Health24.com | New nerve stimulation technique might relieve back pain

Stimulating a specific set of nerves that are nestled along the spine may deliver relief to those who suffer from chronic back pain and cut the need for opioid painkillers, new research suggests.

The therapy, which targets the root ganglion nerves, is more effective than other spine stimulation procedures because it places tiny leads precisely at the area where pain originates, unlike other devices that provide more generalised stimulation, the researchers said.

Small electronic pulses

“In certain patients who have not gotten relief from other treatments, this therapy may give sustained pain relief and may allow them to reduce opioids for at least 18 months and perhaps longer,” said lead researcher Robert McCarthy. He’s a professor of anaesthesiology at Rush University Medical Center in Chicago.

The dorsal root ganglions are nerve cells, on both sides of each of the spine’s vertebrae, and are the gateway to pain between nerves in different parts of the body, spinal cord and brain. Stimulating this area interrupts pain signals between the painful area and the brain, the researchers explained.

A pacemaker-like device implanted under the skin in the lower back sends small electronic pulses through a wire placed near the specific dorsal root ganglion associated with the pain, McCarthy said.

The pulses replace pain with tingling or numbness. The strength of stimulation, programmed by a doctor, is based on the patient’s level of pain, he said.

The treatment has two advantages over spinal cord stimulation, McCarthy said. In spinal cord stimulation, a wire runs along the spinal cord sending pulses along the entire spine, but the pulses don’t target the specific pain source.

In addition, dorsal root ganglion stimulation requires significantly lower levels of electric current to quell pain, McCarthy said.

The goal of this study, he said, was to judge the effectiveness of the therapy over a long period. McCarthy and his colleagues implanted the device in 67 people suffering with chronic back pain and followed them for three to 18 months. Among the participants, 17 had the device for over a year.

Not without complications

Before receiving the device, most patients rated their pain as an eight on a scale of one to 10, with 10 being the worst. For most patients, the device reduced pain by 33%, which was significant, the researchers reported.

In addition, patients said they experienced a 27% reduction in disability or limitations on daily activities caused by pain. In all, 94% of the participants said the treatment was beneficial.

The procedure was not without complications. Five patients needed to have the wires implanted again, two patients had them removed because they were infected, and one had the device removed because of a complication.

McCarthy said the therapy is not widely available, even though it was approved by the FDA in 2016. At the moment, its use is confined to more advanced medical centres where doctors have been trained in how to implant and regulate the device.

Also, the procedure isn’t covered by all insurance companies, so out-of-pocket costs to patients can be very high. It is, however, covered by Medicare, he said.

For uninsured patients, the cost of having spine stimulation devices can range from $15 000 to $50 000 (roughly R213 000 to R708 000) or more, according to a 2008 report funded by the Washington State Department of Labor and Industries.

Very significant results

Spine stimulation is usually approved only after patients have not responded to other treatment, according to Blue Cross Blue Shield. Other insurance companies may have varying policies.

McCarthy hopes that more doctors will be trained in the procedure and that it will become more available, especially because it has the potential to allow patients to stop taking opioids to control their pain.

One pain specialist not involved with the study saw the benefits of this procedure.

“The results of this study are very significant,” said Dr Kiran Patel, director of neurosurgical pain at Lenox Hill Hospital in New York City.

It shows long-term data that patients experienced significant pain relief and functional improvements, she said.

“In my pain practice and career, dorsal root ganglion stimulation therapy has been one of the most effective technologies available to combat chronic pain,” Patel said.

“I encourage chronic pain patients to seek out physicians who are trained and experienced in the application of dorsal root ganglion stimulation therapy to determine if they are a candidate,” she said.

The findings were presented Sunday at the American Society of Anesthesiologists annual meeting, in San Francisco.

Image credit: iStock

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Health24.com | Walking, not driving, the greens boosts health in golfers with knee woes

Walking the golf course instead of riding in a cart offers heart health benefits that may outweigh potential joint harm for golfers with knee osteoarthritis, a new small study reports.

The study included 10 golfers with knee osteoarthritis who played two 18-hole rounds of golf. They walked the course in one round and used a golf cart in the other round.

Wear-and-tear on the joints

Walking did increase the golfers’ knee inflammation, but they also got significant cardiovascular benefits, according to the researchers.

