1. Research
    Neisseria meningitidis  Tuberculosis  Colorectal Cancer  Human Papilloma Virus (HPV) and Cervix Uteri (Cervical) Cancer 

2. Personal struggles in London

3. References

Natasha Anwar (born 1971) is a Molecular Biologist born in Britain to Pakistani parents. She completed her education in London at the Imperial College of Science Technology and Medicine, getting a PhD in Molecular Biology. Soon after she moved back to her home in Lahore, Pakistan, she began conducting her research at Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH & RC) focusing mainly on health issues specific to the Pakistani population. She became a professor at the Froman Christian College in 2011 and has also partnered with biotechnology companies and is now partaking in research on tuberculosis and viral infections.

She has contributed to the Pakistani and Muslim community by investigating infected minority populations in many of her researches. Such investigation sheds light on improving the health security and establishment of improved health systems over time in developing areas.

Between 1998-2001, she published a paper on the effects of N. meningitidis and how such association are affected through immunogenicity, the immune response, and also the serotypes through the Pakistani population. In addition, she has studied different ways by which the bactericidal activity of the blood against the pathogen can be quantified.

In 2008, she published another paper about HPV/Cervical cancer and carcinoma on the Pakistani and Muslim community, giving more insight to how current stages of cancer are affecting specifically the Pakistani population relative to worldwide numbers, including finding more effective ways of prevention for the Muslim community. Three years later, she was involved in comparing molecular and conventional methods of diagnosing tuberculosis. By comparing traditional techniques used in Pakistan and evaluating their efficacy against high-powered expensive techniques highly used in developed countries such as PCR, they established pros and cons to each technique and what would be the most appropriate approach depending on time and resource availability.

Research

Neisseria meningitidis

Neisseria meningitidis is a parasitic organism which colonizes the upper respiratory tract.^[1] It is usually commensal, but will sometimes become pathogenic, attacking the host and causing meningococcal disease.^[1] If the infection becomes systemic, fatality rates of infected victims is usually 10%.^[1] N. meningitidis possesses five possible serogroups on the capsule A, B, C, W135, and Y2.

Vaccines exist for serogroups A, C, W135, and Y.^[2] No effective vaccine exists for the variations of serogroup B.^[2] As a result, serogroup B N. meningitidis is responsible for the majority of diseases in temperate countries.^[2] For example, a B strain of N. meningitidis was responsible for an outbreak in Cuba in the 1980s, with an infection rate of 14 per 100 000 people.^[2]

Anwar’s research on N. meningitidis involved determining effects that modifying the organism’s outer components had on its susceptibility to attack by the host’s immune system.^[3] Specifically, the ability of mannose binding lectin, a component of the immune system involved in the lectin pathway of opsonization, to bind onto N. meningitidis when it’s LOS outer core and/or capsule had been removed was determined by utilizing flow cytometry and gel electrophoresis.^[3] It was found that when the outer core was removed, strong binding of MBL to N. meningitidis was detected, even when physiologically low levels of MBL had been used.^[3] In addition, activation of the lectin pathway of opsonization had also been detected by the presence of a cleaved product.^[3] Both results indicate that removal of the outer core increases the host’s immune response against the pathogen.^[3]

Anwar has also studied different ways to measure the host’s bactericidal activity against N. meningitidis.^[1] The traditional method to determine activity is through the use of serum blood assay; serum blood assay involves purifying the serum components out of blood, exposing it to a bacteria, and performing viable cell counts on the bacteria after a certain time has passed.^[1] Likewise, whole blood assay also performs viable counts, but on whole blood instead.^[1] Serum blood assay will not be able to detect phagocytic activity, but whole blood assay on the other hand will.^[1] Serum and whole blood from subjects that were infected with B or C strains were acquired and then introduced to different strains of B and C N. meningitidis.^[1] It was found that when a strain was introduced into serum/blood from a subject who was already infected with the alternate one, bactericidal activity was detected in whole blood assay against the opposite strain, while serum blood assay failed to.^[1] This result implies that phagocytic activity is more involved in clearing out N. meningitidis infections than the traditional method shows.

Both the MBL and bactericidal studies show the importance of phagocytosis in dealing with N. meningitidis infections. Such results can be used to design treatments that can more effectively deal with the pathogen in future cases.

Tuberculosis

Specific to this, Dr. Natasha Anwar and her colleagues investigated the methods associated with the diagnosis of tuberculosis, which involve the molecular and conventional methods. Amongst developing countries, conventional methods including the Lowenstein Jensen culturing media and the Zheil Neelsen (also known as acid fast staining specific for mycobacterium) are the current methods being used. Polymerase chain reaction, a type of molecular method, has not been widely tested in those countries. They investigated the ability of the bacterium by comparing the results of PCR to the products of possible smear and culture positivity. Traces of such bacterium were examined in patients with pulmonary or extra-pulmonary patients with certain physiological problems. Clinical data was taken from the collaboration involving King Edward Medical University and S.K.M.C Hospital. Dr. Anwar and her colleagues found that PCR was the most influential compared to culture and smear positivity, when diagnosing tuberculosis.

