Tackling Drug-Resistant Tuberculosis: New Challenges from the Old Pathogen Mycobacterium tuberculosis

Antibiotics have played a crucial role in the reduction in the incidence of TB globally as evidenced by the fact that before the mid-20th century, the mortality rate within five years of the onset of the disease was 50%. The use of antibiotics has eliminated TB as a devastating disease, but the challenge of resistance to anti-TB drugs, which had already been described at the time of the introduction of streptomycin, has become a major global issue in disease management. Mismanagement of multidrug-resistant tuberculosis (MDR-TB) cases, resulting from intermittent drug use, prescription errors, and non-compliance of patients, has been identified as a critical risk factor for the development of extensively drug-resistant tuberculosis (XDR-TB). Antimicrobial resistance (AMR) in TB is a multi-factorial, complex problem of microbes evolving to escape antibiotics, the gradual decline in antibiotic development, and different economic and social conditions. In this review, we summarize recent advances in our understanding of how Mycobacterium tuberculosis evolves drug resistance. We also highlight the importance of developing shorter regimens that rapidly reach bacteria in diverse host environments, eradicating all mycobacterial populations and preventing the evolution of drug resistance. Lastly, we also emphasize that the current burden of this ancient disease is driven by a combination of complex interactions between mycobacterial and host factors, and that only a holistic approach that effectively addresses all the critical issues associated with drug resistance will limit the further spread of drug-resistant strains throughout the community.

Corrigendum: Editorial: New approaches to how bilingualism shapes cognition and the brain across the lifespan: beyond the false dichotomy of advantage versus no advantage

[This corrects the article DOI: 10.3389/fpsyg.2023.1149062.].

Current status of vaccine research, development, and challenges of vaccines for Mycoplasma gallisepticum

Mycoplasma gallisepticum (MG) is an important avian pathogen that causes significant economic losses in the poultry industry. Surprisingly, the limited protection and adverse reactions caused by the vaccines, including live vaccines, bacterin-based (killed) vaccines, and recombinant viral vaccines is still a major concern. Mycoplasma gallisepticum strains vary in infectivity and virulence and infection may sometimes unapparent and goes undetected. Although extensive research has been carried out on the biology of this pathogen, information is lacking about the type of immune response that confers protection and selection of appropriate protective antigens and adjuvants. Regardless of numerous efforts focused on the development of safe and effective vaccine for the control of MG, the use of modern DNA vaccine technology selected in silico approaches for the use of conserved recombinant proteins may be a better choice for the preparation of novel effective vaccines. More research is needed to characterize and elucidate MG products modulating MG-host interactions. These products could be used as a reference for the preparation and development of vaccines to control MG infections in poultry flocks.

Wood Composites and Their Polymer Binders

This review presents first, rather succinctly, what are the important points to look out for when preparing good wood composites, the main types of wood composites manufactured industrially, and the mainly oil-derived wood composite adhesives and binders that dominate and have been dominating this industry. Also briefly described are the most characteristic biosourced, renewable-derived adhesives that are actively researched as substitutes. For all these adhesives, synthetic and biosourced, the reviews expose the considerable progresses which have occurred relatively recently, with a host of new approaches and ideas having been proposed and tested, some even implemented, but with even many more already appearing on the horizon.

A case study of new approaches to address health inequalities: Due North five years on

INTRODUCTION

When local councils took on responsibility for public health in England in 2013, leaders from across the north of England met to consider the scale of the challenge. As a result, Public Health England commissioned the Due North Report which outlined new approaches in tackling health inequalities. This second paper outlines what has been learnt in five years as a case study. This includes influencing devolution deals and new elected city mayors, planning for economic growth in deprived areas and developing community asset-based approaches. The paper outlines a new framework for place-based planning to reduce health inequalities.

SOURCES OF DATA

Data was gathered from annual reports from north of England directors of public health, Office for National Statistics, Public Health England's fingertips database and regional and national publications and strategies such as the Northern Powerhouse.

AREAS OF AGREEMENT

Devolution to English cities and councils as 'places' is a new opportunity to address local needs and inequalities. Due North has supported a new public health narrative which locates health action in the most fundamental determinants-how local economies are planned, jobs created and power is to be transferred to communities and connects reducing years of premature ill health to increased economic productivity. Community asset approaches to empower local leaders and entrepreneurs can be effective ways to achieve change.

AREAS OF CONTROVERSY

The north-south divide in health is not closing and may be worsening. Different ways of working between local government, health and business sectors can inhibit in working together and with communities.

