EMERGING

DISEASES
Biology 1

TSEs :TRANSMISSIBLE
SPONGIFORM ENCEPHALOPATHIES
BSE (sometimes referred to as "mad cow disease") and
variant and classic CJD belong to the unusual group of
progressive, degenerative neurological diseases known as
transmissible spongiform encephalopathies (TSEs).
These diseases are characterized by a long incubation period
of up to several years, during which there is no visible
indication of the disease. The incubation period for BSE
among cattle ranges from three to eight years; for CJD among
humans, the incubation period is unknown, but is at least five
years and could extend up to 20 years or longer. The diseases
are invariably fatal; there is no known treatment

KURU

TSE
Kuru and CJD should be thought of as two different
spongiform encephalopathies. Kuru studies were
instructive since they showed for the first time that a
slowly progressive neurological disease of humans
can be INFECTIOUS, that is transmitted from one
person to another.
For this discovery Carleton Gajdusek was awarded
the Nobel Prize.
Spongiform encephalopathies, (scrapie, BSE, and
others in animals, and CJD, kuru and GerstmannStraussler-Scheinker disease in humans) is caused
by a distinct variant prion.

MAD COW DISEASE

Human

Cow
Vacuoles in the brain cells

Sheep

 PRIONS,
(PROTEINACEOUS
INFECTIOUS PARTICLES)
have been determined to be
misfolded, protease
resistant proteins which can
mediate transmission of
disease.
Prions have been implicated
in a number of human
diseases, specifically
kuru,
Creutzfeldt-Jakob
disease,(CJD),
Gerstmann-StrausslerScheinker, (GSS)
Fatal familial insomnia,
(FFI).

The propagation of infectious prion protein occurs via

conversion of normal prion protein (PrPc, left) to a diseasecausing form (PrPSc, right). In the refolding process, some of
the -helical regions (green) in PrPc unfold, forming an
extended -sheet region (flat blue arrows)

 The two proteins, the disease-specific PrPSc and the

normal PrPC, differ in their spatial structures and the fact
that PrPSc is resistant to destruction by digestive enzymes
(proteins which digest food in the human stomach),
whereas PrPC is completely destroyed when treated with
digestive enzymes.
As a result of many studies it has been possible for
scientists to come to the conclusion that PrPSc is a
component of the pathogen of the prion diseases. It is even
speculated that PrPSc represents the complete pathogen.
According to this theory, an infection brought about by the
penetrating PrPSc causes PrPC to be converted into PrPSc.
The newly formed PrPSc can now, for its part, bring about
the conversion of more PrPC into PrPSc. This leads to the
disastrous chain reaction where the PrPSc production
increases exponentially and the brain is damaged
irrevocably. Notably, the increase in PrPSc during the
course of the disease correlates with the increase in
infectivity.

DIABETES

Type 1: IDD
In type 1 diabetes, the body makes little or no
insulin. People with type 1 diabetes must take
insulin shots to live.
type 1 diabetes is also called "insulin-dependent
diabetes." Less than 10% of people with
diabetes have type 1. Although it most often
begins when people are young, it may also
occur in older adults.

TYPE 2: NIDD
In type 2 diabetes, the

Type 2 diabetes is more likely to

occur in people who:
body makes insulin but
are over 40 years of age
cannot use the insulin it
makes. Type 2 is also called are overweight.
"non-insulin-dependent
have a family history of diabetes.
diabetes" because the
have had diabetes during a
people who have it do not
pregnancy.
have to take insulin shots
have had a baby weighing over 9
to stay alive.
pounds.
have the stress of an illness or
Type 2 is the most common injury.
form of diabetes. At least
have high blood pressure.
90% of people with
are African American.
diabetes have type 2
are Hispanic American.
are Native American.

