Common defences

Perceptions of patients and caregivers toward the management of rare disease in Malaysia: a qualitative research study

OBJECTIVE

The management of rare diseases is rarely addressed among policymakers and public communities. It is hindered by the lack of information on its epidemiology and burden, especially from the perspective of patients and families with rare diseases. This study aims to understand the perceptions of rare disease patients and their families in the management of rare diseases in Malaysia.

METHODOLOGY

A qualitative interview was used to explore the perceptions of patients and families regarding the management of rare diseases in Malaysia. In-depth interviews were conducted with the rare disease patients or their parents/guardians provided by three major rare disease advocacy groups, between 1 July and 15 September 2016. The interviews focused on two key areas: the challenges associated with rare disease and the issues related to accessing medication.

FINDINGS

Out of the nineteen recruited participants, seventeen (89.5 percent) completed the interview sessions. The significance of awareness, knowledge, and support from others emerged as crucial for families and patients living with rare diseases. Despite facing delayed diagnosis and treatment, a majority of patients and parents expressed satisfaction with the advancements in rare disease management. Nevertheless, a prominent challenge revolves around access to enzyme replacement therapy for eligible patients.

CONCLUSION

This study emphasizes the importance of healthcare professionals understanding patient with rare diseases perceptions to tailor communication strategies, provide accurate information, and address concerns effectively. The message underscores the significance of collaboration between healthcare providers and patient support groups to deliver adequate health information, potentially enhancing patients' understanding and their illness perceptions.

Danger signals in traumatic hemorrhagic shock and new lines for clinical applications

Hemorrhage is the leading cause of death in severe trauma injuries. When organs or tissues are subjected to prolonged hypoxia, danger signals-known as damage-associated molecular patterns (DAMPs)-are released into the intercellular environment. The endothelium is both the target and a major provider of damage-associated molecular patterns, which are directly involved in immuno-inflammatory dysregulation and the associated tissue suffering. Although damage-associated molecular patterns release begins very early after trauma, this release and its consequences continue beyond the initial treatment. Here we review a few examples of damage-associated molecular patterns to illustrate their pathophysiological roles, with emphasis on emerging therapeutic interventions in the context of severe trauma. Therapeutic intervention administered at precise points during damage-associated molecular patterns release may have beneficial effects by calming the inflammatory storm triggered by traumatic hemorrhagic shock.

A Systems Approach to Agricultural Biosecurity

This article highlights the importance of systems approaches in addressing agricultural biosecurity threats. On the basis of documentary analysis and stakeholder interaction, a brief survey of agricultural biosecurity threats and vulnerabilities from global and Indian perspectives is provided, followed by an exploration of technological and institutional capabilities. Finally, a perspective on the agricultural disease diagnostic networks is provided, drawing instances from global developments. Technical barriers to agroterrorism are lower than those to human-targeted bioterrorism, and the sector is unique as even a very small disease outbreak could prompt international export restrictions. Key vulnerabilities in the agriculture sector stem from, among others, the structure of agricultural production; insufficient monitoring, surveillance, and controls systems at the borders and in the food chain; inefficient systems for reporting unusual occurrences and outbreaks of disease; and lack of sufficiently trained human resources capable of recognizing or treating transboundary pathogens and diseases. An assessment of technology and institutions pertaining to crop and animal protection management suggests certain gaps. Investment in developing new technologies for civilian application in agriculture, as well as for legitimate actions pertaining to defense, detection, protection, and prophylaxis, and in upgrading laboratory facilities can increase the agricultural sector's level of preparedness for outbreaks. To address potential threats and vulnerabilities of agroterrorism effectively requires the development of a comprehensive strategy and a combined, interagency approach, ideally on an international level. It is proposed that a systems-oriented approach for developing knowledge and innovation networks and strengthening skills and capacities would enable a more resilient agricultural biosecurity system.

