Kuvan approved for PKU

kuvanBroadcaster: BBC1

Year: 2017

Genre: News package

Duration: 2 minutes 33 seconds

URL: https://learningonscreen.ac.uk/ondemand/index.php/clip/101735

This is a brief (two and a half minute) news piece about a patient “S” , who suffers from Phenylketonuria (PKU) and the successful application by his parents for treatment using the drug Kuvan.

PKU is a well-characterised autosomal recessive inborn error of metabolism in which the body cannot appropriately process the amino acid phenylalanine (Phe) dues to mutation in the gene for the enzyme Phenylalanine hydroxylase (PAH), whose role is to convert phenylalanine to tyrosine. Because the genetic basis of PKU is well characterised, it features regularly in introductory courses on biochemistry and/or genetics.

Kuvan, also known as sapropterin, is a pharmaceutical version of tetrahydrobiopterin or BH4, which is an essential cofactor for PAH. Taking Kuvan is essentially increasing the concentration of BH4 in the body and thus promoting the activity of naturally occurring PAH to process more Phe to Try. Since the action of PAH is the rate-limiting step in the degradation of excess phenylalanine, increasing this reaction makes a significant contribution to lowering the concentration of Phe. However, this is not a complete solution, and patients with PKU are sometimes recommended to have a low phenylalanine diet, even if they are on the drug.

This clip could be used in a module teaching about the genetics and biochemistry of PKU. It is also an example of healthcare rationing, the complexities of deciding which medicines should be provided by the NHS. Decisions on the cost effectiveness of drugs is often made by the NICE, the National Institute for Health and Care Excellence (the name evolved, the acronym didn’t!) On this occasion, however, the decision was made by the High Court. Kuvan cost £100 per day, and the hospital treating S had argued it was not warranted on grounds of clinical efficacy. The high court disagreed, stating that the effectiveness of the drug was well established (eg. in this 2007 article from The Lancet).

Background on PKU can be found via this link (same article as liked above)

Some background to the case of S can be found via this link.



Antibiotics: Britain’s greatest invention?


Invention or discovery? The case is put that sufficient work needed to be done after Fleming’s observation that the Penicillium mould killed bacteria

Broadcaster: BBC2

Year: 2017

Genre: Factual

URL: https://learningonscreen.ac.uk/ondemand/index.php/clip/99491

This clips (8:50) involves former newsreader Angela Rippon putting the case for antibiotics to be the winner of a poll to identify Britain’s Greatest Invention. She has a vested interest in the choice, having been saved from TB as a child. All other inventions being considered (the jet engine, steam engine, fridge, television, mobile phone and concrete) pale into insignificance, she argues, as you cannot benefit from the other inventions suggested if you are dead. This argument may have prevailed, as antibiotics were declared the winner on the night.

In truth this is not a particularly great clip. The opening gambit that “antibiotics literally kill bacteria” is a simplification and the popular myths surrounding the role played by Alexander Fleming are trotted out. There are, however, two features that might make this worth sharing with students.

The first is the debate over whether antibiotics are a discovery or an invention. This is an example of a broader debate about whether natural products are “invented” (this was also at the heart, for example, of the tensions regarding the legitimacy of patenting human genes). Rippon suggests there was sufficient need to technological innovation for antibiotics to be an invention not a discovery. I would have to concur with this view, especially since the fluoroquinolones, my favourite family of “antibiotics”, are in fact entirely man-made. Continue reading

Performance enhancing drugs: the dark side of doping


Sprinter Tim Montgomery was the 100 metre world record holder, but was later caught using performance-enhancing drugs and was banned

Broadcaster: Al Jazeera

Year: 2015

Genre: Documentary

URL: http://bobnational.net/record/351053

Review by Ella Yabsley

In this Al Jazeera Investigates documentary, former UK hurdler Liam Collins embarks on an undercover investigation seeking to expose ‘the dark side’ of professional sports; blood doping and the use of performance enhancing drugs (PEDs) by professional athletes. This 16-minute clip splices together key sections of the documentary (The full programme can be seen on YouTube as well as on Box of Broadcasts).

