A snapshot of lung cancer: where are we now?—a narrative review

Background and Objective

The global impact of cancer and cancer-related deaths has been a huge challenge and continues to be a setback in the health sector and beyond even in recent times. Cancer is the second leading cause of death globally with lung cancer (LC) being the second most prevalent malignancy and the leading cause of mortality amongst cancers in men and women worldwide. LC still constitutes a major burden despite recent advances in diagnostic and treatment tools. In this article, we review the trends in LC with an emphasis on non-small cell LC. We aimed to identify nuclear and mitochondrial genetic alterations, microbiome dysbiosis, and their significance in non-small cell LC tumorigenesis as well as its relevance in the future management of LCs.

Methods

We identified studies for this review by searching the PubMed, Cochrane, Education Resources Information Center (ERIC), and Surveillance, Epidemiology, and End Results (SEER) databases for English-Language articles published from January 1, 2000 through to July 30, 2022, using keywords: lung cancer, non-small cell lung cancer, early detection, treatment, mitochondria, microbiome and epigenetics.

Key Content and Findings

This review will highlight the genomic environment, mitochondrial and nuclear alterations that play a role in the etiopathogenesis of LC and its application in the progression as well as management of the disease. We also elaborate on current molecular tumor biomarkers and their therapeutic targets.

Conclusions

LC remains the leading cause of cancer-related deaths globally with poor prognosis despite available treatment options and even recent advances in both diagnostic tools and management guidelines. Human nuclear and mitochondrial alterations clearly play a role in tumorigenesis and progressive genomic evolution is crucial in the early carcinogenesis of LC which is strongly influenced by host immune surveillance. It is imperative that more research and clinical trials be undertaken to appreciate an in-depth understanding of LC from the molecular level to facilitate the discovery of more targeted therapy and overall better management of LC.

Molecular characterisation of the rotavirus strains prevalent in Maua, Meru North, Kenya

BACKGROUND

Rotavirus is the most common cause of severe infantile diarrhoea disease in infants and young children below five years worldwide. Rotavirus is associated with high cases of morbidity and mortality and it is estimated that up to 650,000 deaths in young children occur annually in the less developed countries and approximately 150,000-200,000 deaths occur in Africa alone.

OBJECTIVE

To characterise the circulating rotavirus strains in Maua, Meru North district, Kenya.

DESIGN

A prospective study to investigate and characterise rotavirus serotypes/genotypes and electropherotypes in infants and children with severe diarrhoea hospitalised and/or attending the outpatient department of Maua Methodist Hospital during the period April 2004 to September 2005.

SETTING

Maua Methodist Hospital, Meru North, Kenya.

SUBJECTS

Faecal samples were collected from 135 infants and children with acute diarrhoea and were screened first for the presence of human Group A rotavirus antigen using commercially available enzyme linked immunosorbent assay kit (ELISA). The positive samples were evaluated by sodium dodecyl polycrylamide gel electrophoresis (SDS-PAGE) to determine the viral RNA electropherotype profile. Rotavirus strains were also genotyped using reverse transcriptase polymerase chain reaction (RT-PCR) of the VP7 gene.

RESULTS

Assay of these samples with commercial ELISA showed that 17.8% (24/135) were positive for group A rotavirus antigen. Twenty of these ELISA positive samples were also analysed by SDS-PAGE of which 75% (15/20) gave detectable electropherotype pattern with the long electropherotype being predominant 80.0% (12/15) followed by the short RNA profile 20.0% (2/ 15). Seventeen of the ELISA positive samples were genotyped for VP7 and the results showed that G9 was the most predominant genotype comprising 47.1% (8/17) followed by G8 29.4% (5/17), GI 17.4% (3/17) and the mixed genotype was G8/G9 5.9% (1/17). Most patients with rotavirus infection were of the age of 3 - 60 months, with 79% being less than 18 months old.

CONCLUSION

The overall prevalence of rotavirus infection in young children with diarrhoea hospitalised and/or attending the out-patient department of Maua Methodist Hospital was 17.8% with the predominant serotype being G9. These results show that rotavirus plays an important role in severe viral diarrhoea in young children in Maua Meru North district, Kenya. Furthermore, this high G9 rotavirus prevalence in Kenya may require vaccine trials to be held in Kenya so as to determine the efficacy of new rotavirus vaccine candidates that do not include the G9 serotype.

Human group C rotaviruses identified in Kenya

BACKGROUND

Rotavirus is associated with acute infantile gastro-enteritis in infants and young children worldwide. Rotavirus is associated with the high cases of morbidity and mortality and it is estimated that up to 650,000 deaths in young children occur annually in the less developed countries. Approximately a quarter of these deaths occur in African children yet minimal data exist on the circulating rotavirus strains in Africa.

OBJECTIVE

To characterise the circulating rotavirus strains in Kenya.

DESIGN

A prospective study to investigate rotavirus infection in infants and young children with acute diarrhoea in different areas of Kenya. Between September 2001 and February 2002, 119 faecal specimens were collected from children aged between 1 and 60 months with acute infantile gastro-enteritis.

SETTING

Faecal samples were collected from clinics around Nairobi and its suburbs including Karen, Ngong, Ongata Rongai.

SUBJECTS AND METHODS

Faecal samples were collected from 119 infants and young children with diarrhoea and were analysed by commercial ELISA and polyacrylamide gel electrophoresis (SDS-PAGE) to identify possible non-group A rotaviruses. Extraction of any potential rotavirus double-stranded RNA from faeces and characterisation by SDS-PAGE showed the presence of human group C rotaviruses.

RESULTS

Examination of these samples with a commercial ELISA assay for the presence of group A rotavirus antigen showed that 13 specimens (11%) were positive. An analysis of all stool specimens was performed by polyacrylamide gel electrophoresis to identify possible non-group A rotaviruses. Extraction of any potential rotavirus double-stranded RNA from faeces and characterisation by SDS-PAGE showed the presence of human group C rotaviruses.

CONCLUSION

This is the first report of group C rotaviruses in Kenya. Further studies are underway to continue the surveillance of rotavirus strains in Kenya; as this information will be useful in planning rotavirus vaccine trials in Africa.

The prevalence of anti-phospholipid antibodies in a selected population of Kenyan women and development of a non-human primate model

The mechanisms by which anti-phospholipid antibodies (aPLs) may induce pregnancy losses, intrauterine growth retardation and pregnancy-induced hypertension are not clearly understood. Moreover, there is a controversy regarding the possible direct effects of these antibodies on the physiology of the placenta since the target antigens of these antibodies are intracellular antigens and are potentially inaccessible to the antibody. Also, controversy exists regarding the usefulness of the treatment regimens currently available. In this study, we present preliminary data on the prevalence of aPLs in a selected population (n = 80) of Kenyan women visiting Kenyatta National Hospital, Nairobi, Kenya for obstetrical complications including recurrent pregnancy losses. Our results showed approximately 13.8% of the patients were positive for anti-cardiolipin antibodies whereas 33.8% were positive for aPS. Additionally, we screened 72 non-human primates for presence of aPLs and our results showed that the olive baboon (Papio anubis) had the highest prevalence rate (52.2%, n = 23). Overall, our results suggest that the olive baboon may be a suitable animal model for studying the mechanism of action of the anti-phospholipid antibody and pregnancy complications associated with aPLs.