Artificial intelligence successfully predicts protein interactions

UT Southwestern and University of Washington researchers led an international team that used artificial intelligence (AI) and evolutionary analysis to produce 3D models of eukaryotic protein interactions. The study, published in Science, identified more than 100 probable protein complexes for the first time and provided structural models for more than 700 previously uncharacterized ones. Insights into the ways pairs or groups of proteins fit together to carry out cellular processes could lead to a wealth of new drug targets.

“Our results represent a significant advance in the new era in structural biology in which computation plays a fundamental role,” said Qian Cong, Ph.D., Assistant Professor in the Eugene McDermott Center for Human Growth and Development with a secondary appointment in Biophysics.

Dr. Cong led the study with David Baker, Ph.D., Professor of Biochemistry and Dr. Cong’s postdoctoral mentor at the University of Washington prior to her recruitment to UT Southwestern. The study has four co-lead authors, including UT Southwestern Computational Biologist Jimin Pei, Ph.D.

Proteins often operate in pairs or groups known as complexes to accomplish every task needed to keep an organism alive, Dr. Cong explained. While some of these interactions are well studied, many remain a mystery. Constructing comprehensive interactomes — or descriptions of the complete set of molecular interactions in a cell — would shed light on many fundamental aspects of biology and give researchers a new starting point on developing drugs that encourage or discourage these interactions. Dr. Cong works in the emerging field of interactomics, which combines bioinformatics and biology.

Until recently, a major barrier for constructing an interactome was uncertainty over the structures of many proteins, a problem scientists have been trying to solve for half a century. In 2020 and 2021, a company called DeepMind and Dr. Baker’s lab independently released two AI technologies called AlphaFold (AF) and RoseTTAFold (RF) that use different strategies to predict protein structures based on the sequences of the genes that produce them.

In the current study, Dr. Cong, Dr. Baker, and their colleagues expanded on those AI structure-prediction tools by modeling many yeast protein complexes. Yeast is a common model organism for fundamental biological studies. To find proteins that were likely to interact, the scientists first searched the genomes of related fungi for genes that acquired mutations in a linked fashion. They then used the two AI technologies to determine whether these proteins could be fit together in 3D structures.

Their work identified 1,505 probable protein complexes. Of these, 699 had already been structurally characterized, verifying the utility of their method. However, there was only limited experimental data supporting 700 of the predicted interactions, and another 106 had never been described.

To better understand these poorly characterized or unknown complexes, the University of Washington and UT Southwestern teams worked with colleagues around the world who were already studying these or similar proteins. By combining the 3D models the scientists in the current study had generated with information from collaborators, the teams were able to gain new insights into protein complexes involved in maintenance and processing of genetic information, cellular construction and transport systems, metabolism, DNA repair, and other areas. They also identified roles for proteins whose functions were previously unknown based on their newly identified interactions with other well-characterized proteins.

“The work described in our new paper sets the stage for similar studies of the human interactome and could eventually help in developing new treatments for human disease,” Dr. Cong added.

Dr. Cong noted that the predicted protein complex structures generated in this study are available to download from ModelArchive (https://modelarchive.org/doi/10.5452/ma-bak-cepc). These structures and others generated using this technology in future studies will be a rich source of research questions for years to come, she said.

Dr. Cong is a Southwestern Medical Foundation Scholar in Biomedical Research. Other UTSW researchers who contributed to this study include Jing Zhang and Josep Rizo, Ph.D., who holds the Virginia Lazenby O’Hara Chair in Biochemistry.

Collaborating institutions include: Harvard University, Wayne State University, Cornell University, MRC Laboratory of Molecular Biology, Memorial Sloan Kettering Cancer Center, Gerstner Sloan Kettering Graduate School of Biomedical Sciences, Fred Hutchinson Cancer Research Center, Columbia University, University of Würzburg in Germany, St Jude Children’s Research Hospital, FIRC Institute of Molecular Oncology in Milan, Italy, and the National Research Council, Institute of Molecular Genetics in Rome, Italy.

