Heath News Repository - English (April

Transcription

Adolescent
Adolescent girls
Girls more likely to have sex before 15’ (The Times of India: 25.4.2012)
Adolescent girls in developing countries like India are more likely than adolescent boys
to have sex before they turn 15.
While 3% boys, in the 15-19 age category, had sex before reaching 15 between 2005 and
2010 in India, almost 8% girls in the same age group had become sexually intimate.
Unicef's “Global Report Card on Adolescents 2012” published in the Lancet said among
15-19 year olds in the developing world (excluding China), 11% girls had sex before the
age of 15 against 5% boys. Early sex also resulted in early childbearing, and also
increased the risk of HIV.
While only 35% adolescent boys in India had comprehensive knowledge of HIV, it was
lower among girls at 19%.
In India, 49,000 male adolescents and 46,000 girls were living with HIV in 2010.
Globally, about 2.2 million adolescents, aged 10-19, are living with HIV, and most of
them are unaware. In absolute numbers, it works out to 1.3 million and 870,000
adolescent girls and boys, respectively.
Birth rates among Indian adolescents were also very high. About 22% women aged 2024 years now gave birth before turning 18. Bangladesh, India and Nigeria alone account
for one in every three of the world’s adolescent births. The report, to be announced on
Wednesday, says globally each year about 16 million girls, aged 15-19, give birth,
accounting for about 11% of births.
Unicef says early childbearing often results from child marriage. Approximately 95% of
adolescent births occur in low and middleincome countries. The only industrialized
country among the top 10 nations with highest number of adolescent births is the US.
More than one in four women in sub-Saharan Africa has given birth before she turned 18.
Early marriage is also rampant globally. Nearly 25% of adolescent girls aged 15-19 in the
developing world (excluding China) is currently married or in union. In south Asia,
nearly one in every three adolescent girls aged 15-19 is married, compared to one in 14 in
Central and Eastern Europe.
Aging
Age-Defying Therapies
Age-Defying Therapies May Result From Rapamycin Study (Medical
News Today: 2.4.2012)
The drug rapamycin has been shown to extend lifespan in lab animals, yet rapamycin has
also been linked to impaired glucose tolerance and insulin sensitivity, two hallmarks of
diabetes. By teasing apart rapamycin's activity at the cellular level, researchers at
Whitehead Institute and the University of Pennsylvania have determined that inhibiting
only the protein cluster known as the mechanistic target of rapamycin complex 1
(mTORC1) prolongs life in mice without adversely affecting glucose tolerance or insulin
sensitivity.
With this novel understanding of how rapamycin produces its anti-aging effects,
researchers may be able to develop a drug that specifically targets mTORC1, thereby
promoting longevity while preventing the adverse effects associated with rapamycin.
One of the secrets to a longer, healthier life is simply to eat less. When subjected to
calorie restriction (CR), typically defined as a 20-40% reduction in caloric intake with
corresponding maintenance of proper nutrition, animals in labs not only live longer, but
also have improved insulin sensitivity and glucose tolerance, both of which decline
during aging.
Yet, for all of its benefits, CR's restricted diet is a stumbling block for most Americans. If
only we had a drug that could do the same thing.
Well, we do, sort of. The drug rapamycin, which is used for immunosuppression in organ
transplantations, mimics the longevity effects of CR and may tap into the same cellular
pathway as CR. Unlike CR, however, rapamycin actually impairs glucose tolerance and
insulin sensitivity, two hallmarks of diabetes. Clearly, rapamycin is doing something CR
is not.
To understand better rapamycin's benefits and risks, researchers from the lab of
Whitehead Institute Member David Sabatini and Joseph Baur, assistant professor of
Physiology, at the University of Pennsylvania's Perelman School of Medicine, have
discovered precisely how rapamycin is behaving at the cellular level. Their intriguing
results are published in the journal Science.
"We know that despite its adverse effects, rapamycin still prolongs lifespan, so there's a
potential that we could make it better by just having lifespan affected and not induce the
adverse effects," says Sabatini, who is a professor of biology at MIT and a Howard
Hughes Medical Institute (HHMI) investigator. "The data in this paper suggest that it's
possible."
Rapamycin, which is also called sirolimus and marketed in the United States as
Rapamune, is a known inhibitor of the mechanistic target of rapamycin complex 1
(mTORC1), a protein complex that regulates many cellular processes linked to growth
and differentiation. mTORC1 is part of a cellular signaling pathway, called mTOR,
which responds to nutrients and growth factors. Mechanistic target of rapamycin complex
2 (mTORC2) is also part of the mTOR pathway and regulates insulin signaling.
Rapamycin has generally been thought to target primarily mTORC1. But work by Dudley
Lamming and Lan Ye, co-authors of the Science paper and postdoctoral fellows in the
Sabatini and Baur labs respectively, indicates that in mice, rapamycin also inhibits
mTORC2, thereby reducing insulin sensitivity.
To see if rapamycin's positive effects on lifespan effects could be separated from its
negative metabolic effects, Lamming and Ye bred mice whose mTORC1 activity was
partially inhibited but whose mTORC2 activity remained largely intact. The females of
this mouse population lived longer than control mice while maintaining normal insulin
sensitivity.
"This shows that disrupting mTORC1 alone is capable of extending lifespan, if you can
find a way do that," says Lamming.
For Baur, the experiments' results indicate that there is a possibility of identifying a better
anti-aging drug than rapamycin.
"Our work highlights the potential utility of molecules that target mTORC1 specifically
and suggests there is hope that by targeting this pathway, you could really get something
that ameloriates age-related diseases without causing more problems than it solves," says
Baur. "If you're taking an anti-aging drug as a preventive measure, you probably don't
want to pay the price of diabetes."
Elderly & child care
Trained professionals for elderly & child care soon (The Tribune:
2.4.2012)
Time is not far when working mothers would be able to hire trained professionals to look
after their newborns while they are away to office and when older persons can get
professional care if their families are too busy to help.
In the first bold move to create a professional cadre of new age professionals, the
Ministry of Human Resource Development (through the All India Council for Technical
Education) has signed a formal contract with the prestigious Tata Institute of Social
Sciences (TISS) which will help the Government design courses and teaching
methodologies for vocational training in social and industrial sectors.
The three-year MoU will help the Government roll out its ambitious National Vocational
Curriculum Framework which was launched about two months ago to train unskilled
workers in India.
Against 12.1 million Indians who require skills training annually, only three million
actually receive any and the rest is added to the unskilled workforce pool, denting the
otherwise huge benefits India could derive from the demographic dividend.
That explains why in the first two years of the MoU (it is a three-year deal), TISS will
work to develop curricula and teaching processes for creating a cadre of professionals in
five social fields - child care, geriatric (elderly) care, mental health volunteers, medical
technicians with special focus on dialysis operations and child protection volunteers. It
will also develop courses in 15 industrial sectors.
Once the courses are ready and institutions capacitated to undertake vocational training of
professionals, working mothers, who don’t have families to look after their children, can
hire professionals and won’t need to quit work. Likewise, the elderly can help
themselves.
“India needs at least five lakh geriatric care professionals and even more child
development professionals. An increasing number of older people are living longer and
away from their families. The idea is to create professionals who take care of both the
physical and psychological needs of the aged and children,” Dr S. Parasuraman, Director,
TISS, told The Tribune today.
The demand for these vocations is estimated to be huge but there is no current capacity to
address it. In India, out of the 157 lakh students who appeared for Class XII exam in
2008-2009, only 79 lakh passed.
The MoU will also have TISS research gaps in the vocational education sector and create
study models and content for various skill sectors. 5 social fields identified
TISS will work to develop curricula and teaching processes for creating a cadre of
professionals in five social fields — child care, geriatrics, mental health volunteers,
medical technicians with special focus on dialysis operations and child protection
volunteers.
Aging
Aging may not be be that avoidable when it comes to the brain.(Med
India: 1.5.2012)
So say researchers in the April 27th issue of the Cell Press journal Trends in Cognitive
Sciences explaining that it is what you do in old age that matters more when it comes to
maintaining a youthful brain not what you did earlier in life.
"Although some memory functions do tend to decline as we get older, several elderly
show well preserved functioning and this is related to a well-preserved, youth-like brain,"
says Lars Nyberg of Umeå University in Sweden.
Education won't save your brain -- PhDs are as likely as high-school dropouts to
experience memory loss with old age, the researchers say. Don't count on your job either.
Those with a complex or demanding career may enjoy a limited advantage, but those
benefits quickly dwindle after retirement.
Engagement is the secret to success. Those who are socially, mentally and physically
stimulated reliably show better cognitive performance with a brain that appears younger
than its years.
"There is quite solid evidence that staying physically and mentally active is a way
towards brain maintenance," Nyberg says.
The researchers say this new take on successful aging represents an important shift in
focus for the field. Much attention in the past has gone instead to understanding ways in
which the brain copes with or compensates for cognitive decline in aging. The research
team now argues for the importance of avoiding those age-related brain changes in the
first place. Genes play some role, but life choices and other environmental factors,
especially in old age, are critical.
Elderly people generally do have more trouble remembering meetings or names, Nyberg
says. But those memory losses often happen later than many often think, after the age of
60. Older people also continue to accumulate knowledge and to use what they know
effectively, often to very old ages.
"Taken together, a wide range of findings provides converging evidence for marked
heterogeneity in brain aging," the scientists write. "Critically, some older adults show
little or no brain changes relative to younger adults, along with intact cognitive
performance, which supports the notion of brain maintenance. In other words,
maintaining a youthful brain, rather than responding to and compensating for changes,
may be the key to successful memory aging."
Gene Therapy against Aging
First Gene Therapy against Aging-associated Decline Successfully
Tested (Med India: 17.5.2012)
Scientists have proved that mouse lifespan can be boosted by gene therapy. The therapy
has been found to be safe and effective in mice.
The results are published today in the journal EMBO Molecular Medicine. The CNIO
team, in collaboration with Eduard Ayuso and Fátima Bosch of the Centre of Animal
Biotechnology and Gene Therapy at the Universitat Autònoma de Barcelona (UAB),
treated adult (one-year-old) and aged (two-year-old) mice, with the gene therapy
delivering a "rejuvenating" effect in both cases, according to the authors.
Mice treated at the age of one lived longer by 24% on average, and those treated at the
age of two, by 13%. The therapy, furthermore, produced an appreciable improvement in
the animals' health, delaying the onset of age-related diseases – like osteoporosis and
insulin resistance – and achieving improved readings on ageing indicators like
neuromuscular coordination.
The gene therapy utilised consisted of treating the animals with a DNA-modified virus,
the viral genes having been replaced by those of the telomerase enzyme, with a key role
in ageing. Telomerase repairs the extremes of chromosomes, known as telomeres, and in
doing so slows the cell's and therefore the body's biological clock. When the animal is
infected, the virus acts as a vehicle depositing the telomerase gene in the cells.
This study "shows that it is possible to develop a telomerase-based anti-ageing gene
therapy without increasing the incidence of cancer", the authors affirm. "Aged organisms
accumulate damage in their DNA due to telomere shortening, [this study] finds that a
gene therapy based on telomerase production can repair or delay this kind of damage",
they add.
'Resetting' the biological clock
Telomeres are the caps that protect the end of chromosomes, but they cannot do so
indefinitely: each time the cell divides the telomeres get shorter, until they are so short
that they lose all functionality. The cell, as a result, stops dividing and ages or dies.
Telomerase gets round this by preventing telomeres from shortening or even rebuilding
them. What it does, in essence, is stop or reset the cell's biological clock.
But in most cells the telomerase gene is only active before birth; the cells of an adult
organism, with few exceptions, have no telomerase. The exceptions in question are adult
stem cells and cancer cells, which divide limitlessly and are therefore immortal – in fact
several studies have shown that telomerase expression is the key to the immortality of
tumour cells.
It is precisely this risk of promoting tumour development that has set back the
investigation of telomerase-based anti-ageing therapies.
In 2007, Blasco's group proved that it was feasible to prolong the lives of transgenic
mice, whose genome had been permanently altered at the embryonic stage, by causing
their cells to express telomerase and, also, extra copies of cancer-resistant genes. These
animals live 40% longer than is normal and do not develop cancer.
The mice subjected to the gene therapy now under test are likewise free of cancer.
Researchers believe this is because the therapy begins when the animals are adult so do
not have time to accumulate sufficient number of aberrant divisions for tumours to
appear.
Also important is the kind of virus employed to carry the telomerase gene to the cells.
The authors selected demonstrably safe viruses that have been successfully used in gene
therapy treatment of haemophilia and eye disease. Specifically, they are non-replicating
viruses derived from others that are non-pathogenic in humans.
This study is viewed primarily as "a proof-of-principle that telomerase gene therapy is a
feasible and generally safe approach to improve healthspan and treat disorders associated
with short telomeres", state Virginia Boccardi (Second University of Naples) and Utz
Herbig (New Jersey Medical School-University Hospital Cancer Centre) in a
commentary published in the same journal.
Although this therapy may not find application as an anti-ageing treatment in humans, in
the short term at least, it could open up a new treatment option for ailments linked with
the presence in tissue of abnormally short telomeres, as in some cases of human
pulmonary fibrosis.
More healthy years
As Blasco says, "ageing is not currently regarded as a disease, but researchers tend
increasingly to view it as the common origin of conditions like insulin resistance or
cardiovascular disease, whose incidence rises with age. In treating cell ageing, we could
prevent these diseases".
With regard to the therapy under testing, Bosch explains: "Because the vector we use
expresses the target gene (telomerase) over a long period, we were able to apply a single
treatment. This might be the only practical solution for an anti-ageing therapy, since other
strategies would require the drug to be administered over the patient's lifetime,
multiplying the risk of adverse effects".
Aging and Cancer
Key Gene Found Responsible For Chronic Inflammation, Accelerated
Aging and Cancer (Medical News Today: 28.5.2012)
Researchers at NYU School of Medicine have, for the first time, identified a single gene
that simultaneously controls inflammation, accelerated aging and cancer.
"This was certainly an unexpected finding," said principal investigator Robert J.
Schneider, PhD, the Albert Sabin Professor of Molecular Pathogenesis, associate director
for translational research and co-director of the Breast Cancer Program at NYU Langone
Medical Center. "It is rather uncommon for one gene to have two very different and very
significant functions that tie together control of aging and inflammation. The two, if not
regulated properly, can eventually lead to cancer development. It's an exciting scientific
find."
The study, funded by the National Institutes of Health, appears online ahead of print
today in Molecular Cell and is scheduled for the July 13 print issue.
For decades, the scientific community has known that inflammation, accelerated aging
and cancer are somehow intertwined, but the connection between them has remained
largely a mystery, Dr. Schneider said. What was known, due in part to past studies by
Schneider and his team, was that a gene called AUF1 controls inflammation by turning
off the inflammatory response to stop the onset of septic shock. But this finding, while
significant, did not explain a connection to accelerated aging and cancer.
When the researchers deleted the AUF1 gene, accelerated aging occurred, so they
continued to focus their research efforts on the gene. Now, more than a decade in the
making, the mystery surrounding the connection between inflammation, advanced aging
and cancer is finally being unraveled.
The current study reveals that AUF1, a family of four related genes, not only controls the
inflammatory response, but also maintains the integrity of chromosomes by activating the
enzyme telomerase to repair the ends of chromosomes, thereby simultaneously reducing
inflammation, preventing rapid aging and the development of cancer, Dr. Schneider
explained.
"AUF1 is a medical and scientific trinity," Dr. Schneider said. "Nature has designed a
way to simultaneously turn off harmful inflammation and repair our chromosomes,
thereby suppressing aging at the cellular level and in the whole animal."
With this new information, Dr. Schneider and colleagues are examining human
populations for specific types of genetic alterations in the AUF1 gene that are associated
with the co-development of certain immune diseases, increased rates of aging and higher
cancer incidence in individuals to determine exactly how the alterations manifest and
present themselves clinically.
Aging
The Aging Brain Benefits From Persistent Sensory Experience (Medical
Scientists have believed for decades that most of the wiring of the brain is established by
the time a person has reached adolescence. Now, a new study published in Neuron
reveals that even in adulthood, changes in sensory experiences can cause massive
rewiring of the brain.
Researchers from the Max Planck Florida Institute (MPFI) and New York's Columbia
University have discovered that the rewiring involves fibers that provide primary input to
the cerebral cortex, which is involved in cognition, sensory perception and motor control.
The discovery could pave the way for future research on ageing and brain remodeling.
First author, MPFI neuroscientist Marcel Oberlaender, PhD, declared:
"This study overturns decades-old beliefs that most of the brain is hard-wired before a
critical period that ends when one is a young adult. By changing the nature of sensory
experience, we were able to demonstrate that the brain can rewire, even at an advanced
age. This may suggest that if one stops learning and experiencing new things as one ages,
a substantial amount of connections within the brain may be lost."
In their study, the researchers examined the brains of older rats, focusing on the thalamus,
an area within the brain that processes and transmits information from sensory organs to
the cerebral cortex. Scientists believed for years that the connections between the
thalamus and the cortex would be fixed by early adulthood. However, the researchers
observed that this was not true in the animals they studied.
Given that rats are nocturnal and depend on their whiskers as sensory organs to explore
and navigate makes them an ideal model for investigating whether the brain can be
remodeled through changes in sensory experience. To find out whether extensive
rewiring would occur between the thalamus and the cortex, the researchers simply
trimmed the rats whiskers, hence preventing them receiving important and frequent
sensory input.
They discovered that rats with trimmed whiskers had altered axons, i.e. neurons or nerve
cells that act like a fiber-optic cables carrying outgoing impulses, whilst in those with
untrimmed whiskers the axons remained unchanged. The finding was significant
considering that the rats were older, which means that rewiring still occurs at a later age.
Furthermore, the researchers observed that the rewiring occurred in as little as a few days.
Dr. Oberlaender stated:
"We've shown that the structure of the rodent brain is in constant flux, and that this
rewiring is shaped by sensory experience and interaction with the environment. These
changes seem to be life-long and may pertain to other sensory systems and species,
including people. Our findings open the possibility of new avenues of research on
development of the aging brain using quantitative anatomical studies combined with
noninvasive imaging technologies suitable for humans, such as functional MRI (fMRI)."
Recent advances in high-resolution imaging and reconstruction techniques, which Dr.
Oberlaender helped to develop in part, enabled the team to automatically and reliably
trace the fine and complex branching patterns of individual axons throughout the entire
brain. To put things into perspective, axons have a typical diameter of less than a
thousandth of a millimeter.
Dr. Oberlaender and Nobel laureate Dr. Bert Sakmann are part of the Max Planck Florida
Institute's Digital Neuroanatomy group that focuses on the functional anatomy of circuits
in the cerebral cortex that form the basis of simple behaviors (e.g. decision making). The
group's most significant development is to develop a three-dimensional map of the rodent
brain. This will provide new insight into the functional architecture of entire cortical
areas as well as offering a better mechanical understanding of sensory perception and
behavior.
Aging
Study Says Aggressive Management of Osteoporosis among Extreme
Elderly Needed to Prevent Hip Fractures (Med India: 11.6.2012)
Citing widespread instances of osteoporotic hip fractures among the elderly over 80 years
of age, a new study presented at the at EULAR 2012, the Annual Congress of the
European League Against Rheumatism said that an aggressive management of
osteoporosis is needed to prevent such incidents among the extreme elderly population.
Via the Nationwide Inpatient Sample (NIS), 4.3 million patients over the age of 65 with
osteoporotic hip fractures were studied. Results showed that 67.3% of hip fractures
occurred in the extreme elderly, increasing from 172,209 in 1993 to 180,428 in 2008.
This growth was despite the fact that hip fracture prevalence decreased from 2,236 to
1,600 per 1,000 person-years in the same period, but is coincident with the dramatic rise
in the extreme elderly population, from 7.7 million in 1993 to 11.2 million in 2008.
In addition, in 2008, the extreme elderly made up 42.3% of the elderly population, but
accounted for 69% of hospitalisations. "We know that hip fracture in the extreme elderly
is a serious problem due to the associated consequences of hospitalisation, disability and
mortality," commented Ms. Amrita Sehgal from University of California, USA and lead
study author. "This data is cause for concern as the impact highlighted will only increase
along with this population segment. The question now is how we manage the extreme
elderly more effectively to limit the impact that osteoporotic fractures have going
forward."
With the extreme elderly predicted to comprise 25% of the total US population by 2050,
this study calls for more aggressive measures to be introduced to enable osteoporosis to
be more effectively prevented, diagnosed and treated. The study recommends that this
should be via traditional methods, e.g. medical professionals, or more holistically via
non-traditional settings and providers, like assisted living facilities.
Elderly parents
30% SURVEYED REPORT ABUSE (The Times of India:15.6.2012)
Sons hurt elderly parents most: Study
TIMES NEWS NETWORK
Last year, a resident of Model Town had taken his 85-year-old mother to Indirapuram on
the pretext of showing her around. He suddenly dropped her midway and drove back. He
didn’t attempt to look for her again. The abandoned mother — too frail to find her way
back — broke down on the roadside. She was taken to an old age home. Months later,
HelpAge India representatives tracked down her son and grandson. But the woman’s
heart was probably too severed by then.
This is just one example of elder abuse cases that NGOs come across regularly. Help-Age
India’s research report on the issue, released on the eve of World Elder Abuse Awareness
Day, reveals there has been a dramatic rise in the number of abuse cases in the city.
While last year only 12% of those surveyed reported abuse, this time the figure stood at
30%.
Interestingly, the son has assumed the role of the primary abuser in over 60% cases,
followed by the daughter-in-law in 24% cases. “The traditional saas-bahu equation
depicted on TV doesn’t always hold true. In most real life cases, it’s the son who illtreats
parents. In 51% cases, we found that the reason for abuse was property related,” said
chief executive, HelpAge India, Mathew Cherian.
In most instances, elders faced verbal abuse with 69% of them feeling disrespected.
“There are cases where children don’t acknowledge the presence of elderly parents. Not
talking to them is also a form of abuse. Around 12% of our respondents reported verbal
abuse. However, most of them don’t raise their voice against the treatment meted out to
them. Cops said they hardly get any complaints from elders,” Cherian explained. Often,
they hold back for the fear of defaming the family.
Around 35% of the elders surveyed felt economic dependence on their children made
them more vulnerable to abuse. Majority of senior
citizens said they had been facing abuse for over four years continuously.
However, the situation in Delhi is not as grim as many other cities. Bhopal performed the
worst among the 20 cities surveyed. Around 77% elders in Bhopal said they had faced
abuse, followed closely by Guwahati (60%) and Lucknow (52%). “I think culture also
plays some role in preventing abuse. For instance, Jaipur in Rajasthan had the lowest
reports of abuse (1.67%), probably because of the prevalence of joint families,” Cherian
added. Around 5,600 people participated in the survey.
Special commissioner of police (law and order) Amulya Patnaik said the rate of crime
against elders in Delhi is steadily declining. In 1995, at least 34 cases of senior citizens
being murdered were reported. In 2011, the figure dropped to 15. “Family members
should act with more responsibility and caution. They can install a magic eye on the door,
avoid helpers without police registration, and check the credentials of security guards,
plumbers and electricians to ensure elders’ security,” Patnaik said.
Lt Governor of Delhi, Tejendra Khanna, chief guest at the event, urged elders not to feel
emotionally or financially dependent on others.
Aging
How Aging Normal Cells Fuel Tumor Growth and Metastasis(Science
Daily:15.6.2012)
It has long been known that cancer is a disease of aging, but a molecular link between the
two has remained elusive.
Now, researchers at the Kimmel Cancer Center at Jefferson (KCC) have shown that
senescence (aging cells which lose their ability to divide) and autophagy (self-eating or
self-cannibalism) in the surrounding normal cells of a tumor are essentially two sides of
the same coin, acting as "food" to fuel cancer cell growth and metastasis.
Michael P. Lisanti, M.D., Ph.D., Professor and Chair of Stem Cell Biology and
Regenerative Medicine at Jefferson Medical College of Thomas Jefferson University and
a member of the KCC, and his team previously discovered that cancer cells induce an
oxidative stress response (autophagy) in nearby cells of the tumor microenvironment to
feed themselves and grow.
In this study, senescent cells appear to have many of the characteristics of these
autophagic cancer-associated fibroblasts and to be part of the same physiological process.
In other words, normal neighboring cells that are becoming senescent or "old" are
directly making food to "feed" the cancer. Aging literally fuels cancer cell growth.
Since senescence is thought to reflect biological aging, this research on autophagyinduced senescence may explain why cancer incidence dramatically increases
exponentially with advanced age, by providing a "fertile soil" to support the anabolic
growth of "needy" cancer cells.
The findings were reported in the June 15 issue of Cell Cycle.
"This research merges the two paradigms of aging and cancer, and it also brings in cell
metabolism," said Dr. Lisanti. "We provide genetic support for the importance of 'twocompartment tumor metabolism' in driving tumor growth and metastasis via a very
simple energy transfer mechanism. Senescence and autophagy metabolically support
tumor growth and metastasis."
Simply put, aging is the metabolic engine that drives cancer growth.
To test this link, the researchers developed a genetically tractable model system to
directly study the compartment-specific role of autophagy in tumor growth and
metastasis. First, they took human fibroblasts immortalized with telomerase and
transfected them with autophagy genes.
Next, they validated that these fibroblasts show features of mitophagy, mitochondrial
dysfunction and a shift toward aerobic glycolysis, with increases in lactate and ketone
production, mimicking the behavior of cancer-associated fibroblasts. They observed that
autophagic-senescent fibroblasts promoted metastasis, when co-injected with human
breast cancer cells, by more than 10-fold.
Thus, metastasis may be ultimately determined by aging or senescent cells in the tumor
microenvironment, rather than by the cancer cells themselves. This finding completely
changes how we view cancer as a disease.
This observation directly calls into question the long-standing notion that cancer is a cellautonomous genetic disease. Rather, it appears that cancer is really a disease of host
aging, which fuels tumor growth and metastasis, thus, determining clinical outcome.
Normal aging host cells are actually the key to unlocking effective anti-cancer therapy.
In the study, the autophagic fibroblasts also showed features of senescence. What's more,
the senescent cells shifted toward aerobic glycolysis, and were primarily confined to the
tumor stromal compartment.
Autophagy action is also clearly compartment specific, since the researchers showed that
autophagy induction in human breast cancer cells resulted in diminished tumor growth.
Therefore, selective induction of self-cannibalism in cancer cells is a new therapeutic
target for the prevention of tumor growth and metastasis. In this strategy, cancer cells
actually eat themselves, reversing tumor growth and metastasis.
To stop tumor growth and metastasis, researchers will need to "cut off the fuel supply"
which is provided by aging senescent cells, before it gets to cancer cells by targeting
autophagy and senescence in the tumor microenvironment.
These findings are paradigm shifting and will usher in a completely new era for anticancer drug development, according to the researchers. New approaches for targeting the
"autophagy-senescence transition" could have important implications for preventing
tumor growth and metastasis, and effectively overcoming drug resistance in cancer cells.
"Rapidly proliferating cancer cells are energetically dependent on the aging host tumor
stroma," Dr. Lisanti said. "As such, removing or targeting the aging tumor stroma would
then stop tumor growth and metastasis. Thus, the aging stroma is a new attractive
metabolic or therapeutic target for cancer prevention."
A clear by-product of this research would also be the development new anti-aging drugs
to effectively combat, stop or reverse aging, thereby preventing a host of human diseases,
and especially cancer.
Elderly
Grey matter of concern
Mala Kapur Shankardass
Of the about 100 million elderly in India, one in every three faces abuse,
often at the hands of family members. To combat this scenario we need
a comprehensive ‘rights’ based action plan(The Tribune:22.6.2012)
EVERY year since 2006, there
starts a month long observance of
the
World
Elder
Abuse
Awareness
Day
(WEAAD),
officially marked as 15 June. This
year the observance had special
significance for all involved with
ageing issues, especially those
combating the menace of elder
abuse. It is during the first United
Nations celebration of WEAAD
at the 89th plenary meeting of the
UN General Assembly (19
December
2011
Resolution
66/127, para. 21), it was decided
TO THE WALL: 70 percent of the elderly, who receive
to involve all Member States, PUSHED
abuse from their own children, live in houses owned by them.
organizations of the United Photo: ANI
Nations
system,
other
international and regional organizations, as well as civil society, including NGOs and
individuals, to observe the day in an appropriate manner. While in New York, UN
Secretary General Ban Ki-moon reaffirmed that human rights of older persons are as
absolute as those of other human beings, in India, very aptly, the UN Resident
Coordinator, a.i. Frederika Meijer inaugurated observance of WEAAD in a programme
organised by United Nations Information Centre, United Nations Population Fund and
Development, Welfare & Research Foundation, a national voluntary organisation, which
stressed elder abuse as an unacceptable attack on human dignity and human rights. The
students, young adults, middle aged and the old voiced their concerns for ignoring the
rights of the older people. Lack of well defined rights, laws and action plans make the
senior citizens vulnerable to the risk of abuse, neglect, exploitation and marginalisation,
was the conclusion.
Vulnerability
Reviewing the recent HelpAge report on elder
abuse crime in India, I see a clear violation of
rights of older people, more so of women by the
family members. What is also striking is the
ignorance of the older people about their right to
life of dignity, respect and protection. This is not
only an Indian phenomena or an Asian one but
rather cuts across all nations. World Health
Organization statistics reveal around 4 to 6 per
cent of older people have experienced some form
of maltreatment at home and the number is much
higher in institutional settings. But, there is also
acknowledgement by gerontologists and age care
workers that elder abuse is often unreported and
under recognised in Asian countries. The crux of
the problem lies in the fact that many older people Thinkstockphotos/ Getty images
do not enjoy fundamental human freedom and rights, even though human rights
mechanisms identify older men and women at greater risk of human rights violations.
They require specific measures of protection. In countries across the globe senior citizens
can be divided into two categories; those who are in good health and have economic and
emotional security, and those who do not have adequate means of support, are deprived
of social and health care, exploited financially and psychologically. Unfortunately, the
latter are in majority and are among the most vulnerable, marginalised and unprotected.
Yet, seldom are there any effective preventive strategies to reduce the risk of abuse for
them, nor are there strong laws and
policies to address these concerns.
Substitute for family


A rapidly increasing number of
older people and shrinking and
burdened care givers from the
family point towards developing
alternative facilities, services and
provisions for housing senior
citizens. The American Association
of Retired Persons, one of the
largest organised group of older
persons, has been advocating with
policymakers, programme
managers and researchers to
maintain and create housing
options and communities that
meet the needs of older people
and facilitate ageing with dignity.
There are just about 728 Old Age
Homes in India. Detailed
information on only 547 homes is
available. Out of these, 325 homes
are free of cost, run by charitable
Implementation- a problem
trusts, while 95 old age homes are
on pay- and -stay basis, 116
homes have both free as well as
pay- and- stay facilities and 11
homes have no information. A
total of 278 old age homes all over
the country are available for the
sick and 101 homes are
exclusively for women.
Kerala has 124 old age homes, the
maximum in any state.
Pune and Banglore have some
retirement homes for the elderly.
The 21st century, on the one hand, has led
to the positive development in many
countries in terms of formulation of
legislations to protect older people from
abuse. On the other hand, despite the right
based perspective in legal reforms, the

rights based action in implementing
measures is missing. Most national legal

systems stipulate punishment for the
perpetrators of elder abuse, but have no
adequate legal instruments to detect and
report abuse of different forms and more importantly to rehabilitate the victims of abuse.
In many Asian countries in particular, legislations deal more with getting just the
maintenance money from family members, though they aspire to have inclusive policies
for all sections of the population, including the elderly. During the last decade China,
Thailand like India and even small countries like Nepal, Philippines, Singapore and
Vietnam have adopted a special Act at legislative level, as an enforceable legal
instrument to address elder abuse. These Acts combine provisions on family support and
state responsibility through social welfare. Review of the use of the Act in different
countries carried out to create enabling environments for older people to enable them a
life of dignity and respect found huge gaps in implementation. Significantly, they found
when older people report a case of maltreatment, abuse, neglect or violence against their
own children, legal recourse helps in getting a monetary sum from children for meeting
their daily financial needs, but overlooks their consequent state of loneliness, lack of
available care givers, threat of emotional insecurity, depression and break down after
estrangement with children.
Growing number of suicides
Rights based mechanism to provide comprehensive support to victims of abuse and
neglect, is missing from national action plans. No wonder in our country the rate of
suicide among the old is increasing, Kerala with the highest population of the ageing is an
appropriate example of this scenario. In fact the world statistics state that the highest rate
of suicide occurs among persons aged 65 and older.
The Maintenance and Welfare of Parents and Senior Citizens Act (2007) in India, which
provides a framework for welfare, security, and protection to senior citizens, has till now
not been notified in all the states and union territories of the country. The 21 states where
it has been notified, not all the state governments have taken the five steps required for its
implementation, namely; must notify the Act, frame rules for the Act, appoint
maintenance tribunals, appoint maintenance officers and appoint appellate tribunals. Only
five states have taken care of all the five steps. Further, like in Europe, elder abuse in
India is also addressed by legislation on domestic violence, but notwithstanding the fact
that older women in particular, who lack alternative provisions for their support are
reluctant to use this legal instrument to safeguard themselves for a life of dignity, despite
their right to it.
Do laws favour the young?
The debate began with Section 498- A, which though, was framed to save young women
from dowry harassment, victimised many elderly people in the process. There is growing
empirical evidence of the misuse of the Dowry Act and a strong movement is emerging
asking for amendment to the Act which does not violate the rights of older persons and
does not victimise them. Incidentally the Home Ministry has directed the Law
Commission of India to consider amendments to Section 498-A of Indian Penal Code.
The Law Commission has published a Consultation Paper-cum-Questionnaire regarding
Section 498-A of IPC on its website (www. lawcommissionofindia.nic.in).
In the last few years, international conventions adopted by UN Member States have
addressed the issue of rights for other specific vulnerable population groups, such as
women, children, persons with disabilities, migrant workers, and others. But all the
continents have not united to call for a convention on the rights of older persons. There is
an opinion among certain groups that the existent conventions protect certain
vulnerabilities of the people in old age, such as of older women and disabled elderly.
What needs to be stressed is that without a Convention for Rights of Older People,
vulnerabilities and risks to abuse and neglect of older population will continue.
Particularly of those who are denied geriatric health care, dementia care, facilities for
their recreation and leisure, standards for provision of services, universal pensions, and
social assistance etc.
They have diverse needs
Entitlements of older persons should not be just on the basis of being a destitute and
disadvantaged, but as an ageing person with diverse needs to maintain an adequate
standard of living. There is need for hard legal instruments to appropriately monitor and
regularise the implementation of policies and programmes. Madrid Plan of Action on
Ageing to which many countries are adhering in planning for fast increasing numbers of
older people is more of a soft law, a statement of intention. What is required in Asia, and
for influential countries like India and China, is to take a lead in establishing a protocol
on older people’s right and work comprehensively on developing human rights
instrument for older people as has been done by developing countries like Argentina,
Brazil, Chile and others who are part of the Inter-American Regional Convention on the
rights of older people. It is also being done by the European and African countries. We
should not be left behind in combating elder abuse, in all its forms.
The writer, a sociologist and gerontologist, is Associate Professor, Maitreyi College,
University of Delhi
Aging And Cancer
Discovery Of How Key Enzyme Involved In Aging And Cancer
Assembles: UCLA Biochemists(Med India:22.6.2012)
Mapping of the structure of a key protein–RNA complex that is required for the assembly
of telomerase was done by UCLA biochemists. Telomerase is an enzyme important in
both cancer and aging.
The researchers found that a region at the end of the p65 protein that includes a flexible
tail is responsible for bending telomerase's RNA backbone in order to create a scaffold
for the assembly of other protein building blocks. Understanding this protein, which is
found in a type of single-celled organism that lives in fresh water ponds, may help
researchers predict the function of similar proteins in humans and other organisms.
The study was published June 14 in the online edition of the journal Molecular Cell and
is scheduled for publication in the print edition on July 13.
The genetic code of both the single-celled protozoan Tetrahymena and humans is stored
within long strands of DNA packaged neatly within chromosomes. The telomerase
enzyme helps create telomeres — protective caps at the ends of the chromosomes that
prevent the degradation of our DNA, said Juli Feigon, a UCLA professor of chemistry
and biochemistry and senior author of the study.
Each time the cell divides, the telomeres shorten, acting like the slow-burning fuse of a
time bomb. After many divisions, the telomeres become eroded to a point that can trigger
cell death.
Cells with abnormally high levels of telomerase activity constantly rebuild their
protective chromosomal caps, allowing them to replicate indefinitely and become,
essentially, immortal. Yet undying cells generally prove to be more of a curse than a
blessing, Feigon said.
"Telomerase is not very active in most of our cells because we don't want them to live
forever," said Feigon, who is also a researcher at UCLA's Molecular Biology Institute
and a member of the National Academy of Sciences. "After many generations, DNA
damage builds up and we wouldn't want to pass those errors on to subsequent cells."
Overactive telomerase has potentially lethal consequences far beyond the propagation of
erroneous DNA. The enzyme is particularly lively within cancer cells, which prevents
them from dying out naturally. Finding a way to turn off telomerase in cancer cells might
help prevent the diseased cells from multiplying.
Flipping the switch on telomerase might mean stopping it from forming in the first place,
said Feigon.
"Any time you want to stop an enzyme, you can target activity, but you can also target
assembly," she said. "If you keep it from assembling, that's just as good as keeping it
from being active, because it never even forms."
While there is enormous interest in telomerase due to its connection to cancer and aging,
very little is known about its three-dimensional structure or its formation, Feigon said.
Four years ago, UCLA postdoctoral scholar Mahavir Singh set out to determine how a
strand of RNA and multiple proteins bind together to form telomerase. He set his sights
on the p65 protein, one of the key components of the enzyme. Like many proteins, p65 is
a long chain of both stiff and supple links that fold in upon one another in a prescribed
pattern. At the very end of the p65 protein is a floppy, disordered tail.
"We knew the tail was important for the protein's function, but it wasn't clear how or
why," said Singh, first author of the current study. "From the structure, it became evident
how it interacts with the telomerase RNA."
When Singh snipped off the flexible tail from p65, he found that the assembly of
telomerase became severely limited. The tailless p65 simply couldn't help put together
the enzyme.
Using both X-ray crystallography and nuclear magnetic resonance spectroscopy, Singh
probed the structure of the protein and its interaction with telomerase RNA. He found
that upon assembly, the flexible tail transforms into a rigid crowbar that pries apart the
strands of the RNA double helix. The newly altered protein tail bends the RNA into a
new shape required for binding an essential component of telomerase, a protein called
telomerase reverse transcriptase, or TERT.
The p65 protein not only brings two parts of the RNA closer together to allow for the
attachment of the TERT protein, but it also folds around the end of the RNA strands to
protect them before the telomerase assembles. Without its protein shield, the "naked"
RNA is susceptible to degradation and could be chewed up by other enzymes, Singh said.
The p65 protein belongs to a family of "La-motif" proteins, molecules that act as "RNA
chaperones" in many organisms including humans, said Feigon.
"How the p65 protein binds with RNA has never been clear," Feigon said. "Nobody could
figure it out, and that's partly because they were missing a critical, extra part of the
protein which changes from being a completely random coil to being folded and ordered
when it interacts with RNA."
Studying p65 within the humble Tetrahymena may help Singh and Feigon better
understand its La-motif cousins within the human body, which may also sport protein
tails.
"A lot of data indicates that the protein tail is important for the binding of all kinds of
RNAs in human cells," Feigon said. "It is particularly critical for the translation of the
hepatitis C viral RNA. Now we can potentially predict how those proteins will assemble
and interact with their RNAs."
The researchers who first discovered telomerase were awarded the Nobel Prize in 2009.
They also used Tetrahymena thermophila, a tiny microorganism with hair-like flagella
commonly found in fresh water.
Ageing
'Ageing not linked to drop in testosterone levels'(New Kerala:
25.6.2012)
Ageing, surprisingly, may have little to do with a gradual drop in testosterone levels, but
is more likely to result from a man's behavioural and health changes, says a new study.
"It is critical that doctors understand that declining testosterone levels are not a natural
part of aging and that they are most likely due to health-related behaviours or health
status itself," said study co-author Gary Wittert, professor of medicine at the University
of Adelaide, Australia.
"Men who had declines in testosterone were more likely to be those who became obese,
had stopped smoking or were depressed at either clinic visit," Wittert said.
