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Joint Pain Injections Market Size By Product Analysis, By Application, By End-Users, By Regional Outlook, By Top Companies and Forecast to 2027 -…

Sanofi S.A

Joint Pain Injections Market Segment Analysis-

The research report includes specific segments by Type and Application. Each type provides information about the production during the forecast period of 2015 to 2027. The application segment also provides consumption during the forecast period of 2015 to 2027. Understanding the segments helps in identifying the importance of different factors that aid market growth.

Joint Pain Injections Market, By Application

Shoulder & Elbow Knee & Ankle Spinal Joints Hip Joint Others

Joint Pain Injections Market, By Type

Steroid Joint Injections Hyaluronic Acid Injections Platelet-rich Plasma (PRP) Injections Placental Tissue Matrix (PTM) Injections Others

Joint Pain Injections Market, By Distribution Channel

Hospital Pharmacies Online Pharmacies Retail Pharmacies

The study analyses the following key business aspects:

Analysis of Strategies of Leading Players: Market players can use this analysis to gain a competitive advantage over their competitors in the Joint Pain Injections market.

Study on Key Market Trends: This section of the report offers a deeper analysis of the latest and future trends of the Joint Pain Injections market.

Market Forecasts:Buyers of the report will have access to accurate and validated estimates of the total market size in terms of value and volume. The report also provides consumption, production, sales, and other forecasts for the Joint Pain Injections market.

Regional Growth Analysis:All major regions and countries have been covered in the report. The regional analysis will help market players to tap into unexplored regional markets, prepare specific strategies for target regions, and compare the growth of all regional markets.

Segmental Analysis:The report provides accurate and reliable forecasts of the market share of important segments of the Joint Pain Injections market. Market participants can use this analysis to make strategic investments in key growth pockets of the Joint Pain Injections market.

Business Opportunities in Following Regions and Countries:

North America (United States, Canada, and Mexico)

Europe (Germany, UK, France, Italy, Russia, Spain, and Benelux)

Asia Pacific (China, Japan, India, Southeast Asia, and Australia)

Latin America (Brazil, Argentina, and Colombia)

How will the report assist your business to grow?

The document offers statistical data about the value (US $) and size (units) for the Joint Pain Injections industry between 2020 to 2027.

The report also traces the leading market rivals that will create and influence the Joint Pain Injections business to a greater extent.

Extensive understanding of the fundamental trends impacting each sector, although greatest threat, latest technologies, and opportunities that could build the global Joint Pain Injections market both supply and offer.

The report helps the customer to determine the substantial results of major market players or rulers of the Joint Pain Injections sector.

Reason to Buy this Report:

Save and reduce time carrying out entry-level research by identifying the growth, size, leading players, and segments in the global Joint Pain Injections Market. Highlights key business priorities in order to assist companies to realign their business strategies. The key findings and recommendations highlight crucial progressive industry trends in Joint Pain Injections Market, thereby allowing players to develop effective long term strategies.

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Joint Pain Injections Market Size By Product Analysis, By Application, By End-Users, By Regional Outlook, By Top Companies and Forecast to 2027 -...

When your hair falls off and leaves scars – The Star, Kenya

The texture was different. In fact, my remaining hair seemed to look like the hair of our Muslim sisters. It was soft and light, something that was quite different from my natural hair, she said.

But she said even with the texture change, her hair began falling off and only a little was left at the back of her head.

There were patches on my head which turned into wounds. When I slept at night, I could wake up and find my hair on the pillow. This left me worried. When I combed my hair, the hair fell off, she said.

Onyinge then decided to braid her hair to see if the falling off would be tamed.

This did not work. I then decided to do weaves or wear wigs as I sought for a solution, she said.

An adults head has 100,000150,000 hair follicles, and each follicle can grow about 20 individual hairs. On average, every normal individual loses 75 to 100 hairs a day.

In 2016, Onyinge could not walk with her hair, whether it was braided or not.

Painful wounds began forming in the patches that were now scars. The hair was now not growing anymore. This is the time I decided to go and see a specialist, who recommended some lotions that I was to apply on my head, she said.

The pain on the wounds reduced but the hair continued to fall off.

LOST HOPE

The specialist told Onyinge that whatever condition it was, it must have been inherited.

I went to the specialist to repair my hair but then he asked me if anybody in my family had the same problem. This is the time I had to tell him about my father and my sister, she said.

It was at this point that she was given a lotion to apply on her hair, which did not guarantee that her hair would grow.

The doctor first drew blood from my system and extracted plasma, which was used to inject my scalp. I had 15 injections on my scalp just as a way to treat my hair loss, she said.

Trichologist Hillary Onyango says that the plasma used for the injection should be able to stimulate the growth of the hair follicles.

Though she had to part with around Sh15,000 per session, Onyinge said the hair continued to fall off.

Then a few days ago, a friend told me he knew a good doctor who could help me with the condition. I decided to give it a shot. When I arrived, I realised the clinic was being run by a man and his wife, all from Indian origin, she said.

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When your hair falls off and leaves scars - The Star, Kenya

Ron Evans steals a trick from I/O, and points the way to a transformational diabetes therapy – Endpoints News

Salk Institute scientist and serial biotech entrepreneur Ron Evans showed new mouse work yesterday that could point to a long-sought holy grail for diabetes treatment.

The study, published in Nature,involved a new approach for islet cell transplant, a diabetes therapy where dysfunctional insulin-producing cells on the pancreas are replaced with functional ones. The treatment has been around for a while and new ones are in development, but theyve been hampered by the fact that patients will reject the cells unless they go on immuno-suppressive drugs.

But, working with iPSC stem cells and tricks from immunotherapy, Evans and his team developed what they called immune-evasive clusters of cells essentially mini pancreases. Placed into mice, these cells secreted proper amounts of insulin without coming under fire from immune cells, pointing the way toward a similar approach in humans.

Most type 1 diabetics are children and teenagers, Evans said in a statement. We hope that regenerative medicine in combination with immune shielding can make a real difference in the field by replacing damaged cells with lab-generated human islet-like cell clusters that produce normal amounts of insulin on demand.

Evans, who most recently co-founded and sold to Astellas the exercise-in-a-pill biotech Mitobridge, and his co-authors are hardly alone in this race. ViaCyte has received major backing from both private donors and the Juvenile Diabetes Research Foundation for their own stem cell-derived islet cell transplant. Flagship also launched Sigilon earlier this year with $80.3 million in Series B funding. With technology from Robert Langer, the company is developing polymers that can encase cells for transplant. A diabetes program is in the IND-enabling phase with Eli Lilly.

Four years ago, Evans and his team figured out how to make functional pancreatic beta cells for the first time, using a series of molecular switches to get them to not only produce insulin but do so in response to glucose, as normal cells do. But that still left questions about how to go from individual cells into pancreas-like clusters, and how to get those cells to avoid the immune system when transplanted.

To cluster the cells, Evans lab figured out that a protein involved in embryonic development called WNT4 could trigger the same molecular mechanisms that created the functional beta cells. Adding that protein led to the creation of 3-D clusters of cells similar to what would be seen in a humans. They called them human islet-like organoids, or HILOs.

To make those organoids, Evans and Eiji Yoshihara, a scientist in his lab, stole a trick from another field: immuno-oncology. Using short pulses of a protein called interferon gamma, Yoshihara got the cells to express PD-L1.

The PD-L1 had the opposite effect of the PD-L1 inhibitors used in cancer. Rather than making sure T cells saw a tumor, they made sure T cells didnt see the islet cells.

This is the first study to show that you can protect HILOs from the immune system without genetic manipulation, Michael Downes, an author on the paper, said. If we are able to develop this as a therapy, patients will not need to take immune-suppressing drugs.

