Fulminant cryptosporidiosis after near-drowning: a human Cryptosporidium parvum strain implicated in invasive gastrointestinal adenocarcinoma and cholangiocarcinoma in an experimental model

In the present work, we report the characterization of a Cryptosporidium parvum strain isolated from a patient who nearly drowned in the Deule River (Lille, France) after being discharged from the hospital where he had undergone allogeneic stem cell transplantation. After being rescued and readmitted to the hospital, he developed fulminant cryptosporidiosis. The strain isolated from the patient's stools was identified as C. parvum II2A15G2R1 (subtype linked to zoonotic exposure) and inoculated into SCID mice. In this host, this virulent C. parvum isolate induced not only severe infection but also invasive gastrointestinal and biliary adenocarcinoma. The observation of adenocarcinomas that progressed through all layers of the digestive tract to the subserosa and spread via blood vessels confirmed the invasive nature of the neoplastic process. These results indicate for the first time that a human-derived C. parvum isolate is able to induce digestive cancer. This study is of special interest considering the exposure of a large number of humans and animals to this waterborne protozoan, which is highly tumorigenic when inoculated in a rodent model

Urban mobility and transportation

Urban areas are developing quickly, innovative technologies grant enlarged scope for mobility management. According to literature, 50% of world population and as much as 75% of EU population live in cities, where the majority of GDP is generated. CO2 is responsible of 75% GHG worldwide and transportation is worth around 20% of this share and the contribution is rising, in particular in urban areas. Besides pollution and noise, also collisions (70% of which in urban areas) and congestion - which is worth around 1% of EU GDP in terms of time lost due to delay suffered - are negative externalities. Finally, due to urban sprawl induced by car-centric cultural regimen under the justification of cheaper land costs, the need to travel has been growing notwithstanding economic downturns, resulting in an increased threat of social exclusion for those who cannot afford a car. The attitude towards urban transportation has shifted from laissez-faire to deep concern: as far as EU is concerned, the Action plan on Urban Mobility (2009) recommended the adoption of Sustainable Urban Mobility Plans (SUMPs), the 2011 White Paper envisaged SUMPs to become mandatory for cities over 100,000 inhabitants and a base requisite to access to EU Funds. The 2013 Guidelines and the 2015 EC Urban Mobility Package have further established the SUMP policy. In 2015, UN adopted the “Agenda for sustainable development 2030” (7 out of 17 objectives deal with transportation) and a new worldwide agreement on climate has been signed in Paris. Finally, the funding foreseen by EU research project H2020 (8,2% of the total budget allocated on transportation) will further encourage the investigation of new strategies and technologies. SUMPs emphasize long term vision, the active involvement of citizen and stakeholders (Priester et al., 2014), the setting of targets, measures and a radical reform of regulatory and funding framework to avoid start-and-stop approach (Hickman et al., 2013; Stephenson et al., 2018). Nevertheless, the commitment level is different: developing countries would rather urge to build more and modern infrastructures, leaving the environment as a secondary priority. SUMPs are expected to find solution to road congestion and policy fragmentation between documents (Baidan, 2016). According to EU CIVITAS project’s outcomes, the implementation of SUMPs can be hindered by pro-car & infrastructure building lobbyism, inefficient planning - monitoring – dissemination, lack of stakeholder involvement and support, excessive outsourcing, fluctuation of political commitment over time (Ibeas et al., 2011; Persia et al., 2016), inadequate coordination among policy tiers and plans (Stephenson et al., 2018), unsupportive or inappropriate regulation and financial structures, poor or missing data and reliance to business-as-usual scenarios. The topics facing less acceptance have been accessibility, logistic, traffic control, cycling and walking measures (Bruhova Foltynova & Jordova, 2014)