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Subject: Biotech and Medical Sciences

  • A missing science pillar in the COVID response

    The article deals with the emerging trends from the surge in Covid cases and suggests a data-driven policy approach followed by a national vaccination program to deal with the challenge.

    Surge in Covid cases

    • Recently, there has been a sharp increase in new cases and deaths from the disease.
    • Maharashtra seems to be particularly affected, but nearly all States are reporting increases.
    • The epidemiology of COVID-19 is poorly understood.
    • But some early understanding of the transmission of the virus can enable a more effective science-driven response.

    Variant of virus could be behind the spread

    • The surge is probably driven by variants from the original, as variants worldwide comprise much of the current wave.
    •  Evolutionary theory would expect SARS-CoV-2, the virus that causes COVID-19, to mutate to become more transmissible.
    • However, the expected concomitant decrease in lethality has not yet been documented.
    • Anecdotal reports that the current surge is occurring more in younger adults and accompanied by unusual symptoms also support the idea that variants are responsible.
    • Direct evidence is needed from genetic sequencing of the virus.

    No herd immunity

    • Various serosurveys have consistently found that half or more of tested urban populations have antibodies to the virus.
    • However, this high level of infection is not the same as a markedly reduced level of transmission, which is what is required for herd immunity.
    • Notions of herd immunity do not fully capture the fact that for largely unknown reasons, viral transmission is cyclical.
    • Much of the infection in India might well be mild, with less durable immune protection than induced by vaccination.
    • Asymptomatic infection is more commonly reported in Indian serosurveys, exceeding 90% in some, in contrast to high-income countries, where about one-third of infections report as asymptomatic.
    • Milder infection might well also correlate with lower severity of clinical illness, helping to explain the Indian paradox of widespread transmission but with low mortality rates.

    Policy must be data-driven

    • Theories or mathematical models are hugely uncertain, particularly early on in the epidemic.
    • A better understanding of the unique patterns of Indian viral transmission has a few pillars, which can be achieved quickly.
    • First, collection of anonymised demographic and risk details like age, sex, travel, contact with other COVID-19 patients, existing chronic conditions, current smoking on all positive cases on a central website in each State remains a priority.
    • Second, greatly expanded sequencing of the viral genome is needed from many parts of India, which can be achieved by re-programming sequencing capacity in Indian academic and commercial laboratories.
    • Third, far better reporting of COVID-19 deaths is needed.
    • Daily or weekly reporting of the total death counts by age and sex by each municipality would help track if there is a spike in presumed COVID-19 deaths.
    • Fourth, the Indian Council of Medical Research’s national serosurvey had design limitations such that it probably underestimated the true national prevalence.
    • A far larger and better set of serial surveys is required.
    • Finally, we need to understand better why some populations are not affected.

    Counter the inequality in vaccination

    • Affluent and connected urban elites of India are vaccinating quickly, but the poorer and less educated Indians are being left behind.
    • Vaccination campaigns need to reach the poor adults over age 45, without having to prove anything other than approximate age.
    • Follow-up studies among the vaccinated can establish the durability of protection, and, ideally, reduction in transmission.
    • Similarly, India must capture and report data on who is vaccinated, including by education or wealth levels.
    • The poor cannot be left in the dark.

    Prepare for future pandemics through adult vaccination plan

    • COVID-19 could well turn into a seasonal challenge and thus, the central government should actively consider launching a national adult vaccination programme.
    • The Disease Control Priorities Project estimates an adult national programme would cost about ₹250 per Indian per year to cover routine annual flu vaccination, five-yearly pneumococcal vaccines, HPV vaccines for adolescent girls and tetanus for expectant mothers.
    • Per year, vaccines for one billion adults might save about 200,000 lives from the targeted diseases.
    • Indeed, we might already be in the era where major zoonotic diseases are not once-a-century events, but once a decade.
    • Thus, adult and child vaccination programmes are essential to prepare for future pandemics.

    Conclusion

    The resurgence of COVID-19 presents a major challenge for governments, yet the best hope is to rapidly expand epidemiological evidence, share it with the public and build confidence that the vaccination programme will benefit all Indians.

  • Novel Open Reading Frames (NORF)

    A team from the University of Cambridge set out to find whether new genes emerge in the genome of living organisms and if they do, how they do so. They have now catalogued 1,94,000 novel regions.

    Genes/Genomes/DNA/RNA is all-time favourite of UPSC. You can easily find 1-2 questions every year since 2017 in Prelims.

