Our body is like a fortress, tirelessly defending itself against intruders. Suddenly, a silent menace sneaks through the gates – sepsis. This assassin hides in infections, then launching a devastating assault on vital systems of the body.

Sepsis is defined as an abnormal reaction to infection leading to fatal organ damage. In 2017, there were an estimated 48.9 million cases of sepsis, and 11 million sepsis-related deaths worldwide, accounting for almost 20 per cent of all global deaths.

Children made up nearly half of all sepsis cases, claiming the lives of 2.9 million children under the age of five worldwide.

Adults over 65 years are particularly vulnerable. While incidence and mortality are greater in low- and middle-income countries, higher-income countries with cutting-edge medical facilities are not spared. In Malta, there were around 1,349 sepsis cases and 272 sepsis-associated deaths in 2017.

Those who survive continue to suffer from long-term complications and misery. Despite advances in our understanding of sepsis pathophysiology, particularly the centrality of the immune system, no specific treatment for sepsis has been approved so far. Thus, the WHO recently approved resolution WHA70.7, recognising sepsis as a global health priority.

Sepsis is defined as an abnormal reaction to infection leading to fatal organ damage

Although its importance is recognised, monitoring the condition of a person’s immune system is not adopted in clinical practice. Changes in the functionality of immune cells can assist in early recognition of sepsis, as well as identify who is at risk of poor outcomes. The challenge is to connect those changes to treatment implications.

Two ongoing local trials aim to bridge this gap. The MENDSEP trial is enrolling sepsis patients admitted to the Intensive Therapy Unit at Mater Dei Hospital, which seeks to evaluate the clinical implications of immune functional assays and a novel sepsis patient sub-classification strategy.

The EPICURE study is recruiting participants at St Vincent de Paul Hospital to test new treatments that aim to rejuvenate key immune cells implicated in sepsis. Importantly, we are transitioning to a more individualised approach to sepsis and acute medicine in general, which will help put an end to the ineffective one-size-fits-all model.

Brendon Scicluna is the principal investigator of the MENDSEP trial (ClinicalTrials.gov ID: NCT06287684) and MCST-funded EPICURE project (REP-2023-0049), conducted in collaboration with the clinical teams coordinated by Carmel Abela (consultant anaesthetist) and Antoine Vella (consultant geriatrician), respectively. Scicluna is specialised in experimental internal medicine, serving as senior lecturer at the University of Malta and research associate of the Amsterdam Infection and Immunity Institute. Members of the public interested in participating can contact brendon.scicluna@um.edu.mt.

Sound Bites

•        At about the size of a pinkie nail, the jellyfish species Cladonema can regenerate an amputated tentacle in two to three days – but how? Regenerating functional tissue across species, including salamanders and insects, relies on the ability to form a blastema, a clump of undifferentiated cells that can repair damage and grow into the missing appendage. Jellyfish, along with other cnidarians such as corals and sea anemones, exhibit high regeneration abilities, but how they form the critical blastema has remained a mystery until now. A research team based in Japan has revealed that stem-like proliferative cells – which are actively growing and dividing but not yet differentiating into specific cell types – appear at the site of injury and help form the blastema.

•        The health benefits of exercise are well known but new research shows that the body’s response to exercise is more complex and far-reaching than previously thought. In a study on rats, a team of scientists has found that physical activity causes many cellular and molecular changes in all 19 of the organs they studied in the animals.

For more soundbites, listen to Radio Mocha every Saturday at 7.30pm on Radju Malta and the following Monday at 9pm on Radju Malta 2 https://www.fb.com/RadioMochaMalta/.

DID YOU KNOW?

•        Superficial knowledge gained by flicking through a book is index-learning. Superficial knowledge gained by flicking through a book while standing in a bookstore is stall-learning.

•        In the 1830s, France and Mexico fought a three-month war. It began after a complaint by a pastry chef.

•        Over €1,000,000 are thrown into Rome’s Trevi Fountain every year. The money is donated to a local charity.

•        In 2020, the UK’s Met Office was mocked for naming a winter storm ‘Heulwen’ which is welsh for ‘sunshine’.

•        In the United States, the average dog’s lifespan is longer than the average marriage.

For more trivia, see: www.um.edu.mt/think.