This work was supported by Southwestern Medical Foundation, the Cancer Prevention and Research Institute of Texas (CPRIT) (RP210041), Amgen, Microsoft, the Washington Research Foundation, Howard Hughes Medical Institute, National Science Foundation (DBI 1937533), National Institutes of Health (R35GM118026, R01CA221858, R35GM136258, R21AI156595), UK Medical Research Council (MRC_UP_1201/10), HHMI Gilliam Fellowship, the Deutsche Forschungsgemeinschaft (KI-562/11-1, KI-562/7-1), AIRC investigator and the European Research Council Consolidator (IG23710 and 682190), Defense Threat Reduction Agency (HDTRA1-21-1-0007), and the National Energy Research Scientific Computing Center.

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Research in mice shows how diet alters immune system function through a gut microbe

The cliché “you are what you eat” has been used for hundreds of years to illustrate the link between diet and health. Now, an international team of researchers has found the molecular proof of this concept, demonstrating how diet ultimately affects immunity through the gut microbiome.

The work, conducted in mice, reveals that what animals consume initiates the release of a metabolic byproduct from a specific gut microbe that, in turn, modulates the animals’ gut immunity.

The findings, published Nov.10 in Nature, offer a unifying explanation for the complex interplay between diet, gut microbiota, and immune function. They are the result of collaboration among scientists at Harvard Medical School, Brigham and Women’s Hospital, Seoul National University, and Monash University in Australia.

The experiments pinpoint a microbial molecule, the synthesis and release of which are influenced by host diet. That molecule, in turn, stimulates the activation and signaling of a subset of cells known as natural killer (NK) T cells, which are involved in immune regulation and implicated in a range of inflammatory conditions.

While scientists have surmised for a long time that diet plays a role in immune health, the new study elucidates the precise molecular cascade behind this interplay, said study senior author Dennis Kasper, professor of immunology in the Blavatnik Institute at Harvard Medical School.

“We have shown how diet affects the immune system through a microbial mediator in the gut, and this is a really striking example of the diet-microbiota-immunity triad at play,” Kasper said. “What this work really does is provide a step-by-step pathway from beginning to end that explains how and why this triad works and how diet ultimately affects the immune system.”

If confirmed in larger animals and eventually in humans, the findings can help inform the design of small-molecule treatments that enhance both intestinal and overall immunity, the researchers said.

“Gut-resident microbes produce molecules with enormous structural diversity. We used microbial and chemical tools to elucidate how these molecules are synthesized by gut bacteria and how they act in the host gut,” said study first author Sungwhan Oh, a principal investigator at the Center for Experimental Therapeutics and Reperfusion Injury at Brigham and Women’s Hospital and a former postdoctoral fellow in the Kasper lab.”Our findings yield fascinating insights about the microbiome, diet, and immune function and provide interesting clues about how molecules made by our inner neighbors can be used to design therapies.”

In a series of experiments, the team identified the immune-signaling cascade triggered by the metabolic breakdown of dietary amino acids in the mouse gut. This multistep pathway begins with an animal consuming food that contains branched-chain amino acids, so named for the tree branch-like structure of one of their molecular chains. The branched-chain amino acids are then taken up by B. fragilis, a gut-resident microbe, and converted by a specific enzyme into sugar-lipid molecules that also have branched chains. B. fragilis then releases branched-chain molecules that are spotted and picked up by a class of immune-signaling cells known as antigen-presenting cells, which in turn induce NK T cells to exercise their immunoregulatory response through upregulating inflammation-controlling genes and immune-regulatory chemicals.

Notably, the experiments demonstrated that it is the branching of the chain structure that initiates the cascade. Straight-chain versions of the molecule did not yield the same effect. Furthermore, the team found that B. fragilis alters the structure of the sugar-lipid molecules that it metabolizes and renders them better capable of binding to receptors on specific immune cells and initiating a signaling cascade that culminates in downregulating inflammation.

The work also showed that each of three different branched-chain amino acids consumed by mice yielded slightly different structural changes to the bacterial lipid molecules, resulting in different patterns of binding with immune cells.

Study coinvestigator Seung Bum Park, professor of chemistry at Seoul National University, synthesized, and the Harvard team tested, 23 different configurations of the microbe-made immunomodulatory molecule to determine how each one interacts with the immune cells that regulate inflammation.

The Harvard team’s experiments revealed that synthetic, lab-made branched-chain lipid molecules induced NK T cells to release the immune-signaling chemical IL-2, whereas the lab-made straight-chained versions of these molecules did not. Thus activated, the NK T cells, in turn, induced the expression of genes that regulate immunity but not of genes that drive inflammation.

