Thursday, August 21, 2025

Global study warns hepatitis B care must be overhauled to meet WHO 2030 elimination targets

University of Liverpool

The first global systematic review and meta-analysis of hepatitis B care has found critical patient losses at every step of care, calling for decentralised, integrated models to improve diagnosis, treatment, and patient retention.

Published in The Lancet Gastroenterology & Hepatology, the findings reveal that current hepatitis B service delivery models are failing to keep patients engaged in lifelong care — threatening the world’s ability to meet the World Health Organisation (WHO) 2030 hepatitis B elimination goals.

The WHO-commissioned review was conducted by researchers from the University of Liverpool and Imperial College London in collaboration with colleagues from The Gambia, India, the Philippines, the USA, and Vietnam. It analysed data from more than 1.7 million people with chronic hepatitis B across 50 countries and found significant drop-offs in diagnosis, treatment initiation, and long-term retention, even in the best-performing systems.

Key findings of the review show that:

Specialist-led hospital care achieved the best results but still showed major gaps: fewer than 75% of patients were assessed for treatment eligibility; of those eligible, only 78% began therapy. Retention plummeted among those not receiving treatment.
Primary care, co-managed care, and passive referral models fared worse, with lower rates of assessment, initiation of care, and retention once in care.
Postpartum care for women diagnosed during antenatal care had particularly low follow-up rates.
Community screening with active linkage to specialist care achieved high treatment initiation rates for eligible patients.

Lead author Dr Alexander Stockdale from the University of Liverpool, said: “This is the first global review to map our progress across the hepatitis B care pathway. Without urgent changes, millions will miss out on lifesaving treatment. Many patients are not being fully assessed or being started on antivirals when they could benefit, and far too many are lost to follow-up over time. Strengthening primary care in low- and middle-income countries is essential to prevent hepatitis B-related deaths — already estimated at 1.1 million in 2022.”

Senior author Professor Philippa Easterbrook (Imperial College London; formerly WHO Global Hepatitis Programme) added: “WHO’s 2024 guidelines were a major step forward, expanding treatment eligibility to nearly half of all people living with chronic hepatitis B. But simplifying criteria alone is not enough. Too many still lack access to services, and even where clinics exist, patients often fall through the cracks.

“We need simple, decentralised models — integrating hepatitis B into primary care or existing HIV and chronic disease services. The HIV response has proven that streamlined care can achieve over 90% diagnosis, treatment initiation, and retention. It’s time we applied those lessons to hepatitis B.”

Professor Easterbrook added: “An integrated approach is even more pressing given the recent reductions in funding through USAID and the US President’s Emergency Plan for AIDS Relief (PEPFAR) for health programmes in LMICs”

The researchers have made the following recommendations:

Decentralise care into primary health facilities and integrate with HIV/non-communicable disease (NCD) clinics.
Remove financial barriers by eliminating out-of-pocket costs for testing and treatment.
Accelerate access through same-day assessment and treatment initiation.
Improve long-term engagement using adherence and retention strategies from HIV care programmes.

Click here to read the full review.

Journal

The Lancet Gastroenterology & Hepatology

Method of Research

Meta-analysis

Subject of Research

People

New antibody therapy shows promise in reducing Zika virus in reproductive tissues

University of Alabama at Birmingham

A new study from the University of Alabama at Birmingham reveals that an antibody originally designed to fight dengue virus may also block the spread of Zika virus in vulnerable areas of the body — including the reproductive organs. The findings, published today in the Journal of Virology, offer new hope in the fight against a virus that has affected more than 80 countries since 2007 and poses serious risks to pregnant women and their babies.

What makes Zika especially dangerous is its ability to hide in protected areas of the body, including the brain, eyes and reproductive organs, where it can linger undetected. Even more troubling, Zika can be passed through sex or from a pregnant mother to her baby, potentially leading to severe birth defects.

In this new study, led by J. Victor Garcia, Ph.D., and Angela Wahl, Ph.D., in the Department of Microbiology at UAB, scientists tested the effectiveness of the C10 dengue virus antibody using a novel preclinical in vivo model. They found that a single dose of C10 administered before Zika virus exposure:

Significantly suppressed viral replication in blood and tissues
Prevented viral shedding in saliva and reproductive secretions
Reduced viral levels in the brain, eyes and reproductive organs
Improved survival rates in preclinical models

“Our work lays the foundation for deploying passive immunization strategies in high-risk populations,” Garcia said. “This could be a game-changer in outbreak response, especially in regions where Zika is endemic or resurging.”