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Ron Evans steals a trick from I/O, and points the way to a transformational diabetes therapy - Endpoints News

Research Roundup: Lasting Immunity to COVID-19 and More – BioSpace

Every week there are numerous scientific studies published. Heres a look at some of the more interesting ones.

Multiple Studies Suggest Lasting Immunity to COVID-19 After Infection

Although probably not enough time has passed to know definitively, several studies are now suggesting that even mild cases of COVID-19 stimulate lasting immune responses, not only in disease-fighting antibodies, but in B- and T-cells.

Things are really working as theyre supposed to, Deepta Bhattacharya, an immunologist at the University of Arizona, and an author of one of the studies, told The New York Times.

Its difficult, probably impossible, to predict how long those immune responses will last, but many of the researchers believe the results are promising for long-term protection.

This is exactly what you would hope for, Marion Pepper, an immunologist at the University of Washington and an author of a study currently being reviewed by the journal Nature. All the pieces are there to have a totally protective immune response.

Pepper notes that the protective effects cant be completely evaluated until there is proof that people exposed to the virus a second time can fight it off. But the data suggests the immune system is indeed able to fight resistance a second time. Some of this qualification comes from unconfirmed reports of people being reinfected by the virus.

Antibody responses are typically relatively short-lived, disappearing from the blood weeks or months after being produced. Generally, the majority of the B-cells that produce antibodies die off, too. But the body keeps some longer-lived B-cells that are able to manufacture virus-fighting antibodies should the immune system be triggered by re-exposure to the virus. Some stay in the bloodstream while others wait in the bone marrow where they manufacture small numbers of antibodies that can sometimes be observed years, even decades later. Several studies, some by Bhattacharya and Pepper, have identified antibodies at low levels in the blood months after people recovered from COVID-19.

The antibodies decline, but they settle in what looks like a stable nadir, Bhattacharya said. These have been observed about three months after symptoms show up. The response looks perfectly durable.

Additional studies, including one published in the journal Cell, have isolated T-cells from recovered patients that can attack SARS-CoV-2. In laboratory studies, the T-cells produced signals to fight the virus and cloned themselves in large numbers to fight the potential infection.

This is very promising, said Smita Iyer, an immunologist at the University of California, Davis, who was not involved in the new studies, but has researched immune responses to the novel coronavirus in rhesus macaques. This calls for some optimism about herd immunity, and potentially a vaccine.

It's still has not been definitely determined if milder cases of COVID-19 will lead to long-term or even medium-term immunity. There have been some studies that suggest it does not and some newer studies suggesting it does. Iyer notes that the recent paper indicates, You can still get durable immunity without suffering the consequences of infection.

This idea is reinforced by Eun-Hyung Lee, an immunologist at Emory University who was not involved in these studies. He told The New York Times, Yes, you do develop immunity to this virus, and good immunity to this virus. Thats the message we want to get out there.

Why Seasonal Flu Vaccines Only Last a Year

As most everyone knows, flu vaccines only last about a year. Some of this is related to viral mutations. But in fact, the actual immunity itself caused by the vaccine does not appear to last longer than a year, even though the flu vaccine increases the number of antibody-producing cells specific for the flu in the bone marrow. Researchers out of Emory Vaccine Center found that for most newly-generated plasma cell lineages, between 70 and 99% of the cells were gone after one year, but that the levels of antibody-secreting cells in blood correlated with long-term response in the bone marrow.

Gut Bacteria Can Help Immuno-Oncology Therapies

Researchers with the University of Calgary identified gut bacteria that help our immune system fight cancerous tumors. This also helped provide more information about why immunotherapy works in some cases, but not others. By combining immunotherapy with specific microbial therapy, they believe they can help the immune system and immunotherapy be more effective in treating three types of cancer: melanoma, bladder and colorectal cancers. They found that specific bacteria were essential for immunotherapy to work in colorectal cancer tumors in germ-free mice. The bacteria produced a small molecule called inosine that interacts directly with T-cells and together with immunotherapy.

An Online Calculator to Predict Stroke Risk

Scientists at the University of Virginia Health System developed an online tool that measures the severity of a patients metabolic syndrome, a mix of conditions that includes high blood pressure, abnormal cholesterol levels and excess body fat. With it, they can then predict the patients risk for ischemic stroke. The study discovered that stroke risk increased consistently with metabolic syndrome severity even in patients that did not have diabetes. The tool is available for free at https://metscalc.org/.

A Link Between Autism and Cholesterol

Researchers at Harvard Medical School, Massachusetts Institute of Technology (MIT) and Northwestern University identified a subtype of autism that is the result of a cluster of genes that regulate cholesterol metabolism and brain development. They believe this information can help design precision-targeted therapies for this specific type of autism and improve screening efforts for earlier diagnosis of autism. They analyzed the DNA from brain samples that they then confirmed with the medical records of autistic individuals. They found that children with autism and their parents had significant alterations in lipid blood. However, there is much more to be understood, emphasizing the complexity of autism, which is affected by a variety of genetic and environmental factors.

Researchers Grow First Functioning Mini Human Heart Model

Investigators with Michigan State University grew the first miniature human heart model in the laboratory that is complete with all primary heart cell types and a functioning structure of chambers and vascular tissue. They utilized induced pluripotent stem cells which were obtained from consenting adults and created a functional mini heart in a few weeks. The primary value was in giving them an unprecedented view into how a fetal heart develops.

In the lab, we are currently using heart organoids to model congenital heart diseasethe most common birth defect in humans affecting nearly 1% of the newborn population, said Aitor Aguirre, senior author and assistant professor of biomedical engineering at MSUs Institute for Quantitative Health Science and Engineering. With our heart organoids, we can study the origin of congenital heart disease and find ways to stop it.

Another area of focus is that improving on the final organoid will help with future research. Current heart organoids are not identical yet to human hearts and so are flawed in their use as research models.

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Research Roundup: Lasting Immunity to COVID-19 and More - BioSpace

The global market for Peripheral Blood Mononuclear Cells (PBMC) is projected to grow at a CAGR of around 9% during 2020 – 2025 – GlobeNewswire

August 21, 2020 13:04 ET | Source: ReportLinker

New York, Aug. 21, 2020 (GLOBE NEWSWIRE) -- Reportlinker.com announces the release of the report "Global Peripheral Blood Mononuclear Cells Market, By Product, By Application, By Technique, By Source, By Region, Competition, Forecast & Opportunities, 2025" - https://www.reportlinker.com/p05953172/?utm_source=GNW

The global market for Peripheral Blood Mononuclear Cells (PBMC) is projected to grow at a CAGR of around 9% during 2020 - 2025.The PBMC are crucial to carry out the biology and pathology related studies as well as in clinical research.

Besides, PBMCs are also utilized in research related to fatal diseases, immunology, vaccine development, etc. However, high cost of PBMCs related studies might act as a challenge for the adoption of technology, especially in developing economies. The global peripheral blood mononuclear cells market is segmented based on product, application, technique, source, and region.The product segment is further divided into cryopreserved or frozen PBMC, cultured or fresh PBMC and peripheral blood mononuclear cell isolation & viability kits.

As of 2019, the cryopreserved PBMC or the frozen PBMC segment held the highest market share as they can be used for longer durations of time if stored carefully at lower temperatures.In terms of regional analysis, North America accounted for the largest market share in the year 2019, on the back of a number of pre-existing peripheral blood mononuclear cells-based companies in the region.

