital, and you would still have new strains of A. baumannii popping up,” said co-senior author Mario Feldman, PhD, a professor of molecular microbiology. “Cleaning is just not enough, and nobody really knows why. This study shows that patients may be unwittingly carrying the bacteria into the hospital themselves, and that has implications for infection control. If someone has a planned surgery and is going to be catheterized, we could try to determine whether the patient is carrying the bacteria and cure that person of it before the surgery. Ideally, that would reduce the chances of developing one of these life-threatening infections.”
Feldman and Hultgren — along with co-first authors Jennie E. Hazen, a graduate student, and Gisela Di Venanzio, PhD, an instructor in molecular microbiology — investigated whether A. baumannii can hide inside cells like E. coli can. They studied mice with UTIs caused by A. baumannii. They used mice with weakened immune systems because, like people, healthy mice can fight off A. baumannii.
Once the infections had resolved and no bacteria were detected in the mice’s urine for two months, the researchers inserted catheters into the mice’s urinary tracts with a sterile technique. Within 24 hours, about half of the mice developed UTIs caused by the same strain of A. baumannii as the initial infection.
“The bacteria must have been there all along, hiding inside bladder cells until the catheter was introduced,” Hultgren said. “Catheterization induces inflammation, and inflammation causes the reservoir to activate, and the infection blooms.”
Since A. baumannii rarely causes symptoms in otherwise healthy people, many people who carry the bacteria may never know they’re infected, the researchers said. As part of this study, the researchers searched the scientific literature and discovered that about 2 pc of healthy people carry A. baumannii in their urine.
“I wouldn’t put much weight on the precise percentage, but I think we can say with certainty that some percentage of the population is walking around with A. baumannii,” Feldman said.
“As long as they’re basically healthy, it doesn’t cause any problems, but once they’re hospitalized, it’s a different matter. This changes how we think about infection control. We can start considering how to check if patients already have Acinetobacter before they receive certain types of treatment; how we can get rid of it; and if other bacteria that cause deadly outbreaks in hospitals, such as Klebsiella, hide in the body in the same way. That’s what we’re working on figuring out now.”
Ischemic cardiac diseases reduces the heart’s ability to pump blood which might lead to heart attacks, or irregular heart rhythm and heart failure as well. Here’s all you need to know about its causes, risk factors, different symptoms in men and women, diagnosis and treatment.
A partial or total blockage of the arteries pumping the heart muscle with blood results in ischemic heart disease, a health condition that is sometimes also referred to as coronary heart disease. If the coronary arteries were thought of as a network of tubes, then as they progressively become blocked, the blood that is flowing through them, in this situation, is prevented from properly reaching its destination, the heart.
The prevalence of ischemic heart disease is currently decreasing in developed countries due to improved treatments and healthier lifestyles; but the same is increasing in developing countries. In either case, ischemic heart disease remains the leading cause of death among adults in both developing and developed countries.
Causes:
A significant population in both developed and developing nations are affected by ischemic heart disease, which is a prevalent condition. In an interview with HT Lifestyle, Dr Yogendra Singh, Associate Director at Max Super Speciality Hospital’s Department of Cardiology in Dehradun, explained, “Ischemic heart diseases occur when blood flow to the heart decreases, which prevents the heart which is a muscle from receiving enough oxygen. Ischemic cardiac diseases reduces the heart’s ability to pump blood which might lead to heart attacks, or irregular heart rhythm and heart failure as well. The decrease in blood flow is a result of blockage in the heart’s arteries. Under this condition, the treatment usually is to improve the blood flow in arteries by simultaneously reducing the blockage.”
Dr MM Yusuf, Consultant Cardiac Surgeon at Apollo Hospital in Chennai’s Greams Road, elaborated, “Ischemic Heart Disease (IHD) denotes, narrowing or blockage in the blood vessels over the heart, (Coronary arteries). These vessels supply blood to the heart muscles and enable good function. There are 3 blood vessels, 2 on the left and 1 on the right side of the heart. Triple vessel or multivessel coronary artery disease indicates disease in all these 3 vessels. These narrowing or blockages are caused by fat deposits within the blood vessel, which reduces blood supply to the heart muscle. This can lead to angina (chest pain), breathing difficulty or heart attack which can lead to death.”
