Molecular farming for sustainable production of clinical-grade antimicrobial peptides

Antimicrobial peptides (AMPs) are emerging as next-generation therapeutics due to their broad-spectrum activity against drug-resistant bacterial strains and their ability to eradicate biofilms, modulate immune responses, exert anti-inflammatory effects and improve disease management. They are produced through solid-phase peptide synthesis or in bacterial or yeast cells. Molecular farming, i.e. the production of biologics in plants, offers a low-cost, non-toxic, scalable and simple alternative platform to produce AMPs at a sustainable cost. In this review, we discuss the advantages of molecular farming for producing clinical-grade AMPs, advances in expression and purification systems and the cost advantage for industrial-scale production. We further review how 'green' production is filling the sustainability gap, streamlining patent and regulatory approvals and enabling successful clinical translations that demonstrate the future potential of AMPs produced by molecular farming. Finally, we discuss the regulatory challenges that need to be addressed to fully realize the potential of molecular farming-based AMP production for therapeutics.

CRISPR-Based Multiplex Detection of Human Papillomaviruses for One-Pot Point-of-Care Diagnostics

The World Health Organization's global initiative toward eliminating high-risk Human Papillomavirus (hrHPV)-related cancers recommends DNA testing over visual inspection in all settings for primary cancer screening and HPV eradication by 2100. However, multiple hrHPV types cause different types of cancers, and there is a pressing need for an easy-to-use, multiplex point-of-care diagnostic platform for detecting different hrHPV types. Recently, CRISPR-Cas systems have been repurposed for point-of-care detection. Here, we established a CRISPR-Cas multiplexed diagnostic assay (CRISPRD) to detect cervical cancer-causing hrHPVs in one reaction (one-pot assay). We harnessed the compatibility of thermostable AapCas12b, TccCas13a, and HheCas13a nucleases with isothermal amplification and successfully detected HPV16 and HPV18, along with an internal control in a single-pot assay with a limit of detection of 10 copies and 100% specificity. This platform offers a rapid and practical solution for the multiplex detection of hrHPVs, which may facilitate large-scale hrHPV point-of-care screening. Furthermore, the CRISPRD platform programmability enables it to be adapted for the multiplex detection of any two nucleic acid biomarkers as well as internal control.

Inverse regulation of SOS1 and HKT1 protein localization and stability by SOS3/CBL4 in Arabidopsis thaliana

To control net sodium (Na+) uptake, Arabidopsis plants utilize the plasma membrane (PM) Na+/H+ antiporter SOS1 to achieve Na+ efflux at the root and Na+ loading into the xylem, and the channel-like HKT1;1 protein that mediates the reverse flux of Na+ unloading off the xylem. Together, these opposing transport systems govern the partition of Na+ within the plant yet they must be finely co-regulated to prevent a futile cycle of xylem loading and unloading. Here, we show that the Arabidopsis SOS3 protein acts as the molecular switch governing these Na+ fluxes by favoring the recruitment of SOS1 to the PM and its subsequent activation by the SOS2/SOS3 kinase complex under salt stress, while commanding HKT1;1 protein degradation upon acute sodic stress. SOS3 achieves this role by direct and SOS2-independent binding to previously unrecognized functional domains of SOS1 and HKT1;1. These results indicate that roots first retain moderate amounts of salts to facilitate osmoregulation, yet when sodicity exceeds a set point, SOS3-dependent HKT1;1 degradation switches the balance toward Na+ export out of the root. Thus, SOS3 functionally links and co-regulates the two major Na+ transport systems operating in vascular plants controlling plant tolerance to salinity.

Enhancement in the dielectric and magnetic properties of Ni2+-Cu2+ co-doped BaFe11Cu1-xNixO19 hexaferrites (0.0 ≤ x ≤ 1.0)

Herein, Ni2+-Cu2+ co-doped barium hexaferrites (BaFe11Cu1-xNixO19, 0.0 ≤ x≤ 1.0 with an interval of 0.25) were successfully synthesized using a co-precipitation method. The formation of a magnetoplumbite structure with the P63/mmc space group was confirmed by Rietveld refinement of the obtained X-ray diffraction patterns. Microstructural investigations revealed grains in the shape of hexagonal plates, while co-doping resulted in a variation in the grain sizes of the prepared samples. X-ray photoelectron spectroscopy was performed to determine the valence state of iron in the prepared hexaferrites. Impedance spectroscopy analysis revealed that dielectric permittivity initially decreased with an increase in the co-dopant content up to x = 0.5 and then increased by two orders of magnitude for x = 1.0. Alternatively, resistive properties showed microstructural resistance values in the range 105-108 Ω, with the highest value obtained for the sample with x = 0.5. Furthermore, magnetic measurements indicated that all the prepared samples exhibited ferrimagnetic behaviour. Saturation magnetization and magnetic anisotropy values were found to be the highest for the sample with x = 1.0, which also had the lowest coercivity among the prepared samples. Herein, the observed variations in the obtained results can be explained by the variations in grain sizes and the Fe2+/Fe3+ ratio associated with the preferential occupation of co-dopants at octahedral sites. Based on our findings, the BaFe11Ni1O19 (x = 1.0) composition appears to be the most promising choice as a microwave absorption material among the prepared samples owing to the coexistence of high dielectric permittivity (>103 at 107 Hz) and saturation magnetization (73 emu g-1).

Natural history of occult hernias in adults at a safety-net hospital

PURPOSE

Occult hernias, hernias seen on radiologic imaging but not felt on physical exam, are common. Despite their high prevalence, little is known about the natural history of this finding. Our aim was to determine and report on the natural history of patients with occult hernias including the impact on abdominal wall quality of life (AW-QOL), need for surgery, and risk of acute incarceration/strangulation.

METHODS

This was a prospective cohort study of patients who underwent a computed tomography (CT) abdomen/pelvis scan from 2016 to 2018. Primary outcome was change in AW-QOL using the modified Activities Assessment Scale (mAAS), a hernia-specific, validated survey (1 = poor, 100 = perfect). Secondary outcomes included elective and emergent hernia repairs.

RESULTS

A total of 131 (65.8%) patients with occult hernias completed follow-up with a median (IQR) of 15.4 (22.5) months. Nearly half of these patients (42.8%) experienced a decrease in their AW-QOL, 26.0% were unchanged, and 31.3% reported improvement. One-fourth of patients (27.5%) underwent abdominal surgery during the study period: 9.9% were abdominal procedures without hernia repair, 16.0% involved elective hernia repairs, and 1.5% were emergent hernia repairs. AW-QOL improved for patients who underwent hernia repair (+ 11.2 ± 39.7, p = 0.043) while those who did not undergo hernia repair experienced no change in AW-QOL (- 3.0 ± 35.1).

