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The Central Drugs Standard Control Organization (CDSCO) has launched an urgent inquiry into four India-made cough and cold syrups used for paediatric groups after the World Health Organization (WHO) issued an alert.

“Urgent investigation in the matter has been already taken up by CDSCO with the State Regulatory Authorities immediately after receiving communication from WHO based on the available information. While all required steps will be taken in the matter, as a robust National Regulatory Authority, WHO has been requested to share at the earliest with CDSCO the report on the establishment of causal relation to death with the medical products in question, photographs of Labels/ products etc. which is awaited,” Sources told ANI.

WHO on Wednesday issued an alert over four India-made cough and cold syrups which are made by Maiden Pharmaceuticals in India. WHO has also notified that the same cough and cold syrups could be linked to the deaths of 66 children in The Gambia.

According to the sources, “WHO on September 29, 2022, informed DCGI, the National Drug Regulator of India, that it is currently providing technical assistance and advice to the Gambia, where children were suspected to have died where a significant contributing factor, is suspected to be the use of medicines which may have been contaminated with Diethylene glycol or Ethylene glycol (this has been confirmed in some of the samples by further analysis conducted by WHO).”

The Central Drugs Standard Control Organisation(CDSCO) took up the matter immediately and further investigation was launched, “CDSCO while responding to WHO within an hour and a half, took up the matter immediately thereafter with the concerned State Regulatory Authority, under whose jurisdiction the drug manufacturing unit is located. Further, a detailed investigation was launched to ascertain the facts/ details in the matter in collaboration with State Drugs Controller, Haryana (the concerned State Drug Control Authority), said sources.

From the preliminary enquiry, it has been made out that Maiden Pharmaceutical Limited, Sonipat, Haryana is a manufacturer licensed by the State Drug Controller for the products under reference, and holds manufacturing permission for these products. The company has manufactured and exported these products only to The Gambia so far.

“It is a practice that the importing country tests these products on quality parameters, and satisfies itself as to the quality of the products before their release for usage in the country,” said a source and explained the quality parameter needs to be followed by the country that imports these products

“As per the tentative results received by WHO out of the 23 samples tested, four samples have been found to contain Diethylene Glycol/ Ethylene Glycol as indicated. It has also been informed by WHO that the certificate of analysis will be made available to WHO in near future and WHO will share it with India. At the same time, the exact one-to-one causal relation of death has not yet been provided by WHO, nor have the details of Labels/ products been shared by WHO with CDSCO enabling it to confirm the identity/ source of the manufacturing of the products,” they said.

Also Read: “DO NOT use them”: WHO issues alert on four cough syrups made by India’s Maiden Pharmaceuticals

The World Health Organization (WHO) issued a medical product alert on four cough and cold syrups manufactured by India’s Maiden Pharmaceuticals Limited on Wednesday, stating that these “substandard” products are dangerous, particularly in children, and may result in serious damage or death.

According to the WHO study, these four goods have only been found in The Gambia, although they may have been spread to other nations or regions via informal marketplaces. It was pursuing additional investigations with the company and Indian regulatory agencies.

“This WHO Medical Product Alert refers to four substandard products, identified in The Gambia and reported to WHO in September 2022. Substandard medical products are products that fail to meet either their quality standards or specifications and are, therefore “out of specification,” the WHO said.

The manufacturer of these products is Maiden Pharmaceuticals Limited based out of Haryana, India, the WHO said and gave out the names of the products. “The four products are Promethazine Oral Solution, Kofexmalin Baby Cough Syrup, Makoff Baby Cough Syrup and Magrip N Cold Syrup,” it added.

To date, the international health organization said, “the stated manufacturer has not provided guarantees to WHO on the safety and quality of these products.”

“Laboratory analysis of samples of each of the four products confirms that they contain unacceptable amounts of diethylene glycol and ethylene glycol as contaminants.”