Risk factors and symptoms:
Dr Yugal Kishore Mishra, Head of Cardiac Sciences and Chief Cardiovascular Surgeon at Manipal Hospital in Delhi’s Dwarka, revealed, “The risk of this condition rises with age and is common in the elderly. In terms of men and women, men are more likely to have ischemic heart disease as compared to women. According to various studies, men and women who are 65 to 94 years old are twice as likely to have coronary heart disease than those who are 35 to 64 years old. The most common symptom of ischemic heart disease in men is myocardial infarction (heart attack), while the most common symptom in women is angina pectoris.”
Talking about the common risk factors for ischemic heart disease, Dr MM Yusuf blamed diabetes, high blood pressure, high cholesterol, smoking and family history of IHD.
Diagnosis:
According to Dr Yogendra Singh, it is advised to consult a doctor for advice if one experiences persistent or severe chest pain. He said, “An ischemic cardiac condition can be diagnosed with the help of an ECG, stress test, echocardiogram, coronary angiography, and cardiac CT scan, which will show which artery or arteries are afflicted. Your doctor might advise drugs, surgery, or a combination of the two depending on the seriousness of your disease. Consume a balanced diet low in saturated fat, cholesterol and sodium to help treat coronary artery disease and reduce your risk of problems. Additionally, you’ll receive advice on how to exercise safely given your condition. Don’t think of lifestyle adjustments as temporary remedies. Instead, resolve to create lasting healthy behaviours.”
Treatment for Ischemic Heart Disease
Dr Yugal Kishore Mishra shared, “Increasing blood flow to the heart muscle is part of the treatment for ischemia heart disease. Treatment options include prescription drugs, an angioplasty procedure to unblock clogged arteries, or bypass surgery. The treatment of ischemic heart disease, there are a number of treatments in each class. To control any ischemic episodes, using medication is sometimes the best course of action. In other circumstances, when dealing with a more serious issue or if medication is not enough, it is recommended to unblock the artery.”
He added, “Sometimes, there can be numerous lesions or blocked coronary arteries that make angioplasty a challenge so in such cases a heart bypass surgery can be the best option to open up the blocked arteries of the heart. A robotic assisted bypass surgery of heart is considered to be the best option for heart disease. Robotic heart surgery is performed through very small chest incisions. Surgeons can perform open-heart surgery without as much trauma as they can with minimally invasive procedures using robot-controlled tools and microscopic instruments. In order to prevent a recurrence of angina or an infarction, this can be supported by long-term treatment (heart attack). To lower the risk of heart disease, a mix of lifestyle modifications and medication therapy is prescribed.”
As per Dr Yogendra Singh, treatment options include:
Medications
Angioplasty
Bypass Surgery
Explaining the process, he said, “A long, thin tube (catheter) is placed into the blocked area of your artery during coronary angioplasty. The artery is widened by inserting a wire carrying a tiny balloon there and inflating it. To keep the artery open, a tiny coil of wire mesh called a stent is typically employed. Drug eluting stents are safe and effective. This procedure can be performed radially from the groin to the thigh or from the wrist. As a result of it being easier, more accurate and less painful than the femoral technique, radial angioplasty is gaining more popularity.”
He added, “Contrarily, a coronary artery bypass surgery involves the creation of a graft that allows blood to move around a blocked or constricting coronary artery using a vascular from another region of your body. This kind of open-heart surgery is typically only performed on patients with several narrowed coronary arteries.”
Dr MM Yusuf suggested, “Sensible eating, regular exercise and good lifestyle would prevent IHD. Ischemic Heart Disease is widely prevalent in India. Patients with risk factors should have regular health checks and follow preventive measures, while patients with IHD should seek medical help early and take appropriate treatment. The outcomes of treatment are extremely good with minimally invasive treatment procedures hence, patients need not be worried and keep away from getting appropriate treatment.”
