The tricky business of unblocking your brain

Don’t read this if you’ve got an aneurysm.

Spend 24 hours in the company of a couple of hundred brain surgeons and you’d have a sense of unease too. I’m at a conference where “minimally invasive neurological therapies” are being discussed. My take-home message? No one knows anything for sure. Until it’s too late, that is.

Not that they aren’t good at their job – they’re the best in the world at getting at blockages and other problems inside your brain. But they are here to discuss the things they don’t know. And those are conversations you’d rather not overhear.

The typical presentation goes like this. “So, we went to perform an angioplasty on patient A, who was suffering from acutely reduced vision” (I may be paraphrasing badly). “Here’s the imaging.”

On the screen appears a picture of some loopy, tangled-looking blood vessels. There are murmurs and sharp intakes of breath. A voice just behind me mutters “ay-ay-ay”.

I have no idea what I’m looking at. I’m only here to give a talk about more general issues in scientific research. But I have that sinking feeling, like in the first five minutes of an episode of Casualty, that something bad is about to happen.

“I’d like to know: what would you have done?” the presenter asks. She offers two options. The room votes. The split is even, an observation that makes me hugely uncomfortable. There is no consensus. Why is there no consensus? Surely there’s a right thing to do in any situation? The presenter goes on to explain what she did. There is another round of murmuring in the room. Clearly, many people – approximately half – think this was a very bad idea.

The next presenter describes a surgery that started to go wrong 4 hours into an operation. He talks like it’s Who Wants To Be A Millionaire. “What do you think?” he asks the audience. “Shall I go on or stop now?” A voice from the back shouts, “No, no, no. Stop. You have to stop!”

He did go on, as it happened. He describes how the procedure progressed, blow by blow. “No, no, don’t do that!” comes an anguished shout, like this is Surgery Live. It’s not: this all happened last year. “Yeah,” the presenter mutters. “Thanks, I know that now.”

The next presentation ends with, “Well, I’ll never do that again.” Then comes another: “So, I’d like your opinions – should I treat this? If so, how?” The audience is calling out answers like a classroom full of show-offs. The session chair asks for calm.

Not all the answers are helpful. “If you get bleeding there, that’s going to be catastrophic.” The presenter furrows his brow. “I know,” he says. “That’s why I’m asking.”

This one is not a done deal, as it turns out. “Thanks,” the presenter says as the deluge of conflicting answers abates. “I’m due to see her again in ten days, so that’s really helpful.”

Here’s hoping she’s not reading this.

 

A patient prepped for surgery. Photograph: Getty Images

Michael Brooks holds a PhD in quantum physics. He writes a weekly science column for the New Statesman, and his most recent book is At the Edge of Uncertainty: 11 Discoveries Taking Science by Surprise.

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The answer to the antibiotics crisis might be inside your nose

The medical weapons we have equipped ourselves with are losing their power. But scientists scent an answer. 

They say there’s a hero in everyone. It turns out that actually, it resides within only about ten percent of us. Staphylococcus lugdunensis may be the species of bacteria that we arguably don’t deserve, but it is the one that we need.

Recently, experts have cautioned that we may be on the cusp of a post-antibiotic era. In fact, less than a month ago, the US Centres for Disease Control and Prevention released a report on a woman who died from a "pan-resistant" disease – one that survived the use of all available antibiotics. Back in 1945, the discoverer of penicillin, Alexander Fleming, warned during his Nobel Prize acceptance speech against the misuse of antibiotics. More recently, Britain's Chief Medical Officer Professor Dame Sally Davies has referred to anti-microbial resistance as “the greatest future threat to our civilisation”.

However, hope has appeared in the form of "lugdunin", a compound secreted by a species of bacteria found in a rather unlikely location – the human nose.

Governments and health campaigners alike may be assisted by a discovery by researchers at the University of Tubingen in Germany. According to a study published in Nature, the researchers had been studying Staphylococcus aureus. This is the bacteria which is responsible for so-called "superbug": MRSA. A strain of MRSA bacteria is not particularly virulent, but crucially, it is not susceptible to common antibiotics. This means that MRSA spreads quickly from crowded locations where residents have weaker immune systems, such as hospitals, before becoming endemic in the wider local community. In the UK, MRSA is a factor in hundreds of deaths a year. 

The researchers in question were investigating why S. aureus is not present in the noses of some people. They discovered that another bacteria, S. lugdunensis, was especially effective at wiping out its opposition, even MRSA. The researchers named the compound created and released by the S. lugdunensis "lugdunin".

In the animal testing stage, the researchers observed that the presence of lugdunin was successful in radically reducing and sometimes purging the infection. The researchers subsequently collected nasal swabs from 187 hospital patients, and found S. aureus on roughly a third of the swabs, and S. lugdunensis on up to 10 per cent of them. In accordance with previous results, samples that contained both species saw an 80 per cent decrease of the S. aureus population, in comparison to those without lugdunin.

Most notably, the in vitro (laboratory) testing phase provided evidence that the new discovery is also useful in eliminating other kinds of superbugs, none of which seemed to develop resistance to the new compound. The authors of the study hypothesised that lugdunin had evolved  “for the purpose of bacterial elimination in the human organism, implying that it is optimised for efficacy and tolerance at its physiological site of action". How it works, though, is not fully understood. 

The discovery of lugdunin as a potential new treatment is a breakthrough on its own. But that is not the end of the story. It holds implications for “a new concept of finding antibiotics”, according to Andreas Peschel, one of the bacteriologists behind the discovery.

The development of antibiotics has drastically slowed in recent years. In the last 50 years, only two new classes of this category of medication have been released to the market. This is due to the fact almost all antibiotics in use are derived from soil bacteria. By contrast, the new findings record the first occurrence of a strain of bacteria that exists within human bodies. Some researchers now suggest that the more hostile the environment to bacterial growth, the more likely it may be for novel antibiotics to be found. This could open up a new list of potential areas in which antibiotic research may be carried out.

When it comes to beating MRSA, there is hope that lugdunin will be our next great weapon. Peschel and his fellow collaborators are in talks with various companies about developing a medical treatment that uses lugdunin.

Meanwhile, in September 2016, the United Nations committed itself to opposing the spread of antibiotic resistance. Of the many points to which the UN signatories have agreed, possibly the most significant is their commitment to “encourage innovative ways to develop new antibiotics”. 

The initiative has the scope to achieve a lot, or dissolve into box ticking exercise. The discovery of lugdunin may well be the spark that drives it forward. Nothing to sniff about that. 

Anjuli R. K. Shere is a 2016/17 Wellcome Scholar and science intern at the New Statesman