New research offers hope for new treatments for multiple sclerosis

Parliamentary Yearbook reports on the new research led by scientists at the University of Edinburgh and the University of Cambridge which may help to develop a treatment to repair nerve damage in multiple sclerosis. The research identifies the important role of immune cells, called macrophages, in the regeneration of the myelin sheath.

Nerve cells have extremely long thin nerve fibres which transmit impulses between distant parts of the body, enabling normal body function. A fatty layer called the myelin sheath insulates each nerve fibre in the brain and spinal cord.  This protective layer speeds up the transmission of electrical impulses as they pass along nerve fibres to and from the brain.  At certain intervals, the myelin layer is interrupted creating what is called “a node of Ranvier”.  These nodes in the myelin sheath have a vital function in speeding up the transmission of signals or impulses to and from the brain.  Rather than travelling the entire length of nerve fibres, electrical impulses travel from node to node. This enables nerve fibres to conduct signals at tremendous speeds in excess of 100 metres per second.

If the myelin sheath is inflamed, damaged or destroyed, nerve fibres are unable to transmit impulses efficiently. The transmission of impulses gets slower - as the impulse has no alternative but to travel the entire length of the nerve fibre - or stops.  In MS, the immune system attacks the myelin sheath causing it to becomes damaged.  At the same time, a natural process (called remyelination) in which cells called ‘oligodendrocytes’ repair myelin damage gradually fails.  Consequently, the transmission of nerve signals becomes disrupted in the way described which in turn causes impairment in sensation, movement, cognition or other functions depending on which nerves are involved. 

Currently, there are few treatments to suppress the immune system from causing further damage and no treatments which can repair the damage done.

Driven by the lack of therapies for progressive MS, the MS Society in the UK, the Wellcome Trust and the MS of Canada has funded this latest research.  Led by the University of Edinburgh and the University of Cambridge, the research investigated the regenerative process of remyelination in samples of brain tissue from humans with MS and in mice.

The researchers studied immune cells - called macrophages - known to be involved in remyelination.  They found that macrophages were found at higher levels when myelin regeneration was working well.  In addition, they identified that these important immune cells played a vital role in triggering remyelination. The macrophages released a protein called activin-A which stimulated oligdendrocytes to make myelin.

The study’s results suggest that studying macrophages and activin-A might lead to the development of regenerative therapies for multiple sclerosis.  Further research is planned which looks at how activin-A can be released artificially and whether its effects can be enhanced.

 A statement by the first author, Dr Veron Miron, from the Medical Council Centre for Regenrative Medicine at the University of Edinburgh, said:  “Approved therapies for multiple sclerosis work by reducing the initial myelin injury - they do not promote myelin regeneration. This study could help find new drugs to enhance myelin regeneration and help to restore lost functions in patients with multiple sclerosis.”

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Diabetics denied access to prescriptions for vital blood testing strips

Parliamentary Yearbook reports on a survey by the charity Diabetes UK. The findings reveal alarming facts about the difficulties experienced by people with diabetes in accessing blood testing strips within the NHS. The charity warns of serious long-term health complications and consequent increased costs for the NHS.

Diabetes cannot be cured but can be controlled through diet and medication.  Treatment aims to keep blood glucose to normal levels in order to control symptoms and to minimise associated health problems. Monitoring and controlling blood sugar levels is vital because left untreated the condition can cause very serious complications which are difficult and expensive to treat.  Even a mildly raised blood glucose level that does not present any immediate symptoms can have damaging effects on blood vessels, nerves and organs in the longer term. Complications are frequently dramatic and include limb amputation, blindness, kidney failure, heart disease and stroke.

Effective treatment therefore relies crucially on regular measurement of blood glucose levels to establish that levels are within normal limits.  This is particularly important for people with Type 1 diabetes and those with insulin treated Type 2 diabetes. Measurement allows the diabetes patient to safely perform everyday activities that most people take for granted. For example, people with Type 1 diabetes need to test their blood every time they eat, more frequently if they exercise, and every time they drive. According to the charity Diabetes UK, a person with Type 1 diabetes typically self-tests blood at least four times a day. 

Diabetics rely on blood glucose testing strips - currently prescribed by the NHS - in order to test blood glucose levels. However, a new survey by Diabetes UK has revealed some alarming facts about the difficulties experienced by diabetics in getting access to blood glucose testing strips in the NHS. The results are summarized below.

Difficulty accessing blood test strips:

·      Out of 2,203 respondents, 39% had either been refused a prescription of blood glucose test strips or had their prescription restricted.

·     Of these, 55% had test strips restricted within the last year with 33% experiencing a prescription being refused or restricted in the last 6 months.

·      Of those experiencing restrictions, over half had Type 1 diabetes (or were carers of people with Type 1)

Reasons given for refusal or restricted access:

·    Of those who said their prescriptions had been restricted, nearly a quarter (24%) had been told by their GP that this was because of restrictions put in place by their local Clinical Commissioning Group (CCG), NHS boards or local health board guidelines

·       34% due to “cost saving measures”

·       30% told they were testing too much

·       19% were given no reason

Commenting on the findings, Barbara Young, Diabetes UK Chief Executive, said: “Test strips are the most basic tools for managing Type 1 diabetes ad insulin treated Type 2 diabetes so it is very worrying that so many people are telling us they are having their test strips rationed because of cost saving measures.”

