Long term prevention and vector control of arboviral diseases: What does the future hold?

Future Use of AI in Diagnostic Medicine: 2-Wave Cross-Sectional Survey Study

BACKGROUND

The rapid evolution of artificial intelligence (AI) presents transformative potential for diagnostic medicine, offering opportunities to enhance diagnostic accuracy, reduce costs, and improve patient outcomes.

OBJECTIVE

This study aimed to assess the expected future impact of AI on diagnostic medicine by comparing global researchers' expectations using 2 cross-sectional surveys.

METHODS

The surveys were conducted in September 2020 and February 2023. Each survey captured a 10-year projection horizon, gathering insights from >3700 researchers with expertise in AI and diagnostic medicine from all over the world. The survey sought to understand the perceived benefits, integration challenges, and evolving attitudes toward AI use in diagnostic settings.

RESULTS

Results indicated a strong expectation among researchers that AI will substantially influence diagnostic medicine within the next decade. Key anticipated benefits include enhanced diagnostic reliability, reduced screening costs, improved patient care, and decreased physician workload, addressing the growing demand for diagnostic services outpacing the supply of medical professionals. Specifically, x-ray diagnosis, heart rhythm interpretation, and skin malignancy detection were identified as the diagnostic tools most likely to be integrated with AI technologies due to their maturity and existing AI applications. The surveys highlighted the growing optimism regarding AI's ability to transform traditional diagnostic pathways and enhance clinical decision-making processes. Furthermore, the study identified barriers to the integration of AI in diagnostic medicine. The primary challenges cited were the difficulties of embedding AI within existing clinical workflows, ethical and regulatory concerns, and data privacy issues. Respondents emphasized uncertainties around legal responsibility and accountability for AI-supported clinical decisions, data protection challenges, and the need for robust regulatory frameworks to ensure safe AI deployment. Ethical concerns, particularly those related to algorithmic transparency and bias, were noted as increasingly critical, reflecting a heightened awareness of the potential risks associated with AI adoption in clinical settings. Differences between the 2 survey waves indicated a growing focus on ethical and regulatory issues, suggesting an evolving recognition of these challenges over time.

CONCLUSIONS

Despite these barriers, there was notable consistency in researchers' expectations across the 2 survey periods, indicating a stable and sustained outlook on AI's transformative potential in diagnostic medicine. The findings show the need for interdisciplinary collaboration among clinicians, AI developers, and regulators to address ethical and practical challenges while maximizing AI's benefits. This study offers insights into the projected trajectory of AI in diagnostic medicine, guiding stakeholders, including health care providers, policy makers, and technology developers, on navigating the opportunities and challenges of AI integration.

Viral and cellular determinants of polarized trafficking of viral envelope proteins from insect-specific and insect-vectored viruses in insect midgut and salivary gland cells

Systemic viral infection of insects typically begins with the primary infection of midgut epithelial cells (enterocytes) and subsequent transit of the progeny virus in an apical-to-basal orientation into the hemocoel. For insect-vectored viruses, an oppositely oriented process (basal-to-apical transit) occurs upon secondary infection of salivary glands and is necessary for virus transmission to non-insect hosts. To examine this inversely oriented virus transit in these polarized tissues, we assessed the intracellular trafficking of two model viral envelope proteins (baculovirus GP64 and vesicular stomatitis virus G) in the midgut and salivary gland cells of the model insect, Drosophila melanogaster. Using fly lines that inducibly express either GP64 or VSV G, we found that each protein, expressed alone, was trafficked basally in midgut enterocytes. In salivary gland cells, VSV G was trafficked apically in most but not all cells, whereas GP64 was consistently trafficked basally. We demonstrated that a YxxØ motif present in both proteins was critical for basal trafficking in midgut enterocytes but dispensable for trafficking in salivary gland cells. Using RNAi, we found that clathrin adaptor protein complexes AP-1 and AP-3, as well as seven Rab GTPases, were involved in polarized VSV G trafficking in midgut enterocytes. Our results indicate that these viral envelope proteins encode the requisite information and require no other viral factors for appropriately polarized trafficking. In addition, they exploit tissue-specific differences in protein trafficking pathways to facilitate virus egress in the appropriate orientation for establishing systemic infections and vectoring infection to other hosts.

