Chronic kidney disease
Non-dialysis chronic kidney disease (CKD) patients receiving intravenous (IV) iron therapy may have increased risks for infection, according to a poster presentation at the American Society of Nephrology’s Kidney Week 2018 conference.
Summer Dyer, PharmD, and colleagues from VA San Diego Healthcare System, compared infection risk in 136 treated and 411 untreated CKD patients at their clinic during 2014 to 2017. Treated patients received IV ferumoxytol 510 mg every week for two doses or iron sucrose 200 mg every week for five doses. None had end stage renal disease, active infection, or immunosuppression.
At 1 infection (defined as an IV or oral antibiotic prescription) developed in twice as many patients receiving IV iron in the three months after their visit: 16.2 percent vs 8.0 percent. IV iron recipients had 2.2 times higher risks for infection than non-recipients.
Respiratory and osteomyelitis infections were more common in IV iron users, although sepsis rates were similar between the groups. Hospitalization was required for just 23 percent of iron users vs 48 percent of nonusers. Investigators noted that previous studies associated bacterial growth (Escherichia coli and Staphlyococus epidermidis) with iron supplementation.
“The use of intravenous iron therapy has escalated in the treatment of anemia of CKD in order to optimize hemoglobin outcomes with the use of erythropoiesis-stimulating agents,” Dyer and her colleagues concluded. “Thoughtful consideration of the risks and benefits are warranted in prescribing IV iron.”
Infectious disease
Millions of people with high blood sugar may be at greater risk of tuberculosis (TB) than previously thought, scientists said, warning that diabetes and TB could combine to create the “perfect storm” of disease.
Tuberculosis, a severe infection caused by bacteria in the lungs, kills almost as many people each year as HIV/AIDS and malaria combined. In 2017 nearly 10 million people developed TB, according to the World Health Organization (WHO), and experts are concerned that a global explosion in diabetes will put millions more at risk.
New research was recently unveiled at a global lung health conference in The Hague also suggests further cause for worry.
For the study, scientists at the London School of Hygiene and Tropical Medicine conducted blood tests on people living with tuberculosis and diabetes in four countries: South Africa, Romania, Indonesia and Peru. They then tested people with TB and blood sugar levels that were high, but below the threshold for diabetes. They found that blood samples from those who did not have diabetes still contained molecules associated with people suffering from TB/diabetes.
In some countries such as India, home to roughly a quarter of all TB cases, anyone found to be carrying TB must automatically be screened for diabetes, and vice versa.
The link between diabetes and tuberculosis is known, though poorly understood. Diabetes slows the body’s natural defences, allowing TB the chance to develop. While TB infections and deaths have declined slightly in the last decade, type II diabetes has exploded.
It is a potent risk: roughly one in four people on Earth carry the tuberculosis bacteria in their bodies, and the World Health Organization (WHO) says more than 450 million people worldwide are type II diabetic.
Paul Jensen, director of policy and strategy at The Union, said the countries of greatest concern were those with a high latent TB rate and a growing diabetes problem which includes India, China, Pakistan and several southeast Asian countries.
Although TB is curable, the treatment regimen has historically been long, painful, and comes with significant side effects. The global fight against TB has frequently focused on HIV/AIDS prevention, as that disease, like diabetes, increases TB risk.
Blood collection
Numerous studies have examined whether storage time affects the safety and quality of red blood cells (RBCs), but few studies have taken into account the collection and processing methods which may confound these results.
In order to investigate differences in collection and processing methods, Almizraq and colleagues recently collected blood from donors using four different methods (n = 8 per method): (1) whole blood which was leukoreduced; (2) RBCs separated from whole blood by centrifugation and then leukoreduced; (3) RBCs collected using apheresis; and (4) whole blood with plasma extracted by centrifugation.
Using an in vitro transfusion model, the cytokine profile of monocytes exposed to the four different types of blood product were then measured at days 5 and 42. While immunomodulatory effects were largely independent of storage time, the cytokine profile of the monocytes differed based on the collection and processing method. The RBCs collected via apheresis were immunosuppressive, while whole blood that was leukoreduced was inflammatory since the monocytes produced more interleukin-8.