Citing risks, it said that Diethylene glycol and ethylene glycol are toxic to humans when consumed and can prove fatal. “Toxic effects can include abdominal pain, vomiting, diarrhoea, inability to pass urine, headache, altered mental state, and acute kidney injury which may lead to death,” it noted.

All batches of these products should be considered unsafe until they can be analysed by the relevant National Regulatory Authorities, according to WHO, who also stated that the substandard products mentioned in the alert are dangerous, and their use, particularly in children, can result in serious injury or death.

WHO advised regulatory agencies and the general public that it is critical to detect and remove substandard items from circulation in order to protect people.

WHO requested increased surveillance and diligence within the supply chains of countries and regions likely to be affected by these products. “Increased surveillance of the informal/unregulated market is also advised,” it said.

“All medical products must be approved and obtained from authorized/licensed suppliers. The products’ authenticity and physical condition should be carefully checked. Seek advice from a healthcare professional when in doubt.”

Giving out a clear warning WHO said if you have these substandard products, please “DO NOT use them.”

“If you, or someone you know, have used these products or suffered any adverse reaction/event after use, you are advised to seek immediate medical advice from a qualified healthcare professional and report the incident to the National Regulatory Authority or National Pharmacovigilance Centre.”

“National regulatory/health authorities are advised to immediately notify WHO if these substandard products are discovered in their respective country,” it concluded.

Also Read: Study examines positions of college football players for risk of injuries

A new research looks into the brains of college football players to see how many traumatic brain injuries (TBI) biomarkers they have per position. The research sheds information on which jobs are most vulnerable to rises in brain injury signs. Proteins and other substances produced from the wounded brain are known as biomarkers.

This study was conducted in collaboration with researchers at Orlando Health Orlando Regional Medical Center (ORMC) and Penn State University, and published in the Journal of Neurotrauma. Researchers followed 52 college football athletes, pre-season and post-season, and measured four biomarkers (glial fibrillary acidic protein [GFAP], ubiquitin C-terminal hydrolase-L1 [UCH-L1], total Tau, and neurofilament light chain polypeptide [NF-L]). The players were grouped by two established classification systems: speed versus non-speed positions, and Profile 1, Profile 2, and Profile 3.

“We found the biomarkers were much higher in football players in speed positions such as quarterbacks, wide receivers, defensive backs, running backs, halfbacks, fullbacks, tight ends, defensive backs, safety, and linebackers who build up momentum prior to tackling or being tackled, compared to non-speed positions like offensive and defensive linemen who engage other players before significant momentum can be generated,” said Linda Papa, MD, lead author of the study and emergency medicine physician and director, Academic Clinical Research, Orlando Health ORMC. “Interestingly, biomarkers increased in all positions over the course of the season despite very few players being diagnosed with a concussion. This suggests that repetitive head impact exposures elevate TBI biomarkers without having a concussion.”

Furthermore, Papa and colleagues used a three-tier player position classification system developed by researchers using biomechanical measurements including head impact strain magnitude, head impact frequency and intervals. Profile 1 positions are those receive high intensity hits, but not often (termed high strain magnitudes/low frequency by the researchers). These positions include quarterbacks, wide receivers, and defensive backs. Profile 2 positions are mid-range impact frequency and strain positions including linebackers, running backs, and tight ends. Profile 3 positions are those who are hit often, but the hits are of lower intensity (low strain magnitude/high frequency) and include defensive and offensive linemen.

“It appears that head impact magnitude and not frequency causes the greatest elevations in TBI biomarkers,” said Dr. Papa. “We found incremental increases in the biomarkers GFAP, Tau, and NF-L by player position from Profile 3 to Profile 2 to Profile 1, with highest biomarker levels in Profile 1 players and lowest biomarker levels in Profile 3 players.”

An unexpected finding was that the biomarker elevation patterns in speed (and Profile 1) versus non-speed (and Profile 3) players were not only present at the end of the season but also before the season began. “This was surprising because blood was collected before any practices or football activity,” said Linda Papa. “It may indicate that pre-season biomarker elevations in these players reflect head impact exposures from previous seasons.”

