Regulation of stem cell therapies under attack in Europe: for whom the bell tolls

At the time of writing, the Italian Parliament is debating a new law that would make it legal to practice an unproven stem cell treatment in public hospitals. The treatment, offered by a private non‐medical organization, may not be safe, lacks a rationale, and violates current national laws and European regulations. This case raises multiple concerns, most prominently the urgent need to protect patients who are severely ill, exposed to significant risks, and vulnerable to exploitation. The scientific community must consider the context—social, financial, medical, legal—in which stem cell science is currently situated and the need for stringent regulation. Additional concerns are emerging. These emanate from the novel climate, created within science itself, and stem cell science in particular, by the currently prevailing model of ‘translational medicine’. Only rigorous science and rigorous regulation can ensure translation of science into effective therapies rather than into ineffective market products, and mark, at the same time, the sharp distinction between the striving for new therapies and the deceit of patients.     

Cardiovascular disease after Escherichia coli O157:H7 gastroenteritis

Background:

Escherichia coli O157:H7 is one cause of acute bacterial gastroenteritis, which can be devastating in outbreak situations. We studied the risk of cardiovascular disease following such an outbreak in Walkerton, Ontario, in May 2000.

Methods:

In this community-based cohort study, we linked data from the Walkerton Health Study (2002–2008) to Ontario’s large healthcare databases. We included 4 groups of adults: 3 groups of Walkerton participants (153 with severe gastroenteritis, 414 with mild gastroenteritis, 331 with no gastroenteritis) and a group of 11 263 residents from the surrounding communities that were unaffected by the outbreak. The primary outcome was a composite of death or first major cardiovascular event (admission to hospital for acute myocardial infarction, stroke or congestive heart failure, or evidence of associated procedures). The secondary outcome was first major cardiovascular event censored for death. Adults were followed for an average of 7.4 years.

Results:

During the study period, 1174 adults (9.7%) died or experienced a major cardiovascular event. Compared with residents of the surrounding communities, the risk of death or cardiovascular event was not elevated among Walkerton participants with severe or mild gastroenteritis (hazard ratio [HR] for severe gastroenteritis 0.74, 95% confidence interval [CI] 0.38–1.43, mild gastroenteritis HR 0.64, 95% CI 0.42–0.98). Compared with Walkerton participants who had no gastroenteritis, risk of death or cardiovascular event was not elevated among participants with severe or mild gastroenteritis.

Interpretation:

There was no increase in the risk of cardiovascular disease in the decade following acute infection during a major E. coli O157:H7 outbreak.Escherichia coli O157:H7 is one cause of acute bacterial gastroenteritis, causing 63 000 infections each year and 12 major outbreaks since 2006 in the United States alone.^1,2 This strain was most recently implicated in the outbreak involving beef from XL Foods (September 2012), with 17 confirmed cases across Canada.³ A similar enterohemorrhagic strain E. coli O104:H4 was responsible for an outbreak in Germany in May 2011, causing 3792 cases of gastroenteritis and 43 deaths.^4,5Most patients fully recover from acute gastroenteritis caused by E. coli. However, such an illness may predispose patients to long-term disease. Shiga toxin is produced by E. coli O157:H7; this toxin damages the microvasculature of the kidneys leading to hypertension^6–13 and directly damages the systemic vasculature.^14–16 Infected people may progress from a state of acute inflammation of the vasculature to subclinical chronic inflammation, which could promote atherosclerosis.^17–20In Walkerton, Ontario, in May 2000, heavy rains transported bovine fecal matter into the town’s well, contaminating the inadequately chlorinated municipal water supply with E. coli O157:H7.²¹ Over 2300 people developed acute gastroenteritis, and 7 people died.²² The unique circumstances of this outbreak provided a rare opportunity to study the natural history following exposure to this pathogen in a single cohort.²³ Other outbreaks have been geographically dispersed, making it difficult to track cases.^24,25In Walkerton, affected individuals were followed annually in a clinic to assess their long-term outcomes (Walkerton Health Study, 2002–2008). We previously reported that adults who experienced acute gastroenteritis during the outbreak had a higher than expected incidence of hypertension, chronic kidney disease and self-reported cardiovascular disease in follow-up.²³ However, 46% of participants were lost to follow-up by the end of the study, and there were limitations associated with the assessment of cardiovascular disease by participant recall. Thus, we conducted an expanded and extended follow-up study, linking the Walkerton study data to Ontario’s health care databases. Our objective was to more accurately determine the 10-year risk of major cardiovascular events after exposure to E. coli O157:H7.     