"While stopping smoking may be a cause of a slight decrease in testosterone, the benefit
of quitting smoking is huge," added Wittert. This hormone is important for many bodily
functions, including maintaining a healthy body composition, fertility and sex drive.
Few population-based studies have tracked changes in testosterone levels among the
same men over time, as their study did, Wittert said, according to an Aadelaide statement.
Wittert and his co-authors analysed testosterone measurements in more than 1,500 men
recorded at two clinic visits five years apart. All blood testosterone samples underwent
testing at the same time for each time point, said Wittert.
Researchers included 1,382 men in the data analysis, aged between 35 and 80 years,
averaging 54 years, after screening out those who were taking medicines or had medical
conditions known to affect hormones.
On average, testosterone levels did not decline significantly over five years; rather, they
decreased less than one percent each year, the authors reported. However, when the
investigators analysed the data by subgroups, they found that certain factors were linked
to lower testosterone levels at five years than at the beginning of the study.
Unmarried men in the study had greater testosterone reductions than did married men.
Wittert attributed this finding to past research showing that married men tend to be
healthier and happier than unmarried men. "Also, regular sexual activity tends to increase
testosterone," he explained.
These results will be presented Monday at the Endocrine Society's 94th annual meeting in
Houston, US. (IANS)
Ageing
Alzheimer's just a normal part of ageing (New Kerala:29.6.2012)
Alzheimer's is the second most feared disease after cancer, but a mental health specialist
has said that it shouldn't be regarded as a tragedy, but as a normal part of the ageing
process in people aged 85 and over.
Just as other parts of the body degenerate - eyes, bones, heart and skin - our brain is also
likely to degenerate as we enter advanced age.
David Spektor, a specialist in aged persons' mental health, will address the international
conference on dementia in Sydney and tell that labelling people in their 80s and 90s with
Alzheimer's disease is unfair and may serve no productive purpose.
''We bring fear to millions by telling them they have a disease; everyone's brain ages and
in different ways. We risk turning a normal process into a disease,'' the Age quoted him
as saying in an interview.
Dr Spektor, senior clinical psychologist at Melbourne Health, a public health provider
connected to the Royal Melbourne Hospital, said that the reality of ageing was that many
people in their 80s and 90s would lose memory and cognitive abilities, just as they were
likely to suffer hearing loss and deteriorating eyesight.
''Getting the diagnosis can lead people to overestimate what they can't do and underestimate what they can do. And the things they can do - laugh, hug, empathise, love - are
arguably far more important aspects of being human,'' he said.
Dr Spektor said he did not question the existence of Alzheimer's disease as a medical
condition and for people under 85 diagnosis and medication to slow the condition, if
appropriate, were useful.
But the focus on Alzheimer's as a disease meant much of the research effort was on
finding a cure rather than finding better ways to care for millions of old people with
Alzheimer's and other forms of dementia as they reached the end of their lives.
''We need more research on how people can live with quality and dignity during all the
worsening symptoms of the condition,'' he said. (ANI)
Aging Eyes
Good News for Aging Eyes: Debilitating Eyesight Problems on the
Decline for Older Americans(Science Daily:29.6.2012)
Today's senior citizens are reporting fewer visual impairment problems than their
counterparts from a generation ago, according to a new Northwestern Medicine study.
Improved techniques for cataract surgery and a reduction in the prevalence of macular
degeneration may be the driving forces behind this change, the researchers said.
"From 1984 until 2010, the decrease in visual impairment in those 65 and older was
highly statistically significant," said Angelo P. Tanna, M.D., first author of the study.
"There was little change in visual impairments in adults under the age of 65."
The study, published in the journal Ophthalmology, shows that in 1984, 23 percent of
elderly adults had difficulty reading or seeing newspaper print because of poor eyesight.
By 2010, there was an age-adjusted 58 percent decrease in this kind of visual impairment,
with only 9.7 percent of elderly reporting the problem.
There was also a substantial decline in eyesight problems that limited elderly Americans
from taking part in daily activities, such as bathing, dressing or getting around inside or
outside of the home, according to the study.
"The findings are exciting, because they suggest that currently used diagnostic and
screening tools and therapeutic interventions for various ophthalmic diseases are helping
to prolong the vision of elderly Americans," Tanna said.
Tanna is the vice chairman of ophthalmology at Northwestern University Feinberg
School of Medicine and an attending physician at Northwestern Memorial Hospital.
Stephen Kaye, of the Institute for Health & Aging and Disability Statistics Center,
University of California, is the second author of the study.
The study used self-reported data collected from 1984 to 2010 through two major
population-based surveys, the National Health Interview Survey and the Survey of
Income and Program Participation.
Survey questions revealed how vision problems can impact the daily activities and
quality of life of Americans and helped researchers analyze trends in the prevalence of
visual impairment of adults in the United States.
While this study didn't identify any of the causes of the change in the prevalence of visual
impairment, Tanna said there are three likely reasons for the decline:
•Improved techniques and outcomes for cataract surgery
•Less smoking, resulting in a drop in the prevalence of macular degeneration
•Treatments for diabetic eye diseases are more readily available and improved, despite
the fact that the prevalence of diabetes has increased
Future studies should identify which treatment strategies help prevent vision in older
adults and then make those treatments available to as many people as possible, Tanna
said.
Alcohol Dependence
Alcohol
Alcohol can help you solve riddles faster (New Kerala: 13.4.2012)
Strange but true... scientists say that drinking some beer before solving brain teasers can
help you do better than those who attempt the riddles in a sober state.
Alcohol clouds analytical thinking or so it is thought, but frees stifled 'creative' thoughts
to well up, allowing subjects to come up with more imaginative insights or solutions.
University of Illinois psychologists set 40 healthy young men a series of brain teasers.
They were given three words, such as coin, quick and spoon, and coming up with a fourth
word that links the three - in this case silver, the journal of Consciousness and Cognition
reports.
Half the group drank the equivalent of two pints of beer before doing the tests, while the
rest carried them out sober, according to The Telegraph.
The drinking group solved nearly 40 percent more problems than the others, and took an
average of 12 seconds compared to the 15.5 seconds needed by sober subjects.
The researchers said: "The current research represents the first demonstration of alcohol's
effect on creative problem solving."
Study author Jennifer Wiley said: "The bottom line is that we think being too focused can
blind you to novel possibilities, and a broader, more flexible state of attention is needed
for creative solutions to emerge." (IANS)
Alcohol
reports.
Alcohol
reports.
Alcohol
Moderate drinking before and after heart attack tied to lower mortality
risk (New Kerala: 19.4.2012)
Compared with no alcohol consumption, the pre and post-heart attack intakes of light and
moderate amounts of alcohol could be associated with lower risk of all-cause mortality
and cardiovascular morality, a new study has revealed.
The Health Professionals Follow-up Study (HPFS) is a prospective cohort study of
51,529 US male health professionals. During the follow up of these men between 1986 to
2006, 1,818 men were confirmed with incident non-fatal myocardial infarction (MI) – a
non-fatal heart attack.
Among heart attack survivors, 468 deaths were documented during up to 20 years of
follow up. Repeated reports were obtained on alcohol consumption every four years.
Average alcohol consumption was calculated prior to and then following the MI.
The overall results showed that the significant reductions in all-cause mortality risk were
no longer present for those who drank more than 30 g/day; for this highest consumer
group, the adjusted hazard ratio was 0.87 with 95 percent CI of 0.61-1.25.
Even though exposures (such as alcohol) for cardiovascular events (such as MI) may be
different after a person has an event than it was before the event, in this study the
reductions in risk were almost the same.
For example, both for alcohol intake reported prior to a MI, and that after a non-fatal MI,
the risk of mortality was about 30 percent lower for moderate drinkers than it was for
abstainers.
This suggests that, in terms of reducing cardiovascular disease, alcohol may have
relatively short-term effects, suggesting that frequent but moderate consumption (of
under 30g a day for men) may result in the best health outcomes.
The study has been published in the European Heart Journal. (ANI)
Alcohol
Teens drinking hand sanitizers for a quick high (The Times of India:
26.4.2012)
Following the trend of cough medicine, hand sanitizer is the latest in a string of
household items used to induce intoxication and has public health officials worried as a
few squirts of it could equal a couple of shots of hard liquor.
As many as six California teenagers were hospitalized with alcohol poisoning last
month, and two last weekend alone, from drinking hand sanitizer. “This is a rapidly
emerging trend,” ABC News quoted Cyrus Rangan, medical toxicology consultant for
Children’s Hospital Los Angeles, as saying.
About 2,600 cases have been reported in California since 2010, but it’s become a
national problem.
“It’s not just localized to us,” Helen Arbogast, an injury prevention coordinator in the
trauma programme at Children’s Hospital Los Angeles, said.
“Since 2009 we can see on YouTube it’s in all regions of the country. We see it in the
south, in the midwest, in the east,” Arbogast said.
Liquid hand sanitizer is 62% to 65% ethyl alcohol, or ethanol, the main ingredient in
beer, wine and spirits, making it 120-proof. To compare, a bottle of vodka is 80-proof. “A
few swigs is all it takes to get a person to get the intoxicated effects of alcohol,” Rangan
said.
According to doctors, ingesting hand sanitizer can produce the same side effects as
consuming large amounts of alcohol — slurred speech, unresponsiveness, possibly falling
into a coma state.
Rangan warned that long-term use could lead to brain, liver and kidney damage.
Teenagers use salt to break up the alcohol from the sanitizer to get a more powerful dose.
These distillation instructions can be found on the internet in tutorial videos that describe
in detail how to do it.
Sean Nordt, director of toxicology at USC Los Angeles county emergency department,
said he used to get reports of children accidentally consuming small amounts of hand
sanitizer, but now the trend is toward purposeful ingestion by those who cannot purchase
or obtain alcohol legally.
Alcohol
Alcohol more harmful for women (New Kerala:8.5.2012)
Alcohol in any amount can be dangerous to anyone but it affects women more than men,
with increased health risks like liver and heart diseases and infertility for them, according
to experts.
According to Monika Jain, a senior hepatologist with Fortis Hospital, "the female
physiology is such that it allows for greater toxicity with lesser amounts of alcohol and in
lesser time, as compared to males."
"A woman's body doesn't break down the alcohol as quickly as a man's body does. This
results in greater levels of alcohol in blood, resulting in greater toxicity," Jain told IANS.
"The enzyme, alcohol dehydrogenase (ADH) which breaks down the alcohol in stomach
is produced in smaller quantities in women resulting in slower action as compared to
men," Jain added.
According to a publication by the US National Institute on Alcohol Abuse and
Alcoholism(NIAAA), women who drink heavily face greater health risks than men who
drink heavily, with women alcoholics being more prone to liver disease, heart damage
and brain damage.
Amongst the other problems, the report claims, chronic heavy drinking can lead to
menstrual problems, infertility, and early menopause while drinking during adolescence
can interfere with puberty, growth, and bone health.
But the most vulnerable are the pregnant women who drink because in their case, even
the unborn child is at risk from alcohol, which is a teratogen, a substance that can harm a
foetus.
"Alcohol consumption by pregnant women can induce problems like Fetal Alcohol
Disorder(FAD) and Abruption," Shivani Gour, a gynecologist and director of Isis
hospital, told IANS.
"FAD is a major problem with ill-effects ranging from mental retardation to delayed
physical growth. Any amount of alcohol consumed by an expecting mother is enough to
harm the unborn child. And then there is abruption, which means premature detachment
of the placenta," she added.
"The women are more vulnerable to alcohol because of increased percentage of fat as
well as estrogen, which delays alcohol breakdown and increases alcohol toxicity in
women," said Gour.
However, the damage is not just physical.
Beyond the physiological ill-effects, the NIAAA report claims heavy drinking can make
a woman more vulnerable to violence, including sexual assault and they are twice as
likely as men to die from alcohol-related causes such as suicide, accidents, and illnesses.
Alcohol
Modest alcohol intake may benefit patients with common liver disease
(New Kerala: 17.5.2012)
Modest alcohol consumption has been found to be associated with less inflammation in
patients with NAFLD (non-alcoholic fatty liver disease), the most common type of liver
disease in the developed world.
NAFLD is often associated with obesity and other parameters of the so-called 'metabolic
syndrome,' which is a major risk factor for the development of cardiovascular disease.
In a well-done study among subjects with NAFLD, the investigators have demonstrated
that modest alcohol consumption (an average of up to 20 grams of alcohol per day and no
binge drinking) is associated with less evidence of inflammation of the liver
(steatohepatitis), a condition known to markedly increase the risk of progression of liver
disease to cirrhosis.
Given that NAFLD and other conditions associated with the metabolic syndrome are so
common, and are major risk factors for developing cardiovascular disease, the results of
the present study are important.
They show that modest drinking is associated with decreased, not increased,
inflammation of the liver.
Further, even among subjects with NAFLD, cardiovascular disease is a much more
common cause of death than liver disease.
The researchers suggested that intervention studies should be done to support their
findings; if confirmed, subjects with NAFLD should not be advised to avoid all alcohol,
which is the current advice usually given to such patients. (ANI)
Alcohol
COCKTAIL CULTURE
Women in top jobs drink more (The Times of India: 21.5.2012)
Women in highflying jobs drink twice as much than those in manual jobs, according to
UK’s official statistics, reflecting a startling ‘cocktail and business card culture’ which is
on the rise.
Figures from the office of National Statistics in the UK showed that women in top
positions, such as managers in large companies, drink a bottle of wine a week on average,
around 11.2 units, compared with 6.2 units for female hairdressers, cleaners and factory
workers.
Expressing concerns over the figures, UK’s shadow health minister Diane Abbott said
the figures lifted the lid on some of the problems around the cocktail and business card
culture.
“It’s good that more women are out in the workforce and are enjoying social life in
pubs and bars. But these disturbingly high figures reveal women’s drinking patterns have
changed in a generation, reflecting a silent, middle class epidemic,” Abbott was quoted as
saying by the Daily Telegraph.
“These figures reflect the rise of the British ‘Margarita culture’, and some of the
surrounding problems,” she said.
Sir Ian Gilmore, chairman of the Alcohol Health Alliance group, said some women
used alcohol to cope with daily stresses of balancing work and a family life. “While
alcohol may help people to reduce stress when used occasionally, if used regularly there
is a real risk of it leading to dependence,” he added. PTI
Alcohol
Limiting Alcohol To Half A Unit Per Day Could Save Lives(Medical
News Today:1.6.2012)
Limiting alcohol to half a unit per day is best for health, say Oxford University
researchers who analyzed the link between alcohol consumption and 11 chronic diseases
and concluded 4,600 more lives would be saved every year if people in England were to
cut the amount they drink to within this level.
They write about their findings in a BMJ Open paper that was published online on 30
May.
The lead author of the study was Dr Melanie Nichols of the BHF Health Promotion
Research Group, in the Department of Public Health, at Oxford University. She told the
press:
"People who justify their drinking with the idea that it is good for heart disease should
also consider how alcohol is increasing their risk of other chronic diseases. A couple of
pints or a couple of glasses of wine per day is not a healthy option."
One unit is 10ml or 8g of pure alcohol. The UK government currently recommends
people should not regularly drink more than 3 to 4 units (about 1.5 pints of 4% beer) a
day for men, and 2 to 3 units (a 175ml glass of wine) a day for women.
Changing the government recommended limit to half a unit a day would mean drinking
no more than a quarter of a glass of wine or a quarter of a pint of beer a day.
Several studies have examined the effect of alcohol intake on heart disease and other
diseases like liver disease and cancers, but these have only studied the links individually.
For their study, Nichols and colleagues set out to find the optimum daily intake of alcohol
that would result in the fewest number of deaths in England from a range of diseases
known to have links to alcohol.
From the 2006 General Household Survey they could work out the alcohol consumption
levels among adults in England, and from a wealth of available published research, they
had data on the effect of different levels of alcohol intake on the risk of developing
various diseases. They got mortality data for 2006 from the Office for National Statistics.
They then developed a mathematical model to calculate the effect that changing alcohol
consumption might have on deaths from 11 diseases and conditions linked to alcohol
intake.
The 11 diseases included: five cancers, coronary heart disease, stroke, high blood
pressure, cirrhosis of the liver, epilepsy, and diabetes. In 2006, they caused over 170,000
deaths in England.
Nichols explained what they found:
"Although there is good evidence that moderate alcohol consumption protects against
heart disease, when all of the chronic disease risks are balanced against each other, the
optimal consumption level is much lower than many people believe."
The results showed that just over half a unit of alcohol a day was the optimum level
whereby limiting drinking to within this level would prevent around 4,579 premature
deaths, or around 3% of all deaths from the 11 conditions.
Deaths from heart disease would go up by 843, but there would be 2,600 fewer deaths
from cancer and nearly 3,000 fewer deaths from liver cirrhosis.
Although the study did not look at patterns of alcohol consumption, Nichols said that
regardless of average intake, the best possible health comes from avoiding heavy
drinking sessions or "binge drinking". She said there was very clear evidence that binge
drinking increases people's risk of many diseases, as well as the risk of injuries.
"Moderating your alcohol consumption overall, and avoiding heavy-drinking episodes, is
one of several things, alongside a healthy diet and regular physical activity, that you can
do to reduce your risk of dying early of chronic diseases," said Nichols.
She added: 'We are not telling people what to do, we are just giving them the best
balanced information about the different health effects of alcohol consumption, so that
they can make an informed decision about how much to drink."
Alcohol consumption
Level of alcohol consumption 'optimal' for health revealed (New Kerala:
8.6.2012)
Scientists from Australia and Oxford University have determined the 'optimal' level of
alcohol consumption that is associated with the lowest rates of chronic disease.
They concluded that the intake of about one-half of a typical drink per day would result
in the healthiest outcomes.
And the researchers concluded that the recommended alcohol intake for the UK should
be reduced from the current advised level of drinking.
The level of alcohol that is most likely to be associated with the lowest risk of adverse
health outcomes and the most likely health benefits varies markedly among individuals.
Middle-aged men and post-menopausal women are most likely to demonstrate enhanced
health (e.g., lower risk of cardiovascular diseases, diabetes, dementia) from moderate
drinking.
For all ages, binge drinking is associated with predominantly adverse outcomes. In
general, women should drink less than men.
While the analyses presented in this paper are of scientific interest, they alone do not
support changes in the current population recommendations for alcohol consumption.
(ANI)
Alcohol consumption
Level of alcohol consumption 'optimal' for health revealed (New Kerala:
8.6.2012)
Scientists from Australia and Oxford University have determined the 'optimal' level of
alcohol consumption that is associated with the lowest rates of chronic disease.
They concluded that the intake of about one-half of a typical drink per day would result
in the healthiest outcomes.
And the researchers concluded that the recommended alcohol intake for the UK should
be reduced from the current advised level of drinking.
The level of alcohol that is most likely to be associated with the lowest risk of adverse
health outcomes and the most likely health benefits varies markedly among individuals.
Middle-aged men and post-menopausal women are most likely to demonstrate enhanced
health (e.g., lower risk of cardiovascular diseases, diabetes, dementia) from moderate
drinking.
For all ages, binge drinking is associated with predominantly adverse outcomes. In
general, women should drink less than men.
While the analyses presented in this paper are of scientific interest, they alone do not
support changes in the current population recommendations for alcohol consumption.
(ANI)
Alcohol dependence
Alcohol dependence 'may be influenced by genes'(New Kerala:
21.6.2012)
There is a strong genetic influence on the risk of developing alcohol dependence (AD), a
new study has suggested.
According to a first-of-its-kind study, there is a significant association between AD and
CNVs on chromosome 5q13.2.
Excessive drinking is not only the third leading cause of preventable death in the United
States, there is also a very strong genetic influence on the risk of developing alcohol
dependence (AD).
Given its serious public-health impact, as well as strong evidence for genetic influence, a
new study has examined links between AD and genetic variations called common copy
number variations (CNVs), finding a significant association between AD and CNVs on
chromosome 5q13.2.
"Twin and adoption studies have estimated the heritability of AD - the proportion of
variability in risk that is due to genetic factors - to be to be about 50 percent," John P.
Rice, corresponding author of the study from Washington University, said.
Rice explained that CNVs are a form of structural variation in which relatively large
regions of the genome have been deleted, meaning fewer than a normal number, or
duplicated, meaning more than a normal number.
"For two unrelated individuals, they can differ by about .5 percent with respect to copy
number," he said.
"They can be inherited or be a genetic mutation that neither parent possessed nor
transmitted. CNVs are in contrast to single nucleotide polymorphisms, which differ by
one base pair. In addition, CNVs have been reported to influence diseases such as autism
and schizophrenia," Rice said.
David Goldman, chief of the lab of neurogenetics at the National Institute on Alcohol
Abuse and Alcoholism, also commented on this.
"Alcoholism's pervasive impact on public health and its heritability make searches for
genes influencing vulnerability a priority," Goldman said.
"Although only a few genes influencing alcoholism risk have been discovered so far, we
can expect this picture to change rapidly as more powerful genomic tools, including
genotyping arrays and next-generation sequencing, are applied, and as geneticists become
ever more ambitious in the size and phenotypic depth of the populations they study," he
said.
As part of the larger, Rice and his colleagues interviewed 3,829 adult participants (1,761
males, 2,068 females) using the Semi-Structured Assessment for the Genetics of
Alcoholism; subsequently, 2,610 non-Hispanic, European-American individuals (1,144
males, 1,466 females) were genotyped using the Illumina Human 1M array, and CNV
analysis was conducted.
"We found two CNVs - on chromosomes 5q13.2 and 6q14.1 - that were associated with
AD," Rice said.
"For both CNVs, AD cases tended to have more duplications than controls without AD.
These two CNVs are statistically significant but the effect on risk is modest.
"The region identified on chromosome 5 contains several genes that have been implicated
is rare neurological disorders and play a role in the nervous system. It will be a challenge
to understand what gene(s) are causing this association and how they work to increase
one's risk for AD," he said.
Goldman and Rice agreed on the results of the study.
"This is a carefully done study and results are conservatively interpreted," Goldman said.
"The association to the 5q13.2 region is highly significant statistically, but further it is
compelling that the region they have found is one that plays a role in other neurologic
disorders.
"The chromosome 6 findings are statistically more highly significant but more difficult to
pursue because the region involved is a gene desert. It will be fascinating to see the
outcome of efforts to replicate these findings in other populations and validate through
other means, for example, by studies of the individual genes in the regions involved in
the CNVs," he said.
The study will be published in Alcoholism: Clinical and Experimental Research, and is
currently available at Early View. (ANI)
Alcohol
Drinking during pregnancy not safe, experts warn (New Kerala:
25.6.2012)
Experts from U.S have refuted claims that consumption of up to 8 alcoholic drinks a
week or occasional binge drinking during pregnancy is generally safe for the developing
baby.
A series of new studies from Denmark had suggested that consumption of up to 8
alcoholic drinks a week is relatively harmless for foetus.
Kenneth Lyons Jones, MD, professor in the UCSD Department of Pediatrics and a
renowned expert in birth defects, and Christina Chambers, MPH, PhD, director of the
California Teratogen Information Service (CTIS) Pregnancy Health Information Line
claimed that these studies are misleading to pregnant women, citing more than 30 years
of research to the contrary.
"This series of studies collected data on alcohol exposure during an interview conducted
sometime between 7 and 39 weeks of pregnancy. The quantity and frequency of alcohol
consumed was based on mother's recall which may not be accurate," Jones who was one
of the first doctors to identify Fetal Alcohol Syndrome (FAS) in 1973, said.
In the Danish study, the data from more than 1,600 women in the Danish National Birth
Cohort was analysed. The amount of alcohol taken by the women during their pregnancy
was classified as either none, low, moderate, or high. In addition, binge drinking was
defined as consuming 5 or more drinks on a single occasion.
When the child reached the age of 5, the kids underwent various development tests.
Researchers discovered that no significant association between prenatal alcohol
consumption at low and moderate levels and general intelligence, attention, executive
function or IQ.
However, only 50 percent of the women invited in the follow-up studies agreed to
participate. Moreover, it is possible that those women who drank during pregnancy and
who agreed to participate were more likely to have higher functioning children.
However, Chambers, a UCSD School of Medicine professor, revealed that the
overwhelming evidence of more than 30 years of research supporting the conclusion that
alcohol, especially alcohol consumed in a binge pattern, could be harmful to the
developing baby.
"Individual women metabolise alcohol differently, and vary in terms of how susceptible
they may be to having an affected child," Chambers said.
"Although we do not want to alarm women who find out they are pregnant and realize
that they have consumed low levels of alcohol before they knew they were pregnant, we
emphasize that a 'safe' amount of alcohol that any individual woman can drink while
pregnant is impossible to establish.
"The best advice continues to be that women should avoid alcohol entirely during the
nine months that she is carrying the baby," he added. (ANI)
Alcohol
Alcohol in cola, but won’t make even kids tipsy (Hindustan times:
29.6.2012)
Here’s something that could take a bit of fizz off your Coca-Cola and Pepsi bottles.
An international study has found the two soft drinks to contain small traces of alcohol,
sparking concerns among teetotallers who abstain because of religious reasons and those
who believe the worst that colas can do is cause a sugar and caffeine overload.
The Paris-based National Institute of Consumption’s study found the alcohol content in
colas — measured as alcohol by volume — to be 0.001% (around 10 mg per litre),
making them much safer than fruit juices (0.1-0.5%), beer (3-10%), wine (8-14%) and
vodka and whisky (40%).
Most juices naturally contain 0.07-0.5% levels of alcohol through fermentation of sugar.
The natural alcohol content goes up after a fruit is picked, depending on how it is stored.
“There are no health concerns about alcohol in colas, even for children, but one needs to
worry about the sugar and caffeine that mess with weight and sleep,” said nutritionist Ishi
Khosla, director, WholeFoods.
The study found small alcohol traces in 10 out of 19 popular cola brands in France,
including Coca-Cola, Pepsi Cola, Coca-Cola Classic Light and Coke Zero.
“Some of these soft drinks contain minute traces of alcohol because of the ingredients
used”, but the “Pepsi Cola recipe doesn’t contain alcohol”, UK’s Daily Mail quoted a
Pepsi spokesperson as saying.
Coca-Cola France said the Paris Mosque had issued a certificate that its products could be
consumed by the Muslim community.
Arthritis
Osteoarthritis
Third Genetic Link to Osteoarthritis Discovered (Science daily:
3.4.2012)
Researchers have just revealed a new gene associated with osteoarthritis. This is only the
third gene to be identified for this painful and debilitating disease that affects more than
40 per cent of people aged more than 70 years.
The disease-associated variant, in the gene MCF2L, was discovered when Wellcome
Trust Sanger Institute researchers used data from the 1000 Genomes Project to increase
the power of their genome-wide association scan. The preliminary stage of the original
arcOGEN study, funded by Arthritis Research UK, compared the genomes of 3,177
people with osteoarthritis with 4,894 people from the general population and looked at
600,000 variants.
At that level of detail, no new genes were identified (although the full study has yet to be
published). By imputing the data from the 1000 Genomes Project, the new study was able
to scan for 7.2 million variants and revealed the association of MCF2L with osteoarthritis
without requiring any new sequencing to be carried out.
"By using the 1000 Genomes Project data to add value to our original genome-wide
association scan for osteoarthritis, we have uncovered a disease-associated gene that had
previously remained hidden," says Dr Eleftheria Zeggini, senior author from the Sanger
Institute. "We were able to analyse our results in greater detail and zoom in on variants
that we hadn't been able to identify before. We hope that this approach and our findings
will help to improve our biological understanding of this very painful disease."
Osteoarthritis is a complex condition and researchers have found it difficult to identify its
genes. Only two loci have been found so far in European populations -- GDF5 and a
signal from a region on chromosome 7.
The newly identified gene, MCF2L, is found on chromosome 13 and regulates a nerve
growth factor (NGF). It has been reported that when people with osteoarthritis in the knee
are treated with a humanized monoclonal antibody against NGF, they experience less
pain and show improvement in their movement. This suggests that MCF2L is involved in
the development of osteoarthritis and provides a new focus for future research.
To ensure that the variant of MCF2L is associated with the development of osteoarthritis,
the team worked with international collaborators to investigate 19,041 people with
arthritis and 25,504 people without the condition. A number of centres across Europe
collaborated by screening people in Iceland, Estonia, the Netherlands and the UK for the
newly identified variant to corroborate the association.
"The discovery of this MCF2L variant suggests a possible genetic link to the finding that
regulating NGF is important in knee osteoarthritis, and is supported by the fact that the
variant is more strongly associated with knee osteoarthritis than hip osteoarthritis in the
study," says Aaron Day-Williams, first author of the study from the Sanger Institute. "We
hope the identification of this variant will lead to further insights into the biological
processes at work and offer potential treatment targets."
The study's findings are based on the work of the arcOGEN Consortium, which has been
funded by Arthritis Research UK and is a vital supporter of research in this area.
"Osteoarthritis is a complex disease with many genetic causes. Yet it has proved very
difficult to find the genes involved and help us to identify potential areas of treatment,"
says Alan Silman, Medical Director of Arthritis Research UK. "We are delighted that
researchers at the Sanger Institute have been able to identify a new gene associated with
this painful condition and offer new lines of research for possible treatments. We are also
excited that employing the technique of using the 1000 Genomes Project data to
investigate genetic associations in far greater depth could reveal even greater insights into
this debilitating disease."
This work was supported by Arthritis Research UK and the Wellcome Trust.
Back Pain
Back Pain - Genetically Engineered Drug less Effective (Medical News
Today: 18.4.2012)
It appears that spinal injections of etanercept, a new type of anti-inflammatory genetically
engineered drug, are not as effective in relieving the severe leg and lower back pain of
sciatica, as steroid injections into the spine, the current standard of care, according to a
new study reported in the 17 April issue of the Annals of Internal Medicine.
Dr Steven P Cohen, an associate professor of anesthesiology and critical care medicine at
the Johns Hopkins University School of Medicine in Baltimore, Maryland led the study.
He told the press pain experts have long been looking for a, safe, reliable alternative to
steroids as a way to treat sciatica. The current treatment, where steroids are injected into
the spine, often has mixed results and only temporarily relieves pain. It also has the
potential for "catastrophic complications".
Etanercept is a genetically-engineered tumor necrosis factor inhibitor (TNF) that is
currently used to treat rheumatoid arthritis and other autoimmune disorders, where the
patient's own immune system attacks healthy tissue, causing damage, pain and swelling.
Cohen said research interest in etanercept, sold under the brand-name Enbrel, arose from
attempts to prevent or limit the pain produced by herniated discs pressing on nerve roots
in the lower back or neck.
The drug works by blocking TNF, a naturally produced substance that causes
inflammation. Unlike steroids that combat inflammation generally, TNF inhibitors target
the specific inflammation molecules that cause the pain from sciatica and other
conditions. They do this by stopping them being able to bind to nerve cell receptors,
which should in theory prevent pain altogether.
However, Cohen said while this new treatment shows a lot of promise, "at least in the
doses we gave it - the dose known to be safe - steroids still work better".
For the blinded, placebo-controlled study, 84 adult patients with sciatica (lumbosacral
radiculopathy) of less than 6 months' duration received epidural injections. The patients
were randomly assigned to receive either 60 milligrams of a steroid, 4 milligrams of
etanercept, or 2 milliliters of saline.
The idea behind giving sciatica patients an epidural injection is to provide better pain
relief at lower doses, and fewer side effects compared with giving drugs by mouth or
intravenously, because the spinal nerve roots are bathed directly in the medication
designed to reduce inflammation (and pain).
The trial ran from 200 to 2011 and took place at several military and civilian treatment
centers. Pharmacists prepared the epidural syringes, while neither the physicians who
administered the injections, nor the nurses who assessed the outcomes, knew which
patient received which treatment.
The results showed that one month after receiving the second of two injections, the
patients who received steroids reported less pain and disability than the patients who
received etanercept or the saline placebo.
However, Cohen and colleagues found that while the steroids worked, their effect did not
last.
Cohen comments that another study published last month, where patients received more
than twice the dose of etanercept used in their study, found one and two weeks after
injection, the etanercept patients felt better than the patients given steroids, but not four
weeks after.
It could be that in lower doses, "etanercept may not be the drug everyone's hoping it is",
says Cohen, noting that "There's still a lot more work to be done".
He suggests there is a need to investigate the safety and effectiveness of higher doses of
etanercept and other drugs that block pain receptors.
Most of the funds for the study came from the John P. Murtha Neuroscience and Pain
Institute, the International Spinal Intervention Society and the Center for Rehabilitation
Sciences Research.
Arthritis
Now, a pill to kill arthritis (The Times of India: 26.4.2012)
Scientists have come up with a new pill which they claim could dramatically reduce knee
pain in people suffering from osteoarthritis. The condition is incurable and many
sufferers are left to rely on anti-inflammatory painkillers that can cause stomach damage
when used over longer time. Researchers have shown that a pill, called duloxetine halved
pain levels in patients.
Arthritis
Arthritis - Anxiety Twice As Common As Depression(Medical News
Today: 1.5.2012)
Approximately one third of adults with arthritis in the USA aged 45+ years suffer from
anxiety or depression, researchers from the CDC reported in the journal Arthritis Care &
Research. The authors added that the prevalence of anxiety in adults with arthritis is
almost twice as high as depression, in spite of more studies focusing on the arthritisdepression link.
27 million patients aged 25+ years have been diagnosed with osteoarthritis, and another
1.3 million with rheumatoid arthritis, according to data US health authorities. The CDC
(Centers for Disease Control and Prevention) estimates that approximately 50 million
people are affected by arthritis in the USA. The illness is the leading cause of disability in
the country.
According to prior research, depression is common among patients with arthritis and
other chronic illnesses and conditions. However, researchers and health care
professionals have long been saying that anxiety among people with arthritis is common,
under-treated and under-recognized. Until recently, anxiety was not taken into
consideration as a depression risk-factor.
Team leader, Dr. Louise Murphy, who works at the Arthritis Program at the CDC,
Atlanta, Georgia, and colleagues gathered data on participants of the CDC's Arthritis
Conditions and Health Effects Survey. The researchers say the sample is representative of
people around the USA with arthritis symptoms who are aged at least 45 years. They
identified 1,793 patients who had been diagnosed with arthritis or some other rheumatic
condition.
They used the Arthritis Impact Measurement Scales to assess anxiety and depression in
the participants.
They found that:
31% of arthritis patients suffered from anxiety
18% of arthritis patients suffered from depression
One third of the participants suffered from at least one of the two conditions - anxiety
and/or depression
84% of arthritis patients who had depression said they also had anxiety
Only half of those with depression or anxiety got medical help for their anxiety or
depression during the previous twelve months.
Dr. Murphy said:
"Given their high prevalence and the effective treatment options that are available, we
suggest that all people with arthritis be screened for anxiety and depression. With so
many arthritis patients not seeking mental health treatment, health care providers are
missing an intervention opportunity that could improve
Arthritis
FDA Panel Urges Approval for New Arthritis Treatment (med India:
10.5.2012)
The US Food and Drug Administration urges approval for Pfizer arthritis drug.
Tofacitinib, taken orally, could serve as an alternative approach to treating moderate to
severe patients who did not respond to one or more traditional therapies such as
methotrexate, said the advisory committee by a vote of 8-2.
The panel urged the drug's approval despite mixed results on its effects at different doses,
and some safety concerns about the risks of cancer -- mainly lymphoma -- and infections.
Rheumatoid arthritis is a progressive autoimmune disease that causes debilitating joint
pain that can lead to deformity, and affects about one percent of people in the United
States and Europe, most of them women.
Exactly what causes the disease remains a mystery, and there is no known cure.
The FDA does not have to follow the recommendations of the advisory panel though it
often does.
Osteoarthritis
Joint responsibility (The Tribune:17 May 2012)
Osteoarthritis has overtaken hypertension as India’s top ailment. According to last year’s
estimates, around 66 million people, who are more than 65 years of age, were at an
enhanced risk of osteoarthritis
Osteoarthritis (OA) is a disorder of the joints which results from the degeneration of the
joint cartilage. Cartilage is a white glistening protein, having a highly smooth and
finished surface, which facilitates frictionless motion at the joints.
Osteoarthritis affects more than 25 million persons in the USA. According to a rough
estimate, more than 360 million persons worldwide and about 150 million persons in
India constituting 15 per cent of the population will suffer from osteoarthritis. According
to the 2007 TNS Arogya study, osteoarthritis has overtaken hypertension as India's no 1
ailment. Around 66 million persons, who are 65 years plus, were at an enhanced risk of
osteoarthritis according to last year's estimates.
In some people, it appears earlier and causes more symptoms, while in others despite its
presence in the joints, there may be minimal or no symptoms. The disease is more
commonly seen in women after the age of 55. A higher incidence of osteoarthritis of the
knee joints is seen in Asians probably due to genetic factors and the habit of squatting.
Causes
Since it is primarily related to ageing, persons with longer lifespan will suffer from it.
Depending upon the genetic constitution, the timing of onset and the severity of the
disease may vary.
At the molecular level, OA is caused by an increase in the water content of the cartilage
and degeneration of its protein structure causing fissuring and flaking on the surface of
the joint, which results in friction during motion. The enhanced friction irritates the joint
lining (synovial membrane), causing inflammation, pain and accumulation of fluid in the
joint (effusion). Finally, there is formation of new bony spikes and spurs at the margins
of the bones (osteophytes).
The factors that promote wear and tear also enhance the onset of osteoarthritis. In the
layman's language, our joints may be equated with the tyres of a car, which, on an
average, have fixed life in terms of mileage (kilometres) when driven in the ideal driving
conditions. Factors like mal-alignment of the car suspension, faulty shockers, running the
car on a bad road in an overloaded condition and poor driving habits can result in an early
wear and tear of the tyres. Similarly, in the case of the weight-bearing joints like the
knee, overweight (obesity), mal-alignment of the knees (knock knees or bow legs),
neglected injuries of shock absorbers of joints (ligaments/ meniscal injuries etc), rough
and improper use of the joints (competitive sports requiring aggressive use of the joint in
an unsupervised and faulty manner) are the common predisposing factors of
osteoarthritis.
Osteoarthritis occasionally can develop in multiple members of the same family,
implying a hereditary (genetic) basis for this condition.
Arthritic conditions like gout, rheumatoid arthritis, haemophilia (bleeding disorder),
ankylosing spondylitis etc result in the early and severe onset of all the changes brought
about by osteoarthritis.
Hormone disturbances, such as diabetes and growth hormone disturbances, are also
associated with early cartilage wear and secondary osteoarthritis.
Symptoms
The most common symptom is pain on repeated movements of the joint which worsens
during the late hours of the day. Pain during stair climbing and while getting up from the
sitting position are classic symptoms of osteoarthritis of the knee joint. In severe cases,
swelling, creaking sounds, raised local temperature of the skin overlying the joint and
stiffness are additional symptoms. Symptoms can be intermittent so that the patients may
have long pain-free intervals between the symptoms. Unrestricted damage of the joints
can progress to the formation of deformities.
Diagnosis
The diagnosis is mainly clinical which is confirmed by X ray examination. Common Xray findings include the narrowing of the joint space between adjacent bones and bonespur formation. X-ray examination is also important to know the degree of severity of the
disease so that the treatment that is best suited to the existing degree of the disease can be
prescribed.
An MRI may be required in young patients to see the pathology of some soft tissue
structures inside or around the knee joint (menisci/ ligaments). The torn menisci and/ or
ligaments worsen the progression of the OA by altering biomechanics of the joint and
increasing the friction.
Blood tests, as such, have no role for the diagnosis of osteoarthritis. Sometimes these are
required to exclude the secondary causes of osteoarthritis like gout, rheumatoid arthritis,
infection etc. Blood tests may also be required to assess the overall health status of the
patient if a surgical intervention is being planned.
Aspiration of the joint fluid with a needle may be required in some patients to test the
joint fluid for the exclusion of causes of secondary arthritis, and also to relieve the pain in
some patients resulting from the sudden accumulation of fluid inside the joint.
Treatment
Reduction of the body weight by 5 kg usually results in the reduction of symptoms by 50
per cent. Thus, irrespective of the severity of the disease, all obese persons should reduce
weight.
The treatment modalities are non-operative and operative. Non-operative modalities are
first exhausted before resorting to operative modalities. The non-operative modalities
include rest, exercise, diet control for weight reduction, physical therapy, occupational
therapy and mechanical support devices, such as knee braces. Oral medications, topical
applications or injections into the joints are used to decrease joint inflammation and pain.