Using a structural biology approach, Jamie Rossjohn, professor of biochemistry and molecular biology at Monash Biomedicine Discovery Institute in Australia, elucidated how the lipid structure engages with and binds to antigen presenting cells — the immune cells that give NK T cells the go-ahead to produce anti-inflammatory chemicals.

In a final step, the researchers treated mice with ulcerative colitis with the branched-chain sugar-lipid molecule. Animals that received treatment with the branched-chain molecule fared much better than untreated animals. They not only gained weight, but when researchers examined the gut cells of the mice under a microscope, they observed that these cells also had minimal signs of colon inflammation.

Taken together, the experiments provide a structural and molecular explanation of previously observed anti-inflammatory effects of this class of sugar-lipids produced by the gut microbe B. fragilis.

“This work offers a great example of transdisciplinary discovery-based research aimed at answering a major question in biomedical sciences, namely, how the immune system can be modulated by the interplay between diet and the microbiota,” Rossjohn said.

In 2014, Kasper and colleagues published a study showing that a sugar-lipid molecule released by B. fragilis had anti-inflammatory effects on the gut and protected mice from colitis, but the scientists did not know how these molecules were made by the microbe, nor the specific structural features of the sugar-lipids that conferred the anti-inflammatory effect. The current study answers this question demonstrating that the sugar-lipid molecules made by this particular organism are branched-chain and it is precisely that branched-chain structure that allows them to bind to immune cells in a way that dampens these cells’ proinflammatory signaling.

“Our new work demonstrates that the branching of the lipid structure induces a very different response — the branching in the structure induces an anti-inflammatory rather than a proinflammatory response,” Kasper said.

The findings offer hope that inflammatory diseases mediated by these NK T cells could one day be treated with inflammation-dampening microbial molecules made in the lab, the researchers said.

The exact function of NK T cells — the immune cells that the microbe-made molecule ultimately activates to control colonic inflammation in mice — is not well-understood, Kasper said. However, given that these cells line the human gastrointestinal tract and the lungs and are also found in the liver and spleen, they likely play a significant role in immune regulation. Previous research points to these cells’ likely involvement in a range of inflammatory conditions, including ulcerative colitis, and to a possible role in airway inflammatory conditions such as asthma.

“We can never isolate enough of these immune-modulatory molecules from bacteria for therapeutic use, but the beauty of this is now we can synthesize them in the lab,” Kasper said. “The idea would be that we’d have a drug that can modulate inflammation in the colon and beyond.”

Co-authors included T. Praveena, Heebum Song, Ji-Sun Yoo, Da-Jung Jung, Deniz Erturk-Hasdemir, Yoon Soo Hwang, ChangWon Lee, Jérôme Le Nours, Hyunsoo Kim, Jesang Lee, and Richard Blumberg.

The work was supported by National Institutes of Health grants K01-DK102771, R01-AT010268, and R01-DK044319; by Department of Defense grant W81XWH-19-1-0625; by Brigham and Women’s Hospital Department of Anesthesiology, Perioperative and Pain Medicine Basic Science Grant; by the National Research Foundation of Korea grants 2014R1A3A2030423 and 2012M3A9C404878; and by the Australian Research Council grant CE140100011 and Australian Research Council Laureate Fellowship and Future Fellowships.

Relevant disclosures

Oh, Blumberg, and Kasper have filed a patent for Bacteroides fragilis α-galactosylceramides(BfaGCs) and related structures. Oh, Park, and Kasper have filed a patent on the functions of BfaGCs and related structures.

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Why drug used to treat critically ill COVID-19 patients may only benefit males

A new study from the University of Calgary shows how dexamethasone, the main treatment for severe COVID-19 lung infections, alters how immune cells work, which may help male patients, but has little to no benefit for females.

These remarkable findings are the result of a multidisciplinary study published in Nature Medicine, led by Dr. Jeff Biernaskie, PhD, professor, Comparative Biology and Experimental Medicine in the Faculty of Veterinary Medicine (UCVM) and Dr. Bryan Yipp, MD, associate professor, Department of Critical Care Medicine, Cumming School of Medicine.

“We found that the males derived benefit from the steroids, and the females, at both the cellular level and at the population level, received limited benefit,” says Yipp, Tier II Canada Research Chair in Pulmonary Immunology, Inflammation and Host Defense. “Currently, it’s possible the mainstay therapy for severe COVID-19 that we’re giving everybody is only benefiting half the population. This is a big problem.”

