Publisher Health

New research published in Diabetologia (the journal of the European Association for the Study of Diabetes [EASD]) finds that the consumption of healthy plant-based foods, including fruits, vegetables, nuts, coffee, and legumes, is associated with a lower risk of developing type 2 diabetes (T2D) in generally healthy people and support their role in diabetes prevention.
The study was conducted by Professor Frank Hu and colleagues at the Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA, and aimed to identify the metabolite profiles related to different plant-based diets and investigate possible associations between those profiles and the risk of developing T2D.
A metabolite is a substance used or produced by the chemical processes in a living organism and includes the vast number of compounds found in different foods as well as the complex variety of molecules created as those compounds are broken down and transformed for use by the body. Differences in the chemical makeup of foods means that an individual’s diet should be reflected in their metabolite profile. Recent technological advances in the field of high-throughput metabolomics profiling have ushered in a new era of nutritional research. Metabolomics is defined as the comprehensive analysis and identification of all the different metabolites present within a biological sample.
Over 90% of diabetes cases are the type 2 form, and the condition poses a major threat to health around the world. Global prevalence of the disease in adults has more than tripled in less than two decades, with cases increasing from around 150 million in 2000 to over 450 million in 2019 and projected to rise to around 700 million in 2045.
The global health burden of T2D is further increased by the numerous complications arising from the disease, both macrovascular, such as cardiovascular disease, and microvascular, which damage the kidneys, the eyes, and the nervous system. The diabetes epidemic is primarily caused by unhealthy diets, having overweight or obesity, genetic predisposition, and other lifestyle factors such as a lack of exercise. Plant-based diets, especially healthy ones rich in high quality foods such as whole grains, fruits, and vegetables, have been associated with a lower risk of developing T2D but the underlying mechanisms involved are not fully understood.
The team conducted an analysis of blood plasma samples and dietary intake of 10,684 participants from three prospective cohorts (Nurses’ Health Study, Nurses’ Health Study II and Health Professionals Follow-up Study). Participants were predominantly white, middle-aged (mean age 54 years), and with a mean body mass index (BMI) of 25.6kg/m2.

A teenage girl who tried to take her own life is volunteering her time to help other young people struggling with mental health.Chelsea, from Nottingham, experienced low mood, anxiety and self-harm and was eventually referred to the crisis team at Nottinghamshire Healthcare’s Child and Adolescent Mental Health Service (CAMHS).She’s recently converted a shed into an outdoor therapy room and hopes one day to become a mental health nurse.If you are affected by the issues in this video, help and support is available via the BBC Action Line.Video journalist: Chris WaringFollow BBC East Midlands on Facebook, on Twitter, or on Instagram. Send your story ideas to eastmidsnews@bbc.co.uk.

Many cities and counties say that shoring up local public health systems is crucial to recovering from the pandemic and addressing entrenched health disparities.LANSING, Mich. — In an underserved neighborhood of Michigan’s capital city, a health clinic is being built with nearly $900,000 in federal pandemic relief funds, a project that could transform the community’s access to care.Wedged among new affordable apartments and a community center, the clinic is a symbol of the rapid effect the funds have had on many local public health programs.In Michigan and some other states, stimulus aid for cities and counties has been put to use more quickly than billions in state-designated funds, some of which remain tied up in legislatures deadlocked over how to spend them. And while much of the local aid is going to other priorities, many cities and counties say the rescue funds have provided an opening to improve chronically underfunded public health systems as they recover from the pandemic, addressing entrenched health disparities that Covid-19 has made worse.Here in mid-Michigan, where officials have warned of soaring rates of violence, drug addiction and delayed care during the pandemic, the local aid from last year’s stimulus bill, the American Rescue Plan, has rewritten the economic fortunes of Ingham County and its public health programs — at least for now.Of the $350 billion for states and localities in the rescue plan, $195 billion went to state governments, with another $130 billion steered to cities, counties and other local governments, many of which were projecting enormous revenue losses at the onset of the pandemic. Local governments were given broad discretion over how to spend the money, and many are using at least some of it to shore up public health.Nearly $60 million was sent to Ingham County, home to almost 300,000 people in Lansing and its suburban and rural surroundings. Local officials worked quickly last year to use an initial tranche of $28 million, and are ready to begin applying another $28 million that will arrive this spring, some of which could be spent on an ambitious series of public health proposals.