“The impetus for the study stemmed from the fact that the majority of rounds of golf in the United States are now played with a golf cart, which has been suggested to affect the health benefits of the sport. We wanted to measure the effect of this in individuals with knee osteoarthritis,” said study co-author Dr Prakash Jayabalan. He is a clinician-scientist in sports medicine at AbilityLab, in Chicago.

More than 17 million people play golf in the United States each year. In nearly 70% of the rounds, golfers ride in motorised carts to travel between holes. Many golfers with knee arthritis may avoid walking because they think doing so may worsen their joint pain and cartilage degradation.

Osteoarthritis is often described as being caused by wear-and-tear on the joints, and it is a leading cause of disability for Americans aged 50 and older.

However, even though walking may increase inflammation in golfers with knee osteoarthritis, the researchers said there is evidence of cartilage remodelling effects in knees whether golfers walk or ride in a cart.

Good walking exercise

Golfers should consider their individual symptoms and follow their doctor’s advice, the study authors said in a news release from the Association of Academic Physiatrists.

“Walking exercise is commonly advocated for individuals with knee osteoarthritis. Our study suggests that golf may be a good prescription of walking exercise, particularly if they walk the course, as they get more health benefits,” said Jayabalan, who is also an assistant professor at Northwestern University Feinberg School of Medicine.

The study included people who played golf regularly, so Jayabalan said the next step would be to evaluate golf as an exercise intervention for occasional golfers.

The report was presented at the annual meeting of the Association of Academic Physiatrists, in Puerto Rico. The research should be considered preliminary until it is published in a peer-reviewed journal.

Image credit: iStock

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Public health ‘improving under councils despite cuts’

Teenage pregnancies, smoking rates, and sexually transmitted infection have all decreased, councils say

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Canada appeals court orders tobacco firms to pay billions in damages

A Quebec appellate court has upheld a 2015 decision that ordered the firms to pay over C$15bn.

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New chemical probes advance search for new antibiotics

Indiana University researchers are advancing knowledge about how bacteria build their cell walls that could contribute to the search for new antibacterial drugs. They have created a new tool to observe living cells in real time under a microscope.

“If you look at the history, no one’s really discovered a fundamentally new class of antibiotic for the past 40 to 50 years,” said IU chemist Michael VanNieuwenhze, who led the study. “Antibiotic resistance is a significant and urgent public health threat, and we think that new ways to address it — including this — have significant value.”

The need for new ways to study bacteria is driven in large part by the threat of bacterial resistance. According to the Centers for Disease Control and Prevention, at least 2 million people in the U.S. get an antibiotic-resistant infection each year, and at least 23,000 people die.

“This new technology takes advantages of specific cellular enzymes to stick colored dyes — or ‘probes’ — into the walls of bacterial cells,” VanNieuwenhze said. “Since these same enzymes are inhibited by other well-known antibacterial compounds — most notably, penicillin — we could theoretically also use these probes to seek out entirely new classes of drugs that inhibit the same reaction.”

VanNieuwenhze’s lab has already created two other cellular probes patented through IU — called FDAAs (fluorescent D-amino acids) and DAADs (d-amino acid dipeptides) — which are in use in laboratories across the globe. Their new class of probes, which build upon these earlier advances, are called rotor-fluorogenic D-amino acids, or RfDAAs. IU has also filed for a patent on this technology.

The main advantage of RfDAAs is their ease of use and ability to show cellular activity in real time.This is because the probes don’t require washing steps to remove unincorporated chemicals that blur the distinct boundaries between bacterial cells and their surrounding environment.

Instead, RfDAAs only light up when they’re integrated into bacteria’s cell walls as part of the regular growth process. The probes illuminate cell walls faster and clearer without the steps that can stop cellular activity.

It’s the difference between a snapshot and a video, VanNieuwenhze said. A video provides much more information about how cell walls grow, change and interact with their environment. Video: https://news.iu.edu/doc/2019-02-25-rfdaas-in-action.mp4

Already, VanNieuwenhze has launched a collaboration with IU School of Medicine to apply these methods to the search for new inhibitors of bacterial cell wall synthesis, and the probes are also in use to study bacterial cell division, which may unveil new targets for antibiotic discovery. In addition, the biotechnology company ThermoFisher Scientific recently purchased exclusive rights to market the two earlier probes as commercial products; other industrial groups have reached out about applying the technology to high-throughput screens designed to identify new drug leads.