CONCLUSION

When untreated, patients with occult hernias on average experience no change in their AW-QOL. However, many patients experience improvement in AW-QOL after hernia repair. Additionally, occult hernias have a small but real risk of incarceration requiring emergent repair. Further research is needed to develop tailored treatment strategies.

PNA-Pdx: Versatile Peptide Nucleic Acid-Based Detection of Nucleic Acids and SNPs

Monitoring diseases caused by pathogens or by mutations in DNA sequences requires accurate, rapid, and sensitive tools to detect specific nucleic acid sequences. Here, we describe a new peptide nucleic acid (PNA)-based nucleic acid detection toolkit, termed PNA-powered diagnostics (PNA-Pdx). PNA-Pdx employs PNA probes that bind specifically to a target and are then detected in lateral flow assays. This can precisely detect a specific pathogen or genotype genomic sequence. PNA probes can also be designed to invade double-stranded DNAs (dsDNAs) to produce single-stranded DNAs for precise CRISPR-Cas12b-based detection of genomic SNPs without requiring the protospacer-adjacent motif (PAM), as Cas12b requires PAM sequences only for dsDNA targets. PNA-Pdx identified target nucleic acid sequences at concentrations as low as 2 copies/μL and precisely detected the SARS-CoV-2 genome in clinical samples in 40 min. Furthermore, the specific dsDNA invasion by the PNA coupled with CRISPR-Cas12b precisely detected genomic SNPs without PAM restriction. Overall, PNA-Pdx provides a novel toolkit for nucleic acid and SNP detection as well as highlights the benefits of engineering PNA probes for detecting nucleic acids.

Kenyan palliative care providers' and leaders' perceptions of palliative care research needs and support to facilitate rigorous research

BACKGROUND

Palliative care (PC) can reduce symptom distress and improve quality of life for patients and their families experiencing life-threatening illness. While the need for PC in Kenya is high, PC service delivery and research is limited. Qualitative research is needed to explore potential areas for PC research and support needed to enable that research. This insight is critical for informing a national PC research agenda and mobilizing limited resources for conducting rigorous PC research in Kenya.

OBJECTIVES

To explore perceptions of priority areas for PC research and support needed to facilitate rigorous research from the perspective of Kenyan PC providers and leaders.

METHODS

Focus groups (FGs) were conducted in November and December of 2018 using a semi-structured interview guide. FGs were audio-recorded, transcribed, and analyzed using a thematic content analysis approach.

RESULTS

Three FGs were conducted (n = 22 participants). Ten themes related to PC research emerged, including research on: 1) beliefs about death, disease, and treatment to inform PC; 2) awareness about PC, 3) integration of PC within the health system; 4) understanding caregiver experiences and needs; 5) community health volunteers (CHVs) and volunteer programs; 6) evaluation of costs and benefits of PC; 7) treatment approaches, including complementary and alternative medicine (CAM) and advanced diagnostics at end of life; 8) other suggestions for research, 9) populations in need of PC research; and 10) resources for enabling research.

CONCLUSIONS

Kenyan PC providers and leaders identified key areas requiring increased scientific inquiry and critical resources needed to enable this research. These findings can help to focus future PC research in Kenya and encourage funding agencies to prioritize the issues identified.

Efficient in planta production of amidated antimicrobial peptides that are active against drug-resistant ESKAPE pathogens

Antimicrobial peptides (AMPs) are promising next-generation antibiotics that can be used to combat drug-resistant pathogens. However, the high cost involved in AMP synthesis and their short plasma half-life render their clinical translation a challenge. To address these shortcomings, we report efficient production of bioactive amidated AMPs by transient expression of glycine-extended AMPs in Nicotiana benthamiana line expressing the mammalian enzyme peptidylglycine α-amidating mono-oxygenase (PAM). Cationic AMPs accumulate to substantial levels in PAM transgenic plants compare to nontransgenic N. benthamiana. Moreover, AMPs purified from plants exhibit robust killing activity against six highly virulent and antibiotic resistant ESKAPE pathogens, prevent their biofilm formation, analogous to their synthetic counterparts and synergize with antibiotics. We also perform a base case techno-economic analysis of our platform, demonstrating the potential economic advantages and scalability for industrial use. Taken together, our experimental data and techno-economic analysis demonstrate the potential use of plant chassis for large-scale production of clinical-grade AMPs.

Fabrication of La3+ doped Ba1-x La x TiO3 ceramics with improved dielectric and ferroelectric properties using a composite-hydroxide-mediated method

Lanthanum (La³⁺) doped Ba_1-x La _x TiO₃ (x = 0.0, 0.0025, 0.005, 0.0075) ceramics were synthesized by the composite-hydroxide-mediated method. Rietveld refinement of the XRD patterns confirmed the formation of a perovskite crystal structure that transforms from tetragonal to pseudo-cubic with La³⁺ doping content (x). Scanning electron microscopy displayed a dense and homogeneous microstructure with reduced grain size on La³⁺ doping. The frequency and temperature-dependent dielectric measurements showed an improvement in the dielectric permittivity, a decrease in the ferroelectric-paraelectric transition temperature, and an increase in the dielectric diffusivity with increasing La³⁺ doping content. Complex impedance analysis indicated the semiconducting behavior with a positive temperature coefficient of resistance effect, which could be explained in terms of a charge compensation mechanism in the donor doped BaTiO₃. The ferroelectric hysteresis loops revealed that these ceramics are ferroelectric in nature, while an improvement in the energy storage density and energy storage efficiency was observed for the doped samples due to reduced grain size on La³⁺ doping. Here, the sample with x = 0.005 has a high dielectric permittivity, a low dielectric tangent loss, and the highest energy storage efficiency. This makes this composition interesting for energy storage applications.

