News in focus

with more than 500 staff members. On site, we
director-general of the National Public Health
have samples of COVID-19, influenza, measles, Laboratory in Khartoum.
polio, tuberculosis and cholera, among others.
We also have a biosecure unit. Specimens are
in a secure place, but we’re worried that they
AZZA AHMED ABDEL AZIZ
‘THE MILITARY IS OVERTURNING
might be mishandled by armed groups enter-
ing health facilities.
Several days ago, armed groups entered DEMOCRACIES’
the lab and ordered our security staff, who
are trained to handle emergencies, to leave. The situation at the University of Khartoum

COURTESY OF HISHAM BILAL

Hisham Bilal is an anthropologist at the
University of Khartoum.
base. The electricity went off and we didn’t have
water. Nobody was able to leave the campus
to go anywhere to get any supplies, including
food. My apartment was hit by many bullets.
I counted four and they entered from the
balcony and the windows. At that point, we
decided to leave no matter what might happen.
Hisham Bilal is an anthropologist at the
University of Khartoum.
We are worried that there might be a bio-risk
for these groups if they open fridges, because
they go in and they sabotage.
Power has been cut in several hospitals and
in our lab. There are always electricity short-
ages in Sudan — that’s why we have power from
diesel generators. But now, because of this
war, we can’t refuel them. By now, most of the
unrefrigerated samples will have died. But we
need to get people to come in and safely assess
what’s happening, deal with issues, and do bio-
and chemical-waste management.
The other thing is that we have very sensi-
tive analytical chemistry equipment, such as
gas-chromatography apparatus. Some are
attached to cylinders of gases such as helium
and hydrogen, so we don’t want somebody
going in and shooting. That’s a worry for us.
Shahinaz Bedri is a pathologist and
has left people traumatized, but this is a gen-
eral trauma: the violence has left bodies strewn
across different parts of the city. Forced to stay
at home, academics are turning to social media
to write analyses of the situation. But there’s
also a lot of propaganda — unidentifiable peo-
ple writing and spreading misinformation.
This is a challenge for academics working on
the ground to counter. We have a problem here
with the military overturning democracies in
the post-colonial era. It’s always the Sudanese
state not accepting alternative ideologies.
Azza Ahmed Abdel Aziz is a social and medical
anthropologist at the Centre for Economic,
Legal and Social Studies in Khartoum.
Interviews by Miryam Naddaf.
These interviews have been edited for length
and clarity.

SHAHINAZ BEDRI
‘ARMED GROUPS ARE ENTERING
HEALTH FACILITIES’ ALZHEIMER’S DRUG TRIAL:
I left Khartoum yesterday with my mother,
who has dementia and is bedridden and WHAT PROMISING RESULT
whose health has deteriorated. We headed to
Port Sudan, 800 kilometres away from Khar-
toum by the Red Sea, because it’s safer and my
MEANS FOR TREATMENTS
mother can have access to health services. Donanemab slows cognitive decline in some people,
I run the National Public Health Laboratory
in Khartoum, which is the national reference but questions remain over potential side effects.
regulatory laboratory for infectious diseases,
By Sara Reardon

F
or the second time, an experimental
drug has been shown to reduce the
cognitive decline associated with
Alzheimer’s disease. On 3 May, US phar-
maceutical company Eli Lilly announced
in a press release that its monoclonal antibody
donanemab slowed mental decline by 35% for
some participants in a 1,736-person trial. But
researchers warn that until the full results are
published, questions remain as to the drug’s
clinical usefulness, as well as whether the ben-
efit outweighs the risk of harmful side effects.
Cummings, a neuroscientist at the University
of Nevada, Las Vegas. “These are transforma-
tive in an enormously important way from a
scientific point of view,” he adds.
But Marsel Mesulam, a neurologist at
Northwestern University in Chicago, is more
cautious. “The results that are described are
extremely significant and impressive, but
clinically their significance is doubtful,” he
says, adding that the modest effect suggests
that factors other than amyloid contribute to
Alzheimer’s disease progression.
In the press release, Eli Lilly said that
people with mild Alzheimer’s who received
NAYEF KHEYRI

Shahinaz Bedri leads the National Public
Health Laboratory in Khartoum.
Like the Alzheimer’s drug lecanemab,
donanemab targets amyloid protein, which
is thought to cause dementia by accumulat-
ing in the brain and damaging neurons. The
trial results provide strong evidence that amy-
loid is a key driver of Alzheimer’s, says Jeffrey
donanemab showed 35% less clinical decline
over 18 months than did those who received a
placebo, and 40% less decline in their ability
to perform daily tasks. The company, based in
Indianapolis, Indiana, says it will present the
full results at a conference in July and publish