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Materials provided by Indiana University. Note: Content may be edited for style and length.

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Spider silk could be used as robotic muscle

Spider silk, already known as one of the strongest materials for its weight, turns out to have another unusual property that might lead to new kinds of artificial muscles or robotic actuators, researchers have found.

The resilient fibers, the team discovered, respond very strongly to changes in humidity. Above a certain level of relative humidity in the air, they suddenly contract and twist, exerting enough force to potentially be competitive with other materials being explored as actuators — devices that move to perform some activity such as controlling a valve.

The findings are being reported today in the journal Science Advances, in a paper by MIT Professor Markus Buehler, head of the Department of Civil and Environmental Engineering, along with former postdoc Anna Tarakanova and undergraduate student Claire Hsu at MIT; Dabiao Liu, an associate professor at Huazhong University of Science and Technology in Wuhan, China; and six others.

Researchers recently discovered a property of spider silk called supercontraction, in which the slender fibers can suddenly shrink in response to changes in moisture. The new finding is that not only do the threads contract, they also twist at the same time, providing a strong torsional force. “It’s a new phenomenon,” Buehler says.

“We found this by accident initially,” Liu says. “My colleagues and I wanted to study the influence of humidity on spider dragline silk.” To do so, they suspended a weight from the silk to make a kind of pendulum, and enclosed it in a chamber where they could control the relative humidity inside. “When we increased the humidity, the pendulum started to rotate. It was out of our expectation. It really shocked me.”

The team tested a number of other materials, including human hair, but found no such twisting motions in the others they tried. But Liu said he started thinking right away that this phenomenon “might be used for artificial muscles.”

“This could be very interesting for the robotics community,” Buehler says, as a novel way of controlling certain kinds of sensors or control devices. “It’s very precise in how you can control these motions by controlling the humidity.”

Spider silk is already known for its exceptional strength-to-weight ratio, its flexibility, and its toughness, or resilience. A number of teams around the world are working to replicate these properties in a synthetic version of the protein-based fiber.

While the purpose of this twisting force, from the spider’s point of view, is unknown, researchers think the supercontraction in response to moisture may be a way to make sure a web is pulled tight in response to morning dew, perhaps protecting it from damage and maximizing its responsiveness to vibration for the spider to sense its prey.

“We haven’t found any biological significance” for the twisting motion, Buehler says. But through a combination of lab experiments and molecular modeling by computer, they have been able to determine how the twisting mechanism works. It turns out to be based on the folding of a particular kind of protein building block, called proline.

Investigating that underlying mechanism required detailed molecular modeling, which was carried out by Tarakanova and Hsu. “We tried to find a molecular mechanism for what our collaborators were finding in the lab,” Hsu explains. “And we actually found a potential mechanism,” based on the proline. They showed that with this particular proline structure in place, the twisting always occurred in the simulations, but without it there was no twisting.

“Spider dragline silk is a protein fiber,” Liu explains. “It’s made of two main proteins, called MaSp1 and MaSp2.” The proline, crucial to the twisting reaction, is found within MaSp2, and when water molecules interact with it they disrupt its hydrogen bonds in an asymmetrical way that causes the rotation. The rotation only goes in one direction, and it takes place at a threshold of about 70 percent relative humidity.

“The protein has a rotational symmetry built in,” Buehler says. And through its torsional force, it makes possible “a whole new class of materials.” Now that this property has been found, he suggests, maybe it can be replicated in a synthetic material. “Maybe we can make a new polymer material that would replicate this behavior,” Buehler says.

“Silk’s unique propensity to undergo supercontraction and exhibit a torsional behavior in response to external triggers such as humidity can be exploited to design responsive silk-based materials that can be precisely tuned at the nanoscale,” says Tarakanova, who is now an assistant professor at the University of Connecticut. “Potential applications are diverse: from humidity-driven soft robots and sensors, to smart textiles and green energy generators.”

It may also turn out that other natural materials exhibit this property, but if so this hasn’t been noticed. “This kind of twisting motion might be found in other materials that we haven’t looked at yet,” Buehler says. In addition to possible artificial muscles, the finding could also lead to precise sensors for humidity.

