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Saturday, 22 July 2017
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Latest Headlines
 
Could cows be the clue that leads to an HIV vaccine? - 21 Jul 2017

"Cows have shown an 'insane' and 'mind-blowing' ability to tackle HIV which will help develop a vaccine, say US researchers," BBC News reports.

The report is based on new research in cows that were immunised against HIV before having their immune response to HIV assessed. There's currently no vaccine for HIV because the virus mutates so easily.

Scientists aim to develop a vaccine that is not only potent (produces a strong immune system response), but also causes the immune system to make "broadly neutralising antibodies" (able to protect against many different strains of virus).

The four cows in this study were immunised against HIV with a specially developed vaccine to test both strength and "breadth". Some cows developed a weak response with reasonable breadth (20% – or it helped protect against 1 in 5 strains tested in the lab) at 42 days. One cow in particular showed an impressive immune response to most of the lab strains of HIV ("96% breadth") 381 days after being vaccinated.

This research, done in a small number of cows, may help scientists work out if immune proteins made in cows could potentially be used to protect humans against a range of HIV strains.

While this is certainly welcome news, it doesn't mean an effective HIV vaccine is guaranteed to appear in the future. The most effective way to protect yourself from HIV is to always use a condom during sex, including oral and anal sex. Men who have sex with other men are particularly at risk if they don't practise safe sex.

Read more advice about HIV and gay health.

 

Where did the story come from?

The study was carried out by researchers from The Scripps Research Institute the International AIDS Vaccine Initiative, Texas A&M University, Kansas State University, and Ragon Institute of MGH, MIT and Harvard, all in the US.

The research was funded by various grants from the International AIDS Vaccine Initiative, the National Institutes of Health, the Centre for HIV/AIDS Vaccine Immunology and Immunogen Discovery and the US Department of Agriculture. The study was published in the peer-reviewed medical journal Nature.

The UK media reporting was generally accurate and made clear the research was carried out in cows and not humans. However, the Mail Online's claim that "An injection may soon be available that prevents the virus spreading and could rid sufferers of the infection" is incredibly optimistic.

This research is at a very early stage and will need to be repeated and refined before testing in humans is considered. There is no imminent vaccine for HIV.

 

What kind of research was this?

This was an investigational laboratory study carried out using cows. Researchers attempted to immunise cows against HIV and assessed their response to the vaccine.

HIV infects the body's immune system, causing progressive damage that eventually stops the body's ability to fight off infection. The virus attaches itself to immune cells that protect the body against bacteria, viruses and other germs. Once HIV has attached itself, it enters the cell and uses it to create thousands of copies of itself. The copies then leave the original immune cell and kill it in the process.

The process continues until the number of immune cells is so low, the immune system stops working. This process can take as long as 10 years, during which time the person may feel and appear to be well.

Thankfully, due to medical advances, antiretroviral drugs are now available that help protect the immune system from further damage and prevent secondary infections.

 

What did the research involve?

Researchers aimed to immunise cows with a substance called an immunogen, which are designed to provoke an immune response.

In this study the researchers used an immunogen called BG505 SOSIP. This mimics the outside of the HIV virus to produce an immune response. Researchers were able to see if the immunogens were "broad" (could neutralise many different viral strains) and potent by measuring how long it took for the immune response to occur; the quicker the response the more potent a vaccine tends to be.

Researchers chose to look at cows because, unlike most animals, they have longer amino acid chains.  Amino acids are the "building blocks" of proteins. Previous research has found that a small proportion of people with HIV who develop a level of natural immunity to the virus also have similarly long amino acid chains.

Four six-month-old calves were immunised with the BG505 SOSIP immunogen and the researchers looked at the subsequent immune response.
 

What were the basic results?

All cows developed immune cells to HIV 35 to 50 days following two injections. One cow showed an immune response that could neutralise 20% of HIV strains tested in the lab in 42 days and another neutralised 96% of HIV strains in 381 days.

When analysing the proteins created as part of the immune response, the researchers found that one in particular binds to a key HIV site that the virus uses to infect cells.

 

How did the researchers interpret the results?

The researchers conclude that they "have shown that immunization with a well-ordered immunogen in cows reliably and rapidly elicits broad and potent neutralizing serum responses in contrast to previous experiments in other animals."

 

Conclusion

This early stage research on cows indicates that they had a broad and quick immune response to HIV infection when given a specific vaccine. Because the immune proteins produced in cows are able to neutralise many different strains of HIV virus, the authors suggest this potentially gives them an edge over the human proteins that have been looked at so far.

