News & numbers “The silver lining of Covid is that it has focused people’s attention on access. The tragedy is that
a lot of people died to get that focus.” Charles Gore, executive director of the Medicines Patent Pool (MPP) speaking in The Guardian
New target for colon cancer
Researchers at Mount Sinai’s Tisch Cancer Institute have identified a new gene essential to colon cancer growth. They also found that inflammation in the external environment around the tumour can contribute to the growth of tumour cells. This is the first time that scientists have discovered the environment around a colon cancer tumour can programme what is known as a “super enhancer” – a complex area of DNA with a high concentration of transcriptional machinery that controls whether a cell is malignant. This super enhancer – the name given to the largest 1–2% of all enhancers in a cancer cell – regulates the gene PDZK1IP1, which has been previously identified as an oncogene in other cancers. Once the researchers deleted PDZK1IP1, colon cancer growth slowed down, suggesting the gene and its super enhancer could be targets for anti-cancer therapies. “What this means for most patients with
colon cancer is that inflammation that’s occurring in the tumour is contributing to its growth. This stresses the importance of understanding what we can do to curb the inflammatory effects in the colon through prevention or understanding what dietary effects might have on the microenvironment in the colon,” said senior author Ramon Parsons, MD, PhD, director of The Tisch Cancer Institute at the Icahn School of Medicine at Mount Sinai. “In terms of treatment, we have genetic evidence that targeting this gene actually inhibits tumours. By understanding all these different components, we will have better tools to try to prevent the disease.” The study found that the super enhancer is activated by surrounding inflammation in the tumour microenvironment. Inflammatory bowel disease is a known risk for colon cancer and this finding could add to the understanding of the mechanisms involved.
Long-Covid increases healthcare use
A large study on the impact of long-Covid found increased rates of health system use in the two months following infection with SARS-CoV-2, which has implications for health care delivery in the future. Researchers looked at ICES data – data collected through the routine administration of Ontario’s system of publicly funded health care – on 531,702 people in Ontario, 268,521 of whom tested positive on a PCR test for the virus that causes Covid-19 between January 1, 2020 and December 31,2021. The findings showed that two months or more after infection, health care use was more frequent among people who tested positive, especially women (the mean age of the study was 44 years, and 51% were female).
“Given the number of recent infections, our findings portend substantial health care use by people in Canada,” says Dr. Candace McNaughton, an emergency physician at Sunnybrook Research Institute, Toronto,
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Ontario. “For family medicine doctors who had 20 clinic visits per day before the Covid-19 pandemic, based on the number of people in Canada who were recently infected, they will need to find time and resources for 100 more clinic visits per year, and there are fewer physicians now than before the pandemic.”
The greatest increase in healthcare use was in a small subset of the population – about 1% of people who tested positive. These patients spent an extra week or more in hospital over the following year compared with people who weren’t infected. In early 2022, it was estimated that almost half (45%) the population of Canada had been infected with SARS-CoV-2. Most people who were infected with SARS-CoV-2 will not have more health care encounters, but they will be competing for scarcer resources, as will the 1% of people whose health care needs increase substantially.
Centurion livers
There is a small but growing subset of livers that have been transplanted and have a cumulative age of more than 100 years, according to researchers from University of Texas (UT) Southwestern Medical Center, Dallas, and TransMedics, Andover, Massachusetts. They studied these livers to identify characteristics to determine why these organs are so resilient, paving the way for considering the potential expanded use of older liver donors. “We looked at pre-transplant survival – essentially, the donor’s age – as well as how long the liver went on to survive in the recipient,” said lead study author Yash Kadakia, a medical student at UT Southwestern Medical School. “We stratified out these remarkable livers with more than 100-year-survival and identified donor factors, recipient factors, and transplant factors involved in creating this unique combination where the liver was able to live to 100 years.” The researchers used the United Network for Organ Sharing (UNOS) STARfile to identify livers that had a cumulative age (total initial age at transplant plus post- transplant survival) of at least 100 years. Of 253,406 livers transplanted between 1990-2022, 25 livers met the criteria of being centurion livers.
For these centurion livers, the average donor age was significantly higher, 84.7 years compared with 38.5 years for non- centurion liver transplants. The researchers noted that for a liver to make it to 100, they expected to find an older average donor age as well as healthier donors. Notably, the donors from the centurion group had lower incidence of diabetes and fewer donor infections. “We previously tended to shy away from using livers from older donors,” said study co-author Christine S. Hwang, MD, FACS, associate professor of surgery, UT Southwestern Medical Center. “If we can sort out what is special among these donors, we could potentially get more available livers to be transplanted and have good outcomes.”
According to the Organ Procurement
& Transplantation Network There are 11,002 patients in the US on liver transplant waiting list as of October 16 2022. As Hwang noted, using older liver donors more often could potentially expand the liver donor pool.
Practical Patient Care /
www.practical-patient-care.com
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