Giving rest to the joints during severe pain decreases stress on the joints and relieves pain
and swelling. Exercise strengthens the muscles around the joints thus protecting them
from further wear and tear. Applying local heat before and cold packs after exercise can
relieve pain and inflammation.
Obese patients should avoid loading exercises like treadmill, jogging and running.
Swimming is good because it causes little stress to the joints. Other useful exercises
include walking, cycling and light-weight training.
The devices like splints, canes, walkers and braces help in reducing stress on the joints.
Physiotherapy modalities like paraffin wax dips, warm water soaks, short-wave
diathermy etc can be useful during acute inflammation and stiffness.
Simple pain medications like aspirin and acetaminophen may be sufficient in a majority
of patients. For severe pain, non-steroidal anti-inflammatory drugs (NSAIDs) which
include ibuprofen, diclofenac, aceclofenac, celecoxib, naproxen, indomethacin etc. can be
used. In between the oral medications, local application creams and other physical
therapy measures are often sufficient.
Other medications include chondro-protective drugs namely glucosamine, chondroitin
and diacerin. These drugs are supposed to decelerate the cartilage degeneration and also
relieve symptoms in some patients. Fish-oil supplements also have been shown to have
some anti-inflammatory properties.
While oral steroids (cortisone) are not used in treating osteoarthritis, steroid injection into
the joint can swiftly relieve pain. Repeated cortisone injections can harm the joint, so
these are reserved for patients with disabling symptoms, who want to buy time for
undergoing surgery.
Injections of hyaluronic acid preparations into the joint have also been tried in OA. These
act by replacing the thinned out synovial fluid of an arthritic joint with a thick fluid
allowing better lubrication, and also probably by directly affecting pain receptors. These
injections can relieve pain for six months to an year, sometimes longer. However, these
do not help everyone and are quite expensive.
Surgery is an option for severe OA resistant to conservative treatments. The surgical
interventions include arthroscopic debridement, osteotomy, total joint replacement and
arthrodesis.
Arthroscopy is a minimal invasive surgery done by making tiny cuts wherein damaged
parts (debris) of the joint are removed (called debridement). Any loose particles and
inflammatory materials are flushed from the joint with the help of fluid known as
irrigation. Arthroscopy is, however, useful only in selective patients where there are
demonstrable debris, loose bodies or torn menisci and blocking osteophytes in the joint
and may only provide temporary relief from pain.
Osteotomy is a surgical procedure used to correct the mal-alignment of the joint. It is
mainly recommended in younger patients with osteoarthritis confined to a part of the
joint. These patients may also require total joint replacement also in future.
Total joint replacement is a rewarding option for severe disabling OA resistant to
conservative options. It is a major surgery involving high cost in which the damaged
parts of the joint are replaced with artificial metallic and plastic components. The life of
an artificial joint usually ranges between 10 and 20 years so this operation is often not
advised in patients younger than 60 years.
For poor patients requiring painless, strong joint with minimal cost, the operation of
fusion of the joint (arthrodesis) can be considered in which the bones constituting the
joint are surgically fused with each other. This operation provides a painless joint which,
however, has no movement at all.
Outcome of osteoarthritis
Every patient should be individually assessed for degree of the disease so that specific
treatment option can be selected. Surgical modalities are usually recommended after the
non-operative treatment has been exhausted. Arthroscopy and osteotomy may be useful
in some patients for prolonging or avoiding the surgery of total joint replacement. The
joint replacement surgery can bring life back to a patient who is socially and physically
disabled. Surgery for joint replacement, however, generally provides a restricted lifestyle
to the patient. The patients requiring high exertive demands from the joint should be
counselled before selecting this option because patients undergoing joint replacement are
advised to avoid activities like sitting on the floor, running, jumping etc
Back pain
Home remedies for back pain (The Times of India:17 May 2012)
Yoga expert Surakshit Goswami gives practical suggestions on how to cure your back
pain—with massage, hot water packs, state of mind and food
There are some simple remedies for back pain that give immediate relief. Follow these:
Oil massage: Ayurveda says back pain is a vata symptom caused by maladjustment of gas
within the body. Massaging with oil at the point of the pain is very soothing. Do not press
the spine while massaging, but gently massage the muscles around it. Exposure to breeze
should be avoided, so switch off fans and ACs. Cover yourself with a sheet and rest after
the massage. Hot packs: Using a hot water bottle or sitting in a bathtub filled with warm
water helps.
Temperature and back pain: In winter, muscles shrink and old wounds and pains
resurface. Current wounds also give more trouble. Likewise in summer, pain worsens
with AC draughts. Avoiding direct breeze on the back, is, therefore, important. Food and
back pain: Food also plays an important role. Some foods aggravate the pain and some
reduce its intensity. Ayurveda says that back pain is a vata ailment. Our body remains
healthy when its vata, pitta and kapha are in balance. Therefore, avoid food that increases
the vata element in your body as this aggravates the pain. Keep away from rice, curd,
lassi, kadhi, urad dal, rajma, okra, arvi and lemons till the pain disappears. Eat light and
easily digestible food. Keep your spine strong with calcium. Walk in the sun for your
daily dose of vitamin D.
Mental state and back pain: Back pain can also be psychosomatic. If you are pessimistic
and grumpy, there are chances that the problem may aggravate. If you remain positive
and cheerful, it will pass.
Obesity and back pain: More weight means more pressure on back muscles. Over time,
the muscles become weak and this leads to pain. So keep an eye on your weight.
Constipation and back pain: It has been seen that when you have back pain, your
metabolism is also affected. In fact, constipation, gastric trouble and back pain are very
closely related. To treat constipation, take two big tablespoons of isabgol husk half an
hour before dinner or take a spoonful of trifala powder or 8-10 munnakas boiled in milk.
Also have fibre-rich food.
Arthritis
Hope for Arthritis Treatment: Report (Med India: 30.5.2012)
The Independent reported on Monday that hip replacements for some patients could be a
thing of the past after surgeons pioneered a new stem cell procedure to tackle a bone
disease that leads to arthritis.
Doctors at Southampton General Hospital are extracting stem cells from the bone marrow
of patients in need of hip repair due to osteonecrosis - a condition where poor blood
supply causes significant bone damage leading to severe arthritis.
These cells are mixed with cleaned, crushed bone from another patient who has had their
own hip replaced and used to fill the hole made by surgeons after dead and damaged
tissue has been removed from the joint, according to the newspaper.
Arthritis usually strikes people between 30 and 50 years of age
Arthritis
Injection of Methotrexate Not Superior to Oral Therapy in Juvenile
Arthritis Treatment: Analysis (31.5.2012)
The findings of a retrospective analysis of methotrexate (MTX) safety data show that the
injection of this disease-modifying anti-rheumatic drug (DMARD) was not superior to
oral therapy in long-term treatment of patients with juvenile idiopathic arthritis (JIA).
Findings published in Arthritis Care & Research, a peer-reviewed journal of the
American College of Rheumatology (ACR), suggest that with similar efficacy and
tolerability the more comfortable oral approach may be more suitable to treat pediatric
arthritis patients.
There are a number of chronic arthritis conditions, collectively referred to as JIA, that
affect children and teens. Medical evidence reports JIA incidence ranges from 10 to 100
per 100,000 children under 16 years of age, making it the most common chronic pediatric
inflammatory disease. In the U.S. the ACR estimates that 294,000 children are diagnosed
with JIA, which can lead to severe disability.
Previous studies have confirmed the safety and efficacy of MTX, which is one of most
common first line DMARD treatments for arthritis. While side effects such as nausea and
vomiting may limit MTX use in children, the type of delivery method may also pose a
significant burden to the patients," explains Dr. Ariane Klein from Asklepios Klinik in
Sankt Augustin, Germany. "Our study compares the efficacy of oral MTX to injection of
the drug and to assess side effects in children with JIA."
Using data collected by the German Methotrexate Registry since 2005, researchers
identified JIA patients who were treated with MTX for at least 6 months and who did not
receive additional biologic therapies. Participants who changed their MTX approach
during the observation period were excluded. The study groups consisted of 259 (63%)
patients who received oral MTX and 152 (32%) patients receiving MTX injections. In
both groups, patients had a median age of ten years, two-thirds were female, and all
received a comparable dose of MTX.
A clinical response (efficacy) based on the PedACR 30 score after six months of MTX
therapy was found in 72% receiving oral therapy and 73% of patients using injections. At
least one adverse event was reported in 22% of patients in the oral cohort compared to
27% in the injection therapy group. Researchers found that significantly more patients
receiving MTX injections discontinued treatment due to adverse events compared to
those on oral treatment at 11% versus 5%, respectively.
Dr. Klein concludes, "Our analysis found that efficacy and tolerability of MTX was
similar in both delivery methods. The often unpopular MTX injection did not appear to
be superior to oral administration and may likely be spared without clinical
consequences." The authors advised further controlled studies to determine the best
application route of MTX treatment in patients with juvenile arthritis
Atrhritis
Special Ultrasound Detects Heart Problems In Rheumatoid Arthritis
Patients (Medical News Today:7 June 2012)
A special type of ultrasound - speckle-tracking echocardiography - can detect potentially
fatal heart complications in rheumatoid arthritis patients, researchers from the Mayo
Clinic, USA, reported at the European League Against Rheumatism annual meeting in
Berlin, Germany. The researchers explained that individuals with rheumatoid arthritis
have a higher chance of developing heart disease, and for them early intervention is vital.
However, risk assessment tools currently used by doctors tend to underestimate the
danger.
researcher, Sherine Gabriel, M.D., explained that speckle-tracking Senior
echocardiography shows promise as an effective way of screening rheumatoid arthritis
patients for cardiovascular disease.
Dr. Gabriel said:
"The challenge that we've had in our studies, and other people have had as well, is
identifying patients with rheumatoid arthritis early enough so that we can intervene,
before the symptoms become clinically apparent.
So before they have a heart attack, before they have heart failure, so that we can identify
those high-risk patients early, at a time when we can make a difference."
The immune system of patients with rheumatoid arthritis attacks tissue, inflames joints
and sometimes affects other organs too. A Mayo Clinic study that was recently published
found that the Framingham and Reynolds risk scores, two commonly utilized heart
disease risk assessment tools, frequently underestimate the danger rheumatoid arthritis
patients face.
Individuals with rheumatoid arthritis are in danger of two cardiovascular conditions; the
type of heart disease that causes heart attacks to occur, and the type that causes heart
failure, according to Dr. Gabriel. Gabriel and team are working to create a more accurate
and effective risk assessment tool. Meanwhile, however, they say the echocardiogram
findings are a step in the right direction.
In this study, involving 100 patients with rheumatoid arthritis and no cardiovascular
disease diagnosis, as well as 50 others with no heart disease or rheumatoid arthritis, those
with rheumatoid arthritis where shown to have cardiac impairments when scanned with
the speckle-tracking echocardiography. The healthy cohorts showed no such
impairments.
Dr. Gabriel added that the impairment found in the arthritic patients had a unique pattern
- a sign that could be used to indicate heart disease before any clinical signs become
apparent.
Dr. Gabriel said:
"It's potentially part of the answer. Our research team here at Mayo is working to identify
better ways to predict heart disease in persons with rheumatoid arthritis, including
developing better risk scores, imaging tests and perhaps better blood tests.
We're also evaluating a number of immunological blood tests that could help us identify
patients early, and exploring better imaging approaches like myocardial strain that can
help us identify patients with RA who have heart problems as early as possible."
Arthritis
Special Ultrasound Detects Heart Problems In Rheumatoid Arthritis
Patients (Medical News Today:7 June 2012)
A special type of ultrasound - speckle-tracking echocardiography - can detect potentially
fatal heart complications in rheumatoid arthritis patients, researchers from the Mayo
Clinic, USA, reported at the European League Against Rheumatism annual meeting in
Berlin, Germany. The researchers explained that individuals with rheumatoid arthritis
have a higher chance of developing heart disease, and for them early intervention is vital.
However, risk assessment tools currently used by doctors tend to underestimate the
danger.
Senior researcher, Sherine Gabriel, M.D., explained that speckle-tracking
echocardiography shows promise as an effective way of screening rheumatoid arthritis
patients for cardiovascular disease.
Dr. Gabriel said:
"The challenge that we've had in our studies, and other people have had as well, is
identifying patients with rheumatoid arthritis early enough so that we can intervene,
before the symptoms become clinically apparent.
So before they have a heart attack, before they have heart failure, so that we can identify
those high-risk patients early, at a time when we can make a difference."
The immune system of patients with rheumatoid arthritis attacks tissue, inflames joints
and sometimes affects other organs too. A Mayo Clinic study that was recently published
found that the Framingham and Reynolds risk scores, two commonly utilized heart
disease risk assessment tools, frequently underestimate the danger rheumatoid arthritis
patients face.
Individuals with rheumatoid arthritis are in danger of two cardiovascular conditions; the
type of heart disease that causes heart attacks to occur, and the type that causes heart
failure, according to Dr. Gabriel. Gabriel and team are working to create a more accurate
and effective risk assessment tool. Meanwhile, however, they say the echocardiogram
findings are a step in the right direction.
In this study, involving 100 patients with rheumatoid arthritis and no cardiovascular
disease diagnosis, as well as 50 others with no heart disease or rheumatoid arthritis, those
with rheumatoid arthritis where shown to have cardiac impairments when scanned with
the speckle-tracking echocardiography. The healthy cohorts showed no such
impairments.
Dr. Gabriel added that the impairment found in the arthritic patients had a unique pattern
- a sign that could be used to indicate heart disease before any clinical signs become
apparent.
Dr. Gabriel said:
"It's potentially part of the answer. Our research team here at Mayo is working to identify
better ways to predict heart disease in persons with rheumatoid arthritis, including
developing better risk scores, imaging tests and perhaps better blood tests.
We're also evaluating a number of immunological blood tests that could help us identify
patients early, and exploring better imaging approaches like myocardial strain that can
help us identify patients with RA who have heart problems as early as possible."
Arthritis
Changes in gut bacteria may trigger diseases like rheumatoid arthritis
(New Kerala: 13.6.2012)
Researchers including one of an Indian origin have found that the billions of bugs in our
guts regulate the immune system and related autoimmune diseases such as rheumatoid
arthritis.
Larger-than-normal populations of specific gut bacteria may trigger the development of
diseases like rheumatoid arthritis and possibly fuel disease progression in people
genetically predisposed to this crippling and confounding condition, say the scientists, at
Mayo Clinic and the University of Illinois at Urbana-Champaign.
'A lot of people suspected that gut flora played a role in rheumatoid arthritis, but no one
had been able to prove it because they couldn't say which came first ' the bacteria or the
genes,' says senior author Veena Taneja, Ph.D., a Mayo Clinic immunologist.
'Using genomic sequencing technologies, we have been able to show the gut microbiome
may be used as a biomarker for predisposition,' she said.
The roughly 10 trillion cells that make up the human body have neighbors: mostly
bacteria that often help, training the immune system and aiding in digestion, for example.
The bacteria in the intestines, in addition to a relatively small number of other
microorganisms (the gut microbiome), outnumber human cells 10-to-1.
Researchers found that hormones and changes related to aging may further modulate the
gut immune system and exacerbate inflammatory conditions in genetically susceptible
individuals.
Nearly 1 percent of the world's population has rheumatoid arthritis, a disease in which the
immune system attacks tissues, inflaming joints and sometimes leading to deadly
complications such as heart disease.
Other diseases with suspected gut bacterial ties include type I diabetes and multiple
sclerosis.
Researchers with the Mayo Illinois Alliance for Technology Based Healthcare say that
identifying new biomarkers in intestinal microbial populations and maintaining a balance
in gut bacteria could help physicians stop rheumatoid arthritis before it starts.
'This study is an important advance in our understanding of the immune system
disturbances associated with rheumatoid arthritis. While we do not yet know what the
causes of this disease are, this study provides important insights into the immune system
and its relationship to bacteria of the gut, and how these factors may affect people with
genetic susceptibilities to disease,' Eric Matteson, M.D., chairman of rheumatology at
Mayo Clinic, who was not a study author, said.
Dr. Taneja and her team genetically engineered mice with the human gene HLADRB1*0401, a strong indicator of predisposition to rheumatoid arthritis.
A set of control mice were engineered with a different variant of the DRB1 gene, known
to promote resistance to rheumatoid arthritis.
Researchers used these mice to compare their immune responses to different bacteria and
the effect on rheumatoid arthritis.
'The gut is the largest immune organ in the body,' co-author Bryan White, Ph.D., director
of the University of Illinois' Microbiome Program in the Division of Biomedical Sciences
and a member of the Institute for Genomic Biology, said.
'Because it's presented with multiple insults daily through the introduction of new
bacteria, food sources and foreign antigens, the gut is continually teasing out what's good
and bad,' White said.
The gut has several ways to do this, including the mucosal barrier that prevents
organisms ' even commensal or 'good' bacteria ' from crossing the lumen of the gut into
the human body.
However, when commensal bacteria breach this barrier, they can trigger autoimmune
responses.
The body recognizes them as out of place, and in some way this triggers the body to
attack itself, he says.
These mice mimic human gender trends in rheumatoid arthritis, in that females were
about three times as likely to generate autoimmune responses and contract the disease.
Researchers believe these 'humanized' mice could shed light on why women and other
demographic groups are more vulnerable to autoimmune disorders and help guide
development of new future therapies.
'The next step for us is to show if bugs in the gut can be manipulated to change the course
of disease,' Dr. Taneja says.
The study was recently published in PloS ONE. (ANI)
Arthritis
Low calorie diet could help arthritis sufferers (New Kerala: 20.6.2012)
A simple diet, which is very low on calorie and high in protein combined with regular
exercise, could end the misery of arthritis for millions of sufferers, according to new
research.
A relatively small weight loss can have a dramatic effect by reducing swelling, relieving
pain and even helping prevent further deterioration of the joints.
Researchers in Denmark found that patients on the strict diet for 16 weeks lost radical
amounts of weight and reported a huge improvement in their pain levels, the Daily
Express reported.
The drastic diet is based on an intake of as little as 440 calories a day, as compared to the
recommended 2,500 for a man and 2,000 for a woman.
Despite the method being controversial, the results of the study were described as a
"revelation" by the team leader.
Volunteers ate special shakes, soups, bars and porridge and took mineral and vitamin
supplements to ensure that they received key nutrients.
Moreover, the fat loss did not cause any reduction in the bone mass density.
"It was a fantastic surprise that patients with little or no mobility could lose that amount,"
Professor Henning Bliddal, of Frederiksberg Hospital in Copenhagen, said.
"Thanks to the diet they were able to reduce their dependence on painkillers and antiinflammatory drugs."
Although the diet, a form of the Cambridge Weight Plan, proved successful, Prof Bliddal
cautioned it is not meant for long-term use.
"Patients are very close to starving in the first few weeks and you cannot go on like that
for very long. They need to follow the diet up with a sensible eating plan," he said.
"Research shows that losing weight, however modest, when combined with exercise, is a
panacea at every stage," Professor Alan Silman, medical director of Arthritis Research
UK, said.
"A healthy weight reduces the risk of developing the disease, relieves existing symptoms
and helps to prevent further deterioration. Weight loss and exercise has been shown to
achieve the same level of symptom relief as joint replacement surgery."
"There are two major risk factors for developing osteoarthritis – ageing and obesity – and
as both these factors are on the rise in the UK, it's an obvious prediction to make that the
outcome could be a massive cost," he said.
A separate study of 454 patients at Wake Forest University in the US found strict dieting
and moderate exercise slashed osteoarthritis knee pain in half.
Researchers concluded that the combination of controlling eating habits and keeping
mobile was "potentially one of the best treatments".
This study has been published in the European Journal of Clinical Nutrition. (ANI)
Ayurveda
Herbal compound
Herbal compound triggers kidney failure, cancer (New Kerala:
11.4.2012)
Aristolochic acid (AA), a plant compound used in herbal remedies since ancient times, is
among the leading causes of kidney failure and upper urinary tract cancer (UUC).
In a study of 151 UUC patients in Taiwan, Arthur Grollman, professor of
pharmacological sciences, Stony Brook University School of Medicine, and a team of
scientists, concluded that exposure to AA is a primary contributor to UUC in Taiwan,
where its incidence is stated to be the highest in the world.
This finding holds broad implications for global public health, as individuals treated with
herbal preparations available worldwide that contain Aristolochia are at significant risk of
developing chronic kidney disease or UUC, the journal Proceedings of the National
Academy of Science reports.
"We believe our latest research highlights the importance of a long-overlooked disease
that affects many individuals in Taiwan, and, by extension, in China and other countries
worldwide, where Aristolochia herbal remedies traditionally have been used for
medicinal purposes," says Grollman.
Aristolochic acid is recognized by the US health department as a powerful nephrotoxin
and human carcinogen linked with chronic kidney disease and UUC, according to a Stony
Brook statement.
The dual toxicities and target tissues were originally revealed when a group of healthy
Belgian women developed renal failure and UUC after ingesting Aristolochia herbs to
lose weight. Other cases of aristolochic acid nephropathy (AAN) and UUC were
subsequently reported worldwide.
Most recently, Grollman and colleagues proved AA to be the causative agent of endemic
nephropathy in the Balkans, solving a 50-year-old medical mystery that pointed to the
ingestion of Aristolochia clematitis, or birthwort, contained in wheat.
Using their previous work in the Balkans as a guide, Grollman and colleagues looked
toward other areas where Aristolochia might be consumed and in which there was a high
incidence of kidney disease and UUC. Taiwan appeared to demonstrate exactly that
connection. (IANS)
Herbal Remedy
Accusing Herbal Remedy for Soaring Cancer Rate in Taiwan: Study
(Med India: 11.4.2012)
A popular herbal remedy containing a toxic ingredient is linked to over half of all cases
of urinary tract cancer in Taiwan where use of traditional medicine is extensive, said a
US study on Monday.
Aristolochic acid (AA) is a potent human carcinogen that is found naturally in
Aristolochia plants, an ingredient common in botanical Asian remedies for aiding weight
loss, easing joint pain and improving stomach ailments.
The ancient herb has been touted around the world for thousands of years for everything
from gout to childbirth, but scientists now know it carries serious risks of causing kidney
disease and urinary cancers.
The latest research found it can interact with a person's DNA and form unique
biomarkers of exposure, as well as creating signals within tumor suppressing genes that
indicate the carcinogen has been ingested.
In Taiwan, where previous research has shown about one-third of the population has
taken AA in recent years, rates of urinary tract and kidney cancer are about four times
higher than in Western countries where use is less common, said the findings in the
Proceedings of the National Academy of Sciences.
"It is a rare tumor and Taiwan has the highest incidence of any country in the world," said
lead author Arthur Grollman of the department of pharmacological sciences at Stony
Brook University in New York.
"The fact that Taiwan had the highest incidence both of cancer and this renal disease -that was our clue that something was going on there," Grollman told AFP.
The research was based on 151 patients with urinary tract cancer, of whom 60 percent
showed specific mutations linked to the herbal remedy.
In particular, after being ingested the acid forms a unique kind of lesion in the renal
cortex, and also gives rise to a particular mutational signature in the TP53 tumor
suppressing gene, said the study.
The herb is known in Europe by the name birthwort because it was often given to women
during childbirth. Derived from the Greek, "aristolochia" means noble birth.
"This has been used by every culture in the world from the earliest written record," said
Grollman.
Signs of harm have emerged in recent decades, and the acid is blamed for causing a
kidney disease called Balkan endemic nephropathy, first described in 1956, that afflicted
rural farmers in Bosnia and Herzegovina, Bulgaria, Croatia, Romania and Serbia.
The villagers were found to be baking seeds from a weed called Aristolochia clematitis in
their bread.
In the 1990s, a group of Belgian women reported sudden late stage kidney failure after
taking a weight loss drug that contained AA.
And even though many countries have taken steps to warn of the risks, the ingredient is
difficult to control and still finds its way into products via the Internet, said Grollman,
adding that most of the AA products currently being used in Taiwan are made in China.
"Many countries ban it but it is always available on the Internet. And in fact you can't ban
it in the United States. You can only ban its importation."
The US Food and Drug Administration warned of the risks of aristolochic acid in 2001
after two patients developed serious kidney disease after using botanical products
containing it.
"Natural is not necessarily safe, nor is long-term usage," said Grollman.
Remedies
Scant Evidence That Insect Bite Remedies Work (Medical News Today:
13.4.2012)
A UK review in the April Drug and Therapeutics Bulletin (DTB) says there is scant
evidence that over-the-counter remedies for simple insect bites work, suggesting that in
most cases, no treatment at all is enough.
The DTB concludes:
"There is little evidence for the efficacy of treatments for simple insect bites. The
symptoms are often self limiting and in many cases, no treatment may be needed."
Most of the insect bites inflicted on people in the UK are from midges, mosquitoes, flies,
fleas and bedbugs, looking for a blood meal.
When they bite, these insects inject saliva into the wound, causing a reaction, such as
itching and inflammation.
Some bites can result in infection, an eczema flare-up, or anaphylactic shock. Clearly
these reactions warrant appropriate treatment, says DTB, but that is not what their review
is about: their beef is with the over-the-counter medications used to treat the vast majority
of milder reactions: the itching, swelling, pain, and secondary problems that come from
scratching.
For instance, steroid creams have been shown to help people with eczema, but there is no
evidence they are effective for the sort of itching and inflammation you get from an
insect bite, says DTB.
Also, there is no evidence that steroid tablets work for severe localized and systemic
reactions to insect bites, despite the fact they are recommended for this.
DTB urges people to use steroid creams very sparingly and never apply them to the face
or broken skin.
Another remedy they raise doubts about is the widely recommended antihistamine tablet,
used for pacifying the itching that accompanies insect bites. But according to DTB, there
is little evidence to support this either.
DTB says they could find no hard evidence on the effectiveness of Crotramiton against
itching. They cite a note in the British National Formulary, the UK expert's drug bible,
that says the drug is of "uncertain value".
There is little evidence that antiseptics and astringents relieve itching or burning,
although there is some evidence that dilute ammonium solution (counter-irritant) helps,
says DTB.
As for creams that contain painkillers or anaesthetics like lidocaine, benzocaine,
sometimes with antihistamines and antiseptics, DTB says they are "marginally effective
and occasionally cause sensitisation".
DTB suggests that applying a cloth soaked in cold water to the wound is often the most
effective way to treat a simple insect bite.
The review does not include treatments for bites from ticks, mites and lice.
DTB is published by BMJ Publishing Group Ltd. It is not a peer-reviewed journal; its
articles are produced by editors in consultation with experts.
Garlic
Garlic fights food poisoning: Study( The Indian Express:4.5.2012)
Dread food poisoning? Take garlic.
Diallyl sulphide, the active ingredient of the humble garlic, a study conducted at
Washington State University and published in the Journal of Antimicrobial
Chemotherapy has found, is 100 times more effective in killing Campylobacter Jejuni,
the most common cause of food poisoning, than some of the most advanced antibiotics.
Researchers compared the effect of diallyl sulphide on a film of Campylobacter formed
on food with that of ciprofloxacin and erythromycin, two of the most advanced
antibiotics used to treat food poisoning, and found that “diallyl sulphide eliminated
planktonic cells and sessile cells in biofilms at a concentration that was at least 100-fold
less than used for either ciprofloxacin or erythromycin on the basis of molarity”.
This result prompted the researchers to conclude that given such potency, diallyl sulphide
could not only be effective against food poisoning but also emerge as a powerful agent to
deal with drug-resistant strains of bacteria.
Doctors, however, seem less enthusiastic. “There have to be control trials before
pronouncing judgment on the efficacy of any drug,” said Dr S Chatterjee, medicine
consultant at Indraprastha Apollo Hospital. “The same should apply to garlic.”
That,of course, is standard scientific procedure. But if trials establish the potency of
diallyl sulphide, it will bolster the reputation of garlic as the “nature’s wonder drug”.
Garlic is believed to have anti-cancer properties and is effective in keeping in check
cholesterol and blood pressure as well as cold and flu.
Turmeric
Turmeric may help walking ability in spinal injuries (New Kerala:
28.6.2012)
A diet enriched with a popular omega-3 fatty acid and curcumin, found in Indian curry
spice turmeric, preserved walking ability in rats with spinal-cord injury.
The findings by researchers from the University of California Los Angeles (UCLA)
suggest that these dietary supplements help repair nerve cells and maintain their function
after degenerative damage to the neck.
"Normal aging often narrows the spinal canal, putting pressure on the spinal cord and
injuring tissue," explained principal investigator Langston Holly, associate professor of
neurosurgery at the David Geffen School of Medicine at UCLA, the Journal of
Neurosurgery: Spine reports.
"While surgery can relieve the pressure and prevent further injury, it can't repair damage
to the cells and nerve fibres. We wanted to explore whether dietary supplementation
could help the spinal cord heal itself," added Holly, according to an UCLA statement.
The UCLA team studied two groups of rats with a condition that simulated cervical
myelopathy -- a progressive disorder that often occurs in people with spine-weakening
conditions like rheumatoid arthritis and osteoporosis.
This condition can lead to disabling neurological symptoms, such as difficulty in
walking, neck and arm pain, hand numbness and weakness of the limbs. It is the most
common cause of spine-related walking problems in people over 55 years.
The first group was fed rat chow that mimicked a Western diet high in saturated fats and
sugar. The second group consumed a standard diet supplemented with docosahexaenoic
acid, or DHA and curcumin. A third set of rats received a standard rat diet and served as a
dummy group.
DHA is an omega-3 fatty acid shown to repair damage to cell membranes. Curcumin is a
strong antioxidant that previous studies have linked to tissue repair. Both reduce
inflammation.
"Our findings suggest that diet can help minimize disease-related changes and repair
damage to the spinal cord," said Holly. (IANS)
Bimarou states
Bimarou states
After 10 years, Bimarou states still miss the bus (Business
standard:11.4.2012)
Even after 10 years of growth, India’s Bimarou states (Bihar, Madhya Pradesh,
Rajasthan, Orissa and Uttar Pradesh) continue to underperform other states.
An analysis of the Houselisting and Housing Census Data, 2011, shows despite
improvement in all socio-economic parameters vis-à-vis 2001, in a national list, these
states remain where these stood a decade ago — at the bottom.
The data showed Bimarou states, so called for their lag in development, underperformed
national averages on most socio-economic parameters, such as access to tap water,
electricity, toilets, and banking services. In some cases, however, their growth
percentages surpassed national growth. But these states failed to introduce any substantial
change in ground realities, owing to a very low base, which was also responsible for
sharp percentage increases in most cases.
Access to tap water
In 2011, Bihar, much publicised for the development it has seen in recent years, managed
to ensure only 4.4 per cent of its households secured access to tap water, an increase of
just 0.7 percentage points in 10 years (2001 to 2011). In Bihar, the percentage increase
over 2001, despite a very low base, was lower than the national increase. In the same
period, the national average rose from 36.7 to 43.5.
The case of Uttar Pradesh, Orissa, Rajasthan and Madhya Pradesh was no different. In
these states, the percentage of households with access to tap water was lower than the
national average. Also, in these states, the percentage increase, compared to 2001, was
lower than the average national increase.
Interestingly, many states showed considerable improvement in ensuring more of their
citizens had access to tap water. Punjab, where the numbers were below the national
average in 2001, saw the number of such households rise from 33.61 per cent in 2001 to
51 per cent in 2011. Improvements were also recorded by Andhra Pradesh, Kerala and
Haryana.
Access to toilets
While the issue of more than half the country’s population not having access to toilets
was much debated, 65 per cent of the households in five states were yet to use a toilet.
These were Orissa (78 per cent of households without toilets), Bihar (76.9 per cent),
Madhya Pradesh (71.2 per cent), Rajasthan (65 per cent) and Uttar Pradesh (64.4 per
cent). The list of states that fared poorly remained unchanged since 2001.
The rates at which these states provided toilets to their citizens were also lower than the
national average. While at the national level, the number of households with toilets rose
16.5 per cent between 2001 and 2011, in Bihar it rose only 4.8 per cent, Uttar Pradesh
6.12 per cent, Madhya Pradesh 6.3 per cent, Orissa 8.3 per cent and Rajasthan 8.4 per
cent.
Access to electricity
Access to electricity, essential to the growth of any state, remained below the national
average in all Bimarou states. Bihar had the least number of households with access to
electricity, followed by Uttar Pradesh, Assam and Orissa.
In Bihar, the number of such households rose from 10.3 per cent in 2001 to 16.4 per cent
in 2011. Nationally, it increased from 55.8 per cent in 2001 to 67.3 per cent in 2011.
Among Bimarou states, Rajasthan fared much better than other states. The state saw the
percentage of households with access to electricity rise from 54.7 per cent in 2001 to 67
per cent in 2011.
Access to banking services
Apart from the states in the northeast, Bihar had the least number of households with
access to banking services. Bihar was preceded by Orissa and Madhya Pradesh.
However, the percentage growth between 2001 and 2011 in these three states was more
than the national increase. Uttar Pradesh, with a relatively high percentage of households
with access to banking services, recorded growth that was lower than the national
average.
Biomedical Science
Gene
Gene Variations Linked to Intestinal Blockage in Newborns with Cystic
Fibrosis (Science daily: 2.4.2012)
University of North Carolina at Chapel Hill researchers working as part of the
International Cystic Fibrosis Consortium have discovered several regions of the genome
that may predispose cystic fibrosis (CF) patients to develop an intestinal blockage while
still in the uterus.
A report of this international study appears online April 1, 2012 in the journal Nature
Genetics. It was the work of the North America CF Gene Modifier Consortium, which
brought together dozens of investigators from the United States, Canada, and from
France, to identify genetic variations that could be linked with meconium ileus (MI), an
intestinal obstruction that usually requires emergency surgery for treatment, and can
result in a substantially increased rate of serious health problems.
MI affects roughly 15-20 percent of all patients with CF, a genetic condition that causes
scarring throughout the body, especially the lungs and pancreas. Though every CF patient
carries mutations in both copies of the same gene -- coding for a protein called cystic
fibrosis transmembrane conductance regulator, or CFTR -- symptoms can vary widely
from patient to patient.
The genome-wide association study (GWAS) of more than 3,700 CF patients identified
non-CFTR genetic variants in the cell membrane that separates the interior of cells from
the outside environment. More specifically, the variants involved genes responsible for
ion transport in the lower end of the small intestine.
"These variants involve cells in the small intestine that predispose CF patients to develop
MI while still in the womb," said one of the senior study authors Michael Knowles, MD,
professor of pulmonary and critical care medicine at UNC and a member of UNC's
Cystic Fibrosis-Pulmonary Research and Treatment Center.
"The discovery provides new understanding of the pathogenic mechanisms underlying
MI. In addition, it offers the possibility of developing therapies to intervene in utero,"
Knowles said. "Further, it provides molecular insight into the role of genetic variation in
ion transporters in CF, which may be applicable to more commonly, and severely,
involved organs such as the lungs."
Other UNC study coauthors are Wanda K. O'Neal, Rhonda G. Pace, Jaclyn R.
Stonebraker, Sally D. Wood, and Fred A. Wright. In the U.S., the study was funded by
the National Heart, Lung and Blood Institute, the National Institute of Diabetes and
Digestive and Kidney Diseases, and the U.S. Cystic Fibrosis Foundation.
Ozone therapy
Ozone therapy is good for health (The Times of India: 2.4.2012)
Mohamed Nabil Mawsouf, head of the ozone therapy unit at a cancer institute in Egypt,
describes how ozone therapy can heal damaged cells in the body
Ozone is oxygen with three atoms. The ozone layer is created by the action of ultraviolet
rays on atmospheric oxygen 20 to 30km from the earth’s surface. It is also generated by
action of high-voltage thunder (lightning) on atmospheric oxygen near the earth and from
the action of waves on oxygen at the sea shore.
Benefits of ozone in nature
In the upper atmosphere, the ozone layer protects earth from the harmful effects of
ultraviolet rays. In the lower atmosphere, ozone protects us from pollution by
hydrocarbons by reacting with them to form non-toxic carbon dioxide and water.
Ozone’s effect on health
•Inactivates viruses, bacteria, yeast, fungi, parasites, protozoa
•Stimulates immune system, speeds healing
•Cleans arteries, veins, improves circulation
•Oxidizes toxins, facilitates their excretion
•Normalizes hormone and enzyme production
•Reduces inflammation and pain; scavenges free radicals
•Stimulates production of protective enzymes
Medical usages
During World War I, ozone was used to treat wounds, foot gangrene, and the effect of
poisonous chlorine gas. Infected wounds washed with rainwater containing ozone healed
well. When a cell is stressed by physical or chemical shock or by viral, bacterial or fungal
attack, its energy levels are reduced by the outflow of electrons and it becomes
electropositive. Ozone has the third atom of oxygen which is electrophilic. This atom’s
free radical electrical charge seeks to balance itself electrically with material that has a
corresponding unbalanced charge. Diseased cells, viruses, harmful bacteria and
pathogens that carry such a charge attract ozone and its byproducts. Ozone in the blood
reacts with these oxidisable substrates, killing viruses, bacteria and fungi. The metabolic
waste products of these organisms are also oxidized and an oxygen-rich environment is
provided in which healthy cells thrive. Healthy cells have a balanced electrical charge
and don’t react with ozone.
Methods of application
•Through injections
•Direct injection into a muscle, joint or directly into a tumour
•Through insufflations in the ear, vagina, rectum, and urethra
•Through ingestion of ozonated water
•Through steam and sauna
Fat cells
Fat cells can protect our body against diabetes (New Kerala: 3.4.2012)
Researchers have shed light on how fat cells protect the body against diabetes – the
finding that may lead to a new therapeutic strategy for preventing and treating type 2
diabetes and obesity-related metabolic diseases.
In the last decade, several research groups have shown that fat cells in people play a
major role in controlling healthy blood sugar and insulin levels throughout the body.
To do this crucial job, fat cells need a small portion of the sugars derived from food.
Obesity often reduces the dedicated sugar transport molecules on fat cells, blocking the
glucose from entering fat cells. As a result, the whole body becomes insulin resistant, and
blood sugar rises, leading to diabetes.
The new study by researchers at Beth Israel Deaconess Medical Center (BIDMC)
revealed why glucose is so important to fat cells. The team discovered a new version of a
gene inside fat cells that responds to sugar with a powerful systemic effect.
"If we change that one gene, that makes the animal more prone to or more protected from
diabetes. Many foods get converted into sugar, so there is no need to eat more sugar,"
said senior author Barbara Kahn MD, the George R. Minot Professor of Medicine at
Harvard Medical School and Vice Chair of the Department of Medicine at BIDMC.
In the study, the BIDMC researchers pinpointed the fat gene and its effect in mouse
models of human obesity and insulin resistance and reported supporting evidence from
fat tissue samples from both lean and obese people.
"Two things were surprising – first, that a lone gene could shift the metabolism of the fat
cell so dramatically and then, that turning on this master switch selectively in adipose
tissue is beneficial to the whole body," Kahn said.
Twelve years ago, Kahn first demonstrated that fat cells are a master regulator of healthy
levels of glucose and insulin in mice and require sugar to do the job.
In the latest study, evidence suggests the newfound gene also may account for the
protective effect of glucose uptake in human fat. German collaborators found more gene
activity in people with greater insulin sensitivity, based on 123 adipose tissue samples
from non-diabetic, glucose tolerant people. The fat gene activity also correlated highly
with insulin sensitivity in obese, non-diabetic people, as measured in 38 fat samples by
another pair of co-authors based in St. Louis.
In fat cells, the newfound gene acts as a glucose sensor that converts the sugars into fatty
acids, which may play a role in the powerful systemic effect. In response to rising
glucose levels, the gene makes a more active version of itself. The active version turns on
the cellular machinery that disassembles the sugar molecules and remakes them into fatty
acids.
The novel version of this gene is called carbohydrate-responsive-element-binding
protein-beta, or ChREBP-beta for short.
In the liver, where the original gene was discovered by other scientists, the same fatty
acid synthesis process is harmful. There, the transformation of glucose into fatty acids
raises triglycerides in the blood and leads to nonalcoholic fatty liver disease.
The mice in the latest study were first developed in Kahn's lab two decades ago to model
a surprising feature of human obesity. The number of glucose transporters (GLUT4)
drops with obesity – but only on fat cells – and it happens early in the development of
diabetes. (GLUT4 is also found on muscle and heart cells.) Kahn generated mice with
genetic alterations in the amount of GLUT4 in fat cells, seeking clues to the link between
obesity and diabetes.