I can take a guy with average genetics and I can make him a world champion. I can with drugs. Oh absolutely.

The documentary stirred controversy, primarily for featuring accusations regarding several NFL footballers,  notably Peyton Manning, who went on to steer his Denver Broncos team to success at Superbowl 50 before announcing his retirement. More importantly, the documentary highlights loopholes in the drug testing regimes of several popular sports. Athletes play a ‘cat and mouse game’ with the testing system; timely drug administration combined with an awareness of testing procedures results in athletes coming up negative in tests. Continue reading

TB: Return of the Plague

TB documentary screenshot

Swaziland has declared the current TB epidemic a national emergency

Broadcaster: BBC 4

Year: 2014

Genre: Documentary

URL: http://bobnational.net/record/351052

Reviewed by Emma Sterling

“It’s very difficult to cure XDR because we’re just giving what we have on the table. The reality of XDR is that it’s almost incurable.”

(WARNING: Distressing content): BBC 4’s long-format (90 minute) documentary TB: Return of the Plague, reports on the fight against tuberculosis (TB) in Swaziland, the country with the highest rate of infection in the world. Continue reading

Are we entering a post-antibiotic era?

"Eat your Christmas dinner and don't worry"

“Eat your Christmas dinner and don’t worry”

Broadcaster: BBC News

Year: 2015

Genre: News

URL: http://bobnational.net/record/342114

Review by Emma Sterling

Bacteria resistant to the “last resort” antibiotic colistin have been found in the UK. Public Health England says the threat to human health is low. Clive Myrie speaks to health correspondent James Gallagher in this 2 minute clip.

The colistin-resistant bacteria were first reported on a farm in China in November 2015 and have since been found in Africa and other parts of Europe. Chinese researchers have found the mcr-1 ­gene that is responsible for this resistance.

Gallagher stresses that this does not mean these bacteria are unbeatable or that a bacterial apocalypse is nigh (we hope his “Eat your Christmas dinner and don’t worry” does not become the antibacterial version of Michael Fish’s famous promise that a hurricane was not on the way). Those that are resistant to colistin are currently susceptible to other antibiotics, but the discovery raises the spectre of an entirely resistant infection. If this was to occur then routine surgery and cancer therapies might be rendered unsafe.

For more on the story see the BBC News website, and for more scientific detail this article from Nature.



Ablation, Ibrutinib & PSA testing (Curing Cancer)

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In a clinical setting; MRI Imaging is routinely used to identify tumour locations in preparation for treatments like microwave ablation (MWA) or high intensity focused ultrasound (HIFU)

Broadcaster: Channel 4

Year: 2014

Genre: Documentary

URL: http://bobnational.net/record/350267

Review by Ella Yabsley

The Curing Cancer documentary outlines in simple terms how cancer occurs. I do not recommend watching the entire hour-long episode from the Cutting Edge series as it only briefly covers certain areas and contains anecdotal sections which are irrelevant for educational purposes. This 14 minute clip (spliced together from shorter segments in the programme) could serve as a brief introduction to cancer cell biology.

If you already have a more advanced knowledge of cancer biology then I recommend skipping to the four specific cases below (rather than watching the longer clip). Each case describes and demonstrates a different cancer treatment in action; Ibrutinib, high intensity focused ultrasound (HIFU)  and microwave ablation (MWA). Case 2 describes the diagnosis techniques prostate-specific antigen (PSA) testing and biopsy extraction.

Watching the cases below could be valuable if you are taking a cancer biology module and want to demonstrate knowledge of emerging therapies. Additionally, please take a look at this post which highlights a recent BBC News item on immunotherapy techniques used for treating melanoma (skin cancer).

Continue reading

Cancer immunotherapy breakthrough (BBC News)

“Society is going to have to make a judgement on what value it puts on extending the lives of cancer patients against all the other demands on the NHS”

Broadcaster: BBC 1

Year: 2015

Genre: News

URL: http://bobnational.net/record/298571

On 1st June 2015, there was quite a large amount of coverage of a recent clinical trial reported to have had dramatic effects on the survival rates of patients with melanoma (a form of skin cancer). The reason this particular clip (4:45) stands out as useful for teaching is the combination of a clear explanation of what the new cancer immunotherapy drugs are doing, but also the difficult decisions to be made in the light of a growing number of exciting but expensive new drugs for cancer. What price can a health service afford to pay to extend one person’s life when, with a finite budget, buying their medicine means that someone elsewhere in the system will miss out on their treatment instead?