GROWING POINTS

Place-based working with devolved powers can help move away from top down and silo working, empower local government and support communities. Linking policies on health inequalities to economic planning can address upstream determinants such as poverty, homelessness and unsafe environments.

AREAS TIMELY FOR DEVELOPING RESEARCH

More research is needed on; (i) addressing inequalities at scale for interventions to influence community-led change and prosperity in deprived areas, and (ii) the impact of devolution policy on population health particularly for deprived areas and marginalised group.

DISCUSSION AND CONCLUSIONS

Commissioning high profile reports like Due North is influential in supporting new approaches in reducing inequality of health through local government, elected mayors; and working with deprived communities. This second paper describes progress and lessons.

New Perspectives Regarding Anaplastic Thyroid Carcinoma Approach Improvement

BACKGROUND AND OBJECTIVE

Anaplastic thyroid carcinoma is rare, but represents the deadliest type of thyroid cancer that is characterised by a rapid course. Diagnosis is usually made at a late stage, when more than half of the patients have distant metastasis. Our main purpose is to review the current information on anaplastic thyroid aetiology and risk factors that might contribute to an earlier diagnosis as well as to give new perspectives regarding the most recent treatment options and future directions.

RESULTS

The treatment options are mainly palliative and lack efficacy. In particular, the multikinase inhibitors, BRAF inhibitors and other directed agents aim to stabilize the tumour growth and might enable a radical surgery with curative intent.

CONCLUSION

With the mutational landscape investigation and the discovery of new targets, new directed treatments are being tried. Considering the current tendency to be more conservative regarding the multinodular goiter approach and some differentiated thyroid carcinomas treatment, it is vital to understand that it might evolve to anaplastic cancers.

Perspectives on the Therapeutic Benefits of Arginine Supplementation in Cancer Treatment

BACKGROUND

Arginine is considered a semi-essential amino acid in healthy adults and the elderly. This amino acid seems to improve the immune system, stimulate cell growth and differentiation, and increase endothelial permeability, among other effects. For those reasons, it has been theorized that arginine supplementation may be used as an adjuvant to conventional cancer therapy treatments.

OBJECTIVE

This review aims to evaluate the existing knowledge of the scientific community on arginine supplementation in order to improve the efficacy of current cancer treatment.

RESULTS

Despite the continued efforts of science to improve treatment strategies, cancer remains one of the greatest causes of death on the planet in adults and elderly people. Chemo and radiotherapy are still the most effective treatments but at the cost of significant side effects.

CONCLUSION

Thus, new therapeutic perspectives have been studied in recent years, to be used in addition to traditional treatments or not, seeking to treat or even cure the various types of cancer with fewer side effects.

Perspectives on In Vitro to In Vivo Extrapolations

Quantitative in vitro to in vivo extrapolation (QIVIVE) is broadly considered a prerequisite bridge from in vitro findings to a dose paradigm. Quality and relevance of cell systems are the first prerequisite for QIVIVE. Information-rich and mechanistic endpoints (biomarkers) improve extrapolations, but a sophisticated endpoint does not make a bad cell model a good one. The next need is reverse toxicokinetics (TK), which estimates the dose necessary to reach a tissue concentration that is active in vitro. The Johns Hopkins Center for Alternatives to Animal Testing (CAAT) has created a roadmap for animal-free systemic toxicity testing, in which the needs and opportunities for TK are elaborated, in the context of different systemic toxicities. The report was discussed at two stakeholder forums in Brussels in 2012 and in Washington in 2013; the key recommendations are summarized herein. Contrary to common belief and the Paracelsus paradigm of everything is toxic, the majority of industrial chemicals do not exhibit toxicity. Strengthening the credibility of negative results of alternative approaches for hazard identification, therefore, avoids the need for QIVIVE. Here, especially the combination of methods in integrated testing strategies is most promising. Two further but very different approaches aim to overcome the problem of modeling in vivo complexity: The human-on-a-chip movement aims to reproduce large parts of living organism's complexity via microphysiological systems, that is, organ equivalents combined by microfluidics. At the same time, the Toxicity Testing in the 21st Century (Tox-21c) movement aims for mechanistic approaches (adverse outcome pathways as promoted by Organisation for Economic Co-operation and Development (OECD) or pathways of toxicity in the Human Toxome Project) for high-throughput screening, biological phenotyping, and ultimately a systems toxicology approach through integration with computer modeling. These 21st century approaches also require 21st century validation, for example, by evidence-based toxicology. Ultimately, QIVIVE is a prerequisite for extrapolating Tox-21c such approaches to human risk assessment.