One set of mice features 5 to 10 times the usual number of glucose transporters in its fat
cells. These mice are obese but exhibit none of the diseases usually associated with
obesity. Another set of mice is missing the glucose transporters on their fat cells, which
causes diabetes symptoms despite the fact that these mice have normal body weight.
"There's something very special about GLUT4. When you wake up and haven't eaten all
night, the GLUT4 transporters are inside the cell. Within minutes of eating and glucose
reaching the blood and stimulating insulin secretion, the GLUT4 transporters move to the
cell surface. It's reliable, fast, dynamic and critical to maintaining normal blood sugar
after we eat," Kahn explained.
Now, the Kahn team has identified how fat cells with GLUT4 can sense the change in
glucose transport into the cell and respond by regulating insulin sensitivity in the entire
body.
The new study reveals a new, potent version of a gene that transforms glucose into fatty
acids.
"We definitely do not want to imply that people should eat more sugar," Kahn noted.
In future research, the team will investigate whether the gene activity could be working
directly through fatty acids or altering fat cells and the molecules they secrete in other
ways.
The study has been published online in the journal Nature. (ANI)
Fat cells
Fat cells can prevent diabetes? (The Times of India: 3.4.2012)
Gene In Body Fat Beats Insulin Resistance, Controls Blood Sugar
London: Scientists have identified a gene in body’s fat cells, which they claim could
protect one against diabetes, a finding that independent experts say may pave the way for
effective treatments for the ailment.
In fact, a team, led by Harvard Medical School in the US, has found that contrary to
popular perception, body fat can actually be of benefit, boosting body’s ability to regulate
blood sugar.
In their research, the scientists found that the gene — called ChREBP — resists type 2
diabetes by converting glucose sugar into fatty acids and boosting sensitivity to insulin,
which regulates the blood sugar, the ‘Daily Express’ reported. Type 2 diabetes normally
develops during middle age from obesity or an unhealthy lifestyle. “The general concept
that all fat is bad is not true.
“Obesity is commonly associated with metabolic dysfunction that puts people at higher
risk for diabetes, stroke and heart disease, but there is a large percentage of obese people
who are metabolically healthy,” said team leader Dr Mark Herman.
For most obese people, levels of sugar rise too much because it is prevented from
entering fat cells. But, the scientists found in their trial on laboratory mice that if they
increased levels of a “glucose transporter” gene in obese rodents, it allowed more sugar
into their fat cells and protected against diabetes.
Sugar in fat cells triggered a response from the gene that regulated insulin sensitivity
throughout the body, revealed the findings published in the ‘Nature’ journal.
The scientists found that — conversely — normal weight mice missing the transporter
gene developed diabetic symptoms.
Experts have hailed the findings. Professor Ulf Smith at the University of Gothenburg
in Sweden, who is president of the European Association for the Study of Diabetes, said:
“It’s a really exciting finding. We’ve been looking for the mechanism to try to understand
why glucose metabolism in adipose tissue is so important for whole-body sensitivity to
insulin.” PTI
FAT CAN BE GOOD: The gene converts glucose into fatty acids and boosts sensitivity
to insulin
Key Enzyme
Key Enzyme That Protects Nerves from Degeneration Identified (Med
India: 3.4.2012)
A critical role of an enzyme called Nmnat in nerve fiber maintenance and
neuroprotection has been uncovered by scientists in an animal model of nerve injury.
Understanding biological pathways involved in maintaining healthy nerves and clearing
away damaged ones may offer scientists targets for drugs to mitigate neurodegenerative
diseases such as Huntington's and Parkinson's, as well as aid in situations of acute nerve
damage, such as spinal cord injury.
University of Pennsylvanian biologists developed the model in the adult fruit fly,
Drosophila melanogaster.
"We are using the basic power of the fly to learn about how neurons are damaged in acute
injury situations," said Nancy Bonini, senior author of the research and a professor in the
Department of Biology at Penn. "Our work indicates that Nmnat may be key."
The research was published in Current Biology. First author on the study is postdoctoral
researcher Yanshan Fang, with additional contributions from postdoctoral researcher
Lorena Soares and research technicians Xiuyin Teng and Melissa Geary, all of Penn's
Department of Biology.
When a nerve suffers an acute injury -- as might be caused by a penetrating wound, for
example, or a broken bone that damages nearby tissues -- the long projection of the nerve
cell, called the axon, can become injured and degenerate. The process by which it
disintegrates is known as Wallerian or Wallerian-like degeneration and is an active,
orderly process.
Though this function of eliminating damaged nerve cells is crucial, biologists do not have
a clear understanding of all of the molecular signaling pathways that govern the process.
Bonini's lab has previously focused on chronic neurodegenerative diseases but made this
foray into acute nerve injury to determine if mechanistic overlaps exist between acute
axon injury and chronic neurodegeneration. They first searched for an appropriate nerve
tract to target and identified the wing of adult flies as a prime option.
The fly wing is not only translucent and a site of lengthy nerve fibers that can be easily
observed, but it can also be cut to cause injury without killing the fly. That way, the
researchers can follow the animal's response to nerve injury for weeks.
Using various reagents to manipulate the fly's genetic traits, the team confirmed that the
cut wing nerve underwent Wallerian degeneration. They then tested versions of Nmnat
and another protein called WldS, all of which had previously been shown to protect
nerves from degeneration, to see if any of these might stop the process. All significantly
delayed neurodegeneration. Even a form of Nmnat that hadn't worked in other animal
models suppressed degeneration, although to a lesser extent.
"That indicates that our assay is really sensitive," Bonini said. "This sensitivity could help
us identify genes that have moderate although important functionality at protecting
against nerve degeneration."
Their investigations into the wing nerve also showed that the degenerating axon "died
back," fragmenting first from the axon terminals, the side farthest from the nerve cell
body—a pattern similar to what has been seen in other disorders.
Doing more genetic tinkering, the researchers showed that when the animal's own Nmnat
was depleted, the nerves fragmented in the same way as if the axon was physically cut.
And when Nmnat and the other "rescue" proteins were added back to these genetically
modified flies, they were able to block degeneration, highlighting that Nmnat is critical to
maintaining healthy axons.
In a final set of experiments, the biologists sought to narrow where in the nerve cells
Nmnat might be working. They focused on mitochondria, the powerhouses of cells.
When they created a genetic line of flies that blocked mitochondria from entering the
axon fibers, the nerve tract degenerated, again, in a dying-back fashion. Yet now WldS
and Nmnat failed to prevent axon degeneration, suggesting that those proteins may act on
and require the presence of axonal mitochondria to maintain healthy nerves in normal
flies.
Flipping that scenario around, they looked to see what happened to the mitochondria of
flies upon nerve injury. When they cut the wing nerve axons, the mitochondria rapidly
disappeared. Yet they can largely preserve the mitochrondria by increasing expression of
Nmnat.
Their results, taken together with the findings of other studies, suggest that Nmnat may
stabilize mitochondria in some way in order to keep axons in a healthy state.
"We have some hope that these proteins or their activity may someday serve as drug
targets or could provide the foundation for a therapeutic advance," Bonini said. "But right
now, my hope is that the power of the fly model will open up a lot of new directions of
research and new pathways that could be targets for development in the future."
Source-Eurekalert
Plastic surgery
What happens to plastic surgery leftovers? (World Newspapers:
3.4.2012)
Last October, Rebecca Travers, a PhD student, got in her Renault and drove to a private
hospital in Bath known for its cosmetic surgery. Travers wasn't interested in having a
tummy tuck. She wanted the fat that was left after the tuck was done. At the appointed
time, and with the patient still sedated, the theatre staff produced the sample abdominoplasty can result in quite large pieces of intact flesh and this weighed around
1kg. Travers placed it into her container - a metal tray in a plastic box - and then she
drove back to Bath University to begin her analysis.
She was investigating adipose tissue - fat - and is part of a growing number of medical
researchers and specialists who see in cosmetic surgery what many miss: the waste.
Cosmetic surgery, after all, is all about removing excess fat and tissue. The mission of
these experts is to rescue it from the incinerator.
"We don't have any figures," says Sian Harding, professor of cardiac pharmacology,
Imperial College London, and one of the authors of the report "Human Bodies: donation
for medicine and research", by the Nuffield Council on Bioethics, "but it's a growth area
and is driven by some very interesting developments."
For years, people thought fat was something to hide or apologise for. "It was just the soft
squidgy bits no one really wanted," says Dr Dylan Thompson, senior lecturer in human
and exercise psychology at Bath University. But recently, scientists have discovered that
it's much more than "just" fat. It releases hormones and proteins and offers all sorts of
insights into the human body.
And now it's being mined for a multitude of uses. Dr Thompson and his team are
studying fat to investigate the impact of exercise. Other scientists are working on
everything from turning fat into stem cells (far less controversial than using human
embryos); recycling it for breast reconstruction (thus doing away with toxic implants);
and investigating obesity. In short, fat has became an enormously significant material.
The challenge is how to get hold of it.
In 2000, Dr Thompson started recruiting volunteers. "We put advertisements in
newspapers, local GP practices and emailed big companies, asking people to come to the
university and take part in experiments," he explains. Once in the lab, he would remove a
sample of fat from their stomachs with a needle. "Typically we would get anything from
between half a gram and a gram of tissue." Tiny amounts, in other words. Which meant
they were very limited in the type of observations and experiments they could do.
Harvesting fat from animals wasn't an option, because besides from ethical concerns,
"you get such tiny amounts [of fat] from a mouse or a rat", he says.
In 2008, Dr Thompson took a six-month sabbatical at Toulouse University, and he was
stunned by what he discovered. "Researchers had been using surplus tissue from cosmetic
surgery for years. They didn't do anything like we did; they never recruited volunteers,
they simply capitalised on this spin-off from local clinics." Dr Thompson thought of the
challenges back home. He'd recruited some 500 donors over 10 years, but could never
quite get enough adipose tissue. And although the fat extraction technique wasn't painful
exactly, it did leave the volunteer with a nasty bruise. "It really was a no-brainer to try
and do the same thing here in the UK as well."
Since last autumn, his team have collected around six kilograms of human fat from the
Bath clinic. This is nothing compared to Cytori, a "cell therapy clinic", in San Diego,
working on recycling fat for breast reconstruction. "We've recently processed our 3,000th
sample of fat - a grand total of more than 5,000lbs [2,268kg] over nine years," says a
spokesperson. San Diego, it transpires, has an abundance of fat.
Recycling intimate body parts is not new, and in most people's minds is tied up with
organ donation for heart or liver transplants. "Tissue donation", on the other hand, covers
anything that isn't a vital organ: blood vessels, bone marrow, corneas, heart valves, skin,
even bones (which can be pulped down and used for hip implants). The source of such
material tends to be families donating the bodies of deceased loved ones to research; and
surgical operations - for example, a diseased heart can be harvested for valves (for
patients) and tissue (for pathologists). Cancer growths can also be a rich supply of
material. "People who've had tumours removed are usually very happy to have cells
grown out of those tumours that can then be tested for new drugs for cancer," says
Professor Harding.
A whole industry has grown up around tissue collection. Firms have stepped in to open
"bio banks" where human material is collected, stored in well-regulated freezers and sold.
(PromoCell, the German-based company, for instance, charges around pounds 300pounds 600 for a batch of adipose cells - not tissue - enough for several experiments.)
And ever since the Alder Hey Children's Hospital scandal in Britain in 1998, when
organs were stripped, without parents' permission, from babies who'd died at the hospital,
guidelines have been set to regulate the business more carefully. The Human Tissues Act,
which came into effect in 2004, aims to "ensure that human tissue is used safely and
ethically, and with proper consent".
Genetic Disorder
Rare Genetic Disorder That Turns Organs into Crystals (Med India:
13.4.2012)
A distressed couple in Leeds has revealed that both of their children are suffering from a
rare genetic disorder that slowly turns their organs into crystals.
Jessica Kemp revealed that her daughters, Emily, 3, and Poppy-Mae, 2, have been
diagnosed with cystinosis, a rare genetic disorder that affects just one in 3.5 million.
Cystinosis is an incurable condition with just 2,000 patients in the world and as it is a
genetic disease, there is a one in four chance that Ms Kemp’s children may suffer from
the disease.
Ms Kemp said that when Emily was diagnosed with the disease, she was pregnant with
Poppy-Mae and knew that she too would be suffering from the condition. “I already
knew in my heart that she had it. I was devastated when the doctors confirmed our worst
fears - both our little girls had cystinosis”, she said.
Genes
How Genes are controlled - New Perspective (Med India: 13.4.2012)
Scientists have developed a new way of looking at how genes are controlled. Anyone
who's tried a weekend home improvement project knows that to do a job right, you've got
to have the right tools. For cells, these "tools" are proteins encoded by genes. The right
genes for the job are turned on only in the specific cells where they are needed. And
every cell in your body has a specific job to do. Cells in your pancreas have to produce
insulin, while cells in the retina of your eye must be able to sense light and color. Like
using the wrong tool for the job, if the wrong genes are turned on in a cell, it can cause a
real mess. Worse, in some cases it can cause serious disease like cancer.
Scientists have known this for decades. They've also known that there are specific
proteins called "transcription factors" that control which genes are turned on or off in
cells by binding to nearby DNA. Transcription factors were thought to act like a switch;
they are either "on" (bound to DNA) or "off" (not bound).
A UNC-led team of scientists has now shown that transcription factors don't act like an
'on-off' switch, but instead can exhibit much more complex binding behavior.
"This is a new way of looking at how genes are controlled," says Jason Lieb, PhD, study
senior author. "For a while now there have been molecular maps that show the location of
where the proteins are bound to DNA – like a roadmap. For the first time, we are able to
show the molecular equivalent of a real-time traffic report." Their study appears in the
April 12, 2012 issue of the journal Nature. Lieb is a professor of biology and a member
of UNC Lineberger Comprehensive Cancer Center.
Working in yeast, the UNC team learned that the transcription factors' binding process is
dynamic and involves more than just being bound or unbound. In addition to a stable
binding state (on or off), the team demonstrates a state that they call "treadmilling,"
where no forward transcription process is occurring. Within this process, they
hypothesize the existence of a molecular "clutch" that converts treadmilling to a stable
bound state, moving the transcription process forward to completion to turn the gene on.
Lieb explains, "This discovery is exciting because we developed a new way to measure
and calculate how long a protein is associated with all of the different genes it regulates.
This is important because it represents a new step in the process of how genes are
regulated. And with every new step, there are opportunities for new mechanisms of
regulation." Lieb is director of the Carolina Center for Genome Sciences.
He adds, "We found that proteins that bind in the stable state are associated with high
levels of gene transcription. We think that if we can regulate the transition between
treadmilling and stable binding, we can regulate the outcome in terms of gene expression.
Ultimately, this type of regulation could be important for genetic medicine – a new way
to regulate the 'switches' that turn gene expression associated with disease on or off."
The team set up a controlled competition between two copies of the same transcription
factor, each with a unique molecular tag. They let one of the proteins bind to all of its
gene targets, then introduced the second copy. Next the team measured how long it took
the competitor transcription factor to replace the resident protein and used this data to
calculate the residence time at each location in the genome. Colin Lickwar, MS, first
author of the paper, says, "We didn't know if the residence time was important, but we
found that the residence time was a much better indicator of whether a gene was turned
on or off than previous measures of binding."
Anthony Carter, PhD, who oversees gene regulation grants at the National Institutes of
Health's National Institute of General Medical Sciences, explains, "By taking an
interdisciplinary approach that incorporates the use of mathematical modeling tools, Dr.
Lieb has shed new light on a fundamental cellular process, the ability to quickly shift
between active and inactive states of gene expression. The findings may offer new
insights on how cells respond to developmental cues and how they adapt to changing
environmental conditions." The National Institute of General Medical Sciences partially
supported the work.
Cells
How Cells Distinguish Between Disease-Causing and Innocuous
Invaders (Science daily: 13.4.2012)
The specific mechanisms by which humans and other animals are able to discriminate
between disease-causing microbes and innocuous ones in order to rapidly respond to
infections have long been a mystery to scientists. But a study conducted on roundworms
by biologists at UC San Diego has uncovered some important clues to finally answering
that question.
In a paper published in this week's early online issue of the journal Cell Host & Microbe,
the researchers discovered that intestinal cells in the roundworm C. elegans, which are
similar in structure to those in humans, internalize bacterial toxins that inactivate several
host processes. This then triggers an immune response, which results in the body
mounting an immediate attack against the disease-causing microbes.
"The human intestine is teeming with trillions of bacteria, most of which are innocuous,
or even beneficial," said Emily Troemel, an assistant professor of biology at UC San
Diego who headed the study. "However, sometimes microbes cause disease, such as
occurs in food poisoning."
The UC San Diego study and two others published this week in the journals Cell and Cell
Host & Microbe by research teams headed by Frederick Ausubel and Gary Ruvkun at the
Massachusetts General Hospital and the Harvard Medical School, show that the way
animal cells detect an attack by poisons or disease-causing bacteria is by monitoring the
function of their own cells. If those cells detect a deficit in functions, the scientists
discovered, they then trigger a variety of antibacterial or antitoxin responses against the
invaders.
The roundworms proved to be the ideal laboratory model for these studies. Not only do
they have intestinal cells that are similar in structure to human intestinal cells, but they
are transparent and easy to maintain and study in lab.
"C. elegans provides a wonderful system in which to study questions of how humans and
other animals defend themselves against attacks from disease-causing organisms," said
Troemel. "It lacks an adaptive immune system and, instead, relies solely on the
evolutionarily ancient innate immune system to fight off attacks. Our findings in these
roundworms may have uncovered a new 'pathogen-specific' branch of the innate immune
system, which could function in humans as well."
Troemel's team of researchers -- who included Tiffany Dunbar, Zhi Yan, Keir Balla and
Margery Smelkinson -- found in their experiments that a particular genetic system -- the
"ZIP-2 surveillance pathway" -- was used by the roundworm in detecting an infection by
the disease-causing bacterium Pseudomonas aeruginosa. The biologists also found that a
specific toxin in the bacterium -- "Exotoxin A" -- blocks protein synthesis in the worm's
intestine.
"Surprisingly, this block leads to increased protein levels of the ZIP-2 transcription factor
to ultimately induce expression of defense genes," the scientists conclude in their paper.
"Thus, a common form of pathogen attack acts to switch on host defense, allowing
discrimination of pathogens from innocuous microbes."
"In addition to P. aeruginosa Exotoxin A," said Troemel, "there are several other bacterial
toxins known to block protein synthesis, such as Diphtheria toxin, Ricin toxin and Shiga
toxin. These toxins cause substantial impact on public health. For example, a recent
epidemic outbreak of Shiga-toxin producing E. coli caused over 3000 cases of food
poisoning in Germany leading to 39 deaths. Like Exotoxin A, these toxins can be
internalized into the host cell to block protein synthesis. Perhaps the human intestine also
monitors disruption of host protein synthesis to detect food poisoning, and induce a
response similar to what is found in the C. elegans intestine."
Troemel noted that it makes sense why animals have evolved systems that respond to
core cellular dysfunction, rather than directly to specific toxins.
"We live in an environment filled with a wide variety of disease-causing organisms that
can attack us using toxins," she said. "While these toxins are diverse in structure, the
manner by which they disrupt our cellular machinery can be very similar. Directly
monitoring the functioning of our cellular machinery may provide the optimal system for
early detection and response to unknown toxins or pathogens."
The UC San Diego study was funded by the NIAID, Moores Cancer Center, Searle
Scholars Program, Ray Thomas Edwards Foundation and David & Lucille Packard
Foundation.
Immune system
New therapy uses immune system to fight cancer (World Newspapers
Today: 13.4.20120
Make way for a new weapon in the arsenal of cancer treatments — dendritic cell therapy
(DCT). Doctors in major Indian centres, like Mumbai, Delhi, Chennai, Bangalore, Pune
and Hyderabad, have been carrying out medical trials of this new treatment for a year
now and the results have been very encouraging.
The therapy works on the principle that the immune system of a cancer patient is
extremely important in battling the disease. The process involves the drawing of blood
into a cell separator, which filters out immunologically active mono-nuclear or dendritic
cells.
About 120ml of these dendritic cells are required. They are then treated with various
agents, including a portion of the cancerous tumour in an incubator to make a vaccine
that is injected into the patient’s body once in a couple of weeks.
“So, what we are doing is essentially using the cells of the body’s immune system to fight
the cancerous cells by making the immunologically active cells stronger. These cells
present the malignant cancerous cells to the body’s immune system for clearing. They act
as an interface between the body’s immune system and the tumour,” says Dr Ashok Vaid,
senior oncologist with Medanta Hospital in Gurgaon.
This dendritic cell vaccine that is created externally in the laboratory can be used
alongside chemotherapy, to help boost its effectiveness, as well as on its own, according
to Dr Sameer Kaul, head of surgical oncology at Indraprastha Apollo Hospital at Delhi .
“I’ve treated about 19-20 patients using this therapy and I’ve had a success rate of over
50%. I’ve used DTC on its own and in conjunction with chemotherapy. The results have
been very positive.”
Doctors say the benefits of this therapy are not only restricted to prostate cancer. “I’ve
used DCT to treat ovarian cancer, prostate cancer, malignant brain tumours as well as
some non-cancerous conditions like pulmonary fibrosis. For brain cancer, it is said to
improve the survival rates by five times,” says Dr Purvish Parekh, an oncologist and
haematologist at Mumbai.
The doctorsunderstand the necessity of conducting proper trials before the treatment is
made widely available to cancer patients across India. “The trials are ongoing. Hopefully,
we can get the approval from the Indian authorities by next year,” said Dr Kaul.
Stem cells
Pelvic bone stem cells could help preserve heart function (new Kerala:
16.4.2012)
Scientists, including an Indian-origin, have revealed that stem cells from the pelvic bone
may help the heart beat stronger.
Doctors and other clinicians at the Orlando Health Heart Institute are researching the use
of stem cells from pelvic bone marrow to restore tissue and improve heart function after
muscle damage from heart attacks.
"The thought is the body may use itself to heal itself," Vijaykumar S. Kasi, principal
investigator of the study, said.
"Because stem cells are immature cells they have the potential to develop into new blood
vessels and preserve cardiac muscle cells. By infusing certain stem cells into the area of
the heart muscle that has been damaged from a heart attack, tissue can be preserved and
heart function restored," Kasi said.
The PreSERVE-AMI Study, sponsored by Amorcyte, LLC, a NeoStem, Inc. company, is
for patients who have received a stent to open the blocked artery after a specific heart
attack history.
The study evaluates the effectiveness and safety of infusing stem cells collected from a
patient's bone marrow into the artery in the heart that may have caused the heart attack.
About 160 patients will participate in this national study at approximately 34 sites.
The infusion procedure begins with a catheter inserted through an incision in the groin.
An X-ray camera is used to guide doctors in positioning the catheter in the heart artery
where the stent was placed.
A balloon is inflated within the stent and the infusion takes place in the area impacted by
the heart attack. Because the study is randomized, double blinded and placebo controlled,
patients are infused with either AMR-001, a cell therapy product comprised of stem cells
taken from one's own bone marrow, or a placebo.
Prior to the infusion, patients are screened using various assessments including an
electrocardiogram, a cardiac MRI (magnetic resonance image) and a cardiac nuclear test.
After the necessary screenings, patients have a mini-bone marrow procedure where the
stem cells are "harvested" (removed) from the bone marrow in their pelvic bone, using a
special needle.
The stem cells are processed at Progenitor Cell Therapy, another NeoStem, Inc.
company, in preparation for infusion. Patients who are randomized to placebo will have
their bone marrow frozen and stored and available to them for clinical use, should they
require bone marrow for any reason.
"We are excited to participate in innovative clinical trials as part of our continued efforts
to play a vital role in future solutions to improve patient outcomes.
"Heart disease remains the No.1 killer of men and women in our country," he said. (ANI)
Genetic
Genetic Regions Linked to Osteoporosis and Fractures (Med India
16.4.2012)
New genetic regions are associated with osteoporosis and fractures, says researcher.
Variations in the DNA sequences in these regions confer either risk or protection from
the bone-weakening disease. Many, but not all, of the regions encode proteins involved in
pathways known to involve bone health.
The research shows that osteoporosis results from the combined contributions of dozens,
if not hundreds, of genes. It also suggests many new avenues for anti-osteoporosis drug
development.
"We're learning that the genetic architecture of disease is very complex," said Ioannidis,
who is one of seven senior authors of the study and the methodological leader of the
consortium. The research will be published online April 15 in Nature Genetics.
The unprecedented prospective meta-analysis — which involved 17 genome-wide
association studies, 180 researchers and more than 100,000 participants — also identified
six regions strongly correlated with the risk of fractures of the femur or lower back.
However, the predictive power of the study for individuals is relatively low: Those with
multiple risk-increasing variants are only about three to four times more likely than those
with the fewest variants to have lower bone mineral density and experience fractures.
"As a result," said Ioannidis, "the next step of incorporating this information into basic
patient care is not clear. Each variant conveys a small quantum of risk or benefit. We
can't predict exactly who will or won't get a fracture."
Although factors such as body weight, build and gender are currently much more
predictive of osteoporosis than any of the genetic variants identified in the study, the
research identified many pathways involved in bone health. The biological relevance of
the findings was confirmed by the fact that some of the pathways are already targeted by
current anti-osteoporosis drugs. Other, previously unsuspected pathways will help
researchers understand more about the disease and how to develop drugs to fight it.
The research belies recent frustration with the ability of genome-wide association studies,
or GWAS, to live up to their early hype. When first introduced in 2005, many researchers
predicted that GWAS — a way of quickly scanning whole genomes for minute
differences associated with disease occurrence — would quickly identify critical
mutations for many conditions. This optimistic assessment proved to be largely
unfounded for complex conditions such as osteoporosis, type-2 diabetes and obesity,
which likely involve the combined effects of many genes and environmental components.
This study suggests that the number of participants in most GWAS may need to be vastly
expanded to render useful data.
"The real power of our study lies in the ability to generate prospectively a huge combined
data set and analyze it as a single study," said Ioannidis. "It's likely that our expectations
have been too high in terms of what single studies can accomplish. Each one of the many
teams identified at most only one or two markers; many found none."
Instead, increasingly larger studies will be needed to identify genes important in disease.
"In reality, there may be 500 or more gene variants regulating osteoporosis," said
Ioannidis. "To find all of them, we'll need to study millions of patients. Is this unrealistic?
I don't think so. Sooner or later this will be feasible."
With a few exceptions, people have all the same genes in their DNA as everyone else; it's
one of the things that makes us human. But the way those genes are spelled in each
person's DNA can vary — much like how some words are spelled differently in the
United States and Britain (think "center" and "centre"). Our genomes are riddled with
such differences, which sometimes affect the gene's function. Studies like this one
correlate certain genetic spellings, or variants, with specific outcomes, such as low bone
mineral density and fractures. Any one person can have several or none of the variants
identified by the study.
The current study grew gradually out of a decade of research conducted by Ioannidis and
a few colleagues. At the time, a few teams across the world were attempting to correlate
variations in individual genes with the development of osteoporosis. "We were doing
small studies here and there on popular genes," said Ioannidis, "and then we thought we
should collaborate with other researchers to do a meta-analysis. That marked the
beginning of the first consortium."
However, despite the researchers' enthusiasm, they were hampered by the lack of wholegenome information and had instead to focus on specific genetic clusters they suspected
might be involved in osteoporosis. That changed with the advent of the first GWAS. "The
technology kept getting better, and we began to recruit more people," said Ioannidis.
For the current study, teams around the world combined data from 17 genome-wide
association studies focused on bone mineral density on nearly 33,000 participants in
North America, Europe, east Asia and Australia. Combining the study results allowed the
researchers to identify even weak associations that would have been missed in any one
study.
Together, the teams identified 87 regions of the genome for further study. They then
analyzed these regions in an additional 34 studies of bone mineral density with a total of
nearly 51,000 participants. This validation step narrowed the field to 56 associated
regions — 32 of which had not been previously associated.
Finally, the teams checked to see if there was an association between those variants that
affect bone mineral density and the actual prevalence of fractures. To do so, they
compared the sequences, or spelling, of those regions among 31,000 people who had
experienced fractures of the spine or femur, with that of more than 100,000 people who
had not had a fracture. They found six variants that were significantly associated with
fracture risk.
People with the highest number of variants associated with decreased bone mineral
density were about 1.56 times more likely than people with an average number of
variants to have osteoporosis, and those with the most of those variants associated with
fracture risk were about 1.60 times more likely to have experienced fractures. Compared
with those who had the fewest associated variants, they were about four times more likely
to have either osteoporosis or a fracture.
When the researchers looked more closely at the regions identified by their analyses, they
found many genes that had been previously implicated in bone formation and bone
health: members of the Wnt signaling pathway that is important in many types of
development, several involved in a pathway important to the differentiation of
mesenchymal cells that become bone, and others involved in endochondrial ossification
during the formation of the mammalian skeleton.
"We saw many of these regions and genes clustering within specific types of pathways,
which suggests certain disease mechanisms," said Ioannidis. "It certainly wouldn't be
unexpected to eventually identify many more genetic regions involved in the regulation
of osteoporosis and fracture risk."
Electrical Device
Electrical Device Fitted to Muamba’s Heart to Prevent Another Heart Attack (Med
India: 16.4.2012)
Bolton Wanderers' midfielder Fabrice Muamba, who suffered a heart attack on the
football pitch last month, will be wearing a Implantable Cardioverter Defibri (ICD) in
order to prevent a similar incident from occurring in the future.
The ICD releases an electric charge if it detects a heart malfunction, and the device will
not impair his ability to play football again, as several European players are known to
wear ICDs on the pitch.
Muamba had suffered a cardiac arrest during Bolton's FA Cup clash against Tottenham
Hotspurs, and his heart had stopped beating for 78 minutes but since then he but had
recovered astonishingly in the hospital.
In June 2009, Belgium Under-21 international Anthony Van Loo suffered a heart attack
on the field before the device kicked in and saved his life, The Sun reports.
An ex-South Africa international Khalilou Fadiga became the first professional footballer
to wear an ICD after he collapsed before a game in October 2004, and in an amazing
coincidence, he was also due to play for Bolton against Tottenham, the same fixture in
which Muamba fell ill nearly a month ago.
Fadiga said Muamba would need to be psychologically and physically right to return to
football.
"It will be very tough, but hopefully he will show everyone what he can do", the paper
quoted him, as saying.
Muamba is expected to take another step on Friday in his remarkable recovery by leaving
the hospital where he has been treated since he collapsed.
He will be moved 200 miles from the London Chest Hospital for ongoing treatment at the
Alexandra Hospital in Cheadle, Greater Manchester, and much closer to his family home.
Biomarkers
Biomarkers May Predict Chemo-Resistant Breast Cancers (Medical
Researchers at the University of Hull in the UK have identified a family of proteins that
could potentially be used as biomarkers to predict resistance to chemotherapy in estrogen
receptor-positive (ER-positive) breast cancer patients.
In an "in press" issue of their study published online in the Journal of Proteomics on 3
April, lead researcher Dr Lynn Cawkwell and colleagues explain how they discovered a
number of potential biomarkers for resistance to epirubicin, docetaxel and other chemo
drugs.
Resistance to chemotherapy is a big problem in the treatment of some types of cancer.
Without a means to predict whether chemo will work, some patients with resistant
cancers undergo much hardship: suffering the side effects of ineffective chemo options
without the benefits, plus they lose valuable time until an effective therapy is found.
So a major goal in cancer research is to predict how particular cancers might respond, and
one way to do this is to test for particular proteins or biomarkers.
"Unfortunately, a reliable test has not yet been developed to achieve this [for ER-positive
breast cancer]. We hope our work can help to bring us a step closer," Cawkwell told the
press.
Some scientists working in this field use cell lines to try and track down biomarkers, but
Cawkwell's team used clinical breast tumour tissue samples taken from patients, which
she says helped them gain a "more accurate representation of what is relevant in real-life
diseases".
For their study, Cawkwell and colleagues also used two "high-throughput processes", one
based on antibodies and the other using mass spectrometry, to identify candidate
biomarker proteins.
Using these to conduct "comparative proteomic experiments", they identified 132 unique
proteins that were significantly differently expressed (more than two-fold) in chemoresistant samples, 57 of which were identified in at least two experiments, they write.
Five of the proteins in the 57 candidates belong to the 14-3-3 protein family (namely the
"isoforms" theta/tau, gamma, epsilon, beta/alpha and zeta/delta), and have previously
been associated with chemotherapy resistance in breast cancer.
The team says their findings confirm the 14-3-3 protein family as a strong candidate for a
predictive test for chemo-resistance.
The team is now working on showing how these proteins might be used as biomarkers to
predict chemo-resistant ER-positive breast cancers. Cawkwell said:
"If we're correct, we hope that by testing for these proteins, doctors will be able to
anticipate a patient's response to different chemotherapies, and decide which course of
treatment is most appropriate for them."
The team is also investigating radiotherapy resistance in a number of different cancers.
Engineered Cells
Engineered Cells Suppress HIV in Living Tissue Medical News Today:
16.4.2012)
For the first time, US scientists have shown that HIV-fighting cells engineered from
human stem cells can suppress the virus in living human tissue in mice.
The team, from UCLA in Los Angeles, California, had already shown in principle that it
was possible to create cells that seek out and destroy HIV, but this is the first time they
have shown this can be done in a living organism.
Writing in the 12 April issue of the online open access journal PLoS Pathogens, the
researchers suggest their findings show it may be possible to use human stem cells to
create tailored cells that target and eradicate viruses like HIV, and thereby "engineer the
human immune response to combat viral infections".
However, there is still a lot of work to do before what happens in mice can be replicated
in humans.
The lead investigator on the study was Scott G. Kitchen, assistant professor of medicine
in the division of hematology and oncology at the David Geffen School of Medicine at
UCLA. Kitchen is also a member of the UCLA AIDS Institute.
There is a desperate need for new approaches to eradicate HIV, a virus that actively
subverts the powerful response that the immune system mounts against it.
One particular way the virus subverts the host immune system is by foiling cellular
cytotoxic T lymphocyte (CTL) responses. CTLs, or "killer" T cells, are a type of white
blood cell that triggers death of cells infected with viruses and other pathogens. To do
this, they have to carry a particular molecule, a receptor, that helps them find and
eliminate the target pathogen.
One goal that researchers like Kitchen and his team are pursuing, is to find a way to
contain HIV, then restore and boost the CTL response sufficiently to eradicate the virus
in the body.
In a previous piece of work, they took CTLs from an HIV-infected person and identified
they had an HIV-targeting T-cell receptor.
But while they showed the CTLs carrying the HIV-targeting T-cell receptor were able to
eliminate HIV-infected cells, the numbers were not sufficient to be able to clear HIV
from the body.
So, to overcome this, the researchers embarked on this current study, where they cloned
the HIV-targeting T-cell receptor and used it to genetically engineer human bloodforming stem cells (hematopoietic stem cells, HSCs) destined to mature into working
CTLs that kill HIV-infected cells.
Then they put the genetically engineered stem stells into human thymus tissue that had
been implanted into lab mice.
The researchers saw that the stem cells matured into a large population of multifunctional HIV-specific T-cells capabale of targeting cells containing HIV proteins.
To check the T-cells were actually behaving in the way intended, they ran a series of tests
on the mice's peripheral blood, plasma and organs. The tests were done two and six
weeks after implanting the engineered cells.
They found that levels of CD4 "helper" T cells went up, and levels of HIV in the blood,
went down. Normally, following an HIV infection, there is a drop in CD4, a group of
white blood cells that also help fight off infections.
The researchers conclude this showed the engineered cells were capable of growing and
migrating to the organs and fighting off HIV there.
Kitchen told the media:
"We believe that this study lays the groundwork for the potential use of this type of an
approach in combating HIV infection in infected individuals, in hopes of eradicating the
virus from the body."
However, he and his team point to an important limitation of their study: human immune
cells reconstituted at a lower level in humanized mice than in humans, allowing the
mice's immune systems to be almost completed restored.
Because of this, it could be that HIV mutates more slowly in mice than in humans. So
perhaps when this type of approach is tested in humans, several T cell receptors should be
used, to mount a stronger attack on what might be a higher pace of HIV mutation in
humans.
Kitchen said they see their work as a "first step in developing a more aggressive approach
in correcting the defects in the human T-cell responses that allow HIV to persist in
infected people".
The team is already working on making T-cell receptors that target different parts of the
HIV that could be used in more genetically matched individuals.
(In this study, Kitchen and colleagues also found that HIV-specific T-cell receptors have
to be matched to an individual; rather like organs are matched to transplant recipients).
Funds from the National Institutes of Health, the California HIV/AIDS Research
Program, the California Institute for Regenerative Medicine, the UC Multicampus
Research Program and Initiatives from the California Center for Antiviral Drug
Discovery, and the UCLA Center for AIDS Research (CFAR) helped pay for the study.
Human Brain
Human Brain Understood In Simple Statistical Model (Medical News
Today: 17.4.2012)
By modeling the trade-off between two competing ways of making useful connections, a
team of UK and US scientists has created a remarkably complete statistical picture of the
human brain's complex network. They suggest the simple mathematical model not only
helps us better understand healthy brains, but also offers unique insights into
schizophrenia and similar disorders.
The scientists report their work in a recently published issue of the Proceedings of the
National Academy of Sciences (PNAS), and comment on it in a press statement released
on 12 April.
The lead author of the study is Ed Bullmore, a professor in the Department of Psychiatry,
Behavioural and Clinical Neuroscience Institute, at the University of Cambridge in the
UK.
In the way it makes connections, the "wiring" of the human brain appears similar to other
complex networks such as social networks and the world wide web.
However, until this study, we knew little about the rules involved in the shaping of the
human brain network, as the authors explain in their background information:
"Although a sophisticated set of measures is available to describe the topology of brain
networks, the selection pressures that drive their formation remain largely unknown."
Bullmore and colleagues found they could produce a good model from two competing
pressures: a "distance penalty" for maintaining long-range connections, and a preference
to link regions (including those quite far apart), that share similar input. At first they just
had the first one, but then when they introduced the second one, the model greatly
improved, as Bullmore himself explains:
"There is a huge amount of evidence that the wiring of brain networks tends to minimize
connection costs. Less costly, short-distance connections are much more numerous than
more costly, long-distance connections. So our model realistically includes a distance
penalty on long-distance connections, which will tend to keep connection costs low."
"However", he adds, "we found that cost control alone was not enough to reproduce a
wide range of network properties. To do that, we had to model an economical trade-off
between cost control and another term which favoured new, direct connections between
regions that shared similar input or were otherwise already indirectly linked."
The team writes that, together, these two "biologically plausible factors" were enough to
represent an "impressive range of topological properties of functional brain networks".
They calibrated the model using functional magnetic resonance imaging (fMRI) data
from one set of healthy volunteers, and then showed it provided a good fit to networks
estimated in a second independent data set.
Furthermore, by slightly "detuning" the model so it favored more connections between
distant brain regions, they found it "generated a reasonable simulation of the abnormal
properties of brain functional networks in people with schizophrenia".
Co-author Dr Petra E Vértes, also of the University of Cambridge, says:
"This result echoes some prior neuroimaging results which suggest that brain networks in
schizophrenia may be associated with an abnormal trade-off between connection costs
and other topological properties of brain networks."
The authors suggest simple models like this, based on trade-off rules about connectivity
between different brain areas, may help explain many aspects of brain network
organization, both in health and disease.
Neural Stem Cell
Neural Stem Cell Regulator Identified: Lack of Regulator Can Cause
Neural Tube Defects (Science daily: 17.4.2012)
Researchers at the University of Colorado School of Medicine have found that lack of a
specific gene interrupts neural tube closure, a condition that can cause death or paralysis.
"The neural tube is the beginning of the brain and spinal cord," said the study's lead
investigator Lee Niswander, Ph.D., professor of pediatrics at the CU School of Medicine.
"A defect in the mLin41 gene doesn't allow the tube to close because not enough neural
progenitor cells are being made."
The study was the cover story this week in the journal Genes & Development.
Niswander and the paper's first author, Jianfu Chen, Ph.D., made their findings while
studying neural stem cells in mice. They said the cells use distinct self-renewal programs
to meet the demand of tissue growth and repair during different stages of embryonic
development. The molecular mechanisms that control these programs remain largely
unknown.
The researchers discovered that the gene mLin41 in mice controls the extent of neural
stem cell proliferation during the process of neural closure but not at the later stage of
brain development.