Researchers evaluated the antiviral compound DFMA (7-deaza-2’-C-methyladenosine), which significantly reduced viremia and prolonged survival in a preclinical model.

“This study provides compelling evidence that antibody-based therapies can be used to reduce systemic infection and target the very tissues where Zika hides and causes the most damage,” Wahl said. “This is especially important for protecting pregnant individuals and preventing sexual transmission during future outbreaks.”

Currently, there are no approved treatments for Zika virus. This research marks a significant step toward developing effective countermeasures against future outbreaks.

Other collaborating institutions in this study include the University of North Carolina at Chapel Hill and Emory University.

Funding for this study was provided by the National Institutes of Health grant AI106695 (R.S.B.).

Journal

Journal of Virology

Article Title

Envelope-dimer epitope 1 (EDE1) antibody (C10) treatment significantly reduces Zika virus replication in the male and female reproductive tracts

Article Publication Date

18-Aug-2025

Study reveals how HPV reprograms immune cells to help cancer grow

Using animal models, researchers from the USC Norris Comprehensive Cancer Center at the Keck School of Medicine of USC uncovered how cervical and throat cancers linked to the human papillomavirus evade the immune system, opening the door to new treatment

Keck School of Medicine of USC

The most common cancer-causing strain of human papillomavirus (HPV), HPV16, undermines the body’s defenses by reprogramming immune cells surrounding the tumor, according to new research from the Keck School of Medicine of USC. In mice, blocking this process boosted the ability of experimental treatments for HPV to eliminate cancer cells. The results were just published in the Journal for ImmunoTherapy of Cancer.

HPV16 causes more than half of cervical cancer cases and roughly 90% of HPV-linked throat cancers. It can be neutralized with the preventive vaccine Gardasil-9, but only if vaccination occurs prior to HPV exposure.

Researchers are now working to develop “therapeutic vaccines,” which can be taken after HPV exposure—for instance, following an abnormal pap smear or cancer diagnosis—to trigger an immune response against infected cells by T-cells, a type of “fighter” cell that helps defend the body from disease. But these vaccines, now in clinical trials, have limited effectiveness—and the new study helps explain why.

The research, funded in part by the National Institutes of Health, focuses on a signaling protein in the immune system with inflammatory properties called Interleukin-23 or IL-23. While IL-23 was previously implicated in cervical and throat cancers, its exact role was unclear. In a series of tests in mice and cell cultures, USC researchers found that two HPV proteins, E6 and E7, prompt nearby cells to release IL-23, which in turns prevents the body’s T-cells from attacking the tumor.

“In order to eliminate the cancer, T-cells need to proliferate and destroy infected cells. But IL-23 stops them from working effectively, so the tumor keeps growing,” said the study’s senior author, W. Martin Kast, PhD, professor of molecular microbiology & immunology, obstetrics & gynecology, and otolaryngology and Walter A. Richter Cancer Research Chair at the Keck School of Medicine.

Kast and his colleagues found that blocking IL-23 made an HPV therapeutic vaccine more effective because it let T-cells do their job: find and kill cancer. Antibodies that inhibit IL-23 are already FDA-approved for treating psoriasis and other conditions, offering a clear and potentially quick path to use in cancer treatment when they are combined with therapeutic vaccines.

“The fact that these antibodies are already FDA-approved for something else makes this approach promising—and it also allows for rapid translation into the clinic,” said Kast, who also co-leads the Tumor Microenvironment Program at the USC Norris Comprehensive Cancer Center.

The role of IL-23

Researchers used a combination of cell cultures, mouse studies and genomic analyses to uncover IL-23’s role in cancers caused by HPV16.

First, they implanted mice with HPV16 tumors, then delivered a therapeutic vaccine that caused the mice to develop specialized T-cells for fighting the tumor. They extracted these T-cells, then combined them with IL-23. When IL-23 was present, the T-cells had reduced capacity to multiply and destroy cancerous cells.