The study, which combines TBI biomarkers in blood with established player classifications systems (based on biomechanical measurements) across pre- and post-seasons, is among the first of its kind.

“Measuring TBI biomarkers in blood could potentially offer an objective and relatively simple way of quantifying and monitoring head impact exposures in different players,” said Dr. Papa.

Understanding TBI biomarker changes by player position can be helpful in considering safety measures, game rule changes, on-field behavior, enhancements to equipment, return-to-play guidance, career decisions, and other factors.

Future evaluation of a larger sample of players over a longer period of time, could reveal more information and provide greater understanding about the long-term impact of traumatic brain injuries associated with player positions, said Dr. Papa.

Researchers at Orlando Health ORMC were leaders in identifying GFAP and UCH-L1 – the two FDA-approved biomarkers used in blood testing to detect brain injury and have continued to evaluate different aspects of the biomarkers through various studies. Dr. Papa, who has 20 years of experience in traumatic brain injury biomarkers research, has been the lead author of many studies published in various publications including JAMA Network Open, JAMA Neurology, BMJ Paediatrics Open, Academic Emergency Medicine, and Journal of Trauma. Dr. Papa has published more than 200 articles related to traumatic brain injury.

Also read: Researchers find hospital readmission rate higher in women than men after heart attack

In a recent study of younger heart attack victims in Ontario, Canada, researchers revealed that the healthcare system delivers excellent quality treatment for younger heart attack survivors; nevertheless, there are substantial variations between men and women.

Young females have higher rates of all-cause and cardiovascular hospital readmission than young males. As the risk factors for heart disease in young women continue to rise, it emphasises the significance of continuing efforts to improve preventative measures.

Their findings were published in Elsevier’s Canadian Journal of Cardiology. Despite improvements in the management and outcomes of patients with ischemic heart disease, a large number of women are hospitalized with acute myocardial infarction (AMI) annually. Several prior studies have found that women have worse outcomes compared to men after experiencing a heart attack. Young women were found to be at particularly high risk, with much higher mortality rates than young men, and worse outcomes even when compared with older women. As a result, vigorous efforts to address these treatment disparities were aimed at the public and healthcare providers.

“Many care gaps are closing for younger women with AMI in Ontario, but readmission rates remain higher than for younger men,” explained lead investigator Mina Madan, MD, MHS, Schulich Heart Centre, Sunnybrook Health Sciences Centre, and Department of Medicine, University of Toronto, Toronto, ON, Canada.

Using ICES data, investigators studied clinical outcomes in 38,071 heart attack survivors aged 18 to 55 years who were hospitalized in Ontario, Canada, between April 1, 2009 and March 31, 2019 with a diagnosis of AMI. Of these, 8,077 (21.2%) were women. They compared trends in cardiac risk factors, angiographic findings, and revascularization rates in men and women and studied their outcomes during the first year after the heart attack.

The researchers found that younger women hospitalized with an AMI had a significantly higher prevalence of cardiac risk factors and comorbidities compared to younger men with AMI. Notably, there was a steady increase in the prevalence of diabetes in women over time. Close to 25% had diabetes in 2009 compared to close to 35% in 2018, which was much higher than among men, whose rates of diabetes increased by just 4%, from 18% to 22%, over the same time period. By 2018, more than one in three young women with AMI had diabetes, almost half had hypertension and dyslipidemia, and more than two in five were current smokers.

Although earlier studies found that women were less frequently referred for coronary angiography to evaluate for blockages of the blood supply to the heart, by 2018 the use of coronary angiography was largely universal for both sexes. Young women were less frequently referred for angioplasty or bypass surgery compared to young men, which could be explained by a greater prevalence of normal coronary arteries and non-obstructive coronary artery disease observed during angiography among women.

Hospitalization for heart attack

Over the study period, adjusted mortality rates for younger men and women after hospitalization for heart attack were similar. However, rehospitalization rates for adverse cardiovascular events and all-cause readmission rates were significantly higher for women (25.8% for women vs. 21.1% for men).

