GLP-1s may offer better dementia protection than metformin

GLP-1 agonists vs metformin: Which diabetes drugs are linked to the lowest dementia risk?

• There were about 589 million adults around the world living with diabetes in 2024, with 90% having type 2 diabetes.
• Past studies have shown that people who have type 2 diabetes are at a higher risk of developing dementia.
• A new study has found that when it comes to the neuroprotective abilities of diabetes medications, people taking GLP-1 agonists had a significantly lower cumulative risk of developing dementia, when compared to metformin users.

The International Diabetes Federation reports there were about 589 million adults around the world living with diabetes in 2024, with 90% of these having type 2 diabetes.

Past studies show that people who have type 2 diabetes — a chronic condition where the body does not use its insulin properly — are at a higher risk of developing dementia.

“Type 2 diabetes is not only a metabolic disorder but also a major risk factor for dementia, particularly Alzheimer’s disease and other nonvascular dementiasTrusted Source,” Szu-Yuan Wu, MD, MPH, PhD, professor of radiation oncology and pharmacoepidemiology at Asia University, and director of the Big Data Center at Lo-Hsu Medical Foundation at Lotung Poh-Ai Hospital, both in Taiwan, told Medical News Today.

“The risk of developing dementia is approximately 1.7 times higher in individuals with type 2 diabetes than in the general population. This imposes significant burdens on families and healthcare systems,” Wu explained.

He is first and co-senior author of a new study recently published in the journal BMJ Open Diabetes Research & Care.

The study found that when comparing the neuroprotective abilities of two diabetes medications — metformin and glucagon-like peptide-1 receptor agonists (GLP-1 agonists) — participants taking GLP-1 agonists had a significantly lower cumulative risk of developing dementia, when compared to metformin.

Comparing GLP-1s, metformin head-to-head

For this study, researchers analyzed electronic health record data from the global health research network TriNetX. Scientists focused on data from more than 87,000 people with an average age of 58 who had type 2 diabetes and were prescribed either metformin or a GLP-1 agonist, to track any dementia development.

“Although metformin is widely accepted as the first-line therapy for type 2 diabetes, its effects on cognitive outcomes have been inconsistent,” Wu said. “We aimed to investigate whether starting with a second-line agent like GLP-1 agonists might confer greater protective effects against dementia.

“No previous real-world study has directly compared GLP-1 agonists and metformin head-to-head for dementia prevention,” he continued. “If GLP-1 agonists show superior neuroprotective benefits, this could challenge the traditional treatment paradigm and support initiating therapy with GLP-1 agonists in selected patients.”

“GLP-1 agonists have demonstrated mechanisms that include reducing neuroinflammation, enhancing cerebral glucose metabolism, and improving synaptic plasticity,” Wu added. “Given these benefits, it is imperative that we continue exploring their broader therapeutic potential beyond glucose lowering.”

GLP-1s lower Alzheimer’s risk by 12% compared to metformin

At the study’s conclusion, Wu and his team found that study participants taking GLP-1 agonists had a significantly lower cumulative risk of developing dementia — namely, 10% — with an incidence of about 2.5%.

By comparison, the dementia incidence rate for those taking metformin was almost 5%.

“This nearly twofold difference in dementia incidence is clinically significant,” Wu explained.

“It suggests that initiating treatment with GLP-1 agonists may be more effective than metformin in reducing dementia risk among individuals with type 2 diabetes. Given the high prevalence of both diabetes and dementia in aging populations, this strategy may reduce long-term public health burdens, including healthcare costs, caregiver stress, and institutionalization needs.”– Szu-Yuan Wu, MD, MPH, PhD

The researcher team also discovered that study participants taking GLP-1 agonists had a 25% lower risk of developing non-vascular dementias and a 12% lower chance of developing Alzheimer’s disease, compared to participants taking metformin.

“These subtype-specific findings reinforce the mechanistic rationale for GLP-1 agonists in neuroprotection,” Wu said. “They are known to reduce amyloid-beta accumulation, suppress tau hyperphosphorylation, improve cerebrovascular integrity, and lower systemic inflammation.“

“These effects are not only theoretical; clinical trials of agents like liraglutide have shown cognitive improvements in patients with early Alzheimer’s disease. Our results support that these biological actions may translate into meaningful risk reduction in real-world populations,” he detailed.

A novel, effective way of lowering dementia risk?

MNT had the opportunity to speak with Michael Snyder, MD, FACS, FASMBS, medical director of the Bariatric Surgery Center at Rose Medical Center, founder and director of the Denver Center for Bariatric Surgery Foundation, and in-house obesity specialist for FuturHealth, about this study.