The economy of the region is also rich enough, which makes it easier to carry out the complex and costly R&D procedures. Major players operating in the global peripheral blood mononuclear cells market include Astarte Biologics, Inc., ATZLabs, BioIVT, BioLegend, Inc., BioVision, Bio-Rad, Cell Applications, Inc., Celgene, Creative Bioarray, Dapcel, Inc, HemaCare, iXCells Biotechnologies, Miltenyi Biotec, Merck, Novo Nordisk, Precision Medicine, Qiagen NV, STEMCELL Technologies Inc., Thermo Fisher Scientific, ZenBio, Inc., etc.

Years considered for this report:

Historical Years: 2015 - 2018 Base Year: 2019 Estimated Year: 2020 Forecast Period: 2021 - 2025

Objective of the Study:

To analyze and forecast the market size of global peripheral blood mononuclear cells market. To classify and forecast global peripheral blood mononuclear cells market based on product, application, technique, source, and region. To identify drivers and challenges for global peripheral blood mononuclear cells market. To examine competitive developments such as expansions, new product launches, mergers & acquisitions, etc., in global peripheral blood mononuclear cells market. To conduct pricing analysis for global peripheral blood mononuclear cells market. To identify and analyze the profile of leading players operating in global peripheral blood mononuclear cells market. The analyst performed both primary as well as exhaustive secondary research for this study.Initially, the analyst sourced a list of leading market players across the globe.

Subsequently, the analyst conducted primary research surveys with the identified companies.While interviewing, the respondents were also enquired about their competitors.

Through this technique, the analyst could include the research organizations and companies which could not be identified due to the limitations of secondary research. The analyst examined the research organizations and companies, and presence of all major players across the globe. The analyst calculated the market size of global peripheral blood mononuclear cells market using a bottom-up approach, wherein data for various end-user segments was recorded and forecast for the future years. The analyst sourced these values from the industry experts and company representatives and externally validated through analyzing historical data of these product types and applications for getting an appropriate, overall market size.

Various secondary sources such as company websites, news articles, press releases, company annual reports, investor presentations and financial reports were also studied by the analyst.

Key Target Audience:

Biotechnology and pharma companies and other stakeholders Government bodies such as regulating authorities and policy makers Organizations, forums and alliances related to peripheral blood mononuclear cells Market research and consulting firms The study is useful in providing answers to several critical questions that are important for the industry stakeholders such as research organizations & companies and partners, end users, etc., besides allowing them in strategizing investments and capitalizing on market opportunities.

Report Scope:

In this report, global peripheral blood mononuclear cells market has been segmented into following categories, in addition to the industry trends which have also been detailed below: Market, By Product: o Cryopreserved or Frozen PBMC o Cultured or Fresh PBMC o Peripheral Blood Mononuclear Cell Isolation & Viability Kits Market, By Application: o Immunology o Infectious disease o Hematology o Others Market, By Technique: o Density gradient centrifugation process o Leukapheresis Market, By Source: o Human o Animals Market, By Region: o Asia-Pacific - China - India - Japan - South Korea - Singapore - Australia o Europe - France - Germany - United Kingdom - Italy o North America - United States - Mexico - Canada o South America - Brazil - Argentina - Colombia o Middle east & Africa - South Africa - Saudi Arabia - UAE

Competitive Landscape

Company Profiles: Detailed analysis of the major companies present in global peripheral blood mononuclear cells market.

Available Customizations:

With the given market data, we offers customizations according to a companys specific needs. The following customization options are available for the report:

Company Information

Detailed analysis and profiling of additional market players (up to five). Read the full report: https://www.reportlinker.com/p05953172/?utm_source=GNW

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The global market for Peripheral Blood Mononuclear Cells (PBMC) is projected to grow at a CAGR of around 9% during 2020 - 2025 - GlobeNewswire

Stem Cell Therapy Market Segmentation, Assessment and Growth Opportunities by Forecast 2025 – Scientect

Global Stem Cell Therapy Market: Overview

Also called regenerative medicine, stem cell therapy encourages the reparative response of damaged, diseased, or dysfunctional tissue via the use of stem cells and their derivatives. Replacing the practice of organ transplantations, stem cell therapies have eliminated the dependence on availability of donors. Bone marrow transplant is perhaps the most commonly employed stem cell therapy.

Osteoarthritis, cerebral palsy, heart failure, multiple sclerosis and even hearing loss could be treated using stem cell therapies. Doctors have successfully performed stem cell transplants that significantly aid patients fight cancers such as leukemia and other blood-related diseases.

Know the Growth Opportunities in Emerging Markets

Global Stem Cell Therapy Market: Key Trends

The key factors influencing the growth of the global stem cell therapy market are increasing funds in the development of new stem lines, the advent of advanced genomic procedures used in stem cell analysis, and greater emphasis on human embryonic stem cells. As the traditional organ transplantations are associated with limitations such as infection, rejection, and immunosuppression along with high reliance on organ donors, the demand for stem cell therapy is likely to soar. The growing deployment of stem cells in the treatment of wounds and damaged skin, scarring, and grafts is another prominent catalyst of the market.

On the contrary, inadequate infrastructural facilities coupled with ethical issues related to embryonic stem cells might impede the growth of the market. However, the ongoing research for the manipulation of stem cells from cord blood cells, bone marrow, and skin for the treatment of ailments including cardiovascular and diabetes will open up new doors for the advancement of the market.

Global Stem Cell Therapy Market: Market Potential

A number of new studies, research projects, and development of novel therapies have come forth in the global market for stem cell therapy. Several of these treatments are in the pipeline, while many others have received approvals by regulatory bodies.

In March 2017, Belgian biotech company TiGenix announced that its cardiac stem cell therapy, AlloCSC-01 has successfully reached its phase I/II with positive results. Subsequently, it has been approved by the U.S. FDA. If this therapy is well- received by the market, nearly 1.9 million AMI patients could be treated through this stem cell therapy.

Another significant development is the granting of a patent to Israel-based Kadimastem Ltd. for its novel stem-cell based technology to be used in the treatment of multiple sclerosis (MS) and other similar conditions of the nervous system. The companys technology used for producing supporting cells in the central nervous system, taken from human stem cells such as myelin-producing cells is also covered in the patent.

The regional analysis covers:

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Global Stem Cell Therapy Market: Regional Outlook

The global market for stem cell therapy can be segmented into Asia Pacific, North America, Latin America, Europe, and the Middle East and Africa. North America emerged as the leading regional market, triggered by the rising incidence of chronic health conditions and government support. Europe also displays significant growth potential, as the benefits of this therapy are increasingly acknowledged.

Asia Pacific is slated for maximum growth, thanks to the massive patient pool, bulk of investments in stem cell therapy projects, and the increasing recognition of growth opportunities in countries such as China, Japan, and India by the leading market players.

Global Stem Cell Therapy Market: Competitive Analysis

Several firms are adopting strategies such as mergers and acquisitions, collaborations, and partnerships, apart from product development with a view to attain a strong foothold in the global market for stem cell therapy.

Some of the major companies operating in the global market for stem cell therapy are RTI Surgical, Inc., MEDIPOST Co., Ltd., Osiris Therapeutics, Inc., NuVasive, Inc., Pharmicell Co., Ltd., Anterogen Co., Ltd., JCR Pharmaceuticals Co., Ltd., and Holostem Terapie Avanzate S.r.l.

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Stem Cell Therapy Market Segmentation, Assessment and Growth Opportunities by Forecast 2025 - Scientect

Congress must save lives and reauthorize cell transplant funding | Opinion – NorthJersey.com

Ronald Roth, Special to the USA TODAY NETWORK Published 4:02 a.m. ET Aug. 19, 2020

In May of this year, religious Jews celebrated Pesach Sheni. Pesach Sheni literally means Second Passover and marks the day in ancient times when someone who was unable to participate in Passover was given a second chance to observe the holiday.

The concept of second chances is a powerful one, not just in the Jewish faith, but in our society as a whole. Some times a second chance is more than just an opportunity for spiritual or personal redemption some times a second chance is literally a second chance at life itself.