    Novel genomic regions

    • The ‘novel’ genomic regions cannot be defined by our current ‘definition’ of a gene.
    • Hence, researchers call these novel regions – novel Open Reading Frames or as nORFs.
    • Researchers found that the mutations in nORFs do have physiological consequences and a majority of mutations that are often annotated as benign have to be re-interpreted.

    What novel did the researchers find?

    • nORF regions were uniquely present in the cancer tissues and not present in the control tissue.
    • They found that some nORF disruptions strongly correlated with the survival of patients.
    • nORFs proteins can form structures, can undergo biochemical regulation like known proteins and be targeted by drugs in case they are disrupted in diseases.
    • The researchers also identified these nORFs in Plasmodium falciparum, the parasite which causes the deadliest form of malaria.

    Connected to disease

    • The research found that these regions are also broadly involved in diseases.
    • The nORFs were seen as dysregulated in 22 cancer types.
    • Dysregulated is a term which means that they could either be mutated, upregulated, or downregulated, or they could be uniquely present.

  • Why do Viruses mutate?

    SARS-CoV-2 variants have emerged independently in several countries, and research published over the past week indicates that the virus is changing more quickly than was once believed.

    Try this PYQ:

    Q.H1N1 virus is sometimes mentioned in the news with reference to which one of the following diseases?

    (a) AIDS

    (b) Bird flu

    (c) Dengue

    (d) Swine flu

    Mutation of Virus

    • Mutation, an alteration in the genetic material (the genome) of a cell of a living organism or of a virus that is more or less permanent and that can be transmitted to the cell’s or the virus’s descendants.
    • Like all life, viruses carry a genetic code in the form of nucleic acids — either DNA or RNA.
    • When cells multiply, the DNA within them replicates as well, to make copies for the new cells.
    • During replication, random errors are introduced into the new DNA, much like spelling errors when we write.
    • While the errors in DNA virus genomes can be corrected by the error-correcting function of cells in which they replicate, there are no enzymes in cells to correct RNA errors.
    • Therefore, RNA viruses accumulate more genetic changes (mutations) than DNA viruses.

    Effect of mutation on the virus

    • Evolution requires not just mutations, but also selection.
    • While most mutations are deleterious to the virus, if some allow a selective advantage — say better infectivity, transmission, or escape from immunity — then the new viruses out-compete the older ones in a population.
    • The mutations can be synonymous (silent) or non-synonymous (non-silent); the latter also changes an amino acid (protein building block) at that position in the coded protein.

    Mutations in COVID

    • As of January 26, about 29,000 infections are attributed to UK variants from 63 countries, many due to local transmission.

    Why is it harmful?

    • Viruses with mutations within the receptor-binding domain (RBD) of the Spike protein have the most potential to evade antibodies that develop as a result of natural infection or vaccination.
    • The RBD binds the cellular receptor allowing the virus to infect cells, and anti-RBD antibodies neutralize the virus.
    • Such mutations were recently found in variant viruses that emerged in the UK, South Africa and Brazil.

    Testing of mutation

    • Indirect tests are done in laboratories to assess if an emerging variant might escape antibodies developed after natural infection or vaccination.
    • Serum (the blood components that contain antibodies) from recovered patients or vaccinated people, and antibodies are known to neutralize the original virus, are tested.
    • Serial dilutions of the serum or antibodies are separately mixed with a fixed amount of the original and variant viruses, and the mixture is added to cells in culture.
    • After a period of incubation, cells are washed and stained. Cells infected and killed by viruses multiplying within them appear as clear zones (plaques) on a dark background.
    • The effectiveness of serum or antibody is expressed as an inhibitory concentration (IC) or plaque reduction neutralisation titer (PRNT) value.
    • The IC50 or PRNT50 value is the reciprocal dilution of serum or antibody that neutralises 50 per cent viruses in the sample.

    India’s response

    • Only the UK variant viruses have so far been reported from India — and that too, in travellers.
    • There is no reported local transmission, but considering its increased infectivity, this is likely to happen.
    • The evidence so far suggests that current vaccines would still protect against the UK variant, even if with reduced efficacy.
    • The evidence at this time, though of concern, does not indicate that current vaccines are failing.
    • But this has to be watched carefully, and all efforts made to limit transmission between people, which drives mutations and the emergence of variants.

  • Bird Flu Outbreak

    An outbreak of bird flu was confirmed in Kerala, Rajasthan and Himachal.

    Try this question from our AWE initiative:

    There is been an increase in occurance of zoonotic human infectious diseases are zoonotic . Give reasons for this. Also suggest ways to contain and decrease the frequency of such events.(250 Words)

    What is Bird Flu?