For more on this story see this link (BBC website).

O’Neill Report on Antimicrobial Resistance

Broadcaster: various

Year: 2015

Genre: News

From time to time we will use BiologyOnTheBox to aggregate coverage on the same story from a number of different broadcast sources. This is one such post.

In 2014, David Cameron established a Review on Antimicrobial Resistance, under the chairmanship of economist Jim O’Neill (the man previously credited with coining the acronym BRIC to group together the emerging economies in Brazil, Russia, India and China). In December 2014 The review published their first report Antimicrobial Resistance: Tackling a crisis for the health and wealth of nations followed in February 2015 with their second, Tackling a Global Health Crisis: Initial steps.

The press coverage described below comes from 14th May 2015, the day on which the Review published their most important report to date, Securing New Drugs for Future Generations: The pipeline of antibiotics. Publication of the report garnered widespread coverage, including the news items documented here. This is by no means an exhaustive list, but reflects the kinds of issues raised across the day (programmes are listed here in chronological order).

fergusBBC Breakfast:
http://bobnational.net/record/295287 (6:26)
This file is actually a splice of two sections from the programme; a prefilmed package in which Fergus Walsh (1:50) gives background to the situation and includes an interview a woman who is immunocompromised following transplant surgery and therefore reliant on effective antimicrobials. The second part is one of the many interviews conducted with Jim O’Neill over the course of the day. He emphasises that this is a global problem, needing a global solution and that China may play a crucial role in their forthcoming role as chair of the G20. I was struck by his use of the notion of “enlightened self-interest” as a motivator for the pharma industry to become re-engaged in antimicrobial production. Continue reading

Defeating the Superbugs (Horizon)

Research led by Roy Kishony uses a

Research led by Roy Kishony uses a “morbidostat” to deliberately develop antibiotic resistant bacteria

Broadcaster: BBC 2

Year: 2012

Genre: Documentary

URL: http://bobnational.net/record/293666

Review by Josh Sutton

Antibiotic resistance in bacteria is currently one of the largest problems facing modern medicine. The rise in cases of multiple drug resistance tuberculosis (MDR-TB) and methicillin-resistant Staphylococcus aureus (MRSA) are only the best-known examples of a wider issue. In this Horizon documentary from 2012, the increasing threat of antibiotic resistance is covered, as well as reflections on the new treatments and drugs that scientists are developing to combat the growing resistance threat.

The importance of antibiotic resistance is immediately highlighted in the programme, with the story of a soldier put into a critical condition after his legs were blown off. His perilous state was actually due to an infection with antibiotic-resistant bacteria he went on to develop: MRSA, Pseudomonas aeruginosa and Acinetobacter baumannii. This infection could only be treated with antibiotics of last resort, which were toxic to both the bacteria and the soldier himself. Continue reading

Vaccination: From Jenner to Foot & Mouth Disease (Countryfile)

Edward Jenner made a crucial breakthrough in developing vaccination, though his experiment was unethical by modern standards

Edward Jenner made a crucial breakthrough in developing vaccination, though his experiment was unethical by modern standards

Broadcaster: BBC 1

Year: 2015

Genre: Magazine

URL: http://bobnational.net/record/294432

The role of Edward Jenner in developing vaccination has been told many times on TV. This 6.5 minute clip from a Countryfile “Heroes of farming” special visits Jenner’s house in Gloucestershire to tell the famous story. Drawing on the wisdom of local dairymaids, Jenner took pustules from people infected with cowpox and deliberately introduced material from the pustules into local children. This work would not get through an ethical review today!

Anita Rana then brings the story of vaccination up to date by visiting the Pirbright Institute, where a new vaccine against Foot and Mouth Disease (FMD) is being developed. A vaccine against FMD already exists, but the production involves use of the live virus, with inherent risks. The new vaccine retains the protective element without the infective.