The researchers then gave IL-23 neutralizing antibodies to mice with HPV16 tumors. Blocking IL-23 increased the number of T-cells around the tumor that could recognize and kill cancer. When combined with the HPV therapeutic vaccine, this approach triggered a stronger immune response and led to longer survival than either treatment on its own.

Researchers also analyzed the RNA and chromatin (the DNA and proteins that control gene activity) of tumor cells to reveal precisely how HPV’s E6 and E7 proteins increase IL-23 production. Understanding the biological mechanism is a key step toward better treatments for HPV-linked cancers, Kast said.

New strategies for treatment

The study offers insight into why therapeutic vaccines for HPV, now in clinical trials, have had limited success.

“Therapeutic vaccines do prompt the immune system to create HPV-specific T-cells, but they don’t work well—and now we have an idea why,” Kast said.

Combining experimental vaccines with IL-23 neutralizing antibodies could significantly increase their effectiveness, he added. He and his team are now developing their own therapeutic vaccine, which they will test in combination with antibodies that block IL-23.

The findings may have implications for cancers not related to HPV, such as testicular and bladder cancers, where IL-23 is also found at high levels. Further research is needed to clarify what role IL-23 plays in those diseases, the researchers said.

About this research

In addition to Kast, the study’s other authors are Ruben Prins, Daniel Fernandez and Omid Akbari from the Department of Molecular Microbiology and Immunology and the USC Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California; and Diane Da Silva from the Department of Obstetrics & Gynecology and the USC Norris Comprehensive Cancer Center, Keck School of Medicine of USC, University of Southern California.

This work was supported by the National Institutes of Health [R01 CA074397], the American Association of Immunologists, R.F. Brennan, S. Bloch and I.Y. Khandros.

Journal

Journal for ImmunoTherapy of Cancer

DOI

10.1136/jitc-2025-011915

Method of Research

Experimental study

Subject of Research

Animals

Article Title

HPV16 E6 AND E7 EXPRESSING CANCER CELLS SUPPRESS THE ANTI-TUMOR IMMUNE RESPONSE BY UPREGULATING KLF2 MEDIATED IL-23 EXPRESSION IN MACROPHAGES

Article Publication Date

19-Aug-2025

Smithsonian study reveals carbon markets undervalue shade-grown coffee farms

Existing shade trees on coffee farms store more carbon than tree-planting projects can sequester

Smithsonian

Shade-grown Coffee Farm — image:
The diversity of trees on shade-grown coffee farms makes them a haven for biodiversity.
view more
Credit: Roshan Patel, Smithsonian’s National Zoo and Conservation Biology Institute.

A new global analysis reveals a critical oversight in sustainable coffee and carbon-capture initiatives. These programs incentivize the planting of new trees yet fail to reward the preservation of mature shade trees in existing agroforestry farms, despite their far greater carbon storage potential.

According to new research from the Smithsonian’s National Zoo and Conservation Biology Institute (NZCBI) and Smithsonian Tropical Research Institute (STRI), published today in the journal Communications Earth & Environment, more than twice as much carbon stands to be lost through the removal of non-coffee shade trees than might be gained through tree planting—even if every plantation-style coffee farm in the world planted new shade trees.

Globally, coffee farms cover more than 10 million hectares. Farming systems vary in intensity, from plantation-style monocultures to agroforestry systems with native trees that provide shade, wildlife habitat and carbon storage. Planting new shade trees is currently incentivized through carbon markets, which allow coffee farmers to sell carbon credits generated via tree planting. However, existing agroforestry systems are rapidly converting to monoculture plantations, releasing significant amounts of carbon into the atmosphere while destroying habitat.

Scientists from NZCBI and STRI identified a critical gap in current carbon markets, which compensate coffee farmers for planting new trees but not for protecting standing trees. This potentially creates an incentive to remove existing trees to plant new ones that store less carbon but would be eligible for carbon-credit payments.