    • Bird flu is an infection caused by avian influenza viruses, which are of different types A, B and C.
    • Type A avian influenza viruses are the most frequently associated with avian influenza epidemics and pandemics.
    • There are 16 hemagglutinin (H1 to H16) and 9 neuraminidase types (N1 to N9) identified till date.
    • There are various modes of transmission of human influenza including inhalation, direct or indirect contact etc. can have manifestations ranging from mild to severe or fatal disease.
    • Avian influenza A (H5N1) results in a high death rate amongst infants and young children.
    • The first outbreak of human infection by avian influenza viruses (H5N1) was observed in 1997 in Hong Kong. Since then a large number of outbreaks have been reported in different parts of the world.

    The H5N8 strain

    • The presence of the H5N8 subtype of the Influenza A virus was reported in ducks in parts of Kerala.
    • While it can prove lethal for birds, the H5N8 strain of avian influenza has a lower likelihood of spreading to humans compared to H5N1.
    • While the source of infection is yet to be pinpointed, the role of migratory birds in passing on the virus is suspected.

  • How epigenetics alters inherited genetics’ message

    Researchers have found the cause of vision impairment due to ageing as the accumulation of “epigenetic noise” that disrupts gene expression patterns leading to changes in inherent DNA function

    Genetics is an all-time favourite of UPSC. Every year you can find a question in prelims. Try this one from CSP 2020:

     

    Q.Consider the following statements:

    1. Genetic changes can be introduced in the cells that produce eggs or sperms of a prospective parent
    2. A person’s genome can be edited before birth at the early embryonic stage.
    3. Human-induced pluripotent stem cells can be injected into the embryo of a pig.

    Which of the statements given above is/are correct?

    (a) 1 only

    (b) 2 and 3 only

    (c) 2 only

    (d) 1, 2 and 3

    What is Epigenetics?

    • Epigenetics is the study of how your behaviours and environment can cause changes that affect the way your genes work.
    • Unlike genetic changes, epigenetic changes are reversible and do not change your DNA sequence, but they can change how your body reads a DNA sequence.
    • Environmental stimuli can cause genes to be turned off or turned on.
    • This determines a cell’s specialization (e.g., skin cell, blood cell, hair cell, liver cells, etc.) as a fetus develops into a baby through gene expression (active) or silencing (dormant); and nurture.
    • This normal epigenetic control on our genes can get altered during normal ageing, stress and disease conditions.

    Cellular regulators

    • The functioning of cells and tissues in our body are controlled by thousands of proteins that regulate various cellular functions.
    • These proteins are in turn encoded by the respective genes which are a part of our genome or the cellular DNA.
    • Any minor or major changes to our inherited DNA (addition or mutation) can result in altered protein production, which in turn leads to defective cellular functions.
    • This forms the basis for many heritable genetic disorders affecting mankind.

    A trigger for various inactivities

    • Apart from DNA or protein sequence level alterations, there are other biochemical changes that influence and dictate if a gene should be active or inactive in a given cell type.
    • For example, the gene that encodes for the insulin protein is present in the exact form, in every cell of the body.
    • However, it is allowed to express only in the insulin-secreting beta cells of the pancreas and is kept inactive in the rest of the cells of the body.
    • This phenomenon is tightly regulated by a combination of regulatory proteins that changes the expressivity of the gene.
    • Also, the histone proteins that bind the DNA and help to compactly wrap it inside the chromosomes can undergo chemical modifications such as methylations and acetylations on different lysine amino acids within the protein.
    • These modifications both on the DNA and its associated proteins alter the chromosomal conformations and regulate gene expression.
    • These changes can either unwind the DNA and allow gene expression or can compact the DNA and render the genes in the region inactive or silent.

    Epigenetics and the human eye

    • The human (and mammalian) eye is a remarkable organ in the course of evolution which has allowed us to “see” the external world clearly and in colour.
    • Earlier forms, such as microbes and plants, reacted to light in other ways (for absorption and use, such as photosynthesis).
    • The front part of the human eye (cornea, lens and the vitreous humour gel) is transparent, colourless and helps focus the incoming light into the retina, helping us see colour.
    • It is the retina that sends the message to the brain.
    • Its main component, called the retinal ganglion cells (RGC) are the ones that help in this process of sending the message in the form of electrical signals, called neurons or nerve cells.
    • Thus, RGCs are the ones that convert optics into electronics.

  • Plasmodium Ovale and Other types of Malaria

    A not very common type of malaria, Plasmodium Ovale, has been identified in a jawan in Kerala.

    Try this PYQ:

    Q. Widespread resistance of malarial parasite to drugs like chloroquine has prompted attempts to develop a malarial vaccine to combat malaria.