Snyder, who was not involved in the research, commented that these findings are quite significant as an introduction to a novel and seemingly extremely effective way of decreasing the risk of type 2 diabetes related dementia, specifically, Alzheimer’s disease and nonvascular dementia.

“Early research has suggested that GLP-1 medications may offer powerful benefits for brain health,” he explained.

“Obesity, insulin resistance, and type 2 diabetes are all known to increase the risk of dementia, largely due to their role in driving inflammation, vascular damage, and other long-term stressors on the brain. By targeting these underlying issues, GLP-1s, which are already widely used to treat obesity and diabetes, may offer indirect protection against cognitive diseases,” Snyder pointed out.

“In addition, emerging evidence shows that GLP-1s may have direct neurological effects, influencing memory, cognitive function, and neuroinflammation,” he continued. “Although promising, long-term studies and clinical trials are needed to fully understand GLP-1s impact on the brain. With that said, GLP-1s could play a pivotal role in preventing or slowing neurodegenerative diseases, marking a major step forward in the future of brain health.”

More research needed for definitive conclusions

MNT also spoke to Jennifer Cheng, DO, chief of endocrinology at Hackensack Meridian Jersey Shore University Medical Center in New Jersey, about this research.

“As an endocrinologist who treats type 2 diabetes on a regular basis, I found the study to be thought provoking and an interesting avenue of research,” Cheng, who likewise was not involved in the research, commented. “The cognitive complications of diabetes can be significant and life debilitating. The protective effect for diabetes is promising and may help with treatment decisions in the future. It is an interesting method of research and can lead to further discoveries.”

“We are discovering new effects of the GLP-1 medications and it is interesting to see the possible protective effects. Patients with diabetes do have increased risk for neurological disorders including vascular issues and dementia. This is just an observational study so there can be no conclusions about the medications being the definitive cause of the decreased risk of Alzheimer’s and/or dementia.”– Jennifer Cheng, DO

“For research next steps, it would be interesting to see the new GLP-1 medications, and effects of the GLP-1s, studied to see if it is definitive,” Cheng added. “We cannot conclude that based on an observational study that the GLP-1 was the primary agent to help prevent the cognitive complications of diabetes, but it does warrant further investigation, especially with new GLP-1 medications in development.”

https://www.medicalnewstoday.com/articles/glp-1s-may-offer-better-dementia-protection-than-metformin

Ivory Tower: Study sheds light on heart health, psoriasis link

A recent study conducted by the Department of Cardiology at the Dayanand Medical College and Hospital (DMCH), Department of Dermatology, Venereology and Leprology and Department of Internal Medicine-Postgraduate Institute of Medical Education and Research, Chandigarh, has shed new light on the complex relationship between psoriasis and cardiovascular health, revealing that the skin condition may carry risks far beyond its visible symptoms.

Psoriasis, a chronic inflammatory disorder affecting nearly 2–3 per cent of the population, has long been associated with the skin and joint discomfort.

However, this new research highlights how fat tissue found in psoriasis patients becomes a hub of immune activity, contributing to systemic inflammation, insulin resistance and increased vulnerability to heart disease.

“We’re beginning to understand psoriasis as a multi-system condition,” said one of the lead researchers. “The inflammation doesn’t stop at the skin — it extends into fat tissue, which plays a key role in metabolic and cardiovascular complications.”

The study further found elevated levels of substances like leptin, resistin and adiponectin in psoriasis patients — biomarkers that influence both inflammation and heart health. These findings suggest that psoriasis may independently contribute to cardiovascular risk, even in the absence of traditional factors like hypertension or diabetes.

Importantly, the research also explored how psoriasis treatment may impact heart health. Medications such as methotrexate and TNF inhibitors showed promise in reducing cardiovascular events, though further investigation is needed to fully understand their long-term effects.

A senior author of the study, emphasised the need for routine cardiovascular screening in psoriasis patients. “We recommend that dermatologists and primary-care physicians work closely with cardiologists to monitor heart health in these individuals,” she further said.

The study also advocates for lifestyle interventions, including a balanced diet, stress reduction and smoking cessation, as essential components of care.

Additionally, medications like statins and metformin may help manage cardiovascular risk factors in psoriasis patients.