“We have the relationships in the community and know where it can go quickly,” said Gregg Todd, the county controller.The Ingham Health Department requested money to replace septic systems along the county’s rural fringes; hire a nurse case manager and more health providers for the new clinic and a separate addiction clinic; renovate a community dental practice; and start a harm reduction program that would aim to reduce transmission of H.I.V. and viral hepatitis. So far, the county plans to use the rescue money to fund the septic program, Mr. Todd said.Nowhere is the money’s effect clearer than the new clinic, the Allen Neighborhood Community Health Center, which will join a network of community health centers that serve tens of thousands of patients each year. Linda Vail, Ingham County’s public health officer, said that before the stimulus funds arrived, her department had planned to open the clinic in a “bare bones” fashion and pull staff from other community clinics, “robbing Peter to pay Paul.” The stimulus funding, $750,000 for construction of the clinic and $137,956 for hiring staff, allowed the county to scrap that plan and speed up the timeline.The county hopes to open the clinic by the summer and have it serve as many as two dozen patients a day to start.An exam room at the Forest Community Health Center in Lansing, which could use federal funds to renovate its dental facilities.Elaine Cromie for The New York TimesNearly two miles away at the Capitol, lawmakers in the Republican-controlled Legislature have yet to allocate billions in American Rescue Plan funds designated for state use, in what some state Democrats have described as an attempt to stifle the agenda of Gov. Gretchen Whitmer, a Democrat. Congress last month considered taking back unspent state funds, including from Michigan, raising howls from both parties.Curtis Hertel Jr., a Democratic state senator who represents Ingham County, said the county’s swift use of its stimulus funds was an apt counterexample to the State Legislature’s grip on the larger pot of money, which he said could have already had a meaningful impact had more of it been released quickly.“Michigan has a broken mental health structure,” he said. “We could have saved more Michigan lives.”Local officials have until 2026 to spend American Rescue Plan money. In some communities, the money is just beginning to flow. Everywhere, the stimulus funds are proving to be a litmus test of local priorities.Ingham County’s first $28 million tranche went not just to public health initiatives, but to infrastructure projects and hundreds of local businesses. One million dollars was spent on emergency medical equipment, including new ambulances, and training. The county also spent $150,000 to repair public storm drains, and $450,000 to hire more behavioral health specialists in a local mental health program, with a focus on adolescent mental health.The resources have extended far beyond public health. Over $8 million in small business grants helped curb some of the commercial downturn Lansing suffered during the pandemic. Nikki Thompson Frazier, who owns the Sweet Encounter Bakery and Café in downtown Lansing, said her $5,000 grant allowed her to purchase more mixers, produce more pastries and hold more baking classes. The money snowballed into more growth, she said, allowing her to hire two workers.“Sometimes you just need that little bit of push,” she said.The Allen clinic is hiring a small staff that it hopes to gradually expand, if more funding materializes: two front office employees, a nurse, two medical assistants, one behavioral health specialist and a physician assistant. Local officials hope to eventually hire a physician and one more medical assistant.The clinic will have a pharmacy that provides free or low-cost prescriptions to its patients, and a lab for blood draws.The Allen Neighborhood Center, which features a mural by the artist Brian Whitfield, sits next to the future health clinic.Elaine Cromie for The New York TimesThe neighborhood the clinic will serve has more than 17,000 residents and is roughly 20 percent Black, 12 percent Hispanic, 60 percent white and 3 percent Asian, according to Joan Nelson, who directs a community center next to the future health clinic. Roughly 25 percent of the community lives below the poverty level, and 20 percent of the families do not own cars, she said. A new bus stop was recently added outside the center, to help patients get to the clinic.Dr. Adenike Shoyinka, the county Health Department’s medical director, called the investment in the Allen complex a “template” for how to reshape public health programs in Lansing.The community center next to it includes a food pantry that distributes over 1,000 pounds of baked goods and produce each week and has a year-round farmers’ market, gardening classes and a community-supported agriculture program. The center also enrolls low-income residents in Medicaid and Affordable Care Act coverage. But Ms. Nelson said her staff often has to refer people to community clinics far away, a position it will no longer be in after the clinic opens next door.Ms. Vail, the county health officer, said the influx of stimulus money had helped renew a focus on primary care in the area. It served a different purpose than vaccines, tests, treatments and personal protective equipment, she said, but one that was equally important.