I know this first-hand, because thanks to a bone marrow transplant, I was given a second chance at life.

In May 2015, I was diagnosed with a myelofibrosis, a rare form of blood cancer. For three years, I travelled back and forth to Mount Sinai Hospital for blood tests and medications that treated my illness. For those first three years I was fortunate to have few symptoms of my disease and I was able to continue my very busy schedule as rabbi of Fair Lawn Jewish Center/Congregation Bnai Israel.

Patrick Gustoso registers for the National Marrow Donor Program on March 28, 2017, at the Nutley Health Department. Organizers hope to find a match for resident Anne Rotonda.(Photo: Owen Proctor/NorthJersey.com)

In the spring of 2018, my medical fortunes changed dramatically as the disease began a more rapid progression. Since my diagnosis, I had known that a bone marrow transplant would be my only chance at a cure and in August 2018, I received that bone marrow transplant and a second chance at life.

After my transplant, I became an ambassador advocate for National Marrow Donor Program/Be The Match. I committed myself to using this second chance to help others who are in need of access to life-saving cellular therapy. I am not alone in this, all across the country men and women, doctors and patients, survivors and co-survivors, donors and recipients are working tirelessly to make sure live-saving materials are delivered to those in need.

We cant do it alone, we need help help from our elected officials in Washington.

The CW Bill Young Cell Transplantation program provides access to live-saving bone marrow, peripheral blood stem cell and cord blood transplants for patients living with one of more than 70 blood cancers or disorders for which a transplant is the only curative option.

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Since its inception, the CW Bill Young Cell Transplantation Program has always enjoyed broad bipartisan support in both chambers of Congress. The program has been reauthorized by Congress every five years. It is up for re-authorization again this year and Congress should act swiftly to ensure the program remains able to fulfill its critical live-saving function.

Over the past 30 years, the National Marrow Donor Program (NMDP)/Be The Match has been entrusted by Congress to operate this critical program. During that time, more than 100,000 life-saving and life-extending transplants have been facilitated through the national registry.Many of these transplants took place here in New Jersey.

The Program is up for reauthorization again this summer and it is absolutely imperative that both chambers act swiftly to ensure that the program is reauthorized and that the critical life-saving work continues.The mission of the national registry to match patients and donors and ensure the timely transportation of lifesaving cellular products through the United States and around the world has been made even more challenging by COVID-19.Despite the pandemic, NMDP/Be The Match completed more transplants in June than in any single month in the programs history.This was only made possible by having the status of a federally authorized program that is recognized by other Federal, state, and local agencies and foreign governments.Should the programs authorization lapse at the end of September, there is concern that the program may not be able to operate as efficiently during the continuing public health emergency.

By reauthorizing the CW Bill Young Cell Transplantation Program, Congress can help give second chances to tens of thousands of men and women in need all across the country and here in New Jersey.

Rabbi Ronald Roth lives in Fair Lawn.

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Congress must save lives and reauthorize cell transplant funding | Opinion - NorthJersey.com

How Far Have We Come In Treating COVID-19? – The Dispatch

Six months and counting into our coronavirus era, weve gotten much better at quantifying the fight against the disease. How well a country or state or county is faring is broken down into charts and scatterplots: Cases per capita and tests run per capita, hospital capacity and PPE availability, test positivity rate and test turnaround rate and case fatality rate.

Given that blizzard of data, its strange that one question remains so difficult to examine: How much better are we actually getting at fighting the disease?

Weve certainly gotten better at fighting the diseases spread. Everyone knows the drill by now: Masks, social distancing, washing your hands. Whats less obvious is how far weve progressed in the task of healing the very sick. Doctors and hospitals have tried to defeat the virus with a cornucopia of drugs and treatments. But in part because that effort has been so improvisational and eclectic, tracking its effectiveness over time remains a serious challenge.

The central fact of the current stage of the pandemic is this: Although new cases soared throughout July and August far above what we saw in April and May, daily COVID deaths have not climbed back to their late-April heights. That rate may continue to rise even with new cases descending againdeaths are, after all, a lagging indicatorbut the discrepancy is too sharp to ignore.

But this discrepancy itself does not necessarily indicate improved outcomes in COVID treatment, because other differences between the pandemics spring manifestation and its summer one affect the data too. The first wave of the pandemic was clustered primarily in New York and New Jersey, states that failed terribly at keeping the virus, which is most dangerous to the elderly, out of nursing homes. Further, our national testing operation was then in such a sorry state that it's hard to tell how much viral spread we missed the first time around.

I think most of the reduction in fatality rate across the country is accounted for by protecting vulnerable populations and by overtesting, Dr. Howard Forman, a Yale radiologist and health policy professor, told The Dispatch. So by testing more people who are healthier, we make ourselves look better.

This certainly isnt to say there hasnt been improvement in treating the virus. Clinicians will tell you in no uncertain terms theyve seen genuine progress. Gone is the desperate chaos of the early months, with their frantic smorgasbord of ad-hoc treatments and what-have-you-got-to-lose therapeutics; now doctors share a sort of anti-COVID folklore, wedding what solid clinical data exists with treatments that their compatriots around the country have found effective from hard experience.

Theres kind of two parts to the decision-making, said Dr. Megan Ranney, an emergency physician and professor at Brown University. Part one, and the part that we are all most comfortable with, is relying on peer-reviewed evidence. She rattled off a few examples: The antiviral drug remdesivir, which has been shown to reduce COVIDs recovery time; the anti-inflammatory dexamethasone, which can help soothe a berserk immune response to the virus; placing patients who are struggling to breathe on their stomachs rather than their backs.

The other side is the anecdote, the case series, the shared experiences of groups of physicians, she said. This was particularly prominent early in the pandemic when we really had nothing, and no guidance whatsoever. We saw Facebook and WhatsApp groups spring up, as well as email listservs, to try to allow real-time sharing of best practices and to allow people to compare what worked in one setting to what worked in another.

This loose-cannon treatment style helped doctors begin to catch up to a horribly powerful virus under incredibly bad circumstances, but it had its drawbacks too. Several doctors we spoke to brought up the example of hydroxychloroquine, a drug that showed some early promise in treating COVID patients but was ultimately shown in controlled clinical trials to be unhelpful in treating very sick patients. Ordinarily, that would be the end of the road for a given treatmentbut in this case, there were already a number of small case studies and doctors personal testimonies floating around with positive assessments of the drug and endorsements from President Donald Trump created a political constituency for its success. Such case studies and anecdotes are inherently less reliable than large-scale clinical trials, but their existence helped fan the flames of the bizarre conspiracy theories that cropped up around the drug.

And it isnt true that doctors are comfortable now, exactly. It can be hard to remember that were still in the very early days of the fight against a brand-new disease. Staying up to date on all the research coming out is a constant struggle of its own. Just this week, for instance, the FDA unexpectedly decided not to issue an emergency authorization for convalescent plasma, a promising treatment involving transfusions of antibody-rich blood serum donated by those who have already had COVID-19, suggesting the data was not yet strong enough to support it.

I still feel likemaybe not that Im working in the dark, but that maybe Im working with one eye closed, said Dr. Akino Yamashita, who has spent the year treating COVID patients in New Jersey and New York. Every day, its Oh, theres this new study, theres this new article. But does [one study] really change what I do when I see the next patient with this disease? Probably not.

Of the convalescent plasma story, she added: Certainly this goes along with the theme that although there are more treatment options available now, this is a constantly changing story.

