Monday, February 10, 2025

From Spanish flu to today: how immune cells keep up with a changing virus


In a breakthrough for influenza research, scientists have discovered immune cells that can recognise influenza (flu) viruses even as they mutate, raising hopes for a longer-lasting vaccine and a universal protection against future flu pandemics



University of Melbourne




The flu virus is constantly evolving, meaning immunity from past infections or vaccinations may not fully protect against new strains. These mutations are why last year’s flu vaccine may no longer be effective, requiring annual updates to keep up with the latest variants. 

But what if our immune system could recognise a broader range of flu viruses, providing longer-lasting protection? New research suggests that certain immune cells, a subset of T cells, might hold the key. 

Research led by the Peter Doherty Institute for Infection and Immunity (Doherty Institute) and Monash University has uncovered how specific T cells, which play a critical role in fighting infections, can detect multiple flu strains, even those that have evolved over a century. This process, known as cross-reactivity, could be crucial in developing more effective immunity against influenza. 

In the study, published in Science Immunology, researchers analysed samples from individuals with different flu viruses and identified a subset of T cells that recognise a particular protein present in influenza A viruses, from the 1918 Spanish flu to the latest 2024 H5N1 strains. 

The University of Melbourne’s Dr Oanh Nguyen, Senior Research Fellow at the Doherty Institute and co-author of the study, explained the molecular mechanisms that enable these T cells to recognise multiple influenza variants. 

“We tested how people’s T cells respond to a specific part of the influenza virus that changes frequently. Over the last 100 years, this region has evolved into 12 different forms,” said Dr Nguyen. 

“We found that some individuals have T cells that can recognise up to nine of these variants, while others have T cells that can only detect a couple.” 

Professor Jamie Rossjohn, Immunologist at Monash University and co-senior author of the study, explained how the team uncovered the molecular details behind this immune response. 

“This work reveals an untapped ability of the immune system to respond to flu viruses, even as they change over time,” said Professor Rossjohn. 

“We used an advanced technique called crystallography to determine how T cells see flu viruses at the molecular level. We observed specific interactions between the T cells and the flu proteins that determine why some T cells are better at detecting a wide range of strains than others. 

“While our findings deepen our understanding of how T cells react to changing flu viruses, they are also highly relevant for understanding immune responses to other rapidly evolving viruses such as SARS-CoV-2.” 

The flu remains a major global health threat. According to the WHO, flu causes 3 to 5 million cases of severe illness and up to 650,000 respiratory deaths each year, particularly among vulnerable populations. 

The University of Melbourne’s Professor Katherine Kedzierska, Head of the Human T cell Laboratory at the Doherty Institute, said a universal vaccine, one that protects against multiple strains for longer periods, would be a game changer. 

“This research is hugely significant. It shows how certain T cells can recognise multiple flu strains, which is a big step towards understanding universal protective immunity – not just for the flu, but potentially for other viral diseases too,” said Professor Kedzierska. 

“Harnessing these cross-reactive responses could be the key to a vaccine that offers longer-lasting protection and reduces the risk of future flu pandemics.” 

## END ##

Additional information:

  • Peer-reviewed paper: Quiñones-Parra S, Gras S et al. Molecular determinants of cross-strain influenza A virus recognition by αβ T cell receptors. Science Immunology (2025). DOI: http://doi.org/10.1126/sciimmunol.adn3805 
  • Collaboration: This study is the result of a major collaborative effort between the Doherty Institute and Monash University. 
  • Funding: This work was supported by the National Health and Medical Research Council of Australia (NHMRC), the University of Melbourne, a Consejo Nacional de Ciencia y Tecnología Scholarhip (Mexico), a Victoria-India Doctoral Scholarship and the Research Grants Council of the Hong Kong Special Administrative Region (China). 

 

Cash and counselling slash unsuccessful TB outcomes by half



A new study shows that tuberculosis patients cash-incentivised and counselled have a 52% lower relative risk of having an unsuccessful treatment outcome




University of the Witwatersrand





Professor Nazir Ismail from Wits University, Johannesburg, and Dr Harry Moultrie from SA’s National Institute for Communicable Diseases (NICD) led the study, which was  published in The Lancet Infectious Diseases journal on 6 February 2025.

The study demonstrated that a combination of conditional cash transfers and TB counselling significantly improves treatment success rates and reduces loss to follow-up among TB patients in South Africa.

Loss to follow-up refers to individuals diagnosed with TB who either do not start treatment or who stopped treatment during care.

Cash transfers were conditional upon participants attending their appointments within the prespecified window period, which included returning for their results and starting treatment, as well as the monthly follow-up visits until the end of treatment.

About the study

The study, a randomised controlled trial conducted across nine clinics in Johannesburg, evaluated the effects of a patient-centred intervention combining pre-test and post-test TB counselling with financial incentives on treatment adherence and outcomes.

The intervention resulted in halving unsuccessful TB outcomes compared to standard care.

“Our findings bring us closer to the 90–90–90 TB targets, which aim for 90% treatment success. By addressing financial and behavioural barriers, this approach can help reduce disease transmission and improve public health outcomes,” says lead author Professor Nazir Ismail, Department of Clinical Microbiology and Infectious Diseases at Wits University.

90-90-90 refers to 90% of people with TB are diagnosed, 90% of those diagnosed are put on treatment, and 90% of those on treatment are successfully treated.

Joint senior author of the paper, Professor Ibrahim Abubakar, Dean for the Faculty of Population Health Sciences, and Pro-Provost Health, at UCL, says, “We are delighted that this partnership with Wits has resulted in this policy relevant evidence, with implications for South African and global tuberculosis control and elimination.”