“There is a lot of money behind planting trees on degraded coffee farms, yet there are basically no financial incentives, outside of the Smithsonian Bird Friendly certification, to protect standing shade trees,” said NZCBI ecologist Ruth Bennett, senior author of the study and leader of Smithsonian Bird Friendly program, which offers a gold standard certification for coffee and cocoa farms that conserve high-quality habitat for wildlife. “To be clear, planting shade trees on monoculture coffee farms is a positive step, but our findings show tree planting alone can’t make up for what you lose when you remove mature shade trees.”

The study, conducted in collaboration with The Nature Conservancy and CIRAD, also found carbon-focused tree planting efforts do not necessarily boost biodiversity. Carbon sequestration is optimized by maximizing tree density, while biodiversity benefits more from tree diversity.

“To protect nature and fight climate change, coffee companies need to focus on planting a diversity of the right trees, not just planting a high density of fast-growing trees that capture carbon,” said Emily Pappo, the study’s first author and a postdoctoral climate fellow at the Smithsonian.

Prior research demonstrated coffee farms that include a diverse mixture of shade trees harbor roughly four times more bird species than coffee monocultures. Such findings are at the heart of the Bird Friendly coffee certification criteria, which ensure farms maintain dense and diverse shade trees. This certification grants farmers access to specialty markets and enables them to set higher asking prices, rewarding them for conserving biodiversity.

Coffee farmers are facing economic pressure and reduced yields due to climate change, and some are responding by removing shade trees on their properties in hopes of producing more coffee, even though scientists believe shade trees may help producers adapt to climate change by assisting with temperature and moisture regulation. At the same time, some large coffee companies are investing millions in tree-planting efforts to meet their climate goals via carbon credits.

Researchers wanted to understand just how much carbon is stored in coffee farming landscapes and evaluate how carbon and biodiversity could change through tree planting or the removal of shade trees.

The researchers gathered data from 67 scientific studies conducted in coffee regions around the world. They examined farms across a spectrum—from bare “sun coffee” monocultures with no trees at all to complex agroforestry systems where coffee grows under a canopy of native forest trees. The researchers compared the carbon stored in each type of farm, then applied these measurements to existing data on global coffee growing that shows 41% is grown in full sun, 35% with minimal shade and 24% under diverse tree cover. Finally, the team modeled what might happen under various scenarios—calculating the maximum possible carbon gains if every sun farm planted trees, and the potential losses if farms cut down existing shade trees.

The study estimated coffee farms currently store 482 million metric tons of carbon above ground. The modeled scenarios revealed that even if all sun coffee farms added shade trees, they would sequester only 82–87 million additional metric tons of carbon. In contrast, if all shade-grown coffee were converted to monocultures, 174–221 million metric tons of carbon could be released into the atmosphere.

These extreme scenarios expose a fundamental issue with current carbon-market incentives for coffee farms: Mature shade trees store more carbon than newly planted trees, yet only new trees are incentivized via carbon markets. Prioritizing tree-planting above conserving existing shade trees could undermine the effectiveness of the coffee industry’s investments in climate solutions.

“If we don’t prioritize biodiversity on carbon sequestration projects, it won’t accidentally happen,” Pappo said. “This means choosing a diverse suite of shade trees with the aim of conserving biodiversity.”

To maximize the potential of coffee farming to fight climate change and boost biodiversity, the study authors call for creating carbon payment programs that reward protecting existing shade trees and ensuring these payments are accessible to small farms. For tree-planting efforts, researchers recommend explicitly prioritizing tree diversity in all planting initiatives to support biodiversity. Without these changes, global coffee agriculture may continue to lose carbon and biodiversity despite investments in tree planting.

Going forward, Smithsonian researchers are continuing to develop the Shade Catalog, a resource to help coffee farmers select shade trees that work well alongside coffee while providing benefits to wildlife and ecosystem services. Bird Friendly-affiliated researchers are also working on tools to help farmers find the balance between carbon storage, biodiversity and farm productivity.

Tree canopy on shade-grown coffee farms helps mitigate impacts of climate change by lowering ground temperatures and maintaining moisture levels.

Credit

Roshan Patel, Smithsonian’s National Zoo and Conservation Biology Institute.