Biomarkers for mitochondrial energy metabolism diseases

Biomarkers are an indicator of biologic or pathogenic processes, whose function is indicating the presence/absence of disease or monitoring disease course and its response to treatment. Since mitochondrial disorders (MDs) can represent a diagnostic challenge for clinicians, due to their clinical and genetic heterogeneity, the identification of easily measurable biomarkers becomes a high priority. Given the complexity of MD, in particular the primary mitochondrial respiratory chain (MRC) diseases due to oxidative phosphorylation (OXPHOS) dysfunction, a reliable single biomarker, relevant for the whole disease group, could be extremely difficult to find, most of times leading the physicians to better consider a 'biosignature' for the diagnosis, rather than a single biochemical marker. Serum biomarkers like lactate and pyruvate are largely determined in the diagnostic algorithm of MD, but they are not specific to this group of disorders. The concomitant determination of creatine (Cr), plasma amino acids, and urine organic acids might be helpful to reinforce the biosignature in some cases. In recent studies, serum fibroblast growth factor 21 (sFGF21) and serum growth differentiation factor 15 (sGDF15) appear to be promising molecules in identifying MD. Moreover, new different approaches have been developed to discover new MD biomarkers. This work discusses the most important biomarkers currently used in the diagnosis of MRC diseases, and some approaches under evaluation, discussing both their utility and weaknesses.

Minimally invasive devices for treating lower urinary tract symptoms in benign prostate hyperplasia: technology update

Benign prostatic hyperplasia (BPH) represents a spectrum of related lower urinary tract symptoms (LUTS). The cost of currently recommended medications and the discontinuation rate due to side effects are significant drawbacks limiting their long-term use in clinical practice. Interventional procedures, considered as the definitive treatment for BPH, carry a significant risk of treatment-related complications in frail patients. These issues have contributed to the emergence of new approaches as alternative options to standard therapies. This paper reviews the recent literature regarding the experimental treatments under investigation and presents the currently available experimental devices and techniques used under local anesthesia for the treatment of LUTS/BPH in the vast majority of cases. Devices for delivery of thermal treatment (microwaves, radiofrequency, high-intensity focused ultrasound, and the Rezum system), mechanical devices (prostatic stent and urethral lift), fractionation of prostatic tissue (histotripsy and aquablation), prostate artery embolization, and intraprostatic drugs are discussed. Evidence for the safety, tolerability, and efficacy of these "minimally invasive procedures" is analyzed.

Health, equity and the north of England: a case study on a new approach

INTRODUCTION OR BACKGROUND

In 2013, responsibility for public health returned to local government from the National Health Service (NHS) in England. This article describes, as a case study, a new fresh approach to tackling health inequalities, which built on a desire by local councils in the north of England to rethink approaches and collaborate on new ideas to improving health and reducing health inequalities.

SOURCES OF DATA

The collaboration was supported by an independently commissioned inquiry that assessed the evidence and proposed new policy options. This article describes the context to the collaboration, called Health Equity North, findings from the independent inquiry and emerging impact. Four areas for action were recommended: linking poverty with economic prosperity, devolution and public sector reform, investment in early years and renewed impetus for the health sector.

AREAS OF AGREEMENT

That health service action alone had been limited without addressing the wider determinants of health such as employment, education and housing.

AREAS OF CONTROVERSY

The so-called north-south divide appears to be widening, and renewed efforts are needed locally and nationally to tackle these wider determinants of health.

GROWING POINTS

This collaborative approach spanning a large geography supported by local and national leaderships, enabled new work locally and influenced policy nationally, such as devolution of power and resources to local areas.

AREAS TIMELY FOR DEVELOPING RESEARCH

Research is needed on the economic returns of investing in the social determinants of health. The examples of local action indicate the need for research on 'asset-based approaches' to improving community health, presented so to empower local lay decision makers such as councillor rather than for technical experts.

Economics of vaccines revisited

Performing a total health economic analysis of a vaccine newly introduced into the market today is a challenge when using the conventional cost-effectiveness analysis we normally apply on pharmaceutical products. There are many reasons for that, such as: the uncertainty in the total benefit (direct and indirect) to be measured in a population when using a cohort model; (1) appropriate rules about discounting the long-term impact of vaccines are absent jeopardizing therefore their value at the initial investment; (2) the presence of opposite contexts when introducing the vaccine in developed vs. the developing world with high benefits, low initial health care investment for the latter vs. marginal benefit and high cost for the former; with a corresponding paradox for the vaccine becoming very cost-effective in low income countries but rather medium in middle low to high middle income countries; (3) and the type of trial assessment for the newer vaccines is now often performed with immunogenicity reaction instead of clinical endpoints which still leaves questions on their real impact and their head-to-head comparison. (4.)