In the last few decades, scientists have finally learned to harness the immune system to successfully treat cancer. Image for Representation.
| Photo Credit: Freepik

In the last few decades, scientists have finally learned to harness the immune system to successfully treat cancer. Although doctors often use immunotherapy drugs, another type of treatment uses patient’s cells to treat their own cancers.

Car-T therapy, short for “chimeric antigen receptor T-cell”, is a cutting-edge treatment that reprogrammes a patient’s immune cells to fight their cancer. This innovative approach involves taking T-cells, a type of white blood cell that plays a crucial role in the immune system, from a patient and modifying them in a laboratory to better recognise and attack cancer cells.

These enhanced T-cells are then multiplied and infused back into the patient, where they seek out and destroy cancer cells. Lots of data shows that in difficult-to-treat lymphomas, a type of cancer, patients can do so well.

In November 2023, the US Food and Drug Administration (FDA) announced an investigation into this celebrated cancer treatment. They were looking into whether Car-T therapy might be causing new cancers in some patients who had undergone the treatment. This was a significant concern given the therapy’s reputation as a revolutionary cancer-fighting strategy.

Initially, the FDA mentioned that it had observed 20 cases where patients developed new immune-cell cancers, such as lymphomas or leukaemias, which are types of blood cell cancer, after receiving Car-T therapy. This prompted questions about who these patients were, how many such cases existed and what other treatments they might have received before Car-T therapy.

By March 2024, the FDA had documented 33 such cases among around 30,000 treated patients. Consequently, all Car-T therapies now carry a boxed warning about the potential risk of developing secondary cancers. The European Medicines Agency also started its own investigation into the matter.

Despite these concerns, it is still unclear whether the new cancers are directly caused by the Car-T cells or whether other factors are involved. It is also important to note that these cancers are very rare – as data published this month shows.

Many cancer treatments come with a risk of secondary malignancies and, of course, the cancer returning. And patients receiving Car-T therapy often have had several other treatments that could also contribute to the risk. Researchers are now working to determine if Car-T therapy is a contributing factor or the primary cause of these new cancers.

Car-T therapy was initially used for patients with no other treatment options, but it has since been approved as a second-line treatment for certain types of blood cancers, like lymphoma and multiple myeloma. Scientists are also exploring its potential for treating solid tumours including hard to treat brain cancers, autoimmune diseases, ageing, HIV and other conditions.

The process of creating Car-T cells involves using viruses to insert new genetic material into T-cells. These viruses, called retroviruses, are engineered to carry the gene for a chimeric antigen receptor (Car) into the T-cells.

Massive benefits

While these retroviruses are modified to be safe, there is always a risk that the new genetic material could disrupt other important genes and potentially lead to cancer – a phenomenon known as “insertional mutagenesis”. This means new genetic material is added to a cell.

This risk isn’t new. About 20 years ago, gene therapy treatments for severe combined immunodeficiency syndrome using similar retroviruses led to leukaemia in some patients. As a result, scientists have worked to improve the safety of these viral vectors. The FDA now requires thorough testing to ensure that the viruses used in Car-T therapy cannot replicate and cause harm.

Despite these findings, the most important thing to emphasise is that secondary cancers remain rare and these cell therapies can have massive benefits in very sick people.

The new review of patients treated with Car-T therapies at various centres found that only a small percentage developed secondary cancers, and most were not the type directly linked to the Car-T treatment. This suggests that while there is a risk, it is relatively low compared to the immediate threat posed by the patient’s existing cancer.

Medical professionals now inform patients about the potential but rare risk of secondary cancers when discussing Car-T therapy. For most patients, especially those with advanced cancers, the potential benefits of Car-T therapy far outweigh these risks.

As mentioned, Car-T therapy is also being investigated for other applications beyond cancer. For instance, it has shown promise in treating autoimmune diseases such as lupus and even in preventing organ transplant rejection. The potential uses for Car-T cells are continually expanding, offering hope for treating a wide range of diseases.

Ultimately, while the risk of secondary cancers from Car-T therapy is a serious consideration, the benefits for many patients are significant and far outweigh this small risk. Research will continue to refine these treatments and improve their safety.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Washington, United States:

US officials on Thursday reported the country’s third human case of bird flu linked to the current outbreak of the virus in dairy cattle.

The Michigan farm worker is the second person sickened by the disease in the Midwestern state, following a first case in Texas in April.

The Centers for Disease Control and Prevention (CDC) said in a statement all three cases were spread from cows to humans, as opposed to human-to-human, which would be more concerning.

But it added it was the first case “to report more typical symptoms of acute respiratory illness associated with influenza virus infection,” while the previous cases resulted in mild symptoms including conjunctivitis.

The person’s symptoms included cough without fever, eye discomfort and watery eye discharge. They were treated with the antiviral medicine oseltamivir and isolated at home, with their symptoms resolving.

The worker was not wearing personal protective equipment, which health authorities have recommended for those in close contact with dairy herds, said Michigan’s health department.