Improvement of Soybean; A Way Forward Transition from Genetic Engineering to New Plant Breeding Technologies

Soybean is considered one of the important crops among legumes. Due to high nutritional contents in seed (proteins, sugars, oil, fatty acids, and amino acids), soybean is used globally for food, feed, and fuel. The primary consumption of soybean is vegetable oil and feed for chickens and livestock. Apart from this, soybean benefits soil fertility by fixing atmospheric nitrogen through root nodular bacteria. While conventional breeding is practiced for soybean improvement, with the advent of new biotechnological methods scientists have also engineered soybean to improve different traits (herbicide, insect, and disease resistance) to fulfill consumer requirements and to meet the global food deficiency. Genetic engineering (GE) techniques such as transgenesis and gene silencing help to minimize the risks and increase the adaptability of soybean. Recently, new plant breeding technologies (NPBTs) emerged such as zinc-finger nucleases, transcription activator-like effector nucleases, and Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR/Cas9), which paved the way for enhanced genetic modification of soybean. These NPBTs have the potential to improve soybean via gene functional characterization precision genome engineering for trait improvement. Importantly, these NPBTs address the ethical and public acceptance issues related to genetic modifications and transgenesis in soybean. In the present review, we summarized the improvement of soybean through GE and NPBTs. The valuable traits that have been improved through GE for different constraints have been discussed. Moreover, the traits that have been improved through NPBTs and potential targets for soybean improvements via NPBTs and solutions for ethical and public acceptance are also presented.

Bio-SCAN V2: A CRISPR/dCas9-based lateral flow assay for rapid detection of theophylline

Rapid, specific, and robust diagnostic strategies are needed to develop sensitive biosensors for small molecule detection, which could aid in controlling contamination and disease transmission. Recently, the target-induced collateral activity of Cas nucleases [clustered regularly interspaced short palindromic repeats (CRISPR)-associated nucleases] was exploited to develop high-throughput diagnostic modules for detecting nucleic acids and small molecules. Here, we have expanded the diagnostic ability of the CRISPR-Cas system by developing Bio-SCAN V2, a ligand-responsive CRISPR-Cas platform for detecting non-nucleic acid small molecule targets. The Bio-SCAN V2 consists of an engineered ligand-responsive sgRNA (ligRNA), biotinylated dead Cas9 (dCas9-biotin), 6-carboxyfluorescein (FAM)-labeled amplicons, and lateral flow assay (LFA) strips. LigRNA interacts with dCas9-biotin only in the presence of sgRNA-specific ligand molecules to make a ribonucleoprotein (RNP). Next, the ligand-induced ribonucleoprotein is exposed to FAM-labeled amplicons for binding, and the presence of the ligand (small molecule) is detected as a visual signal [(dCas9-biotin)-ligRNA-FAM labeled DNA-AuNP complex] at the test line of the lateral flow assay strip. With the Bio-SCAN V2 platform, we are able to detect the model molecule theophylline with a limit of detection (LOD) up to 2 μM in a short time, requiring only 15 min from sample application to visual readout. Taken together, Bio-SCAN V2 assay provides a rapid, specific, and ultrasensitive detection platform for theophylline.

A CRISPR-based lateral flow assay for plant genotyping and pathogen diagnostics

Efficient pathogen diagnostics and genotyping methods enable effective disease management and breeding, improve crop productivity and ensure food security. However, current germplasm selection and pathogen detection techniques are laborious, time-consuming, expensive and not easy to mass-scale application in the field. Here, we optimized a field-deployable lateral flow assay, Bio-SCAN, as a highly sensitive tool to precisely identify elite germplasm and detect mutations, transgenes and phytopathogens in <1 h, starting from sample isolation to result output using lateral flow strips. As a proof of concept, we genotyped various wheat germplasms for the Lr34 and Lr67 alleles conferring broad-spectrum resistance to stripe rust, confirmed the presence of synthetically produced herbicide-resistant alleles in the rice genome and screened for the presence of transgenic elements in the genome of transgenic tobacco and rice plants with 100% specificity. We also successfully applied this new assay to the detection of phytopathogens, including viruses and bacterial pathogens in Nicotiana benthamiana, and two destructive fungal pathogens (Puccinia striiformis f. sp. tritici and Magnaporthe oryzae Triticum) in wheat. Our results illustrate the power of Bio-SCAN in crop breeding, genetic engineering and pathogen diagnostics to enhance food security. The high sensitivity, simplicity, versatility and in-field deployability make the Bio-SCAN as an attractive molecular diagnostic tool for diverse applications in agriculture.

Adults with concomitant atopic dermatitis and asthma have more frequent urgent health care utilization and less frequent scheduled follow-up visits than adults with atopic dermatitis or asthma only: A nationwide cohort study

BACKGROUND

Atopic dermatitis (AD) and asthma often co-occur in the same patient, and health care utilization is related to disease severity of these diseases.

OBJECTIVE

To investigate differences in healthcare utilization in adults with concomitant AD and asthma compared to patients with asthma or AD only.

METHODS

All Danish adults with a hospital-diagnosis of AD, asthma or concomitant AD and asthma recorded in national registries were included. Health care utilization data were obtained in 3-month intervals from two year prior to index date (the date of the first hospital diagnosis), and to five years after.

RESULTS

A total of 12,409 patients with AD were included (11,590 with AD only and 819 with concomitant AD and asthma), and 65,539 with asthma only. Adults with concomitant AD and asthma had higher risk of hospitalization for AD (OR 1.38, 95% CI (1.15-1.67), p=0.001) and asthma (OR 1.16, 95% CI (1.00-1.35), p=0.047) compared to patients with only AD and asthma, respectively. These patients also had fewer visits in outpatient clinics for AD (OR 0.10, 95% CI (0.08-0.12), p<0.001) and asthma (OR 0.34, 95% CI (0.29-0.39), P<0.001) compared to patients with only AD or asthma. Outpatient clinic visits for rhinitis were more frequent among patients with concomitant AD and asthma compared to patients with only AD or asthma.

CONCLUSION

Adults with concomitant AD and asthma had different patterns of healthcare utilization compared to adults with AD or asthma alone, suggesting that improvements in management and monitoring may reduce unscheduled health care visits, and lower healthcare costs.

P-738 Impact of limited reproductive health awareness on PCOS diagnosis timelines and the need for improved patient education

Study question

Does the lack of awareness of Polycystic ovary syndrome (PCOS) symptoms contribute to a delay in diagnosis?

Summary answer

Limited awareness regarding reproductive health symptoms can negatively impact help-seeking behaviour, delaying diagnostic timelines.

What is known already

PCOS is a common endocrine condition estimated to affect up to 20% of women worldwide. Frequently observed symptoms include oligomenorrhea or amenorrhea, clinical features of hyperandrogenism, metabolic dysfunction, infertility and poor mental health.

Despite its prevalence and the debilitating impact of symptoms on quality of life, it takes an average of two years and over three clinical consultations to diagnose. Delayed diagnosis may be influenced by a lack of standardised screening guidelines, poor understanding of how PCOS manifests in ethnic minorities and hesitancy from the general public to seek help for their reproductive health symptoms.

