In the hustle and bustle of Pakistan's healthcare landscape, a silent war is raging, and it's not against a visible foe but rather microscopic troublemakers – antibiotic-resistant microbes.

Antibiotic resistance poses a growing threat to health globally. According to a report by Fleming on Antimicrobial Consumption by 700,000 individuals each year lose their lives to resistant infections. In Pakistan, this issue is exacerbated by a lack of antimicrobial stewardship in hospitals, indiscriminate antibiotic prescriptions, and a surge in respiratory diseases due to polluted air.

Healthcare providers, lacking the much-needed antimicrobial stewardship, are caught in a loop of overreliance on intravenous and oral antimicrobials. It's a revelation that makes you wonder – are we unintentionally brewing a storm of resistance right under our noses?

There's a surprising twist in the narrative of antimicrobial resistance. The air we breathe carries pollutants and potentially acts as a highway for antibiotic-resistant genes. A study by Lancet, a reputed medical journal, reveals a compelling connection between PM 2.5 air pollution and antibiotic resistance. PM 2.5 refers to particulate matter with a diameter of 2.5 micrometers or smaller. As these particles carry bacterial genomic material, inhaling them contributes to incorporating resistant genes into opportunistic pathogens, exacerbating antibiotic resistance.

Analyzing global data from 116 countries between 2000 and 2018, the study estimated that a 10% rise in annual PM 2.5 led to a 1.1% increase in aggregate antibiotic resistance, resulting in approximately 43,654 premature deaths. Regional variations highlighted potential significant increases in antibiotic resistance in Africa and Asia. Notably, for Pakistan, a 10% PM 2.5 elevation was predicted to increase antibiotic resistance by 2.6%.  

To tackle this, Dr. Shaper Mirza has been at the forefront of addressing antibiotic resistance in Pakistan. She is actively engaged in projects addressing different facets of antibiotic resistance and stewardship.  She participated in development of the first National Action Plan for Antimicrobial Resistance in Pakistan. The initiative involves identifying rates of antimicrobial resistance from a One-Health perspective in Pakistan.  This was the first effort of its kind which furnished sufficient data suggesting resistance across all sectors which include human health, animal health and agriculture. The investigation and its outcome led to the development of National Action Plan for AMR in Pakistan.  The National Action Plan was implemented in Pakistan in 2017 and currently there are 43 sentinel sites collecting and reporting data on antimicrobial resistance strains.  The Situation analysis for National Action Plan was done in collaboration with  Global Alliance for Antimicrobial Resistance Partnerships (GARP). The GARP consortium, comprising seven countries, collaborates to exchange knowledge, build capacity, and develop antimicrobial stewardship guidelines.

To improve on stewardship practices, Dr Mirza in collaboration with Pakistan Kidney and Liver Institute (PKLI) developed two courses on adult and pediatric antimicrobial stewardship.  Both courses were very well attended both by physicians and basic science researchers working in the field of antimicrobial resistance.

Tips from the experts:
As Pakistan grapples with the dual challenges of smog and antibiotic resistance, practical steps can make a difference. When the air is thick with smog, consider preventive measures like wearing masks, frequent nasal cleaning to minimize pollutant exposure and emphasizing a high-protein diet to bolster immune systems. 
While smog-induced respiratory symptoms might initially prompt concern, antibiotics are specifically designed to combat bacterial infections, not viral foes. Viruses, often the culprits behind seasonal respiratory ailments, don't respond to antibiotics. Therefore, before rushing to antibiotics, look for telltale signs of a bacterial infection – persistent high fever, green or discolored mucus, and specific radiological findings in chest X-rays. If symptoms persist, consult a healthcare professional who can guide you on the most effective and responsible course of action. By adopting these practices and following World Health Organization’s (WHO) guidelines for antibiotic usage, we protect ourselves from the smog's impact and contribute to the collective effort to preserve the effectiveness of antibiotics for when they're truly needed.

After all, a breath of fresh air should be just that – fresh and invigorating!
 

Picture a grand orchestra, with each musician playing a crucial role in creating a harmonious symphony. In a similar vein, researchers at the Department of Biology at SBASSE, LUMS, have uncovered a key 'conductor' in the biological orchestra of gene regulation controlling cell fates – the Mask protein. Just like a conductor leads an orchestra, the Mask protein in fruit flies directs the activity of cell fate specific genes, ensuring they play their parts at the right times. 
Research led by Ammad Shaukat and Mahnoor Hussain Bakhtiari, as the first authors under the supervision of Dr Muhammad Tariq, has been published in the prestigious journal Developmental Biology. Their study reveals that the Mask protein in fruit flies shares functional traits with the Trithorax group (trxG) proteins. Unlike the Polycomb group (PcG) proteins, which silence gene expression, trxG proteins play a pivotal role in sustaining the active state of genes, ensuring their continuous and proper expression.

The study essentially explores how Mask operates at the molecular level. In every cell, genes are constantly being turned on and off, a process critical for proper functioning. Mask plays a role similar to a switch, helping to keep certain genes in the 'on' position. This is especially important during an organism's development, where precise gene activity patterns are essential for normal growth and formation of different cell types.
The research team found that Mask binds to areas in chromosomes marked by H3K27ac, a chemical tag indicating active gene regions. When Mask levels were reduced, these active regions showed changes in H3K27ac, leading to alterations in gene expression that are crucial for the development and identity of cells. They have also discovered that Mask counteracts repression by the PcG to ensure activation of cell type specific genes which are linked to maintenance of cell fates. 

By examining fruit flies, a common model organism in genetics, the researchers identified that Mask interacts with specific sites in chromosomes where other trxG proteins are also present. When the Mask is not present, or its levels are altered, the normal pattern of gene activity is disrupted, leading to developmental abnormalities. Since Mask belongs to a specific class of proteins known as cell signaling factors, the study by Tariq Lab opens a new avenue that may help link cell signaling and cell fate maintenance in future. 
This discovery is akin to finding a new way to understand and potentially direct the biological orchestra in humans. It opens possibilities for new treatments for diseases, such as developmental disorders and cancers, where the genetic symphony goes awry. The conservation of this mechanism in flies and mammals suggests that the role of Mask may be a universal theme in the biological orchestras across species.