“It takes investment and money to recover from a pandemic, not to just respond to a pandemic,” she said.The new resources, Ms. Vail added, could help reverse sagging faith in local public health departments, some of which are working to restore their reputations after they became the target of people angry about pandemic restrictions.“I think we have a big job to do to regain trust,” she said. “Unless people trust us, then they’re not going to continue to come to us for all of the things that we can provide for them,” including “the immunizations, the nurse home visiting programs that keep mothers from losing their babies before they’re a year old” and the food assistance program for women, infants and children, known as WIC.United States Representative Elissa Slotkin, a Democrat whose district includes Ingham County, traveled to Lansing recently to announce a project she had shepherded with federal funds, which will add social service workers to the Lansing Police Department for mental-health-related calls.Ms. Slotkin said she worried that the benefits of federal Covid-19 stimulus aid could be fleeting in a state in which some counties have just one public health official.Representative Elissa Slotkin, Democrat of Michigan, met with President Biden in Lansing last year.Doug Mills/The New York Times“The entire health care system is being propped up by Covid money,” she said in an interview, referring to stimulus funds passed under both the Trump and Biden administrations. “What are they going to do to take some of those temporary gains and turn them into a strategic change in the state on public health and mental health?”The next day, several miles north at another community health center, staff members prepared strips of Suboxone, a medication that can help wean opioid users off the drugs, part of a program that aims to address a spiraling fentanyl crisis in Lansing.The clinic, which treats homeless residents of an adjoining shelter, is still looking to hire more providers. More funds are needed for a new project to reduce drug overdoses and deaths, which spiked during the pandemic, Ms. Vail said.Further south, at the Forest Community Health Center, federal stimulus could be used to revamp the facilities of the dental practice, which is seeing enormous demand. In a refugee resettlement city, the clinic treats thousands of refugees each year, including more than 300 who arrived recently from Afghanistan.Federal relief was initially a challenge for the clinic to use quickly, said Izabela Wackowski-Norris, who oversees it. But federal and local assistance eventually helped the clinic to afford protective equipment, an outdoor drive-through structure and telehealth software, among other resources.Ms. Wackowski-Norris said she hoped to soon hire a psychiatrist and a dietitian, and to build out the clinic’s H.I.V. treatment program.“We’re here, and we do the best that we can,” she added. “But we just can’t do everything we want to do, because we’re not made out of money.”

Two neurologists argue that calling T.I.A.s what they are — minor strokes — could prompt patients to seek the help they need more quickly.On a recent afternoon in Bastrop, Texas, Janet Splawn was walking her dog, Petunia, a Pomeranian-Chihuahua mix. She said something to her grandson, who lives with her and had accompanied her on the stroll. But he couldn’t follow; her speech had suddenly become incoherent.“It was garbled, like mush,” Ms. Splawn recalled a few days later from a hospital in Austin. “But I got mad at him for not understanding. It was kind of an eerie feeling.”People don’t take chances when 87-year-olds develop alarming symptoms. Her grandson drove her to the nearest hospital emergency room, which then transferred her to a larger hospital for a neurology consultation.The diagnosis: a transient ischemic attack, or T.I.A.For decades, patients have been relieved to hear that phrase. The sudden onset of symptoms like weakness or numbness (often on one side), loss of vision (often in one eye) and trouble with language (speaking, understanding or both) — if resolved in a few minutes — is considered “transient.” Whew.But in a recent editorial in JAMA, two neurologists called for doctors and patients to abandon the term transient ischemic attack. It’s too reassuring, they argued, and too likely to lead someone with passing symptoms to wait until the next morning to call a doctor or let a week go by before arranging an appointment. That’s dangerous.Better, they said, to call a T.I.A. what it is: a stroke. More specifically, a minor ischemic stroke. (Almost 90 percent of strokes, which afflict 795,000 Americans a year, are ischemic, meaning they result from a clot that reduces blood flow to the brain.)Until recently, T.I.A.s “were played down,” said Dr. J. Donald Easton, a neurologist recently retired from the University of California, San Francisco, and an author of the editorial. “The person thinks, ‘Oh, it’s over. It goes away, so all is well.’ But all is not well. There’s trouble to come, and it’s coming soon.”The advent of brain imaging — first CT scans in the late 1970s, then the more precise M.R.I.s in the 1990s — has shown that many T.I.A.s, sometimes called ministrokes, cause visible and permanent brain damage.“Very quickly, nerve cells and their connections start to die,” Dr. Easton explained. And the risk of a subsequent stroke, possibly a more severe one, is highest within the first 24 to 48 hours.He and his co-author on the editorial, Dr. S. Claiborne Johnston, a neurologist at the University of Texas at Austin and former dean of its medical school, want people who experience these episodes to head for an emergency room, stat.“We’re trying to get rid of a term that has comforted people in the past,” Dr. Johnston said. Because “your brain is likely injured and you don’t want it to be injured further, you need to come in right away.”Dr. Jeffrey Saver, a stroke neurologist at U.C.L.A., called the proposed change in nomenclature “an intriguing, radical and potentially good idea.” The transient ischemic attack name dates to a 1975 report from the National Institutes of Health. So, he said, “this upends 50 years of classifying low-blood-flow events in the brain.”But will health care professionals change their terminology? “The T.I.A. concept is deeply entrenched in medical thinking,” Dr. Saver said. “It’s the kind of idea that will gather adherents slowly.”He supports the change, however, because “it reflects what we’ve learned over the last two decades — even very brief episodes of low blood flow to the brain lead to damage” and because calling such episodes “minor strokes” may lead patients to respond more quickly.“The treatments for ischemic stroke are very time-dependent,” he explained. “Every minute counts towards getting a better outcome.”In an emergency room or specialized stroke center, patients undergo a brain scan to be sure their symptoms resulted from a minor stroke rather than from a condition that can mimic it, like a seizure or a migraine.Patients who have suffered minor strokes usually start taking two drugs, typically aspirin and clopidogrel, which prevent clotting. (Some may need other medications or a surgical procedure, like a stent placement.)After three weeks, when the highest risk for another stroke has passed, most continue with just one drug, usually a low-dose aspirin. “It’s easy, it’s cheap and it’s well tolerated,” Dr. Johnston said.Twenty years ago, when Dr. Johnston led an early study of stroke risk after a T.I.A., 10.5 percent of patients suffered another stroke within three months; half of those occurred within the first two days.That rate has declined substantially, thanks to improved treatments for stroke, lower smoking rates and the widespread use of cholesterol and blood pressure drugs and blood thinners. Recent studies in The New England Journal of Medicine put the risk of a subsequent stroke, coronary syndrome or death after a T.I.A. at 6.4 percent in the first year and another 6.4 percent in years two through five.For neurologists, however, that is still high, given how devastating a major stroke can be. A name change for T.I.A.s might lead to quicker responses that further reduce the rate of subsequent stroke risk.Circumstances can arise when older people or their caregivers choose not to seek immediate medical help. In 2017, Maggie Flanagan was 88 and into her seventh year with Alzheimer’s disease when Therese Flanagan, her daughter and caregiver, suddenly noticed odd physical symptoms.“She was sitting in a recliner next to me when her head tilted back a little and her eyelids started to flutter,” Ms. Flanagan said. “One eye was drooping a little. I held her hand and said, ‘Are you OK?’ There was no response at all.” Then, a couple of minutes later, “she was back.”Before, when their mother was still able to make such decisions, she had signed a do-not-resuscitate order and an advance directive instructing that “she didn’t want her life prolonged,” her daughter said. The family agreed that taking her to a hospital would only cause fear and disorientation. She and her siblings decided not to call 911.Maggie Flanagan’s doctor said that she had probably experienced a T.I.A.; she had a more serious stroke five months later and died the following year, at home in her Chicago apartment.But most people choose treatment. Ms. Splawn, the dog owner from Texas, said she was feeling fine and expected to go home to Petunia shortly.Patients treated appropriately for minor strokes will remain at a higher-than-normal risk for another stroke, especially in the first year, Dr. Saver said. But “by two or three years out, the risk is just a little higher than for folks who never had a T.I.A. or a minor stroke.”Wanda Mercer, for example, had a minor stroke four years ago, at age 66. An administrator at the University of Texas, she had donated blood during her lunch break, then fainted in an Austin restaurant. The staff called 911, but in the emergency room, everything seemed normal; she went back to work and regaled co-workers with her noontime adventure.Suddenly, “I couldn’t find my words,” Dr. Mercer said. “I couldn’t articulate.” The problem lasted only seconds, but colleagues recognized a possible stroke and sent her back to the emergency room, where an M.R.I. revealed tissue damage. She has taken a statin, a cholesterol-lowering drug, and aspirin ever since.“I’m lucky,” she said. “I haven’t had one adverse symptom since.”

