News
World Sepsis Day
Sepsis remains the primary cause of death from infection, despite advances in modern medicine like vaccines, antibiotics, and intensive care. A recent global assessment of the mortality rate of patients with sepsis treated in an intensive care unit found that over one third of these patients died without leaving hospital.
In the developing world sepsis accounts for 60-80% of lost lives per year, affecting more than 6 million newborns and children annually and over 100,000 women contract sepsis in the course of pregnancy and childbirth. It is more common than heart attack, and claims more lives than any cancer, yet even in the most developed countries fewer than half of the adult population have heard of it.
Learn more about sepsis in support of World Sepsis Day:
A cinematic approach to drug resistance
Scientists from Harvard Medical School and Technion-Israel Institute of Technology have designed a simple way to observe how bacteria move as they become impervious to drugs. The experiments, described in an issue of Science, are thought to provide the first large-scale glimpse of the maneuvers of bacteria as they encounter increasingly higher doses of antibiotics and adapt to survive.
To do so, the team constructed a 2-by-4 foot petri dish and filled it with 14 liters of agar. Observing how the bacterium Escherichia coli adapted to increasingly higher doses of antibiotics, researchers divided the dish into sections and saturated them with various doses of medication. The outermost rims of the dish were free of any drug. The next section contained a small amount of antibiotic — just above the minimum needed to kill the bacteria — and each subsequent section represented a 10-fold increase. Over two weeks, a camera mounted on the ceiling above the dish took periodic snapshots that the researchers spliced into a time-lapsed montage. The result? A powerful, unvarnished visualization of bacterial movement, death, and survival; evolution at work, visible to the naked eye.
Lab-on-a-chip diagnostics: When will clinical laboratories see the revolution?
For nearly 20 years, researchers have heralded microfluidic devices, paper-based diagnostics, and other lab-on-a-chip (LOC) technologies, as ways to reduce the time and costs of clinical laboratory services. When is the revolution?
A paper published in ScienceDirect discusses the largest obstacles believed to face the widespread use of LOC devices. Co-author Mazher-Iqbal Mohammed, research fellow at Deakin University, noted, "Many academic researchers are found guilty of leaving the challenge of technology transfer into a commercially viable product as an afterthought over being a critical consideration of the overall engineering process chain."
Another major issue is the dependence of many lab-on-a-chip devices on ancillary equipment. While the chip itself might offer an affordable and easily-accessed alternative to traditional laboratory tests, by the time the costs of pumps, power supplies, signal acquisition equipment, and other needs are included, LOC devices are no longer the pocket- and budget-friendly devices seen in headlines. Lastly, the paper’s authors noted that a lack of standardization is preventing the mass production, development, and implementation of most LOC devices.
Microbiology
Do patients admitted with community-acquired pneumonia really require IV antibiotics?
Although the majority of community-acquired pneumonia (CAP) cases can be managed purely in the outpatient setting, approximately one-fifth of patients presenting to the emergency department require hospital admission.
The Infectious Diseases Society of America (IDSA), American Thoracic Society (ATS) and the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) based their treatment management guidelines heavily on a meta-analysis performed in 2004, which found no differences in mortality between non-ICU CAP patients treated with oral and IV antibiotics.
Since the 2004 meta-analysis, two small trials evaluated the guidelines. The first was a small single-arm prospective trial showing high clinical response rates (96.1%) in CAP patients treated with oral gemifloxacin. This study, however, included both inpatient- and outpatient-treated CAP and didn’t report how many fell into each category. The second was a small prospective trial that showed no difference in clinical efficacy of oral versus IV levofloxacin in CAP patients. Again, this study included a mixture of inpatients (42%) and outpatients, it’s unknown if treatment rates are retained when stratifying the two populations. It appears that the IDSA/ATS recommendation of choosing initial IV antibiotics except in those with less severe disease may be substantiated by this study. To truly answer this question, however, a randomized, controlled trial is required. The IDSA/ATS plans for the release of revised CAP guidelines in summer 2017.
Molecular Biology
Toronto study questions 'reproductive benefits' of newborn genetic tests
A majority of mothers ignore their newborn’s genetic screening results when deciding whether to get pregnant again, a new Canadian study suggests. The paper, published in the journal Genetics in Medicine, questions the "reproductive benefits" of sharing certain genetic testing results with parents when "people don’t make use of the information or make inappropriate use of the information," said Dr. Yvonne Bombard, a genomics health services researcher at St. Michael’s Hospital.