Study design, size, duration

A cross-sectional study investigating the barriers to diagnosis of PCOS.

Participants aged 18 or older with an existing or suspected diagnosis of PCOS were invited to complete an online survey across five days in January 2022.

The survey assessed general demographic information, the influence of symptoms on their daily life and their experiences with receiving a diagnosis.

Of the 200 responses, 143 responses were analysed and 99 were included in the results.

Participants/materials, setting, methods

Participants were aged between 18 - 45 and provided informed consent after reading a patient information leaflet detailing the background of the study.

75 (52.44%) participants were UK-based, while 68 (47.55%) were based abroad.

Ethical approval of all study-related documents was given by the Hertility Health Research Ethics Committee.

The online survey was presented on Typeform and disseminated via the social media platforms Instagram, Twitter and LinkedIn.

Descriptive statistics are presented.

Main results and the role of chance

Of the 143 participants, 99 (69.2%) reported a PCOS diagnosis. Anxiety (71.4%), irregular menstrual cycles (69.4%) and weight-related concerns (64.3%) were the most commonly reported symptoms.

Despite the majority reporting that their symptoms impacted daily life (80.8%), mental health (82.8%), and educational or work performance (70.7%), only 10.2% had sought medical help immediately while 75.5% waited for up to 2 years.

Not realising their symptoms required medical help (73.2%), lack of information regarding routes to care (18.3%) and stigma from family members (18.3%) were the most common reasons why medical help was not sought immediately.

Following clinical consultations, 54.7% of participants were not satisfied with the information provided to manage their diagnosis. Although mental health-related symptoms were most frequently reported (75.5%), only 4.8% reported that management strategies for mental health were referenced in their consultations.

Of the 93.2% of those looking for extra information online, only 52.3% used official websites such as the National Health Service (NHS) website. Many participants also chose to use social media sources such as Instagram and Tik Tok for information (52.3%) and support (59.3%).

Limitations, reasons for caution

Although there was a global uptake, the study needs to be carried out on a larger scale with an emphasis on minority ethnicities.

Recall bias could have also impacted findings as the participants were required to provide details on their entire diagnosis experience.

Wider implications of the findings

It is evident that limited awareness regarding reproductive health can delay the diagnosis of PCOS.

Due to unsatisfactory management by healthcare providers, patients heavily rely on unregulated channels such as social media to obtain reproductive health information, highlighting the need for better Sex and Fertility Education programs and improved accessibility.

Trial registration number

NA

Unusual semiconductor-metal-semiconductor transitions in magnetite Fe3O4 nanoparticles

Magnetite (Fe₃O₄) nanoparticles were successfully prepared by a co-precipitation method. Rietveld refinement on the X-ray diffraction pattern confirmed the development of a single-phase cubic spinel structure with space group Fd3̄m. However, ⁵⁷Fe Mössbauer spectroscopy suggested the presence of Fe³⁺ and Fe^2.5+ (mixed Fe³⁺ and Fe²⁺) ions at the tetrahedral and octahedral sites of the inverse spinel structure, respectively. Impedance spectroscopy measurements showed a discontinues variation in the temperature dependence of the sample's resistive behavior, indicating the appearance of semiconductor–metal–semiconductor like transitions between the temperature range of 293 and 373 K. A similar dual transition was also observed from the dielectric and conductivity measurements around the same temperature regions. The observed unusual transition is explained in term of the competitive effects among the hopping of localized/delocalized and short-range/long-range charge carriers present in the sample. Moreover, the prepared sample exhibits colossal dielectric permittivity (∼10⁶), reduced tangent loss (∼0.2) and moderate conductivity (>10⁻⁶ S cm⁻¹) values, making Fe₃O₄ nanoparticles a potential candidate for electromagnetic absorbing materials.

Herein, we report the existence of a novel semiconductor–metal–semiconductor type transition in Fe₃O₄ nanoparticles by employing impedance spectroscopy techniques.

iSCAN-V2: A One-Pot RT-RPA–CRISPR/Cas12b Assay for Point-of-Care SARS-CoV-2 Detection

Rapid, specific, and sensitive detection platforms are prerequisites for early pathogen detection to efficiently contain and control the spread of contagious diseases. Robust and portable point-of-care (POC) methods are indispensable for mass screening of SARS-CoV-2. Clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas)-based nucleic acid detection technologies coupled with isothermal amplification methods provide a straightforward and easy-to-handle platform for detecting SARS-CoV-2 at POC, low-resource settings. Recently, we developed iSCAN, a two-pot system based on coupled loop-mediated isothermal amplification (LAMP) and CRISPR/Cas12a reactions. However, in two-pot systems, the tubes must be opened to conduct both reactions; two-pot systems thus have higher inherent risks of cross-contamination and a more cumbersome workflow. In this study, we developed and optimized iSCAN-V2, a one-pot reverse transcription-recombinase polymerase amplification (RT-RPA)-coupled CRISPR/Cas12b-based assay for SARS-CoV-2 detection, at a single temperature in less than an hour. Compared to Cas12a, Cas12b worked more efficiently in the iSCAN-V2 detection platform. We assessed and determined the critical factors, and present detailed guidelines and considerations for developing and establishing a one-pot assay. Clinical validation of our iSCAN-V2 detection module with reverse transcription-quantitative PCR (RT-qPCR) on patient samples showed 93.75% sensitivity and 100% specificity. Furthermore, we coupled our assay with a low-cost, commercially available fluorescence visualizer to enable its in-field deployment and use for SARS-CoV-2 detection. Taken together, our optimized iSCAN-V2 detection platform displays critical features of a POC molecular diagnostic device to enable mass-scale screening of SARS-CoV-2 in low-resource settings.

CS-Cells: A CRISPR-Cas12 DNA Device to Generate Chromosome-Shredded Cells for Efficient and Safe Molecular Biomanufacturing

Synthetic biology holds great promise for translating ideas into products to address the grand challenges facing humanity. Molecular biomanufacturing is an emerging technology that facilitates the production of key products of value, including therapeutics and select chemical compounds. Current biomanufacturing technologies require improvements to overcome limiting factors, including efficient production, cost, and safe release; therefore, developing optimum chassis for biomolecular manufacturing is of great interest for enabling diverse synthetic biology applications. Here, we harnessed the power of the CRISPR-Cas12 system to design, build, and test a DNA device for genome shredding, which fragments the native genome to enable the conversion of bacterial cells into nonreplicative, biosynthetically active, and programmable molecular biomanufacturing chassis. As a proof of concept, we demonstrated the efficient production of green fluorescent protein and violacein, an antimicrobial and antitumorigenic compound. Our CRISPR-Cas12-based chromosome-shredder DNA device has built-in biocontainment features providing a roadmap for the conversion of any bacterial cell into a chromosome-shredded chassis amenable to high-efficiency molecular biomanufacturing, thereby enabling exciting and diverse biotechnological applications.