He recommended, “Patients affected with IHD can be treated depending on the severity of the coronary artery stenosis (narrowing / blockage). Minimal stenosis can be managed with medications and lifestyle modifications. Significant stenosis in 1 or 2 vessels can be treated with angioplasty and stent insertion. Much more severe and multiple blockages especially in diabetics or patients with reduced heart function is best treated by Coronary Artery Bypass Graft (CABG) surgery. Use of Internal Mammary Artery in CABG has the best long-term outcome.”
Traditionally, CABG was performed by splitting open the chest bone and patients would take 3 to 6 months to recover depending on their age and other co-morbid conditions. Dr MM Yusuf revealed, “Over the past decade minimally invasive cardiac surgery with the use of surgical robot (Robotic assist CABG) has significantly reduced the trauma and recovery in treating patients requiring CABG surgery. Patients undergoing robotic assisted CABG stay in hospital for 2 to 4 days and recover to full normal activity within 2 to 3 weeks. Over the years, CABG had been performed with the use of cardiopulmonary bypass (CPB) and cardioplegic arrest. With the advent of self-retaining coronary stabilizers and intracoronary shunts, CABG is being performed in many centers without the use of CPB-Off Pump CABG (OPCABG).”
He added, “However, conventional CABG has its own limitations in terms of being invasive and associated with morbidity. Stroke, bleeding, wound infections, arrhythmias, prolonged ICU stay and hospital stay has been the known common complications of conventional CABG. Minimally Invasive Direct Coronary Artery Bypass Surgery (MIDCAB) is gaining increasing popularity in recent years owing to its technique and lesser incidence of complications associated with conventional CABG and OPCABG surgery.”
He explained, “Conventional CABG uses median sternotomy. In contrast, MIDCAB is performed using anterolateral thoracotomy in the 4th or 5th intercostal space using a 5-7 cm incision. Thorax is entered through this incision. LIMA is harvested either under direct vision or using Robotic assistance or thoracoscope camera. Bypass Grafting is then performed under direct vision with the aid of MICS instruments – MICS retractor system, MICS stabilizer (Octopus Nuvo) and Heart positioner (Starfish NS). Intracoronary shunts and mister blower are used to keep the field bloodless. The notable advantages of MIDCAB surgery are decrease in incidence of post operative complications such as stroke, decrease in ICU stay & hospital stay, lesser blood product transfusion, lesser wound infection, quick recovery and better cosmoses. The disadvantages being longer learning curve and limited working space.”
Talking about Minimally Invasive Hybrid Coronary Artery Revascularization (MIHCR), he said, “Minimally Invasive Hybrid Coronary artery Revascularization (MIHCR) combines the benefits of PCI and OPCABG surgery. This involves IMA grafting to one or two major coronary arteries, usually the left coronaries through a left mini thoracotomy, followed by the stenting of the non-LAD vessels. MIHCR provides the advantages of reduced incidence of MACCE in the immediate post operative period with best long term outcome. This less invasive procedure minimizes the incidence of known complications of off pump coronary artery bypass surgery and hastens the recovery. Another added advantage with MIHCR is that the patency of IMA can be assessed while undergoing PCI to non- bypassed vessel. This provides an opportunity for the graft to be revised in case of need while the patient is still in hospital.”
He concluded, “Due to these advantages it is emerging as the method of choice among the younger population as it enables faster return to routine activities and also among the older group as it is less invasive and reduces post-operative complications.
There is a growing interest in MIHCR, although conventional open techniques remain more popular, a study to assess the early outcomes of MIHCR in our population is opted here.
A small study shows promise in deploying mRNA technology against melanoma, but fighting tumors is vastly more complex than tackling Covid.
The long-awaited cancer vaccine revolution is getting a little closer to reality. New data from Moderna Inc. and Merck & Co. suggest that after decades of failures, researchers are finally figuring out the right way to design a vaccine that can teach immune cells how to recognize and combat tumors.
Earlier this month, the companies said that when used in concert with Merck’s cancer immunotherapy Keytruda, Moderna’s mRNA cancer vaccine reduced the risk of certain skin cancers from returning or patient deaths by 44% compared with Keytruda alone.