The survey revealed widespread variation - in different parts of the country – in guidance on prescriptions, with some patients only receiving 2 strips per day. 

Ms Young described some of the reported impacts of these restrictions: “Our survey showed a lack of test strips was stopping them driving, exercising or knowing how much insulin to take when they are eating or whether they are experiencing a ‘hypo’ (hypoglycaemic episode) which needs to be treated immediately.”

As a result of their findings – which many will find scandalous - Diabetes UK is calling on health leaders to remove all blanket policies restricting the number of test strips being prescribed.  The charity has called for “the focus to be on supporting clinicians on how to approach individual assessment and review to reduce waste and meet individual needs”.

The charity has warned that rationing will put people’s lives at risk and, more importantly for government, will store up costs for the NHS in the future.  This is because diabetic complications - related to poorly monitored and controlled blood glucose - are extremely expensive to treat.

According to the charity’s Chief Executive: “Rationing test strips to save money does not make any sense, because it’s putting people at risk of complications that are hugely expensive to treat.”

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Access to water, sanitation, and hygiene linked to height increase in young children

Parliamentary Yearbook reports on evidence from studies of children across several countries which suggests that access to water, sanitation and hygiene may boost growth in young children under the age of five years. The Cochrane Review identifies a height increase of 0.5cm.

The Cochrane Collaboration is an international network of over 31,000 people from over 120 countries who work together to help healthcare practitioners, policy makers, patients, their advocates and carers, make well-formed decisions about health care. It believes that global healthcare decision-making should be informed by high-quality, timely research evidence.  This independent and democratic organisation produces and disseminates evidence across all areas of health care. To this end, it has prepared over 5,000 formal reviews - known as the Cochrane Reviews - which have been published online in the Cochrane Database of Systematic Reviews. The reviews form part of The Cochrane Library. 

The London School of Hygiene and Tropical Medicine (LSHTM) and the international charity Wateraid have recently jointly carried out and authored a study for the Cochrane Review. The study examined how water, sanitation and hygiene - so called WASH interventions - impact on nutrition outcomes for children.

The background to the review - led by Dr Alan D Dangour, a public heath nutritionist from the LSHTM, states that 165 million children under the age of five years suffer from chronic undernutrition causing them to be short in height and 52 million suffer from acute undernutrition causing them to be very thin. This is important because poor growth in early life is known to increase the risks of illness and death in childhood.  The immediate causes of childhood undernutrition are cited as being inadequate dietary intake and infectious diseases such as diarrhoea. 

The aim of the review was to evaluate the effect of water, sanitation and hygiene on nutrition outcomes for children. This was done by compiling data WASH interventions and nutrition outcomes on nearly 10,000 children from studies of 14 countries. Data was collected from studies on low and middle-income countries where clean water and soap was not accessible relative to more developed countries.  This included Bangladesh, Ethiopia, Nigeria, Chile, Guatemala, Pakistan, Nepal, South Africa, Kenya and Cambodia.

The researchers found evidence that good sanitation resulted in a small increase (0.5cm) in height of children under five.  The authors believe that access to clean water and soap is likely to have led to the increase in height because of the reduction in microbiological and parasitic infestations in early childhood, which are know to negatively impact on growth.

The research was funded by the Department for International Development (DFID). According to the LSTMH website, Professor Tim Wheeler, Deputy Chief Scientific Adviser to the DFID, said:  “Failure to get the right nutrition in childhood can cause lifelong damage that cannot be undone.  This report provides further support to the idea that using clean water and soap remains one of the best ways to prevent contracting diarrhoea and stopping young children losing the essential nutrients vital for them to grow.”

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Concern about ocean iron levels: implications for reduced ocean uptake of CO2

Parliamentary Yearbook examines an article which reports large regional variations in the presence of iron in our oceans.  This is important because ocean iron plays a vital role in determining the rate at which oceans absorb atmospheric carbon dioxide. This absorption - and its rate - are critically important to the rate and  extent  of global warming and so affects the prospects for human survival.

The burning of coal, oil and methane gas provides the main source of energy in modern society.  However, this process releases carbon dioxide as a by-product. Years of burning these fossil fuels have significantly increased carbon dioxide levels in the Earth’s atmosphere. The atmospheric carbon dioxide level has become so great that it acts like a blanket. An overwhelming majority of the world’s scientists agree that this is causing the Earth to warm and driving climate change.

The oceans play an important role in moderating the impact of global warming.  According to the National Oceanography Centre, the oceans absorb one quarter of all the carbon dioxide emitted into the atmosphere.  Once dissolved into the ocean, it is estimated that this absorbed human waste product will stay there for more than 500 years on average. So, as with the rain forests, the oceans form a sink absorbing pollution. As is now well understood, pollution of the common environment is not a cost of production which is computed by our market-based costing system and is instead an “externality” assigned to populations. In this way, market accounting can continue to respect and privilege the paramount interests of short-term economic profit and rent on which – with the best will in the world - our present form of life unsustainably depends.