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What causes that peak? Answering a long-standing question for covalent liquids

Materials that have a disordered structure with no regular repeating pattern are described as amorphous. Such materials can be found in nature and also have a variety of applications in technology. However, the disordered nature of these materials makes them more challenging to characterize than crystalline structures.

Now, researchers at The University of Tokyo Institute of Industrial Science have shown that the structure of a particular class of liquids and amorphous materials, known as tetrahedral glass formers, can be understood from experimental measurements. Their findings were published in Science Advances.

When a crystalline material scatters X-rays or neutrons, it produces a well-defined pattern as a result of its structure. In contrast, the patterns produced by liquids and amorphous materials show broad peaks that do not provide the same degree of information. However, liquids and amorphous materials that have a tendency to form a network, such as silica and silicon, are known to exhibit a feature called the first sharp diffraction peak (FSDP).

Many theories linking the properties of the FSDP to the structure of the related material have been presented; however, there is still no accepted consensus on what gives rise to these features. Now researchers have demonstrated that the FSDP is a result of the tetrahedral nature of the local ordering of atoms in the liquid.

“The covalent nature of the bonding in the liquids we studied results in a certain degree of organization on a local level, although the order does not extend over a long range,” study corresponding author Hajime Tanaka explains. “We focused on the tetrahedral unit structure that forms in the materials, and as a result have established a model that is able to support a range of experimental findings.”

The researchers tested their tetrahedron model using simulated and experimental data for numerous oxide, halide, chalcogenide, and monoatomic materials in the liquid or amorphous states. The findings were able to explain the origin of the FSDP as well as other higher wavenumber peaks and features.

“We have shown direct evidence of a two-state structure in which order and disorder coexist in the same network forming liquid,” First author Rui Shi explains. “We hope that our findings will lead to an improved understanding of the properties of tetrahedral liquids and glasses, and consequently have an impact on areas such as earth science and semiconductor materials.”

The direct link between data that can be acquired using standard techniques and quantitative structural information on the degree and range of local order demonstrates the practical significance and potential of the presented model.

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Materials provided by Institute of Industrial Science, The University of Tokyo. Note: Content may be edited for style and length.

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Everything You Need to Know About Essential Oils

I am exhausted—I need to go to sleep this second, I thought. Only it was 7:20 on a weeknight and I had tasks to do and kids to get to bed. I'd recently gotten an essential oil diffuser for our bedroom; I thought it might come in handy for stress relief. Now, though, I reached for revitalizing grapefruit oil. I plopped in a few drops and pressed "on." Minutes later, I felt more awake. It worked! Then my husband walked in. "Ew, what's that smell?" he asked. Uh-oh.

Extracted from plants, flowers and citrus fruits, essential oils are hot: Industry revenue has gone up about 13 percent in five years, according to the market-research firm IbisWorld. The ancient Chinese, Egyptians, Indians and Greeks relied on essential oils as medicine. They're now gaining new ground because of growing evidence of their powers; a review published in the International Journal of Neuroscience concluded that various scents can significantly affect mood, cognition and physiology. Increased openness to complementary and alternative treatments is fueling this boom, says Woodson Merrell, MD, director of integrative medicine at Beth Israel Medical Center in New York City: "Patients like essential oils because they're a remedy that is natural, effective and typically safe."

MORE: Natural Ways to Reduce Stress

Today, nurses in hospitals reach for essential oils to treat everything from nausea to anxiety. And it's not just patients who benefit: In the emergency room at Nashville's Vanderbilt University Medical Center, when diffusers were installed to spread citrus scents, the portion of staffers who reported frequently experiencing work-related stress dropped from 41 percent to 3 percent. In stores, you'll find essential oils in body lotions, shampoos, even household cleaners. Someday they may be tapped for other benefits; findings show that applied essential oils can inhibit growth of tumors and kill potentially deadly bacteria like E. coli.

How aromatherapy works
When you sniff an essential oil, your olfactory bulb fires off signals to the limbic system, the part of the brain that controls emotions—that's how scents affect your mood. Depending on the type of oil used, your blood pressure or heart rate may rise or fall, and your body may release certain hormones.

That said, you have to like an oil for it to have an optimal effect (why my husband wasn't rejuvenated by our grapefruited room). "Besides the physical reaction, a psychological one happens when you smell a scent," notes Adriane Fugh-Berman, MD, associate professor of pharmacology at Georgetown University Medical Center. She recalls dissecting cadavers in medical school, when professors dropped peppermint oil into the formaldehyde to mask the odor. "For years, the smell of peppermint reminded me of dead bodies!" she says. "I still have to buy nonpeppermint toothpaste."