Covid vaccines and treatments have made a huge difference in the UK’s fight against the virus – and in February all remaining restrictions on people’s daily lives were lifted.But the government says it recognises the concerns of the “small group” of people whose children remain at a higher risk from the disease.Isabel Pearson, 11, from Exeter, has a condition called Trisomy 18. She is considered clinically extremely vulnerable. Her mum, Alison, says life with no restrictions has been “much worse than I thought it was going to be”.Video by Dave Cheeseman, Katie Inman and Nikki Fox

What happens below the cellular level when the heart contracts and relaxes has long been unexplored. Thanks to new ultra-high-resolution electron microscopy techniques, scientists can now watch the heart beating — almost at a molecular level. Researchers at the Medical Faculty of the University of Freiburg summarise the most important developments in cardiac electron microscopy and their significance for research in a recent publication, published in Nature Reviews Cardiology. Insight at the nanometre scale is of great importance for the development of new therapies, for example for heart attacks or cardiac arrhythmias.
“With the high-resolution microscopy techniques developed by us and others worldwide, we gain fascinating insights into the dynamic ultrastructure of the heart,” says the study’s lead author Dr Eva Rog-Zielinska. She heads the 4D Imaging Section at the Institute of Experimental Cardiovascular Medicine (IEKM) of the University Heart Centre at the University Medical Centre Freiburg. “We can use this insight to analyse the three-dimensional structure of heart cells with unprecedented precision. Our images are made up of cubes — so-called voxels — with an edge length of one nanometre or less. For illustration: one nanometre is the distance a fingernail grows in one second,” Rog-Zielinska explains.
Watching the heart beat in super slow motion
A challenge is to link ultra-high resolution mapping of the heart to a moving target. “Thanks to recent advances in imaging, we now have a much better understanding of how muscle and connective tissue cells behave in the beating heart,” says co-author Prof Peter Kohl, Director of the IEKM, who is also the spokesperson of the German Collaborative Research Centre 1425 dedicated to exploring cardiac scarring.
Electron microscopy itself, but crucially also newly developed methods for the preparation and post-processing of corresponding samples, play a central role in the generation of molecular insight. “It is particularly exciting that we can record muscle cells like individual frames in a film — thanks to millisecond-precise high-pressure freezing. This allows us to watch the heart’s molecular structures beating in super slow motion, as it were,” says Kohl.
Experiments, simulations and artificial intelligence intertwine
The microscopic images are evaluated at IEKM with the help of artificial intelligence, assisted by computer simulations to depict heart function and pathological changes as realistically as possible. “Newly gained insight allows us to gain a completely new understanding of cardiac activity and, based on this, to develop new therapeutic concepts. We are looking forward to a very exciting time in heart research,” says Kohl.
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A group of bat viruses related to SARS-CoV-2 can also infect human cells but uses a different and unknown entryway.
While researchers are still honing in on how these viruses infect cells, the findings could help in the development of new vaccines that prevent coronaviruses from causing another pandemic.