Nor does the constant churn of new research focus only on better understanding the effects of the treatments already in circulation. Possible new treatments are working their way through the early stages of clinical trials all the time. Antibody treatments, both artificially manufactured and derived from animals, and stem cell therapies featuring cells known as MSCs (which stands, somewhat confusingly, for either medicinal signaling cells or mesenchymal stem cells)these are a few of the bleeding-edge projects that could potentially follow hydroxychloroquine and remdesivir into the public consciousness in the months to come.

Of course, this multiplication of possible treatments brings another set of challenges entirely.

The standard of treatment for a severe COVID-19 illness is changing, Dr. David Ingbar, a professor of medicine and pulmonary care expert at the University of Minnesota, told The Dispatch. Dr. Ingbar is currently heading up an early clinical trial into treating COVID with MSCs.

Now we believe dexamethasone works in certain populations at certain levels of illness, he said. We know that remdesivir has some benefit in terms of shortening the disease and maybe improving mortality. There are suggestions that, if given early, convalescent plasma might be beneficial. What we dont know very much about is, how do all of these treatments interact? Is it better to get one from column A, B, C, D, and E? Or are only certain combinations beneficial? So its a complicated field, and I think we all as clinicians want to help our patients as much as possible. But there is potential to do harm as well as good with all these treatments.

Presented like this, all this can seem like a dreary deluge of obstacles and complications. So its worth stating unequivocally: All of this is a pretty good problem to have. It may be a while before we can say for sure how far back our medical researchers and clinicians have beaten the virus already. But that fight gets a little less favorable to the virus, and a little more favorable to the humans, every day.

People forget that the longer you can wait to get COVIDhopefully well get a vaccine quickly, so well be able to protect us all from getting infectedbut if you get infected today, your chance of living through that infection is better than if you got infected in February or March, Dr. Ranney said. And I expect that to continue to improve. Its not a linear process. Its two steps forward, one step back in terms of that knowledge generation. So there are going to continue to be things that change, there are going to continue to be things that we think help and maybe dont. Thats normal in medicine. But overall, the trajectory is absolutely a positive and encouraging trajectory in terms of our ability to effectively treat and save lives of patients who are sick with COVID.

Photograph by Go Nakamura/Getty Images.

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How Far Have We Come In Treating COVID-19? - The Dispatch

Each of Us Has the Ability to Save a Life; That Is the Power of Blood. – CSRwire.com

Aug. 21 /CSRwire/ - DKMS #PowerOfBlood

With Black donors currently only making up 7 percent of the registry, DKMS has launched the Power of Blood initiative with an aim to increase awareness of the topic in the Black community and encourage participation in the registry. For Emma Hall, a 10-year-old battling Aplastic Anemia, this initiative is a chance to share her story and change the fortunes of patients like her across the country.

Sitting in her backyard in Olathe, KS, Emma daydreams about going back to school, playing soccer with her friends, and - surprisingly for such a young child - simply not being tired all the time. Diagnosed with Aplastic Anemia (AA) in early 2019, Emma has been forced to give up her usual activities and routines, confronted by the reality that even sitting and reading a book can become an exhausting activity.

With their lives currently a blur of hospital visits and blood transfusions, Emmas doctors have told her family that the only cure for her disease is to receive a stem cell transplant from a matching donor. Though the search began with great hope, now over a year later Emma is still unable to find the match she needs to have a second chance at life. Could you be the difference?

Register now to save a life!

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Each of Us Has the Ability to Save a Life; That Is the Power of Blood. - CSRwire.com

Viruses have big impacts on ecology and evolution as well as human health – The Economist

Aug 20th 2020

I The outsiders inside

HUMANS ARE lucky to live a hundred years. Oak trees may live a thousand; mayflies, in their adult form, a single day. But they are all alive in the same way. They are made up of cells which embody flows of energy and stores of information. Their metabolisms make use of that energy, be it from sunlight or food, to build new molecules and break down old ones, using mechanisms described in the genes they inherited and may, or may not, pass on.

It is this endlessly repeated, never quite perfect reproduction which explains why oak trees, humans, and every other plant, fungus or single-celled organism you have ever seen or felt the presence of are all alive in the same way. It is the most fundamental of all family resemblances. Go far enough up any creatures family tree and you will find an ancestor that sits in your family tree, too. Travel further and you will find what scientists call the last universal common ancestor, LUCA. It was not the first living thing. But it was the one which set the template for the life that exists today.

And then there are viruses. In viruses the link between metabolism and genes that binds together all life to which you are related, from bacteria to blue whales, is broken. Viral genes have no cells, no bodies, no metabolism of their own. The tiny particles, virions, in which those genes come packagedthe dot-studded disks of coronaviruses, the sinister, sinuous windings of Ebola, the bacteriophages with their science-fiction landing-legs that prey on microbesare entirely inanimate. An individual animal, or plant, embodies and maintains the restless metabolism that made it. A virion is just an arrangement of matter.

The virus is not the virion. The virus is a process, not a thing. It is truly alive only in the cells of others, a virtual organism running on borrowed hardware to produce more copies of its genome. Some bide their time, letting the cell they share the life of live on. Others immediately set about producing enough virions to split their hosts from stem to stern.

The virus has no plan or desire. The simplest purposes of the simplest lifeto maintain the difference between what is inside the cell and what is outside, to move towards one chemical or away from anotherare entirely beyond it. It copies itself in whatever way it does simply because it has copied itself that way before, in other cells, in other hosts.

That is why, asked whether viruses are alive, Eckard Wimmer, a chemist and biologist who works at the State University of New York, Stony Brook, offers a yes-and-no. Viruses, he says, alternate between nonliving and living phases. He should know. In 2002 he became the first person in the world to take an array of nonliving chemicals and build a virion from scratcha virion which was then able to get itself reproduced by infecting cells.

The fact that viruses have only a tenuous claim to being alive, though, hardly reduces their impact on things which are indubitably so. No other biological entities are as ubiquitous, and few as consequential. The number of copies of their genes to be found on Earth is beyond astronomical. There are hundreds of billions of stars in the Milky Way galaxy and a couple of trillion galaxies in the observable universe. The virions in the surface waters of any smallish sea handily outnumber all the stars in all the skies that science could ever speak of.

Back on Earth, viruses kill more living things than any other type of predator. They shape the balance of species in ecosystems ranging from those of the open ocean to that of the human bowel. They spur evolution, driving natural selection and allowing the swapping of genes.

They may have been responsible for some of the most important events in the history of life, from the appearance of complex multicellular organisms to the emergence of DNA as a preferred genetic material. The legacy they have left in the human genome helps produce placentas and may shape the development of the brain. For scientists seeking to understand lifes origin, they offer a route into the past separate from the one mapped by humans, oak trees and their kin. For scientists wanting to reprogram cells and mend metabolisms they offer inspirationand powerful tools.

II A lifestyle for genes

THE IDEA of a last universal common ancestor provides a plausible and helpful, if incomplete, answer to where humans, oak trees and their ilk come from. There is no such answer for viruses. Being a virus is not something which provides you with a place in a vast, coherent family tree. It is more like a lifestylea way of being which different genes have discovered independently at different times. Some viral lineages seem to have begun quite recently. Others have roots that comfortably predate LUCA itself.

Disparate origins are matched by disparate architectures for information storage and retrieval. In eukaryotescreatures, like humans, mushrooms and kelp, with complex cellsas in their simpler relatives, the bacteria and archaea, the genes that describe proteins are written in double-stranded DNA. When a particular protein is to be made, the DNA sequence of the relevant gene acts as a template for the creation of a complementary molecule made from another nucleic acid, RNA. This messenger RNA (mRNA) is what the cellular machinery tasked with translating genetic information into proteins uses in order to do so.