Bio-SCAN: A CRISPR/dCas9-Based Lateral Flow Assay for Rapid, Specific, and Sensitive Detection of SARS-CoV-2

Simple, rapid, specific, and sensitive point-of-care detection methods are needed to contain the spread of SARS-CoV-2. CRISPR/Cas9-based lateral flow assays are emerging as a powerful alternative for COVID-19 diagnostics. Here, we developed Bio-SCAN (biotin-coupled specific CRISPR-based assay for nucleic acid detection) as an accurate pathogen detection platform that requires no sophisticated equipment or technical expertise. Bio-SCAN detects the SARS-CoV-2 genome in less than 1 h from sample collection to result. In the first step, the target nucleic acid sequence is isothermally amplified in 15 min via recombinase polymerase amplification before being precisely detected by biotin-labeled nuclease-dead SpCas9 (dCas9) on commercially available lateral flow strips. The resulting readout is visible to the naked eye. Compared to other CRISPR-Cas-based pathogen detection assays, Bio-SCAN requires no additional reporters, probes, enhancers, reagents, or sophisticated devices to interpret the results. Bio-SCAN is highly sensitive and successfully detected a clinically relevant level (4 copies/μL) of synthetic SARS-CoV-2 RNA genome. Similarly, Bio-SCAN showed 100% negative and 96% positive predictive agreement with RT-qPCR results when using clinical samples (86 nasopharyngeal swab samples). Furthermore, incorporating variant-specific sgRNAs in the detection reaction allowed Bio-SCAN to efficiently distinguish between the α, β, and δ SARS-CoV-2 variants. Also, our results confirmed that the Bio-SCAN reagents have a long shelf life and can be assembled locally in nonlaboratory and limited-resource settings. Furthermore, the Bio-SCAN platform is compatible with the nucleic acid quick extraction protocol. Our results highlight the potential of Bio-SCAN as a promising point-of-care diagnostic platform that can facilitate low-cost mass screening for SARS-CoV-2.

Improving and Sustaining the Quality of Discharge Summaries

High quality discharge information communication has been linked to a reduction in the incidence of adverse events, decreasing the risk of prescription errors and lost follow up. In this paper we describe how our trust-wide quality improvement project, led by acute physicians, successfully improved discharge documentation. We demonstrate how we identified obstacles to continued success, and the interventions we implemented. We recommend how discharge summary quality can be optimised through training of junior doctors, recruitment of local champions, and use of novel methods to preserve engagement, such as gamification.

The interplay of saliva, erosion and attrition on enamel and dentine

Purpose

This investigation aimed to compare the protective role of saliva against erosion and attrition challenges.

Method

Polished enamel and dentine samples (n = 160) were prepared and randomly assigned to either the saliva or saliva-free group (n = 40 enamel and n = 40 dentine/group). Within each subgroup, they were allocated to four subgroups: negative control (deionized water exposure 10 min), erosion (0.3% citric acid 10 min), attrition (120 S of 300 g force), or combined erosion/attrition (0.3% citric acid 10 min then 120 S of 300 g force). Experimental cycles were repeated three times. Data analysis was performed using SPSS.

Results

The mean and standard deviation (SD) of step heights produced by the attrition and erosion/attrition groups in enamel in the saliva-free group were 5.6 µm (2.4) and 13.4 µm (2.8), respectively, while they were 2.4 µm (3.8) and 12.9 µm (3.5) in the saliva group, with no significant difference between the saliva and saliva-free groups. For dentine, the corresponding step heights were 25.2 µm (5.5) and 35.9 µm (7.9) for the saliva-free group, but 21.8 µm (5.3) and 27.3 µm (6.4) for the saliva group (p < 0.001).

Conclusion

There was a trend that saliva decreased wear, but this was only statistically significant for erosion/attrition dentine wear.

Development of laser induced breakdown spectroscopy technique to study irrigation water quality impact on nutrients and toxic elements distribution in cultivated soil

This study is focused mainly on impact of irrigation water quality in cultivated soil on distribution of essentials nutrients (Al, Mg, Ca, Fe, S, Si, Na, P, and K) and relatively toxic metals (As, Ba, Cr, Cu, Ti, Sn, Mn, Ni, and Zn) using an elegant Laser induced breakdown spectroscopy (LIBS) technique. A pulsed Nd:YAG laser operating at 1064 nm in conjunction with suitable detector was applied to record soil emission spectra. The abundance of these elements were evaluated via standard calibration curve Laser Induced Breakdown Spectroscopy (CC-LIBS) and calibration free Laser Induced Breakdown Spectroscopy (CF-LIBS) approaches. Quantitative analyses were accomplished under conjecture of local thermodynamic equilibrium (L.T.E) and optically thin plasma. The average electron temperatures were estimated by Boltzmann plot method for cultivated soil samples in 7800 to 9300 K range. The electron number density was ~ 1.11 × 1017 cm − 3 to 1.60 × 1017 cm − 3. Prior to application on soil samples, the experimental setup was optimized at the following parameters: pulsed energy = 60 mJpulse-1, sample to lens distance of 9.0 cm, and the gate delay of 3.5 μs. It is noteworthy that nutritional elements content of cultivated soils were found strongly dependent upon the irrigation water quality. The cultivated soil from industrial area was found rich of toxins while the cultivated land using tube well water contains toxins in least amount. Our LIBS findings were also validated by comparing its results with contents measured using a standard inductively coupled plasma optical emission spectroscopy (ICP-OES) method and both were found in excellent agreement. The present study could be highly beneficial for agricultural applications and for farmers to produce safe food products and higher crops yield.