MORE: How Fragrance Can Lift Your Mood

FYII (For Your Inhaling Information)
Aromatherapy isn't healthy for everyone. People with asthma should avoid essential oils, says Alan Hirsch, MD, neurological director of the Smell & Taste Treatment and Research Foundation in Chicago, and pregnant women need to check with their doctors first. Never drink an essential oil, even in a small amount, without medical supervision. "Essential oils can be poisonous if you ingest too much—they could affect your nervous system and cause seizures," Dr. Fugh-Berman cautions. (Hel-lo: They're strong enough to decimate E. coli.)

Also note that essential oils may not mix well with certain drugs. For example, blue chamomile oil can hamper the enzyme that metabolizes some antidepressants. "If you're using patch medication, applying essential oils in the area could cause an interaction," adds Andrea Butje, a clinical aromatherapist who runs the Aromahead Institute, which offers virtual courses.

 

 

 

 

 

 

 

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The essence of finding good oils
Don't buy into claims that an oil is "therapeutic," "clinical" or "premium" grade—they're marketing ploys. "There is no body that oversees the essential oil industry, and there is no seal of approval," says Jade Shutes, a clinical aromatherapist and president of the National Association for Holistic Aromatherapy. Generally, USDA-certified organic oils are best because they're not contaminated with pesticides. Telltale signs of a quality product:

• The label or website description lists the Latin name of the plant from which the oil is derived, which indicates that it's pure (thus offering the most potent payoffs). If the label states only "lavender essential oil," the product could contain filler ingredients.

• The company does gas chromatography/mass spectrometry (GC/MS) testing, science-speak for "This oil passed a purity test." (However, smaller companies sometimes can't afford the testing, so don't make this your sole marker.)

• A company's oils are different prices. It's far cheaper to extract oil from, say, citrus fruits than from flowers; companies that charge the same for every kind may very well be including synthetic substances.

• The oil comes in a glass container that's amber or dark blue to protect it from oxidation. Keep oils in the fridge to prolong their life.

MORE: Bogus Health Trends That Waste Your Time

Rules for inhaling
The best way to disseminate an essential oil: through a little machine. Diffusers (they cost around $30 to $40 each) work fine for simply chillaxing—you fill a small basin with water and plop in a few drops of your chosen essential oil, and a fan emits a scented mist. But for a true therapeutic effect, opt for a nebulizer, which shoots oil particles straight into the air sans water. (Nebulizers are used by clinicians and tend to cost a bit more.)

Whichever device you choose, turn it off within an hour, says aromatherapy expert Robert Tisserand, author of Essential Oil Safety: "There's no need to constantly inhale—you won't get an additional benefit, and you want to give your body a break or it may react adversely to continued inhalation, resulting in increased heart rate, for example." Also: Diffuse when your husband is out of the house, to avoid an adverse reaction in your marriage.

 

 

 

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Health24.com | Science puzzling out differences in gut bacteria around the world

Scientists say nearly 2 000 previously unknown types of bacteria in the human gut have been identified.

The human gut hosts many species of microbes, collectively referred to as the gut microbiota. Scientists are working to identify the individual species and understand the roles they play in human health.

Like reconstructing hundreds of puzzles

While investigators are getting closer to completing a list of common microbes in the guts of North Americans and Europeans, there is a significant lack of data from other regions of the world.

Some microbes remain unidentified because of their low numbers in the gut or because they can’t survive outside it.

For this study, researchers at the European Molecular Biology Laboratory’s European Bioinformatics Institute (EMBL-EBI) and the Wellcome Sanger Institute in England used a number of computational methods to analyse gut bacteria samples from people worldwide and reconstruct the bacteria’s genomes.

These methods allow scientists to understand bacteria they cannot yet culture in a lab, according to Rob Finn, a team leader at EMBL-EBI.

“Using metagenomics [the study of genetic material directly from environmental samples] to reconstruct bacterial genomes is a bit like reconstructing hundreds of puzzles after mixing all the pieces together, without knowing what the final image is meant to look like, and after completely removing a few pieces from the mix just to make it that bit harder,” he explained in a laboratory news release.