    Why is it difficult to develop an effective malaria vaccine?

    (a) Malaria is caused by several species of Plasmodium

    (b) Man does not develop immunity to malaria during natural infection

    (c) Vaccines can be developed only against bacteria

    (d) Man is only an intermediate host and not the definitive host

    What is Malaria?

    • Malaria is caused by the bite of the female Anopheles mosquito if the mosquito itself is infected with a malarial parasite.
    • There are five kinds of malarial parasites — Plasmodium falciparum, Plasmodium vivax (the commonest ones), Plasmodium malariae, Plasmodium ovale and Plasmodium knowlesi.
    • Therefore, to say that someone has contracted the Plasmodium ovale type of malaria means that the person has been infected by that particular parasite.
    • Malaria is treated with prescription drugs to kill the parasite. Chloroquine is the preferred treatment for any parasite that is sensitive to the drug.

    Plasmodium Ovale

    • P ovale rarely causes severe illness and there is no need for panic.
    • Symptoms include fever for 48 hours, headache and nausea, and the treatment modality is the same as it is for a person infected with P vivax.
    • P ovale is no more dangerous than getting a viral infection.
    • It is termed ovale as about 20% of the parasitised cells are oval in shape.

    Burden of Malaria in India

    • In 2018, the National Vector-borne Disease Control Programme (NVBDCP) estimated that approximately 5 lakh people suffered from malaria.
    • 63% of the cases were of Plasmodium falciparum.
    • The recent World Malaria Report 2020 said cases in India dropped from about 20 million in 2000 to about 5.6 million in 2019.

  • Fortified rice in PDS

    As the Odisha government is preparing to launch fortified rice in the Public Distribution System (PDS), some 100 activists have opposed the move.

    Q.What is Fortification of Food? Discuss its various advantages and limitations.

    What is Fortified Rice?

    • Rice can be fortified by adding a micronutrient powder to the rice that adheres to the grains or spraying of the surface of ordinary rice grains with a vitamin and mineral mix to form a protective coating.
    • Rice can also be extruded and shaped into partially precooked grain-like structures resembling rice grains, which can then be blended with natural polished rice.
    • Rice kernels can be fortified with several micro-nutrients, such as iron, folic acid and other B-complex vitamins, vitamin A and zinc.
    • These fortified kernels are then mixed with normal rice in a 1:100 ratio, and distributed for consumption.

    Its advantage

    • Fortified staple foods will contain natural or near natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • It provides nutrition without any change in characteristics of food or course of our meals.
    • If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittent supplements.
    • The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 per cent of the total food value.

    Issues with fortified food

    • Fortification and enrichment upsets nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • They lack immune-boosting substances.
    • Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

    Why did the activists protest?

    • Vitamin C and calcium are available in abundance in natural food. Vitamin C is water soluble.
    • If the rice is laced with Vitamin C, it will get washed away while the rice is cleaned before cooking.
    • It is a futile exercise to add Vitamin C to uncooked rice.
    • In our traditional cooking practices, lemon juice is squeezed into cooked food before its consumption.
    • The decision would lead to wasteful expenditure of taxpayers’ money.

    Note: Biofortification is the process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology. It differs from conventional fortification in that Biofortification aims to increase nutrient levels in crops during plant growth rather than through manual means during the processing of the crops.

    Regulating fortification

    • FSSAI has formulated a comprehensive regulation on fortification of foods namely ‘Food Safety and Standards (Fortification of Foods) Regulations, 2016’.
    • These regulations set the standards for food fortification and encourage the production, manufacture, distribution, sale and consumption of fortified foods.
    • The regulations also provide for the specific role of FSSAI in promotion for food fortification and to make fortification mandatory.
    • WHO recommends fortification of rice with iron, vitamin A and folic acid as a public health strategy to improve the iron status of population wherever rice is a staple food.

    Why it is necessary ?

    • Reaching target populations
    • Avoiding over-consumption in non-target groups
    • Monitoring nutritional status

  • What is Molnupiravir?

    A new drug called Molnupiravir has been shown to stop the transmission of SARS-CoV-2 in 24 hours.

    Must read:

    What is mRNA vaccine?

    Molnupiravir

    • Molnupiravir is an experimental antiviral drug which is orally active and was developed for the treatment of influenza.
    • It is a drug of the synthetic nucleoside derivative N4-hydroxycytidine, and exerts its antiviral action through introduction of copying errors during viral RNA replication.
    • Molnupiravir is being developed by the biotechnology firm Ridgeback Biotherapeutics in collaboration with pharmaceutical firm Merck.
    • The research team repurposed MK-4482/EIDD-2801 against SARS-CoV-2 and tested it on ferrets.
    • This is the first demonstration of an orally available drug to rapidly block SARS-CoV-2 transmission and it can be a game-changer.