Publishing in the journal, eBioMedicine, a team of Washington State University researchers used a computational approach based on network science to distinguish between a group of coronaviruses that can infect human cells from those that can’t. The researchers then confirmed their computational results in the laboratory, showing that a specific cluster of viruses can infect both human and bat cells.
“What we find with these viruses is that they’re able to get into the cells through another mechanism or receptor, and that has a lot of implications for how, and if, they would be able to infect us,” said Michael Letko, co-senior author and assistant professor in the Paul Allen School of Global Health.
Cross-species transmission of coronaviruses poses a serious threat to global health. While numerous coronaviruses have been discovered in wildlife, researchers haven’t been able to predict which pose the greatest threat to humans and are left scrambling to develop vaccines after viruses spill over.
“As we encroach more and more on places where there are human and animal interactions, it’s quite likely that there will be many viruses that will need to be examined,” said Shira Broschat, professor in the School of Electrical Engineering and Computer Science, also co-senior author on the paper.

Research in recent years has demonstrated the diverse roles that gut bacteria can play in health and disease, but what about contributions from viruses, which, like bacteria, perpetually reside within the human intestine? New research published in Science Immunology and led by investigators at Massachusetts General Hospital (MGH) indicates that imbalances in the intestine’s viral community — called the virome — may promote inflammatory bowel disease (IBD).
IBD, which includes Crohn’s disease and ulcerative colitis, is characterized by chronic intestinal inflammation and is thought to be caused by a combination of genetics, an overactive immune system response, and environmental triggers.
“The fecal virome is altered in IBD, suggesting a role for viruses in the onset of these conditions. However, we were stalled at correlations,” says senior author Kate. L. Jeffrey, PhD, investigator in the department of Gastroenterology at MGH and an associate professor of medicine at Harvard Medical School. When Jeffrey and her colleagues isolated viruses from patient colon surgical tissue, they found that viruses in a normal intestine had anti-inflammatory effects and contributed to a healthy gut. Conversely, viruses isolated from the inflamed intestines of patients with IBD provoked inflammation. The team categorized the viruses unique to patients with IBD so that their findings might be used in future research and clinical studies.
In additional experiments, mice whose normal intestinal viruses were replaced with viruses from healthy human colons were protected from intestinal inflammation; however, mice whose intestinal viruses were replaced with viruses associated with IBD exhibited exacerbated inflammation.
“The intestinal virome is established from birth, shaped through life and includes vast numbers of known viruses and copious ‘dark matter’ we cannot yet identify,” says Jeffrey. “Our work provides a missing functional link that our collective virome is an important contributor to human health, but when perturbed does provoke inflammation in IBD and conceivably many other diseases.”
Jeffrey notes that patients with IBD might benefit from therapies that harness the virome, either through targeted elimination — with vaccines or antiviral medications — or replacement of disease-driving intestinal viruses with health-promoting viruses — such as with virome transfers, akin to fecal transfers.
Additional study authors include Fatemeh Adiliaghdam, Hajera Amatullah, Sreehaas Digumarthi, Tahnee L. Saunders, Raza-Ur Rahman, Lai Ping Wong, Ruslan Sadreyev, Lindsay Droit, Jean Paquette, Philippe Goyette, John Rioux, Richard Hodin, Kathie A. Mihindukulasuriya, and Scott A. Handley.
This work was supported by the Kenneth Rainin Foundation, Harvard Catalyst, the National Institutes of Health, and the MGH Research Scholar initiative.
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The international team of scientists aimed to address data gaps in air quality for 46* future megacities in Africa, Asia and the Middle East using space-based observations from instruments onboard NASA and European Space Agency (ESA) satellites for 2005 to 2018.
Published today in Science Advances, the study reveals rapid degradation in air quality and increases in urban exposure to air pollutants hazardous to health. Across all the cities, the authors found significant annual increases in pollutants directly hazardous to health of up to 14% for nitrogen dioxide (NO2) and up to 8% for fine particles (PM2.5), as well as increases in precursors of PM2.5 of up to 12% for ammonia and up to 11% for reactive volatile organic compounds.
The researchers attributed this rapid degradation in air quality to emerging industries and residential sources like road traffic, waste burning, and widespread use of charcoal and fuelwood.