“Researchers are now at a stage where they can use a range of computational tools to complement and sometimes guide lab work, in order to uncover new insights into the human gut,” Finn said.

Blueprint of the human gut

The findings highlight how gut bacteria differ worldwide and the need for samples from around the world, according to the researchers.

“We are seeing a lot of the same bacterial species crop up in the data from European and North American populations,” Finn said. “However, the few South American and African datasets we had access to for this study revealed significant diversity not present in the former populations.”

Finn said collecting data from underrepresented populations is essential to getting a comprehensive picture.

Studies like this one are helping researchers create a blueprint of the human gut, said Trevor Lawley, group leader at the Wellcome Sanger Institute.

“In the future [this] could help us understand human health and disease better, and could even guide diagnosis and treatment of gastrointestinal diseases,” Lawley said.

The study findings were published in the journal Nature.

Image credit: iStock

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Bacteria in frog skin may help fight fungal infections in humans

In the past few decades, a lethal disease has decimated populations of frogs and other amphibians worldwide, even driving some species to extinction. Yet other amphibians resisted the epidemic. Based on previous research, scientists at the INDICASAT AIP, Smithsonian and collaborating institutions knew that skin bacteria could be protecting the animals by producing fungi-fighting compounds. However, this time they decided to explore these as potential novel antifungal sources for the benefit of humans and amphibians.

“Amphibians inhabit humid places favoring the growth of fungi, coexisting with these and other microorganisms in their environment, some of which can be pathogenic,” said Smithsonian scientist Roberto Ibáñez, one of the authors of the study published in Scientific Reports. “As a result of evolution, amphibians are expected to possess chemical compounds that can inhibit the growth of pathogenic bacteria and fungi.”

The team first travelled to the Chiriquí highlands in Panama, where the chytrid fungus, responsible for the disease chytridiomycosis, has severely affected amphibian populations. They collected samples from seven frog species to find out what kind of skin bacteria they harbored.

“Amphibians have glands scattered on their skin that produce different compounds,” Ibáñez said. “In addition, their skin is inhabited by a diverse community of bacteria that produce metabolites that inhibit the growth of fungi and other bacteria.”

Back in the laboratory, 201 bacterial strains were retrieved from their samples and tested against Aspergillus fumigatus, a fungus that causes invasive aspergillosis in immunocompromised patients. Of these, 29 showed antifungal activity, but one in particular caught their attention: a bacterium called Pseudomonas cichorii. This one showed the greatest potential to inhibit the growth of A. fumigatus.

After identifying the most promising bacteria, the scientists had a new question: among all the chemical compounds produced by P. cichorii, which one was keeping the fungi at bay? To find out, they used mass spectrometry and molecular networking techniques. They also observed the interactions between this bacteria and A. fumigatus to identify the bacterial compounds acting in areas where fungal activity was most inhibited. The main compounds were cyclic lipopeptides that included massetolides and viscosin.

The team then separated viscosin from the other components produced by P. cichorii and tested it invitro against A. fumigatus and the chytrid fungus. The results confirmed that viscosin displayed significant activity against both.

This research project holds promise for humans and frogs. Studying the skin bacteria of Panamanian frogs may lead to the development of alternative drugs to treat the fungi causing aspergillosis in humans, which are becoming more drug-resistant, and to defy the chytridiomycosis epidemic, the major source of disease-related death among amphibians worldwide.

“We are showing to the scientific community a set of possible alternative molecules to fight fungal drug resistance in humans,” said Christian Martin, the first author of the study along with the principal investigator Marcelino Gutiérrez, both from INDICASAT. “Although more studies are needed, our collaboration could spark interest in the conservation of amphibians as a novel source of bioactive compounds in humans. For amphibians, this is a promising study because there are only four bacterial secondary metabolites chemically described that inhibit chytrid fungi. In this study, we are introducing a new family of chemical compounds found in Panamanian frogs that could help amphibians worldwide.”

“I consider that bioprospecting compounds from skin secretions or bacteria living in frog’s skins is just beginning,” Ibáñez said. “This research has identified an antifungal compound produced by frog skin bacteria, which may be used to control pathogenic fungi affecting humans and amphibians. More research will be required to determine its potential medicinal use.”

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Materials provided by Smithsonian Tropical Research Institute. Note: Content may be edited for style and length.

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