The researchers also found the number and size of extracellular vesicles to differ based on the collection and processing method used; monocytes exposed to RBCs which were leukoreduced had fewer extracellular vesicles.
Further research is warranted in order to determine if blood collection and processing methods affect clinical outcomes after transfusion.
HIV
Uganda’s army has launched its own brand of condoms, named after the Swahili word for “protection,” to help prevent soldiers contract HIV. A soldier cannot defend his country if he “does not ensure that he’s safe”, said Chief of Staff Brig Leopold Kyanda at the launch of the Ulinzi condom.
Nearly six percent of Ugandan adults are living with HIV but strides have been made in reducing the number of new infections. In the past, the country’s army was known to have a high infection rate.
The Ulinzi condom, which comes in a camouflage packet, should help stop soldiers bringing HIV back home after a tour of duty, said the ministry of health’s Vastha Kibirige.
“The nature of this job has many challenges. [The soldiers] sometimes go to war zones where they meet up with women for pleasure. They have to protect their lives to avoid infecting their wives back home,” she told Uganda’s NTV news.
The United Nations’s HIV/Aids organization, UNAids, says that Ugandans use condoms just over half the time when they engage in what is described as “high-risk sex.”
Aids-related deaths in Uganda peaked in 1999 at 74,000 but have declined since then, the UN says. It estimates that 26,000 people died of Aids-related illnesses in 2017.
The fall in the death rate can be put down to more prevention campaigns as well as greater access to antiretroviral (ARVs) drugs that help stop the growth of the virus in the body.
More than 70 percent of people living with HIV now use ARVs, which are available for free.
Scientific opportunities
The National Institutes of Health’s Human BioMolecular Atlas Program (HuBMAP) issued its first set of research funding awards to develop an open, global framework that will support research community efforts to map the adult human body at the level of individual cells. HuBMAP is a program of the National Institute of Health (NIH) Common Fund. Common Fund programs address emerging scientific opportunities and high-priority challenges for the NIH. The HuBMAP awards total $54 million over the next four years, pending available funds.
The adult human body is composed of tens of trillions of cells carefully organized in tissues to carry out the daily processes to keep us alive and healthy. The organization, specialization, and cooperation of different cells within each normal tissue have a profound impact on tissue growth, function, and aging. These factors can also indicate the emergence of disease. For example, immune cells reside in normal tissues as part of their regular surveillance duties. The ability to detect subtle changes in the activity of individual immune cells and in their interactions with other cells within tissues would help signal the emergence of disease before symptoms are clinically detectable.
Understanding the important high-resolution features of cells in tissues remains a challenge. Recently developed technologies, including many supported through NIH programs, allow researchers to explore the organization of large numbers of cells at the individual cell level. These advances opened the possibility to study and map the organization of all cells within tissues or organs across the human body.
While HuBMAP is not anticipated to map the entire body, it will get the work started, providing a framework for more complete mapping and making data available to the research community for further study.
Through the research awards, HuBMAP investigators will:
- Generate, standardize, and validate extensive data sets on cell organization and variability using existing technologies;
- Develop new tools and techniques to construct high-resolution tissue maps; and
- Coordinate program activities, manage HuBMAP data, and build an atlas of tissue maps.
“We’re excited for HuBMAP to start its journey to expand our understanding of the principles of tissue organization” said James M. Anderson, MD, PhD, director of the Division of Program Coordination, Planning, and Strategic Initiatives, which oversees the NIH Common Fund. “We expect HuBMAP to provide a vital framework for global efforts to comprehensively understand the human body at a biomolecular level.”
Correction
Please note the following correction was made in the September 2018 issue of MLO, Special Feature, “New applications for NGS,” by David Cook, senior product manager for Oxford Gene Technology.
Figures 3a and 3b, found on page 27, were incorrect. The legends read correctly, however, the images needed switching.
Please view the corrected online version, here: https://www.mlo-online.com/new-applications-for-ngs.
We apologize for the error.
