LeSpar AMR Workshop The Nottingham Edition Funding Final conclusions

This is the last post on a series of presentations that were given by researchers as part of the Learned Society Partnership on Antimicrobial Resistance. The workshops took place in London, Dundee and Nottingham. All my posting covered solely Nottinghams Edition; the one I have been to! If youd like to read about the different presentations, please access here, here and also here. 

This final part has to do with funding. The talk was given by Lizzie Garrett and to the best of my knowledge it covered the "Tackling antimicrobial resistance cross council initiative". These are the bullet points I managed to take note of during Lizzies talk: 

• UK funded research on AMR, from 2007 to 2013, in approximately £275M;
• What else is needed then? An AMR funders forum led and managed by the Medical Research Council (MRC). This forum was launched in June 2014 and is restricted to bacterial resistance.
• Theme I is about understanding bacteria, Theme 2 is about accelerating therapeutic and diagnostics, Theme 3 is about understanding real world interactions and Theme 4 is about understanding behaviour within and beyond the healthcare settings;
• Looking deeper into what each of these themes entail, theme I is MRC-led, have innovation grants and collaborative grants; theme 2 is also MRC-led with a deadline on the 4th of June 2015 (also innovation and collaborative grants available) and a panel meeting pointing to September 2015 and March 2016; theme 3 is NERC- and MRC-led [NERC = Natural Environment Research Council] and the discussion panel meets in the Summer of 2015;
• I wasnt able to pick up anything on theme 4, sorry for that!

The organisers then proceeded to producing some funny moments of networking with an organised mishmash of groups and discussion tables.  Participants had to contribute with pertinent questions on the today and tomorrow of antimicrobial resistance research and focus, but also had to offer possible answers to questions posed by other groups. The debate was very interesting, but as I mentioned before in my first post, for most of the students present it was more of a sit-back-and-watch PIs and the like talk rather than actually being able to participate. It was a bit like watching grown ups talk on a Saturday night dinner table and not being heard, even when you know their views are in urgent need of some new fresh approaches. 

The questions prepared by the different groups are listed below:

1) In what way can we identify, group and support people with a common interest in alternative approaches to AMR?

2) Is it too late to attempt to conserve antibiotics?

3) Should we be looking elsewhere for alternatives?

4) Are the experiments that we perform in the lab relevant at all? Can this explain why some strains become dominant?

5) How do we standardise experiments between and among labs in order to latter compare results from different environments?

6) Is selection to AMR happening in the environment? If so, where and how? And what are the implications for human and veterinary medicine?

7) Are we in need of realistic lab-based models and model systems, including alternatives to animals, to study infection and therapeutics?

8) What is resistance anyway? How can we define resistance?

Maybe you can organise a debate in your department and have some interesting discussions trying to find answers for these pertinent questions. I hope youve enjoyed this series of presentations and that you keep visiting The Toxicologist Today.

Image kindly taken from http://www.mrc.ac.uk/research/initiatives/antimicrobial-resistance/

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LESPAR Interdisciplinary Networking Workshop on Antimicrobial Resistance The Nottingham Edition

Yesterday I attended the LESPAR Interdisciplinary Networking Workshop on Antimicrobial Resistance (AMR) - The Nottingham Edition as I call it (@ MediCity). With a 5 stars organisation (these logos on the right side name them) I must say it was definitely one of the workshops that helped me learn the most on AMR these last 7 months. Second place goes to the one in Birmingham organised by Antibiotic Action last April.

As usual I took a lot of notes that I will be sharing with you on 4 different posts, so the information load doesnt pile to utter boredom. If I can list one positive and one negative I would say that the networking model they found is a great one to implement in the future to come in many other events that merge scientists from different backgrounds. It really triggers contribution, it really prepares the tables for the stressing of real life issues and allows possible solutions to rise from sincere discussions. On the negative part something that was present but is not exclusive to this event, as pretty much everyone these days unfortunately go that way, I talk of the neglecting of opinions from those who are mere students. The latter stated doesnt really concern the organisers, they actually promoted an open debate to vocalise everyones thoughts. But when in a table where scientific discussions are taking place, those with a higher status and experience, e.g., PIs, Research Associates, Associate Professors, Funding Bodies Representatives have the upper hand. And students acti wrongly as they just recline, sit back and watch the ping pong take place. I dont do that, I do the opposite whenever I can. I contribute, I share my views, I participate. But sometimes it is just impossible for some students to break the shell and offer their perspective because some on the higher levels will inhibit it (intendedly or unintendedly).