IMPORTANCE

Viruses that use insects as hosts must navigate specific routes through different insect tissues to complete their life cycles. The routes may differ substantially depending on the life cycle of the virus. Both insect pathogenic viruses and insect-vectored viruses must navigate through the polarized cells of the midgut epithelium to establish a systemic infection. In addition, insect-vectored viruses must also navigate through the polarized salivary gland epithelium for transmission. Thus, insect-vectored viruses appear to traffic in opposite directions in these two tissues. In this study, we asked whether two viral envelope proteins (VSV G and baculovirus GP64) alone encode the signals necessary for the polarized trafficking associated with their respective life cycles. Using Drosophila as a model to examine tissue-specific polarized trafficking of these viral envelope proteins, we identified one of the virus-encoded signals and several host proteins associated with regulating the polarized trafficking in the midgut epithelium.

Evidence of Differences in Cellular Regulation of Wolbachia-Mediated Viral Inhibition between Alphaviruses and Flaviviruses

The intracellular bacterium Wolbachia is increasingly being utilised in control programs to limit the spread of arboviruses by Aedes mosquitoes. Achieving a better understanding of how Wolbachia strains can reduce viral replication/spread could be important for the long-term success of such programs. Previous studies have indicated that for some strains of Wolbachia, perturbations in lipid metabolism and cholesterol storage are vital in Wolbachia-mediated antiviral activity against the flaviviruses dengue and Zika; however, it has not yet been examined whether arboviruses in the alphavirus group are affected in the same way. Here, using the reporters for the alphavirus Semliki Forest virus (SFV) in Aedes albopictus cells, we found that Wolbachia strains wMel, wAu and wAlbB blocked viral replication/translation early in infection and that storage of cholesterol in lipid droplets is not key to this inhibition. Another alphavirus, o'nyong nyong virus (ONNV), was tested in both Aedes albopictus cells and in vivo in stable, transinfected Aedes aegypti mosquito lines. The strains wMel, wAu and wAlbB show strong antiviral activity against ONNV both in vitro and in vivo. Again, 2-hydroxypropyl-β-cyclodextrin (2HPCD) was not able to rescue ONNV replication in cell lines, suggesting that the release of stored cholesterol caused by wMel is not able to rescue blockage of ONNV. Taken together, this study shows that alphaviruses appear to be inhibited early in replication/translation and that there may be differences in how alphaviruses are inhibited by Wolbachia in comparison to flaviviruses.

Scorpion envenomation in Brazil: Current scenario and perspectives for containing an increasing health problem

Opportunistic scorpion species can colonize urban environments, establishing high-density communities that enhance the chances of human accidents. This scenario has been taking place in Brazil, in which some Tityus species have taken city centers, causing an explosion in the number of scorpion envenoming cases. The characteristics of this scorpionism epidemic in Brazil is discussed in the present work. The number of Brazilian scorpion stings has surpassed 120,000 cases in 2017, and has been maintained above this number ever since, representing a more than 3-fold increase in 10 years, which was higher than the number of cases for most of the neglected tropical diseases in the country. The escalation in scorpionism cases is even higher in some regions of Brazil. Fortunately, the proportion of mild cases has also increased in the analyzed period, as well as the number of victims seeking for medical attention within the first hour after the accident. The species Tityus serrulatus, Tityus stigmurus, Tityus bahiensis, and Tityus obscurus are traditionally accountable for most of the scorpion accidents in different regions of Brazil, but other species deserve to be closely watched. Despite scorpionism being a notable health problem in Brazil, accident prevention and pest control regarding this venomous animal have not been properly addressed by the scientific community nor by policy makers. Therefore, this review also aims to point possible fields of research that could help to contain the aggravation of the current scorpionism landscape in Brazil.

A Review on Climate, Air Pollution, and Health in North Africa

PURPOSE OF REVIEW

The aim of this review is to summarize and provide clear insights into studies that evaluate the interaction between air pollution, climate, and health in North Africa.

