Fetal haemoglobin response to hydroxycarbamide treatment and sar1a promoter polymorphisms in sickle cell anaemia

The hydroxycarbamide (HC)-inducible small guanosine triphosphate (GTP)-binding protein, secretion-associated and RAS-related (SAR) protein has recently been shown to play a pivotal role in HBG induction and erythroid maturation by causing cell apoptosis and G1/S-phase arrest. Our preliminary analysis indicated that HC inducibility is transcriptionally regulated by elements within the SAR1A promoter. This study aimed to assess whether polymorphisms in the SAR1A promoter are associated with differences Hb F levels or HC therapeutic responses among sickle cell disease (SCD) patients. We studied 386 individuals with SCD comprised of 269 adults treated with or without HC and 117 newborns with SCD identified from a newborn screening program. Three previously unknown single nucleotide polymorphisms (SNPs) in the upstream 5′UTR (−809 C>T, −502 G>T and −385 C>A) were significantly associated with the fetal haemoglobin (HbF) response in Hb SS patients treated with HC (P < 0·05). In addition, four SNPs (rs2310991, −809 C>T, −385 C>A and rs4282891) were significantly associated with the change in absolute HbF after 2 years of treatment with HC. These data suggest that variation within SAR1A regulatory elements might contribute to inter-individual differences in regulation of HbF expression and patient responses to HC in SCD

Vulnerability to Climate Change: Adaptation Strategies and Layers of Resilience – Quantifying Vulnerability to Climate Change in Thailand

This report was prepared as part of the ADB funded project “Vulnerability to Climate Change: Adaptation Strategies and Layers of Resilience”. The study tried to address the perception of farmers on changes in climate variables, trends in village level institutions and other socio-economic variables such as cropping pattern, natural resources, constraints in effective adaptation. Purposive stratified sampling techniques were adopted in selecting the study area and the households. Four villages from northeast region of Thailand (two villages from Chok Chai district and 2 villages from Chatturat district) were selected for this study. Both quantitative and qualitative data were collected through farmer surveys, group discussions and key informant interviews. The villagers perceived a reduction in rainfall and increase in variability including onset of major rainy season. The villages have been experiencing increased incidence of drought resulting in yield loss, non- availability of water for irrigation, increased pest and diseases attack, and migration. Farmers perceived a minor increase in agriculture over the years; however, there is still a trend of diversification of livelihood among farmers from traditional agriculture to high-value crops and other non-agricultural sectors. Over the years, there have been slow but steady improvements in the human development indicators, village infrastructure and collective initiatives in all the study villages. Increased diversification in cropping pattern, improvement in market access, etc, are seen in these villages. The rural community in the study villages tries to cope with these changes by reducing expenses on food, working as agricultural or non-farm labor, leasing crop land, making changes in cropping pattern and in crop management strategies. The higher degree of impact of these climate-related risks is comparatively on landless and smallholder farmers than on medium and large farmers. They have identified a list of constraints that prevents them from succeeding in efficient adaptation such as lack of sufficient information on climate change and potential adaptation technologies, sufficient support programs, market and other livelihood options

Genetic variation associated with infection and the environment in the accidental pathogen Burkholderia pseudomallei

Funder: Thailand National Science and Technology Development Agency (FDA-CO-2562-8764-TH) and Thailand Science Research and Innovation fund (MRG6280226)Funder: Food Standards Agency Fellow and is supported by the BBSRC Institute Strategic Programme Microbes in the Food Chain BB/R012504/1 and its constituent projects BBS/E/F/000PR10348 (Theme 1, Epidemiology and Evolution of Pathogens in the Food Chain) and BBS/E/F/000PR10351 (Theme 3, Microbial Communities in the Food Chain)Abstract: The environmental bacterium Burkholderia pseudomallei causes melioidosis, an important endemic human disease in tropical and sub-tropical countries. This bacterium occupies broad ecological niches including soil, contaminated water, single-cell microbes, plants and infection in a range of animal species. Here, we performed genome-wide association studies for genetic determinants of environmental and human adaptation using a combined dataset of 1,010 whole genome sequences of B. pseudomallei from Northeast Thailand and Australia, representing two major disease hotspots. With these data, we identified 47 genes from 26 distinct loci associated with clinical or environmental isolates from Thailand and replicated 12 genes in an independent Australian cohort. We next outlined the selective pressures on the genetic loci (dN/dS) and the frequency at which they had been gained or lost throughout their evolutionary history, reflecting the bacterial adaptability to a wide range of ecological niches. Finally, we highlighted loci likely implicated in human disease

Is a HIV vaccine a viable option and at what price? An economic evaluation of adding HIV vaccination into existing prevention programs in Thailand

<p>Abstract</p> <p>Background</p> <p>This study aims to determine the maximum price at which HIV vaccination is cost-effective in the Thai healthcare setting. It also aims to identify the relative importance of vaccine characteristics and risk behavior changes among vaccine recipients to determine how they affect this cost-effectiveness.</p> <p>Methods</p> <p>A semi-Markov model was developed to estimate the costs and health outcomes of HIV prevention programs combined with HIV vaccination in comparison to the existing HIV prevention programs without vaccination. The estimation was based on a lifetime horizon period (99 years) and used the government perspective. The analysis focused on both the general population and specific high-risk population groups. The maximum price of cost-effective vaccination was defined by using threshold analysis; one-way and probabilistic sensitivity analyses were performed. The study employed an expected value of perfect information (EVPI) analysis to determine the relative importance of parameters and to prioritize future studies.</p> <p>Results</p> <p>The most expensive HIV vaccination which is cost-effective when given to the general population was 12,000 Thai baht (US$1 = 34 Thai baht in 2009). This vaccination came with 70% vaccine efficacy and lifetime protection as long as risk behavior was unchanged post-vaccination. The vaccine would be considered cost-ineffective at any price if it demonstrated low efficacy (30%) and if post-vaccination risk behavior increased by 10% or more, especially among the high-risk population groups. The incremental cost-effectiveness ratios were the most sensitive to change in post-vaccination risk behavior, followed by vaccine efficacy and duration of protection. The EVPI indicated the need to quantify vaccine efficacy, changed post-vaccination risk behavior, and the costs of vaccination programs.</p> <p>Conclusions</p> <p>The approach used in this study differentiated it from other economic evaluations and can be applied for the economic evaluation of other health interventions not available in healthcare systems. This study is important not only for researchers conducting future HIV vaccine research but also for policy decision makers who, in the future, will consider vaccine adoption.</p