“This may reflect the higher risk profile we observed among younger women in our study compared with younger men or support the notion that younger women may benefit from earlier follow-up care and better support networks that could reduce the need for readmissions soon after discharge,” said Dr. Madan.

In an accompanying editorial, lead author Karin H. Humphries, MBA, DSc, University of British Columbia, Faculty of Medicine, Vancouver, BC, Canada, comments, “This important analysis presents us with both good news and bad news.

While it provides evidence that the sex differences in AMI are diminishing, there is also an urgent need to understand what is driving the higher readmission rates in females. Is this due to unrecognized depression, less use of evidence-based medication post AMI, or delays in access to care? More focus on these areas of investigation is clearly needed.”

“There is definitely room to do better,” Dr. Madan agrees, “by taking steps that could reduce early readmission rates for younger women and renewed public education initiatives to raise awareness about the importance of diet, exercise and healthy lifestyle choices to avoid developing cardiovascular disease.”

Also Read: Chemists advance development of marijuana breathalyzer

India reported 2,468 new covid cases in the last 24 hours, the Union health ministry said in an update on Wednesday. The country’s active caseload has come down to 33,318, with total reported cases till date at 4.45 crore and death toll at 528,733.

The daily positivity rate stands at 1.32 % and the weekly positivity rate at 1.32 %.

A group of academicians devised a method to detect marijuana with a breath analyzer, similar to how an alcohol analyzer detects the presence of alcohol in one’s body through the breath. They are usually used by police to determine if someone is breaking the law by driving while inebriated.

Professor of organic chemistry at UCLA Neil Garg and researchers from the UCLA start-up ElectraTect Inc. describe the method by which THC introduced in a solution into their laboratory-built device can be oxidised, producing an electric current whose strength indicates how much of the psychoactive compound is present.

The research was published in the journal Organic Letters. According to the researchers, the availability of a Breathalyzer-like device could contribute to making roads safer given the recent legalisation or decriminalisation of marijuana in numerous jurisdictions, including California. Marijuana use has been linked to dramatically increased accident risk and has been demonstrated to impair some driving abilities.

In 2020, Garg and UCLA postdoctoral researcher Evan Darzi observed that the bigger THC molecule had a visible colour change when a hydrogen molecule was removed from it. The method, called oxidation, is comparable to how alcohol breath analyzers turn ethanol into an organic chemical molecule by losing hydrogen. This oxidation results in an electric current in the majority of modern alcohol breath analyzer systems, which displays the quantity and concentration of ethanol in the breath.

Since their discovery in 2020, the researchers have been working on creating a THC breath analyzer that functions similarly using their patent-pending oxidation method. The patent rights have been leased exclusively to ElectraTect by UCLA.

How the new device works

Darzi, who is currently the CEO of ElectraTect, Garg, and researchers from ElectraTect describe the operation of their brand-new laboratory-scale THC-powered fuel cell sensor in the new study. THC (technically known as Delta-9-tetrahydrocannabinol) oxidises into a new compound called THCQ when it comes into contact with a negatively charged electrode, or anode, on one side of the device’s H-shaped glass chamber, sending electrons across the chamber to a positively charged electrode, or cathode, on the other, creating a detectable electric current. The current becomes stronger as the amount of THC molecules increases.

THC has never before been utilised to operate a fuel cell sensor, so this development is significant. Researchers are currently working to refine the device to detect and measure THC in exhaled breath and to shrink it to a more compact size suitable for use in a handheld breath analyzer or ignition interlock device–a breath analyzer connected to a vehicle’s ignition that prevents it from starting if THC is detected. The researchers said they expect that the relatively simple, inexpensive technology, once perfected, can be scaled up for economical mass production.