Of the specimens in pulmonary and extra-pulmonary they investigated for both molecular and conventional methods, Dr. Anwar and her team found that PCR was most influential in terms of expressing the highest positivity percentages. Based on the results, Dr. Anwar and her team found PCR to be more rapid and sensitive, even though costly expenses are involved. Cultural and smear methods tend to be insensitive while long durations are required for such results.

Such study serves for future advantages in the scopes of diagnosing early stages of tuberculosis and the regulation of disease development of human survival. In addition, early diagnosis may also benefit effectively for individuals with more than one complicated health problem simultaneously.

Colorectal Cancer

Before the beginning of this study, it was thought that despite colorectal cancer (CRC) being one of the most prevalent forms of gastrointestinal cancer worldwide, that it was rather uncommon in the Pakistani population. During this study, Dr. Anwar and her team reviewed all medical records of CRC from SKMCH & RC from 1995–2004. Through assessing this epidemiological data, it was shown that 69% of these patients were already in the later stages, stages III and IV, of the disease at which the median survival time was calculated as being 54–27 months.^[5]

Comparing the results to Western countries, it was seen that the mean age that CRC was presented was significantly lower (less than 50 in Pakistan versus 70+ in developed countries). Further comparisons to a more related country, Iran, revealed that the age at presentation was almost 10 years lower. In her paper, Dr. Anwar attributes these differences to the living conditions in Pakistan, raising awareness to the way CRC is viewed in the society. She declares several reasons to why such a drastic difference is seen between the Pakistani population and Western or even neighbouring countries. One reason was that the mean age of the population is generally lower. However, she further goes on to describe that poverty, lack of healthcare, and the reliance on traditional healers could be significant reasons as to why many of the patients were in the late stages of the disease. Since SKMCH & RC is a tertiary institute, most patients would have most likely seen other physicians. Anwar states that the lack of properly trained physicians and the assumption that CRC does not have a relatively early age of presentation in Pakistan may lead the physicians to diagnose the patient as having hemorrhoids rather than CRC.

This study shed light on the popular misconception that CRC is not prevalent in Pakistan. Currently Dr. Anwar and her team are interested in investigating environmental and genetic factors that are involved in CRC in Pakistan compared to Western countries.

Human Papilloma Virus (HPV) and Cervix Uteri (Cervical) Cancer

A study looking at rates of cervical cancer in Pakistan compared to global populations was conducted due to the lack of a Pap smear screening program in Pakistan. The study focused on trying to implement HPV testing as a substitute for Pap smears. Although the instances of cervical cancer are globally high, they are relatively low in Pakistani women. However, incidences involving HPV subtypes that can lead to cervical cancer, such as HPV-16, was shown to be common with HPV-16 being prevalent at 2.8% in women 15–59 years of age in Pakistan and seen in 92% of invasive cervical cancer cases. With the worldwide rate of HPV-16 being 3.2% and considered one of the most common types, the study indicates that HPV prevalence is high in Pakistan. Dr. Anwar was involved in advocating for some alternative methods to assess cervical cancer based on these results that do not require Pap smears such as HPV testing, or even other low-cost alternatives such as the Visual Inspection with Acetic acid.^[6]

Dr. Anwar and her team are hopeful to use the SKMCH institute for further epidemiological work for cervical cancer in Muslim populations and to test an approved FDA HPV vaccine in preventing cervical cancer.

Personal struggles in London

In an interview that Dr. Anwar did with The Guardian, she spoke of her choice to move to Pakistan.^[7]

References

• 1973 British Home Championship
• 1973 British Speedway League
• 1973 British Speedway League Division Two
• 1973 Broxbourne Borough Council election
• 1973 Burmese constitutional referendum
• 1973 BYU Cougars football team
• 1973 Calder Cup
• 1973 Calder Cup Playoffs
• 1973 California Golden Bears football team
• 1973 Campeonato Argentino de Rugby
• 1973 Campeonato da 1ª Divisao do Futebol
• 1973 Capital City 500
• 1973 CARIFTA Games
• 1973 CECAFA Cup
• 1973 Central American Games
• 1973 CFL draft
• 1973 CFL Draft
• 1973 Championship of Australia
• 1973 Cincinnati Open
• 1973 Cincinnati Reds
• 1973 Ciskei legislative election
• 1973 City of Bradford Metropolitan District Council election
• 1973 Clemson Tigers football team
• 1973 Coleraine bombings
• 1973 College Baseball All-America Team