Factors influencing integrated information management: Spatial data infrastructure in Pakistan

Spatial data is one of the core components in all information retrieval processes for decision-making. Spatial data acquisition consumes enormous monetary resources and time. The Integrated Geospatial Information Framework (IGIF) provides a basis and guide for developing, integrating, strengthening, and maximizing geospatial information management and related resources in all countries. To this, governments all over the world are establishing national spatial data infrastructures (SDIs). However, such initiatives face a considerable amount of resistance as organizations often do not want to share their data assets. The present study investigates these barriers in the establishment of national SDI in Pakistan. The constraints studied through the IGIF pathways and past studies were adapted via a pilot study and conceptualized in a hypothesized model. We collected primary data via the administration of 520 questionnaire surveys to 280 public and private organizations. Partial least squares structural equation modeling (PLS-SEM) was applied to statistically confirm the conceptual model of the barriers to disseminating spatial data. The results indicate institutional barriers from the absence of national data policy, lack of specified roles of stakeholders, poor inter-organizational coordination, missing data-sharing policy, and weak organizational partnerships, with coefficients 0.26, 1.555, 1.305, 8.288, and 0.136, respectively, at the p < 0.001 significance level. The PLS-SEM R2 0.65 indicates a good explanatory power of the model. The methodology developed in the present study will allow devising more sustainable policies for spatial data management and dissemination in Pakistan and beyond.

Homozygous missense WIPI2 variants cause a congenital disorder of autophagy with neurodevelopmental impairments of variable clinical severity and disease course

WIPI2 is a member of the human WIPI protein family (seven-bladed b-propeller proteins binding phosphatidylinositols, PROPPINs), which play a pivotal role in autophagy and has been implicated in the pathogenesis of several neurological conditions. The homozygous WIPI2 variant c.745G>A; p.(Val249Met) (NM_015610.4) has recently been associated with a neurodevelopmental disorder in a single family. Using exome sequencing and Sanger segregation analysis, here, two novel homozygous WIPI2 variants [c.551T>G; p.(Val184Gly) and c.724C>T; p.(Arg242Trp) (NM_015610.4)] were identified in four individuals of two consanguineous families. Additionally, follow-up clinical data were sought from the previously reported family. Three non-ambulant affected siblings of the first family harbouring the p.(Val184Gly) missense variant presented with microcephaly, profound global developmental delay/intellectual disability, refractory infantile/childhood-onset epilepsy, progressive tetraplegia with joint contractures and dyskinesia. In contrast, the proband of the second family carrying the p.(Arg242Trp) missense variant, similar to the initially reported WIPI2 cases, presented with a milder phenotype, encompassing moderate intellectual disability, speech and visual impairment, autistic features, and an ataxic gait. Brain MR imaging in five patients showed prominent white matter involvement with a global reduction in volume, posterior corpus callosum hypoplasia, abnormal dentate nuclei and hypoplasia of the inferior cerebellar vermis. To investigate the functional impact of these novel WIPI2 variants, we overexpressed both in WIPI2-knockout HEK293A cells. In comparison to wildtype, expression of the Val166Gly WIPI2b mutant resulted in a deficient rescue of LC3 lipidation whereas Arg224Trp mutant increased LC3 lipidation, in line with the previously reported Val231Met variant. These findings support a dysregulation of the early steps of the autophagy pathway. Collectively, our findings provide evidence that biallelic WIPI2 variants cause a neurodevelopmental disorder of variable severity and disease course. Our report expands the clinical spectrum and establishes WIPI2-related disorder as a congenital disorders of autophagy.

Comorbid mental health issues in patients with pemphigus vulgaris and pemphigus foliaceus

The term 'pemphigus' refers to chronic autoimmune skin disorders that cause blistering erosions on the skin and oral mucosa. The two major clinical forms are pemphigus vulgaris and pemphigus foliaceus. Although rare, they confer a stark symptomatic burden upon patients that significantly impacts daily life. Comorbid mental health issues are not routinely screened for in patients with pemphigus, and current UK guidance provides no formal provision for the identification and treatment of psychological issues. This review is the first of its kind, to our knowledge, to systematically examine the available evidence on mental health issues in pemphigus. Published work suggests that the incidence of anxiety and depression is much higher in patients with pemphigus compared with both the general population and with patients having other chronic skin disorders. Disease severity appears to be closely linked to mental health, with worsening of pemphigus associated with deteriorations in psychological wellbeing. Corticosteroids, which are associated with depression in chronic use, are the current first-line therapy for pemphigus and have been identified as a potential confounder and independent risk factor for mental health comorbidity in pemphigus. Current evidence is unclear whether a bidirectional relationship exists between mental health and pemphigus severity, and more thorough research is required to develop understanding of this issue. In conclusion, we have identified a high incidence of mental health comorbidity in pemphigus, and recommend routine screening of patients with pemphigus for mental health issues and signposting toward mental health services as an initial measure to address this.

CRISPR/Cas systems versus plant viruses: engineering plant immunity and beyond

Molecular engineering of plant immunity to confer resistance against plant viruses holds great promise for mitigating crop losses and improving plant productivity and yields, thereby enhancing food security. Several approaches have been employed to boost immunity in plants by interfering with the transmission or lifecycles of viruses. In this review, we discuss the successful application of clustered regularly interspaced short palindromic repeats (CRISPR)/CRISPR-associated protein (Cas) (CRISPR/Cas) systems to engineer plant immunity, increase plant resistance to viruses, and develop viral diagnostic tools. Furthermore, we examine the use of plant viruses as delivery systems to engineer virus resistance in plants and provide insight into the limitations of current CRISPR/Cas approaches and the potential of newly discovered CRISPR/Cas systems to engineer better immunity and develop better diagnostics tools for plant viruses. Finally, we outline potential solutions to key challenges in the field to enable the practical use of these systems for crop protection and viral diagnostics.

Immunotherapy and Systemic Therapy in Metastatic/Recurrent Endometrial and Cervical Cancers

Despite advances in the treatment of gynaecological malignancies, both recurrent endometrial and cervical cancers when not amenable to localised therapy (surgery or radiotherapy), remain incurable with limited prognosis and effective treatment options. Chemotherapy remains the standard of care for women with metastatic endometrial or cervical cancers. The addition of bevacizumab to first-line chemotherapy for metastatic cervical cancer patients represents a significant step forward in improving survival. More recently, immunotherapeutic strategies targeting the PD-1/-L1 pathway have shown clinical activity in both endometrial and cervical cancers. The increased understanding of the molecular biology of these cancers is shaping target-specific treatments. Here we summarise current treatment options and results from clinical trials of immunotherapy and other targeted therapies that have already changed, or have the potential to change, clinical practice in metastatic/recurrent endometrial and cervical cancer.

