Molecular dissection of the human antibody response to the structural repeat epitope of Plasmodium falciparum sporozoite from a protected donor

BACKGROUND: The circumsporozoite surface protein is the primary target of human antibodies against Plasmodium falciparum sporozoites, these antibodies are predominantly directed to the major repetitive epitope (Asn-Pro-Asn-Ala)(n), (NPNA)(n). In individuals immunized by the bites of irradiated Anopheles mosquitoes carrying P. falciparum sporozoites in their salivary glands, the anti-repeat response dominates and is thought by many to play a role in protective immunity. METHODS: The antibody repertoire from a protected individual immunized by the bites of irradiated P. falciparum infected Anopheles stephensi was recapitulated in a phage display library. Following affinity based selection against (NPNA)(3 )antibody fragments that recognized the PfCSP repeat epitope were rescued. RESULTS: Analysis of selected antibody fragments implied the response was restricted to a single antibody fragment consisting of V(H)3 and V(κ)I families for heavy and light chain respectively with moderate affinity for the ligand. CONCLUSION: The dissection of the protective antibody response against the repeat epitope revealed that the response was apparently restricted to a single V(H)/V(L )pairing (PfNPNA-1). The affinity for the ligand was in the μM range. If anti-repeat antibodies are involved in the protective immunity elicited by exposure to radiation attenuated P. falciparum sporozoites, then high circulating levels of antibodies against the repeat region may be more important than intrinsic high affinity for protection. The ability to attain and sustain high levels of anti-(NPNA)(n )will be one of the key determinants of efficacy for a vaccine that relies upon anti-PfCSP repeat antibodies as the primary mechanism of protective immunity against P. falciparum

Preventing empirical antibiotic treatment failure in migrant populations: screening by infection risk, not ethnic background

Multidrug-resistant organisms (MDROs) are a major international health threat. In many low and middle-income countries poorly regulated antibiotic use, limited surveillance, and inadequate sanitation give rise to high rates of antibiotic resistance. A resulting reliance on last-line antibiotic options further contributes to the emergence of MDROs. The potential for these pathogens to spread across international borders is a matter of considerable concern. However, this problem is commonly framed as primarily a threat to the health security of countries where resistance is not yet endemic. In fact, it is little acknowledged that those at greatest risk from antibiotic treatment failure are individuals who move from regions of high MDRO prevalence to settings where standard empirical treatment options remain largely effective. In this perspective, we highlight the poor treatment outcomes for disseminated bacterial infections in individuals who have moved from settings in which MDROs are common to those where MDROs are currently less common. We discuss MDRO screening strategies that could avoid stigmatizing vulnerable populations by focusing on future risk of disseminated infection, rather than past risk of acquisition. In practical terms, this means screening individuals before childbirth, immunosuppressive treatments, major surgery, or other events associated with disseminated infection risk, rather than prioritizing screening for individuals from regions with high carriage rates. We argue that such measures would reduce antibiotic treatment failure and improve outcomes while protecting migrant populations from the divisive consequences of targeted screening programs.Steven L. Taylor, Lito E. Papanicolas, Erin Flynn, Mark A. Boyd, Steve L. Wesselingh, Geraint B. Roger

Opportunistic bacteria confer the ability to ferment prebiotic starch in the adult cystic fibrosis gut

Chronic disruption of the intestinal microbiota in adult cystic fibrosis (CF) patients is associated with local and systemic inflammation, and has been linked to the risk of serious comorbidities. Supplementation with high amylose maize starch (HAMS) might provide clinical benefit by promoting commensal bacteria and the biosynthesis of immunomodulatory metabolites. However, whether the disrupted CF gut microbiota has the capacity to utilise these substrates is not known. We combined metagenomic sequencing, in vitro fermentation, amplicon sequencing, and metabolomics to define the characteristics of the faecal microbiota in adult CF patients and assess HAMS fermentation capacity. Compared to healthy controls, the faecal metagenome of adult CF patients had reduced bacterial diversity and prevalence of commensal fermentative clades. In vitro fermentation models seeded with CF faecal slurries exhibited reduced acetate levels compared to healthy control reactions, but comparable levels of butyrate and propionate. While the commensal genus Faecalibacterium was strongly associated with short chain fatty acid (SCFA) production by healthy microbiota, it was displaced in this role by Clostridium sensu stricto 1 in the microbiota of CF patients. A subset of CF reactions exhibited enterococcal overgrowth, resulting in lactate accumulation and reduced SCFA biosynthesis. The addition of healthy microbiota to CF faecal slurries failed to displace predominant CF taxa, or substantially influence metabolite biosynthesis. Despite significant microbiota disruption, the adult CF gut microbiota retains the capacity to exploit HAMS. Our findings highlight the potential for taxa associated with the altered CF gut microbiotato mediate prebiotic effects in microbial systems subject to ongoing perturbation, irrespective of the depletion of common commensal clades