Over the past few years, a highly pathogenic avian influenza virus called HPAI H5N1 has spread to infect more than 50 animal species, including, from March, dairy cattle in the United States.

Unlike in Europe, American farmers are allowed to feed cattle ground-up chicken waste, which some scientists say may be a risk factor for bird flu — though the feed industry has challenged this claim and US authorities believe wild birds are responsible for infecting cows.

“The risk to members of the general public who do not have exposure to infected animals remains low,” said the CDC.

It added that finding a new case was “not surprising” because Michigan was proactively testing for cases among farmworkers.

In addition to using PPE, people should avoid close exposure to sick or dead animals including wild birds, domesticated birds and other domesticated animals, according to the CDC.

They should also avoid touching animal excrement or bedding, or consuming unpasteurized milk, the agency added.

Recent testing has confirmed mice are sickened by exposure to raw milk contaminated with bird flu, but pasteurization destroys the virus.

Most recently, the disease has been found in farm-raised alpacas in Idaho.

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

The safety of intermittent fasting, a popular strategy to lose weight by limiting food intake to certain times, was called into question by a surprise finding from research presented at a medical meeting. 

Limiting mealtimes to a period of just eight hours a day was linked to a 91% increase in risk of death from heart disease in the study, which was released on Monday in Chicago. The American Heart Association published only an abstract, leaving scientists speculating about the details of the study protocol. The study was reviewed by other experts prior to its release, according to the AHA. 

Lifestyle interventions aimed at weight loss have come under scrutiny as a new generation of drugs help people shed pounds. Some doctors questioned the study’s findings, saying they could have been skewed by differences – such as underlying heart health – between the fasting patients and the comparison group, whose members consumed food over a daily period of 12 to 16 hours. 

“Time-restricted eating is popular as a means of reducing calorie intake,” Keith Frayn, emeritus professor of human metabolism at the University of Oxford, said in a statement to the UK Science Media Center. “This work is very important in showing that we need long-term studies on the effects of this practice. But this abstract leaves many questions unanswered.” 

The researchers, led by Victor Zhong of the Shanghai Jiao Tong University School of Medicine, analyzed data from about 20,000 adults included in the US Centers for Disease Control and Prevention’s National Health and Nutrition Examination Survey. 

The study looked at answers to questionnaires along with death data from 2003 through 2019. Because it relied in part on forms that required patients to recall what they ate over two days, scientists said there was room for potential inaccuracies. About half of the patients were men and the mean age was 48. 

It wasn’t clear how long the patients continued the intermittent fasting, though the researchers assumed they kept it up, according to Zhong. 

The fasting patients were more likely to be younger men with a higher BMI and food insecurity, he said by email. They also had a lower prevalence of hypertension, diabetes and cardiovascular disease based on self-reports. “We controlled for all these variables in the analysis, but the positive association between 8-h time-restricted eating and cardiovascular mortality remained,” Zhong said. 

The abstract was presented at the AHA’s Lifestyle Scientific Sessions meeting in Chicago. 

(Except for the headline, this story has not been edited by NDTV staff and is published from a syndicated feed.)

Reeni Tharakan power lifting at Ulaanbaataar
| Photo Credit: SPECIAL ARRANGEMENT

When Reeni Tharakan hit the gym 10 years ago, at 53, it was driven by a desire to lose weight and stay healthy. The last thing on her mind was powerlifting, let alone winning gold medals at international powerlifting competitions. She won four gold medals in her category at the recently concluded International Powerlifting Federation (IPF) World Classic & Equipped Masters Powerlifting Championships at Ulaanbaatar, Mongolia. 

Gymming was a new experience for Reeni who confesses to not having seen the inside of a gym until then: “I did not know what a dumbbell was or a kettlebell.” Once she began training, her trainer saw potential in her and egged her on to lift weights.  

“My trainer, Jagan KG, encouraged me to lift weights right from the start. He saw my interest and understood my capability, and encouraged me to lift [weights],” says Reeni over the phone from Thycattusserry, near Cherthala. This achievement would not have been possible without her trainer’s support and that of her immediate family which includes her husband and two daughters, she confesses. Despite the backing of her family, the ride has been anything but smooth. “It is not approved of in traditional, conventional families. Questions include ‘why are you doing this at this age?’”  

The IPF Championship had her compete with around 145 weightlifters from 44 countries. The Masters’ competition is held in four categories — M1, M2, M3, and M4 — for the age groups of 40 years and above, 50, 60, and 70 plus years old. Reeni participated in the M3 category. She is all praise for participants in the championships, “A Japanese man, in his 80s, walked in with a walking stick and ‘out-lifted’ the others. There were more women than men, which was an eyeopener about the number of women who powerlift,” says the homemaker. The fitness levels of participants have left her impressed. The Indian contingent had 25 members, of which around 15 were women. 

Reeni travels three times a week to Kochi, travelling 37-odd kilometres one way, to work out at Mr Standard Gym at Vyttilla. “My husband drives me down, and this is one way of showing support.” She works out for close to two hours, the other three days she works out at home and takes one day off from training. Strict about maintaining her weight [at 69 kilograms for her category] she follows a keto diet, which she says works well for her.