Relict conifers from the mid-Pleistocene of Rhodes,Greece

The mid-Pleistocene Kolymbia Flora of Rhodes, Greece occurs in the Lindos Bay Clay facies group of the Rhodes Formation and was deposited in a marine setting at about a depth of 200 m. Recorded in the flora are the youngest presence of Glyptostrobus in the eastern Mediterranean, an extinct species of Pinus very similar to the modern relict Pinus canariensis, and a new species of the disjunct Cedrus. These taxa indicate that some relict plant taxa existed on Rhodes later than previously recognised. The late presence of Taxodiaceae in the eastern Mediterranean may demerit its usefulness for determining the Pliocene–Pleistocene boundary. The finding of Liquidambar, Zelkova and Fagus in the flora supports the idea of Rhodes, and possibly the eastern Mediterranean, as a refugium during the mid-Pleistocene. Similar fossil assemblages should be found in adjacent Turkey because the Lindos Bay Clay records an extensive marine transgression probably resulting from graben tectonics that lead to the ultimate separation of Rhodes from mainland Turkey.     

GENERAL NOTES

Macdonald, M. A. 1980. The ecology of the Fiscal Shrike in Ghana, and a comparison with studies from southern Africa. Ostrich 51:65-74.

The Fiscal Shrike Lanius collaris was studied in southern Ghana in order to compare its ecology there with that in southern Africa. The bird was found mainly in the damper coastal areas and usually in habitats created by man. Feeding behaviour is described. Food consisted mainly of a wide variety of insects. Territories were small at around 0,6 ha. Most nests were built 1,8-2,4 m from the ground, and eggs were laid from December to October. Moult appeared to take place in September to November when breeding activity was low. The normal and maximum clutch was three eggs. At most, 10–17% of clutches produced fledged young. Most losses were probably caused by predators. Two successful broods per pair were reared annually. Post-fledging survival of the young was high, and they remained on the parental territory for 5–7 months. Contrasts between the breeding biology in Ghana and southern Africa may be related to differences in environmental seasonality and perhaps also in the severity of nest losses.     

6. THE PROBLEM OF NOMENCLATURE

Hockey, P. A. R. 1983. Aspects of the breeding biology of the African Black Oystercatcher. Ostrich 54:26-35. Fifty-five pairs of African Black Oystercatchers Haematopus moquini bred at Marcus Island in 1979–1980. Sixteen pairs laid replacement clutches: the mean interval between loss of the fist clutch and laying of a replacement clutch was 22,2 days. Mean inter-nest distance was 19,4 m. The modal clutch size was 2, with a mean of 1.74. Mean dimensions of 105 eggs were 60,7 × 40,l mm and mean fresh egg mass was 55,s g. There were differences in egg mass and dimensions between eggs in one- and two-egg clutches. Rate of egg loss was high, due mainly to depredation by Kelp Gulls Larus dominicanus promoted by human disturbance. Fledging success was lower at a disturbed site than at undisturbed sites, with highest chick mortality occurring in the first week of life. Mortality of first-year birds of eight days and older was estimated at 48% and 69% in two successive seasons. All juvenile birds dispersed from the natal sites, and were resighted up to 168 km away. Dispersed juveniles were concentrated at the edge of an area of high oystercatcher density.     

Distribution of Clostridium botulinum Type E Strains in Nunavik,Northern Quebec,Canada