Making marijuana testing easier – and fairer

The technology may also result in increased road safety and more equitable marijuana law enforcement, according to the researchers. THC usage in drivers is typically detected through urine or blood tests. Such roadside tests can be challenging to do, and they aren’t always reliable for detecting intoxicated drivers because the chemical can persist in the body for weeks after marijuana use without having any lasting impact on cognition. Even if a person doesn’t test positive for drugs when tested, this ambiguity might result in penalties, jail time, or loss of work.

These problems, according to the researchers, emphasise the requirement for cutting-edge forensic technology that are simpler to use and more precise for identifying recent marijuana use. Although a commercial marijuana breathalyser based on their research would be a few years away, Darzi and Garg emphasised that such a device would potentially offer advantages beyond those of law enforcement and traffic safety.

Their scientific advancement, they claimed, could eventually be applied in any circumstance where unbiased marijuana testing is necessary, such as at work where employees might be operating machinery or even at home where people might one day be able to use it proactively — before they ever get behind the wheel.

Also Read: Study looks at why late-night eating increases obesity risk

Prime Minister Narendra Modi opened the All India Institute of Medical Sciences (AIIMS) in Himachal Pradesh’s Bilaspur on Wednesday, naming the facility the ‘Green Hospital.’

“In the last 8 years, we have worked on ensuring development benefits reach the remotest parts of the country. AIIMS Bilaspur will not only increase access to affordable healthcare in Himachal but is also eco-friendly and will be known as ‘Green AIIMS’,” PM Modi said in his address in Bilaspur. Terming the inauguration of AIIMS a moment of pride in Himachal, PM Modi said that the state has played a crucial role in “Rashtra Raksha” and the hospital will now play a “pivotal role in Jeevan Raksha” adding that Himachal is one of the three states chosen for establishing Bulk Drugs Park that will ensure the access to affordable medicines in India.

“Himachal Pradesh is also one of the four states chosen for Medical Device Park. The foundation stone that has been laid in Nalagarh, is a part of this,” he said.

He said that Medical tourism is another important sector needed to be promoted in Himachal so that when people from across the world would come to India, they shall visit Himachal for its holistic healing with world-class health facilities and a beautiful and healthy environment.

To ensure the ease of living for the poor and middle-class sections of society, PM Modi said, “It is the Centre’s attempt to minimise the expense on medicines and also to ensure that they get the required treatment without going to far off places.”
PM Modi also said that it is the priority of the “double-engine government” in Himachal Pradesh to ensure the dignity of the people.

“It is the priority of the double-engine government to ensure the dignity of mothers and sisters by providing them with safety, security, respect, and health,” he said.

He further called the state “the land of opportunities” and said that tourism here provides immense opportunity for employment, fertile land for growing fruits and vegetables, and generating electricity.

In his address, PM Modi said that the various development projects could be launched in the state only because of the people here and also lauded Chief Minister Jairam Thakur for his prompt functioning to bring the plans into action.

“The inauguration of AIIMS Bilaspur, Atal Tunnel, Hydro-Engineering college (at Bandla), and Medical Device Park (at Nalagarh), it all could be possible because of your votes. It is because of you only that you bless me and when I bring development projects to the state, Jairam Thakur turns them successful,” he said.

Also Read: Study looks at why late-night eating increases obesity risk

According to Palakkad Town South Police, three physicians from Thangam Hospital of PMRC, Palakkad, have been arrested on the basis of medical records claiming carelessness during delivery on July 2, 2022, which resulted in the death of a lady and her infant.

According to the police, the arrested physicians are Ajith, Nila, and Priyadarshini. While the deceased have been named as Aishwarya, Ranjith’s wife, a resident of Chittoor Thathamangalam, and their infant. The event occurred in the first week of July, and the medical board began an investigation in response to public objections.

Three doctors were determined to have committed medical malpractice, according to the investigation. Following a meeting two days earlier, the board filed its findings to the Health Department, which resulted in the arrests.

The Palakkad Town South Police had earlier registered a case.

The family alleged that Aishwarya, who was admitted for maternity treatment, and her child, died due to serious negligence on the part of the private hospital.