Development, Characterization, and Evaluation of SLN-Loaded Thermoresponsive Hydrogel System of Topotecan as Biological Macromolecule for Colorectal Delivery

BACKGROUND

Chemotherapeutic drugs cause severe toxicities if administered unprotected, without proper targeting, and controlled release. In this study, we developed topotecan- (TPT-) loaded solid lipid nanoparticles (SLNs) for their chemotherapeutic effect against colorectal cancer. The TPT-SLNs were further incorporated into a thermoresponsive hydrogel system (TRHS) (TPT-SLNs-TRHS) to ensure control release and reduce toxicity of the drug. Microemulsion technique and cold method were, respectively, used to develop TPT-SLNs and TPT-SLNs-TRHS. Particle size, polydispersive index (PDI), and incorporation efficiency (IE) of the TPT-SLNs were determined. Similarly, gelation time, gel strength, and bioadhesive force studies of the TPT-SLNs-TRHS were performed. Additionally, in vitro release and pharmacokinetic and antitumour evaluations of the formulation were done.

RESULTS

TPT-SLNs have uniformly distributed particles with mean size in nanorange (174 nm) and IE of ~90%. TPT-SLNs-TRHS demonstrated suitable gelation properties upon administration into the rat's rectum. Moreover, drug release was exhibited in a control manner over an extended period of time for the incorporated TPT. Pharmacokinetic studies showed enhanced bioavailability of the TPT with improved plasma concentration and AUC. Further, it showed significantly enhanced antitumour effect in tumour-bearing mice as compared to the test formulations.

CONCLUSION

It can be concluded that SLNs incorporated in TRHS could be a potential source of the antitumour drug delivery with better control of the drug release and no toxicity.

755 Elective Surgery in the COVID-19 Pandemic: Outcomes of 100 Consecutive Cases

Introduction

The COVID-19 pandemic halted elective surgical activity. Basildon University Hospital established an elective Green Zone for COVID-19 swab negative patients who isolated for 14 days. This study reviewed the outcomes of the first 100 patients.

Method

A single-centre study was performed. Demographic and perioperative electronic data were supplemented with telephone follow-up for the first 100 Green Zone patients and analysed in Microsoft Excel.

Results

One hundred Green Zone patients underwent surgery between 21/05/2020 and 16/06/2020. The median age was 55 (14-88) years. 52% were female. Their operations were performed by General Surgery (39%), Gynaecology (17%), Vascular Surgery (14%), Oral Surgery (12%), ENT (9%), Urology (8%), and Pain Management (1%).

Preoperatively, 100% had a negative SARS-CoV-2 swab and one had CT evidence of mild resolving COVID-19. Two patients had postoperative SARS-CoV-2 swabs, both negative. Median length of stay was 0 (0-7) days. 84% responded to telephone follow-up at a median 25 (13-54) postoperative days, 69% of whom were asymptomatic There were no 30-day major complications (>Clavien-Dindo IIIa) or 90-day mortality.

Conclusions

Elective surgery can be safe during the COVID-19 pandemic, with appropriate measures in place. This has significant implications in the context of an ever-expanding NHS waiting list during a pandemic of uncertain duration.

Vigilant: An Engineered VirD2-Cas9 Complex for Lateral Flow Assay-Based Detection of SARS-CoV2

Rapid, sensitive, and specific point-of-care testing for pathogens is crucial for disease control. Lateral flow assays (LFAs) have been employed for nucleic acid detection, but they have limited sensitivity and specificity. Here, we used a fusion of catalytically inactive SpCas9 endonuclease and VirD2 relaxase for sensitive, specific nucleic acid detection by LFA. In this assay, the target nucleic acid is amplified with biotinylated oligos. VirD2-dCas9 specifically binds the target sequence via dCas9 and covalently binds to a FAM-tagged oligonucleotide via VirD2. The biotin label and FAM tag are detected by a commercially available LFA. We coupled this system, named Vigilant (VirD2-dCas9 guided and LFA-coupled nucleic acid test), to reverse transcription-recombinase polymerase amplification to detect SARS-CoV2 in clinical samples. Vigilant exhibited a limit of detection of 2.5 copies/μL, comparable to CRISPR-based systems, and showed no cross-reactivity with SARS-CoV1 or MERS. Vigilant offers an easy-to-use, rapid, cost-effective, and robust detection platform for SARS-CoV2.

LAMP-Coupled CRISPR-Cas12a Module for Rapid and Sensitive Detection of Plant DNA Viruses

One important factor for successful disease management is the ability to rapidly and accurately identify the causal agent. Plant viruses cause severe economic losses and pose a serious threat to sustainable agriculture. Therefore, optimization of the speed, sensitivity, feasibility, portability, and accuracy of virus detection is urgently needed. Here, we developed a clustered regularly interspaced short palindromic repeats (CRISPR)-based nucleic acid diagnostic method utilizing the CRISPR–Cas12a system for detecting two geminiviruses, tomato yellow leaf curl virus (TYLCV) and tomato leaf curl New Delhi virus (ToLCNDV), which have single-stranded DNA genomes. Our assay detected TYLCV and ToLCNDV in infected plants with high sensitivity and specificity. Our newly developed assay can be performed in ~1 h and provides easy-to-interpret visual readouts using a simple, low-cost fluorescence visualizer, making it suitable for point-of-use applications.

Thirty-day mortality following surgical management of hip fractures during the COVID-19 pandemic: findings from a prospective multi-centre UK study

PURPOSE

Thirty-day mortality of patients with hip fracture is well researched and predictive; validated scoring tools have been developed (Nottingham Hip Fracture Score, NHFS). COVID-19 has significantly greater mortality in the elderly and comorbid patients which includes hip fracture patients. Non-operative treatment is not appropriate due to significantly higher mortality, and therefore, these patients are often exposed to COVID-19 in the peri-operative period. What is unclear is the effect of concomitant COVID-19 infection in these patients.

METHODS

A multicentre prospective study across ten sites in the United Kingdom (responsible for 7% of hip fracture patients per annum in the UK). Demographic and background information were collected by independent chart review. Data on surgical factors included American Society of Anesthesiologists (ASA) score, time to theatre, Nottingham Hip fracture score (NHFS) and classification of fracture were also collected between 1st March 2020 and 30th April 2020 with a matched cohort from the same period in 2019.

RESULTS

Actual and expected 30-day mortality was found to be significantly higher than expected for 2020 COVID-19 positive patients (RR 3.00 95% CI 1.57-5.75, p < 0.001), with 30 observed deaths compared against the 10 expected from NHFS risk stratification.