Autism community research priorities: the potential of future research to benefit autistics

Despite the enormous amounts of money spent on autism research, there has been little focus to date on what members of the autistic community believe should be prioritised by autism researchers. Our systematic review of the literature identified three published studies that had developed wide-ranging autism research priority sets. We undertook an in-depth analysis of these priorities sets to determine whether research focused on each priority had the potential to benefit the well-being of and/or emancipate autistic individuals. For this purpose, we used published ‘inclusive research’ criteria. We also compared the three sets of autism research priorities in the context of autistic well-being and emancipation. Our findings demonstrated substantial differences between the priorities in the studies in terms of whether they might benefit and/or be emancipatory for autistic people. Autistic people were a small minority of participants in studies where participant numbers had been recorded. There has yet to be a study focused solely on understanding the autism research priorities of autistic adults

Disease trajectories, place and mode of death in people with head and neck cancer: findings from the ‘Head and Neck 5000’ population-based prospective clinical cohort study

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with ‘non-curative’ and ‘curative’ intent respectively. Within 12 months, 109/161 (68%) in the ‘non-curative’ group died compared with 482/5241 (9%) in the ‘curative’ group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in ‘non-curative’ and ‘curative’ groups respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% ‘non-curative’; 23.5% ‘curative’) and 45.7% of the ‘curative’ group died in hospital. Conclusions: In addition to those with incurable head and neck cancer, there is a small but significant ‘curative’ subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met

Judicial actors’ understanding of the mental health impacts of intimate partner violence: a scoping review

Intimate partner violence (IPV) is a global public health issue that has grave physical and mental health consequences for millions of women. The judicial system plays a critical role in responding to IPV principally through the criminal justice system, family law, and/or child welfare jurisdictions. However, victims/survivors who interact with the legal system report negative experiences. An under-researched area of scholarship is the degree to which judicial actors understand the mental health impacts of IPV on victims/survivors and how they apply that knowledge in practice. This scoping review aimed to identify and synthesize existing scholarship on judicial actors’ understanding of the mental health impacts of IPV on women survivors. We searched 10 databases (Medline, Scopus, PubMed, PsycINFO, EMBASE, Westlaw, HeinOnline, the Cochrane Library, and the Joanna Briggs Library databases) for studies published between 2000 and 2023. A total of 27 studies were included in the review. We identified five main themes, including: awareness of survivors’ experiences, gap in judicial actors’ knowledge, understanding of perpetrator tactics and risk factors, disclosing mental health problems, training, and guidance. The review highlights significant gaps in judicial actors’ understanding of this issue and recommends strategies to increase the awareness and understanding of IPV among judicial actors. The findings can be used to justify future research to better understand the training and development needs of judicial actors to improve their level of awareness of the dynamics and impact of IPV and to make policy and practice recommendations to build the capacity of the judicial workforce

Impact of long-term erythromycin therapy on the oropharyngeal microbiome and resistance gene reservoir in non-cystic fibrosis bronchiectasis