One way the ocean takes up carbon dioxide is through the process of photosynthesis occurring in microscopic plant-like organisms called phytoplankton. These single cell plants use energy from the sun to convert carbon dioxide and nutrients into complex organic compounds which form new plant material. During the process, phytoplankton also release oxygen into the water.  It is a vitally important process. Half of the world’s oxygen is produced via phytoplankton photosynthesis.

However, photosynthesis is limited by a lack of iron. Dr Will Homoky, from the University of Southampton, has recently described the importance of iron in this process: “Iron acts like a giant lever on marine life, storing carbon.  It switches on growth of microscopic marine plants, which extract carbon dioxide from our atmosphere and lock it away in the ocean.”

‘Continental margins’ are a major source of dissolved iron entering the oceans.  This is the zone of the ocean floor that separates the thin oceanic crust - composed of rocks rich in iron and magnesium - from thick continental crust (made of the igneous, sedimentary and metamorphic rock that forms continents). 

To date, iron measurements have been taken from a limited number of global regions. However, a new study, which focused on a region in Atlantic waters off the coast of South Africa, has identified that the amount of dissolved iron released into the oceans varies in ways previously not understood, by up to 10,000 times. 

The study, led by researchers based at the National Oceanography Centre in Southampton, reports that the amount of iron leaking from continental margin sediments varies significantly between regions.  Alarmingly, the study identified substantially smaller levels of iron being released into the seawater than measured anywhere before.

The findings are important because they have implications for models of climate change and could alter predictions for the future of climate change in the most unwelcome way.

The scientific community continues to issue its warnings. But to largely deaf ears in business, government and media, for reasons that are deep and not easily changed.

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New observations of neutrinos: one of the universe’s smallest sub-atomic particles

Parliamentary Yearbook reports on observations of one of the universe’s smallest and least understood particles - neutrinos - by the international T2K project. Neutrinos exist in three types. 

The T2K project has recently conclusively established - through observation for the first time - that muon neutrinos transform into electron neutrinos as they travel. It is hoped that the findings will help solve one of the great mysteries of the universe.

The T2K (Tokai-to-Kamioka) project is a multinational experimental project led by Japan and part-funded by the UK’s Science and Technology Facilities Council (STFC). It was designed to detect and study some of the least understood particles in the universe, including tiny particles called neutrinos.

Neutrinos are invisible particles which are one of the basic building blocks of nature.  They have no electrical charge and very tiny masses, making them extremely hard to detect. Their mass is thought to be tiny even by the standards of subatomic particles (particles smaller than an atom). This allows them to travel at close to the speed of light. They only interact via weak force which means they can pass straight through large amounts of dense matter - like the Earth - unimpeded.  For example, every second hundreds of billions of neutrinos can travel through your thumbnail.

Neutrinos occur in three types or “flavours”: electron neutrinos, muon neutrinos and tau neutrinos.  T2K’s recent experiment has provided conclusive proof that muon neutrinos transform into electron neutrinos through a process known as neutrino oscillation.

The T2K project is spread across several sites in Japan. The J-PARC accelerator in the village of Tokai, on the east coast of Japan, produces a beam of neutrinos - primarily muon neutrinos - which is transmitted via a local detector in Toakai to the Super-Kamiokande detector, located 295km away the Kamioka Zinc Mine near the west coast of Japan.  The neutrino beam is produced when high-energy protons strike a graphite target.  This results in short-lived secondary particles (such as kaons and pions). As these particles decay, neutrinos are produced.  To increase the volume of neutrinos reaching the Super-Kamiokande detector, three huge magnetic horns are used to focus the direction of secondary pions.

In the experiment, an analysis of data observed at the Super-Kamiokande detector associated with a neutrino beam transmitted from the J-PARC accelerator the presence of more electron neutrinos than would be expected. The observation is the first of its kind to explicitly see a unique flavour of neutrinos appear at the detection point (in Super-Kamiokande) from a beam initially consisting of a different type of neutrino (in Tokai).

It was previously known that neutrinos transform from one kind but this particular transformation had never been conclusively observed and is regarded as a major milestone.

Commenting on the results, Professor Alfons Weber, a British collaborator on the T2K from the STFC and Oxford, said in a statement:  “Up until now the oscillations have always been measured by watching the types disappear and then deducing that they had turned into another type.  But in this instance, we observe muon neutrinos disappearing and we observe electron neutrinos arriving - and that’s a first.”

The findings may play an important role in helping to answer one of the most important questions about the universe: ‘Why is there so much more ‘matter’ than ‘antimatter’ in the universe?’  Every particle has a corresponding anti-particle (with a charge opposite to that of its counterpart). This is known as anti-matter.  Physicists have long puzzled over why, if anti-matter and matter are equal but opposite, should there be so much more matter in the universe than antimatter.

It is anticipated that T2K’s recent findings will be compared to future data with anti-neutrinos to test whether muon and electron neutrinos oscillate in a different manner to their antimatter counterparts.  It is believed that this asymmetry could help explain why anti-matter is so comparatively rare.

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