The NBS-LRR architectures of plant R-proteins and metazoan NLRs evolved in independent events

There are intriguing parallels between plants and animals, with respect to the structures of their innate immune receptors, that suggest universal principles of innate immunity. The cytosolic nucleotide binding site-leucine rich repeat (NBS-LRR) resistance proteins of plants (R-proteins) and the so-called NOD-like receptors of animals (NLRs) share a domain architecture that includes a STAND (signal transduction ATPases with numerous domains) family NTPase followed by a series of LRRs, suggesting inheritance from a common ancestor with that architecture. Focusing on the STAND NTPases of plant R-proteins, animal NLRs, and their homologs that represent the NB-ARC (nucleotide-binding adaptor shared by APAF-1, certain R gene products and CED-4) and NACHT (named for NAIP, CIIA, HET-E, and TEP1) subfamilies of the STAND NTPases, we analyzed the phylogenetic distribution of the NBS-LRR domain architecture, used maximum-likelihood methods to infer a phylogeny of the NTPase domains of R-proteins, and reconstructed the domain structure of the protein containing the common ancestor of the STAND NTPase domain of R-proteins and NLRs. Our analyses reject monophyly of plant R-proteins and NLRs and suggest that the protein containing the last common ancestor of the STAND NTPases of plant R-proteins and animal NLRs (and, by extension, all NB-ARC and NACHT domains) possessed a domain structure that included a STAND NTPase paired with a series of tetratricopeptide repeats. These analyses reject the hypothesis that the domain architecture of R-proteins and NLRs was inherited from a common ancestor and instead suggest the domain architecture evolved at least twice. It remains unclear whether the NBS-LRR architectures were innovations of plants and animals themselves or were acquired by one or both lineages through horizontal gene transfer.

Fungal Innate Immunity Induced by Bacterial Microbe-Associated Molecular Patterns (MAMPs)

Plants and animals detect bacterial presence through Microbe-Associated Molecular Patterns (MAMPs) which induce an innate immune response. The field of fungal-bacterial interaction at the molecular level is still in its infancy and little is known about MAMPs and their detection by fungi. Exposing Fusarium graminearum to bacterial MAMPs led to increased fungal membrane hyperpolarization, a putative defense response, and a range of transcriptional responses. The fungus reacted with a different transcript profile to each of the three tested MAMPs, although a core set of genes related to energy generation, transport, amino acid production, secondary metabolism, and especially iron uptake were detected for all three. Half of the genes related to iron uptake were predicted MirA type transporters that potentially take up bacterial siderophores. These quick responses can be viewed as a preparation for further interactions with beneficial or pathogenic bacteria, and constitute a fungal innate immune response with similarities to those of plants and animals.

Modeling Pseudomonas aeruginosa pathogenesis in plant hosts

A pathogenic model in which both the pathogen and its host are amenable to genetic manipulation can greatly facilitate the understanding of bacterial pathogenesis. Plants are genetically tractable and can be used as experimental models for human microbial pathogenesis. We present protocols for both lettuce and Arabidopsis leaf infection models using the opportunistic human bacterial pathogen, Pseudomonas aeruginosa. The lettuce model allows for high-throughput qualitative analysis of virulence and is suitable for screening large numbers of bacterial strains, whereas the Arabidopsis model provides a quantitative approach and permits the tracking of bacterial cell proliferation in planta. The lettuce model takes approximately 24 h including bacterial growth using store-bought lettuce, and the Arabidopsis model takes 4-6 weeks to grow the plants and a similar time as with lettuce to infect the plants. Both models are monitored for up to 5 d post-infection. These methodologies can and have been used to identify novel and critical P. aeruginosa pathogenicity agents, as virulence factors are often conserved across phylogeny.

Tracing the ancient origins of plant innate immunity

Resistance to pathogens is one of the most ancient traits; mechanisms for discriminating self from non-self have evolved to accomplish this task. Animal and plant immune systems use a set of similar receptors to recognize pathogens. These receptors are located either at the cell surface or inside the cell. Kinases modulate further signalling and are either associated to the receptors or are part of the receptors themselves. In this review, we compare gene families and the nucleotide binding (NB) and the Toll-interleukin-1 receptor (TIR) domains of various kingdoms that are important for the immune systems. Possibilities to deconstruct and reconstruct evolutionary events contributing to the immune systems are explored together with functional aspects.