As always with animal studies it is important to remember that what works in cows might not work in the same way in humans. Many drug studies that appear promising at first, fall at the first hurdle once humans are involved.

The study was also carried out on just four cows and the most promising finding – neutralisation of 96% of HIV strains in 381 days – was found in just one cow. It is therefore best seen as promising early research, rather than a proven cure.

While we all hope an HIV vaccine or cure may be on the horizon, until that time, using a condom during penetrative, oral and anal sex is the most effective method of preventing infection with HIV.

Links To The Headlines

'Mind-blowing' cows hold clue to beating HIV. BBC News, July 21 2017

Scientists may be one step closer to a cure for HIV: Injection prevents the virus spreading and could rid sufferers of the disease. Mail Online, July 21 2017

Links To Science

Sok D, Le KM. Vadnais M, et al. Rapid elicitation of broadly neutralizing antibodies to HIV by immunization in cows. Nature. Published online July 20 2017

Nine lifestyle changes may reduce risk of dementia - 20 Jul 2017

"Nine lifestyle changes can reduce dementia risk," BBC News reports. A major review by The Lancet has identified nine potentially modifiable risk factors linked to dementia.

The risk factors were:

  • low levels of education
  • midlife hearing loss
  • physical inactivity
  • high blood pressure (hypertension)
  • type 2 diabetes
  • obesity
  • smoking
  • depression
  • social isolation

However, it's important to note that even if you add up the percentage risk of all of these factors, they only account for about 35% of the overall risk of getting dementia. This means about 65% of the risk is still due to factors you can't control, such as ageing and family history.

Although not guaranteed to prevent dementia, acting on the risk factors above should improve your physical and mental wellbeing.

What is dementia?

Dementia refers to a group of symptoms associated with the gradual decline of the brain and its abilities. Symptoms include problems with memory loss, language and thinking speed.

The most common cause of dementia is Alzheimer's disease. Vascular dementia is the next most common, followed by dementia with Lewy bodies.

For more information, visit the NHS Choices Dementia Guide.

Where did the review come from?

This review was written by the Lancet Commission on Dementia Prevention, Intervention and Care (LCDPIC). The commission is established by convening experts in the field to consolidate current and emerging evidence on preventing and managing dementia. It generates evidence-based recommendations on how to address risk factors and dementia symptoms. These are presented in this review.

The LCDPIC endeavoured to use the best possible evidence to make the recommendations. However, in cases where the evidence was incomplete, it summarised the balance of the evidence, drawing attention to the strengths and limitations.

The media in general has covered the review responsibly and accurately, with helpful comments from experts in the field.

What does the review say?

The review examines aspects of how better to manage the burden of dementia: the risk factors, interventions for prevention and interventions for treatment.

Risk factors

The LCDPIC discusses the effects of several different risk factors potentially linked to dementia.

The review reported population attributable fractions (PAFs). PAFs are an estimate of the proportion of cases of a certain outcome (in this case, dementia) that could be avoided if exposure to specific risk factors were eliminated – for example, how many lung cancer cases would be prevented if nobody smoked.

Using the available evidence, researchers calculated PAFs for the following risk factors.

Education

Less time in education – specifically, no secondary school education – was responsible for 7.5% of the risk of developing dementia.

Hearing loss

The relationship between hearing loss and the onset of dementia is fairly new. It's thought that hearing loss may add stress to an already vulnerable brain with regard to the changes that occur. Hearing loss may also increase feelings of social isolation. However, it's also possible that old age could have a role to play in this association.

The LCDPIC analysis found that hearing loss could be responsible for 9.1% of the risk of developing dementia.

Exercise and physical activity

A lack of physical activity was shown to be responsible for 2.6% of the risk of dementia onset. Older adults who do not exercise are less likely to maintain higher levels of cognition than those who do engage in physical activity.

Hypertension, type 2 diabetes and obesity

These three risk factors are somewhat interlinked; however, all had PAFs lower than 5%, with hypertension contributing the greatest risk of the three:

  • hypertension – 2%
  • type 2 diabetes – 1.2%
  • obesity – 0.8%

Smoking

Smoking was found to contribute to 5.5% of the risk of dementia onset. This is a combination of smoking being more widespread in older generations, and there being a link between smoking and cardiovascular conditions.

Depression

It's possible that depressive symptoms increase dementia risk due to their effect on stress hormones and hippocampal volume. However, it's not clear whether depression is a cause or a symptom of dementia. It was found to be responsible for 4% of the risk of developing dementia.

Lack of social contact

Social isolation is increasingly thought to be a risk factor for dementia as it also increases the risk of hypertension, heart conditions and depression. However, as with depression, it remains unclear whether social isolation is a result of the development of dementia.