How do our bodies battle COVID-19 infection?

At the onset of the pandemic, hospitals’ treatments of the severely ill were not yet informed by research into how effective the drugs were under COVID-19 conditions. Steroids were the first identified drugs with proven benefit, but they were only moderately successful at reducing deaths, and exactly what they did was not understood.

In addition, when the study began, no one knew exactly how immune cells would react to COVID-19 infection at a cellular level. Why did some people get really sick while others did not? Why did certain drugs help some but not others?

“To be able to develop new treatments, we wanted to study how different people respond to SARS-CoV2 infection and how different immune responses dictate the severity of their disease,” says Biernaskie, the Calgary Firefighters Burn Treatment Society Chair in Skin Regeneration and Wound Healing.

Yipp and Biernaskie sought to better understand how steroids helped and, at the same time, evaluate why a clinical trial of steroids in COVID-19 showed they only helped some males, but not females.

When Yipp accessed the provincial eCRITICAL database of all ICU admissions during the pandemic, he discovered that the introduction of dexamethasone therapy in Alberta reduced the number of males dying but had no affect on the female population. “That was an unsettling observation.”

Analyzing thousands of immune cells from ICU patients

Blood was collected from both COVID-19 and non-COVID-19 patients who were admitted to Calgary ICUs in severe respiratory distress. Researchers in the Biernaskie lab used cutting-edge single cell RNA sequencing and bioinformatics techniques to simultaneously analyze the functional states of thousands of immune cells from each patient. This allowed them to document cellular behaviours at different stages of the disease (COVID-19 or non-COVID infections) and to measure treatment effects.

“We sampled as many patients as we could, not just at one time point but at a follow-up time point so we could get an idea of the evolution of the disease and the evolution of the immune response,” says Biernaskie.

In most viral infections, proteins called interferons work to clear the virus quickly. But with COVID-19, rather than working fast, “the interferon response trickles along, which actually fuels the fire of inflammation, and then you get worse organ damage,” says Yipp.

“What we found was that specifically in males, we see an exaggerated neutrophil interferon response, that is significantly restrained when a patient is given dexamethasone,” says Biernaskie. “But with females, relative to males, their neutrophil interferon response was much more tempered, so dexamethasone had little effect.”

Find therapies that benefit more people

After identifying the reasons why there’s a sex bias in the way dexamethasone works, Yipp believes that the way forward is for researchers to figure out how to make therapies that benefit more people, or individualized therapies, also known as precision or personalized medicine, so that a blanket approach isn’t being used.

Biernaskie and Yipp credit significant contributions from the trainees and junior scientists involved in the research, including Dr. Nicole Rosin and Sarthak Sinha who spent countless hours managing the project and analyzing the results.

The project was supported by a grant Biernaskie and Yipp received from the Thistledown Foundation and by the Calgary Firefighters Burn Treatment Society, “who enthusiastically supported my request to divert some of the CFBTS Chair funds to support this initiative early on in the pandemic,” Biernaski says.

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Rare case of woman’s body ridding itself of HIV

The patient’s immune cells appear to have eliminated the virus without drugs or therapy.

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Covid: ‘Putting people to sleep knowing they may not wake’

An intensive care consultant says most Covid cases are those aged between 40 and 50.

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As we develop, the brain connects lessons learned differently

A new study of brain activity patterns in people doing a memory task finds that the way we make inferences — finding hidden connections between different experiences — changes dramatically as we age. The study’s findings might one day lead to personalized learning strategies based on a person’s cognitive and brain development.

The researchers found that whereas adults build integrated memories with inferences already baked in, children and adolescents create separate memories that they later compare to make inferences on the fly.

“How adults structure knowledge is not necessarily optimal for children, because adult strategies might require brain machinery that is not fully mature in children,” said Alison Preston, professor of neuroscience and psychology and senior author of the study published today in the journal Nature Human Behaviour. She co-led the study with first author Margaret Schlichting, formerly a doctoral student in Preston’s lab and currently assistant professor of psychology at the University of Toronto.

To understand the distinction between how adults and children make inferences, imagine visiting a day care center. In the morning, you see a child arriving with one adult, but in the afternoon that child leaves with a different adult. You might infer that the two grown-ups are the child’s parents and are a couple, and your second memory would include both the second person you saw and information from your earlier experience in order to make an inference about how the two adults — whom you didn’t actually see together — might relate to each other.

