Volume 3, Issue 2, October 2016
Dhananjaya Saranath and Aparna Khanna
Come October and all in the Biomedical field await the announcement of the Nobel laureates in our fields. The 2016 Nobel Prize in Physiology or Medicine was awarded to Professor Yoshinori Ohsumi, for his discoveries of mechanisms underlying autophagy. The Nobel Prizes are announced for the most important discoveries for the benefit of mankind, at Karolinska Institutet, Stockholm. Dr. Ohsumi, Ph.D., from University of Tokyo, Batch of 1974, did a three year post-doctoral at Rockefeller University, New York, USA, and later established his research team at the Tokyo Institute of Technology. Dr. Ohsumi discovered and elucidated mechanisms underlying autophagy, a fundamental process for degrading and recycling cellular components. In the 1990's, Yoshinori Ohsumi, envisaged a series of innovative experiments using baker's yeast to identify genes essential for autophagy, and unravelled the mechanisms for autophagy initially in yeast and confirmed the process in mammalian cells.
Ohsumi's discoveries led to a paradigm shift with respect to the concept of recycling the content of mammalian cells. His discoveries revealed the fundamental path to understand the role of autophagy in several physiological processes, particularly in response to stress due to starvation, response to infection and other stresses. Mutations in genes associated with autophagy often leads to diseases including infections, neurological diseases and cancer. The Nobel laureate built his dogma on degradation as a critical function in living cells, with the lysosome organelle containing enzymes for digestion of cellular contents for degradation of cellular constituents. The autophagosome vesicles, engulfing cellular contents such as damaged proteins and organelles, fusing the contents/organelle with the lysosome, and degradation of the contents into smaller constituents, providing the cell with nutrients and building blocks for renewal.
Yoshinori Ohsumi focused on protein degradation in yeast mutants in a vacuole similar to lysosome in mammalian cells, and identified 15 critical genes comprising a cascade of proteins in complex cellular pathways in autophagy. He demonstrated that the proteins regulated distinct stages of autophagosome initiation and formation. Autophagy provides fuel for energy and building blocks for renewal of cellular components during stress, and can eliminate intracellular bacteria and viruses. Autophagy contributes to embryo development and cell differentiation. Besides, autophagy eliminates damaged proteins and organelles, and provides a critical balance for the errors, wear and tear in the ageing process. Deregulation in autophagy has been associated with Parkinson's disease, type 2 diabetes, genetic diseases, age related problems in the elderly, and cancer. Dr. Ohsumi thus provided target molecules to develop drugs to target autophagy in various diseases, through his extensive research.
Another current issue in India is cervical cancer in Indian women, and hence we would like to briefly summarize the current International meeting on ‘Cervical Cancer Prevention & Control in India and Beyond – A comprehensive Approach Towards Elimination’, held on 16-18th October 2015, New Delhi, organised by Global Health Strategies with several international/national partners including American Cancer Society, and WOMEN DELIVER. The issue is so intense that several Non-Government Organisations working to alleviate Cervical Cancer were felicitated by the organisers ‘In appreciation of their Inspiring and Enduring Commitment to Fight Against Cervical Cancer’ by Hon’ble Minister of State, Ministry of Health and Family Welfare, Government of India.
The central theme of the meeting, repeatedly reinforced at the inaugural session by Dr. N. K. Ganguly, Former Director, ICMR, New Delhi, Chris Elstoft, Deputy High Commissioner, Australian High Commission, New Delhi, Dr. C. N. Purandare, President, International Federation of Gynecology and Obstetrics (FIGO), Dr. Soumay Swaminathan, Secretary, Department of Health Research, Ministry of Health and family Welfare, Government of India and Director General – ICMR was: ‘Cervical Cancer is Preventable, and it is imperative to change the course of the disease and ‘Women Need Not Die of the Disease. Preventing cervical cancer is the right thing to do, the only thing to do’. The main features to be considered in order to achieve the goal needs to focus on ‘Cervical Cancer Screening in Women and Uptake of Human Papilloma Virus (HPV) Vaccine in Girls’. The statistics of Cervical Cancer in India are appalling with an estimated 123,000 new cases diagnosed annually, and 67,000 deaths due to the disease, contributing 25% of the global cervical cancer incidence and death by a single country – India. We need to be aware that every eight minute an Indian woman is dying of cervical cancer in India. HPV vaccines with proven 70% prevention of cervical cancer is available and accessible to 5% women in rural India, the most vulnerable women.
The mandate and consensus with the cumulative expertise and experience of the delegates was – ‘HPV vaccine should be given to girls in the age group of 10-12 years, with emphasis on School Based Campaigns’. The challenges with the health officials, doctors and various groups for implementation of screening strategies and HPV vaccination will be – Public Education, Understanding and Practice, Acceptance, Coverage and Financial/Manpower resource. An investment in ‘Health Care for Women’ needs to follow the government efforts in ‘Maternal and Child Care’ campaign with a comprehensive approach with reduction in maternal/child mortality to 50% of the figures to 44,000 deaths. A comprehensive approach will make a difference in reducing cervical cancer incidence and deaths. Ms. Barkha Dutt, Consulting Editor, NDTV, moderating the session ‘Elimination of Cervical Cancer in India: A Utopian Dream or a Possible Reality?’ with excellent national/international participants including Reshma Pai - President FOGSI (Elect) 2017, Madhu Chopra, Managing Director - Studio Aesthetique, Neerja Batle - Professor Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Christine Kaseba-Sata - Former First Lady, Republic of Zambia, Genevieve Sambhi - Former Miss Malayasia and a cervical cancer survivor, to name a few. Barkha Dutt reiterated that 65 countries have already accepted HPV vaccination program, adopted as a national program.
It is essential to remove any stigma associated with cervical cancer, and assure safety of the vaccine with no serious side-effects in HPV naïve girls, is the critical information for all the stakeholders. The sessions on Scene Setting, Bringing Screening Services to Women, Global experiences in introducing Vaccines, Availability, Accessibility and Affordability of Treatment, set the tone for the India to battle cervical cancer. Dr. Dhananjaya Saranath highlighted the contribution of Cancer Patients Aid Association indicating a holistic approach and ‘Total Management of Cancer’, the vivion and mission of CPAA. The focus of CPAA included – Cancer Awareness and Screening, Diagnosis, Patient Care, Research on Psycho-social-Behavioral aspects of Cancer Patients and HPV molecular diagnostic tests, Affordable Cancer Insurance in conjunction with New India Assurance as partners, and rehabilitation for cancer survivors through ‘CPAA Rehabilitation Centre’ providing a modicum of economic/financial independence.
The take home message from the meeting deliberations were extremely optimistic emphasizing necessity of planned cervical cancer awareness with screening, treatment and follow-up. The meeting ended with the delegates committed to ‘Cervical Cancer Screening and HPV Vaccination’ in order to bring to reality ‘Elimination (to zero) of Cervical Cancer’. The presence of manufacturers of quadrivalent HPV vaccine, assured their commitment to cervical cancer elimination, emphasizing priority to ‘Women Health in India’. The role of media, National Radio/ Television / Print and Digital Media support will ensure success of ‘Women Health – Free of Cervical Cancer’.