The findings are expected to throw light on future screening guidelines and treatment strategies, with researchers calling for greater collaboration between dermatologists, rheumatologists, and cardiologists to address the full spectrum of psoriasis-related health concerns.

https://www.tribuneindia.com/news/amritsar/ivory-tower-study-sheds-light-on-heart-health-psoriasis-link/

Cancer Drugs Show Surprising Power To Reverse Alzheimer’s in Mice

In a surprising twist, researchers used computational tools to find that two FDA-approved cancer drugs might counteract Alzheimer’s disease by reversing its gene expression patterns. After analyzing gene activity in Alzheimer’s-affected brain cells and comparing it with data from over 1,300 existing drugs, they discovered a powerful drug duo that not only reduced brain degeneration in mice but also restored memory. Credit: Stock

A study that compared the gene expression profile of Alzheimer’s disease with those triggered by 1,300 approved drugs identified a combination of two cancer medications as a potential treatment for the most common form of dementia.

Researchers from UC San Francisco and the Gladstone Institutes have discovered that certain cancer medications may help counteract the brain changes caused by Alzheimer’s disease. This breakthrough could lead to treatments that slow or potentially reverse the condition’s symptoms.

To begin, the scientists examined how Alzheimer’s alters gene activity in individual brain cells. They then searched for FDA-approved drugs that produced the opposite effect on gene expression.

Their focus was on medications that could correct changes in neurons and glial cells, both of which are disrupted during the progression of Alzheimer’s.

The team also reviewed millions of anonymized medical records and found that people who had taken some of these drugs for unrelated health issues were less likely to develop Alzheimer’s.

Finally, when the researchers tested the two most promising drugs (both originally developed to treat cancer) in mice with Alzheimer’s-like symptoms, the results were striking: the treatment reduced brain damage and helped restore memory function in the animals.

“Alzheimer’s disease comes with complex changes to the brain, which has made it tough to study and treat, but our computational tools opened up the possibility of tackling the complexity directly,” said Marina Sirota, PhD, the interim director of the UCSF Bakar Computational Health Sciences Institute, professor of pediatrics, and co-senior author of the paper. “We’re excited that our computational approach led us to a potential combination therapy for Alzheimer’s based on existing FDA-approved medications.”

The findings appeared in Cell on July 21. The research was funded in part by the National Institutes of Health and the National Science Foundation.

Big data from patients and cells points to a new Alzheimer’s therapy

Alzheimer’s disease affects 7 million people in the U.S. and causes a relentless decline in cognition, learning, and memory. Yet decades of research have only produced two FDA-approved drugs, neither of which can meaningfully slow this decline.

“Alzheimer’s is likely the result of numerous alterations in many genes and proteins that, together, disrupt brain health,” said Yadong Huang, MD, PhD, senior investigator and director of the Center for Translational Advancement at Gladstone, professor of neurology and pathology at UCSF, and co-senior author of the paper. “This makes it very challenging for drug development — which traditionally produces one drug for a single gene or protein that drives disease.”

The team took publicly available data from three studies of the Alzheimer’s brain that measured single-cell gene expression in brain cells from deceased donors with or without Alzheimer’s disease. They used this data to produce gene expression signatures for Alzheimer’s disease in neurons and glia.

The researchers compared these signatures with those found in the Connectivity Map, a database of results from testing the effects of thousands of drugs on gene expression in human cells.

Out of 1,300 drugs, 86 reversed the Alzheimer’s disease gene expression signature in one cell type, and 25 reversed the signature in several cell types in the brain. But just 10 had already been approved by the FDA for use in humans.

Poring through records housed in the UC Health Data Warehouse, which includes anonymized health information on 1.4 million people over the age of 65, the group found that several of these drugs seemed to have reduced the risk of developing Alzheimer’s disease over time.

“Thanks to all these existing data sources, we went from 1,300 drugs, to 86, to 10, to just 5,” said Yaqiao Li, PhD, a former UCSF graduate student in Sirota’s lab who is now a postdoctoral scholar in Huang’s lab at Gladstone and the lead author of the paper. “In particular, the rich data collected by all the UC health centers pointed us straight to the most promising drugs. It’s kind of like a mock clinical trial.”

A combination therapy poised for primetime

Li, Huang, and Sirota chose 2 cancer drugs out of the top 5 drug candidates for laboratory testing. They predicted one drug, letrozole, would remedy Alzheimer’s in neurons; and another, irinotecan, would help glia. Letrozole is usually used to treat breast cancer; irinotecan is usually used to treat colon and lung cancer.

The team used a mouse model of aggressive Alzheimer’s disease with multiple disease-related mutations. As the mice aged, symptoms resembling Alzheimer’s emerged, and they were treated with one or both drugs.