Also Read: Study looks at why late-night eating increases obesity risk

According to Penn State College of Medicine researchers, acetaminophen use during pregnancy is linked to sleep and behaviour problems associated with attention deficit hyperactivity disorder (ADHD).

Acetaminophen is a widely used medication that is used to treat a range of conditions, including fever, infection, muscular discomfort, headache, migraine, colds, and allergies. Medical doctors have always regarded the drug as safe for use during pregnancy.

However, according to Kristin Sznajder, assistant professor of public health sciences and lead author, emerging studies support the idea that this drug may affect child development and may be associated with attention problems. Sznajder said their new study confirms these trends and was also the first to observe an association between acetaminophen use during pregnancy and child sleep challenges.

“Pregnant people experience pain, fever and other ailments that could be alleviated through the use of acetaminophen,” said Sznajder, a Huck Institutes of the Life Sciences researcher. “While the medication may provide relief in the moment, research increasingly indicates there may be downstream effects that could be detrimental to child development. More research is needed so appropriate recommendations can be made to pregnant people.”

The researchers used data from a study of more than 2,400 women who had never given birth before and followed them and their children from the third trimester of pregnancy to 3 years postpartum. Women were surveyed once during their pregnancies about their medication use and frequency and stress levels. Of these, 41.7% of women reported using acetaminophen during pregnancy.

The participants were then interviewed at 1, 6, 12, 18, 24, 30 and 36 months after their child was born. At the 36-month interview, participants were asked to rate their child using a three-point scale to describe how often they exhibit a wide variety of neurodevelopmental and behavioral outcomes (very often true, somewhat or sometimes true, and not true) like “can’t sit still or restless,” “avoids looking others in the eyes” and “doesn’t want to sleep alone.” Scores for each behavior were then compiled to determine whether children scored highly in the domains of emotionally reactive, anxious or depressed, withdrawn, sleep problems and aggressive behavior.

Using responses from the 99-item Child Behavior Checklist, the researchers then evaluated whether children of mothers who used acetaminophen during pregnancy were more likely to have attention, sleep or other neurobehavioral issues. Because women who used acetaminophen during pregnancy were more likely to have been diagnosed with anxiety or depression before becoming pregnant and to report high levels of stress during pregnancy, the research team controlled for stress, depression during pregnancy, and previous diagnoses of depression or anxiety in their statistical analyses.

After adjusting for confounding variables, children of women who used acetaminophen were significantly more likely to have sleep problems and attention problems compared with children of those who did not use acetaminophen during pregnancy.

The results confirm the findings of previous studies that suggest that prenatal acetaminophen use could lead to attention issues, while also showing that sleep may also be affected. Among women who used acetaminophen during pregnancy, 22.7% described their child as having sleep problems and 32.9% described their children as having attention problems. Of the participants who did not report using acetaminophen while pregnant, 18.9% reported their child had sleep problems while 28.0% reported their child had attention problems. The results were published in PLOS One on Sept. 28.

According to the study team, more research is needed to understand these relationships. Survey responses lacked data on the trimester of use, frequency of use and dosage amount. According to Sznajder, these are factors that could have an impact on the outcome. She noted a study is underway that will attempt to dive deeper into the trimester, frequency and dosage and how that affects outcomes. She also said using a child development expert to assess children’s behaviors might help ensure more accurate results.

Acetaminophen during pregnancy

According to the researchers, it is not clear what processes in prenatal development may be disrupted by prenatal acetaminophen use. But they said some possibilities include acetaminophen damaging the placenta and thereby disrupting fetal development, or acetaminophen damaging liver cells in the fetus, in turn disrupting gut health and impacting neurodevelopment.

“We should interpret these results with some degree of caution,” Sznajder said. “Although acetaminophen is generally considered safe for use during pregnancy, data from multiple studies suggest that there could be effects on childhood development by its use. It’s important we learn as much as we can about this subject so we can give expecting mothers data-driven recommendations to care for their children and themselves.”