According to Chen, mLin41 works with small RNAs and RNA regulators that have never
been investigated before in connection with neural tube formation.
Niswander, who is also an investigator with the Howard Hughes Medical Institute based
in Washington, D.C., said the findings shed new light on neural tube development.
"Our work opens up a whole other pathway toward understanding neural tube defects.
Stem cells
Pelvic bone stem cells could help preserve heart function (The Tribune:
18.4.2012)
Washington: Scientists, including an Indian-origin, have revealed that stem cells from the
pelvic bone may help the heart beat stronger. Doctors and other clinicians at the Orlando
Health Heart Institute are researching the use of stem cells from pelvic bone marrow to
restore tissue and improve heart function after muscle damage from heart attacks.
“The thought is the body may use itself to heal itself,” Vijaykumar S. Kasi, principal
investigator of the study, said. “Because stem cells are immature cells they have the
potential to develop into new blood vessels and preserve cardiac muscle cells. By
infusing certain stem cells into the area of the heart muscle that has been damaged from a
heart attack, tissue can be preserved and heart function restored,” Kasi said. — ANI
Human Brain
Human Brain Understood In Simple Statistical Model (Medical News
Today: 18.4.2012)
By modeling the trade-off between two competing ways of making useful connections, a
team of UK and US scientists has created a remarkably complete statistical picture of the
human brain's complex network. They suggest the simple mathematical model not only
helps us better understand healthy brains, but also offers unique insights into
schizophrenia and similar disorders.
The scientists report their work in a recently published issue of the Proceedings of the
National Academy of Sciences (PNAS), and comment on it in a press statement released
on 12 April.
The lead author of the study is Ed Bullmore, a professor in the Department of Psychiatry,
Behavioural and Clinical Neuroscience Institute, at the University of Cambridge in the
UK.
In the way it makes connections, the "wiring" of the human brain appears similar to other
complex networks such as social networks and the world wide web.
However, until this study, we knew little about the rules involved in the shaping of the
human brain network, as the authors explain in their background information:
"Although a sophisticated set of measures is available to describe the topology of brain
networks, the selection pressures that drive their formation remain largely unknown."
Bullmore and colleagues found they could produce a good model from two competing
pressures: a "distance penalty" for maintaining long-range connections, and a preference
to link regions (including those quite far apart), that share similar input. At first they just
had the first one, but then when they introduced the second one, the model greatly
improved, as Bullmore himself explains:
"There is a huge amount of evidence that the wiring of brain networks tends to minimize
connection costs. Less costly, short-distance connections are much more numerous than
more costly, long-distance connections. So our model realistically includes a distance
penalty on long-distance connections, which will tend to keep connection costs low."
"However", he adds, "we found that cost control alone was not enough to reproduce a
wide range of network properties. To do that, we had to model an economical trade-off
between cost control and another term which favoured new, direct connections between
regions that shared similar input or were otherwise already indirectly linked."
The team writes that, together, these two "biologically plausible factors" were enough to
represent an "impressive range of topological properties of functional brain networks".
They calibrated the model using functional magnetic resonance imaging (fMRI) data
from one set of healthy volunteers, and then showed it provided a good fit to networks
estimated in a second independent data set.
Furthermore, by slightly "detuning" the model so it favored more connections between
distant brain regions, they found it "generated a reasonable simulation of the abnormal
properties of brain functional networks in people with schizophrenia".
Co-author Dr Petra E Vértes, also of the University of Cambridge, says:
"This result echoes some prior neuroimaging results which suggest that brain networks in
schizophrenia may be associated with an abnormal trade-off between connection costs
and other topological properties of brain networks."
The authors suggest simple models like this, based on trade-off rules about connectivity
between different brain areas, may help explain many aspects of brain network
organization, both in health and disease.
Bariatric Surgery
Bariatric Surgery can reduce Risk of Diabetes among Obese Individuals
(Med India: 18.4.2012)
A new study published in the Archives of Surgery suggests that undergoing weight loss
surgery can help reduce the risk of type II diabetes among obese people.
Obesity has been linked as one of the major reasons for the rapid rise in the number of
type II diabetes cases with experts predicting that a third of the population in United
States are expected to suffer from the disease by 2050.
Undergoing weight loss surgeries may help reduce the number of diabetes cases after
researchers in Italy found that patients who opted for such surgeries displayed remission
of the condition in more than 80 percent of cases.
“In our opinion, 80 percent diabetes resolution is a dramatically excellent result,
compared with results of a medical approach in which there's not diabetes resolution”,
lead researcher Dr Nicola Basso said.
Gene
Gene clue to osteoporosis found (The Times of India: 18.4.2012)
Scientists claim to have identified 32 genetic regions linked to osteoporosis and fracture.
An international team says that variations in the DNA sequences in these regions confer
either risk or protection from the bone-weakening disease. Many of the regions encode
proteins involved in pathways known to involve bone health.
NEW ADDITION: : One of the two new frog species that have been discovered in a
degraded forest in the central Philippine island of Leyte
Cells
Repairing damaged hearts by healing affected cells(The Hindu:
19.4.2012)
Reprogramming helped to reduce the scar tissue size and improve heart functioning in
mice
Scientists have found an easier way of repairing hearts damaged by cardiac arrest —
reprogramming one kind of heart cells into another. A paper published today (April 19)
in Nature details how the remarkable feat of reprogramming cardiac fibroblasts into adult
cardiac muscle-like cells (cardiomyocyte) produced promising results.
A few years ago, researchers introduced stem cells directly into the heart and saw some
improvement in heart functioning. With further progress, scientists were able to
reprogram adult heart cells into pluripotent cells in the lab and inject them into the heart.
A step further
Deepak Srivastava of the University of California and his team went a step further and
reprogrammed cardiac fibroblasts into adult cardiac muscle-like cells in the lab.
But in the work reported today, Dr. Srivastava and his team were able to change
(reprogram) the cardiac fibroblasts into adult cardiac muscle-like cells inside the body of
mice.
This was accomplished by injecting three transcription factors directly into the heart.
Behold, the cardiac fibroblasts, which make up nearly 50 per cent of the heart cells,
reprogrammed into heart muscle-like cells.
Significant changes were seen three months after the researchers induced heart damage in
the mice and the transcription factors were introduced.
Significantly improved
“The fraction of blood ejected with each ventricular contraction (ejection fraction), the
volume of blood ejected (stroke volume), and the total cardiac output per minute were
significantly improved” in the mice, they write. The most significant being the “stroke
volume and cardiac output,” they note.
It is not difficult to find out why the mice with damaged hearts showed an improvement
in cardiac functions — ejection fraction and stroke volume.
Shrinking scar area
The researchers found the scar area (damaged heart cells) shrinking in size eight weeks
after the transcription factors were directly introduced into the hearts of the mice.
Shrinkage of the scar tissue is proof that the damaged heart muscle cells were healing.
It was once thought that heart muscle cells once damaged after a heart attack (due to lack
of oxygen) turn into scar tissue, and can never be healed. Scar tissue reduces the heart's
pumping ability.
They also found a “significant increase” in vascular density in the “border zone of
reprogrammed hearts at eight weeks.”
One more important observation was that the initial reprogramming efficiency was the
same as that obtained in the lab. Also, the cardiac fibroblasts were “more fully
reprogrammed” into heart muscle cells and “more closely resembled endogenous
cardiomyocyte [heart muscle cells] than their cultured counterparts,” they write.
“The ability to regenerate adult heart tissue from endogenous cells is a promising
approach to treating cardiac disease that may face fewer obstacles to clinical translation
than other approaches,” they write. “Conducting trials in large animals will be important
to refine the technology and assess its safety and efficacy.” The next logical step is to
achieve the same level of success in large animals.
Keywords: heart functioning, cardiac arrest, cardiac fibroblasts, cardiomyocyte, stem
cells, damaged heart, heart tissue, endogenous cells, damaged heart cells,
Brain scans
Brain scans can predict weight gain (The Asian Age: 19.4.2012)
Scans of a brain region linked to both pleasure and addiction could help predict whether a
person will gain weight or have sex in the next six months, a new research has suggested.
Researchers at the Dartmouth University in the US found that young women whose
nucleus accumbens, an area buried deep in the brain, reacts strongly to pictures of
appealing food are more likely to gain weight in the next six months.
Likewise, when the region responds strongly to sexual imagery, women are more likely
to be sexually active within the next six months, the researchers said.
“This study is nice in a sense in that it’s one of the first ones to actually tie your brain
responses to more long-term measures of behaviour,” study researcher Bill Kelley, a
psychologist at Dartm-outh, told LiveScience. In the long run, Kelley added, the brain’s
reward system is likely to be only a piece of the puzzle. How good a person is at
overriding that system through willpower will matter too, he said.
Certain health conditions, including bulimia and obesity, have already been linked to
high nucleus accumbens activity in response to food-related cues. In the study, published
in the Journal of Neuroscience, Kelley and his colleagues wanted to find out if there was
any predictive power to such linkages. So they recruited 58 female college students and
calculated their body mass index (BMI).
Next, their brains were scanned using functional magnetic resonance imaging while the
young women viewed a series of pictures of delicious-looking food, environmental
scenes, people and some erotic images. The scanning measured blood flow to their brain
regions, offering a real-time picture of changing energy use in the brain at any given
moment.
New Blood Marker
New Blood Marker May Detect COPD Earlier (Medical News Today:
19.4.2012)
New research from Austria suggests that a protein called HSP27 has the potential to be a
new blood biomarker for the earlier detection of chronic obstructive pulmonary disease
(COPD), thereby increasing the chance of earlier treatment and better outcomes.
Study leader Hendrik Jan Ankersmit and colleagues, from the University Department of
Surgery at MedUni Vienna and the Christian Doppler Laboratory for the Diagnosis and
Regeneration of Heart and Thorax Diseases, write about their findings in Respiration, the
international journal of thoracic medicine. An early edition of their study appeared online
in March.
Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term for chronic lung
diseases that limit the flow of air in the lungs. Doctors no longer use the more familiar
terms 'chronic bronchitis' and 'emphysema', which are now included within a COPD
diagnosis.
About 90% of COPD cases result from smoking.
Although the most common symptoms of COPD are breathlessness, excessive sputum,
and a chronic cough, it is not simply a "smoker's cough", but an under-diagnosed, lifethreatening lung disease that can slowly kill.
According to the World Health Organization (WHO), COPD is expected to be the third
leading cause of death worldwide by 2030. Latest estimates for 2004 show about 3
million people worldwide died from the disease that year, and 64 million are affected.
Early detection is the key to successful treatment of COPD. As the disease progresses, it
causes lung damage, such as air trapping (air that cannot be exhaled due to overinflation
of the alveoli) and pulmonary emphysema (holes in the lung filled with air that reduce the
lung surface area).
People can feel healthy in the early stages of COPD, and because current lung function
tests only detect changes in lung volume, which occur in later stages of the disease,
patients and doctors may assume there is no cause for concern.
Now Ankersmit and colleagues suggest high levels of HSP27 in the bloodstream can
indicate lung damage in the early stages of COPD, before a lung function test detects the
reduction in lung volume.
For their study, they recruited 94 apparently healthy male and female smokers of average
age 43, who volunteered to undergo high-resolutions CT scans, lung function tests, and
give blood samples.
The scan results showed that 57.5% of them showed signs of air trapping or air trapping
with emphysema, even though their lung function test results appeared normal.
From the blood samples, using a special kit called ELISA kit from R&D Systems, the
researchers established that levels of HSP27 showed a significant correlation with the
lung damage detected in the CT scans.
Ankersmit told the press:
"If there is increased prevalence of the marker HSP27 and risk behaviour, such as
smoking, is evident, then this may signify lung damage and, potentially, the early onset of
chronic obstructive pulmonary disease."
Although the majority of cases are due to smoking, certain jobs can also increase risk for
COPD. Examples include welding, furnace stoking and jobs that expose workers to
smoke and chemical vapours.
Ankersmit hopes one day to see GPs and lung specialists using HSP27 as a screening
marker for lung disease.
Estrogen hormone
Estrogen hormone 'may have protective ability after traumatic brain
injury'(New Kerala: 24.4.2012)
In a new study, scientists have investigated the biomarkers and novel therapies for
traumatic brain injury.
With more than 1.7 million people sustaining a traumatic brain injury each year, the need
to identify processes to limit inflammation and subsequent damage is critical.
Approximately 275,000 people are hospitalised annually with traumatic brain injury,
leaving 85,000 with long-term disabilities and taking the lives of more than 50,000.
More than 5 million people live with disabilities caused by traumatic brain injuries, often
the result of car accidents and falls. Direct and indirect costs exceed 75 billion dollars.
In his previous work, Joshua Gatson from the University of Texas Southwestern Medical
Center in Dallas, has shown that estrone, one of the three naturally occurring estrogen
hormones in the body, has shown some promise in reducing inflammation and cell death
in the brain.
His latest study is the first to demonstrate estrone provides those anti-inflammatory and
antioxidant capabilities after traumatic brain injury. It is likewise the first to reveal the
cellular pathways that are involved.
The study, conducted on male rats, compared 0.5 mg of estrone to a placebo, both given
30 minutes after the injury.
It demonstrated that estrone is involved in promoting brain-derived neurotrophic factor
(BDNF), which promotes cell survival. "BDNF, one of the main growth factors that
regulates repair following injury, is actually increased following treatment with estrone
after brain injury," said Gatson, who administered the injections within 30 minutes of the
injury.
"So if you give this drug shortly after injury, it is thought to increase repair mechanisms,"
Gatson said.
The study has been presented during Experimental Biology 2012 in San Diego, CA.
(ANI)
Just 15 mins of exercise a day can help smokers kick the butt
Genes
Genes that increase risk of osteoporosis and fractures discovered (New
Kerala: 25.4.2012)
Researchers have identified the genetic variations that are believed to cause osteoporosis.
They found that women with a higher proportion of genetic variations associated with
osteoporosis have a more than 50 percent increased fracture risk.
Osteoporosis is a common and a devastating age-related disease. About 50 percent of all
who have a hip fracture after age 80 die within one year from the time of injury.
The consequences of osteoporosis are therefore well-known, but the causes of the disease
are largely unknown.
In a groundbreaking international study, which is led partially from the Sahlgrenska
Academy at the University of Gothenburg, Sweden, researchers have now succeeded in
identifying a total of 56 genetic regions that control bone density in human beings.
Fourteen of these genetic variants increase the risk of fractures, the study has found.
"This is the first time anyone has identified the genetic variants that are so strongly
associated with an increased risk of fracture," said Claes Ohlsson, a professor at the
Sahlgrenska Academy.
An international consortium, which also involves researchers from Umea University,
Uppsala University and Malmpo University, is behind the study.
In total, the researchers studied the genetic make-up of a total of 80,000 people and
30,000 fracture cases, making it the world's largest genetic study in this particular area of
research.
"We can prove that women who have a large number of genetic variants associated with
low bone density have up to a 56 percent higher risk of osteoporosis as compared with
women who have a normal set-ups of the same genetic variants," Ohlsson added.
The results have led to several new findings in bone biology, among other things the
researchers identified several important molecular signaling pathways for bone density
that can be targets for new treatment methods and therapies.
"In addition to already known proteins and pathways that were confirmed by the study,
we are now facing a whole new biology in the field of bone research," stated Ulrika
Pettersson, Associate Professor in the Department of Pharmacology and Clinical
Neuroscience, Umea University, and co-author of the study.
The finding has been published in the world-leading journal Nature Genetics. (ANI)
Therapy
Combination Therapy Best Way to Control Diabetes in Children(Med
India:1.4.2012)
Researchers at University of Colorado have revealed that using a combination of two
drugs instead of just one could be an effective way of keeping the blood sugar levels
within normal range in children.
The researchers said that combining metformin with Avandia, or rosiglitazone, could be
more effective in reducing blood sugar levels compared to using metformin alone.
However researchers added that they do not recommend using Avandia as it has been
linked to increased risk of heart attacks.
Around 700 obese children aged between 10 and 17 years took part in the study. All of
the participants had type 2 diabetes and the researchers divided them into three groups,
with each group receiving either metformin alone, metformin plus Avandia or metformin
along with intensive lifestyle changes.
The researchers found that just 38.6 percent of those who had taken both metformin and
Avandia struggled to keep their blood sugar levels under control compared to 51.7
percent of those who had taken just metformin and 46.6 percent of those who had made
lifestyle changes along with taking metformin.
T Cell Therapy
Genetically Modified T Cell Therapy Appears to Be Safe, Lasting in
Decade-Long Study of HIV Patients(Science Daily:3.5.2012)
HIV patients treated with genetically modified T cells remain healthy up to 11 years after
initial therapy, researchers from the Perelman School of Medicine at the University of
Pennsylvania report in the new issue of Science Translational Medicine. The results
provide a framework for the use of this type of gene therapy as a powerful weapon in the
treatment of HIV, cancer, and a wide variety of other diseases.
"We have 43 patients and they are all healthy," says senior author Carl June, MD, a
professor of Pathology and Laboratory Medicine at Penn Medicine. "And out of those, 41
patients show long term persistence of the modified T cells in their bodies."
Early gene therapy studies raised concern that gene transfer to cells via retroviruses might
lead to leukemia in a substantial proportion of patients, due to mutations that may arise in
genes when new DNA is inserted. The new long-term data, however, allay that concern
in T cells, further buoying the hope generated by work June's team published in 2011
showing the eradication of tumors in patients with chronic lymphocytic leukemia using a
similar strategy.
"If you have a safe way to modify cells in patients with HIV, you can potentially develop
curative approaches," June says. "Patients now have to take medicine for their whole
lives to keep their virus under control, but there are a number of gene therapy approaches
that might be curative." A lifetime of anti-HIV drug therapy, by contrast, is expensive
and can be accompanied by significant side effects.
They also note that the approach the Penn Medicine team studied may allow patients with
cancers and other diseases to avoid the complications and mortality risks associated with
more conventional treatments, since patients treated with the modified T cells did not
require drugs to weaken their own immune systems in order for the modified cells to
proliferate in their bodies after infusion, as is customary for cancer patients who receive
stem cell transplants.
To demonstrate the long-term safety of genetically modified T cells, June and colleagues
have followed HIV-positive patients who enrolled in three trials between 1998 and 2002.
Each patient received one or more infusions of their own T cells that had been genetically
modified in the laboratory using a retroviral vector. The vector encoded a chimeric
antigen receptor that recognizes the HIV envelope protein and directs the modified T cell
to kill any HIV-infected cells it encounters.
As is standard for any trial, the researchers carefully monitored patients for any serious
adverse events immediately after infusion -- none of which were seen. Additionally,
because of the earlier concerns about long-term side effects, the U.S. Food and Drug
Administration also asked the team to follow the patients for up to 15 years to ensure that
the modified T cells were not causing blood cancers or other late effects. Therefore, each
patient underwent an exam and provided blood samples during each of the subsequent
years.
Now, with more than 500 years of combined patient safety data, June and colleagues are
confident that the retroviral vector system is safe for modifying T cells. By contrast, June
notes, the earlier, worrying side effects were seen when viral vectors were used to modify
blood stem cells. The new results show that the target cell for gene modification plays an
important role in long-term safety for patients treated. "T cells appear to be a safe haven
for gene modification," June says.
The multi-year blood samples also show that the gene-modified T cell population persists
in the patients' blood for more than a decade. In fact, models suggest that more than half
of the T cells or their progeny are still alive 16 years after infusion, which means one
treatment might be able to kill off HIV-infected cells for decades. The prolonged safety
data means that it might be possible to test T cell-based gene therapy for the treatment of
non-life threatening diseases, like arthritis.
"Until now, we've focused on cancer and HIV-infection, but these data provide a
rationale for starting to focus on other disease types," June says. "What we have
demonstrated in this study and recent studies is that gene transfer to T cells can endow
these cells with enhanced and novel functions. We view this as a personalized medicine
platform to target disease using a patient's own cells."
Co-first authors on the paper are John Scholler and Troy L. Brady from Penn. Co-authors
include Wei-Ting Hwang, Gabriela Plesa, Michael Kalos, James L. Riley, Bruce L.
Levine, and Frederic D. Bushman, also from Penn. Additional co-authors include
Gwendolyn Binder-Scholl at Adaptimmune LLC., Ashley N. Vogel, now enrolled at
Lake Erie College of Osteopathic Medicine, Kristen M. Hege from Celgene Corporation
in San Francisco, Steven G. Deeks from University of California, San Francisco, Ronald
T. Mitsuyasu from University of California, Los Angeles, and Wendy B. Bernstein and
Naomi E. Aronson from Walter Reed National Military Medical Center in Bethesda.
The project was supported by a grant from the National Institutes of Health
(1U19AI082628), the University of Pennsylvania Center for AIDS Research, and the
Infectious Diseases Clinical Research Program, a Department of Defense program funded
in part with federal funds from the National Institute of Allergy and Infectious Diseases
under InterAgency Agreement Y1-AI-5072.
Native Gene
Naturally Blond Hair in Solomon Islanders Rooted in Native
Gene(Science Daily:4.5.2012)
The common occurrence of blond hair among the dark-skinned indigenous people of the
Solomon Islands is due to a homegrown genetic variant distinct from the gene that leads
to blond hair in Europeans, according to a new study from the Stanford University School
of Medicine.
"This is one of the most beautiful examples to date of the mapping of a simple genetic
trait in humans," said David Reich, PhD, a professor of genetics at Harvard University,
who was not involved in the study.
The study identifying the gene responsible for blond hair in the Solomon Islands, a nation
in the South Pacific, represents a rare case of simple genetics determining human
appearance, and shows the importance of including understudied populations in gene
mapping studies, said co-senior author Carlos D. Bustamante, PhD, professor of genetics
at Stanford. The findings were published May 4 in Science.
"Since most studies in human genetics only include participants of European descent, we
may be getting a very biased view of which genes and mutations influence the traits we
investigate. Here, we sought to test whether one of the most striking human traits, blond
hair, had the same -- or different -- genetic underpinning in different human populations,"
Bustamante said.
Globally, blond hair is rare, occurring with substantial frequency only in northern Europe
and in Oceania, which includes the Solomon Islands and its neighbors. "Its frequency is
between 5 and 10 percent across the Solomon Islands, which is about the same as where
I'm from," said co-first author Eimear Kenny, PhD, who was born in Ireland.
Many assumed the blond hair of Melanesia was the result of gene flow -- a trait passed on
by European explorers, traders and others who visited in the preceding centuries. The
islanders themselves give several possible explanations for its presence, said co-senior
author Sean Myles, PhD, a former Stanford postdoctoral scholar who is now an assistant
professor at the Nova Scotia Agricultural College. They generally chalked it up to sun
exposure, or a diet rich in fish, he said.
After researchers at UCSF generated genetic data from the samples, Kenny, a
postdoctoral scholar in Bustamante's lab, began the analysis in September 2010, the week
she started at Stanford. "Within a week we had our initial result. It was such a striking
signal pointing to a single gene -- a result you could hang your hat on. That rarely
happens in science," she said. "It was one of the best experiences of my career."
In terms of genetic studies, the analysis was straightforward, said Kenny. But gathering
the data, accomplished in 2009 by Myles and co-first author Nicholas Timpson, PhD, was
more difficult. Much of the Solomon Islands is undeveloped, without roads, electricity or
telephones. It's also one of the most linguistically diverse nations in the world, with
dozens of languages spoken.
It was a return trip for Myles who had been there in 2004 as a graduate student with Max
Planck Institute molecular anthropologist Mark Stoneking, PhD, (also a co-author of the
study) to investigate whether the language variations correlated with genetic variations.
While there, Myles was fascinated by the ubiquity of blond hair, which was especially
common among children.
"They have this very dark skin and bright blond hair. It was mind-blowing," said Myles.
"As a geneticist on the beach watching the kids playing, you count up the frequency of
kids with blond hair, and say, 'Wow, it's 5 to 10 percent.'"
A grant from the Wenner-Gren Foundation for Anthropological Research gave Myles,
who at that time was doing a stint as a postdoctoral researcher at Cornell University, his
chance to study the genetics of the Solomon Islanders' hair color. Myles worked with
Bustamante, who was also at Cornell, to design the study. Then back in the islands,
Myles and Timpson went village to village explaining what they wanted to do and asking
for permission to gather data, Myles speaking in Solomon Islands pidgin, the most widely
understood language.
When the local chief gave the OK, the researchers recruited participants and assessed hair
and skin color using a light reflectance meter, took blood pressure readings and measured
heights and weights. They asked the villagers to spit into small tubes to provide saliva to
be used for DNA extraction. In the span of a month they collected more than 1,000
samples.
While the islands fit many people's notion of a tropical paradise, they lack amenities
Westerners take for granted. For instance, simply finding a level spot for the scale to
weigh study participants was a challenge.
Then in 2010 Bustamante joined Stanford's faculty and, with funding from the
Department of Genetics, the team looked for genes underlying this striking phenotype.
Soon after, Kenny joined the lab and started the analysis, selecting 43 blond- and 42
dark-haired Solomon Islanders from the opposite 10 percent extremes of the hair
pigmentation range. She used these in a genome-wide association study, a method to
reveal differences in the frequency of genetic variants between two groups, that usually
requires thousands of samples.
Because the vast majority of human physical characteristics analyzed to date have many
genetic and environmental factors, Kenny expected an inconclusive result that would
require much further study. Instead, she immediately saw a single strong signal on
chromosome 9, which accounted for 50 percent of the variance in the Solomon Islanders'
hair color.
The team went on to identify the gene responsible, TYRP1, which encodes tyrosinaserelated protein 1, an enzyme previously recognized as influencing pigmentation in mice
and humans. Further research revealed that the particular variant responsible for blond
hair in the Solomon Islands is absent in the genomes of Europeans.
"So the human characteristic of blond hair arose independently in equatorial Oceania.
That's quite unexpected and fascinating," Kenny said.
The finding underscores the importance of genetic studies on isolated populations, said
Bustamante. "If we're going to be designing the next generation of medical treatments
using genetic information and we don't have a really broad spectrum of populations
included, you could disproportionately benefit some populations and harm others."
Bustamante is seeking funding to analyze the rest of the data gathered. "For instance, the
genetics of skin pigmentation might be different there too -- not the same as in Europe or
Africa or India. We just don't know."
Additional co-authors were Stanford postdoctoral scholars Martin Sikora, PhD, and
Andres Moreno Estrada, PhD; Stanford research assistant Muh-Ching Yee, PhD; and
researchers from UCSF including professor of bioengineering & therapeutic sciences and
medicine, Esteban González Burchard, MD. Nicholas Timpson is currently a lecturer at
the University of Bristol, U.K.
In addition to the Wenner-Gren Foundation, the research was funded by the MRC Centre
for Causal Analyses in Translational Epidemiology, the National Human Genome
Research Institute, the National Heart, Lung, and Blood Institute and the Max Planck
Society.
Immune System
Immune System: How Memory B Cells Stay 'in Class' to Fight Different
Infections
Scientists at The Scripps Research Institute have made an important discovery about the
internal programming of B cells, the immune cells that make antibodies against
infections. The finding opens the way for the development of vaccines that can work
more efficiently and hints at therapies for conditions in which B cells cause harm -- such
as the autoimmune disease lupus erythymatosus, severe allergies, and B-cell lymphomas.
The discovery reveals that B cells produce special proteins to maintain themselves in a
particular functional "class," even as they lie dormant in the memory-cell state, awaiting a
new infection. The class of a B cell determines how its antibodies marshal other
components of immunity, and thus how well they can remove a certain type of threat, say
bacteria on the skin versus intestinal parasites.
"This is a real breakthrough, in the sense that we now have a much better understanding
of how B cell class is regulated, and how we might target that regulatory process in
vaccine and drug design," said Michael McHeyzer-Williams, a Scripps Research
professor who was the principal investigator for the study, published in Nature
Immunology's advance online edition on May 6, 2012.
Specialized Infection Fighters
Young, "naïve" B cells begin their careers as infection fighters when they are exposed, in
the right way, to pieces of an invading microbe that happen to match their main receptor
(the B cell receptor, or BCR). Some then become plasma B cells, and slowly ramp up the
active production of antibodies. Others instead become memory B cells, which can lie in
wait for years, primed to respond very rapidly and nip in the bud any reinfection.
Either way, as B cells move out of the naïve state, helper T cells secrete chemical signals
that typically force the B cells into particular classes. IgG-class B cells are the most
common in humans, and are broadly effective against viruses and bacteria. IgA-class B
cells are predominantly found on mucosal surfaces such as in the throat and intestines.
IgE-class cells and their antibodies protect against intestinal worms and other parasites.
Some B cells stay in the default IgM class. The class of a B cell is marked by the type of
"stem" it has on its Y-shaped antibodies; this stem, or effector, can mobilize other
elements of the immune system, such as inflammatory chemicals, when the antibody
binds to an invader.
It had been long assumed that the switching of a B cell to a particular class is the result of
a one-time signaling event. "The idea was that the signals that produce this switch don't
persist in B memory cells, for example," said Nathaniel Wang, a graduate student in the
Scripps Research Kellogg School of Science and Technology working in the McHeyzerWilliams laboratory who was first author of the new study.
Testing Assumptions
In the study, Wang, McHeyzer-Williams, and their colleagues tried to determine whether
that assumption is true. They knew, for example, that when T cells cause naïve B cells to
switch to the IgG2a class, a potent antiviral class, they do so by inducing the production
in B cells of a particular protein called T-bet. To clarify T-bet's role, the researchers
engineered transgenic mice whose B cells lack the protein.
Without T-bet, they found, the mouse B cells could not be switched to the IgG2a class,
even when presented with all the normal stimuli, and even though other IgG classes could
be produced normally -- or even in higher amounts. Even more surprisingly, in existing
IgG2a memory B cells, the abrupt knockdown of T-bet levels caused the cells to lose
their ability to respond to a new infection. In fact, most of the T-bet-deprived memory B
cells became undetectable within a few days.
"T-bet turns out to be the central molecule that enforces the IgG2a class in B cells, and if
its production stops in IgG2a memory cells, they become dysfunctional and die," Wang
said.
The finding that T-bet has this all-important, ongoing function in IgG2a memory cells
suggested that other proteins play analogous roles in other classes of memory B cell.
Wang therefore turned to memory B cells of the IgA class, and, with a similar set of
experiments, showed that these memory B cells depend on the transcription factor RORα.
"It essentially does for IgA memory cells what T-bet does for IgG2a memory cells," said
Wang.
Implications for Science and Medicine
Wang and McHeyzer-Williams and their colleagues are now searching for the proteins
that keep other memory B cells healthy and in their classes. But already the work has
clarified how memory B cells work. "Until now we haven't really had a good conceptual
framework for the development and maintenance of these cells," McHeyzer-Williams
said.
The findings clearly also have implications for medicine. By supplying a particular classenforcement protein at the same time that it exposes B cells to microbial proteins, a
vaccine could induce a long-term immunity that is heavily weighted towards a desired
antibody class. "If you're designing a vaccine for certain types of virus, for example, you
would like to have lots of IgG2a and IgA memory cells," said McHeyzer-Williams. "So
the goal would be to design a chemical adjuvant for the vaccine that drives B cells into
those classes."
Similarly, therapies that knock down class-enforcement signals such as T-bet could
usefully reduce or eliminate memory B cells in certain classes. "Some autoimmune,
allergic and lymphoma conditions are driven by B cells of a particular class, for example
IgE cells in allergies," said McHeyzer-Williams. "Being able to target just that class of B
cell would be an obvious advantage over existing therapies, such as steroids, that knock
down large parts of the immune system."
Other contributors to the paper, "Divergent Transcriptional Programming of ClassSpecific B Cell Memory by T-bet and RORα," were Louise J. McHeyzer-Williams and
Shinji L. Okitsu of the McHeyzer-Williams lab; Thomas P. Burris of the Jupiter, Florida
campus of Scripps Research, who provided crucial reagents for manipulating RORα
levels; and Steven L. Reiner of Columbia University's College of Physicians and
Surgeons, who supplied transgenic mice.
Nathaniel Wang is a CTSA TL-1 scholar in association with the Scripps Translational
Science Institute (STSI).
Professor McHeyzer-Williams's research is funded in part by the National Institutes of
Health.
Neurotranmitters
Scientists Identify Neurotranmitters That Lead to Forgetting (Science
Daily:10.5.2012)
While we often think of memory as a way of preserving the essential idea of who we are,
little thought is given to the importance of forgetting to our wellbeing, whether what we
forget belongs in the "horrible memories department" or just reflects the minutia of dayto-day living.
Despite the fact that forgetting is normal, exactly how we forget -- the molecular,
cellular, and brain circuit mechanisms underlying the process -- is poorly understood.
Now, in a study that appears in the May 10, 2012 issue of the journal Neuron, scientists
from the Florida campus of The Scripps Research Institute have pinpointed a mechanism
that is essential for forming memories in the first place and, as it turns out, is equally
essential for eliminating them after memories have formed.
"This study focuses on the molecular biology of active forgetting," said Ron Davis, chair
of the Scripps Research Department of Neuroscience who led the project. "Until now, the
basic thought has been that forgetting is mostly a passive process. Our findings make
clear that forgetting is an active process that is probably regulated."
The Two Faces of Dopamine
To better understand the mechanisms for forgetting, Davis and his colleagues studied
Drosophila or fruit flies, a key model for studying memory that has been found to be
highly applicable to humans. The flies were put in situations where they learned that
certain smells were associated with either a positive reinforcement like food or a negative
one, such as a mild electric shock. The scientists then observed changes in the flies'
brains as they remembered or forgot the new information.
The results showed that a small subset of dopamine neurons actively regulate the
acquisition of memories and the forgetting of these memories after learning, using a pair
of dopamine receptors in the brain. Dopamine is a neurotransmitter that plays an
important role in a number of processes including punishment and reward, memory,
learning and cognition.
But how can a single neurotransmitter, dopamine, have two seemingly opposite roles in
both forming and eliminating memories? And how can these two dopamine receptors
serve acquiring memory on the one hand, and forgetting on the other?
The study suggests that when a new memory is first formed, there also exists an active,
dopamine-based forgetting mechanism -- ongoing dopamine neuron activity -- that begins
to erase those memories unless some importance is attached to them, a process known as
consolidation that may shield important memories from the dopamine-driven forgetting
process.
The study shows that specific neurons in the brain release dopamine to two different
receptors known as dDA1 and DAMB, located on what are called mushroom bodies
because of their shape; these densely packed networks of neurons are vital for memory
and learning in insects. The study found the dDA1 receptor is responsible for memory
acquisition, while DAMB is required for forgetting.
When dopamine neurons begin the signaling process, the dDA1 receptor becomes
overstimulated and begins to form memories, an essential part of memory acquisition.
Once that memory is acquired, however, these same dopamine neurons continue
signaling. Except this time, the signal goes through the DAMB receptor, which triggers
forgetting of those recently acquired, but not yet consolidated, memories.
Jacob Berry, a graduate student in the Davis lab who led the experimentation, showed
that inhibiting the dopamine signaling after learning enhanced the flies' memory.
Hyperactivating those same neurons after learning erased memory. And, a mutation in
one of the receptors, dDA1, produced flies unable to learn, while a mutation in the other,
DAMB, blocked forgetting.
Intriguing Issues
While Davis was surprised by the mechanisms the study uncovered, he was not surprised
that forgetting is an active process. "Biology isn't designed to do things in a passive way,"
he said. "There are active pathways for constructing things, and active ones for degrading
things. Why should forgetting be any different?"
The study also brings into a focus a lot of intriguing issues, Davis said -- savant
syndrome, for example.
"Savants have a high capacity for memory in some specialized areas," he said. "But
maybe it isn't memory that gives them this capacity, maybe they have a bad forgetting
mechanism. This also might be a strategy for developing drugs to promote cognition and
memory -- what about drugs that inhibit forgetting as cognitive enhancers?"
The study was supported by the National Institutes of Health.
New therapy
New therapy to control BP (The Times of India: 21.5.2012)
There is a ray of hope for patients suffering from uncontrolled hypertension. Doctors
claim renal denervation therapy, a new technique which involves disruption of the
hyperactive nerves leading to the kidney, can be used for bringing down blood pressure
(BP). These nerves, which are part of the sympathetic nervous system, are disrupted
using brief radio frequency (RF) energy. The sympathetic nervous system affects the
organs that regulate BP.
Doctors at a city hospital recently conducted this procedure, which is still in trial
phase, on a 28-year-old patient who lives in Laxmi Nagar. “He was suffering from
uncontrollable hypertension for several months. His blood pressure could not be
controlled even after taking five different types of medication. We conducted the surgery
on compassionate grounds and after surgery, he is doing better,” said Dr Mohan Nair,
director, electrophysiology and arrhythmia services, who operated on the patient. They
used special equipment-—Navx 3D mapping and Dyna CT application—for accuracy.
Doctors say the therapy can be used only as a last resort. TNN
Generic
Generic Versions Of Blood Thinning Plavix Approved By FDA(Medical
Generic versions of blood-thinning medication - Plavix (clopidogrel bisulfate) - have
been approved by the FDA (Food and Drug Administration). Clopidogrel bisulfate
reduces the likelihood of blood platelets clumping together and forming clots in blood
vessels, resulting in a lower risk of stroke and heart attack.
Clopidogrel is approved by the FDA for individuals who recently had a stroke or heart
attack, as well as patients who have peripheral artery disease - partial or total blockage of
an artery.
Keith Webber, Ph.D., deputy director of the Office of Pharmaceutical Science in the
FDA's Center for Drug Evaluation and Research, said:
"For people who must manage chronic health conditions, having effective and affordable
treatment options is important. The generic products approved today will expand those
options for patients."
Clopidogrel might not be effective with some patients with genetic factors that cause the
body to metabolize the medication differently. The FDA says that clopidogrel has a
boxed warning alerting doctors about this.
Doctors can screen patients for the genetic factors that alter how clopidogrel is
metabolized in the body.
Clopidogrel's efficacy can also be affected by some medications, such as the proton pump
inhibitors esomeprazole (Nexium) and omeprazole (Prilosec). Patients on such drugs may
continue with high heart attack and stroke risk if they take clopidogrel.
Generic versions of Plavix (clopidogrel) are now on the market
Clopidogrel is associated with a risk of bleeding, which may sometimes be severe and
even deadly. Patients on this medication may bleed and bruise more easily - their
likelihood of having nosebleeds are also greater. Individuals on clopidogrel who bleed
may take longer than normal for the bleeding to stop.
Clopidogrel comes with a Patient Medication Guide, which includes key instructions on
how to use it, as well as drug safety information.
The following companies have received FDA approval for 300 mg clopidogrel:
Teva Pharmaceuticals
Mylan Pharmaceuticals
Gate Pharmaceuticals
Dr. Reddy's Laboratories
The following companies have received FDA approval for 75 mg clopidogrel:
Torrent Pharmaceuticals
Teva Pharmaceuticals
Sun Pharma
Roxane Laboratories
Mylan Pharmaceuticals
Aurobindo Pharma
Apotex Corporation
The FDA emphasizes that generic and brand-name drugs have to undergo the same
stringent requirements before they appear on pharmacy shelves. Brand-name and generic
drugs that are FDA-approved have identical strengths and levels of quality, the Agency
added.
Stem cell therapy
Americans flocking to India for stem cell therapy (New Kerala:
28.5.2012)
A growing number of Americans are travelling to India to seek treatment for rare
diseases through India's experimental embryonic stem cell therapy, according to an
investigative report.
Among them Cash Burnaman, a 6-year-old South Carolina boy, who travelled with his
parents to India seeking treatment for a rare genetic condition that has left him
developmentally disabled, CNN reported.
"Cash is mute. He walks with the aid of braces. To battle his incurable condition, which
is so rare it doesn't have a name, Cash has had to take an artificial growth hormone for
most of his life," it said.
His divorced parents, Josh Burnaman and Stephanie Krolick, have paid tens of thousands
of dollars to have Cash undergo experimental injections of human embryonic stem cells
at New Delhi's NuTech Mediworld run by Dr. Geeta Shroff, a retired obstetrician and
self-taught embryonic stem cell practitioner.
Shroff first treated Cash -- who presents symptoms similar to Down Syndrome -- in 2010.
"I am helping improve their quality of life," she told CNN.
After five weeks of treatment, Cash and his parents returned home to the US. That's when
Cash began walking with the aid of braces for the first time.
For four or five weeks of treatment, Shroff says she has charged her 87 American patients
an average of $25,000.
But doctors cited by CNN said all that work and hope and money Cash's supporters have
funnelled into his experimental therapy likely will have no medical benefits.