The combination of the two cancer drugs reversed multiple aspects of Alzheimer’s in the animal model. It undid the gene expression signatures in neurons and glia that had emerged as the disease progressed. It reduced both the formation of toxic clumps of proteins and brain degeneration. And, importantly, it restored memory.

“It’s so exciting to see the validation of the computational data in a widely used Alzheimer’s mouse model,” Huang said. He expects the research to advance soon to a clinical trial so the team can directly test the combination therapy in Alzheimer’s patients.

“nbs, guide us to the same pathways and the same drugs, and then resolve Alzheimer’s in a genetic model, then maybe we’re onto something,” Sirota said. “We’re hopeful this can be swiftly translated into a real solution for millions of patients with Alzheimer’s.”

https://scitechdaily.com/cancer-drugs-show-surprising-power-to-reverse-alzheimers-in-mice/

Tobacco use among women declines from 20.3pc to 14.2pc: Centre

India has seen a notable decline in tobacco use among women and adolescents. The government credits strict laws like COTPA 2003 and awareness campaigns for this positive trend. Youth tobacco consumption nearly halved from 14.6% to 8.5% in a decade. Health officials continue anti-tobacco efforts through programs like the annual Tobacco Free Youth Campaign.

"There is a decline in tobacco use among women from 20.3% to 14.2%" - Prataprao Jadhav

Tobacco use among women and adolescents has declined, said Union Minister of State for Health and Family Welfare Prataprao Jadhav, in the Parliament on Tuesday.

Key Points

1 Tobacco use among Indian women fell significantly over a decade

2 Youth consumption dropped by nearly half since 2009

3 COTPA 2003 bans smoking in public places and ads

4 Govt enforces complete ban on e-cigarettes since 2019

 

In a written reply in the Rajya Sabha, Jadhav stated the decline in tobacco use, citing two global surveys.

“As per the Global Adult Tobacco Survey (GATS) -I (2009-10) and GATS-2 (2016-17) conducted among the age group of 15 years and above, there is a decline in tobacco use among women from 20.3 per cent to 14.2 per cent,” the Minister said.

“The Global Youth Tobacco Survey (GYTS) conducted for school-going children of age group 13-15 years reported a decline in tobacco use from 14.6 per cent (GYTS-3, 2009) to 8.5 per cent (GYTS-4, 2019),” he added.

Jadhav also shared the measures undertaken by the Health Ministry to reduce tobacco consumption among women and children in the country.

The Ministry enacted a comprehensive legislation, namely the Cigarettes and Other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (COTPA 2003), to regulate the tobacco products and to discourage the consumption of tobacco.

“The provisions under COTPA, 2003 and the Rules made thereunder prohibit smoking in public places, ban on sale of tobacco products to and by minors, sale of tobacco products within a radius of 100 yards of educational institutions, prohibition on direct and indirect advertising of tobacco products and mandatory display of specified health warnings on all tobacco product packs,” Jadav said.

In 2007, the National Tobacco Control Programme (NTCP) was launched to discourage the use of tobacco, create awareness about the harmful effects of tobacco consumption through regular and sustained public awareness campaigns, and ensure effective implementation of the provisions under COTPA 2003.

As part of these, the Ministry launches a 60-day annual Tobacco Free Youth Campaign to educate young people about the dangers of tobacco and empower them to resist or quit its use.

The Government has also enforced a complete ban on electronic cigarettes, including heat-not-burn products, under “The Prohibition of Electronic Cigarettes (Production, Manufacture, Import, Export, Transport, Sale, Distribution, Storage and Advertisement) Act,2019, Jadhav.

https://www.newkerala.com/news/o/tobacco-use-among-women-declines-203pc-142pc-centre-972

Thalassemia: 4,361 patients registered, 2,579 under age 12 in 2025, says Govt

India has registered 4,361 thalassemia patients in 2025, with over half being children under 12. The government has introduced tracking via the Sickle Cell Portal and financial aid for transplants. Health Minister Anupriya Patel highlighted the sharp rise from just 806 cases in 2023. Preventive measures and treatment support are being expanded nationwide to combat this genetic disorder.

"From 806 thalassemia patients in 2023, the number rose to 4,361 in 2025" – Anupriya Patel, Union Health Minister

A total of 4,361 patients have been registered as thalassemics in the country in 2025, of which 2,579 are under the age of 12, the government informed the Parliament during the ongoing Monsoon session on Tuesday.

Key Points

1 Thalassemia cases surged from 806 in 2023 to 4,361 in 2025

2 2,579 affected children under 12 registered in 2025

3 Govt added thalassemia module to Sickle Cell Portal for tracking

4 Thalassemia Bal Sewa Yojana offers Rs 10 lakh for transplants

 

Thalassemia is a severe inherited blood disorder, passed from parents to children.