Also Read: Study looks at why late-night eating increases obesity risk

The TB bacteria has a relative you’ve never heard of: MAC. This bacterial complex is present worldwide, yet most people exhibit no symptoms. However, some people become quite ill. Researchers have recently discovered an immunologic flaw that may explain this disparity.

MAC is an “opportunistic” pathogen, explains Cecilia Lindestam Arlehamn, Ph.D., Research Assistant Professor at La Jolla Institute for Immunology (LJI). Some people do have risk factors — such as cystic fibrosis and structural lung diseases, for example — that make them likely to develop symptoms after MAC exposure. The problem is that no one knows exactly why these factors make such a difference. Now Lindestam Arlehamn’s laboratory has uncovered an immune cell defect tied to the risk of developing MAC disease. As her team reports in Frontiers in Immunology, people who show MAC infection symptoms have fewer specialized Th1* (Th1 “star”) cells, which robs them of the ability to mount an effective immune response to the bacteria.

“We think these people have this cellular defect going into MAC exposure,” explains Lindestam Arlehamn, who worked closely on the study with collaborators at the University of Washington.

This research may be a step toward uncovering biomarkers to predict risk of progressive lung disease and responses to treatment in MAC disease patients.

In 2020, Lindestam Arlehamn received funding through a Tullie and Rickey Families SPARK Award to investigate how T cells fight the disease. The hope was that by analyzing T cells from people previously infected with MAC, she could identify key targets, or epitopes, where MAC-infected cells are vulnerable to immune system attacks.

T cells are normally critical for fighting infections, yet to everyone’s surprise, Lindestam Arlehamn’s work revealed that the human body has a very limited T cell response to MAC infection, and she wasn’t able to uncover MAC-specific epitopes.
It’s pretty unusual for a T cell response to a pathogen to be so limited. It was like the MAC-infected study volunteers had barely any “immune memory” of getting the disease. Instead, Lindestam Arlehamn’s SPARK project highlighted an unexpected cellular defect that could explain why some people get sick while others don’t. “This was also very interesting,” says Lindestam Arlehamn.

When Lindestam Arlehamn looked at global gene expression (which genes are “switched on”) in response to MAC infection, she spotted a stark difference in blood samples from people previously infected with MAC and healthy controls.

People who had MAC appeared to have a immunologic defect that leads to low numbers of special “helper” immune cells called Th1* cells in the body. Th1* cells normally help alert the body’s pathogen-fighting cells to danger.

Lindestam Arlehamn and her colleagues were among the first to show that Th1* cells are particularly critical for fighting a Mycobacterium attack, either from MAC or Mycobacterium tuberculosis.

Their work is the first to suggest that this Th1* defect can lead to increased disease susceptibility. They think it’s likely that without enough Th1* cells, some key immune cells never get the message that MAC is trying to invade. This means MAC-susceptible people may have both an over-performing innate immune response (with certain cells driving inflammation early in the disease process) and an under-performing adaptive immune response (a lack of activated T cells to actually stop the disease).

For some people, this lack of an immune defense is too much to bear. For people with cystic fibrosis, for example, thick mucus in the lungs may interfere with the ability of T cells to patrol the tissue and detect MAC. A lack of Th1* cells could then be a double-blow — adding immune system dysfunction to an already weak defense in the lungs. “That could partially explain it,” says Lindestam Arlehamn.

Lindestam Arlehamn now wants to confirm whether the defect leading to fewer Th1* cells is present in people prior to MAC exposure. She plans to look at samples taken from people earlier in the disease progression to see if a lack of Th1* is a feature for them as well. She’d also like to study samples from people who were exposed to the same sources of MAC in the environment.

“If you live together with someone with MAC disease, it’s likely that you are exposed too,” she says. We want to see if we can define specific T cell responses in those individuals and look for the differences between those who get sick and those who don’t.”

Also Read: Researchers find how biological markers predict risk of postpartum depression