"There is zero evidence for what she (Shroff ) is doing being effective," Rutgers
University's Dr. Wise Young, a leading US neuroscientist, was quoted as saying.
"It's concerning no matter how you look at it," said CNN chief medical correspondent Dr.
Sanjay Gupta. "Frankly it's the complete wrong way of going about this sort of science."
A leading Indian neurosurgeon, Dr. P.N. Tandon, cited by CNN agreed there was zero
medical evidence of the effectiveness of embryonic stem cell therapy like that provided at
NuTech Mediworld
But inside her clinic, surrounded by patients, Shroff disagreed. "Success," she told CNN,
"is defined differently by various groups of people within that therapy mode. So as of
right now, almost everyone -- greater than 90 percent -- have had success." (IANS)
Immune cells
Immune cells ‘hunt’ parasites like animal predators seek prey(The
Tribune:30.5.2012)
London: T cells use a movement tactic to track down parasites that is similar to strategies
that predators like monkeys, sharks and blue-fin tuna use to hunt their prey, a new study
has revealed. With this new insight into immune-cell movement patterns, scientists of the
cross-disciplinary team at the University of Pennsylvania will be able to create more
accurate models of immune-system function, which may, in turn, inform novel
approaches to combat diseases from cancer to HIV/AIDS to arthritis. The study was
conducted in mice infected with the parasite Toxoplasma gondii.
This single-celled pathogen is a common cause of infection in animals and humans. As
much as a third of the world’s population has an inactive form of this infection present in
the brain. However, in immuno-compromised individuals such as those with HIV/AIDS
or undergoing organ transplantation, this infection can have grave consequences,
including brain inflammation and even death. — ANI
Gene
Gene that stunts infants’ growth also makes them grow too big(The
Tribune:30.5.2012)
The mutation responsible for IMAGe syndrome – a rare disorder that stunts infants’
growth – has been identified, and surprisingly it occurs on the same gene that causes
Beckwith-Wiedemann syndrome, which makes cells grow too fast, leading to very large
children. The findings by UCLA geneticists could lead to new ways of blocking the rapid
cell division that allows tumours to grow unchecked. The discovery also offers a new tool
for diagnosing children with IMAGe syndrome, which until now has been difficult to
accurately identify.
The discovery holds special significance for principal investigator Dr. Eric Vilain, a
professor of human genetics, paediatrics and urology at the David Geffen School of
Medicine at UCLA.
Nearly 20 years ago, as a medical resident in his native France, Vilain cared for two boys,
ages 3 and 6, who were dramatically short for their ages. — ANI
Immune system
Immune system glitch that ups death threat by 4 times identified (New
Kerala:5 June 2012)
Washington, June 4 : In a new study researchers including one of Indian origin, have
identified an immune system deficiency the presence of which shows that someone is up
to four times more likely to die as compared to a person without it.
The glitch involves an antibody molecule called a free light chain – people whose
immune systems produce too much of the molecule are far more likely to die of a lifethreatening illness such as cancer, diabetes and cardiac and respiratory disease than those
whose bodies make normal levels.
Researchers from Mayo Clinic studied blood samples from nearly 16,000 people 50 and
older enrolled in a population-based study of plasma cell disorders in Olmsted County,
Minn.
They found that those who had the highest level of free light chains, the top 10 percent,
were about four times more at risk of dying than those with lower levels.
Even after accounting for differences in age, gender and kidney function, the risk of death
was roughly twice as high.
The study suggests that high levels of free light chains are markers of increased immune
system response to infection, inflammation or some other serious disorders, Vincent
Rajkumar, the lead researcher, said.
Researchers have known that high levels of free light chains are associated with increased
risk of death among patients with plasma disorders, such as lymphomas and other blood
cancers, but this is the first study to find that high levels of light chains are associated
with increased mortality in the general population.
Free light chain levels can be measured by using a serum free light chain assay, a simple
blood test.
This test is often used to monitor light chain levels in patients with plasma disorders such
as myeloma to gauge how well they are responding to treatment.
However, Rajkumar cautions against administering this test with the intent of gauging
one's risk of death.
"We do not recommend this test as a screening test, because it will only cause alarm,"
Rajkumar said.
"We do not know why this marker is associated with higher rates of death. We do not
have a way of turning things around. Therefore, I would urge caution in using this test
until we figure out what to do about it and what these results mean," he said.
Plasma cells are white blood cells that produce large amounts of antibodies and are the
key to fighting off infection.
The antibodies are comprised of two different types of molecules tightly joined to each
other – heavy chains and light chains. Most people produce at least a slightly excess
amount of light chains that can be detected in the blood in the "free" state, unbound to
heavy chains.
Free light chains are not usually a threat to health, but excess levels serve as a marker of
underlying immune system stimulation, kidney failure or plasma cell disorders such as
myeloma.
The study has been published in the June issue of Mayo Clinic Proceedings. (ANI)
Stem Cells
Stem cells identified as 'real culprit behind vascular diseases'(New
Kerala: 8.6.2012)
Using genetic tracing, researchers from the University of California, Berkeley, have hunt
down the real culprit of vascular diseases.
The guilty party is not the smooth muscle cells within blood vessel walls, which for
decades was thought to combine with cholesterol and fat that can clog arteries.
Blocked vessels can eventually lead to heart attacks and strokes.
Instead, a previously unknown type of stem cell ' a multipotent vascular stem cell ' is to
blame, and it should now be the focus in the search for new treatments, the scientists said.
'For the first time, we are showing evidence that vascular diseases are actually a kind of
stem cell disease,' said principal investigator Song Li, professor of bioengineering and a
researcher at the Berkeley Stem Cell Center.
'This work should revolutionize therapies for vascular diseases because we now know
that stem cells rather than smooth muscle cells are the correct therapeutic target,' he
added.
The finding that a stem cell population contributes to artery-hardening diseases, such as
atherosclerosis, provides a promising new direction for future research, the researchers
said.
'This is groundbreaking and provocative work, as it challenges existing dogma. Targeting
the vascular stem cells rather than the existing smooth muscle in the vessel wall might be
much more effective in treating vascular disease,' said Dr. Deepak Srivastava, director of
the Gladstone Institute of Cardiovascular Disease at UC San Francisco, who provided
some of the mouse vascular tissues used by the researchers.
It is generally accepted that the buildup of artery-blocking plaque stems from the body's
immune response to vessel damage caused by low-density lipoproteins, the bad
cholesterol many people try to eliminate from their diets. Such damage attracts legions of
white blood cells and can spur the formation of fibrous scar tissue that accumulates
within the vessel, narrowing the blood flow.
The scar tissue, known as neointima, has certain characteristics of smooth muscle, the
dominant type of tissue in the blood vessel wall. Because mature smooth muscle cells no
longer multiply and grow, it was theorized that in the course of the inflammatory
response, they revert, or de-differentiate, into an earlier state where they can proliferate
and form matrices that contribute to plaque buildup.
However, no experiments published have directly demonstrated this de-differentiation
process, so Li and his research team remained skeptical. They turned to transgenic mice
with a gene that caused their mature smooth muscle cells to glow green under a
microscope.
In analyzing the cells from cross sections of the blood vessels, they found that more than
90 percent of the cells in the blood vessels were mature smooth muscle cells. They then
isolated and cultured the cells taken from the middle layer of the mouse blood vessels.
After one month of cell expansion, the researchers saw a threefold increase in the size of
the cell nucleus and the spreading area, along with an increase in stress fibers. Notably,
none of the new, proliferating cells glowed green, which meant that their lineage could
not be traced back to the mature smooth muscle cells originally isolated from the blood
vessels.
'Not only was there a lack of green markers in the cell cultures, but we noticed that
another type of cell isolated from the blood vessels exhibited progenitor traits for
different types of tissue, not just smooth muscle cells,' said Zhenyu Tang, co-lead author
of the study and a Ph.D. student in the UC Berkeley-UCSF Graduate Program in
Bioengineering.
The other co-lead author of the study, Aijun Wang, was a post-doctoral researcher in Li's
lab.
'The different phenotypes gave us the clue that stem cells were involved,' said Wang, who
is now an assistant professor and the co-director of the Surgical Bioengineering
Laboratory at the UC Davis Medical Center.
'We did further tests and detected proteins and transcriptional factors that are only found
in stem cells. No one knew that these cells existed in the blood vessel walls because no
one looked for them before,' he explained.
Further experiments determined that the newly discovered vascular stem cells were
multipotent, or capable of differentiating into various specialized cell types, including
smooth muscle, nerve, cartilage, bone and fat cells. This would explain why previous
studies misidentified the cells involved in vessel clogs as de-differentiated smooth muscle
cells after vascular injury.
'In the later stages of vascular disease, the soft vessels become hardened and more brittle.
Previously, there was controversy about how soft tissue would become hard. The ability
of stem cells to form bone or cartilage could explain this calcification of the blood
vessels,' said Li.
Other tests in the study showed that the multipotent stem cells were dormant under
normal physiological conditions. When the blood vessel walls were damaged, the stem
cells rather than the mature smooth muscle cells became activated and started to multiply.
The researchers analyzed human carotid arteries to confirm that the same type of
multipotent vascular stem cells are found in human blood vessels.
The study will appear in the journal Nature Communications.
Immune System
Immune System 'Circuitry' That Kills Malaria in Mosquitoes Identified
(Science Daily:8.6.2012)
Researchers at the Johns Hopkins Malaria Research Institute have, for the first time,
determined the function of a series proteins within the mosquito that transduce a signal
that enables the mosquito to fight off infection from the parasite that causes malaria in
humans. Together, these proteins are known as immune deficiency (Imd) pathway signal
transducing factors, are analogous to an electrical circuit. As each factor is switched on or
off it triggers or inhibits the next, finally leading to the launch of an immune response
against the malaria parasite.
The study was published June 7 in the journal PLoS Pathogens.
The latest study builds upon earlier work of the research team, in which they found that
silencing one gene of this circuit, Caspar, activated Rel2, an Imd pathway transcription
factor of the Anopheles gambiae mosquito. The activation of Rel2 turns on the effectors
TEP1, APL1 and FBN9 that kill malaria-causing parasites in the mosquito's gut. More
significantly, this study discovered the Imd pathway signal transducing factors and
effectors that will mediate a successful reduction of parasite infection at their early
ookinete stage, as well as in the later oocyst stage when the levels of infection were
similar to those found in nature.
"Identifying and understanding how all of the players work is crucial for manipulating the
Imd pathway as an invention to control malaria. We now know which genes can be
manipulated through genetic engineering to create a malaria resistant mosquito" said
George Dimopoulos PhD, professor in the Department of Molecular Microbiology and
Immunology at the Johns Hopkins Bloomberg School of Public Health.
To conduct the study, Dimopoulos's team used a RNA interference method to "knock
down" the genes of the Imd pathway. As the components were inactivated, the
researchers could observe how the mosquito's resistance to parasite infection would
change.
"Imagine a string of Christmas lights or other circuit that will not work when parts aren't
aligned in the right sequence. That is how we are working with the mosquito's immune
system," explained Dimopolous. "We manipulate the molecular components of the
mosquito's immune system to identify the parts necessary to kill the malaria parasites."
Malaria kills more than 800,000 people worldwide each year. Many are children.
The authors of "Anopheles Imd pathway factors and effectors in infection intensitydependent anti-Plasmodium action" are Lindsey S. Garver, Ana C. Bahia, Suchismita
Das, Jayme A. Souza-Neo, Jessica Shiao, Yuemei Dong and George Dimopoulos.
The research was funded by the Johns Hopkins Malaria Research Institute.
Zinc
Zinc can help treat bacterial infection in babies, says study (The Indian
Express: 1.6.2012)
A study funded by the Department of Biotechnology (DBT) and published in The Lancet
on Thursday — that shows a 43 per cent reduction in mortality among babies suffering
from bacterial sepsis when administered zinc along with standard antibiotics, could have
huge implications for India’s infant mortality rate (IMR) figures.
Of the one million neonatal deaths that occur in India every year, more than a quarter are
attributed to serious bacterial infections such as pneumonia, sepsis and meningitis. As an
agent that in some way increases antibiotic efficacy, zinc can be a potent ally in the
country’s fight against drug resistance.
The study conducted on 700 children admitted to the AIIMS, Kalawati Saran Children’s
Hospital and Deen Dayal Upadhyay Hospital found that significantly fewer treatment
failures occurred in the Zn group (352 infants) against the placebo group (348).
Researchers have concluded that zinc treatment prevented one treatment failure for every
infant it is administered upon.
Coming on the heels of an earlier study that found zinc prevented 25-30 per cent
diarrhoea deaths in children — that caused zinc to be included in the National Rural
Health Mission diarrhoea protocol for ASHAs along with oral rehydration solution —
this study is likely to further underscore the importance of zinc in the human ability to
fight diseases even though the mode of action of the element is still in the realm of
speculation.
DBT is now planning a countrywide trial with some 4,000 babies for further confirmation
of the findings before it can ask the Health Ministry to include zinc in the protocol to
treat bacterial infections too. “Zinc deficiency is a problem peculiar only to South East
Asia which is why all the findings in the field have come from India. There are some
estimates that suggest that 40-45 per cent of our population is zinc deficient even though
it is the second most important micronutrient after iron. The problem is there is no
symptom to identify zinc deficiency with unless one does a blood test,” says Dr M K
Bhan, Secretary, DBT.
The interesting aspect of the importance of zinc is that even as researchers wax eloquent
about the role it plays, they are not yet certain how it acts though there are some
significant pointers in that direction.
“Most likely it acts by activating the innate immune system of the body which is
triggered as soon as the pathogen enters the body. Many of the enzymes in that immune
system have a zinc component. It has also been seen that zinc acts well only when it is
given immediately not if it is given after five-six days. That could also mean that it is the
innate immunity that is activated but we need more studies to say so for certain,” says Dr
Uma Chandra Mouli of the Translational Health Science and Technology Institute, one of
the co-authors of the study.
Zinc
Zinc may cure bacterial infections in infants (The Asian Age: 1.6.2012)
The Department of Biotechnology claims to have made a significant breakthrough using
zinc (tablets), along with standard antibiotics, to cure young children suffering from
serious bacterial infection, including sepsis, meningitis and pneumonia.
In the first worldwide study to show the efficacy of zinc, Indian researchers have shown
that the risk of death of young infants, between 7 and 120 days, being treated for serious
bacterial infections, was reduced by 43 per cent when given 10 milligrams of zinc.
Dr Shinjini Bhatnagar, Prof of Paediatric Biology Centre in Translational Health Science
and Technology Institute conducted a study at AIIMS and two other hospitals in which
352 newborns were given zinc tablets while 348 were given placebo in addition to
antibiotics.
“The result showed that children given zinc were 40 per cent less likely to experience
treatment failure than those given placebo.
Risk of death was also reduced by 43 per cent,“ she said. Dr Bhatnagar added, “Zinc is an
accessible, lowcost intervention that could add to the effect of antibiotic treatment and
lead to substantial improvement, particularly in low and middle-income nations where
millions of children die from serious infections every year and where second-line
antibiotics and intensive care many not be available.“
It was further pointed out that 80 per cent of the immune deficiency in the body was due
to zinc deficiency which is presently on the scale of the HIV AIDS epidemic.
Department of Biotechnology secretary M.K. Bhan said that 80 per cent of immune
deficiency in the body is due to zinc deficiency. After iron, it is the second most
important micro-nutrient in the body.
Immune System
Injection Offers Hope For Treating Autoimmune Disease (Medical
News Today:4 June 2012)
Australian researchers have uncovered a potential new way to regulate the body's natural
immune response, offering hope of a simple and effective treatment for auto-immune
diseases.
Auto-immune diseases result from an overactive immune response that causes the body
to attack itself.
The new approach involves increasing good regulating cells in the body, unlike most
current research which focuses on stopping "bad" or "effector" cells, says lead researcher
Dr Suzanne Hodgkinson, from UNSW's Faculty of Medicine and Liverpool Hospital.
The researchers induced the body's T-cell front-line defences by injecting cell-signalling
proteins called cytokines, in particular cytokine Interleukin-5 (II-5 cytokine).
When T-regulatory cells are grown in a way to make them specific to a particular protein
they develop receptors for the Il-5 cytokine. The Il-5 cytokine boost allows the body's
immune system to better regulate its response to disease without going into overdrive.
The team cloned II-5 cytokine and injected it into rats with the neurological condition
Guillain-"Barré syndrome. These rats recovered much quicker and, if treated as a
precaution, did not fall ill. The method has also shown promise in animals with multiple
sclerosis, with kidney disease nephritis and trying to overcome organ transplantation
rejection.
"One of the nice things about this discovery is that it is one of the few treatments in the
auto-immune world and in the transplantation world that works not by attacking the
effector cells, but by increasing the good regulating cells. So it works in a very different
way from almost every other treatment we've got available," Dr Hodgkinson says.
Il-5 injections could be more palatable than inoculation by parasitic worms - another
approach in regulating auto-immune conditions, the researchers say.
International research shows swallowing helminths parasites can regulate the immune
system and boost T-cell production to combat illnesses such as celiac disease and
multiple sclerosis. The absence of the worms in guts in the developed world has been
cited as a possible cause for the sharp rise in auto-immune diseases in Western nations.
"The process we've developed may be the same process that the helminths kick off. When
you get a helminths infestation, one of the changes in your immune response is an
increase in cells called eosinophils and these cells make the cytokine Interleukin-5," Dr
Hodgkinson says.
"In this new treatment, it's a matter of injecting the interleukin-5 and the body does the
rest. It's both safe and effective and we think inducing the immune response by injection
may be more attractive to people than swallowing parasitic worms."
The next step is to take the treatment to human trials, which could be underway within
two to five years, says Dr Hodgkinson, whose paper outlining the study has been
published in the journal Blood.
Immune system
Immune system glitch that ups death threat by 4 times identified (New
Kerala:5 June 2012)
Washington, June 4 : In a new study researchers including one of Indian origin, have
identified an immune system deficiency the presence of which shows that someone is up
to four times more likely to die as compared to a person without it.
The glitch involves an antibody molecule called a free light chain – people whose
immune systems produce too much of the molecule are far more likely to die of a lifethreatening illness such as cancer, diabetes and cardiac and respiratory disease than those
whose bodies make normal levels.
Researchers from Mayo Clinic studied blood samples from nearly 16,000 people 50 and
older enrolled in a population-based study of plasma cell disorders in Olmsted County,
Minn.
They found that those who had the highest level of free light chains, the top 10 percent,
were about four times more at risk of dying than those with lower levels.
Even after accounting for differences in age, gender and kidney function, the risk of death
was roughly twice as high.
The study suggests that high levels of free light chains are markers of increased immune
system response to infection, inflammation or some other serious disorders, Vincent
Rajkumar, the lead researcher, said.
Researchers have known that high levels of free light chains are associated with increased
risk of death among patients with plasma disorders, such as lymphomas and other blood
cancers, but this is the first study to find that high levels of light chains are associated
with increased mortality in the general population.
Free light chain levels can be measured by using a serum free light chain assay, a simple
blood test.
This test is often used to monitor light chain levels in patients with plasma disorders such
as myeloma to gauge how well they are responding to treatment.
However, Rajkumar cautions against administering this test with the intent of gauging
one's risk of death.
"We do not recommend this test as a screening test, because it will only cause alarm,"
Rajkumar said.
"We do not know why this marker is associated with higher rates of death. We do not
have a way of turning things around. Therefore, I would urge caution in using this test
until we figure out what to do about it and what these results mean," he said.
Plasma cells are white blood cells that produce large amounts of antibodies and are the
key to fighting off infection.
The antibodies are comprised of two different types of molecules tightly joined to each
other – heavy chains and light chains. Most people produce at least a slightly excess
amount of light chains that can be detected in the blood in the "free" state, unbound to
heavy chains.
Free light chains are not usually a threat to health, but excess levels serve as a marker of
underlying immune system stimulation, kidney failure or plasma cell disorders such as
myeloma.
The study has been published in the June issue of Mayo Clinic Proceedings. (ANI)
Stem Cells
Stem cells identified as 'real culprit behind vascular diseases'(New
Kerala: 8.6.2012)
Using genetic tracing, researchers from the University of California, Berkeley, have hunt
down the real culprit of vascular diseases.
The guilty party is not the smooth muscle cells within blood vessel walls, which for
decades was thought to combine with cholesterol and fat that can clog arteries.
Blocked vessels can eventually lead to heart attacks and strokes.
Instead, a previously unknown type of stem cell ' a multipotent vascular stem cell ' is to
blame, and it should now be the focus in the search for new treatments, the scientists said.
'For the first time, we are showing evidence that vascular diseases are actually a kind of
stem cell disease,' said principal investigator Song Li, professor of bioengineering and a
researcher at the Berkeley Stem Cell Center.
'This work should revolutionize therapies for vascular diseases because we now know
that stem cells rather than smooth muscle cells are the correct therapeutic target,' he
added.
The finding that a stem cell population contributes to artery-hardening diseases, such as
atherosclerosis, provides a promising new direction for future research, the researchers
said.
'This is groundbreaking and provocative work, as it challenges existing dogma. Targeting
the vascular stem cells rather than the existing smooth muscle in the vessel wall might be
much more effective in treating vascular disease,' said Dr. Deepak Srivastava, director of
the Gladstone Institute of Cardiovascular Disease at UC San Francisco, who provided
some of the mouse vascular tissues used by the researchers.
It is generally accepted that the buildup of artery-blocking plaque stems from the body's
immune response to vessel damage caused by low-density lipoproteins, the bad
cholesterol many people try to eliminate from their diets. Such damage attracts legions of
white blood cells and can spur the formation of fibrous scar tissue that accumulates
within the vessel, narrowing the blood flow.
The scar tissue, known as neointima, has certain characteristics of smooth muscle, the
dominant type of tissue in the blood vessel wall. Because mature smooth muscle cells no
longer multiply and grow, it was theorized that in the course of the inflammatory
response, they revert, or de-differentiate, into an earlier state where they can proliferate
and form matrices that contribute to plaque buildup.
However, no experiments published have directly demonstrated this de-differentiation
process, so Li and his research team remained skeptical. They turned to transgenic mice
with a gene that caused their mature smooth muscle cells to glow green under a
microscope.
In analyzing the cells from cross sections of the blood vessels, they found that more than
90 percent of the cells in the blood vessels were mature smooth muscle cells. They then
isolated and cultured the cells taken from the middle layer of the mouse blood vessels.
After one month of cell expansion, the researchers saw a threefold increase in the size of
the cell nucleus and the spreading area, along with an increase in stress fibers. Notably,
none of the new, proliferating cells glowed green, which meant that their lineage could
not be traced back to the mature smooth muscle cells originally isolated from the blood
vessels.
'Not only was there a lack of green markers in the cell cultures, but we noticed that
another type of cell isolated from the blood vessels exhibited progenitor traits for
different types of tissue, not just smooth muscle cells,' said Zhenyu Tang, co-lead author
of the study and a Ph.D. student in the UC Berkeley-UCSF Graduate Program in
Bioengineering.
The other co-lead author of the study, Aijun Wang, was a post-doctoral researcher in Li's
lab.
'The different phenotypes gave us the clue that stem cells were involved,' said Wang, who
is now an assistant professor and the co-director of the Surgical Bioengineering
Laboratory at the UC Davis Medical Center.
'We did further tests and detected proteins and transcriptional factors that are only found
in stem cells. No one knew that these cells existed in the blood vessel walls because no
one looked for them before,' he explained.
Further experiments determined that the newly discovered vascular stem cells were
multipotent, or capable of differentiating into various specialized cell types, including
smooth muscle, nerve, cartilage, bone and fat cells. This would explain why previous
studies misidentified the cells involved in vessel clogs as de-differentiated smooth muscle
cells after vascular injury.
'In the later stages of vascular disease, the soft vessels become hardened and more brittle.
Previously, there was controversy about how soft tissue would become hard. The ability
of stem cells to form bone or cartilage could explain this calcification of the blood
vessels,' said Li.
Other tests in the study showed that the multipotent stem cells were dormant under
normal physiological conditions. When the blood vessel walls were damaged, the stem
cells rather than the mature smooth muscle cells became activated and started to multiply.
The researchers analyzed human carotid arteries to confirm that the same type of
multipotent vascular stem cells are found in human blood vessels.
The study will appear in the journal Nature Communications.
Reproductive Health
Universal Access to Sexual and Reproductive Health Mooted by
IPPF(Med India:11.6.2012)
A conference is being held at New Delhi by the International Planned Parenthood
Federation (IPPF) with an aim to ensure the issue of family planning is taken up at the
upcoming G-20 Summit.
Experts said the universal access to sexual and reproductive health is imperative for
social cohesion and development of the country.
The Director General of International Planned Parenthood Federation (IPPF), Tewodros
Melesse said that the people of the country should get access to the family planning
services.
"We will be working with other civil society organisations, parliamentarians and our
affiliates across the globe to ensure that universal access to sexual and reproductive
health remains high in the agenda because we believe that there is not going to be a
cohesive, social, equity based development without including universal access to sexual
and reproductive health," he said.
Melesse further informed that the IPPF would focus extensively on providing family
planning services to women and adolescents.
"We want to ensure that adolescents and women and specially those people who are
underserved have got access to family planning services across every nation and in every
village and in every family and for every individual," he said.
Hailing the efforts of the Indian government, Melesse highlighted that the government
was committed to upgrade the family planning services and they would also involve the
private sector.
"The Indian government is fully committed to ensure that family planning services are
part of the government policy, adequate resources are going to be committed and that it
will be working in partnership with the private sector and the civil society to reach the
most vulnerable and unreachable population across the nation," he added.
Melesse also stressed upon comprehensive sex education and added that there was need
to reach out to millions of women across the country.
"There should be education to the population that whether you have a girl or a boy, it
should be accepted like a blessing, and for that it is not just the government, which can
put that into practice, it is the religious leaders, community leaders. In the community
there should be education," Melesse said. (ANI)
Stem cell
Lab-grown vein transplant is new milestone in stem cell research (The
Indian Express: 15.6.2012)
In a first, doctors in Sweden have transplanted into the body of 10-year-old girl a vein
grown in the laboratory from her own stem cells.
The core team that performed the procedure was led by Dr Suchitra Holgersson, a
transplant medicine specialist originally from Mumbai, and included four other doctors
from India. The landmark transplant was published in the British medical journal The
Lancet on Thursday.
The procedure “could offer a potential new way for patients lacking healthy veins to
undergo dialysis or heart bypass surgery without the problems of synthetic grafts or the
need for lifelong immunosuppressive drugs”, The Lancet said.
The child had a blockage in her extrahepatic portal vein, which was obstructing blood
supply to her liver. Options available to doctors included a liver transplant or taking a
vein graft from the umbilical cord of a donor, which would have led to permanent
dependence on immunosuppressants.
A third alternative was to graft another vein — usually from the leg or neck — on to the
liver vein. But this procedure is associated with risks of lower limb disorders, and was
not considered a viable option due to the girl’s young age.
Speaking to The Indian Express by phone, Dr Holgersson, a professor in the department
of transplant and regenerative medicine at Sahlgrenska Science Park in Gothenburg
University, explained the breakthrough procedure:
“We took a 9-centimetre graft from a deceased donor and removed all its original cells,
leaving a hollow piece of vein. We then extracted stem cells of two kinds from the bone
marrow — endothelial and smooth muscle cells — of the little girl, gave it necessary
growth factors, and let it incubate for two weeks.”
This “manufactured vessel” was then transplanted into the girl. “Blood flow to the liver
started immediately after the procedure, and since the stem cells were the patient’s own,
there was no fear of an adverse immune reaction either, and she needs no drugs,” Dr
Holgersson said.
A year after the procedure, the girl is a “happy child”, Dr Holgersson said. “She had been
repeating classes for the last few years, but now she goes to school regularly, her father
says she has been doing somersaults, and she is generally very happy.”
Dr Holgersson — a graduate of Mumbai University who moved to Sweden for an M Sc.
and has been working on transplant medicine for 25 years — and her team see the
success of the procedure as a breakthrough that would pave the way for manufacturing
other blood vessels and, eventually, organs.
But she cautions against jumping to conclusions. Even in this particular case, blood flow
from the artificial vessel was obstructed nine months after the procedure — when it
started pushing against the colon — and a second manufactured vein had to be
transplanted.
“We need proper controlled clinical trials, this was just one case. Especially in a country
like India, with so many fly-by-night operators promising miracles through stem cells,
this achievement should be dealt with some caution before it is used commercially,” Dr
Holgersson said.
The team will travel to India in September to meet doctors and visit centres for likely
partnerships in multicentric global trials to develop the procedure further.
If all goes well, we are also looking at the first manufactured lung transplant within a
year at our centre. But now we think our success has to be validated by global trials,
and considering the vast disease profile of India where stem cell procedures could
help, if performed scientifically, we think it will be very good for India to participate,”
Dr Holgersson said.
An accompanying comment by doctors from the University College of London (UCL)
has, while acknowledging the promise of the procedure, raised questions about its
cost. The procedure, estimated to have cost $ 6,000- $ 10,000, was funded by the
Swedish government. UCL’s Martin Birchall and George Hamilton added, however,
that such procedures were likely to get cheaper with wider use.
Indian experts in transplant medicine hailed the achievement but cautioned against
seeking “quick solutions”. Dr N K Mehra, head of transplant immunology at AIIMS,
said, “Many institutions were trying to achieve this feat and trials had been under
way with animals, but this is the first significant breakthrough in humans. It will
open the floodgates for a whole new channel of treatment with stem cells, and it is
great that an Indian-origin scientist has managed it.”
A senior official from the Indian Council of Medical Research, who has been working
on national guidelines for stem cell research, said, “We are having a hard time
regulating ‘magic’ stem cell solutions in chronic disorders in neurology and
cardiovascular diseases. With such an achievement, we are moving to a whole new
era of stem cells in manufactured organs and vessels. Indian patients must do well to
remember that this achievement has not been backed up by any population based
controlled clinical trials so far.”
MADE FROM WITHIN
* Problem: Blockage in 10-year-old’s extrahepatic portal vein, obstructing blood
supply to liver
* Graft: 9 cm graft from a deceased donor, all cells removed until only hollow tube
remained
* Recreation: Stem cells of two kinds, endothelial and smooth muscle cells, extracted
from girl’s marrow
* Result: Manufactured vessel transplanted after incubation, blood flow resumes

Complication: Blood flow obstructed nine months later, second manufactured
vein transplanted
CPAP therapy
CPAP therapy improves sexual function, satisfaction in men with sleep
apnea(new Kerala:15.6.2012)
Apart from getting a steady, healthy level of breathing during the night, men who suffer
from obstructive sleep apnea (OSA) are seeing another potential benefit from continuous
positive airway pressure therapy, or CPAP - improved sexual function and satisfaction in
non-diabetic men under age 60.
A study out of Walter Reed National Military Medical Center in Bethesda, Md., assessed
the erectile function and libido of 92 men who were newly diagnosed with OSA and
starting CPAP therapy.
Erectile dysfunction (ED) is common in OSA patients, and nearly half of the men in the
Walter Reed study reported the presence of ED. Patients were assessed again after one,
three and six months of CPAP therapy.
The results showed that CPAP improved the sexual function and satisfaction in the
majority of men in the study regardless of their level of erectile function reported at the
very start.
Those with ED had more robust improvements and even many without ED reported
improved sexual function and satisfaction.
'We were surprised at how prevalent ED is in a relatively young population of men with
sleep apnea. The average age was 45,' said Joseph Dombrowsky, MD, the study's primary
investigator.
'But we were similarly surprised at how robust a clinically significant response the men
had with CPAP therapy,' he added.
OSA is a sleep-related breathing disorder that occurs when the tissue in the back of the
throat collapses and blocks the airway, causing the body to stop breathing during sleep.
OSA disrupts sleep and can increase the risk of other health problems such as heart
disease and stroke.
CPAP is the most common and effective treatment for OSA. The steady flow of air from
a CPAP machine keeps the airway open and restores normal oxygen levels during sleep.
This helps maintain a steady, healthy level of breathing through the night.
The finding has been presented at SLEEP 2012, the 26th annual meeting of the
Associated Professional Sleep Societies (APSS) in Boston. (ANI)
Fat Stem Cells
Fat Stem Cells Grow Bone Faster And Better(medical news
Today:15.6.2012)
US scientists have found a way to grow new bone using fresh, purified stem cells from
fat tissue that produces better quality bone faster than conventional methods. They
suggest this may one day eliminate the need for painful bone grafts that use material
taken from patients with invasive surgery.
They write about their work in the 11 June online first issue of a paper published in the
new peer-reviewed journal Stem Cells Translational Medicine, which aims to span stem
cell research and clinical trials.
The two co-senior authors of the study are Chia Soo, vice chair for research at University
of California - Lost Angeles (UCLA) Plastic and Reconstructive Surgery, and Bruno
Péault, professor of Orthopedic Surgery at UCLA. Both are members of the Eli and
Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA.
Soo told the press that fat tissue is considered a good source of mesenchymal stem cells,
the sort that can be coaxed to form various tissue types such as bone, cartilage and
muscle, because there is plenty of it and it is easy to get hold of with procedures like
liposuction.
One conventional method of growing these stem cells from fat tissue relies on culturing
the fat cells for weeks to isolate the stem cells that form bone. These processes can
increase the risk of infection and lead to genetic instability.
Another traditional method, called stromal vascular fraction (SVF), uses fresh, noncultured cells, but it is not easy to extract SVF cells from fat tissue because there are
many kinds of them, not all capabale of forming bone.
For this study, the researchers isolated and purified human perivascular stem cells (hPSC)
from fat tissue, and using lab animals, showed these cells are a better option for making
bone than SVF cells.
They also showed that a growth factor called NELL-1, speeded up bone formation.
Soo told the press:
"People have shown that culture-derived cells could grow bone, but these are a fresh cell
population and we didn't have to go through the culture process, which can take weeks."
"The best bone graft is still your own bone, but that is in limited supply and sometimes
not of good quality. What we show here is a faster and better way to create bone that
could have clinical applications," she added.
To show that their new approach can grow new bone, the researchers put the hPSCs with
NELL-1 in a muscle pouch, where bone does not normally grow.
Using X-rays they were then able to show the cells did make bone.
Soo explained:
"The purified human hPSCs formed significantly more bone in comparison to the SVF by
all parameters."
"And these cells are plentiful enough that patients with not much excess body fat can
donate their own fat tissue," she added.
If further tests prove successful, then one day doctors may be able to quickly get high
quality bone graft material from patients' fat tissue, purify it to get the hPSCs, and put
them, with NELL-1, in the place where new bone is needed.
The new bone would then grow in situ inside the patient, eliminating the need for painful
surgery to harvest the bone graft.
Soo said they envisage it may one day be possible to isolate the hPSCs, add the NELL-1,
with a matrix or scaffold to help the new bone tissue adhere, and for it to take less than an
hour.
Péault said recent studies have shown similar advances in using perivascular stem cells to
regenerate various different kinds of tissue, including skeletal muscle, lung tissue, and
even heart tissue.
"Further studies will extend our findings and apply the robust osteogenic potential of
hPSCs to the healing of bone defects," he added.
Funds from the California Institute of Regenerative Medicine Early Translational
Research Award and Training Grant Research Fellowship, a University of California
Discovery Grant and the National Institute of Dental and Craniofacial Research Center at
the National Institutes of Health, helped pay for the study.
Blood Cells
Virus Kills Cancer By Hitching Ride On Blood Cells(Medical News
Today:18.6.2012)
Scientists have discovered when a cancer-killing virus is injected in the bloodstream it
hitches a ride on blood cells and evades attack from the immune system, allowing it to
reach cancer tumors, and start destroying cancer cells. They suggest this means it may be
possible to use promising "viral therapy" during routine outpatient sessions, like
chemotherapy, to treat a wide range of cancers.
Certain viruses, like the reovirus, that causes colds and mild stomach upsets, prefer to
attack cancer cells. They also stimulate the immune system to attack tumors.
Using these "oncolytic" viruses to kill cancer is a fairly new approach that is currently
being tested. Trials are currently under way to test "viral therapy" as an approach to treat
cancer in human patients.
But the challenge is how to get the viruses into tumors without alerting the immune
system to destroy them. One way is to inject them into the tumors, but this is technically
difficult and particularly so for tumors that are deep inside the body, such as in the lungs,
stomach, liver and pancreas.
Another way could be to inject the virus into the bloodstream; however, scientists have
assumed this would not be feasible because the virus would likely be spotted and
destroyed by the immune system before it could reach the tumor.
But when a group of scientists decided to test this by injecting the virus into the
bloodstream of patients with advanced colorectal cancer, they found the virus was able to
evade the immune system by "going under cover" and hitching a ride on red blood cells.
The study, led by researchers from the University of Leeds and The Institute of Cancer
Research (ICR) in the UK, reveals how the "hitch-hiking" virus is shielded from
antibodies in the bloodstream that might otherwise neutralize its anti-cancer properties.
The team writes about its work in a paper published online in Science Translational
Medicine on 13 June.
The study participants were 10 patients with advanced colorectal cancer that had spread
to the liver and who were scheduled to undergo surgery on the secondary tumors in their
livers.
In the weeks leading up to their surgery, all patients received up to five doses of the
reovirus as outpatients.
From blood samples taken shortly after treatment, the researchers found that the active
virus associated with blood cells. Later samples showed the virus was no longer in the
blood cells and had quickly cleared from the system.
When the researchers examined samples of liver tissue removed during surgery up to four
weeks later, they found "viral factories" and active virus in the tumor samples but not in
normal tissue samples. This confirmed the virus had travelled specifically to the tumor
after being injected into the bloodstream.
Professor Alan Melcher of the University of Leeds, and Dr Kevin Harrington from The
Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, jointly led
the study.
Melcher told the press:
"It seems that reovirus is even cleverer than we had thought. By piggybacking on blood
cells, the virus is managing to hide from the body's natural immune response and reach
its target intact. This could be hugely significant for the uptake of viral therapies like this
in clinical practice."
Harrington commented that:
"Viral treatments like reovirus are showing real promise in patient trials. This study gives
us the very good news that it should be possible to deliver these treatments with a simple
injection into the bloodstream," he added.
He said if these treatments could only be delivered by injecting into the tumor, they
would have limited use, but discovering that the virus "can hitch a ride on blood cells will
potentially make them relevant to a broad range of cancers".
"We also confirmed that reovirus was specifically targeting cancer cells and leaving
normal cells alone, which we hope should mean fewer side-effects for patients," said
Harrington.
Funds from Cancer Research UK, Leeds Experimental Cancer Medicine Centre,
University of Leeds, The Institute of Cancer Research, Leeds Cancer Vaccine Appeal,
and the Rays of Hope Appeal, paid for the study.
Breast Cancer Cells
Breast Cancer Cells on the Move Being Tracked (Med India: 19.6.2012)
A patient’s chance of survival decreases as the breast cancer cells frequently move from
their primary site and invade bone. This complex process of metastasis factors both
within the breast cancer cells and within the new bone environment play a role. Roger
Gomis and colleagues at the Institute for Research in Biomedicine in Spain investigate
how breast cancer cells migrate to bone in next week's Journal of Biological Chemistry
"Paper of the Week."
In particular, they examined the role of NOG, a gene important to proper bone
development. Previously, NOG was associated with bone metastasis in prostate cancer,
but its specific role in breast cancer to bone metastasis remained unknown.
Gomis and colleagues showed that once breast cancer cells are on the move NOG enables
them to specifically invade the bone and establish a tumor. It does this in two ways. First,
NOG escalates bone degeneration by increasing the number of mature osteoclasts (bone
cells that break down bone), essentially creating a spot in the bone for the metastatic
breast cancer cells to take up residence. Second, NOG keeps the metastatic breast cancer
cells in a stem-cell-like state, which enables them to propagate and form a new tumor in
the bone environment.
Gomis explains that the reason NOG expression leads to an increased potential for breast
cancer to bone metastasis is because it not only affects features inherent to aggressive
cancer cells (such as the ability to establish a new tumor) but also influences properties of
the bone environment (such as osteoclast degeneration of bone).
Stem Cells
Stroke Treatment Using Stem Cells Shows Early Promise In
Controversial Trial (Medical News Today:19.6.2012)
A controversial stem cell treatment for stroke is showing promising signs in the early
results of a small safety trial. Speaking at an international conference last week, the
researchers warn that it is still early days, but so far five of the six patients who have
received doses of the stem cells have shown some improvement and there have been no
side effects.