Because they, too, need to have proteins made to their specifications, viruses also need to produce mRNAs. But they are not restricted to using double-stranded DNA as a template. Viruses store their genes in a number of different ways, all of which require a different mechanism to produce mRNAs. In the early 1970s David Baltimore, one of the great figures of molecular biology, used these different approaches to divide the realm of viruses into seven separate classes (see diagram).

In four of these seven classes the viruses store their genes not in DNA but in RNA. Those of Baltimore group three use double strands of RNA. In Baltimore groups four and five the RNA is single-stranded; in group four the genome can be used directly as an mRNA; in group five it is the template from which mRNA must be made. In group sixthe retroviruses, which include HIVthe viral RNA is copied into DNA, which then provides a template for mRNAs.

Because uninfected cells only ever make RNA on the basis of a DNA template, RNA-based viruses need distinctive molecular mechanisms those cells lack. Those mechanisms provide medicine with targets for antiviral attacks. Many drugs against HIV take aim at the system that makes DNA copies of RNA templates. Remdesivir (Veklury), a drug which stymies the mechanism that the simpler RNA viruses use to recreate their RNA genomes, was originally developed to treat hepatitis C (group four) and subsequently tried against the Ebola virus (group five). It is now being used against SARS-CoV-2 (group four), the covid-19 virus.

Studies of the gene for that RNA-copying mechanism, RdRp, reveal just how confusing virus genealogy can be. Some viruses in groups three, four and five seem, on the basis of their RdRp-gene sequence, more closely related to members of one of the other groups than they are to all the other members of their own group. This may mean that quite closely related viruses can differ in the way they store their genomes; it may mean that the viruses concerned have swapped their RdRp genes. When two viruses infect the same cell at the same time such swaps are more or less compulsory. They are, among other things, one of the mechanisms by which viruses native to one species become able to infect another.

How do genes take on the viral lifestyle in the first place? There are two plausible mechanisms. Previously free-living creatures could give up metabolising and become parasitic, using other creatures cells as their reproductive stage. Alternatively genes allowed a certain amount of independence within one creature could have evolved the means to get into other creatures.

Living creatures contain various apparently independent bits of nucleic acid with an interest in reproducing themselves. The smallest, found exclusively in plants, are tiny rings of RNA called viroids, just a few hundred genetic letters long. Viroids replicate by hijacking a host enzyme that normally makes mRNAs. Once attached to a viroid ring, the enzyme whizzes round and round it, unable to stop, turning out a new copy of the viroid with each lap.

Viroids describe no proteins and do no good. Plasmidssomewhat larger loops of nucleic acid found in bacteriado contain genes, and the proteins they describe can be useful to their hosts. Plasmids are sometimes, therefore, regarded as detached parts of a bacterias genome. But that detachment provides a degree of autonomy. Plasmids can migrate between bacterial cells, not always of the same species. When they do so they can take genetic traits such as antibiotic resistance from their old host to their new one.

Recently, some plasmids have been implicated in what looks like a progression to true virus-hood. A genetic analysis by Mart Krupovic of the Pasteur Institute suggests that the Circular Rep-Encoding Single-Strand-DNA (CRESS-DNA) viruses, which infect bacteria, evolved from plasmids. He thinks that a DNA copy of the genes that another virus uses to create its virions, copied into a plasmid by chance, provided it with a way out of the cell. The analysis strongly suggests that CRESS-DNA viruses, previously seen as a pretty closely related group, have arisen from plasmids this way on three different occasions.

Such jailbreaks have probably been going on since very early on in the history of life. As soon as they began to metabolise, the first proto-organisms would have constituted a niche in which other parasitic creatures could have lived. And biology abhors a vacuum. No niche goes unfilled if it is fillable.

It is widely believed that much of the evolutionary period between the origin of life and the advent of LUCA was spent in an RNA worldone in which that versatile substance both stored information, as DNA now does, and catalysed chemical reactions, as proteins now do. Set alongside the fact that some viruses use RNA as a storage medium today, this strongly suggests that the first to adopt the viral lifestyle did so too. Patrick Forterre, an evolutionary biologist at the Pasteur Institute with a particular interest in viruses (and the man who first popularised the term LUCA) thinks that the RNA world was not just rife with viruses. He also thinks they may have brought about its end.

The difference between DNA and RNA is not large: just a small change to one of the letters used to store genetic information and a minor modification to the backbone to which these letters are stuck. And DNA is a more stable molecule in which to store lots of information. But that is in part because DNA is inert. An RNA-world organism which rewrote its genes into DNA would cripple its metabolism, because to do so would be to lose the catalytic properties its RNA provided.

An RNA-world virus, having no metabolism of its own to undermine, would have had no such constraints if shifting to DNA offered an advantage. Dr Forterre suggests that this advantage may have lain in DNAs imperviousness to attack. Host organisms today have all sorts of mechanisms for cutting up viral nucleic acids they dont like the look ofmechanisms which biotechnologists have been borrowing since the 1970s, most recently in the form of tools based on a bacterial defence called CRISPR. There is no reason to imagine that the RNA-world predecessors of todays cells did not have similar shears at their disposal. And a virus that made the leap to DNA would have been impervious to their blades.

Genes and the mechanisms they describe pass between viruses and hosts, as between viruses and viruses, all the time. Once some viruses had evolved ways of writing and copying DNA, their hosts would have been able to purloin them in order to make back-up copies of their RNA molecules. And so what began as a way of protecting viral genomes would have become the way life stores all its genesexcept for those of some recalcitrant, contrary viruses.

III The scythes of the seas

IT IS A general principle in biology that, although in terms of individual numbers herbivores outnumber carnivores, in terms of the number of species carnivores outnumber herbivores. Viruses, however, outnumber everything else in every way possible.

This makes sense. Though viruses can induce host behaviours that help them spreadsuch as coughingan inert virion boasts no behaviour of its own that helps it stalk its prey. It infects only that which it comes into contact with. This is a clear invitation to flood the zone. In 1999 Roger Hendrix, a virologist, suggested that a good rule of thumb might be ten virions for every living individual creature (the overwhelming majority of which are single-celled bacteria and archaea). Estimates of the number of such creatures on the planet come out in the region of 1029-1030. If the whole Earth were broken up into pebbles, and each of those pebbles smashed into tens of thousands of specks of grit, you would still have fewer pieces of grit than the world has virions. Measurements, as opposed to estimates, produce numbers almost as arresting. A litre of seawater may contain more than 100bn virions; a kilogram of dried soil perhaps a trillion.

Metagenomics, a part of biology that looks at all the nucleic acid in a given sample to get a sense of the range of life forms within it, reveals that these tiny throngs are highly diverse. A metagenomic analysis of two surveys of ocean life, the Tara Oceans and Malaspina missions, by Ahmed Zayed of Ohio State University, found evidence of 200,000 different species of virus. These diverse species play an enormous role in the ecology of the oceans.

A litre of seawater may contain 100bn virions; a kilogram of dried soil perhaps a trillion

On land, most of the photosynthesis which provides the biomass and energy needed for life takes place in plants. In the oceans, it is overwhelmingly the business of various sorts of bacteria and algae collectively known as phytoplankton. These creatures reproduce at a terrific rate, and viruses kill them at a terrific rate, too. According to work by Curtis Suttle of the University of British Columbia, bacterial phytoplankton typically last less than a week before being killed by viruses.

This increases the overall productivity of the oceans by helping bacteria recycle organic matter (it is easier for one cell to use the contents of another if a virus helpfully lets them free). It also goes some way towards explaining what the great mid-20th-century ecologist G. Evelyn Hutchinson called the paradox of the plankton. Given the limited nature of the resources that single-celled plankton need, you would expect a few species particularly well adapted to their use to dominate the ecosystem. Instead, the plankton display great variety. This may well be because whenever a particular form of plankton becomes dominant, its viruses expand with it, gnawing away at its comparative success.