  • [pib] The Cancer Genome Atlas (TCGA)

    The Ministry of Science & Technology has inaugurated the 2nd Cancer Genome Atlas (TCGA) 2020 Conference.

    Do you know?

    According to the World Cancer Report by the WHO, one in 10 Indians develops cancer during their lifetime and one in 15 dies of the disease!

    The Cancer Genome Atlas

    • The Cancer Genome Atlas (TCGA) is a landmark project started in 2005 by the US-based National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI).
    • The idea was to make a catalogue of the genetic mutations that cause cancer.
    • This meant collecting tumour samples and blood samples (known as the germline) from patients and processing them using gene sequencing and bioinformatics.
    • The TCGA is a continuing effort even after fifteen years and has generated over 2.5 petabytes of data for over 11,000 patients.
    • This data is available to researchers all around the world and has been used to develop new approaches to diagnose, treat and prevent cancer.

    Indian Cancer Genome Atlas (ICGA)

    • On similar lines, the establishment of an ICGA has been initiated by a consortium of key stakeholders in India led by CSIR in which several government agencies, cancer hospitals, academic institutions and private sector partners.
    • It is aimed at improving clinical outcomes in cancer and other chronic diseases.

    Why need such Atlas?

    • Diverse molecular mechanisms- including genetic and lifestyle factors contribute to cancer, posing significant challenges to treatment.
    • Therefore, it is necessary to better understand the underlying factors- patient by patient.
    • In this context, it is important to create an indigenous, open-source and comprehensive database of molecular profiles of all cancer prevalent in Indian population.

  • Looming heath crisis in the form of antimicrobial resistance

    Rapidly rising antimicrobial resistance (AMR) poses the threat of the next health crisis if not addressed with urgency. The article examines the severity of the issue.

    The severity of the antimicrobial resistance (AMR)

    • Globally, about 35% of common human infections have become resistant to available medicines.
    • About 700,000 people die every year because available antimicrobial drugs — antibiotics, antivirals, antiparasitic and antifungals — have become less effective at combating pathogens.
    • Resistance to second- and third-line antibiotics — the last lines of defence against some common diseases — are projected to almost double between 2005 and 2030.
    • In India, the largest consumer of antibiotics in the world, this is a serious problem.

    Responsible factors

    •  Microorganisms develop resistance to antimicrobial agents as a natural defence mechanism.
    • Human activity has significantly accelerated the process.
    • The misuse and overuse of antimicrobials for humans.
    • Livestock and agriculture but other factors also contribute.

    Research points  to role of environment and pollution

    • Once consumed, up to 80% of antibiotic drugs are excreted un-metabolised, along with resistant bacteria.
    • Their release in effluents from households and health and pharmaceutical facilities, and agricultural run-off, is propagating resistant microorganisms.
    • Wastewater treatment facilities are unable to remove all antibiotics and resistant bacteria.
    • In India, there is capacity to treat only about 37% of the sewage generated annually.
    • Water, then, may be a major mode for the spread of AMR, especially in places with inadequate water supply, sanitation and hygiene.
    • Wildlife that comes into contact with discharge containing antimicrobials can also become colonised with drug-resistant organisms.

    Initiative to tackle the AMR

    • The United Nations Environment Programme (UNEP) identified antimicrobial resistance as one of six emerging issues of environmental concern in its 2017 Frontiers Report.
    • UN agencies are working together to develop the One Health AMR Global Action Plan (GAP) that addresses the issue in human, animal, and plant health and food and environment sectors.
    • The Ministry of Environment, Forest and Climate Change (MoEF&CC) issued draft standards which set limits for residues of 121 antibiotics in treated effluents from drug production units.
    • The Ministry of Health and Family Welfare and MoEF&CC constituted the inter-ministerial Steering Committee on Environment and Health, with representation from WHO and UNEP.

    Way forward

    • The Centre and State governments in India can strengthen the environmental dimensions of their plans to tackle antimicrobial resistance.
    • It is important to promote measures that address known hotspots such as hospitals and manufacturing and waste treatment facilities.

    Consider the question “Being the largest consumer of antibiotics in the world, India faces a grave threat from growing anti-microbial resistance. What are the factors responsible for it? Suggest the ways to deal with it.”

    Conclusion

    We saw how quickly a pandemic can spread if we are not ready. This is an opportunity to get ahead of the next one.