The hope is that the treatment, by repairing damaged brain tissue, will one day help
stroke patients regain some movement and ability to speak. Even small improvements
can make a big difference to a person who has been robbed of the ability to wash, dress
and feed themselves.
The PISCES trial (Pilot Investigation of Stem Cells in Stroke) study, which is based in
Scotland at the Institute of Neurological Sciences, Southern General Hospital, Greater
Glasgow and Clyde NHS Board, is the first in the world to evaluate genetically
engineered neural stem cells in people with disabling ischemic stroke.
The researchers presented the interim results at the 10th Annual Meeting of the
International Society for Stem Cell Research (ISSR), which took place from 13 to 16
June 2012, in Yokohama, Japan.
The lead investigator of the trial is Professor Keith Muir, SINAPSE Professor of Clinical
Imaging, Division of Clinical Neurosciences at the University of Glasgow. He told the
press:
"We remain pleased and encouraged by the data emerging from the PISCES study to
date."
The Phase I trial, which started towards the end of 2010, and follows five years of
repeated regulatory rebuffs, is testing the safety of ReN001, a genetically engineered
neural stem cell line made by UK biotech ReNeuron.
The trial is controversial because the stem cell line originated nearly ten years ago, from
the tissue of a 12-week fetus.
ReN001 is a genetically engineered line of adult stem cells that are described as
"committed, not pluripotent". That is they are not capable of turning into any type of cell
in the body: they are already part way down the track of becoming neurons or brain cells.
The trial is testing four different doses of ReN001 in 12 patients, all men over the age of
60, with moderate to severe functional neurological impairments resulting from their
stroke. So far only 6 patients, on the lower doses, have received the treatment. The other
6 patients will start receiving the higher doses, comprising around 20 million stem cells,
in the coming months.
At the conference, the researchers reported the interim results on 5 of the 6 patients.
They said so far, no adverse side effects, neither from the stem cells nor from the immune
system, have been reported. Some patients have experienced minor problems such as
superficial scalp infection or minor bleeding where the stem cells were implanted.
Although the main aim of the trial is to evaluate the safety and tolerability of the ReN001
treatment, to help with the design of future clinical studies, the patients are also
undergoing tests of movement and brain function that will show if there are any
reductions in their disability.
One test, National Institutes of Health Stroke Scale (NIHSS), measures things like
speech, eye movement, ability to move arms and legs, and sensation in limbs and face. A
high NIHSS score means more disability. The researchers said the pre-treatment median
score for the first 5 patients was 8 (ranging from 6 to 10), and at the three-month follow
up, it was 4 (ranging from 3 to 9).
Brain imaging data from fMRI scans taken before and after treatment also show some
changes consistent with these improvements.
Muir said:
"The data indicate that the ReN001 treatment has a good safety profile at the doses
administered thus far. The preliminary signals of potential functional benefit, whilst
intriguing, will require further investigation in a suitably designed Phase II efficacy
study. The clinical team looks forward to dosing patients in the remaining higher dose
cohorts in the PISCES study over the coming months."
Michael Hunt, Chief Executive Officer of ReNeuron, said we must be very cautious
about interpreting these early results, because the aim of the study is to test the safety of
the treatment.
"That said, we remain encouraged by the results seen in the study to date and we look
forward to providing further updates on the study as the higher dose cohorts are treated
and to progressing our planning for further clinical trials with ReN001," he added.
Should the early promise bear out, and subject to receiving the go-ahead from the Data
Safety Monitoring Board, the company hope to apply for a Phase II clinical study (to test
the effectiveness of the treatment) during 2013.
Stroke is the third largest cause of death and the single largest cause of disability in adults
in the developed world.
Enzyme
Enzyme Offers New Therapeutic Target for Cancer Drugs(Science
daily:22.6.2012)
Researchers at the University of California, San Diego School of Medicine have
uncovered a new signal transduction pathway specifically devoted to the regulation of
alternative RNA splicing, a process that allows a single gene to produce or code multiple
types of protein variants. The discovery, published in the June 27, 2012 issue of
Molecular Cell, suggests the new pathway might be a fruitful target for new cancer drugs.
Signal transduction in the cell involves kinases and phosphatases, enzymes that transfer
or remove phosphates in protein molecules in a cascade or pathway. SRPK kinases, first
described by Xiang-Dong Fu, PhD, professor of cellular and molecular medicine at UC
San Diego in 1994, are involved in controlling the activities of splicing regulators in
mammalian cells.
Prior studies have implicated SRPK1 in cancer and other human diseases. For example, it
has been shown that SRPK1 plays a critical role in regulating the function of Vascular
Endothelial Growth Factor or VEGF, which stimulates blood vessel growth in cancer.
SRPK1 has been found to be dysregulated in a number of cancers, from kidney and breast
to lung and pancreatic.
Conversely, studies suggest the absence of SRPK1 may be problematic as well, at least in
terms of controlling some specific cancer phenotypes. Reduced SRPK1, for example, has
been linked to drug resistance, a major problem in chemotherapy of cancer.
In their new paper, Fu and colleagues place SRPK1 in a major signal transduction
pathway in the cell. "The kinase sits right in the middle of the PI3K-Akt pathway to
specifically relay the growth signal to regulate alternative splicing in the nucleus," said
Fu. "It's a new signaling branch that has previously escaped detection."
As such, the SRPK offers a new target for disease intervention and treatment, researchers
say. "It's a good target because of its central role and because it can be manipulated with
compounds that suppress its activity, which appears quite effective in suppressing blood
vessel formation in cancer," Fu said.
Hormonal havoc
Hormonal havoc (Hindustan Times: 25.6.2012)
After six hours of commuting to and fro from office each day, Namita Narula, 23,
assistant manager in a public relations firm, had little time to eat and sleep.
She ate out most days. Working late hours meant hitting the bed at 2am. That was six
months ago. "I was
Hormonal disorder faqs
constantly fatigued and became very short-tempered. Within a few months, I gained
weight, my complexion grew dark and my periods got irregular," says Narula.
She was diagnosed with hypothyroidism, where the thyroid gland cannot make enough
hormones to keep the body's metabolism running properly.
Hypothyroidism (underactive gland) causes weight gain, fatigue, constipation,
intolerance to cold and heat, irregular periods, and hair loss. Hyperthyroidism (overactive
gland) causes unexplained weight loss, palpitations and excessive sweating.
Narula is not alone with a hormonal imbalance. While in her case, unhealthy lifestyle was
circumstantial, doctors say many young people deliberately play with their health.
Like many teenagers, Neha Munshi, 17, subsisted on potato chips, French fries, pastries,
cookies and colas.
Two years ago, she developed severe acne and excessive facial hair. When a
dermatologist couldn't help, she was asked to undergo an ultrasound of the pelvis. It
showed markedly enlarged ovaries and cysts.
One in three women between 12 and 45 years suffers from polycystic ovarian syndrome
(PCOS), which interferes with ovulation, leading to infertility.
The first line of treatment for all lifestyle-related diseases includes cutting down on
refined food rich in sugar and carbohydrates and regular exercise, at least 30 minutes of
brisk walk daily.
"There is no cure. It can only be controlled by eating healthy and exercising regularly. In
severe cases, mild doses of oral contraceptives are prescribed," says Dr Anuradha Kapur,
senior consultant, obstetrics and gynaecology, Max Hospital, Saket.
Narula, for one, has shifted to eating mostly home-cooked food; increasing her fluid
intake and going for walks each day.
"It's been six months. Now I sleep better, my temper is well under control and the
tiredness has gone down. I weigh just fine now," she says.
Hypothyroidism cannot, however, be used as an excuse to explain being overweight,
warn experts.
"The weight gain due to hypothyroidism is minor, maybe not more than 5kg of a person's
body weight. Unlike diabetes, thyroid symptoms are reversible with treatment," said Dr
DK Dhanwal, professor of medicine and endocrinology, Maulana Azad Medical College
and Lok Nayak Hospital, who is a part of a national study on thyroid disorders.
"Simple blood tests such as TSH, T3, T4 can detect the problem," Dhanwal added.
Do you think you have symptoms of a thyroid disorder? Take a online quiz here
Are your hormones playing truant? Then write to [email protected] for our
specialists to answer your queries.
Neurons
Neurons That Control Overeating
Cocaine(Science Daily:25.6.2012)
Also
Drive
Appetite
for
Researchers at Yale School of Medicine have zeroed in on a set of neurons in the part of
the brain that controls hunger, and found that these neurons are not only associated with
overeating, but also linked to non-food associated behaviors, like novelty-seeking and
drug addiction.
Published in the June 24 online issue of Nature Neuroscience, the study was led by
Marcelo O. Dietrich, postdoctoral associate, and Tamas L. Horvath, the Jean and David
W. Wallace Professor of Biomedical Research and chair of comparative medicine at Yale
School of Medicine.
In attempts to develop treatments for metabolic disorders such as obesity and diabetes,
researchers have paid increasing attention to the brain's reward circuits located in the
midbrain, with the notion that in these patients, food may become a type of "drug of
abuse" similar to cocaine. Dietrich notes, however, that this study flips the common
wisdom on its head.
"Using genetic approaches, we found that increased appetite for food can actually be
associated with decreased interest in novelty as well as in cocaine, and on the other hand,
less interest in food can predict increased interest in cocaine," said Dietrich.
Horvath and his team studied two sets of transgenic mice. In one set, they knocked out a
signaling molecule that controls hunger-promoting neurons in the hypothalamus. In the
other set, they interfered with the same neurons by eliminating them selectively during
development using diphtheria toxin. The mice were given various non-invasive tests that
measured how they respond to novelty, and anxiety, and how they react to cocaine.
"We found that animals that have less interest in food are more interested in noveltyseeking behaviors and drugs like cocaine," said Horvath. "This suggests that there may be
individuals with increased drive of the reward circuitry, but who are still lean. This is a
complex trait that arises from the activity of the basic feeding circuits during
development, which then impacts the adult response to drugs and novelty in the
environment."
Horvath and his team argue that the hypothalamus, which controls vital functions such as
body temperature, hunger, thirst fatigue and sleep, is key to the development of higher
brain functions. "These hunger-promoting neurons are critically important during
development to establish the set point of higher brain functions, and their impaired
function may be the underlying cause for altered motivated and cognitive behaviors," he
said.
"There is this contemporary view that obesity is associated with the increased drive of the
reward circuitry," Horvath added. "But here, we provide a contrasting view: that the
reward aspect can be very high, but subjects can still be very lean. At the same time, it
indicates that a set of people who have no interest in food, might be more prone to drug
addiction."
Gene Mutations
Gene Mutations
Daily:25.6.2012)
Cause
Massive
Brain
Asymmetry(Science
Hemimegalencephaly is a rare but dramatic condition in which the brain grows
asymmetrically, with one hemisphere becoming massively enlarged. Though frequently
diagnosed in children with severe epilepsy, the cause of hemimegalencephaly is unknown
and current treatment is radical: surgical removal of some or all of the diseased half of the
brain.
In a paper published in the June 24, 2012 online issue of Nature Genetics, a team of
doctors and scientists, led by researchers at the University of California, San Diego
School of Medicine and the Howard Hughes Medical Institute, say de novo somatic
mutations in a trio of genes that help regulate cell size and proliferation are likely culprits
for causing hemimegalencephaly, though perhaps not the only ones.
De novo somatic mutations are genetic changes in non-sex cells that are neither
possessed nor transmitted by either parent. The scientists' findings -- a collaboration
between Joseph G. Gleeson, MD, professor of neurosciences and pediatrics at UC San
Diego School of Medicine and Rady Children's Hospital-San Diego; Gary W. Mathern,
MD, a neurosurgeon at UC Los Angeles' Mattel Children's Hospital; and colleagues -suggest it may be possible to design drugs that inhibit or turn down signals from these
mutated genes, reducing or even preventing the need for surgery.
Gleeson's lab studied a group of 20 patients with hemimegalencephaly upon whom
Mathern had operated, analyzing and comparing DNA sequences from removed brain
tissue with DNA from the patients' blood and saliva.
"Mathern had reported a family with identical twins, in which one had
hemimegalencephaly and one did not. Since such twins share all inherited DNA, we got
to thinking that there may be a new mutation that arose in the diseased brain that causes
the condition," said Gleeson. Realizing they shared the same ideas about potential causes,
the physicians set out to tackle this question using new exome sequencing technology,
which allows sequencing of all of the protein-coding exons of the genome at the same
time.
The researchers ultimately identified three gene mutations found only in the diseased
brain samples. All three mutated genes had previously been linked to cancers.
"We found mutations in a high percentage of the cells in genes regulating the cellular
growth pathways in hemimegalencephaly," said Gleeson. "These same mutations have
been found in various solid malignancies, including breast and pancreatic cancer. For
reasons we do not yet understand, our patients do not develop cancer, but rather this
unusual brain condition. Either there are other mutations required for cancer propagation
that are missing in these patients, or neurons are not capable of forming these types of
cancers."
The mutations were found in 30 percent of the patients studied, indicating other factors
are involved. Nonetheless, the researchers have begun investigating potential treatments
that address the known gene mutations, with the clear goal of finding a way to avoid the
need for surgery.
"Although counterintuitive, hemimegalencephaly patients are far better off following the
functional removal or disconnection of the enlarged hemisphere," said Mathern. "Prior to
the surgery, most patients have devastating epilepsy, with hundreds of seizures per day,
completely resistant to even our most powerful anti-seizure medications. The surgery
disconnects the affected hemisphere from the rest of the brain, causing the seizures to
stop. If performed at a young age and with appropriate rehabilitation, most children suffer
less language or cognitive delay due to neural plasticity of the remaining hemisphere."
But a less-invasive drug therapy would still be more appealing.
"We know that certain already-approved medications can turn down the signaling
pathway used by the mutated genes in hemimegalencephaly," said lead author and former
UC San Diego post-doctoral researcher Jeong Ho Lee, now at the Korea Advanced
Institute of Science and Technology. "We would like to know if future patients might
benefit from such a treatment. Wouldn't it be wonderful if our results could prevent the
need for such radical procedures in these children?"
Co-authors are My Huynh, department of Neurosurgery and Psychiatry and
Biobehavioral Sciences, Mattel Children's Hospital, Geffen School of Medicine, UCLA;
Jennifer L. Silhavy, Tracy Dixon-Salazar, Andrew Heiberg, Eric Scott, Kiley J. Hill and
Adrienne Collazo, Institute for Genomic Medicine, Rady Children's Hospital, UC San
Diego and Howard Hughes Medical Institute; Sangwoo Kim and Vineet Bafna,
Department of Computer Sciences, Jacobs School of Engineering, UC San Diego;
Vincent Furnari and Carsten Russ, Institute for Medical Genetics, Cedars-Sinai Medical
Center, Los Angeles and Department of Pediatrics, Geffen School of Medicine, UCLA;
and Stacey B. Gabriel, The Broad Institute of MIT and Harvard, Cambridge.
Funding for this research came, in part, from the Daland Fellowship from the American
Philosophical Society, the National Institutes of Health (grants R01 NS038992, R01
NS048453, R01 NS052455, R01 NS41537 and P01 HD070494), the Simons Foundation
Autism Research Initiative and the Howard Hughes Medical Institute.
Pancreatic, lung transplants
Pancreatic, lung transplants soon(The Tribune:27.6.2012)
After a series of successful liver transplants at the Army’s Research and Referral (RR)
Hospital in New Delhi, the Armed Forces Medical Services (AFMS) is now planning to
introduce pancreatic, lung and intestinal transplant procedures in its establishments.
A senior Army Medical Corps (AMC) officer said the matter was under deliberation and
modalities concerning forming and training the initial teams, required infrastructure and
allied facilities were on the drawing board. “Though the issue is in the conceptual stage,
AFMS would be introducing these procedures in the near future,” he said.
Pancreatic, lung and intestinal transplants are complex surgical procedures and relatively
new in India. At present, only a handful of top-end hospitals in the country have the
expertise to undertake these surgeries.
A pancreatic transplant is required for certain diabetic disorders whereas lung and
intestinal transplants are for pulmonary and digestive disorders, where part of or the
whole organ has to be replaced.
About 40 liver transplants have been undertaken at the RR Hospital since the procedure
was introduced in 2007 after a core multi-disciplinary team trained for the purpose in the
United Kingdom and a new state-of-the-art set up was provided in the hospital.
The RR Hospital also conducted India’s first in situ split liver transplant, giving a new
lease of life to two patients - a 14-month-old baby and a 25-year-old soldier. The organ
was donated by the brain-dead wife of an officer and split into two.
Army doctors say measures were being initiated to make facilities for transplant
procedures viable and effective. At present, there are just five military centres for kidney
transplant and one each for liver and heart transplant that. These cater to the requirement
of the entire Armed Forces and their dependents.
Reproductive Hormone
Reproductive Hormone Shows Potential as Weight Loss Treatment
(Med India: 28.6.2012)
Oxytocin – a reproductive hormone helps regulate food intake and energy metabolism
and shows potential as an effective weight-loss treatment, say researchers.
Secreted by the brain, the neural hormone, oxytocin, helps initiate contractions of the
uterus and breast-milk-producing glands during childbirth and nursing. Prior research by
lead author Yuko Maejima, Ph.D., and her co-investigators also linked oxytocin to the
process of controlling energy intake and use.
"These findings reveal novel anti-obese and anti-metabolic-syndrome effects of
oxytocin," said Maejima, who also is an assistant professor in the physiology department
at Jichi Medical University in Shimotsuke, Tochigi, Japan. "Thus, our results provide an
avenue for developing an oxytocin-based effective and safe treatment of obesity."
Excess weight is a risk factor for numerous diseases, including diabetes, heart and bloodvessel disease, and cancer, and is a major problem throughout the world. Obesity rates
have more than doubled since 1980, according to statistics from the World Health
Organization, which indicate that more than 1.4 billion adults are overweight and
upwards of 500 million are obese.
In an obese animal model, the investigators found that daily injections of oxytocin
reduced the amount of food the animals consumed, as well as decreased their body
weight during, and for nine days after, treatment.
Similar results were observed with oxytocin administered by implanted mini pumps. This
drug-delivery method also reduced fat in the liver, improved glucose tolerance, and
decreased abdominal fat, which is a major risk factor for heart and blood-vessel, or
cardiovascular disease. Additionally, the mini pumps decreased the size of fat-storage
cells, or adipocytes, but did not adversely affect blood pressure or activity levels.
"The finding that peripheral oxytocin treatment has no effect on the normal bloodpressure levels or the locomotor activity of this mouse model suggests that oxytocin may
not influence the cardiovascular system or emotions," Maejima said.
To induce obesity, investigators first fed the animal model a high-fat diet. They then
administered oxytocin via injection for 17 days, and through the implantable mini pumps
for 13 days.
Stem Cell
Stem Cell Breakthrough Significant For Degenerative Diseases (Medical
News Today; 28.6.2012)
Researchers in Israel have achieved a significant global milestone in stem cell
technology: they have created the first human embryonic stem cell (hESC) lines that are
free of animal contamination and whose production complies with Good Manufacturing
Practices (GMP). The achievement paves the way for developing clinical treatments that
use hESCs to treat degenerative diseases like age-related macular degeneration (AMD),
type 1 diabetes, heart failure and Parkinson's.
The Need for Clinically-Compliant hESCs
Numerous studies have shown that hESC transplants offer great potential in the treatment
of degenerative diseases because they have the ability to regenerate new cells to replace
damaged or diseased tissue.
But it is a long journey from showing something works in the research lab to using it
safely and ethically in patients, and there are many hurdles.
One such hurdle is providing stem cells lines "developed under stringent ethical
guidelines, from traceable and tested donors, preferably in an animal-free, GMP-grade
culture system," write the researchers in a comprehensive paper published online on 20
June in the open access journal PLoS ONE.
Another, is to ensure the hESCs meet safety criteria, and do not have traces of animal
components, such as from mice and cows, as these can introduce the risk of animal
pathogens running amok in the patient's body.
Now after 12 years of painstaking work, researchers at the Hadassah University Medical
Center in Jerusalem, have announced they have created three new lines of "xeno-free and
GMP-grade human embryonic stem cells".
In their paper, lead investigator professor Benjamin Reubinoff, a world-renowned stemcell pioneer and the new chairman of obstetrics/gynecology at the Ein Kerem medical
center, and colleagues, describe the journey they took to produce clinically-compliant
hESCs.
They conclude that the three hESC lines they produced "may be valuable for regenerative
therapy".
And they also suggest that the "ethical, scientific and regulatory methodology" they
followed may serve as a model for developing further clinical-grade hESCs.
Producing hESC Cell Lines
Most of the cell lines produced worldwide are suitable for basic scientific research but are
far from ideal for transplantation in the clinic, Reubinoff told the Jerusalem Post.
"Until now, hESCs were produced mostly using feeder cells from mice and albumen
from cows. This is not good because it may cause contamination of the human cells with
animal-derived viruses," he explained.
"Our cell lines are free of all that," said Reubinoff.
Human embryonic stem cells (hESCs) can differentiate into any type of cell in the body,
giving them the potential to serve as a virtually infinite source of regenerative cells for
transplantation in patients with severe degenerative diseases, such as age-related macular
degeneration (AMD), type 1 diabetes, heart failure and Parkinson's.
Most hESCs are derived originally from human eggs that have been fertilized in an invitro fertilization (IVF) clinic, and then donated for research with informed consent of the
donors. (The ones that Reubinoff and colleagues used came from from six-day-old
embryos donated by couples who had completed IVF treatments).
But this method alone does not produce enough hESCs for research: to do this
researchers create cell lines.
Cell lines are a way of breeding large quantities of identical cells from an initial batch. In
the case of hESCs, the researchers place the initial batch taken from the embryo into a
culture, a medium that supplies the hESCs with the nutrients they need to multiply. These
nutrients come from animal "feeder cells", usually from mice or cows. This is where the
risk of contamination by unwanted pathogens comes in.
Instead of animal feeder cells, Reubinoff and colleagues used "GMP-grade feeders from
umbilical cord tissue", and put them in a new type of hESC culture that is completely
animal free.
"We derived and characterized three hESC lines in adherence to regulations for embryo
procurement, and good tissue, manufacturing and laboratory practices," they write.
The researchers also reduced the amount of freezing and thawing that is usually involved
in producing cell lines, by continuously expanding the lines from initial outgrowths and
then cryopreserving samples as early stocks and banks.
Another part of their paper discusses the stringent criteria they imposed for releasing
batches of cell lines. These criteria included "DNA-fingerprinting and HLA- typing for
identity, characterization of pluripotency-associated marker expression, proliferation,
karyotyping and differentiation in-vitro and in-vivo".
First hESC Trials Likely to Be for AMD
Reubinoff told the Jerusalem Post they expect the first patients who are likely to undergo
hESCs transplants in clinical trials will those with age-related macular degeneration
(AMD), a common cause of blindness in older people, and for which currently there is no
cure and no treatments that halt progress of the disease.
"After trials for AMD, I think clinical trials for multiple sclerosis and other neurological
disorders will be in the next wave," said Reubinoff.
Hadassah are providing hESC cell lines to academic research centers around the world
for a nominal fee, and they are also selling them to companies at a commercial price.
Reubinoff said that those who use Hadassah hESC cell lines will be able to follow the
team's guidelines:
"Safety is always the end point," he said, and, "This is a platform for treating other
diseases."
Two Israeli companies, Cell Cure Neurosciences Ltd and Kadimastem Ltd have already
started using the new Hadassah cell lines to develop stem cell transplant treatments. Cell
Cure is developing an hESC-based treatment for AMD, and Kadimastem is developing
one for type 1 diabetes.
Hadassah's technology transfer company Hadasit awarded the licences to the two
companies and is overseeing the process, reports the Jerusalem Post.
Cancer
Stomach cancer
Stomach cancer second biggest killer in India (World News Papers:
3.4.2012)
The new study from Tata Memorial Centre (TMC) on cancer mortality in India has
rightly focused public attention on the perils of consuming tobacco. Tobacco has
emerged as the leading cause of cancer-related deaths among Indian men. However, the
second largest cause of cancer-related deaths among both Indian men and women is
stomach or gastric cancer.
Twenty-five thousand two hundred men and 27,500 women die of gastric cancer every
year in India.
According to experts, the high rate of the cancer is diet and lifestyle related. “In many
places in India the diet is low in fibre content. Spicy food and lots of non-vegetarian food
can cause the chronic inflammation of the stomach lining, which if left untreated can turn
cancerous,” said Mahesh Goel, associate professor in gastro-intestinal oncology at TMC.
There are other diet related causes too. “Malnutrition causes the hydrochloric acid
produced by the stomach to burn the stomach lining and cause gastroenteritis. If this
condition is exacerbated then it can cause cancer. So, gastric cancer definitely affects the
lower socio-economic classes. But this does not mean that the affluent classes are spared
from stomach cancer.” said Shailesh Shrikhande, HoD of gastro-intestinal cancer surgery
at TMC.
Stress, smoking and alchoholism also contribute towards a high rate of the disease.
“Smoking especially increases the chances of stomach cancer,” said Goel.
Mis-diagnosis or late diagnosis are important factors. “Often, the cancer is diagnosed
when the tumour is fairly large and the patient is in a late stage of the disease. If a person
has repeated acidity or stomach pains then it’s very important for the general practitioner
to suggest that the patient goes in for a gastroscopy to see if there is a tumour,” said
Shrikhande.The other way to diagnose stomach cancer at an early stage is to check the
hemoglobin count in men which should be between 12 and 14.
Lack of awareness too contributes to late diagnosis. In India, there are no guidelines for
diagnosis of the disease.
Cancers
More than 50% cancers preventable (World Newspapers: 3.4.2012)
More than half of all cancer is preventable and society possesses the requisite knowledge
to act on this information, says a new study.
Investigators from the Washington University School of Medicine, St. Louis, have
outlined obstacles that stand in the way of making a huge dent in the cancer burden in the
US and around the world.
"We actually have an enormous amount of data about the causes and preventability of
cancer," said epidemiologist Graham A Colditz, at the Washington School of Medicine,
the journal Science Translational Medicine reported.
According to Colditz and his co-authors, lifestyle choices people make, from tobacco use
to diet and exercise, play a significant role in causing cancer, said a Washington
university statement.
Specifically, researchers cite data demonstrating that smoking alone is responsible for a
third of all cancer cases in the US. Excess body weight and obesity account for another
20%.
But beyond individual habits, they argue that the structure of society itself — from
medical research funding to building design and food subsidies — influences the extent
of the cancer burden and can be changed to reduce it.
The obstacles they see to implementing broad cancer prevention strategies are:
Skepticism that cancer can be prevented.
Smoking rates in different states demonstrate that 75% of lung cancer in the US could be
prevented with elimination of cigarette smoking.
The short-term focus of cancer research: Benefits of prevention may be underestimated
because they take decades to show up, and research funding often spans five years or
less.
Strategies like vaccination against cancer-causing viruses, such as the human papilloma
virus that causes cervical cancer, work best when begun early, in this case before young
people begin sexual activity.
Treatments focus only on a single organ after diagnosis but behavioural changes reduce
cancer and death rates from many chronic diseases.
Health experts have a moral responsibility to highlight cancer risk factors even without
knowing the biological mechanism by which they cause cancer.
Tobacco policy and government subsidies don't do enough to discourage unhealthy
behaviour, and in some cases they make the unhealthy options more accessible,
especially in low-income communities.
Colon Cancer
Breakthrough Discovery Unveils Master Switches in Colon Cancer
(Science daily: 13.4.2012)
A team of researchers at Case Western Reserve University School of Medicine have
identified a new mechanism by which colon cancer develops. By focusing on segments of
DNA located between genes, or so-called "junk DNA," the team has discovered a set of
master switches, i.e., gene enhancer elements, that turn "on and off" key genes whose
altered expression is defining for colon cancers. They have coined the term Variant
Enhancer Loci or "VELs," to describe these master switches.
Importantly, VELs are not mutations in the actual DNA sequence, but rather are changes
in proteins that bind to DNA, a type of alteration known as "epigenetic" or
"epimutations." This is a critical finding because such epimutations are potentially
reversible.
Over the course of three years, the team mapped the locations of hundreds of thousands
of gene enhancer elements in DNA from normal and cancerous colon tissues, pinpointing
key target VELs that differed between the two types.
"What is particularly interesting is that VELs define a 'molecular signature' of colon
cancer. Meaning, they are consistently found across multiple independent colon tumor
samples, despite the fact that the tumors arose in different individuals and are at different
stages of the disease," says Peter Scacheri, PhD, senior author of the study and assistant
professor, Genetics and Genome Sciences, School of Medicine, and member, Case
Comprehensive Cancer Center at Case Western Reserve University. "The set of common
VELs govern a distinct set of genes that go awry in colon cancer."
"The VELs signature is notable because it cuts through the complexity of the many genes
that are changed in colon cancer, to identify genes that are direct targets of alterations on
chromosomes," says Sanford Markowitz, MD, PhD, Ingalls Professor of Cancer Genetics
in the Division of Hematology-Oncology at the School of Medicine, member, Case
Comprehensive Cancer Center, and oncologist at University Hospitals Seidman Cancer
Center, whose team collaborated on the study. "The key next step will be to determine
whether we can use VELs for 'personalized medicine,' to molecularly define distinct
groups of colon cancers that differ in their clinical behavior, and to enable selection of
specific drugs that will best treat a given colon tumor."
In addition to finding that VELs are a "signature" of colon cancer, the team showed that
genetic variants which predispose individuals to colon cancer are located within VELs.
This suggests that individual differences within VELs may play significant roles in
determining different individuals' susceptibility to colon cancer.
"Epigenetics has transformed the way we think about genomes. The genetic code isn't
just a series of As, Ts, Gs, and Cs strung together. Epigenetic 'marks' on DNA tell genes
when, where, and how much to turn on or off to keep cells healthy," says Batool AkhtarZaidi, PhD candidate in Dr. Scacheri's lab and lead author of the study. "When this
epigenetic machinery is disrupted, as we see with VEL events, this can tip the balance to
cancer."
This research was supported by the National Cancer Institute, as well as the Case
Comprehensive Cancer Center.
Cancer
Run a lap, spread the word on cancer in Mumbai (world Newspapers:
20.4.2012)
“Cancer doesn’t sleep. So, for one night, neither will we.” It is with this sentiment that
150-odd students, teachers, activists and celebrities in the city will participate in an
overnight relay walkathon this Friday. The group will camp at the École Mondiale World
School in Juhu at 8pm and will take turns walking or jogging around the track till 8am
the next day.
Called the ‘Relay For Life’, this initiative is a worldwide movement for cancer awareness
and fundraising efforts. More than 20 countries, including the US, the UK and Australia,
have been participating in the event for the last 10 years now.
“It is for the first time that the Relay for Life is being held in India,” says 17-year-old
Neerav Dharia, who studies at the school and is also one of the organisers of the event.
The event will begin on Friday evening with the ‘Survivors’ Lap’, which will celebrate
the spirit of cancer survivors who will walk around the track together in a symbolic
gesture. At the ‘Luminaria Ceremony’, candles will be lit in honour or in memory of
those who have either survived or succumbed to cancer. On Saturday morning, the ‘Fight
Back Ceremony’ will encourage participants to make a commitment to saving lives by
taking up the fight against the disease.
“The Relay for Life is the largest movement in the world that seeks to bring together
activists, doctors, victims, survivors and the general public to not just create awareness
about the disease, but to also raise funds for treatment and research,” says oncologist Dr
Purna Kurkure, who is associated with the Indian Cancer Society and has founded Ugam,
a support group for cancer survivors.
Cancers
Infection behind One Sixth Of Cancers Worldwide (Medical News
Today: 10.5.2012)
Around 2 million, or one sixth of new cancer cases worldwide are due to infections that
are largely preventable or treatable, says a landmark study published in The Lancet
Oncology this week.
Infections with certain bacteria, viruses and parasites have already been cited as strong
risk factors for specific cancers, write the authors in their background information. This
latest study updates the estimated influence that these risk factors have on the worldwide
incidence of cancer.
The lead authors of the study were Dr Catherine de Martel and Dr Martyn Plummer from
the International Agency for Research on Cancer (IARC), in Lyon, France.
Dr Christopher Wild, the Director of IARC, said in a statement:
"This study highlights the need for cancer control priorities to be set on a national and
regional basis in light of the burden of infection-related cancers, particularly in the lowand middle-income countries".
For their analysis, de Martel, Plummer and colleagues examined data on global cancer
incidence for 2008. They used the IARC classification of infectious agents that are linked
to cancer.
Their results show that worldwide, 2 million, or 16.1% of the 12.7 million total new
cancer cases in 2008 were due to infections.
Most of these cancer-causing infections were of the gut, liver, cervix and uterus.
They also note that most of the infection-related cancers are preventable, particularly
those linked to the bacterium Helicobacter pylori, the hepatitis B and C viruses, and
human papillomaviruses.
Between them, these four agents are responsible or 95%, or 1.9 million of infectionrelated cancer cases, say the researchers.
The proportion of such cancer cases is some three higher in less developed countries
(22.9%) than more developed countries (7.4%).
And within this overall picture there is a huge variation by region: for instance only 3.3%
of new cancer cases were due to infection in Australia and New Zealand, compared to
32.7% in sub-Saharan Africa.
The researchers found that worldwide, cancer of the cervix and uterus are responsible for
about half of the new cancer cases due to infection in women, while liver and gut cancers
account for more than 80% of infection-related new cancer cases in men.
About 30% of new cancer cases caused by infection occur in persons younger than 50
years, they add.
Vaccines are available to protect against hepatitis B, known to cause liver cancer, and
human papillomavirus (HPV), which is linked to cervical cancer.
Also, antibiotic treatment can clear the gut of H. pylori bacteria.
The authors conclude that:
"Application of existing public health methods for infection prevention, such as
vaccination, safer injection practice, or antimicrobial treatments, could have a substantial
effect on the future burden of cancer worldwide."
They note that the "2011 UN high-level meeting on non-communicable diseases
highlighted the growing global agenda for prevention and control of non-communicable
diseases", and that although cancer is not classed as a communicable disease, "simple
noncommunicable disease paradigms will not be sufficient" to deal with it, since much of
the incidence can be linked to preventable and treatable infections.
In an accompanying comment, Dr Goodarz Danaei from Harvard School of Public
Medicine in Boston, in the US, writes more priority should be given to increasing the
coverage of low-cost vaccines like those for HPV and hepatitis B, especially in highburden countries.
Funds from the Fondation Innovations en Infectiologie (FINOVI) and the Bill & Melinda
Gates Foundation (BMGF) helped pay for the research.
Chemotherapy
How Chemo Affects the Heart (Medical News Today: 30.5.2012)
The early online edition in the Proceedings of the National Academy of Sciences reveals
a new study, which suggests that blocking a protein in the heart that is produced under
stressful conditions could be a new approach to prevent cardiac damage caused by
chemotherapy.
According to earlier studies, almost a quarter of people who received the common
chemotherapy drug doxorubicin have a risk of developing heart failure later on in life, yet
so far it remains uncertain how this heart damage occurs.
Scientists from Ohio University now discovered in mice and cell cultures that a protein
named heat shock factor-1 (HSF-1) could be the likely culprit of chemotherapy-related
heart damage. HSF-1 is induced by stress, which relates to chemotherapy itself, as the
treatment is stressful for the body.
Senior study author, Govindasamy Ilangovan, associate professor of internal medicine at
Ohio State University explains: "We have found that a simple stress-related factor could
be aggravating chemotherapy's effect on the heart. The results are leading us toward the
idea that any additional stress could hurt the heart more than what chemotherapy itself
can do."
In an animal experiment, the researchers administered two groups of mice with
doxorubicin. One group consisted of normal animals, whilst the animals in the other
group were genetically altered to be unable to produce HSF-1. They discovered that the
hearts of mice without HSF-1 were healthier and the animals lived longer following
chemotherapy than the normal mice.
The findings of a closer examination on the cellular level demonstrated that when HSF-1
is blocked in the heart, a gene is activated, which produces a protein that pumps the
chemo medicine out of heart muscle cells and therefore prevents these cells from dying.
Ilangovan and his team are currently working to develop drugs that could selectively
inhibit HSF-1 in the heart as a possible supplementary therapy for cancer patients who
receive chemotherapy.
In addition to killing cancer cells, chemotherapy can also kill other cell types in various
organs. Ilangovan explained that most of the time, organs are able to regenerate cells after
having been damaged, whereas heart muscle cells or cardiomyocytes cannot be
regenerated. The loss of these cells can weaken the heart muscle, leading to dilated
cardiomyopathy, a condition whereby the heart's pumping action is reduced, and which
can result in heart failure.
Ilangovan explained: "This work arose from that background. We are trying to identify a
factor that can be targeted to prevent the cardiomyopathy."
Earlier studies demonstrated already that doxorubicin leads to activation of HSF-1 in the
heart. In order to establish the association between heat shock factor-1 and multidrugresistance-1 or MDR1, a gene that helps the heart after chemotherapy, the team
conducted various experiments in animals and cell cultures.
Experiments, in which the researchers used heart muscle cells from mice with activated
HSF-1 proteins and mice without demonstrated that MDR1 was more activated in cells
without the HSF-1 protein than in those with normal heart cells. They also observed that
the MDR1 gene induced the production of a protein on these heart cells' surface, which
pumped doxorubicin away from the cells.
Ilangovan declared:
"This was an exciting finding. When we knock out the protein, not only is the cell death
pathway prevented, but it also induces a multidrug-resistant gene, which pumps the drug
away from the cells. So when HSF-1 gets activated by chemo, that leads to
cardiomyocyte death. But if we knock it out, that gene comes and protects the heart."
The team also observed the occurrence of an interaction between HSF-1 and NF-kB,
another protein in the heart cells, which they were able to trace to the production of the
protective gene. Ilangovan explained: "They're sort of antagonizing each other. If HSF-1
is lower, the other protein becomes dominant. They compete for the same binding site,
and when we knock out HSF-1, NF-kB can go freely bind and activate the MDR1 gene."
This also means that in the presence of HSF-1, the NF-kB protein is inhibited, which in
turn blocks activation of the protective gene.
The team noted longer survival times in those mice that failed to produce HSF-1 after
doxorubicin treatment. In addition they observed that images showed less chemotherapyrelated damage to these mice' hearts as compared with normal mice.
To ensure that switching off the HSF-1 protein prior to chemotherapy would not induce
the multidrug-resistant gene in those cells, which could have devastating results, the team
also tested breast cancer cells.
Ilangovan states that the precise timing of inhibiting HSF-1 and limiting this inhibition to
the heart are crucial factors for the development of drugs to target it.
According to various studies of HSF-1, the protein can have both beneficial as well as
damaging effects in the body. However, researchers have come to the overall conclusion
that the timing of its activation helps to determine which effect the protein will have. If
HSF-1 is activated before an injury or other damaging event it can be protective, whereas
after an injury, i.e. chemotherapy with doxorubicin, the protein is generally more
harmful.
Ilangovan concluded:
"I foresee that perhaps a patient would take a drug to silence HSF-1 in the heart one or
two days before chemotherapy. So until the chemo is cleared out, the protein would be in
the knock-down stage and no damage to the heart would occur."
Anti-cancer war
Govt launches anti-cancer war (The Tribune: 31.5.2012)
To tackle the menace of cancer, especially in Malwa, the state government, in cooperation with Roko Cancer, an NGO, would hold free mega camps for detection of the
disease, Chief Minister Parkash Singh Badal said today.
Talking to mediapersons at his residence here after flagging off a multi- specialty van to
detect cancer, he said this was Roko Cancer’s fifth van. It would extensively cover the
Malwa region.
This van, equipped with ultra-modern facilities, would not only diagnose cancer but also
create awareness among the people as cancer was curable, if detected in time. Badal said
the NGO had already covered 70 per cent of the Doaba region for this purpose.
The Chief Minister said apart from conducting mammography tests, the van would be
used to conduct tests for detecting blood pressure, diabetes and heart ailments free of
cost. Badal said it was the need of the hour to make people aware of cancer symptoms for
which awareness drives would be launched.
Reiterating the government’s commitment to eradicate this disease in the state, the Chief
Minister said two new cancer hospitals would be opened shortly for this purpose. A
special hospital would be opened by Roko Cancer in Moga district.
Badal said the state government had already constituted a corpus fund of Rs 20 crore for
helping cancer patients under which a patient was given a financial assistance of Rs 1.5
lakh for treatment.