Nevertheless, what a great event! I will kick-off on the next post with what was said yesterday by the different people. During the whole event I took loads of notes. Please make sure you try to read it because the content comes from professionals who dictate a lot of the pulsating actions that are taking place in AMR research these days. And one thing I learned from this event immediately is that the direction of such pulsating research will very soon turn sides. 

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Chris Dodds opening welcome LeSpar AMR Workshop The Nottingham Edition

If you havent read the previous post please do so by accessing here.

Christine Dodd was my teacher in Sutton Bonington back in 2006/2007. I had the

opportunity to very briefly talk to her and was very happy that she was the one welcoming the audience. Here are the general notes I took from her contribution yesterday:

• A Swedish group reported that an Indian Plant that makes pharmaceuticals discharges an average of 44 Kg of Ciprofloxacin per day to the wastewater. This is a massive environmental problem as bacteria are not static, they travel, carry antibiotic resistances that end up just like the 0104:H4 Escherichia coli hybrid pathogen outbreak.
• The cited outbreak was suggested to have started in Egypt and travelled to germany where tourists disseminated it to other countries. In the end, E. coli 0104:H4 got resistant to 10 different antibiotics!

In addition, a second speaker offered his valuable contribute but I just couldnt get hold of his name. His remarks below:

• To avoid AMR in the environment we need to act as a community. no single discipline can crack AMR.
• The planet scientists support each other  and the microbiologists attack each other, therefore plant scientists get a lot more funding for their research and the microbiologists dont.
• We microbiologists need to draw in the contribution of multiple disciplines.

The coming participation to be posted will be from Rachel Gomes from the University of Nottingham, keep checking!

Image kindly taken from Dr. Ihab Sulimans slideshare presentation on "The outbreak of Shiga toxin-producing E. coli 0104:H4", [http://www.slideshare.net/isuliman/outbreak-of-shiga-toxin-producing-e-coli-8214876], last visited on the 8th of July 2015, last updated opn the 5th of June 2011.

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Rachel Gomes Intervention LeSpar AMR Workshop The Nottingham Edition

On the following up of the Learned Society Partnership (LeSpar) Antimicrobial Resistance workshop see here) last week. Today I bring you incredible interesting research presented by Rachel Gomes (Assistant Professor in Chemical and Environmental Engineering, Faculty of Engineering, University of Nottingham) that took place on the 7th of July at MediCity this year.

Rachel covered "Antimicrobial resistance in the outside environment: Challenges and Opportunities". Her presentation was the one I liked the most at the LeSpar workshop - Nottingham Edition. Interesting, focused, realistic, and most of all almost linking the urban with the industrial settings. Lets read through the elements Rachel Gomes presented us with:

• Everything started back in the 30s with humans and animals being exposed to antimicrobials present in the environment. A particular farm was processing faeces. Immediately an intriguing question emerges from this scenario, "What is the influence of waste management practices on AMR?
• By defining the outside environment we find particulates (matter in the form of minute separate particles). Landfill is where we have the inappropriate disposal of antibiotics that accumulate in these particles.These accumulated antibiotics will be leached (transported to municipal wastewater treatment plants)!
• In Australia there are different classes for direct water reuse, e.g., Class A is for water that can be reused in car washing. However, worldwide, rapid urbanisation and water shortages has led to utilising reclaimed water irrigation, thus our motivations for considering AMR in the outside environment have grown in number and importance.
• In England  and Wales there are 23 water companies.These protect the quality of water and treat effluents released to the received water environment. Their individual systems are not designed to deal with AMR substances. We are talking of substances that have already been linked to acting as endocrine disruptors.
• Observations of wastewater effluent adversely affecting fish has now lead to more than £200M of investment by water companies. Although, the future demands for "new" analytics to track the metabolism and fate of these chemicals present in the wastewater treatment process of aquatic environment.
• Bacterial bordellos, has mentioned in (Edge, 2010); an article that explores the mix of bacteria in activated sludge processes and the fate of antibiotic resistance genes in sewage treatment plants (unfortunately, I personally wasnt able to find his article).
• After the privatisation of the water treatment industry a lot of questions have emerged: Which unit processes do actually form the treatment program? What are the effects of the treatments in terms of UV exposure and chlorination on the horizontal transfer to AMR? What level of detail is considered appropriate to understand AMR in the outside environment? Considering AMR as an emerging pollutant what sites should we monitor? What implications does AMR have on managing wastewater/wastes? How can we better understand complexity?