The disorder occurs when the body doesn’t make enough of a protein called haemoglobin -- an important part of red blood cells -- forcing the need for blood transfusions every fortnight.

In a written reply in the Rajya Sabha, Anupriya Patel, Union Minister of State for Health and Family Welfare, detailed the number of thalassemia patients registered in the country during the last three years.

"From 806 total diseased thalassemia patients in 2023, the number sporadically rose to 2,576 in 2024 and 4,361 in 2025,” Patel stated.

The cases of the blood disorder have also risen among children aged under 12.

"In 2023, there were just 360 children under 12 registered with the disease, in 2024 the number jumped to 892, and 2,579 in 2025," the Minister noted. All the cases were registered in 18 states.

Further, in view of the rising cases of the genetic disease, the government in 2023 added a thalassemia module in the national Sickle Cell Portal to enable states to enter the records of existing patients.

“Monitoring and follow-up are done, and the data of thalassemia for screening is entered regularly on the National Portal,” Patel said.

Other measures rolled out by the government to curb thalassemia cases include support to states under the National Health Mission (NHM).

The Centre provides support to states for the prevention and management of thalassemia at public healthcare facilities, provision of blood bank facilities, day care centres, medicines, and lab services.

“The Ministry, in association with Coal India Limited (CIL), is also implementing a scheme, namely Thalassemia Bal Sewa Yojana (TBSY), wherein financial assistance up to Rs 10 lakh is provided to eligible patients for Bone Marrow transplants (BMT) from CIL Corporate Social Responsibility (CSR) funds,” Patel said.

The scheme, which provides BMT in 17 empanelled hospitals across the country, has so far helped more than 700 children with life-saving transplants. Most of these children are now leading healthy and normal lives.

India is the thalassemia capital of the world. Every eighth thalassemia patient in the world lives in India. And yearly, about 10,000-20,000 new thalassemia majors are born.

https://www.newkerala.com/news/o/thalassemia-4361-patients-registered-2579-age-12-2025-says-850

Why tobacco-style warnings on alcohol bottles can aid fight against cancer

Medical experts are advocating for graphic cancer warnings on alcohol bottles, mirroring India's successful tobacco label strategy. Alcohol is a confirmed carcinogen tied to over 20 cancers, yet public awareness remains dangerously low. With India's youth increasingly consuming alcohol and cancer cases rising 36% in a decade, oncologists call this an urgent public health priority. The proposal highlights how visual warnings could disrupt glamorized alcohol portrayals in media while saving lives through prevention.

"Cancer warning labels on alcohol bottles are a low-cost, high-impact intervention" – Dr. Abhishek Shankar, AIIMS Delhi

Medical experts are advocating for graphic cancer warnings on alcohol bottles, mirroring India's successful tobacco label strategy. Alcohol is a confirmed carcinogen tied to over 20 cancers, yet public awareness remains dangerously low. With India's youth increasingly consuming alcohol and cancer cases rising 36% in a decade, oncologists call this an urgent public health priority. The proposal highlights how visual warnings could disrupt glamorized alcohol portrayals in media while saving lives through prevention.

Adopting tobacco-style warning labels on alcohol bottles can be a key measure to prevent the rising burden of cancer in India, said experts on Tuesday.

Key Points

1 Alcohol linked to 20+ cancers including breast and liver with low public awareness

2 India's alcohol market grows rapidly among youth and adolescents

3 Tobacco-style warnings proven effective in shifting consumption habits

4 Movies and social media myths fuel dangerous alcohol normalization

 

A recent paper, published in the journal Frontiers in Public Health, called for strong, evidence-based warning labels on alcohol products, building on India’s success with tobacco warnings.

Alcohol, like tobacco, is a proven carcinogen linked to several cancers, including liver, breast and colon, yet awareness remains low.

“Cancer warning labels on alcohol bottles are a low-cost, high-impact intervention that can raise awareness, influence consumption habits, and prevent long-term health harm,” lead author Dr Abhishek Shankar, Assistant Professor, Department of Radiation Oncology at All India Institute of Medical Sciences, Delhi, told IANS.

“With India having one of the fastest-growing alcohol markets and the largest adolescent population globally, adopting such preventive measures is not just necessary but urgent to protect our youth and reduce the nation’s growing burden of alcohol-related cancers,” the oncologist added.

Cancer cases in India have seen a steep rise, with data from the 2012 to 2022 period suggesting a 36 per cent uptick in incidence (1.01 million−1.38 million).