It was found to contribute to 2.3% of the risk of developing dementia.

Prevention of dementia

The review highlights that although there are potentially modifiable risk factors for dementia, this does not mean dementia as a condition is preventable or easy to treat. It is evident that there are multiple risk factors contributing to the onset of the disease. However, some interventions that could prevent onset include:

  • Using antihypertensive drugs, such as ACE inhibitors, in people with hypertension.
  • Encouraging people to switch to a Mediterranean diet, which is largely based on vegetables, fruit, nuts, beans, cereal grains, olive oil and fish. This has been proven to improve cardiovascular health, and may help with the symptoms of type 2 diabetes, obesity and hypertension.
  • Encouraging people to meet the recommended physical activity levels for adults. Again, regular exercise may help with the symptoms of type 2 diabetes, obesity and hypertension.
  • Using cognitive interventions, such as cognitive training, which involves a series of tests and tasks to improve memory, attention and reasoning skills. The review points out, however, that the clinical effectiveness of most commercially available brain-training tools and apps is unproven.
  • Encouraging people to become more socially active. This could be by organising social activities – book clubs, for example – for older adults. 
  • Continuing to provide support to smokers who want to quit.

Read more about ways to reduce your dementia risk.

Links To The Headlines

Nine lifestyle changes can reduce dementia risk, study says. BBC News, July 20 2017

Lifestyle changes could prevent a third of dementia cases, report suggests. The Guardian, July 20 2017

Third of dementia cases are preventable through nine lifestyle changes, say researchers. The Independent, July 20 2017

The nine lifestyle changes that could save you from dementia. The Daily Telegraph, July 20 2017

A third of dementia cases are 'preventable' – with lifestyle choices a key factor, experts say. Daily Mirror, July 20 2017

These nine lifestyle changes could PREVENT dementia – 'stopping a third of Alzheimer's cases'. The Sun, July 20 2017

From hearing loss to loneliness, the NINE dementia risk factors: One in three cases could be prevented by changes to lifestyle. Mail Online, July 20 2017

Links To Science

Livingston G, Sommerlad A, Orgeta V, et al. Dementia prevention, intervention, and care. The Lancet. Published online July 19 2017

High-dose vitamin D 'doesn't prevent colds and flu in kids' - 19 Jul 2017

"Vitamin D will not protect your child from a cold: myth-busting study says 'more isn't always better' to help toddlers stay healthy," says the Mail Online.

The story is based on a study that looked at whether giving healthy young children high doses of vitamin D in the winter protects them from colds and flu better than the standard recommended lower dose.

It found children taking the high dose were just as likely to get ill as children taking the standard dose – both groups got an average of about one case of cold or flu during the winter.

There was a reduction in flu cases with the high dose, but flu cases were uncommon and therefore the reduction was small (four fewer infections per 100 children over the winter season).

Current UK advice is that children aged one to four years old should be given a daily supplement containing 10 micrograms (mcg) of vitamin D – the same as the standard dose in this study.

Giving children the higher dose used in the study (50mcg) seems unlikely to offer much benefit for winter colds and flu if they're generally healthy.

Where did the story come from?

The study was carried out by a large group of researchers at various centres in Canada who were part of the TARGet Kids! Collaboration. This group is studying the health of Canadian children and the impact of early health in later life.

It was funded by the Canadian Institutes of Health Research Institutes of Human Development, Child and Youth Health and Nutrition, Metabolism and Diabetes, and the Thrasher Research Fund.

The vitamin D used in the study was provided for free by the manufacturer Ddrops.

The study was published in the peer-reviewed Journal of the American Medical Association (JAMA).

The Mail Online provides good coverage of this story, making it clear that the study isn't challenging the usefulness of the recommended vitamin D dosage, but saying more isn't better for colds.

What kind of research was this?

This randomised controlled trial (RCT) compared the effect of high- and standard-dose vitamin D on the risk of children catching a cold or flu in winter.

Observational studies have suggested that people with low vitamin D levels are at greater risk of getting viral infections affecting their upper airways – essentially colds or the flu.

Young children in the US and the UK are advised to take a daily dose of around 10mcg (400 international units, IU) of vitamin D.

The researchers wanted to see if taking five times as much (50mcg or 2,000 IU) during the winter might be even better for preventing colds and flu.

We get most of our vitamin D from sunlight and some food sources, such as eggs and oily fish like tuna.

Winter is when our vitamin D levels tend to be lower because there's less sunshine, and is also when we tend to get more upper airway infections. It's plausible that giving more vitamin D might be helpful at this time of year.