It is also possible that this endless dance of death between viruses and microbes sets the stage for one of evolutions great leaps forward. Many forms of single-celled plankton have molecular mechanisms that allow them to kill themselves. They are presumably used when one cells sacrifice allows its sister cellswhich are genetically identicalto survive. One circumstance in which such sacrifice seems to make sense is when a cell is attacked by a virus. If the infected cell can kill itself quickly (a process called apoptosis) it can limit the number of virions the virus is able to make. This lessens the chances that other related cells nearby will die. Some bacteria have been shown to use this strategy; many other microbes are suspected of it.

There is another situation where self-sacrifice is becoming conduct for a cell: when it is part of a multicellular organism. As such organisms grow, cells that were once useful to them become redundant; they have to be got rid of. Eugene Koonin of Americas National Institutes of Health and his colleagues have explored the idea that virus-thwarting self-sacrifice and complexity-permitting self-sacrifice may be related, with the latter descended from the former. Dr Koonins model also suggests that the closer the cells are clustered together, the more likely this act of self-sacrifice is to have beneficial consequences.

For such profound propinquity, move from the free-flowing oceans to the more structured world of soil, where potential self-sacrificers can nestle next to each other. Its structure makes soil harder to sift for genes than water is. But last year Mary Firestone of the University of California, Berkeley, and her colleagues used metagenomics to count 3,884 new viral species in a patch of Californian grassland. That is undoubtedly an underestimate of the total diversity; their technique could see only viruses with RNA genomes, thus missing, among other things, most bacteriophages.

Metagenomics can also be applied to biological samples, such as bat guano in which it picks up viruses from both the bats and their food. But for the most part the finding of animal viruses requires more specific sampling. Over the course of the 2010s PREDICT, an American-government project aimed at finding animal viruses, gathered over 160,000 animal and human tissue samples from 35 countries and discovered 949 novel viruses.

The people who put together PREDICT now have grander plans. They want a Global Virome Project to track down all the viruses native to the worlds 7,400 species of mammals and waterfowlthe reservoirs most likely to harbour viruses capable of making the leap into human beings. In accordance with the more-predator-species-than-prey rule they expect such an effort would find about 1.5m viruses, of which around 700,000 might be able to infect humans. A planning meeting in 2018 suggested that such an undertaking might take ten years and cost $4bn. It looked like a lot of money then. Today those arguing for a system that can provide advance warning of the next pandemic make it sound pretty cheap.

IV Leaving their mark

THE TOLL which viruses have exacted throughout history suggests that they have left their mark on the human genome: things that kill people off in large numbers are powerful agents of natural selection. In 2016 David Enard, then at Stanford University and now at the University of Arizona, made a stab at showing just how much of the genome had been thus affected.

He and his colleagues started by identifying almost 10,000 proteins that seemed to be produced in all the mammals that had had their genomes sequenced up to that point. They then made a painstaking search of the scientific literature looking for proteins that had been shown to interact with viruses in some way or other. About 1,300 of the 10,000 turned up. About one in five of these proteins was connected to the immune system, and thus could be seen as having a professional interest in viral interaction. The others appeared to be proteins which the virus made use of in its attack on the host. The two cell-surface proteins that SARS-CoV-2 uses to make contact with its target cells and inveigle its way into them would fit into this category.

The researchers then compared the human versions of the genes for their 10,000 proteins with those in other mammals, and applied a statistical technique that distinguishes changes that have no real impact from the sort of changes which natural selection finds helpful and thus tries to keep. Genes for virus-associated proteins turned out to be evolutionary hotspots: 30% of all the adaptive change was seen in the genes for the 13% of the proteins which interacted with viruses. As quickly as viruses learn to recognise and subvert such proteins, hosts must learn to modify them.

A couple of years later, working with Dmitri Petrov at Stanford, Dr Enard showed that modern humans have borrowed some of these evolutionary responses to viruses from their nearest relatives. Around 2-3% of the DNA in an average European genome has Neanderthal origins, a result of interbreeding 50,000 to 30,000 years ago. For these genes to have persisted they must be doing something usefulotherwise natural selection would have removed them. Dr Enard and Dr Petrov found that a disproportionate number described virus-interacting proteins; of the bequests humans received from their now vanished relatives, ways to stay ahead of viruses seem to have been among the most important.

Viruses do not just shape the human genome through natural selection, though. They also insert themselves into it. At least a twelfth of the DNA in the human genome is derived from viruses; by some measures the total could be as high as a quarter.

Retroviruses like HIV are called retro because they do things backwards. Where cellular organisms make their RNA from DNA templates, retroviruses do the reverse, making DNA copies of their RNA genomes. The host cell obligingly makes these copies into double-stranded DNA which can be stitched into its own genome. If this happens in a cell destined to give rise to eggs or sperm, the viral genes are passed from parent to offspring, and on down the generations. Such integrated viral sequences, known as endogenous retroviruses (ERVs), account for 8% of the human genome.

This is another example of the way the same viral trick can be discovered a number of times. Many bacteriophages are also able to stitch copies of their genome into their hosts DNA, staying dormant, or temperate, for generations. If the cell is doing well and reproducing regularly, this quiescence is a good way for the viral genes to make more copies of themselves. When a virus senses that its easy ride may be coming to an end, thoughfor example, if the cell it is in shows signs of stressit will abandon ship. What was latent becomes lytic as the viral genes produce a sufficient number of virions to tear the host apart.

Though some of their genes are associated with cancers, in humans ERVs do not burst back into action in later generations. Instead they have proved useful resources of genetic novelty. In the most celebrated example, at least ten different mammalian lineages make use of a retroviral gene for one of their most distinctively mammalian activities: building a placenta.

The placenta is a unique organ because it requires cells from the mother and the fetus to work together in order to pass oxygen and sustenance in one direction and carbon dioxide and waste in the other. One way this intimacy is achieved safely is through the creation of a tissue in which the membranes between cells are broken down to form a continuous sheet of cellular material.

The protein that allows new cells to merge themselves with this layer, syncytin-1, was originally used by retroviruses to join the external membranes of their virions to the external membranes of cells, thus gaining entry for the viral proteins and nucleic acids. Not only have different sorts of mammals co-opted this membrane-merging trickother creatures have made use of it, too. The mabuya, a long-tailed skink which unusually for a lizard nurtures its young within its body, employs a retroviral syncytin protein to produce a mammalian-looking placenta. The most recent shared ancestor of mabuyas and mammals died out 80m years before the first dinosaur saw the light of day, but both have found the same way to make use of the viral gene.

This is not the only way that animals make use of their ERVs. Evidence has begun to accumulate that genetic sequences derived from ERVs are quite frequently used to regulate the activity of genes of more conventional origin. In particular, RNA molecules transcribed from an ERV called HERV-K play a crucial role in providing the stem cells found in embryos with their pluripotencythe ability to create specialised daughter cells of various different types. Unfortunately, when expressed in adults HERV-K can also be responsible for cancers of the testes.

As well as containing lots of semi-decrepit retroviruses that can be stripped for parts, the human genome also holds a great many copies of a retrotransposon called LINE-1. This a piece of DNA with a surprisingly virus-like way of life; it is thought by some biologists to have, like ERVs, a viral origin. In its full form, LINE-1 is a 6,000-letter sequence of DNA which describes a reverse transcriptase of the sort that retroviruses use to make DNA from their RNA genomes. When LINE-1 is transcribed into an mRNA and that mRNA subsequently translated to make proteins, the reverse transcriptase thus created immediately sets to work on the mRNA used to create it, using it as the template for a new piece of DNA which is then inserted back into the genome. That new piece of DNA is in principle identical to the piece that acted as the mRNAs original template. The LINE-1 element has made a copy of itself.