That number justly generated a lot of excitement. It’s the first time an mRNA-based cancer vaccine has proven itself in a randomized study, and with an unambiguously positive outcome. If that result holds up in larger trials, it would be a huge advance both for the mRNA technology behind Covid vaccines and for the field of cancer vaccines in general.
But there are a lot of steps between achieving early, positive data for a subset of melanoma patients and developing a widely accessible, cost-effective treatment. Among the more daunting challenges: The vaccine needs to be tailored to the genetic makeup of an individual patient’s tumors.
The study was small, enrolling just 157 people at high risk of their late-stage skin cancer returning. (Moderna and Merck have yet to make available the full dataset, though they plan to do so at an upcoming conference.) Still, even if the results are slightly less dramatic in a bigger study, the vaccine could make a difference for patients. “That would be a substantial change,” translating into long-term remissions, says Julie Bauman, director of the George Washington University Cancer Center. Bauman led an earlier study of Moderna’s cancer vaccine.
The study enrolled melanoma patients who had undergone surgery to remove any signs of their cancer. Unlike vaccines the public is used to taking — mass-produced shots that aim to prevent people from catching a contagious disease like the flu or polio, Moderna’s cancer vaccine instead is intended to keep the disease from returning. It does that by training immune cells to recognize as dangerous proteins found on a patient’s own tumor cells.
The hope was that the vaccine would amplify the already substantial benefit of Keytruda, which blocks a method that cancer cells use to hide from the immune system. Amazingly, the combination worked.
Moderna already demonstrated its capacity for developing and manufacturing mRNA vaccines. It had been working on vaccines for cancer and infectious diseases for more than a decade when the coronavirus pandemic hit, prompting the company to pivot to developing a Covid shot that, along with a similar one developed by Pfizer Inc. and BioNTech, became the first widespread commercial application of mRNA technology.
Building a successful cancer vaccine will be much more difficult. Moderna starts with a biopsy of a patient’s tumor, which it then sequences and uses artificial intelligence to pick out the mutations likely allowing the cancer to thrive. Then, mRNAs encoded for the most relevant cancer-driving proteins are packed inside a delivery system called a lipid nanoparticle, the same kind of delivery method used in Covid vaccines.
From tumor biopsy to first vaccine dose, the process can take between eight and 10 weeks, says Moderna Chief Medical Officer Paul Burton. Repeating this over and over for each patient enrolled in the clinical trial was a major undertaking, he adds.
Now imagine doing that for a commercial drug earmarked for thousands rather than for a few hundred people in a controlled study. There are nearly 100,000 cases of melanoma annually in the US, according to the American Cancer Society. While most cases are curable when detected early, more than 7,500 people die every year of the disease.
Bringing down the “needle-to-needle” time between biopsy and immunization will be critical to ensuring the treatment isn’t just promising, but practical and accessible to anyone who might benefit from it. One way to speed things up would be to establish regional hubs to quickly process biopsies.
Another measure that eventually could accelerate the development of the melanoma vaccine would be to simplify the vaccine’s components. Currently, the vaccine targets a laundry list of 34 mutated proteins to garner the full effect. It would be worth figuring out whether returns start to diminish after, say, 15 or 20 proteins.
Researchers also would like to understand whether certain types of tumors rely on common drivers that, if discovered, could be the foundation for a more broadly designed vaccine that could have some tailor-made components sprinkled in.
Burton says that Moderna so far hasn’t seen any common drivers that could help generalize components of the vaccine, but that data are limited — and the hope is that some clues might emerge as the vaccine is used over the long term and many more people are treated.
Scientists also still need to study the best way to use this vaccine for long-term suppression of cancer, considering, for example, whether people need to continue taking it every three weeks for life, or if they can get by with a periodic boost. And if someone’s disease progresses, does the vaccine itself need to be retooled to match new mutations that might have cropped up?
Perhaps the biggest question right now is whether the effect seen in melanoma can be extended to other types of cancer. Moderna Chief Executive Officer Stephane Bancel told CNBC recently that the company is moving aggressively into Phase 3 studies with the belief that “anywhere Keytruda works, this should work.”