Data from GLOBOCAN 2022 showed about 1.41 million new cancer cases in India, with a five-year prevalence of around 3.25 million and a total cancer mortality of 916,827 cases.

The alcohol attributable fraction for cancer and age-standardised rate per 100,000 in India are 4.7 per cent and 4.8, respectively, according to the GLOBOCAN 2020 data.

“Alcohol consumption in India is rising at an alarming pace, particularly among adolescents and young adults, making it a silent driver of preventable cancers. Evidence now confirms there is no safe level of alcohol use when it comes to cancer risk, with links to cancers of the colon, breast, liver, oral cavity, and more,” Shankar said.

“Among preventable diseases and deaths, alcohol-related conditions rank high. It raises the risk of many types of cancer and also liver cirrhosis -- all of which are expensive and cumbersome to treat,” added Dr Rajeev Jayadevan, Chairman, Scientific Committee, IMA Cochin.

The expert also called out against glorifying the use of alcohol in movies.

“Unfortunately, our movie culture glorifies alcohol use, with younger viewers wanting to emulate movie characters despite statutory warnings. There is also rampant misinformation circulating on social media claiming the health benefits of alcohol, almost all of which have been proven wrong. Still, many people wrongly believe it is good for the heart. Therefore, it is important to include clear health-related labels,” Jayadevan told IANS.

Meanwhile, studies have linked alcohol consumption with more than 20 types of cancers.

The most common cancers linked to alcohol are of the mouth, throat, foodpipe, stomach, colon, rectum, and pancreas. It also causes cancers of the breast in women and prostate in males..

According to experts, chronic alcohol consumption weakens the immune system, reducing its capacity to identify and destroy cancerous cells.

“India successfully demonstrated the power of pictorial warnings on tobacco in shifting behaviors and saving lives. It is time we apply the same public health tool to alcohol. With rising alcohol use, especially among youth, it’s time to act proactively to prevent avoidable cancers and save lives,” Shankar told IANS.

https://www.newkerala.com/news/o/tobacco-style-warnings-alcohol-bottles-aid-fight-against-cancer-978

A Pill That Makes Your Blood Deadly to Mosquitoes? It’s Real – And It Works

A common pill turns your blood into mosquito poison—and slashes malaria in the process.

A simple pill may be the latest breakthrough in the fight against malaria.

A massive study across Kenya and Mozambique found that mass administration of ivermectin—an antiparasitic drug—reduced malaria cases by 26%. The pill works in a surprising way: it makes human blood deadly to mosquitoes, killing them after they bite. This novel approach could complement traditional tools like bed nets, which have lost effectiveness due to mosquito resistance. Even better, communities reported fewer lice, scabies, and bed bugs—bonus benefits from a single monthly dose.

Ivermectin Shows Promise in Reducing Malaria Transmission

A safe and widely available drug, ivermectin, has shown promise in reducing the spread of malaria when given to entire communities. In the largest study of its kind, known as the BOHEMIA trial, researchers found a 26% drop in new malaria infections even when standard tools like bed nets were already in use. These findings highlight ivermectin’s potential to serve as an added layer of protection in malaria prevention.

The study was led by the Barcelona Institute for Global Health (ISGlobal), supported by the “la Caixa” Foundation, in collaboration with the Manhiça Health Research Centre (CISM) and the KEMRI-Wellcome Trust Research Programme. The results were published in The New England Journal of Medicine.

Malaria continues to be a major global health issue, with 263 million cases and 597,000 deaths recorded in 2023. Existing prevention tools such as long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS) are becoming less effective. This is largely due to mosquitoes developing resistance to insecticides and changing their behavior to bite outdoors or during times when people are not shielded by these methods. These challenges have created an urgent demand for new approaches to stop the disease.

Ivermectin tablets used for the BOHEMIA trial in Kenya.

Ivermectin’s Unexpected Role in Fighting Malaria

Ivermectin is typically used to treat neglected tropical diseases such as onchocerciasis (river blindness) and lymphatic filariasis (elephantiasis). However, studies have shown that it can also reduce malaria by killing mosquitoes that bite people who have taken the drug. As resistance to insecticides increases, ivermectin may offer a new and effective way to reduce transmission, especially in areas where standard methods are no longer reliable.

The BOHEMIA project (Broad One Health Endectocide-based Malaria Intervention in Africa), funded by Unitaid, tested this idea through two large-scale Mass Drug Administration (MDA) trials in regions with high malaria burden: Kwale County in Kenya and Mopeia district in Mozambique. Researchers evaluated whether giving a single monthly dose of ivermectin (400 mcg/kg) over three months at the start of the rainy season could lower malaria transmission. In Kenya, the program focused on children aged 5 to 15, while in Mozambique it targeted children under the age of five.