Key Findings

  • TB patients who received counselling and conditional cash transfers were significantly more likely to complete treatment successfully (82.0% vs. 65.6% in the control group).
  • The intervention showed a substantial reduction in the relative risk (0.52) of unsuccessful patient outcomes, which included not starting treatment, not completing treatment, treatment failure, drug-resistance development, or death.
  • Pretreatment loss to follow-up, that is, individuals who did not return and start treatment, was reduced from 15.8% to 3.9%, indicating improved engagement in care.

The study was a collaboration between the University of the Witwatersrand, Johannesburg (Wits University), South Africa’s National Institute for Communicable Diseases (NICD), the South African Human Sciences Research Council (HSRC), and University College London (UCL).

The South African Medical Research Council (SAMRC), the UK Medical Research Council, and the Newton Fund funded the study.




Opioid prescriptions in the  emergency department (ED) linked to small increases in future opioid use, hospitalizations



Canadian Medical Association Journal




Opioid prescriptions in the emergency department (ED) were associated with small increases in later opioid prescriptions and hospital admissions, found new research published in CMAJ (Canadian Medical Association Journalhttps://www.cmaj.ca/lookup/doi/10.1503/cmaj.241542.

To understand the relationship between opioid prescribing in the ED and subsequent harm, researchers looked at opioid prescribing at all Alberta EDs from 2010 to 2020. Of the more than 13 million visits, 689 074 patients (5.3%) filled an opioid prescription. The researchers found that opioid prescriptions did not increase the risk of death or overdose, but that opioid-treated patients were more likely than untreated controls to require a hospital admission (16.4% v. 15.1%) or to receive additional opioid prescriptions (4.5% v. 3.3%) in the year following the ED visit.

“Emergency physicians face growing pressure to curtail opioid prescribing but must manage severe pain and treat opioid-tolerant patients who can no longer access opioids from their physicians,” writes Dr. Grant Innes, professor of emergency medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, with coauthors. “There is little research to guide them.”

The researchers concluded that although single opioid prescriptions are not risk free, the likelihood of harm is low and unlikely to outweigh the benefit of treating severe pain. Their findings also show that patient characteristics influence risk and that adverse outcomes are more likely with opioid-naive patients, older patients, patients with multiple health conditions, and frequent ED users.

“Physicians should understand the concept of patient-specific incremental risks when prescribing opioids for acute pain and prescribe cautiously within high-risk groups,” the authors conclude.

They also suggest that future research should investigate the effects of different opioid drugs, which may not be equal, and identify health conditions where opioid risk is more or less severe.

“Research and guidance in this area is long overdue, and only filling this research gap will allow acute pain prescribers and their patients to consider how best to ameliorate pain while minimizing potential harms related to opioid prescription,” writes Dr. Donna Reynolds, a family physician and acting co-chair of the Canadian Task Force on Preventive Health Care, with coauthors in a related commentary https://www.cmaj.ca/lookup/doi/10.1503/cmaj.250094.

Does pain affect cancer survivors’ use of non-opioid substances?



U.S. data indicate that pain is linked with a greater likelihood of tobacco and cannabis use among cancer survivors.



Wiley





Experiencing pain may increase the odds that cancer survivors will use cigarettes and cannabis, according to a recent study published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society. The study also found that cigarette smoking and pain are linked to more treatment-related side effects and worse health among cancer survivors.

Pain and use of cigarettes, e-cigarettes, alcohol, and cannabis commonly occur together in the general population. To characterize pain in relation to such non-opioid substance use specifically among cancer survivors (who often experience pain), investigators analyzed data from two national samples of individuals with a past diagnosis of cancer in the United States: 1,252 adults from Wave 6 (2021) of the Population Assessment of Tobacco and Health (PATH) Study and 4,130 adults from the 2020 National Health Interview Survey.

PATH data indicated that higher past-week pain intensity was associated with a greater likelihood that cancer survivors would use cigarettes, e-cigarettes, and cannabis, and a lower likelihood that they would drink alcohol. National Health Interview Survey data indicated that chronic pain was associated with a greater likelihood of cigarette smoking and a lower likelihood of alcohol use. In both studies, cigarette smoking and pain were linked to fatigue, sleep difficulties, poorer mental/physical health, and lower quality of life.

“These findings show that because pain and substance use are interconnected among cancer survivors, it’s important to focus on treating both together in cancer care. Pain can drive substance use, and substance use can worsen pain, creating a cycle that’s hard to break,” said lead author Jessica M. Powers, PhD, of Northwestern University’s Feinberg School of Medicine. “While cancer survivors might smoke cigarettes or use substances to get immediate relief from their pain and cope with other symptoms, this can be incredibly harmful for their health by reducing the effectiveness of cancer treatments and increasing risk for cancer recurrence.”

 

Additional information
NOTE:
 The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com 

Full Citation:
“Relationship Between Pain and Non-Opioid Substance Use in Two National Samples of Cancer Survivors.” Jessica M. Powers, Lisa R. LaRowe, Dana Rubenstein, Judith A. Paice, Brian Hitsman, and Christine M. Rini. CANCER; Published Online: February 10, 2025 (DOI: 10.1002/cncr.35701).  

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.35701

Author Contact: Kristin Samuelson at ksamuelson@northwestern.edu

About the Journal     
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on X @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley      
Wiley is one of the world’s largest publishers and a trusted leader in research and learning. Our industry-leading content, services, platforms, and knowledge networks are tailored to meet the evolving needs of our customers and partners, including researchers, students, instructors, professionals, institutions, and corporations. We empower knowledge-seekers to transform today’s biggest obstacles into tomorrow’s brightest opportunities. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on FacebookXLinkedIn and Instagram.