Keytruda, meanwhile, is approved to treat a long list of cancers beyond melanoma—so many, in fact, that it’s expected to bring in more than $24 billion in sales in 2023. Bancel suggested that the vaccine might even make possible responses in tumors where Keytruda has failed, either on its own or by acting synergistically with Merck’s drug.
That’s an optimistic claim—worth studying, but a feat that has eluded other cancer immunotherapies. Melanoma is what’s known as a “hot” tumor, or one that features many mutations and has plenty of immune cells milling about, ready to be pushed into doing their cancer-killing job. It’s reasonable to be hopeful that Moderna’s vaccine could extend Keytruda’s benefits in other hot tumors, such as those found in lung cancer.
But “cold” tumors, or ones without that crowd of immune cells ready to be activated, are a much tougher proposition. In an earlier small study of the Moderna vaccine in solid tumors, for example, none of the patients with colon cancer — a notoriously “cold” tumor — responded, Bauman says.
Another immense challenge is the very high likely cost of a personalized therapy on top of Keytruda, which on its own carries a list price of around $185,000 per year. The only upside to that hefty price tag is that the companies will be motivated to answer these questions as quickly as possible. Indeed, Bancel has said that Moderna plans to aggressively invest in cancer.
All that money flowing into Moderna’s cancer vaccine will teach the field not just about that one product, but how to design, test and use other ones. Let’s hope that’s the catalyst for the true cancer vaccine revolution, one that could convert cancer from a potentially lethal illness into a chronic, stable disease.
The unique and first of its kind Covid vaccine does not require an injection and is administered as nasal drops. All you want to know about nasal vaccines.
Bharat Biotech’s nasal vaccine, iNCOVACC, will soon be available as booster shot for eligible adults come fourth week of January. Nasal vaccines, which are sprayed into the nose directly, however, cannot be taken by those who have already taken their booster shots and is recommended as first booster shot. People who fear the jab can take a sigh of relief as the administration of these vaccines is quick and painless. This nasal vaccine will be administered to people twice with the gap of 28 days. Known as heterologous booster, any 18 + individual can take it who has already received covaxin or covishield vaccine earlier.
What is nasal vaccine
“In direction towards our efforts to prevent spread of covid 19, India had come up with a yet another novel nasal covid vaccine. It is a unique, first of its kind, covid vaccine as it does not require an injection instead it is administered as nasal drops. It has been cleared by DCGI, for administration, as heterologous booster, in 18+ individuals who have already received covaxin or covishield vaccine earlier,” says Dr. Gurmeet Singh Chabbra, Director Pulmonology Marengo QRG Hospital, Faridabad.
How is nasal vaccine given
It is an adeno virus vector based recombinant replication deficient stabilized spike protein vaccine. Heterologous booster vaccination means administration of vaccine other than the primary vaccination.
“It is given as 0.5ml dose (8 drops – 4 drops in each nostril) to be repeated after 4 weeks interval,” says Dr Chabbra.
How does it work
“Nasal vaccine stimulates immunity by development of neutralizing IgG, mucosal IgA and T cell response. It acts at the site of entry of covid virus – the nasal mucosa by local IgA antibody response and possibly preventing both infection to the individual and spread to others. It would help prevent spread from even asymptomatic and mild cases,” says Dr Chabbra.
Side effects of nasal vaccines
“Mild side effects may include headache, fever, running nose and sneezing. It is not to be given to those who are allergic to any of its component or had a severe allergic reaction to it in past and having acute infection or fever,” adds Dr Chabbra.
To better understand brain plasticity, a team of researchers at Baylor College of Medicine and Texas Children’ Hospital used mouse models to investigate how brain cells build connections with new neurons born in adult brains.
The brain’s capacity to change itself by reorganising preexisting neural networks and establishing new ones to gain new functional qualities enables learning new skills, mastering a musical instrument, and adapting to the environment’s constant change. Additionally, this aids in the stability, strength, and health of neuronal circuits.