Lead author Dr Karn Vohra (UCL Geography), who completed the study as a PhD student at the University of Birmingham, said: “Open burning of biomass for land clearance and agricultural waste disposal has in the past overwhelmingly dominated air pollution in the tropics. Our analysis suggests we’re entering a new era of air pollution in these cities, with some experiencing rates of degradation in a year that other cities experience in a decade.”
The scientists also found 1.5- to 4- fold increases in urban population exposure to air pollution over the study period in 40 of the 46 cities for NO2 and 33 of the 46 cities for PM2.5., caused by a combination of population growth and rapid deterioration in air quality.
According to the study, the increase in the number of people dying prematurely from exposure to air pollution was highest in cities in South Asia, in particular Dhaka, Bangladesh (totalling 24,000 people), and the Indian cities of Mumbai, Bangalore, Kolkata, Hyderabad, Chennai, Surat, Pune and Ahmedabad (totalling 100,000 people).
The researchers say that while the number of deaths in tropical cities in Africa are currently lower due to recent improvements in healthcare across the continent resulting in a decline in overall premature mortality, the worst effects of air pollution on health will likely occur in the coming decades.
Study co-author Dr Eloise Marais (UCL Geography) said: “We continue to shift air pollution from one region to the next, rather than learning from errors of the past and ensuring rapid industrialisation and economic development don’t harm public health. We hope our results will incentivise preventative action in the tropics.”
The study was funded by a University of Birmingham Global Challenges PhD Studentship awarded to Dr Vohra and a NERC/EPSRC grant awarded to Dr Marais.
*Cities analysed in the study: Africa — Abidjan, Abuja, Addis Ababa, Antananarivo, Bamako, Blantyre, Conakry, Dakar, Dar es Salaam, Ibadan, Kaduna, Kampala, Kano, Khartoum, Kigali, Kinshasa, Lagos, Lilongwe, Luanda, Lubumbashi, Lusaka, Mombasa, N’Djamena, Nairobi, Niamey, Ouagadougou. South Asia — Ahmedabad, Bangalore, Chennai, Chittagong, Dhaka, Hyderabad, Karachi, Kolkata, Mumbai, Pune, Surat. Southeast Asia — Bangkok, Hanoi, Ho Chi Minh City, Jakarta, Manila, Phnom Penh, Yangon. Middle East — Riyadh, Sana’a.
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Researchers have discovered how Gram-negative bacteria — which cause drug-resistant pneumonia, bloodstream infections, and surgical site infections in hospitalized patients — finish building a crucial component of their outer membrane that shields these pathogens from attacks by the immune system and antibiotics. The new findings could accelerate the development of novel drugs to counteract these potentially deadly bacteria, the source of countless infections in health care settings worldwide.
The study was published online April 6 in Nature.
“Previously, we knew that Gram-negative bacteria construct their outer membrane with two main, non-protein components — lipids and sugars — which together form an impermeable barrier. The missing link was how this lipopolysaccharide component comes together,” says Filippo Mancia, PhD, a co-leader of the study and professor of physiology & cellular biophysics at Columbia University Vagelos College of Physicians and Surgeons.
Using cutting-edge single-particle cryo-electron microscopy, Mancia and colleagues were able to determine the structures of the enzyme that links together the lipids and sugars (called an O-antigen ligase), in two different functional configurations. Then, combining genetic, biochemical, and molecular dynamics experiments, the team learned how the enzyme positions the lipids and sugars so that they can combine to form the protective membrane.
The lipopolysaccharide component of the outer membrane is critical to the survival of Gram-negative bacteria. “If you could block its assembly, then you would make the bacteria more sensitive to antibiotics and more vulnerable to the immune system,” Mancia says.
Construction of this membrane is an ongoing process, beginning when Gram-negative bacteria are first formed and continuing as the membrane naturally degrades and requires repair. “This means that we would have many opportunities to disrupt the membrane, not just at one stage of the bacteria’s life cycle,” Mancia says.
After revealing the structure of the enzyme that performs the last and critical step in assembling lipopolysaccharide barriers in drug-resistant bacteria, the researchers may begin to custom-design drugs that inhibit the biosynthesis of this protective membrane.
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