The devil is in the details: Genomics of transmissible cancers in Tasmanian devils

Cancer poses one of the greatest human health threats of our time. Fortunately, aside from a few rare cases of cancer transmission in immune-suppressed organ transplant recipients or a small number of transmission events from mother to fetus, cancers are not spread from human to human. However, transmissible cancers have been detected in vertebrate and invertebrate animals, sometimes with devastating effects. Four examples of transmissible cancers are now known: 1) canine transmissible venereal tumor (CTVT) in dogs, 2) a tumor in a laboratory population of Syrian hamsters that is no longer cultured, 3) infectious neoplasias in at least four species of bivalve mollusks, and 4) two independently derived transmissible cancers (devil facial tumor disease [DFTD]) in Tasmanian devils (Fig 1A and 1B). The etiologic agents of CTVT, the bivalve cancers, and DFTDare the transplants (allografts) of the neoplastic cells themselves, but the etiologic agent is unknown for the hamster tumor.The effects of these transmissible cancers on their respective host populations vary. CTVT is spread in dogs through sexual contact and is at least 11,000 years old, placing the timing of its origin close to that of the domestication of dogs. Although genomic analyses of the tumor suggest evasion of multiple components of the dog immune system, dogs most commonly survive and often show evidence of spontaneous tumor regression within a year of initial diagnosis. For the infectious bivalve neoplasias, which have existed for at least 40 years, population effects vary from enzootic infections with no noticeable effects on population sizes to evidence of a catastrophic population decline. In Tasmanian devils (Fig 1A), the first infectious tumor discovered (DFT1; Fig 1B) has spread across approximately 95% of the geographic range of Tasmanian devils since 1996 (Fig 1C). DFTD is almost always fatal (Fig 1B), with >90% declines in infected localities and an overall species-wide decline exceeding 80%. Transmission dynamics appear consistent with frequency dependence, with DFTD spread by biting during social interactions, resulting in predictions of extinction from standard epidemiological models. Despite these predictions, long-infected devil populations persist at reduced densities, suggesting that individual-level variability in fecundity and tumor growth rate in infected individuals are key for understanding epidemiological dynamics. Additionally, the origin of the second, independent lineage of DFTD (i.e., DFT2) within 20 years of the discovery of DFT1 suggests that transmissible cancers may be a recurring part of the Tasmanian devils' evolutionary history, without causing extinction

Hospital care for children and young adults in the last year of life: a population-based study

BACKGROUND: To help design population-based pediatric palliative care services, we sought to describe the hospital care received in the last year of life by children and young adults who died. We also determined the proportion with complex chronic conditions (CCCs) and tested whether the use of hospital services increased as the date of death drew nearer. METHODS: For all deaths occurring under 25 years of age from 1990 to 1996 in Washington State, USA, we linked death certificate information to hospital utilization records and analyzed the timing and duration of hospitalizations and the nature of hospital procedures during the year prior to death. RESULTS: Of the 8 893 deaths, 25 % had CCCs. Among infants with CCCs, 84 % were hospitalized at the time of death and 50 % had been mechanically ventilated during their terminal admission. Among the 458 CCC neonates dying under a week of age, 92% of all days of life were spent in the hospital; among the 172 CCC neonates dying during the second to fourth weeks of life, 85 % of all days of life were spent hospitalized; among the 286 CCC infants dying during the second to twelfth month of life, 41 % of all days of life were spent hospitalized. Among children and young adults with CCCs, 55 % were hospitalized at the time of death, and 19 % had been mechanically ventilated during their terminal admission. For these older patients, the median number of days spent in the hospital during the year preceding death was 18, yet less than a third of this group was hospitalized at any point in time until the last week of their lives. The rate of hospital use increased as death drew near. For subjects who had received hospital care, 44 % had governmental insurance as the source of primary payment. CONCLUSIONS: Infants who died spent a substantial proportion of their lives in hospitals, whereas children and adolescents who died from CCCs predominantly lived outside of the hospital during the last year of life. To serve these patients, pediatric palliative and end-of-life care will have to be provided in an integrated, coordinated manner both in hospitals and home communities

The genomic basis of tumor regression in Tasmanian devils (Sarcophilus harrisii)

Understanding the genetic basis of disease-related phenotypes, such as cancer susceptibility, is crucial for the advancement of personalized medicine. Although most cancers are somatic in origin, a small number of transmissible cancers have been documented. Two such cancers have emerged in the Tasmanian devil (Sarcophilus harrisii) and now threaten the species with extinction. Recently, cases of natural tumor regression in Tasmanian devils infected with the clonally contagious cancer have been detected. We used whole-genome sequencing and FST-based approaches to identify the genetic basis of tumor regression by comparing the genomes of seven individuals that underwent tumor regression with those of three infected individuals that did not. We found three highly differentiated candidate genomic regions containing several genes related to immune response and/or cancer risk, indicating that the genomic basis of tumor regression was polygenic. Within these genomic regions, we identified putative regulatory variation in candidate genes but no nonsynonymous variation, suggesting that natural tumor regression may be driven, at least in part, by differential host expression of key loci. Comparative oncology can provide insight into the genetic basis of cancer risk, tumor development, and the pathogenicity of cancer, particularly due to our limited ability to monitor natural, untreated tumor progression in human patients. Our results support the hypothesis that host immune response is necessary for triggering tumor regression, providing candidate genes that may translate to novel treatments in human and nonhuman cancers

The interplay between voluntary vaccination and reduction of risky behavior: a general behavior-implicit SIR model for vaccine preventable infections

The onset in the last 15 years of behavioral epidemiology has opened many new avenues for epidemiological modelers. In this manuscript we first review two classes of behavioral epidemiology models for vaccine preventable diseases, namely behaviour-implicit SIR models with prevalence-dependent vaccination (at birth and among older individuals), and prevalence-dependent contact rate. Subsequently, we briefly propose a general framework of behavior–dependent nonlinear and linear Forces of Infection (FoI) valid for a vast family of infectious diseases, and including delays and ‘epidemic memory’ effects. Finally and mainly, we develop a new general behavioral SIR model. This model combines the two aforementioned types of behavioral phenomena, previously considered only separately, into a single unified model for behavioral responses. The resulting model allows to develop a general phenomenological theory of the effects of behavioral responses within SIR models for endemic infections. In particular, the model allows to complete the picture about the complicate interplay between different behavioral responses acting on different epidemiological parameters in triggering sustained oscillations of vaccine coverage, risky behavior, and infection prevalence