RECENT FINDINGS

Few studies have estimated the effects of climate and air pollution on health in North Africa. Most of the studies highlighted the evidence of the link between climate and air pollution as driving factors and increased mortality and morbidity as health outcomes. Each North African country prioritized research on a specific health factor. It was observed that the health outcome from each driving factor depends on the studied area and data availability. The latter is a major challenge in the region. As such, more studies should be led in the future to cover more areas in North Africa and when more data are available. Data availability will help to explore the applicability of different tools and techniques new to the region. This review explores studies related to climate and air pollution, and their possible impacts on health in North Africa. On one hand, air quality studies have focused mainly on particulate matter exceedance levels and their long-term exposure impacts, namely, morbidity and mortality. The observed differences between the various studies are mainly due to the used exposure-response function, the studied population, background emissions, and natural emission from the Sahara Desert that characterize the region. On the other hand, climate studies have focused primarily on the impact of heat waves, vector-borne disease, and mental disorders. More than half of these studies have been on leishmaniasis disease. The review revealed unbalanced and insufficient research on health impacts from air pollution episodes and climate extremes across the region.

Anticipating New Treatments for Cystic Fibrosis: A Global Survey of Researchers

Cystic fibrosis is a life-threatening disease that affects at least 100,000 people worldwide. It is caused by a defect in the cystic fibrosis transmembrane regulator (CFTR) gene and presently, 360 CFTR-causing mutations have been identified. Since the discovery of the CFTR gene, the expectation of developing treatments that can substantially increase the quality of life or even cure cystic fibrosis patients is growing. Yet, it is still uncertain today which developing treatments will be successful against cystic fibrosis. This study addresses this gap by assessing the opinions of over 524 cystic fibrosis researchers who participated in a global web-based survey. For most respondents, CFTR modulator therapies are the most likely to succeed in treating cystic fibrosis in the next 15 years, especially through the use of CFTR modulator combinations. Most respondents also believe that fixing or replacing the CFTR gene will lead to a cure for cystic fibrosis within 15 years, with CRISPR-Cas9 being the most likely genetic tool for this purpose.

Future of genetic therapies for rare genetic diseases: what to expect for the next 15 years?

Introduction

Rare genetic diseases affect millions of people worldwide. Most of them are caused by defective genes that impair quality of life and can lead to premature death. As genetic therapies aim to fix or replace defective genes, they are considered the most promising treatment for rare genetic diseases. Yet, as these therapies are still under development, it is still unclear whether they will be successful in treating these diseases. This study aims to address this gap by assessing researchers' opinions on the future of genetic therapies for the treatment of rare genetic diseases.

Methods

We conducted a global cross-sectional web-based survey of researchers who recently authored peer-reviewed articles related to rare genetic diseases.

Results

We assessed the opinions of 1430 researchers with high and good knowledge about genetic therapies for the treatment of rare genetic diseases. Overall, the respondents believed that genetic therapies would be the standard of care for rare genetic diseases before 2036, leading to cures after this period. CRISPR-Cas9 was considered the most likely approach to fixing or replacing defective genes in the next 15 years. The respondents with good knowledge believed that genetic therapies would only have long-lasting effects after 2036, while those with high knowledge were divided on this issue. The respondents with good knowledge on the subject believed that non-viral vectors are more likely to be successful in fixing or replacing defective genes in the next 15 years, while most of the respondents with high knowledge believed viral vectors would be more successful.

Conclusion

Overall, the researchers who participated in this study expect that in the future genetic therapies will greatly benefit the treatment of patients with rare genetic diseases.

Gene Editing for Treatment and Prevention of Human Diseases: A Global Survey of Gene Editing-Related Researchers

In the next decades, gene editing technologies are expected to be used in the treatment and prevention of human diseases. Yet, the future uses of gene editing in medicine are still unknown, including its applicability and effectiveness to the treatment and prevention of infectious diseases, cancer, and monogenic and polygenic hereditary diseases. This study aims to address this gap by analyzing the views of over 1,000 gene editing-related researchers from all over the world. Some of our survey results show that, in the next 10 years, DNA double-strand breaks are expected to be the main method for gene editing, and CRISPR-Cas systems to be the mainstream programmable nuclease. In the same period, gene editing is expected to have more applicability and effectiveness to treat and prevent infectious diseases and cancer. Off-targeting mutations, reaching therapeutic levels of editing efficiency, difficulties in targeting specific tissues in vivo, and regulatory and ethical challenges are among the most relevant factors that might hamper the use of gene editing in humans. In conclusion, our results suggest that gene editing might become a reality to the treatment and prevention of a variety of human diseases in the coming 10 years. If the future confirms these researchers' expectations, gene editing could change the way medicine, health systems, and public health deal with the treatment and prevention of human diseases.