In the 100m years or so that this has been going on in humans and the species from which they are descended the LINE-1 element has managed to pepper the genome with a staggering 500,000 copies of itself. All told, 17% of the human genome is taken up by these copiestwice as much as by the ERVs.

Most of the copies are severely truncated and incapable of copying themselves further. But some still have the knack, and this capability may be being put to good use. Fred Gage and his colleagues at the Salk Institute for Biological Studies, in San Diego, argue that LINE-1 elements have an important role in the development of the brain. In 2005 Dr Gage discovered that in mouse embryosspecifically, in the brains of those embryosabout 3,000 LINE-1 elements are still able to operate as retrotransposons, putting new copies of themselves into the genome of a cell and thus of all its descendants.

Brains develop through proliferation followed by pruning. First, nerve cells multiply pell-mell; then the cell-suicide process that makes complex life possible prunes them back in a way that looks a lot like natural selection. Dr Gage suspects that the movement of LINE-1 transposons provides the variety in the cell population needed for this selection process. Choosing between cells with LINE-1 in different places, he thinks, could be a key part of the process from which the eventual neural architecture emerges. What is true in mice is, as he showed in 2009, true in humans, too. He is currently developing a technique for looking at the process in detail by comparing, post mortem, the genomes of different brain cells from single individuals to see if their LINE-1 patterns vary in the ways that his theory would predict.

V Promised lands

HUMAN EVOLUTION may have used viral genes to make big-brained live-born life possible; but viral evolution has used them to kill off those big brains on a scale that is easily forgotten. Compare the toll to that of war. In the 20th century, the bloodiest in human history, somewhere between 100m and 200m people died as a result of warfare. The number killed by measles was somewhere in the same range; the number who died of influenza probably towards the top of it; and the number killed by smallpox300m-500mwell beyond it. That is why the eradication of smallpox from the wild, achieved in 1979 by a globally co-ordinated set of vaccination campaigns, stands as one of the all-time-great humanitarian triumphs.

Other eradications should eventually follow. Even in their absence, vaccination has led to a steep decline in viral deaths. But viruses against which there is no vaccine, either because they are very new, like SARS-CoV-2, or peculiarly sneaky, like HIV, can still kill millions.

Reducing those tolls is a vital aim both for research and for public-health policy. Understandably, a far lower priority is put on the benefits that viruses can bring. This is mostly because they are as yet much less dramatic. They are also much less well understood.

The viruses most prevalent in the human body are not those which infect human cells. They are those which infect the bacteria that live on the bodys surfaces, internal and external. The average human microbiome harbours perhaps 100trn of these bacteria. And where there are bacteria, there are bacteriophages shaping their population.

The microbiome is vital for good health; when it goes wrong it can mess up a lot else. Gut bacteria seem to have a role in maintaining, and possibly also causing, obesity in the well-fed and, conversely, in tipping the poorly fed into a form of malnutrition called kwashiorkor. Ill-regulated gut bacteria have also been linked, if not always conclusively, with diabetes, heart disease, cancers, depression and autism. In light of all this, the question who guards the bacterial guardians? is starting to be asked.

The viruses that prey on the bacteria are an obvious answer. Because the health of their hosts hostthe possessor of the gut they find themselves inmatters to these phages, they have an interest in keeping the microbiome balanced. Unbalanced microbiomes allow pathogens to get a foothold. This may explain a curious detail of a therapy now being used as a treatment of last resort against Clostridium difficile, a bacterium that causes life-threatening dysentery. The therapy in question uses a transfusion of faecal matter, with its attendant microbes, from a healthy individual to reboot the patients microbiome. Such transplants, it appears, are more likely to succeed if their phage population is particularly diverse.

Medicine is a very long way from being able to use phages to fine-tune the microbiome. But if a way of doing so is found, it will not in itself be a revolution. Attempts to use phages to promote human health go back to their discovery in 1917, by Flix dHrelle, a French microbiologist, though those early attempts at therapy were not looking to restore balance and harmony. On the basis that the enemy of my enemy is my friend, doctors simply treated bacterial infections with phages thought likely to kill the bacteria.

The arrival of antibiotics saw phage therapy abandoned in most places, though it persisted in the Soviet Union and its satellites. Various biotechnology companies think they may now be able to revive the traditionand make it more effective. One option is to remove the bits of the viral genome that let phages settle down to a temperate life in a bacterial genome, leaving them no option but to keep on killing. Another is to write their genes in ways that avoid the defences with which bacteria slice up foreign DNA.

The hope is that phage therapy will become a backup in difficult cases, such as infection with antibiotic-resistant bugs. There have been a couple of well-publicised one-off successes outside phage therapys post-Soviet homelands. In 2016 Tom Patterson, a researcher at the University of California, San Diego, was successfully treated for an antibiotic-resistant bacterial infection with specially selected (but un-engineered) phages. In 2018 Graham Hatfull of the University of Pittsburgh used a mixture of phages, some engineered so as to be incapable of temperance, to treat a 16-year-old British girl who had a bad bacterial infection after a lung transplant. Clinical trials are now getting under way for phage treatments aimed at urinary-tract infections caused by Escherichia coli, Staphylococcus aureus infections that can lead to sepsis and Pseudomonas aeruginosa infections that cause complications in people who have cystic fibrosis.

Viruses which attack bacteria are not the only ones genetic engineers have their eyes on. Engineered viruses are of increasing interest to vaccine-makers, to cancer researchers and to those who want to treat diseases by either adding new genes to the genome or disabling faulty ones. If you want to get a gene into a specific type of cell, a virion that recognises something about such cells may often prove a good tool.

The vaccine used to contain the Ebola outbreak in the Democratic Republic of Congo over the past two years was made by engineering Indiana vesiculovirus, which infects humans but cannot reproduce in them, so that it expresses a protein found on the surface of the Ebola virus; thus primed, the immune system responds to Ebola much more effectively. The World Health Organisations current list of 29 covid-19 vaccines in clinical trials features six versions of other viruses engineered to look a bit like SARS-CoV-2. One is based on a strain of measles that has long been used as a vaccine against that disease.

Viruses engineered to engender immunity against pathogens, to kill cancer cells or to encourage the immune system to attack them, or to deliver needed genes to faulty cells all seem likely to find their way into health care. Other engineered viruses are more worrying. One way to understand how viruses spread and kill is to try and make particularly virulent ones. In 2005, for example, Terrence Tumpey of Americas Centres for Disease Control and Prevention and his colleagues tried to understand the deadliness of the influenza virus responsible for the pandemic of 1918-20 by taking a more benign strain, adding what seemed to be distinctive about the deadlier one and trying out the result on mice. It was every bit as deadly as the original, wholly natural version had been.

The use of engineered pathogens as weapons of war is of dubious utility, completely illegal and repugnant to almost all

Because such gain of function research could, if ill-conceived or poorly implemented, do terrible damage, it requires careful monitoring. And although the use of engineered pathogens as weapons of war is of dubious utilitysuch weapons are hard to aim and hard to stand down, and it is not easy to know how much damage they have doneas well as being completely illegal and repugnant to almost all, such possibilities will and should remain a matter of global concern.

Information which, for billions of years, has only ever come into its own within infected cells can now be inspected on computer screens and rewritten at will. The power that brings is sobering. It marks a change in the history of both viruses and peoplea change which is perhaps as important as any of those made by modern biology. It is constraining a small part of the viral world in a way which, so far, has been to peoples benefit. It is revealing that worlds further reaches in a way which cannot but engender awe.

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This article appeared in the Essay section of the print edition under the headline "The outsiders inside"

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Viruses have big impacts on ecology and evolution as well as human health - The Economist