Kenya Sees Clear Impact from Ivermectin

In Kwale County, Kenya, children who received ivermectin experienced a 26% reduction in malaria infection incidence compared to those who received albendazole, the control drug used in the study. The trial involved over 20,000 participants and more than 56,000 treatments, demonstrating that ivermectin significantly reduced malaria infection rates—particularly among children living further from cluster borders or in areas where drug distribution was more efficient. Moreover, the safety profile of ivermectin was favourable, with no severe drug-related adverse events and only mild, transient side effects already seen with ivermectin in campaigns against neglected tropical diseases.

“We are thrilled with these results,” says Carlos Chaccour, co-principal investigator of the BOHEMIA project and ISGlobal researcher at the time of the study. “Ivermectin has shown great promise in reducing malaria transmission and could complement existing control measures. With continued research, ivermectin MDA could become an effective tool for malaria control and even contribute to elimination efforts,” Chaccour, who is now a researcher at the Navarra Centre for International Development at the University of Navarra, adds. 

“These results align with the World Health Organization’s (WHO) criteria for new vector control tools,” states Joseph Mwangangi, from the KEMRI-Wellcome Trust Research Programme. “The findings suggest that ivermectin MDA could be a valuable complementary strategy for malaria control, particularly in areas where mosquito resistance to insecticides is a growing concern,” adds Marta Maia, BOHEMIA’s lead entomologist from the University of Oxford.

Lessons and Setbacks in Mozambique Deployment

In contrast, the implementation of the Mozambique trial in the rural district of Mopeia faced severe disruptions due to Cyclone Gombe (2022) and a subsequent cholera outbreak, which significantly disrupted operations. “One of the most important lessons we learned from the trial in Mopeia is that strong community engagement is essential,” states Francisco Saúte, director of the Manhiça Health Research Centre (CISM). “Building trust with local communities and fostering close collaboration with the Health Ministry, National Malaria Control Program, and local authorities was key to ensuring acceptance of the ivermectin MDA.”

Collateral Public Health Benefits Beyond Malaria

In addition to reducing malaria transmission, ivermectin MDA offers significant collateral benefits. The BOHEMIA team found an important reduction in the prevalence of skin infestations such as scabies and head lice in the ivermectin group in Mozambique, and the community reported a major reduction in bed bugs in Kenya. These effects are particularly valuable when ivermectin is integrated into existing delivery systems, maximising its impact on public health.

Toward a New Era of Malaria Control Strategy

The study is part of a larger global effort to assess ivermectin’s potential in malaria control. The findings have been reviewed by the WHO vector control advisory group, which concluded that the study had demonstrated impact and recommended further studies. Findings were also shared with national health authorities as they evaluate the potential inclusion of ivermectin in malaria control programmes.

“This research has the potential to shape the future of malaria prevention, particularly in endemic areas where existing tools are failing,” concludes Regina Rabinovich, BOHEMIA PI and Director of ISGlobal’s Malaria Elimination Initiative. “With its novel mechanism of action and proven safety profile, ivermectin could offer a new approach using a well-known, safe drug that can add to the effect of other mosquito control tools available today.”

https://scitechdaily.com/a-pill-that-makes-your-blood-deadly-to-mosquitoes-its-real-and-it-works/

World's First Transcervical Robotic AVR Procedures Successfully Performed in 4 Cleveland Clinic Patients

Least-invasive open-heart AVR option to date yielded rapid recovery in all cases surgeon looking at small monitor at operating table during surgery

Four patients who underwent robotically assisted aortic valve replacement (AVR) with transcervical access were able to resume an active life one week later without any restrictions, reporting low-level pain during recovery.

Cleveland Clinic cardiothoracic surgeon Marijan Koprivanac, MD, who performed the operations earlier this year, announced the results in a late-breaking presentation at the American Association for Thoracic Surgery annual meeting in May. The series is the first known report of the clinical application of transcervical robotic AVR.

“We are optimistic that this strategy could be a breakthrough for offering the benefits of surgical AVR without the lengthier and more painful recovery associated with current options,” says Dr. Koprivanac.