Journal

Communications Earth & Environment

DOI

10.1038/s43247-025-02574-w

Method of Research

Literature review

Subject of Research

Not applicable

Article Title

Carbon payment strategies in coffee agroforests shape climate and biodiversity outcomes

Article Publication Date

19-Aug-2025

In Africa, heat waves are hotter and longer than 40 years ago, UIC researchers say

University of Illinois Chicago

Heat waves — prolonged periods of abnormally hot weather — influence egg prices, energy bills and even public transit. And they’re becoming more common as temperatures increase.

In a new study, UIC researchers report that heat waves across Africa are hotter, longer and more frequent today than 40 years ago, mainly due to increased greenhouse gas and black carbon emissions from burning fossil fuels. Understanding heat waves’ origins and effects can help African countries predict them and adapt.

“Raising awareness of heat waves is critical to saving human life,” said Akintomide Afolayan Akinsanola, head of the Climate Research Lab and assistant professor of earth and environmental sciences in the UIC College of Liberal Arts and Sciences. “In a developing continent like Africa, where the capacity for adaptive infrastructure is relatively low, heat waves can have greater consequences.”

Africa is uniquely vulnerable to heat waves in an already warming world; in April 2024, temperatures in the West African city of Kayes exceeded 119 degrees Fahrenheit. Heat waves harm ecosystems, reduce agricultural productivity and strain energy systems. Infants, older adults and those with health conditions are especially susceptible to heat-related illness, which kills 5,600 people annually in the U.S. Some experts have estimated that heat-related deaths in Nigeria may rise to 23,000 or even 43,000 per year by the end of the 21st century.

But climate extremes in Africa and its subregions are understudied due to insufficient computing infrastructure and a lack of data and resources, the researchers said. Filling this knowledge gap could protect people living in these regions and help forecast similar scenarios around the globe.

Akinsanola and his team examined the intensity, frequency and duration of heat waves in Africa during two periods: 1950-1979 and 1985-2014. The researchers used large–ensemble computer models to isolate the factors contributing to daytime, nightime and compound heat waves, including human-driven influences like greenhouse gas and aerosol emissions as well as natural variability.

The researchers saw stark differences between the two periods they studied. The 1950-1979 period was characterized by weak, infrequent heat waves, with about one occurring every three to eight years. About 80% of heat wave activity during this time could be attributed to natural causes, and the researchers highlighted the cooling effects of sulfate aerosol: airborne sulfur particles caused naturally by volcanic eruptions or anthropogenically through fossil fuel burning make clouds reflect more light back into space.

In contrast, the 1985-2014 period saw one or more heat waves every two years, lasting up to three times as long as in the previous period. These changes were mainly due to human activities like increased greenhouse gas and black carbon emissions. In this period, the researchers attributed only 30% of heat wave activity to natural causes.

The team also identified a strong correlation between heat wave frequency and near-surface air temperature, likely due to shared variables like air circulation and surface energy.

“I was surprised to see that these changes were consistent across the African subregions, not just a specific isolated area,” said Vishal Bobde, a doctoral student in Akinsanola’s lab and the study’s first author.

The authors hope their findings will help policymakers, scientists, government officials and African communities develop effective mitigation and adaptation strategies for heat waves, such as strengthening early-warning systems and improving heat-risk literacy.

“The impacts are wide-ranging, from productivity to food shortage to energy,” said Akinsanola, who is jointly appointed at the Environmental Science Division of Argonne National Laboratory. “Remember that the African population is close to 2 billion. Heat waves can lead to drought, trigger migration and spark conflicts, thereby impacting regional, continental and even global stability.”

Looking ahead, the researchers plan to investigate how projections for future heat waves might change based on global adherence to the goals set in the 2015 Paris Agreement.

“While Africa contributes a relatively small share of global greenhouse gas emissions, climate change is a global issue that is intensifying heat waves everywhere. Addressing this requires global cooperation to aggressively reduce emissions and build adaptive capacity,” said Kayode Ayegbusi, co-first author and UIC doctoral student in Akinsanola’s lab.

Institutional collaborators include The Australian National University, Texas A&M and the University of California, Merced.

The researchers used Community Earth System Model 2 — Large Ensemble simulations, which are managed by the National Center for Atmospheric Research and are publicly available through the Earth System Grid Federation or NCAR Climate Data Gateway.

The research appears in the open-access Nature Portfolio journal Communications Earth and Environment.