This was Rachel Gomes oral participation with a very interesting presentation that took me back to those years as a Biotechnological Engineering student, back in Portugal. I managed to ask Rachel if she thought that we could use a barcode footprint system to make the end-user more responsible for correct handling and disposal of the antibiotics. Rachel replied among other things that "...it becomes educational. Cannot force people to do it... companies are talking about recycled antibiotics".

See you next time where I will share with you guys University of Birminghams Jan Krefts contribution. A very interesting view on antimicrobial resistance and gut microbiota. Until then, keep reading The Toxicologist Today. Cheers!

1st image kindly taken from UNESCO-IHE,  Ecological sanitation, [http://ocw.unesco-ihe.org/mod/page/view.php?id=616], last visited on the 13th of July 2015, last update on the 8th of May 2010.

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Jan Kreft Intervention LeSpar AMR Workshop The Nottingham Edition

Jan Kreft from the University of Birmingham shared with the audience at the MediCity a very interesting perspective (with loads of questions outside the box) on Antimicrobial resistance in the human gut. But before we move on to Jans participation, if you havent had the opportunity to read also Chris Dodds contribution and Rachel Gomes contribution, already posted in the blog, just click on the names to do so.

Now moving onto Jans presentation, his most remarkable shared views and points are listed below:

• There is diagnosed antimicrobial resistances present in people who have not taken any antibiotics ever or that for a long time never took them. How was such resistance acquired?
• Resistances are found even in individuals from the Yanomani tribe in Brazils Amazon [1] that were never in contact with humans.
• The prevalence of antimicrobial resistance will decline if the use of an antibiotic is discontinued because of a fitness cost of carrying the resistance. Resistance rises if an antibiotic is used because of positive selection for the resistance. So we have to ask ourselves if discontinuing works? And why does resistance persist?
• Fitness costs, diversity, variation of costs and diversity of microbes, hitchhiking (when a gene is coupled to another gene that is positively selected, e.g., resistance to mercury). We have to consider an approach to the real world.
• There is a huge bacterial diversity in gut also affecting the spread of plasmids. There are huge numbers of bacteria in the gut, ~ 5E13 individual cells. The heterogeneity  goes from small to large scale.

• Will a more prudent use of existing antibiotics be enough? What can we do? Give a narrower spectrum of antibiotics, higher dose or lower dose? Should we give a combination of two drugs rather than one? Should we invest in new drugs, ideally new classes of drugs (new strategies)?
• On the other hand should we start attacking directly the resistance genes and plasmids preventing a possible transfer? Should we prevent infections as they mean fewer treatments? What kind of research do we need? 
• We need to consider consequences of diversity of strains, plasmids, resistance genes and quantitative models to optimise treatment at population level.
• We cannot deal with complexity without models. Take for example the developed iDynoMics software, a free software available online.

Next post will have the final contribution taken from the Learned Society Partnership seminars on antimicrobial resistance - Nottingham Edition, that took place on the 7th of July this year. It will be about getting funding (by Lizzie Garratt) and some final notes on the most important questions that have emerged from the event. Hope to see you soon, have a nice time!

[1] The Yanomami: An isolated yet imperiled Amazon tribe, The Washington Post, [http://www.washingtonpost.com/wp-srv/special/world/yanomami/], last visited on the 21st of July 2015, last update on the 25th July 2014.

2nd image kindly taken from Natural selection, Wikipedia, [https://en.wikipedia.org/wiki/Natural_selection], last visited on the 21st of July 2015, last published on the 14th of July 2015.

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