CONCLUSION

COVID-19 infection appears to be an independent risk factor for increased mortality in hip fracture patients. Whilst non-operative management of these fractures is not suggested due to the documented increased risks and mortality, this study provides evidence to the emerging literature of the severity of COVID-19 infection in surgical patients and the potential impact of COVID-19 on elective surgical patients in the peri-operative period.

Synthesis of CuO-NPS by simple wet chemical method using various dicarboxylic acid salts as precursors: Spectral characterization and in-vitro biological evaluation

In this study, a simple chemical reduction method was employed to synthesize CuO-NPs.  Various dicarboxylic acids were converted into Cu(II) salt of dicarboxylic acid which were used as precursors. NPs were produced by reducing precursors with NaBH4. Characteristics of synthesized NPs were investigated by using important analytical techniques including Fourier transform infrared (FTIR) spectroscopy, X-ray diffraction (XRD), thermo gravimetric analysis (TGA) and scanning electron microscopy (SEM). Developed NPs were investigated for their antibacterial activity against a range of bacterial strains by employing agar well diffusion method. CuO-NPs exhibited good to moderate activity against E-Coli, B. Subtilis and poor activity against K. pneumonia and Methicillin-resistant Staphylococcus aureus (MRSA). It was found that amongst all experienced compounds sample 2 showed good activity with minimum inhibition concentration (MIC) 10 µg/mL (zone of inhibition: 22± 0.12 mm) while sample 3 showed poor activity with MIC 40 µg/mL (zone of inhibition: 8.0 ± 0.18 mm).                     KEY WORDS: CuO-NPs, Dicarboxylic acids, Sodium borohydride, Antibacterial study   Bull. Chem. Soc. Ethiop. 2020, 34(2), 323-334 DOI: https://dx.doi.org/10.4314/bcse.v34i2.10

iSCAN: An RT-LAMP-coupled CRISPR-Cas12 module for rapid, sensitive detection of SARS-CoV-2

The COVID-19 pandemic caused by SARS-CoV-2 affects all aspects of human life. Detection platforms that are efficient, rapid, accurate, specific, sensitive, and user friendly are urgently needed to manage and control the spread of SARS-CoV-2. RT-qPCR based methods are the gold standard for SARS-CoV-2 detection. However, these methods require trained personnel, sophisticated infrastructure, and a long turnaround time, thereby limiting their usefulness. Reverse transcription-loop-mediated isothermal amplification (RT-LAMP), a one-step nucleic acid amplification method conducted at a single temperature, has been used for colorimetric virus detection. CRISPR-Cas12 and CRISPR-Cas13 systems, which possess collateral activity against ssDNA and RNA, respectively, have also been harnessed for virus detection. Here, we built an efficient, rapid, specific, sensitive, user-friendly SARS-CoV-2 detection module that combines the robust virus amplification of RT-LAMP with the specific detection ability of SARS-CoV-2 by CRISPR-Cas12. Furthermore, we combined the RT-LAMP-CRISPR-Cas12 module with lateral flow cells to enable highly efficient point-of-care SARS-CoV-2 detection. Our iSCAN SARS-CoV-2 detection module, which exhibits the critical features of a robust molecular diagnostic device, should facilitate the effective management and control of COVID-19.

National Clinical Guidance for the Management of Cardiovascular Intervention in the COVID-19 Pandemic: From Bangladesh Society of Cardiovascular Interventions (BSCI)

Since the first recorded case of SARS-CoV-2 in Bangladesh on 8th March 2020, COVID-19 has spread widely through different regions of the country, resulting in a necessity to re-evaluate the delivery of cardiovascular services, particularly procedures pertaining to interventional cardiology in resource-limited settings. Given its robust capacity for human-to-human transmission and potential of being a nosocomial source of infection, the disease has specific implications on healthcare systems and health care professionals faced with performing essential cardiac procedures in patients with a suspected or confirmed diagnosis of COVID-19. The limited resources in terms of cardiac catheterization laboratories that can be designated to treat only COVID positive patients are further compounded by the additional challenges of unavailability of widespread rapid testing on-site at tertiary cardiac hospitals in Bangladesh. This document prepared for our nation by the Bangladesh Society of Cardiovascular Interventions (BSCI) is intended to serve as a clinical practice guideline for cardiovascular health care professionals, with a focus on modifying standard practice of care during the COVID-19 pandemic, in order to ensure continuation of adequate and timely treatment of cardiovascular emergencies avoiding hospital-based transmission of SARS-COV-2 among healthcare professionals and the patients. This is an evolving document based on currently available global data and is tailored to healthcare systems in Bangladesh with particular focus on, but not limited to, invasive cardiology facilities (cardiac catheterization, electrophysiology & pacing labs). This guideline is limited to the provision of cardiovascular care, and it is expected that specific targeted pharmaco-therapeutics against SARS-CoV-2 be prescribed as stipulated by the National Guidelines on Clinical Management of Corona virus Disease 2019 (COVID-19) published by the Director General of Health Services, Ministry of Health and Family Welfare of Bangladesh.

A mutation in the major autophagy gene, WIPI2, associated with global developmental abnormalities

We describe a large consanguineous pedigree from a remote area of Northern Pakistan, with a complex developmental disorder associated with wide-ranging symptoms, including mental retardation, speech and language impairment and other neurological, psychiatric, skeletal and cardiac abnormalities. We initially carried out a genetic study using the HumanCytoSNP-12 v2.1 Illumina gene chip on nine family members and identified a single region of homozygosity shared amongst four affected individuals on chromosome 7p22 (positions 3059377–5478971). We performed whole-exome sequencing on two affected individuals from two separate branches of the extended pedigree and identified a novel nonsynonymous homozygous mutation in exon 9 of the WIPI2 (WD-repeat protein interacting with phosphoinositide 2) gene at position 5265458 (c.G745A;pV249M). WIPI2 plays a critical role in autophagy, an evolutionary conserved cellular pathway implicated in a growing number of medical conditions. The mutation is situated in a highly conserved and critically important region of WIPI2, responsible for binding PI(3)P and PI(3,5)P2, an essential requirement for autophagy to proceed. The mutation is absent in all public databases, is predicted to be damaging and segregates with the disease phenotype. We performed functional studies in vitro to determine the potential effects of the mutation on downstream pathways leading to autophagosome assembly. Binding of the V231M mutant of WIPI2b to ATG16L1 (as well as ATG5–12) is significantly reduced in GFP pull-down experiments, and fibroblasts derived from the patients show reduced WIPI2 puncta, reduced LC3 lipidation and reduced autophagic flux.