This new study finds that a child who has the same experiences isn’t likely to make the same kind of inference that an adult would during the second experience. The two memories are less connected. If you ask your child to infer who that child’s parents are, your child can still do it; he or she just has to retrieve the two distinct memories and then reason about how each adult might be related.

The neural machinery of children and adults differs, and the strategy that children use may be optimal for the way their brains are wired before key memory systems in the hippocampus and prefrontal cortex fully mature, the researchers believe. That difference could keep children from recalling past memories during new learning and limit their ability to connect events.

“In the absence of a mature memory system, the best thing a child can do is lay down accurate, non-overlapping memory traces,” Preston said. “From those accurate memory traces, children can later bring them to mind to promote inferences about their connections.”

The researchers asked 87 subjects, ages 7 to 30, to look at pairs of images while lying in an fMRI (functional magnetic resonance imaging) scanner, which measures brain activity by detecting small changes in blood flow with images that, as in the day care example above, provide opportunities to infer relationships between objects that had not appeared together.

The researchers found that the strategy adolescents used for making inferences was different from both that of young children and adults. Going back to the example of the parents at the day care, when an adolescent stores a memory of the second grown-up with the child, the adolescent suppresses the earlier memory involving the first one. Each memory becomes even more distinct than with younger children, and there are even fewer automatic inferences about how the two adults relate.

“Teenagers may have learning strategies that are tuned to explore the world more so than exploiting what they already know,” Preston said.

This and other lessons from the study could inform strategies for improving teaching and learning at various ages.

“From a brain maturation perspective, different people are going to be at different places,” Preston said, “and we can devise learning strategies that take advantage of the neural machinery that an individual has at hand, no matter if they are 7 years old or 70 years old.”

The study’s other authors are Katharine Guarino at Loyola University Chicago and Hannah Roome of UT Austin.

This work was supported by the National Institutes of Health and by the Canada Foundation for Innovation. Preston holds the Dr. A. Wilson Nolle and Sir Raghunath P. Mahendroo Professorship in Neuroscience.

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Trees on the move: Researchers reveal how wildfire accelerates forest changes

Refugees are on the move in forests across the western U.S. As climate conditions change, the ranges of tree species are shifting, especially toward cooler or wetter sites. A new Stanford analysis provides some of the first empirical evidence that wildfire is accelerating this process, likely by reducing competition from established species. The study, published Nov. 15 in Nature Communications, raises questions about how to manage land in an era of shifting ecosystems — a key issue as President Biden prepares to sign into law an infrastructure bill that allocates more than $5 billion for forest restoration and wildfire risk reduction.

“Complex, interdependent forces are shaping the future of our forests,” said study lead author Avery Hill, a graduate student in biology at Stanford’s School of Humanities & Sciences. “We leveraged an immense amount of ecological data in the hopes of contributing to a growing body of work aimed at managing these ecosystem transitions.”

As the climate changes, animal and plant species are shifting their ranges toward conditions suitable for their growth and reproduction. Past research has shown that plant ranges are shifting to higher, cooler elevations at an average rate of almost five feet per year. In many studies, these range shifts lag behind the rate of climate change, suggesting that some species may become stranded in unsuitable habitats. The factors that impact plant species’ ability to keep up with climate change are key to maintaining healthy populations of the dominant trees in western forests, yet have remained largely mysterious.

To better understand the distance, direction and rate at which tree ranges are shifting, Hill and study co-author Chris Field, the Perry L. McCarty Director of the Stanford Woods Institute for the Environment, looked at how the phenomenon is affected by wildfire, a potent and widespread driver of ecosystem structure and composition in the western United States.

Using U.S. Forest Service data collected from over 74,000 plots across nine Western states, the researchers identified tree species that are shifting their ranges toward cooler, wetter sites — an expected response to the recent warming and drying. Then, they compared the rate of these range shifts between places that were burned by wildfire and places that were not.

Of eight species that had seedlings growing in climates significantly different from mature trees of the same species, Hill and Field found strong evidence that two — Douglas fir and canyon live oak — had larger range shifts in areas that burned than in areas that did not.

Although the analysis did not reveal the mechanism for how wildfire accelerates range shifts for certain trees, the researchers hypothesized that burned areas with their open canopies and scorched understory present less competition from other plant species.