“I keep my weight between 66-67 kilograms. When you compete in an international competition, being overweight by even something as seemingly insignificant as five grams can get you disqualified!” For an idea of how much she can lift — she deadlifted 112.5 kilograms.

She also won a medal at the Asian Women’s Equipped Powerlifting Championships held earlier this year at Alappuzha. She has won medals at district level competitions as well; she began competing in 2021. She credits Jagan and Jerry Lopez, owner of Mr Standard Gym for encouraging her and creating an atmosphere of support for her. “It is not easy for someone my age to do this. And the support I get when I train goes a long way.” Jagan credits her for getting more women interested in lifting weights.  

Reeni is excited about her experience and her advice for others is — “Everybody should lift weights. It is critical… do it for your bones, body and general health.”  

Indonesian researchers have tested a cheaper way of monitoring antimicrobial resistance that could be a key tool for developing countries. Image for Representation.
| Photo Credit: Getty Images/iStockphoto

Indonesian researchers have tested a cheaper way of monitoring antimicrobial resistance that could be a key tool for developing countries.

Indonesian researchers have tested a cost-effective, relatively quick method of measuring changes in antimicrobial resistance that could help developing countries fight a problem seen as a global threat.

Instead of sticking to an approach that emphasises the need for intensive laboratory testing that might not be practical in many countries, they assessed lot quality assurance sampling — a system where a population’s antimicrobial resistance can be assessed using smaller sample sizes.

That’s good news for the G20 after health ministers committed to tackling the threat comprehensively at their meeting last month. Antimicrobial resistance is the ability of microbes to block the effect of drugs that are meant to kill them. This makes infections harder to treat and can lead to longer hospital stays, more expensive care and increased risk of death.

The high level of antimicrobial resistance in Indonesia is now becoming a silent pandemic.

Explained | Is air pollution driving the rise of antibiotic resistance? 

The United Nations has warned the rise of ‘superbugs’ could kill 10 million people a year globally by 2050 and be a drain on the world economy. Like in many other countries, the improper use of antimicrobial drugs and other factors that trigger resistance, such as poor sanitation and air pollution, are prevalent in Indonesia. In 2015, the 68th World Health Assembly adopted the Global Action Plan on antimicrobial resistance.

It emphasises the importance of enhanced global surveillance, particularly in low- and middle-income countries where it is a major concern. One of the key pillars of the Global Action Plan is the support for national strategies through improved global surveillance.

The proposed global surveillance system aims to estimate the prevalence of resistance by using laboratory testing of clinical samples. However, this approach is not always practical in developing countries because of their limited access to quality microbiology diagnostics.

Population-based surveillance is a preferred strategy, but it is also time-consuming, labour-intensive and costly. That means many regions need a rapid, feasible and affordable surveillance strategy.

Explained | The challenge of antimicrobial resistance

Indonesian researchers found an alternative approach: they tried lot quality assurance sampling. This method, which was originally developed in the manufacturing industry to assess batch quality, involves classifying a population as having a high or low prevalence of antimicrobial resistance based on a small sample size.

It has proved to be more practical and cost-effective than conventional population-based surveillance. The Indonesian research applied the lot-based approach to assess the prevalence of antimicrobial resistance in patients with suspected urinary tract infections.

The researchers wanted to estimate the test characteristics for identifying populations with a high prevalence of resistance in urinary tract pathogens, provide lot-sampling classifications for 15 antibiotics in 11 different settings and estimate the cost of implementing lot sampling in a single health facility.

The testing was done in the Indonesian cities of Medan and Bandung, and the exercise was repeated 1,000 times for each of the 13 lots.

Also Read | Putting minds and funds together to find ways of tackling drug resistance 

They found lot testing was 98 percent effective in correctly identifying populations with a high prevalence of antimicrobial resistance.

Overall, the researchers were able to show that lot quality assurance sampling is a promising approach to efficiently estimate antimicrobial resistance prevalence and guide treatment decisions, especially in resource-limited settings.

By significantly reducing sample size requirements and increasing efficiency, lot-based surveillance could significantly contribute to public health efforts to combat antimicrobial resistance worldwide. The findings are particularly significant in the context of the growing importance of surveillance as a crucial tool for antimicrobial stewardship.

Previous studies on drug resistance have shown lot-based surveys are effective in identifying local variations in drug-resistant tuberculosis and assessing the prevalence of transmitted drug resistance in HIV.

This style of survey could be implemented at sentinel sites, enabling regular assessments of changing trends, intervention impacts, or early detection of resistance development after introducing new drugs. This utility is particularly beneficial in settings with limited microbiology capacity or where empirical treatment is common, such as primary care settings globally.

The cost of the lot-based surveys, including 15 antibiotics, ranged between US USD 403 and USD 514 in the 11 sites studied — relatively cheaper than conventional testing regimes. Despite some limitations, including the need for careful site selection and ensuring proper laboratory accreditation and quality control, lot quality assurance sampling shows promise in providing valuable information on antimicrobial resistance for both clinicians and policymakers.