To better understand brain plasticity, a team of researchers at Baylor College of Medicine and Texas Children’ Hospital used mouse models to investigate how brain cells build connections with new neurons born in adult brains. Their findings, published in the journal Genes & Development, not only expand our understanding of brain plasticity but also open new possibilities for treating certain neurodevelopmental disorders and repairing injured circuits in the future.
“In this study, we wanted to identify new molecules that help new neurons build connections in the brain,” said corresponding author Dr. Benjamin R. Arenkiel, professor of molecular and human genetics and neuroscience at Baylor and the Duncan Neurological Research Institute at Texas Children’s. “We worked with the olfactory bulb, the part of the brain that is involved in the sense of smell. In mice, the olfactory bulb is a highly plastic sensory area and has a remarkable capacity to maintain plasticity into adulthood via continuous integration of adult-born neurons. We discovered that oxytocin, a peptide, or short protein, produced in the brain, drives events that contribute to neural circuit plasticity.”
The researchers discovered that the levels of oxytocin increase in the olfactory bulb, peaking at the time the new neurons incorporate themselves into neural networks. Using viral labeling, confocal microscopy and cell-type specific RNA sequencing, the team discovered that oxytocin triggers a signaling pathway – a series of molecular events inside cells – that promotes the maturation of synapses, that is, the connections of newly integrated adult-born neurons. When the researchers eliminated the oxytocin receptor, the cells had underdeveloped synapses and impaired function.
“Importantly, we found that synapse maturation occurs by regulating the morphological development of cells and the expression of a number of structural proteins,” said Arenkiel, a MacNair Scholar at Baylor.
“The most exciting aspect of this study is that our findings suggest that oxytocin drives development and synaptic integration of new neurons within the adult brain, directly contributing to adaptability and circuit plasticity,” said first author Brandon T. Pekarek, a graduate student – research assistant in the Arenkiel lab.
The findings, which are relevant to all mammals, including humans, open new possibilities to improve neurological conditions. “Oxytocin is normally present in our brain, so if we understand how to turn it on or off or mobilize it, we can help keep our circuit connections healthy by promoting the growth of underdeveloped connections or strengthening new ones,” Arenkiel said. “Our findings also suggest that oxytocin could promote the growth of new neurons to repair damaged tissue. Further studies are needed to explore these possibilities.”
In its submission to the finance ministry on Wednesday , the industry body said that the healthcare sector has not been able to derive the benefits of the GST transition in comparison to other sectors. In fact, the embedded taxes in the sector have increased in the post-GST regime compared to pre-GST period, it noted.
Healthcare industry body NATHEALTH has sought rationalisation of GST and enhanced insurance coverage especially in smaller cities and towns from the upcoming Budget.
n its submission to the finance ministry on Wednesday , the industry body said that the healthcare sector has not been able to derive the benefits of the GST transition in comparison to other sectors.
In fact, the embedded taxes in the sector have increased in the post-GST regime compared to pre-GST period, it noted.
The industry body has recommended imposition of 5 per cent merit rate on the output healthcare services for all healthcare establishments (both private and government) with the option to claim full input tax credits.
Levying 5 per cent GST rate on output services for all private hospitals and an optional dual rate structure for government healthcare establishments could be an alternative, it added.
Presently GST is exempt on the healthcare services. NATHEALTH recommends imposition of 5 merit rate on these services as this would allow healthcare service providers to claim input tax credit, thereby lowering their embedded taxes burden.
NATHEALTH also sought clearance of working capital arrears both for providers and procurement organisations.
“It is imperative to build infrastructural capabilities so that people have greater access to quality and critical healthcare services. Viability gap funding by the government is essential to set up hospitals in tier-1 and tier-2 cities, encouraging increased investment in the healthcare infrastructure,” NATHEALTH President Shravan Subramanyam said.
Uniform adoption of Ayushman Bharat Digital Mission is another imperative which calls for clearly defined delivery models for innovative modules developed by private players, he added.
“If all payment backlogs both for providers and suppliers under insurance and public procurement are cleared, it would significantly improve the availability of healthcare infrastructure,” Subramanyam said.
It also sought an increase in budgetary allocation for the health sector.