The findings demonstrate not only that fire can accelerate tree migration, but that some species may be slowing the range shifts of others through competition. This, in turn, raises questions about the impact of fire management on trees’ ability to keep up with climate change, and points to the importance of low-intensity prescribed and natural fires.

“This study highlights a natural mechanism that can help forests remain healthy, even in the face of small amounts of climate change,” said Field. “It also illustrates the way that ecosystem processes often have several layers of controls, a feature that emphasizes the value of detailed understanding for effective management.”

Field is also the Melvin and Joan Lane Professor for Interdisciplinary Environmental Studies, a professor of Earth system science and biology, and a senior fellow at the Precourt Institute for Energy.

The research was funded by the Gordon and Betty Moore Foundation.

Story Source:

Materials provided by Stanford University. Original written by Rob Jordan. Note: Content may be edited for style and length.

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Africa’s ‘Green Wall’ also makes economic sense

The Sahel extends south of the Sahara from Senegal in the west to Ethiopia in the east of Africa. Vast areas of the formerly fertile region are now virtually uncultivated. Reasons are droughts, poor agricultural cultivation methods as well as overuse due to the growing demand for food and firewood.

The “Great Green Wall” initiative aims to compensate for and reverse this loss through mass planting of native trees and grasses. 100 million hectares of land are to be restored in this way. So far, however, this ambitious goal is very far from being achieved — partly because of a lack of financial resources.

However, this could change in the future: Earlier this year, various donor countries pledged nearly $15 billion to the project at the One Planet Summit for Biodiversity. “In order to use these funds efficiently, we now have to ask ourselves where and for which measures they should be used most sensibly,” emphasizes Dr. Alisher Mirzabaev of the Center for Development Research (ZEF) at the University of Bonn.

Every dollar invested yields a 20-cent of net returns

The agricultural economist has led a study that provides an answer. The researchers divided the Sahel region into 40 million plots of 25 hectares each. For each of these, they then analyzed which land restoration measures would be possible and how much they would cost. They compared this calculation with the economic benefits that could be achieved.

“On the one hand, these include the so-called provisioning services,” explains Mirzabaev: “These are the things that are produced by the ecosystems: Food and drinking water, raw materials such as wood or medicinal plants.” There are also other effects, such as a better climate, less wind erosion or pollinators services, which in turn increase the farmers’ crop yields. They, too, can have a price tag attached to them today.

The results show that building the “Green Wall” is also economically worthwhile. But how much depends on a number of factors. As a rule, reforestation would be the most advantageous economically and ecologically. But it takes decades for a few hundred seedlings to grow into a forest. The investment therefore only bears fruit in the very long term.

The situation is different when degraded areas are converted into farmland. “Ideally, the first harvest is then possible after just one year,” says Mirzabaev. Cropland restoration can thus pay for itself comparatively quickly, with many poor smallholder farmers also preferring quick returns from their restoration activities. However, the profits that can be achieved as a result are significantly lower, as are the environmental effects.

“In our analysis, we work with different scenarios, some of which are aimed more at short-term benefits, while others are more long-term,” explains the agricultural economist, who is a member of the Transdisciplinary Research Area “Sustainable Futures” at the University of Bonn. The so-called baseline scenario, for example, includes a mixture of both short-term and long-term returns. In it, every dollar spent yields an average net return of 20 cents.

Half of the profitable regions are too uncertain for action

However, there are huge regional variations in this. The most positive economic balance is for parts of Nigeria, Eritrea and Ethiopia. This is where the investment in the “Green Wall” is most worthwhile. To finance all the proposed measures in this scenario, a sum of 44 billion U.S. dollars would be needed. This would allow 28 million hectares of land to be restored.

However, the analysis also shows that this will probably only work in theory. The reason is that, due to violent conflicts, many of the regions where it would make sense to build the Green Wall are simply too unsafe for such measures. “If we take out these areas, we are left with just 14 million hectares,” Mirzabaev points out. “This shows how much such disputes not only cause direct human suffering, but also prevent positive development of the affected regions.”

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Covid booster doses will be offered to over-40s

Also, 16- and 17-year-olds should receive a second dose of vaccine, according to official UK advice.

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MPs find ‘serious failings’ in sickle cell care

Parliamentary report says some patients report being racially abused by doctors and nurses.

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