Journal

Communications Earth & Environment

DOI

10.1038/s43247-025-02578-6

Article Title

Anthropogenic warming is accelerating recent heatwaves in Africa

COI Statement

Akintomide A. Akinsanola is an Editorial Board Member for Communications Earth & Environment but was not involved in the editorial review of this article or the decision to publish it. All other authors declare no competing interests.

Extreme heat increases infant mortality in Sub-Saharan Africa

PNAS Nexus

Sub-Saharan Africa currently has the highest infant mortality rate in the world, with 27 babies out of every 1,000 live births dying in their first month. As the climate warms, pregnant women in the region are increasingly exposed to extreme heat, which can cause reduced placental blood flow and dehydration, potentially affecting fetal development. In addition, extreme heat can lead to the proliferation of pathogenic bacteria in the environment, and can make it difficult for women to travel to prenatal care appointments. Jiafu An and colleagues sought to determine whether in-utero exposure to extreme heat was a contributor to the neonatal mortality rate. The authors cross-referenced 883,623 birth records from 33 African countries from 2006–2022 with data on heat and humidity, finding that an additional fifty days of extreme heat exposure during the nine-month gestation period is associated with an increase of 1 to 4 neonatal deaths per 1,000 births within the first month of life, although the effect was only present in rural areas. Economically disadvantaged and less educated mothers were more strongly affected by the association than mothers with access to resources and education. According to the authors, targeted interventions such as the deployment of community health workers, investments in education and electricity infrastructure, and overall economic development should be pursued to protect vulnerable women from harm and heartbreak.

Journal

PNAS Nexus

Article Title

In utero exposure to extreme heat increases neonatal mortality

Article Publication Date

19-Aug-2025

Exploring long term, complex biodiversity change in Scotland’s landscapes

Despite growing concern about biodiversity loss due to the ongoing biodiversity and climate crises, scientists have relatively little understanding of the pace and complexity of biodiversity change over preceding millennia.

University of Edinburgh

image:
Locations of study sites Migdale (a) and Torran Beithe (b) in the Scottish Highlands, with field photographs showing their terrain and current vegetation.
view more
Credit: Dr Amelia Penny, University of Edinburgh

To address this challenge, ecologists from the University of Edinburgh, University of St Andrews and National Tsing Hua University, Taiwan have applied a recently developed technique to explore how plant biodiversity responded to changes in climate, land use and woodland extent over the past 8,000 years at two sites in Scotland: one in an ancient woodland, and one where woodland has given way to blanket peat bog.

For the first time, researchers analysed records of ancient pollen grains, which lie preserved in layers of peat and are important archives of past changes in plant communities.

This technique allowed the group to investigate changes in the number of plant species, but also the number of functional groups and evolutionary history captured in plant communities throughout thousands of years of environmental change.

This multidimensional approach to measuring biodiversity reveals patterns of biodiversity change which would not otherwise be detectable, and allows these different aspects of biodiversity to be directly compared.

The two sites showed different responses to long-term changes in climate and land use. The development of a large area of thick, acidic peat over centuries at the blanket bog site led to steady but long-term biodiversity change and a lasting shift away from woodland cover.

At the ancient woodland site, biodiversity changed rapidly as a complex mosaic of different habitat types allowed different species, evolutionary lineages and functional groups to persist and recolonise through multiple disturbances.

However, there has been a steep decline in all types of biodiversity over the past 1200 years, as human management of the woodland led to pine predominating over a previously varied mix of tree species.

The research was published by the British Ecological Society.

Dr Amelia Penny, Lecturer in Ecological Science, School of GeoSciences, University of Edinburgh, who led the study, said, “This study illustrates the complex character and dynamics of long-term biodiversity change at two contrasting sites in Scotland. The methods used in this study could be applied more widely to palaeoecological records, to help us understand the history of biodiversity change in our landscapes, and its possible futures under environmental change.”

For further information, please contact the University of Edinburgh Press Office: press.office@ed.ac.uk

Journal

Journal of Ecology

DOI

10.1111/1365-2745.70093

Method of Research

Imaging analysis

Subject of Research

Cells

Article Title

Applying a unified framework to compare taxonomic, functional and phylogenetic diversity in Holocene pollen records

Article Publication Date

21-Aug-2025