DIABETES

CHICKEN FLU
The scientific term for Bird Flu is Avian Influenza. It
normally infects only birds and, less commonly, pigs. While
all bird species are thought to be susceptible to the infection,
domestic poultry flocks are especially vulnerable.
The disease in birds has two forms: the first causes mild
illness, sometimes expressed only as ruffled feathers or
reduced egg production. The second form, known as highly
pathogenic avian influenza was first recognized in Italy in
1878. It is extremely contagious in birds and rapidly fatal,
with a mortality approaching 100 per cent. Outbreaks of
avian influenza, especially the highly pathogenic form, can be
devastating for the poultry industry and for farmers.

CHICKEN FLU
The last century has seen three such pandemics
caused by the influenza virus. All of them spread
worldwide within 1 year of being detected.
The most devastating was termed the Spanish
Flu and in 1918-19 killed an estimated 20 to 50
million worldwide
This was followed by the Asian Flu in 1957-58
and the Hong Kong Flu in 1968-69 each killed
more than a million globally.

CHICKEN FLU

The major concern about the epidemic is that

most of the recent outbreaks have been caused
by the highly virulent H5N1 strain of the virus.

There is mounting evidence that this strain has a

unique capacity to jump the species barrier and
cause severe disease, with high mortality, in
humans.
To date, Vietnam has reported 23 confirmed
cases of human infection, of which 15 have been
fatal.

CHICKEN FLU
The present situation could give rise to another
influenza PANDEMIC in humans. Avian and human
influenza viruses can exchange genes when a person is
simultaneously infected with viruses from both
species.
This process of gene swapping inside the human body
can give rise to a completely new subtype of the
influenza virus to which few, if any, humans would
have natural immunity. Moreover, existing vaccines,
which are developed each year to match presently
circulating strains and protect

VIRION
An influenza virion has about
500"spikes"sticking out from its lipid
envelope. About 80% of the spikes are a
viral protein called HEMAGGLUTININ (or
simply, HA). This was first identified by its
ability to cause red blood cells, which carry
a molecule called "heme", to agglutinate
(stick together). HA is influenza's receptorbinding protein. It plays the critical role of
attaching the virus to the host cell.

Tthe other 20% of the spikes are a viral

protein called NEURAMINIDASE, often
abbreviated NA. This protein is an enzyme
that destroys a host cell molecule called
neuraminic (or sialic) acid. NA might play a
part in getting the virus into the cell but its
most important function is that it helps the
newly made influenza virions to easily
escape

VIRIONS

HIV
There are two types of HIV virus,
i.e. HIV-1 and HIV-2.
HIV-1 is present all over the world
and in India more than 80% people
are affected by it. HIV-2 is mainly
found in Africa and also presents in
India. Some people are infected
with both the viruses.
People only infected with HIV-2 live
longer than those infected with
HIV-1 and chances of transmission
of HIV-2 from mother to child are
very rare.
Once in body, HIV attacks CD4 type
of white blood cells (WBCs) in blood
and gradually kills them.

HIV
HIV infects certain white blood
cells, including T-helper cells and
macrophages, that play key roles in
the immune system.
The virus attaches to CD4 receptor
molecules on the surface of these
cells, which are often called CD4
cells. HIV enters CD4 cells and
inserts its own genes into the cell's
reproductive system.
The cell then produces more HIV,
which spreads to other CD4 cells.
Eventually infected cells die.

AIDS
Pneumocystis carinii PNEUMONIA, which is an infection of
the lungs, is the leading cause of death among AIDS patients
. Yeast infections of the oesophagus cause severe pain when
swallowing and result in weight loss and dehydration.
CYTOMEGALOVIRUS RETINITIS is an eye infection that
can cause blindness.
KAPOSI'S sarcoma is a form of cancer that usually arises in
the skin. The tumours may look like bruises, but they grow.
Another illness that defines AIDS in people is
TUBERCULOSIS. For many decades, the number of cases of
tuberculosis in the United States declined. However, in the
mid-1980's, doctors noticed a growing number of cases of
tuberculosis in HIV patients. People with HIV are especially
vulnerable to HIV-infected tuberculosis because of their
damaged immune systems.