Published 18 April 2018Long-term macrolide therapy reduces rates of pulmonary exacerbation in bronchiectasis. However, little is known about the potential for macrolide therapy to alter the composition and function of the oropharyngeal commensal microbiota or to increase the carriage of transmissible antimicrobial resistance. We assessed the effect of long-term erythromycin on oropharyngeal microbiota composition and the carriage of transmissible macrolide resistance genes in 84 adults with bronchiectasis, enrolled in the Bronchiectasis and Low-dose Erythromycin Study (BLESS) 48-week placebo-controlled trial of twice-daily erythromycin ethylsuccinate (400 mg). Oropharyngeal microbiota composition and macrolide resistance gene carriage were determined by 16S rRNA gene amplicon sequencing and quantitative PCR, respectively. Long-term erythromycin treatment was associated with a significant increase in the relative abundance of oropharyngeal Haemophilus parainfluenzae (P = 0.041) and with significant decreases in the relative abundances of Streptococcus pseudopneumoniae (P = 0.024) and Actinomyces odontolyticus (P = 0.027). Validation of the sequencing results by quantitative PCR confirmed a significant decrease in the abundance of Actinomyces spp. (P = 0.046). Erythromycin treatment did not result in a significant increase in the number of subjects who carried erm(A), erm(B), erm(C), erm(F), mef(A/E), and msrA macrolide resistance genes. However, the abundance of erm(B) and mef(A/E) gene copies within carriers who had received erythromycin increased significantly (P < 0.05). Our findings indicate that changes in oropharyngeal microbiota composition resulting from long-term erythromycin treatment are modest and are limited to a discrete group of taxa. Associated increases in levels of transmissible antibiotic resistance genes within the oropharyngeal microbiota highlight the potential for this microbial system to act as a reservoir for resistance.IMPORTANCE Recent demonstrations that long-term macrolide therapy can prevent exacerbations in chronic airways diseases have led to a dramatic increase in their use. However, little is known about the wider, potentially adverse impacts of these treatments. Substantial disruption of the upper airway commensal microbiota might reduce its contribution to host defense and local immune regulation, while increases in macrolide resistance carriage would represent a serious public health concern. Using samples from a randomized controlled trial, we show that low-dose erythromycin given over 48 weeks influences the composition of the oropharyngeal commensal microbiota. We report that macrolide therapy is associated with significant changes in the relative abundances of members of the Actinomyces genus and with significant increases in the carriage of transmissible macrolide resistance. Determining the clinical significance of these changes, relative to treatment benefit, now represents a research priority.Jocelyn M. Choo, Guy C. J. Abell, Rachel Thomson, Lucy Morgan, Grant Waterer, David L. Gordon, Steven L. Taylor, Lex E. X. Leong, Steve L. Wesselingh, Lucy D. Burr, Geraint B. Roger

Square to stripe transition and superlattice patterns in vertically oscillated granular layers

We investigated the physical mechanism for the pattern transition from square lattice to stripes, which appears in vertically oscillating granular layers. We present a continuum model to show that the transition depends on the competition between inertial force and local saturation of transport. By introducing multiple free-flight times, this model further enables us to analyze the formation of superlattices as well as hexagonal lattice

Muon-Spin Rotation Spectra in the Mixed Phase of High-T_c Superconductors : Thermal Fluctuations and Disorder Effects

We study muon-spin rotation (muSR) spectra in the mixed phase of highly anisotropic layered superconductors, specifically Bi_2+xSr_2-xCaCu_2O_8+delta (BSCCO), by modeling the fluid and solid phases of pancake vortices using liquid-state and density functional methods. The role of thermal fluctuations in causing motional narrowing of muSR lineshapes is quantified in terms of a first-principles theory of the flux-lattice melting transition. The effects of random point pinning are investigated using a replica treatment of liquid state correlations and a replicated density functional theory. Our results indicate that motional narrowing in the pure system, although substantial, cannot account for the remarkably small linewidths obtained experimentally at relatively high fields and low temperatures. We find that satisfactory agreement with the muSR data for BSCCO in this regime can be obtained through the ansatz that this ``phase'' is characterized by frozen short-range positional correlations reflecting the structure of the liquid just above the melting transition. This proposal is consistent with recent suggestions of a ``pinned liquid'' or ``glassy'' state of pancake vortices in the presence of pinning disorder. Our results for the high-temperature liquid phase indicate that measurable linewidths may be obtained in this phase as a consequence of density inhomogeneities induced by the pinning disorder. The results presented here comprise a unified, first-principles theoretical treatment of muSR spectra in highly anisotropic layered superconductors in terms of a controlled set of approximations.Comment: 50 pages Latex file, including 10 postscript figure

Geophysical surveys to help map buried igneous intrusions, Snowdonia, North Wales, UK

The geology of the Snowdonia National Park in North Wales comprises a mixture of Lower Palaeozoic shallow marine sediments, acidic igneous rocks and basic intrusions of the Welsh Basin that were subsequently deformed during the Caledonian Orogeny. Thin igneous intrusions are challenging to map due to variable surface exposures, their intrusive origin, structural deformation and burial by glacial sediments. This study used a combination of traditional geological techniques, near-surface geophysical surveys and remote sensing to detect and map a buried dolerite sheet intrusion. Both simple and mathematical analysis of magnetic anomalies and numerical modelling allowed the dolerite position, depths and target widths to be determined. Results showed that calibrated magnetic surveys can characterize buried igneous bodies in such mountainous environments