The research followed a group of mothers whose babies carried a genetic marker for cystic fibrosis, which generates a large number of carriers and causes problems with breathing and growth. "There is no clinical use to learning that information for that child. But there is a reproductive benefit for their parents immediately. Should they choose to have more children, then it’s likely that one or both of them are carriers and therefore they would be at risk of having an affected child," said Dr. Bombard. Still, 65 per cent of the mothers in the study said they did not expect the screening results to influence their family planning. All the mothers said they valued learning their infants’ carrier results and a little more than half had carrier testing themselves. Others admitted they "told everyone" in their families that they may be cystic fibrosis carriers without confirming which side of the family was at risk. Bombard advises against this approach.
Research
Simple blood test could be used to detect breast cancer
Researchers at The University of Western Australia are working on a quick, simple and less invasive blood-based test that can detect breast cancer progression or relapse much earlier than current methods such as mammogram, MRI or biopsy. "Our research examines cancer 'exosomes' which are parts of the cancer shed into the body fluids that can drive the spread and aggressiveness of cancer. These exosomes, or biomarkers of disease, can be detected during routine blood tests and as early studies show exosome levels increase with more aggressive cancers, our research will monitor exosome levels in patients' blood during treatment." described project lead Dr. Katie Meehan from the School of Pathology and Laboratory Medicine.
"We hope to show that when exosomes become undetectable in the blood, this indicates the cancer is gone or if exosomes remain in the blood, this may identify a cancer at risk of returning." Dr. Meehan said developing blood-based assessments would revolutionize patient care and avoid the need for painful and invasive procedures, which was particularly relevant for women with metastatic breast cancer.
Video: Watch to Dr. Katie Meehan describe this new blood test
TSRI and IAVI researchers harness antibody evolution on the path to an AIDS vaccine
A series of new studies led by scientists at The Scripps Research Institute (TSRI) and the International AIDS Vaccine Initiative (IAVI) describe a potential vaccination strategy to jump-start the selection and evolution of broadly effective antibodies to prevent HIV infection.
The new studies, published September 8, 2016, in the journals Cell and Science, showed the immune system can be prompted to mimic and accelerate a rare natural process during which antibodies slowly evolve to become better at targeting the constantly mutating HIV virus. A vaccine needs to elicit those rare antibodies, called "broadly neutralizing antibodies" (bnAbs), which fight a wide variety of strains of HIV.
One strategy to accomplish this, which scientists at TSRI have dubbed the "reductionist" strategy, is to find which antibody mutations are most important for making them effective against HIV, then to "prime" the immune system to start making antibody precursors. From there, scientists hope to prompt one important mutation after another with a series of different "booster" shots, deliberately building up a bnAb.
It was found that the vaccine priming protein activated the appropriate antibody precursors in one-third to one-half of mice tested, suggesting this feat would also be possible in humans, where the targeted precursor cells are more plentiful. The researchers plan to test this strategy in an upcoming human clinical trial.
Scientists develop forensic method to identify humans using hair proteins
A Lawrence Livermore National Laboratory - led interdisciplinary research team has developed the first-ever biological identification method that exploits the information encoded in proteins of human hair. "Nuclear DNA is the gold standard for human identification, but it is quite fragile," said team member Dr. Brad Hart, a chemist with Lawrence Livermore National Laboratory. "When the DNA molecule degrades from light, heat exposure or other environmental conditions, it becomes useless for identification." In contrast, protein is chemically more stable than DNA, can persist for longer periods and can be found in different tissue types, including hair, shed skin cells, bones, and teeth.
The team investigated whether the protein found in human hair could offer another tool for identifying individuals in forensic or archaeology scenarios. The study examined hair samples for 66 European-Americans, five African Americans, five Kenyans and six skeletal remains from the 1750s and 1850s. They have found a total of 185 hair protein markers to date, which they estimate would be sufficient to provide a unique pattern for an individual that could distinguish that person among a population of one million. They believe that the number could go as high as 1,000.
Thank you!
We appreciate that you have taken the time to read LabBuzz. This is a CSMLS venture to provide relevant medical laboratory news to its members.
We need your help to grow this newsletter! Please pass along the subscription link to any colleague you think would benefit from hearing about med lab news.
If you have any suggestions to improve LabBuzz, we would love to hear from you. In fact, if you have a news or publication link you would like us to consider for a future issue, please send it to labbuzz@csmls.org