232 | Nature | Vol 617 | 11 May 2023

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 them in a peer-reviewed journal. It plans to
apply for approval by the US Food and Drug
Administration (FDA) in the next two months.
If approved, donanemab would be the
third new Alzheimer’s treatment in two years.
In J­ anuary, the agency granted accelerated
approval to lecanemab, made by Biogen in
Cambridge, Massachusetts, and Eisai in Tokyo.
And a study published in November showed
that lecanemab slowed cognitive decline
in 1,800 patients by 27% over 18  months
(C. van Dyck et al. N. Engl. J. Med. 388, 9–21;
2023). The FDA had previously approved
­aducanumab, also made by Biogen and Eisai, on
evidence that it could reduce amyloid plaques.
IMAGINECHINA LIMITED/ALAMY

Eli Lilly found that donanemab worked

best in people whose brains contained only
moderate levels of another protein, tau, that
is also associated with Alzheimer’s progres-
sion. The company had calculated its results
for 1,182 participants with moderate tau levels,
but said that the improvement was still statis-
tically significant when they combined these The spread of COVID-19 is thought to have begun at the Huanan market in Wuhan, China.
patients with those who had high levels of tau.

MARKET SAMPLES FAIL

Brent Forester, a geriatric psychiatrist at
McLean Hospital in Belmont, Massachusetts,

TO SHED FURTHER
says it’s “fascinating” that removing amyloid
also affects tau: the relationship between

LIGHT ON COVID ORIGINS

the two proteins is not fully understood. “If
we could understand that better, we might
understand why removing amyloid might have
a clinical effect,” he says.

Bleeding and seizures

New analysis of genomic data from
Like lecanemab, donanemab carries a high risk market swabs highlights their limitations.
of side effects — particularly a set of conditions
By Dyani Lewis

called amyloid-related imaging abnormalities
(ARIA) that can lead to seizures and bleeding
in the brain. Eli Lilly’s press release said that
ARIA rates were several times higher in people
who received donanemab than in those who
received placebos, and three patients in the
trial died after experiencing the condition.
“The side effect is the biggest concern for all
of us right now,” says Forester, who led earlier
trials of donanemab. He adds that people with
mild cognitive impairment function fairly well,
and that three deaths might signal that the risk
of side effects outweighs the drug’s benefit.
With at least three monoclonal antibodies
soon to be on the market, Mesulam worries
that excitement around them will decrease
drug companies’ enthusiasm for developing
drugs for targets other than amyloid. “The
next 20 to 25 years will be taken up by better
amyloid drugs,” he says. The Alzheimer’s mar-
ket could be very lucrative for drug companies
— lecanemab, for instance, costs more than
US$26,000 per year of treatment — but Mesu-
lam is concerned that the cost of these drugs
will strain the US health-care system.
Still, the initial results provide “further
support that this therapy will have some role
with the right patients”, Forester says. “I’m
cautiously optimistic.”
S
amples collected at the Huanan Sea-
food Wholesale Market in Wuhan,
China, in the early weeks of the COVID-
19 pandemic are of limited value for
pinpointing which animal species — if
any — infected people at the market, according
to a new analysis1.
Two previous analyses 2,3 of the data
described genetic material from various wild
animals, suggesting it was possible that these
animals could have passed the virus to people
at the market. The new analysis attempts to
identify the specific animal responsible for
the spill­over — but comes up empty.
“I would basically describe this as a nega-
tive result,” says Jesse Bloom, a virologist at
the Fred Hutchinson Cancer Center in Seattle,
Washington, who conducted the latest analy-
sis, which has not yet been peer reviewed. “It
doesn’t say either way whether there were ever
any infected animals in the market,” he says.
“It doesn’t say what the origin of the virus is.”
Bloom analysed data on genetic material
detected in swabs collected at the Huanan
market by scientists at the Chinese Center for
Disease Control and Prevention (China CDC)
after the market was closed on 1 January 2020
owing to concerns about an emerging virus,
which was later named SARS-CoV-2. In Febru-
ary 2022, scientists at the China CDC published
a preprint paper4 that revealed the presence
of SARS-CoV-2 in a small number of environ-
mental samples taken at the market. But the
China CDC did not report on animal sequences
detected in those samples and did not release
the underlying data.
Bloom’s analysis is the third study in two
months to focus on the genetic sequences of
animals in the samples. Neither of the two pre-
vious reports on the animal sequences could
confirm that animals were infected with SARS-
CoV-2. Bloom’s analysis supports these results.
He investigated whether environmental
swabs rich in viral sequences were associated
with genetic material from a particular animal,
which could be a sign of infection. But there
was no such association that made sense. In
fact, the strongest associations were with spe-
cies, such as fish, cows and goats, that SARS-
CoV-2 is not known to infect, says Bloom. The
swab data merely confirm that the virus was
widespread at the market, he says.
“We always knew that we could not defini-
tively say if [animals] were carrying [the virus]
or if there had just been a commingling of
the DNA,” says Alice Hughes, a conservation

Nature | Vol 617 | 11 May 2023 | 233

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