 Almost every nation has reported cases of AIDS. By the

end of 1996, UNAIDS, the United Nations organization
dealing with AIDS, estimated that there were 22.6
million people worldwide living with HIV infection or
AIDS.
Of these, 830,000 were children, with men accounting
for 58 per cent and women 42 per cent of the
remainder. Some 90 per cent of adults with HIV
infection or AIDS were living in the developing world.
India had the highest number of infections in the world,
at over 3 million. This figure, however, represented less
than 1 per cent of India's population. In some African
countries in the region south of the Sahara, over 10 per
cent of all adults were reported to be infected with HIV.

HIV

By 1998 an estimated 30 million people worldwide were

infected with HIV, 26 million of them residing in Africa,
where more than 90 per cent of all AIDS deaths have also
occurred.

In some African countries, the epidemic had severely

eroded population growth and life expectancy. Life
expectancy had dropped from 66 years to 48 in Kenya,
and from 62 to 41 in Botswana.
In Zimbabwe, where every fifth adult was infected and
more than 100 people a day were dying from AIDS, life
expectancy was only 31 years. The Zimbabwean National
Aids Coordination Programme (NACP) estimated that of
the 1.5 million Zimbabweans who were infected with HIV,
35,000 had developed AIDS.

HIV

In Africa, India, and Southeast Asia,

transmission of HIV has occurred mostly
among heterosexual men and women. In
Africa, the spread of the virus has been
accelerated by mass population movement
resulting from poverty, war, and drought.
In Asia, prostitution and intravenous drug
use are major factors in the AIDS problem.
Public health departments in many
developing countries lack the resources to
treat patients properly and to control the
epidemic through education.

AIDS: Complications

Kaposis sarcoma

Children with AIDS

NATURE OF CANCER
Genetic disease: gene mutations
Environment-gene interactions
Environmental factors act synergistically
with susceptibility factors (eg. age, race,
gender and lifestyle)
10-20% : Hereditary
80-20% : Lifestyle

30% Food

NATURE OF CANCER
RACE FACTOR
1. Rarity of prostate cancer in all Asian countries.
2. Filipinos have HIGHEST rate of thyroid cancer
among Southeast Asians.
3. Filipinos have the HIGHEST incidence of breast
cancer in Asia.
4. Jewish women have high rate of breast cancer in the
world due to BRCA-1 mutation.

NATURE OF CANCER
Gain-of-function mutations of
PROTO-ONCOGENES
Loss-of-function mutations of
TUMOR SUPPRESSOR GENES.
Inactivation mutations of DNA
REPAIR GENES

ASIA PACIFIC CANCER

BURDEN
Year 2000 : Common cancers

4.4 million new cases

Lung Stomach Liver

Year 2020: Common Cancers

Lung Breast Prostate

RARE
HEREDITARY CANCERS
Li-Fraumeni

Breast

Retinoblastoma

Eye

Wilms tumor

Bladder

BRCA1

Breast

XP

Skin

PHYTOESTROGENS
These PREVENT incidence of cancer, particularly
hormone-related cancers.
Isoflavones

soya beans & other legumes

ginger, onion, garlic

Lignans

seeds, fibers

Coumestrans

fruits & vegetables

 PHYTOESTROGENS have weak

estrogen properties.
These compete with estradiol to lessen
the level of this carcinogenic hormone in
the body.

CANCER MANAGEMENT
EMERGING TRENDS
Complementary and Alternative
Medicine (CAM)
Chemotherapy + Herbals
Chemotherapy + Spiritual Therapy

SARS
CORONAVIRUSES AND SARS (Severe Acute
Respiratory Syndrome): A new type of coronavirus
has been identified as the cause of the emergent
disease called Severe Acute Respiratory Syndrome
or SARS. The "SARS Virus" was officially declared
the causative agent on 16th April 2003 by the World
Health Organization.