Transcervical robotic AVR – an innovative new approach

Surgical AVR (SAVR) has undergone rapid evolution in recent years with the aim of preserving advantages of an open-heart surgical approach — primarily complete debridement and removal of the diseased native valve, and potentially longer durability of the new implanted valve — while reducing invasiveness. “Although SAVR via sternotomy is still regarded as the gold standard for surgical candidates in need of an isolated valve procedure, currently it should be performed infrequently, if ever, because of the availability of excellent less-invasive options, including mini-sternotomy, right anterior thoracotomy, and transaxillary and robotic SAVR,” Dr. Koprivanac notes.

Robotic assistance for AVR is now in the vanguard of this evolution, conferring the advantages of smaller incisions, enhanced visualization and greater precision compared with other surgical methods. Combining robotics with a transcervical approach — potentially offering an even less-invasive option — is being explored by a few groups, but Dr. Koprivanac is unaware that it has been performed by others beyond feasibility studies in cadavers.

He first took an interest in this strategy after learning to perform transcervical thymectomies while in cardiothoracic surgical training. Access is through a small incision in the neck, without need for a thoracotomy or sternotomy incision.

“The transcervical approach is well suited to AVR, as it offers an excellent view of the aorta and aortic valve from above,” Dr. Koprivanac explains.

He developed his novel technique on human cadavers, in an anatomy lab at Cleveland Clinic Lerner Research Institute, using a mammary retractor and then a specialized transcervical retractor. He soon brought in some of his surgical colleagues and team. After demonstrating feasibility on some 20 cadavers, they started offering the procedure to patients at Cleveland Clinic.

The procedure and initial patient experience

The procedure involves four incisions. The main one, for robot entry, is placed at a neck crease to minimize scar visibility, similar to the incision in thyroidectomy patients. Placement of the other three small incisions is detailed in Figure 1. Decalcification and debridement of the aortic annulus is performed as needed, and the new valve sutured in. 

The four patients who underwent the procedure were aged 60 to 74 years. The replacement valves used were the Perceval L in one patient and the Inspiris Resilia #25 in three patients.

The average cross-clamp time was 140 minutes. Postoperative discharge was at 3 days, 4 days (two patients) and 6 days (in a patient who developed complete heart block and ventricular dysfunction, requiring pacemaker implantation).

A local anesthetic was injected when the incision was closed at the robot entry sites. Postoperatively, all patients reported minimal pain and were managed with acetaminophen and ibuprofen unless additional procedures were needed. Patients had no restrictions, from a chest wall healing standpoint, a week after discharge, with one patient reporting that he had resumed running in the gym at that point. Another patient was back to his farmwork at week 3 after surgery. “These types of activities are unimaginable so soon after other AVR approaches, even minimally invasive ones,” says Dr. Koprivanac.

“This is an important advance in cardiac surgery — completion of a surgical aortic valve replacement with no incisions in the chest,” notes Marc Gillinov, MD, Chair of Thoracic and Cardiovascular Surgery at Cleveland Clinic.

Chair of Cardiovascular Medicine Samir Kapadia, MD, concurs. “This is a great advancement in minimally invasive surgical treatment for aortic stenosis,” Dr. Kapadia says. “This surgery may be preferred by patients if it delivers similar safety and efficacy as other, more-invasive surgeries.”

Future goals – streamlining and standardization

Dr. Koprivanac and his colleagues are continuing to offer this new approach to qualified patients who require an isolated aortic valve procedure.

“The procedure is getting easier as we learn from each patient,” Dr. Koprivanac says. “With experience, we are refining techniques — such as optimal port placement and level of valve introduction — and becoming more efficient. As we have proved the safety of the procedure, reducing cross-clamp times is the main goal now.”

He and his colleagues are also exploring designs of new instruments and sutures — and adapting existing ones — to facilitate the careful manipulation required in a very tight space.

Reducing the cross-clamp time to 90 minutes — and ideally to around 1 hour — is an important goal, and Dr. Koprivanac expects they can reach this target once the operation has been streamlined. “Our first priority is always safety, so we are proceeding cautiously to ensure a good outcome in each patient,” he says.

He adds that the potential of this operation is that patients might be able to be discharged on day 2 after the surgery. Although some patients in this series appeared ready for discharge on postoperative day 2, he notes, they were kept longer for observation owing to the novelty of the procedure.

Once Dr. Koprivanac and colleagues develop an efficient technique they are satisfied with, they intend to standardize it for reproducibility by other surgeons, but he says this will likely remain a procedure of highly specialized centers.

“Seeing how these first patients’ experience and recovery were so much better than with current approaches, we are highly motivated to perfect this technique to benefit more of our patients,” he concludes.

https://consultqd.clevelandclinic.org/worlds-first-transcervical-robotic-avr-procedures