Assigning children to receive either the standard or high dose of vitamin D at random makes sure the groups are as similar as possible before the study starts.

This means that any difference between the groups in how many times they got ill would be directly caused by what vitamin D dose they were taking.

What did the research involve?

The researchers enrolled 703 healthy children aged between one and five years old.

They randomly assigned the children to receive either 10mcg or 50mcg of vitamin D by mouth each day during winter. They then compared how often the children got colds or flu over this time.

The children were all from Toronto in Canada and were recruited at "well-child visits" to paediatric or family medicine practices between September and November 2015.

Children with any chronic illnesses (other than asthma) and those born prematurely weren't eligible to take part. The vitamin D3 given to both groups was given as a drop a day of identical-looking and tasting liquid.

Parents and children didn't know what dose they were taking. The parents were told not to give their children any other supplements containing vitamin D during the study.

The children took the drops for between four and eight months.

Whenever the children got symptoms of a cold, their parents filled in a checklist to record what symptoms they had.

Parents were also trained to take a swab of the inside of their child's nose and send it to the lab. The researchers then tested the swab for viruses.

The main outcome the researchers were interested in was how often the children got colds or flu that could be confirmed as being viral infections by laboratory tests.

The researchers also compared how often the parents reported their child as having a cold or the flu.

Children went to the clinic to have blood samples taken to measure vitamin D levels at the four and eight-month mark.

Almost all (99.4%) of the children who started the study remained in it until the end and could be included in the analyses.

What were the basic results?

At the end of the study, children in the high-dose group had higher levels of vitamin D in their blood than those taking the low dose.

The parents didn't report noticing that their children had any side effects from taking the vitamin D drops.

But high-dose vitamin D didn't reduce the number of colds and flu the children got over the winter.

On average there were:

  • 1.97 cases in the high-dose group and 1.91 cases in the standard-dose group of parent-reported cases of cold and flu
  • 1.05 cases in the high-dose group and 1.03 in the standard-dose group of laboratory-confirmed cases of cold and flu

The differences between the groups were very small and not large enough to be statistically significant.

The higher dose of vitamin D did halve the risk of flu compared with the standard dose (incidence rate ratio [iRR] 0.50, 95% confidence interval [CI] 0.28 to 0.89).

But there were very few cases of flu – only 16 in the 349 children in the high-dose group and 31 in the 354 children in the low-dose group – so the difference of four fewer cases per 100 children (CI 1-8 fewer cases per 100 children) over the winter season wasn't considered to be an important reduction.

How did the researchers interpret the results?

The researchers concluded that giving 50mcg of vitamin D a day to healthy young children in the winter didn't reduce the number of upper airway infections overall compared with the standard dose of 10mcg a day.

They said: "These findings do not support the routine use of high-dose vitamin D supplementation in children for the prevention of viral upper respiratory tract infections." 

Conclusion

This study found giving a high dose of vitamin D to healthy children in the winter doesn't reduce their overall risk of upper airway infections compared with the standard recommended dose.

This well-designed study used several measures to ensure the results were robust. For example, researchers:

  • used randomisation to split the children into groups
  • blinded parents as to which treatment the child was receiving to make sure this knowledge couldn't affect their perception of their child's health
  • used laboratory tests to confirm that the child did have a viral infection

There was a reduction in flu with high-dose vitamin D, but the number of cases was very small, so this finding needs to be treated cautiously. The researchers have called for this to be looked at in further studies to see if this finding can be confirmed.

But there are some other important points to bear in mind. The study only included healthy children – it can't rule out possible benefits for children with chronic conditions or in specific subgroups, such as children who have asthma or particularly low vitamin D levels.

And researchers only looked at upper airway infections, so the study doesn't tell us about other outcomes that may be affected by vitamin D.

On balance, this study suggests that if your child is generally healthy, they aren't likely to get much extra cold and flu protection from taking more than the recommended dose of vitamin D in winter.

Flu is normally more serious than a cold – the NHS offers a free flu vaccine to children of certain ages and with certain conditions to reduce this risk. Check if your child is eligible for the children's flu vaccine.

Links To The Headlines

Vitamin D will not protect your child from a cold: myth-busting study says 'more isn't always better' to help toddlers stay healthy. Mail Online, July 18 2017

Links To Science

Aglipay M, Birken CS, Parkin PC. Effect of High-Dose vs Standard-Dose Wintertime Vitamin D Supplementation on Viral Upper Respiratory Tract Infections in Young Healthy Children. JAMA. Published online July 18 2017

 
 
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