The distribution and levels of Clostridium botulinum type E were determined from field sites used by Inuit hunters for butchering seals along the coast of Nunavik. The incidence rates of C. botulinum type E in shoreline soil along the coast were 0, 50, and 87.5% among samples tested for the Hudson Strait, Hudson Bay, and Ungava Bay regions, respectively. Spores were detected in seawater or coastal rock surfaces from 17.6% of butchering sites, almost all of which were located in southern Ungava Bay. Concentrations of C. botulinum type E along the Ungava Bay coast were significantly higher than on the coasts of Hudson Strait and Hudson Bay, with the highest concentrations (270 to 1,800/kg of sample) found near butchering sites located along the mouths of large rivers. The Koksoak River contained high levels of C. botulinum type E, with the highest median concentration (270/kg) found in sediments of the marine portion of the river. C. botulinum type E was found in the intestinal contents (4.4%) and skins (1.4%) of seals. A high genetic biodiversity of C. botulinum type E isolates was observed among the 21 butchering sites and their surroundings along the Nunavik coastline, with 83% of isolates (44/53) yielding distinct pulsed-field gel electrophoresis genotypes. Multiple sources of C. botulinum type E may be involved in the contamination of seal meat during butchering in this region, but the risk of contamination appears to be much higher from environmental sources along the shoreline of southern Ungava Bay and the sediments of the Koksoak River.     

Patterns of population genetic variation in sympatric chiltoniid amphipods within a calcrete aquifer reveal a dynamic subterranean environment

Calcrete aquifers from the Yilgarn region of arid central Western Australia contain an assemblage of obligate groundwater invertebrate species that are each endemic to single aquifers. Fine-scale phylogeographic and population genetic analyses of three sympatric and independently derived species of amphipod (Chiltoniidae) were carried out to determine whether there were common patterns of population genetic structure or evidence for past geographic isolation of populations within a single calcrete aquifer. Genetic diversity in amphipod mitochondrial DNA (cytochrome c oxidase subunit I gene) and allozymes were examined across a 3.5 km² region of the Sturt Meadows calcrete, which contains a grid of 115 bore holes (=wells). Stygobiont amphipods were found to have high levels of mitochondrial haplotype diversity coupled with low nucleotide diversity. Mitochondrial phylogeographic structuring was found between haplogroups for one of the chiltoniid species, which also showed population structuring for nuclear markers. Signatures of population expansion in two of the three species, match previous findings for diving beetles at the same site, indicating that the system is dynamic. We propose isolation of populations in refugia within the calcrete, followed by expansion events, as the most likely source of intraspecific genetic diversity, due to changes in water level influencing gene flow across the calcrete.     

Indices of Anseriform body shape based on the relative size of major skeletal elements and their relationship to reproductive effort

To assess whether relative clutch mass (RCM) in Anseriformes (wildfowl or waterfowl) is constrained by body shape, principal components (PCs) of size‐adjusted measurements of five major skeletal elements of adult males and females of 60 species of Anseriformes provided indices of body shape. PC1 accounted for 69.8% of the variance and contrasted anterior elements (cranium and sternum) to posterior elements (synsacrum, femur and tibiotarsus). PC1 scores were high in species with a ‘duck‐like’ body shape and low in those with a ‘goose‐like’ body shape. Over the phylogeny of Anseriformes, decreased PC1 scores were associated with feeding on land. PC2 accounted for 18.6% of the variance and contrasted core elements (sternum and synsacrum) with peripheral elements (cranium, femur and tibiotarsus). High PC2 scores were associated with dependence on animal food, particularly in diving species. PC3 accounted for 7.7% of the variance and reflected mainly the relative size of the femur, which was low in diving species. Controlling statistically for phylogenetically independent contrasts in female body shape, there was a significant positive partial correlation between RCM and PC1, suggesting that independent of body size, body shape imposes constraints on reproductive effort in Anseriformes. The results suggest that models of the evolution of reproductive effort in this order, and perhaps in other orders, of birds should control for the effects of body shape.     

Discovery of a new HIV-1 inhibitor scaffold and synthesis of potential prodrugs of indazoles

A new oxazole scaffold showing great promise in HIV-1 inhibition has been discovered by cell-based screening of an in-house library and scaffold modification. Follow-up SAR study focusing on the 5-aryl substituent of the oxazole core has identified 4k (EC₅₀ = 0.42 μM, TI = 50) as a potent inhibitor. However, the analogues suffered from poor aqueous solubility. To address this issue, we have developed broadly applicable potential prodrugs of indazoles. Among them, N-acyloxymethyl analogue 11b displayed promising results (i.e., increased aqueous solubility and susceptibility to enzymatic hydrolysis). Further studies are warranted to fully evaluate the analogues as the potential prodrugs with improved physiochemical and PK properties