Lauding the efforts by the state government for curbing the menace of cancer, ‘Global
Ambassador’ of Roko Cancer Kulwant Singh Dhaliwal said the NGO would soon launch
a drive to distribute 80 lakh gloves especially designed for detecting breast cancer.
Dr Dharminder Dhillon, project officer, Roko Cancer, said they had organised 363 camps
in association with the Health Department in two years and screened more than 35,000
women, of which mammography test was performed on 5,790 women.
Anti-cancer war
Govt launches anti-cancer war (The Tribune: 31.5.2012)
To tackle the menace of cancer, especially in Malwa, the state government, in cooperation with Roko Cancer, an NGO, would hold free mega camps for detection of the
disease, Chief Minister Parkash Singh Badal said today.
Talking to mediapersons at his residence here after flagging off a multi- specialty van to
detect cancer, he said this was Roko Cancer’s fifth van. It would extensively cover the
Malwa region.
This van, equipped with ultra-modern facilities, would not only diagnose cancer but also
create awareness among the people as cancer was curable, if detected in time. Badal said
the NGO had already covered 70 per cent of the Doaba region for this purpose.
The Chief Minister said apart from conducting mammography tests, the van would be
used to conduct tests for detecting blood pressure, diabetes and heart ailments free of
cost. Badal said it was the need of the hour to make people aware of cancer symptoms for
which awareness drives would be launched.
Reiterating the government’s commitment to eradicate this disease in the state, the Chief
Minister said two new cancer hospitals would be opened shortly for this purpose. A
special hospital would be opened by Roko Cancer in Moga district.
Badal said the state government had already constituted a corpus fund of Rs 20 crore for
helping cancer patients under which a patient was given a financial assistance of Rs 1.5
lakh for treatment.
Lauding the efforts by the state government for curbing the menace of cancer, ‘Global
Ambassador’ of Roko Cancer Kulwant Singh Dhaliwal said the NGO would soon launch
a drive to distribute 80 lakh gloves especially designed for detecting breast cancer.
Dr Dharminder Dhillon, project officer, Roko Cancer, said they had organised 363 camps
in association with the Health Department in two years and screened more than 35,000
women, of which mammography test was performed on 5,790 women.
Childhood Cancer
Huge Childhood Cancer DNA Catalogue Released (Medical News
today; 31.5.2012)
By releasing a huge catalogue of complete DNA data on childhood cancers to the global
scientific community, a team at St Jude Children's Research Hospital in Memphis,
Tennessee, in the US, hopes to speed up progress in finding causes and new treatments
for cancer and other diseases.
The catalogue contains whole genome sequences, essentially complete DNA maps, from
260 child cancer patients. There are 520 sequences in all, comprising matched sets of
normal and tumor tissue samples.
The scientists releasing the data are working on the Washington University Pediatric
Cancer Genome Project, which is expected to sequence more than 1,200 genomes by the
end of this year.
The release, thought to be the largest ever of its kind to the scientific community, was
announced as part of a Perspective article published in Nature Genetics on Tuesday.
To ensure maximum accuracy of the data, each sample is sequenced 30 times.
The information will be valuable not only to researchers in the field of cancer, but also to
scientists investigating all kinds of diseases.
Researchers at St Jude are looking to pinpoint the differences between the genomes of
healthy and cancerous cells to identify the causes of more than half a dozen deadly
childhood cancers.
Their work has already yielded several important discoveries, which they have written
about in leading scientific journals.
Some of these discoveries include significant insights into aggressive childhood cancers
of the retina, brainstem and blood. For example, while investigating what lies behind the
rapid development of the eye tumor retinoblastoma, project researchers identified a new
promising anti-cancer agent.
On another part of the project, scientists studying a deadly childhood leukemia called
ETP-ALL (short for early T-precursor acute lymphoblastic leukemia), discovered some
unexpected genome differences that could improve diagnosis and treatment for children
with the disease.
James Downing is a St Jude scientific director and leader of the project at St Jude. He
told the press these findings, and others, would not have been possible without the
Pediatric Cancer Genome Project, and:
"By sharing the information ... we're hoping that other researchers can use this rich
resource for insights into many other types of diseases in children and adults," he said.
The Pediatric Cancer Genome Project is different because unlike many genome projects,
it is producing whole genome data sets, that show entire DNA sequences, instead of
focusing on individual genes.
Such data sets give a much richer, complete picture of the DNA changes behind the
causes and progression of disease.
Richard K Wilson, director of The Genome Institute at Washington University School of
Medicine in St Louis, said with this approach they have found some unusual, "cryptic"
changes in many patients' cancer cells that they would not have found using other
methods.
The project has also shown there are some marked differences between childhood and
adult cancers, underlining why it is important to develop separate treatments for each.
Researchers will be able to access the data online by submitting a request to the European
Genome-Phenome Archive.
Anti-cancer
Anti-cancer viruses hide in blood: (The Times of India;21.6.2012)
A virus known to kill cancer cells can sneak around the body by ‘hitchhiking’ on the back
of blood cells, selectively attacking tumours and avoiding attack itself, scientists have
found. A team at the University of Leeds in England found the virus, called a reovirus,
inside patients’ tumour cells but not in their healthy tissues.
Cancer
Soon, magic shotgun to cure cancer (New Kerala:18 June 2012)
Washington, June 16 : A new approach to drug design promises to help identify future
drugs to fight cancer and other diseases that will be more effective and have fewer side
effects.
Rather than seeking to find magic bullets, chemicals that specifically attack one gene or
protein involved in one particular part of a disease process, the new approach looks to
find "magic shotguns" by sifting through the known universe of chemicals to find the few
special molecules that broadly disrupt the whole diseases process.
"We've always been looking for magic bullets," Kevan Shokat, PhD, a Howard Hughes
Medical Institute Investigator and chair of the Department of Cellular and Molecular
Pharmacology at UCSF, said.
"This is a magic shotgun - it doesn't inhibit one target but a set of targets - and that gives
us a much, much better ability to stop the cancer without causing as many side effects,"
he said.
The magic shotgun approach has already yielded two potential drugs, called AD80 and
AD81, which in fruit flies were more effective and less toxic than the drug vandetanib,
which was approved by the U.S. Food and Drug Administration last year for the
treatment of a certain type of thyroid cancer.
Drug design is basically all about disruption. In any disease, there are numerous
molecular interactions and other processes that take place within specific tissues, and in
the broadest sense, most drugs are simply chemicals that interfere with the proteins and
genes involved in those processes.
The better a drug disrupts key parts of a disease process, the more effective it is.
The toxicity of a drug, on the other hand, refers to how it also disrupts other parts of the
body's system.
Drugs always fall short of perfection in this sense, and all pharmaceuticals have some
level of toxicity due to unwanted interactions the drugs have with other molecules in the
body.
Scientists use something called the therapeutic index (the ratio of effective dose to toxic
dose) as a way of defining how severe the side effects of a given drug would be.
Many of the safest drugs on the market have therapeutic indexes that are 20 or higher meaning that you would have to take 20 times the prescribed dose to suffer severe side
effects.
Many cancer drugs, on the other hand, have a therapeutic index of 1. In other words, the
amount of the drug you need to take to treat the cancer is the exact amount that causes
severe side effects.
The problem, said Shokat, comes down to the fact that cancer drug targets are so similar
to normal human proteins that the drugs have widespread effects felt far outside the
tumor.
While suffering the side effects of drugs is a reality that many people with cancer bravely
face, finding ways of minimizing this toxicity is a big goal pharmaceutical companies
would like to solve.
Shokat and his colleagues believe the shotgun approach is one way to do this.
The dogma that the best drugs are the most selective could be wrong, he said, and for
cancer a magic shotgun may be more effective than a magic bullet.
Looking at fruit flies, they found a way to screen compounds to find the few that best
disrupt an entire network of interacting genes and proteins.
Rather than judging a compound according to how well it inhibits a specific target, they
judged as best the compounds that inhibited not only that specific target but disrupted
other parts of the network while not interacting with other genes and proteins that would
cause toxic side effects.
The article, "Chemical genetic discovery of targets and anti-targets for cancer
polypharmacology" appeared in the issue of the journal Nature. (ANI)
Anti-cocaine vaccine
Anti-cocaine vaccine makes mice resistant to drug's effects (New
Kerala: 20.6.2012)
A single-dose vaccine capable of providing immunity against the effects of cocaine offers
a novel and groundbreaking strategy for treating the drug addiction, according to a new
study.
A team of researchers from Weill Cornell Medical College (New York, NY), The Scripps
Research Institute (La Jolla, CA), and Cornell University (Ithaca, NY) used a virus-based
delivery vehicle in mice to transfer a gene that produces a protein capable of binding to
cocaine present in the blood, preventing the cocaine from crossing into the brain.
The protein is a monoclonal antibody that sequesters cocaine, making the vaccinated
mice resistant to the drug's effects.
Whereas unvaccinated mice exhibited hyperactivity when exposed to intravenous
cocaine, the immunized mice showed no effects, according to researchers Jonathan
Rosenberg, et al.
The study is described in an article published Instant Online in Human Gene Therapy, a
peer-reviewed journal from Mary Ann Liebert, Inc.
"This is a very novel approach for addressing the huge medical problem of cocaine
addiction," said James M. Wilson, MD, PhD, Editor-in-Chief, and Director of the Gene
Therapy Program, Department of Pathology and Laboratory Medicine, University of
Pennsylvania Perelman School of Medicine, Philadelphia. (ANI)
Patent for cancer treatment
Indian scientist gets U.S. patent for cancer treatment (The Hindu:
27.6.2012)
Nano-particle carries anti-cancer drug and releases it only in the cancerous cell
In what is being considered a path-breaking innovation, a scientist hailing from
Hyderabad and his colleagues have invented a system in which a nano-particle carries the
payload of anti-cancer drug and releases it only in the cancerous cell, thus protecting
healthy cells around.
The cutting-edge research done in the United States has been patented recently.
The nanotechnology scientist, Rao Papineni, told this correspondent on the phone from
the U.S. that the patent application received approval (patent no. US 8,202,544 B2) on
June 19.
Dr. Papineni, chief scientist and senior principal investigator in medical applications of
nanotechnology at Carestream Health, Inc USA, along with his fellow researchers, filed
for the patent in 2009.
“This patent will potentially change the way radiation is administered. It will improve
localisation and monitoring of tumour and will help in highly targeted delivery of drugs
to kill cancer cells,” he said.
Together with Alan Pollack, chairman of the Department of Radiation Oncology,
University of Miami, Dr. Papineni has been exploring the ability of nano-particles as a
targeted drug carrier. “In rough terms, nano-particles are like payload delivery vehicles
that can enhance… damage to cancer tissues and simultaneously reduce the toxicity of
normal and healthy tissues during radiation treatment.”
“The title of the patent is ‘High Capacity Non-Viral Vectors.’ The non-viral vectors are
nano-particles. The nano-particles will allow the drug particle to target the diseased site
with pinpoint precision. The nano-particles will allow the drug to be released inside the
diseased cell. They will enhance the function of the drug… Our nano-particles will carry
the… drug precisely with minimal collateral damage to healthy tissue,” Dr. Papineni said.
Keywords: cancer research Rao Papineni
Brain Cancer
Brain Cancer
Non-Surgical Test for Brain Cancer (Science daily: 19.4.2012)
In a breakthrough for the way brain cancer is diagnosed and monitored, a team of
researchers, lead by Anna M. Krichevsky, PhD, of the Center of Neurologic Diseases at
Brigham and Women's Hospital (BWH), have demonstrated that brain tumors can be
reliably diagnosed and monitored without surgery. Previously, an accurate non-surgical
test to detect brain tumors was unavailable and methods of monitoring a brain tumor's
progression or response to treatment were not reliable.
The results from this pilot study are published in the online edition of Neuro-Oncology.
"We are excited about the potential that this test has to ease the process of detecting and
monitoring brain tumors," said Krichevsky. "The test needs to be further developed
before it is used in a clinical setting, but I expect it could be particularly valuable for
patients who are not surgical candidates due to the tumor's size or location, or due to an
underlying medical condition."
In a study of 118 patients with different types of brain cancers, researchers showed that
microRNA profiling of cerebrospinal fluid can be used to determine the presence of
glioblastoma, the most common and lethal type of brain tumor. The test utilizes
microRNAs, tiny RNA molecules that provide excellent biomarkers for various
conditions, and whose levels can be accurately measured in body fluids simply and
inexpensively. The same process can be used to detect the presence of cancer that started
in another part of the body and spread to the brain, and furthermore, the process can also
be used to monitor the tumor as it is treated.
A patent related to the test is pending. The study was funded by National Institutes of
Health grants [R01CA138734-01A1, K08CA124804, and ARRA 3P30CA023100-25S8,
the Sontag Foundation and the James S. McDonnell Foundation.
Brain Cancer
How Do Brain Cancer Cells Spread? New Study Finds Clues(Medical
Glioblastoma is the most prevalent and deadliest type of brain cancer, and each year
around 10,000 individuals in the U.S. are diagnosed with the disease. Now, researchers
have found a protein that may provide insight into how the disease moves and invades
nearby healthy brain tissue.
In addition, the researchers suggest that a cost-effective FDA-approved drug already on
the market could slow movement of these deadly cancer cells. The study is published
May 1 in the online, open-access journal PloS Biology.
Lead author of the study, Alfredo Quinones-Hinojosa, M.D., an associate professor of
neurosurgery and oncology at the Johns Hopkins University School of Medicine,
explains:
"The biggest challenge in brain cancer is the migration of cancer cells. We can't control
it. If we could catch these cells before they take off into other parts of the brain, we could
make malignant tumors more manageable, and improve life expectancy and quality of
life. This discovery gives us hope and brings us closer to a cure."
According to Quinones, the life expectancy after being diagnosed with glioblastoma is
only 15 months. In addition, surgical cures are virtually impossible as the disease
metastasizes so rapidly and advances in chemotherapy and radiation have been slow.
In order to find ways to prevent or limit the spread of the disease, the team focused on
NKCC1 in human tumor cells in the lab and in tumor cells injected into mice.
NKCC1 is a protein that transports sodium, potassium and chloride ions, together with
water and controls cell volume.
The researchers discovered that NKCC1 makes it easier for cancerous cells to move
through tissue and that tumor cells were able to travel faster and further the more present
the protein was in the glioblastoma cells. In addition, the team found that when NKCC1
was not present, the cells were able to attach themselves to surrounding cells, as they had
larger focal adhesions keeping them more anchored in place. Quinones notes that smaller
focal adhesions made cells more mobile and allowed them to travel further.
According to Quinones, the team was able to slow the migration of tumor cells by
blocking the protein using diuretic bumetanide - a simple water pill commonly used to
reduce fluid retention and swelling. He explains: less mobility means less invasion of
surrounding tissue.
Quinones explains that if the cells were made less invasive it would be easier to
surgically remove the tumors.
Furthermore, the team were able to correlate human tumor grade with levels of the
protein. They found that the less aggressive the tumor, the smaller the amount of NKCC1
present in the cells. This finding indicates that the protein may not only contribute to the
increased invasiveness of tumors, but also serve as a potential marker for diagnosis.
Breast Cancer
Breast Cancer
Link between Inflammation and Breast Cancer Metastases Identified,
May Be Treatable (2.4.2012)
The incidence of breast cancer-associated metastasis was increased in animal models of
the chronic inflammatory condition arthritis, according to results of a preclinical study
presented at the AACR Annual Meeting 2012, held in Chicago March 31 -- April 4. The
results indicate that inflammatory cells known as mast cells play a key role in this
increase and that interfering with mast cells reduces the occurrence of bone and lung
metastases.
"The most devastating aspect of breast cancer is the emergence of tumor cells that grow
to distant organs," said Lopamudra Das Roy, Ph.D., research assistant professor at the
University of North Carolina in Charlotte, N.C. "It has been reported that sites of chronic
inflammation are associated with the establishment and growth of tumor cells."
Prior research conducted by Das Roy established that the incidence of breast cancer
metastasis to the bone and lungs was increased in arthritic mice. Because both breast
cancer and arthritis are prevalent in women, specifically postmenopausal women, the
researchers conducted an additional study using two groups of mice to identify what
might be causing the association between arthritis and breast cancer metastases.
The first group of mice had spontaneous arthritis and was induced to have breast cancer.
The second group of mice had spontaneous breast cancer and was induced to have
arthritis. Because mice in both groups had enhanced numbers of mast cells within the
bone and lung, Das Roy and colleagues focused on understanding how these cells might
influence breast cancer metastasis.
"We found that there were many proinflammatory factors that are upregulated in the
arthritic microenvironment and several of these proinflammatory factors known to
influence metastases are produced by mast cells, which are activated by tumor-derived
stem cell factor (SCF) binding to its receptor c-Kit," Das Roy said.
A subsequent key finding was that SCF/c-Kit signaling was increased in arthritic mice
with breast cancer versus nonarthritic mice with breast cancer. This set the stage for
examining the effects of blocking this signaling.
When the mice were treated with a therapy to target the c-Kit mast cell receptor in
combination with celecoxib (a drug used to treat autoimmune arthritis), the incidence of
breast cancer metastasis to the bone and lung was greatly reduced.
"The clinical implications of this research are huge," Das Roy said. "We already have
data that show that women with breast cancer and arthritis have lower survival as
compared with women with breast cancer and no arthritis. This research indicates that we
may be able to design a therapy to block SCF/c-Kit signaling, which could help reduce
metastases to the bone and lungs."
This research was funded by a postdoctoral grant on behalf of the Fiscal Year 2008
Department of Defense Breast Cancer Research Program.
Breast cancer
'Intimate relationship' between metastatic breast cancer and arthritis
identified (New Kerala: 3.4.2012)
It may be no accident when doctors observe how patients suffering from both breast
cancer and arthritis apparently have more aggressive cancer, a new study including
Indian origin researchers has suggested.
However, the new-found interaction between the two diseases may also suggest a
possible treatment.
A potential relationship between metastatic breast cancer and autoimmune arthritis, as
suggested by past epidemiological studies, has led researchers from the University of
North Carolina at Charlotte to perform a series of mouse model experiments that appear
to confirm the connection.
"Epidemiological studies have implied that breast cancer survival is significantly lower in
patients who also had autoimmune arthritis," noted Pinku Mukherjee, Irwin Belk
Distinguished Scholar of Cancer Research at UNC Charlotte, whose lab conducted the
experiments.
"As there is no obvious reason this should be so, we were interested in exploring possible
cancer mechanisms that might explain why."
The experiments point to an intimate relationship between mast cells – immune system
cells that are located in various tissues and that can cause inflammation – and metastatic
tumours.
In previously published studies, UNC Charlotte cancer researcher Lopamudra Das Roy
and her mentor Mukherjee established that breast cancer associated metastases were
significantly higher in arthritic mice, with a threefold increase in lung metastases and a
twofold increase in bone metastases.
In their most recent work, the researchers found that mast cells and their associated
inflammation are present in larger numbers in the bones and lungs of arthritic mice than
they are in non-arthritic mice.
Their findings point to a relationship between the cKit receptor found on mast cells and
the transmembrane stem cell factor (SCF) ligand found on metastatic breast cancer cells.
The interaction between SCF and cKit appears to play a critical role in facilitating
metastasis.
"We confirmed the relationship we suspected between autoimmune disease and
metastastic breast cancer cells," Mukherjee said.
"This is an exciting result for us because it confirms an interesting interdependence
between cancer metastasis and a specific component of the immune system."
The researchers worked with two strains of mice. The first group had spontaneous
arthritis (SKG mice) and the second group of mice had spontaneous breast cancer
(MMTV-PyV MT mice).
Each of the mouse strains were artificially induced to develop the other disease and then
tested for differences.
Among the findings of the analysis was that the population of mast cells within bone and
lung microenvironment was significantly higher in those mice with arthritis and breast
cancer vs. those without arthritis and breast cancer.
The differentiation of mast cells from bone marrow derived stem cells was also
significantly higher in the arthritic versus the non-arthritic tumour-bearing mice.
Mast cells are the only "terminally differentiated" (mature) cells in the body that develop,
like blood cells, from stem cells in the bone marrow and that also have a c-Kit receptor.
Suspecting a relationship between the c-Kit receptor on the mast cells and the SCF ligand
expressed by the metastatic cancer cells, the researchers tested the effect of blocking
receptor by treating the mice with an anti-c-Kit receptor antibody and celecoxib, an antiinflammatory medication.
"When the mice were treated with a therapy to target the c-Kit mast cell receptor in
combination with celecoxib -- a drug used to treat autoimmune arthritis -- the incidence
of breast cancer metastasis to the bone and lung was greatly reduced," Das Roy noted.
The researchers concluded that in an arthritic condition, SCF expression in metastatic
breast cancer cells induces the differentiation of mast cells from bone marrow through
SCF/CKit signalling.
Mast cells, in turn, facilitate the efficient metastasis of the breast cancer cells in bone and
lung tissue. Autoimmune arthritis disease increases the intensity of metastatic breast
cancer because bone marrow stem cells in autoimmune arthritis victims have greater
potential to develop into mast cells. (ANI)
Mammography
Mammography out? New blood test can spot breast cancer (The Times
of India: 13.4.2012
Toronto: Scientists are one step closer to developing a blood test that could accurately
detect breast cancer at very early stages, a breakthrough they say could one day make
mammography screening obsolete.
A team at the McGill University in Canada said they have made improvements to the
existing technology while discovering a biomarker “signature” for a common subtype of
breast
cancer
—
which
is
estrogen
receptor-positive.
They sampled the blood of a group of healthy people and breast cancer patients. They
then measured the concentration of 32 proteins in the blood samples.
Using the latest in microarray technology, the team found that out of the 32 proteins, six
could be used to establish a signature for the hormone receptor-positive cancer.
David Juncker, who led the study, said, “Mammography is slow and expensive, and it's
uncomfortable. So, here the idea is you could do a test in a droplet of blood, and it could
be
more
accurate
than
a
mammograph.”
“From this small study we cannot really make the claim, but the hope is that this could
become more accurate,” Juncker said . Mammography does not work well for women
with dense breasts and thus many young and African-American women are actually not
well served by the screening. “So this test could be complementary and more sensitive,”
Juncker
said.
Scientists had identified a protein biomarker more than 40 years ago. However, the
antigen is also found in healthy people, and cannot be used to detect cancer. PTI
Breast Cancer
New Breast Cancer Rehabilitation Model (Med India: 17.4.2012)
An innovative model that address a wide range of physical issues faced by women with
breast cancer has been developed by researchers and is reported in the journal Cancer. A
panel of experts proposes a prospective surveillance model (PSM) that could reduce the
incidence and severity of breast cancer treatment-related physical impairments. The
model was developed over the past year by a panel of internationally known experts, with
the support of the American Cancer Society and input from national healthcare
professional organizations and advocacy groups.
The supplement says the current model of care for people with breast cancer focuses on
treatment of the disease, followed by ongoing surveillance to detect recurrence. That
approach, says the supplement, lacks attention to patients' physical and functional wellbeing. Breast cancer patients experience common impairments including pain, fatigue,
upper extremity dysfunction, lymphedema, weakness, joint arthralgia, neuropathy, weight
gain, cardiovascular effects, and osteoporosis. And even when these impairments lead to
functional limitation, rehabilitation referral is lacking.
The supplement points to evidence that supports the implementation of a prospective
surveillance model for early identification and treatment of physical impairments that
may prevent or mitigate many of these functional concerns as well as provide a venue to
point patients towards exercise and other health promoting activities. The goals of the
model are to promote surveillance for common breast cancer-related physical
impairments and functional limitations, to provide education to facilitate early
identification of impairments, to introduce rehabilitation and exercise intervention when
physical impairments are identified, and to promote and support physical activity and
exercise behaviors through the trajectory of disease treatment and survivorship.
The PSM is ultimately coordinated with disease treatment from diagnosis through followup to create a more comprehensive, multi-disciplinary approach to survivorship care. The
purpose of the supplement is to invite consideration of the model as a means to achieve
reduced impairment, improved function, and increased participation in exercise.
Breast Cancer
Breast Cancer Is 10 Diseases Says Landmark Study ((Medical News
Today: 20.4.2012)
Breast cancer is at least 10 different diseases, each with its own genetic signature and
pattern of weak spots, according to a new landmark study that promises to revolutionize
diagnosis and prognosis, and pave the way for individualized, tailored treatment.
The study group, METABRIC (Molecular Taxonomy of Breast Cancer International
Consortium), reports its findings in the 18 April online issue of Nature.
The Cancer Research UK-funded study is the largest global gene study of breast cancer
tissue ever conducted, involving a large team of researchers, primarily in the UK and
Canada.
Led by Professor Carlos Caldas from Cancer Research UK's Cambridge Research
Institute and Professor Sam Aparicio from the British Columbia Cancer Centre in
Canada, the team uncovered crucial new information about breast cancer.
The researchers analyzed the DNA and RNA of breast tumor samples from nearly 2,000
women who had been diagnosed between five and 10 years ago, and for whom
information about the tumor characteristics had been meticulously recorded.
They compared this with the women's survival, and other information, like their age at
diagnosis.
Because the study was able to look at many tumors with rich data on each, it identified
new patterns and "clusters" in the data not spotted before.
In the study, the team classified breast cancer into at least 10 different subtypes: each
characterized by common genetic features that link to survival.
Breast cancer
‘Breast cancer is actually 10 different diseases’ (The Times of India:
20.4.2012)
Classification As Per Genetic Study To Revolutionize Treatment By Tailoring Drugs For
Exact Subtype
London: Breast cancer is “not one disease, but 10 different diseases”, according to a
‘landmark study’ that could revolutionize its treatment.
An international team of researchers that analysed breast cancers from 2,000 women
said the classifications could help improve treatment by tailoring drugs for patients’ exact
type of breast cancer and also predict survival more accurately. It will take at least three
more years for the findings to be used in hospitals, the researchers said.
In the study, published in the journal Nature, the team analysed genetics of frozen
breast cancer samples from 2,000 women at hospitals in the UK and Canada. They
looked in huge detail at the genetics of the tumour cells — which genes had been
mutated, which genes were working in overdrive, which were being shut down.
They found that all the different ways the cells changed when cancerous could be
grouped into 10 different categories, named IntClust one to 10. Each tumour within a
particular group shares similar genes and different women with the same type have
similar odds of survival.
“Breast cancer is not one disease, but 10 different diseases,” lead researcher professor
Carlos Caldas, was quoted as saying by the BBC News.
He added, “Our results will pave the way for doctors in the future to diagnose the type
of breast cancer a woman has, the types of drugs that will work and those that won’t, in a
much more precise manner than is currently possible.”
At the moment, breast cancers are classified by what they look like under the
microscope and tests for “markers” on the tumours. Those with “oestrogen receptors”
should respond to hormone therapies, while those with a “Her2 receptor” can be treated
with Herceptin.
The vast majority of breast cancers, over 70%, should respond to hormone therapies.
However, their reaction to treatment varies wildly. “Some do well, some do horribly.
Clearly we need better classification,” said Caldas.
Dr Harpal Singh, of Cancer Research UK that funded the study, said, “This study will
change the way we look at breast cancer, it will have an enormous impact in diagnosing
and treating breast cancer.”
He added the charity would begin using the new criteria in clinical trials it funded.
Outside of trials for new cancer drugs, the new breast cancer rulebook could take some
time to directly benefit patients. PTI
Breast cancer
Letting go of old goals can boost quality of life for breast cancer
survivors (New Kerala: 25.4.2012)
Breast cancer survivors who were able to let go of old goals and set new ones showed an
improved well-being overall, researchers have found.
Once the self-imposed pressure of now unrealistic goals was removed, individuals'
quality of life improved, as did their level of physical activity.
Carsten Wrosch of Concordia University's Department of Psychology and Centre for
Research in Human Development and Catherine Sabiston of McGill's Department of
Kinesiology and Physical Education and the Health Behaviour and Emotion Lab were
interested in looking at how to encourage breast cancer survivors to become more active.
Statistics show that as many as 48 per cent of breast cancer survivors are overweight or
obese. They also tend to be more sedentary than women who have not been diagnosed
with breast cancer.
The researchers studied 176 breast cancer survivors between the ages of 28 and 79, who
were, on average, approximately 11 months past their diagnosis and close to three months
post treatment.
Self-reports of the individual's capacity to adjust their goals were measured at the start of
the study. At the same time, researchers also measured self-reports of physical activity,
sedentary activity, emotional well-being, and daily physical symptoms such as nausea
and pain.
Three months later, they took a look at another round of self-reports. The study found
that goal reengagement (being able to set new goals) was associated with more physical
activity, increased emotional well-being and fewer physical symptoms.
In addition, breast cancer survivors who were able to let go of old goals and to find new
ones were less sedentary, which contributed to an improved well-being. These findings
support earlier research showing that goal adjustment can influence better well-being and
health.
"By engaging in new goals a person can reduce the distress that arises from the desire to
attain the unattainable, while continuing to derive a sense of purpose in life by finding
other pursuits of value," said Wrosch.
"Abandoning old goals allows someone to invest sufficient time and energy in effectively
addressing their new realities," he added.
Recent guidelines have suggested that breast cancer survivors should engage in at least
150 minutes of moderate to vigorous-intensity physical activity every week to gain health
benefits.
"It is safe, feasible and effective for enhancing well-being and health among breast
cancer survivors. Unfortunately, few survivors are engaging in the recommended levels
of activity," noted Sabiston.
Wrosch continued "Our research reveals that the capacity to adjust goals plays a pivotal
role in facilitating not only high physical activity but also low sedentary activity and
thereby contributing to overall improved well-being."
"Given that it is possible to influence adjustment to specific goals; it may be beneficial to
integrate goal adjustment processes into clinical practice," he added.
The study results have been published in Psycho-Oncology. (ANI)
Breast cancer
Curing non-palpable breast cancer (The Tribune: 2.5.2012)
Breast cancer [BC] is either palpable when the woman presents with a breast complaint
or a mass is palpable at physical breast examination by a healthcare provider. Cancer
detected on screening mammography is non-palpable and usually asymptomatic. The
incidence of incidental non-palpable breast cancer is progressively increasing. Nearly
20% to 35% of breast cancer cases are treated when non-palpable at oncology centeres.
In a study from Netherlands, with a well-established screening programme, of all the
suspicious non-palpable breast lesions, 10%-55% turned out to be malignant. Screening
programmes play an important role in detecting BC early.
Screen-detected cancers are smaller than the palpable cancers, are less likely to be
advanced and not having spread to lymph nodes. In women with a palpable lump, the size
of the tumour is significantly larger than cancer detected by mammography.
Most of the non-palpable tumours are detected by mammogram. Mammography is the
most effective modality used for breast cancer screening and detection. On mammogram
one sees microcalcification, abnormal opacity or abnormal density, or a combination of
these. Nearly 10% of non-palpable cancers are detected on ultrasound examination. The
size of the mass detected on imaging study may vary from 6mm to 10mm and appear
somewhat irregular in shape. Non-palpable cancer can be effectively detected in the US
and the diagnosis can be confirmed by US-guided biopsy.
Widespread use of screening programmes and diagnostic breast imaging [CT, MRI]
identify these non-palpable breast cancers that eventually require surgical excision for
definitive diagnosis and treatment. PET scan may detect a cancer as small as 4mm which
has been missed on mammography, ultrasound and MRI.
A histopathological examination is required to establish the correct diagnosis of cancer.
Image-guided fine needle aspiration cytology [FNAC], core needle biopsy, the advanced
breast biopsy instrumentation system[ABBI] and vacuum-assisted core biopsy[VACB]
represent alternatives to surgical biopsy for correct identification of cancer.Percutaneous
image-guided biopsy is faster, less invasive and less deforming than surgical biopsy for
diagnosing non-palpable lesions.
Non-palpable tumours are difficult to discern at surgery. A localised procedure is thus
required to enable intraoperative identification and surgical resection. Various procedures
are in practice for localisation of non-palpable lesions. The hook wire localisation [HWL]
has been the gold standard for intraoperative localisation. The radiologist inserts a fine
guide wire to the site of the lesion and the surgeon excises the lesion with the help of the
guide wire to locate the site of biopsy. Specimen mammography is subsequently done to
confirm the presence of the lesion. The problems with wire localization are discomfort,
wire displacement, or even dislodgement. Positive margin rates after wire localisation are
high leading to re-operation or an increased risk of local recurrence.
Radio-guided occult lesion localisation [ROLL] : This enables radio-guided surgery to
identify the occult lesion and perform immediate breast resection with good and safe
margin of normal tissue. A radioactive isotope is injected into or around the tumour under
radiological guidance. A hand-held gamma probe is used to locate the breast lesion and
guide the excision. A specimen mammogram or ultrasound is done to ensure that the
breast lesion has been excised with adequate margin. The advantages of this procedure
are that there is no patient discomfort and the localisation process is easier.
Clinically, occult [non-palpable] cancers which are not palpable and discovered only with
mammography, ultrasound or MRI show a high survival rate. A 98.6% five-year overall
survival is reported. Women with palpable tumours have a large tumour and of a more
advanced stage at presentation. They also have worse cancer-specific survival than those
with mammographically detected cancers. Most of the non-palpable breast cancers are
early cancers.
The writer, a former Professor and Head, Department of General Surgery, PGI,
Chandigarh, is at presented associated with Fortis Hospital, Mohali
Breast Cancer
Spotting Breast Cancer Risk Years before It Occurs (Medical News
Today: 3.5.2012)
Scientists from Imperial College London say that women with very high levels of
methylation in an area of a gene, known as ATM, had double the risk of going on to
develop breast cancer, compared to those without the faulty gene.
Their study, which has been published in the journal Cancer Research, found that a
woman's risk of breast cancer may be decided several years before the disease develops.
Dr James Flanagan say he has uncovered compelling evidence that "epigenetic" gene
changes may be linked with breast cancer risk.
Flanagan and team examined 640 women with breast cancer and 741 women without
(controls) who enrolled in the previous three months. The earliest enrollee joined in 1992.
Women donated blood samples every three years before their breast cancer was
diagnosed. The aim was to determine whether methylation could predict future cancer
risk in women. Methylation is a process by which a single gene undergoes alteration.
Those with the highest level of methylation in a gene area called ATM were found to
have double the risk of developing breast cancer later on, compared to women with the
lowest levels. The link to subsequent breast cancer risk was more evident among women
aged under 60 years.
This is the first study to examine blood at least three years before a cancer diagnosis was
made - in the cases of some participants, blood had been sampled eleven years
beforehand. This study shows, because of this, that it is not the active cancer in the body
or cancer treatment that necessarily alter the genes.
The scientists believe that blood tests could be devised which focus on methylation in
single genes to assess breast cancer risk. The test could be used alongside other tools,
such as risk-factor profiling and genetic testing.
The authors emphasized that their test now needs to be confirmed with rigorous testing in
a much larger number of participants and a wider gene range profiled - just one gene is
not enough.
Epigenetics is altering the way researchers think about genes and how they develop. The
authors believe epigenetics could eventually play a vital role in preventing cancer.
Experts used to think that cancer risk, when talking about genes, had to be in the
fundamental genetic data from our DNA. We now know that chemical modifications to
DNA, which control our genes, might play an even greater role that DNA alone in
determining how our cells grow.
Dr Flanagan explained:
"We know that genetic variation contributes to a person's risk of disease. With this new
study we can now also say that epigenetic variation, or differences in how genes are
modified, also has a role.
We hope that this research is just the beginning of our understanding about the epigenetic
component of breast cancer risk and in the coming years we hope to find many more
examples of genes that contribute to a person's risk. The challenge will be how to
incorporate all of this new information into the computer models that are currently used
for individual risk prediction.
So far we have found alterations in one small region of a gene that appear to associate
with risk of disease and so the next step with this epigenetic research is a genome wide
approach to try and find all the associated genes."
Baroness Delyth Morgan, Chief Executive of Breast Cancer Campaign said:
"Dr Flanagan's research into epigenetics is so exciting because it suggests that there is
every possibility that the risk of developing breast cancer could be decided many decades
in advance. By piecing together how this happens, we can look at ways of preventing the
disease and detecting it earlier to give people the best possible chance of survival."
In an Abstract in the journal, Cancer Research, the authors concluded:
Breast cancer
Family history no clue to risk of breast cancer (The Times of
India:4.5.2012)
No family history of breast cancer should not make Indian women aged 40-49 to stop
yearly screening the disease.
More than half the women aged 40-49 diagnosed with breast cancer on screening
mammography report no family history, a new study shows. The study, conducted at
Rochester of all breast cancers diagnosed between 2000 and 2010, found that 228 out of
373 cancers (61%) were found in women, aged 40-49 with no family history of breast
cancer.
“Out of 211 women we looked at finally in this study, 135 (64%) who did not have a
prior personal history of breast cancer or abnormal cells and had no family history of
breast cancer, had the disease,” said Stamatia Destounis, study’s lead author.
Screening mammography rate in India is abysmally low. WHO’s latest World Health
Statistics (WHS) said less than 5% women, aged 50-69 years, underwent screening by
mammography in India between 2000-2003.
Among women, breast cancer is the most common cause of cancer mortality,
accounting for 16% of cancer deaths globally. “Less than a quarter of women globally
undergo breast cancer screening. In India, breast cancer is the most common form of
cancer in women. One in 26 women in India are expected to be diagnosed with breast
cancer in their lifetime,” WHO said.
Dr Bhavana Sirohi, breast cancer specialist said screening should actually start from
age 45 on Indian women. “Indian women attain menopause five years before the women
in the West making the former more susceptible. That’s why women in Indian should be
screened from age 45.”
Breast cancer
Molecule that inhibits estrogen, key risk factor for endometrial and
breast cancer found (new Kerala: 11.5.2012)
Researchers at Albert Einstein College of Medicine of Yeshiva University have
discovered a molecule that could lead to new therapies for preventing and treating
endometrial and breast cancer and other estrogen-related diseases in hum
The molecule, discovered in animal studies, inhibits the action of estrogen.
This female hormone plays a key role in the growth, maintenance and repair of
reproductive tissues, and fuels the development of endometrial and breast cancers.
The hormones estradiol (the most important form of estrogen) and progesterone prepare
the uterus for pregnancy. They trigger a series of cell proliferation and cell differentiation
events that prepare the uterine lining (endometrium) for implantation of a fertilized egg.
Although this process is tightly controlled, uterine cells sometimes proliferate
abnormally, leading to menstrual irregularities, endometrial polyps, endometriosis, or
endometrial cancer - the most common female genital tract malignancy, causing six
percent of cancer deaths among women in the U.S. and a higher proportion worldwide.
'The molecular mechanisms that underlie these pathologies are still obscure - and so are
the mechanisms involved in normal hormonal regulation of cell proliferation in the
endometrium, which is essential for successful pregnancy,' said lead author Jeffrey
Pollard, Ph.D., professor of developmental and molecular biology and of obstetrics and
gynecology and women's health at Einstein.
He also holds the Louis Goldstein Swan Chair in Women's Cancer Research and is the
deputy director of the Albert Einstein Cancer Center.
In studies involving rodents, Dr. Pollard discovered that a molecule called KLF15
(Kruppel-like transcription factor-15) controls the actions of estradiol and progesterone in
the endometrium by inhibiting the production MCM2, a protein involved in DNA
synthesis.
'Our findings raise the possibility that it may be feasible to prevent or treat endometrial
and breast cancer and other diseases related to estrogen by promoting the action of
KLF15,' said Dr. Pollard.
The findings were published online last month in the PNAS Plus. (ANI)
Breast Cancer
Chemical found in celery, parsly effective against breast cancer (New
Kerala:18 May 2012)
Apigenin, a natural substance found in grocery store produce aisles, shows promise as a
non-toxic treatment for an aggressive form of human breast cancer, a new study has
revealed.
University of Missouri researchers found apigenin shrank a type of breast cancer tumor
that is stimulated by progestin, a synthetic hormone given to women to ease symptoms
related to menopause.
"This is the first study to show that apigenin, which can be extracted from celery, parsley
and many other natural sources, is effective against human breast cancer cells that had
been influenced by a certain chemical used in hormone replacement therapy," said coauthor Salman Hyder, the Zalk Endowed Professor in Tumor Angiogenesis and professor
of biomedical sciences in the College of Veterinary Medicine and the Dalton
Cardiovascular Research Center.
In the study, Hyder and his colleagues implanted cells of a deadly, fast-growing human
breast cancer, known as BT-474, into a specialized breed of mouse. Some of the mice
were then treated with medroxyprogesterone acetate (MPA), a type of progestin
commonly given to post-menopausal women. A control group did not receive MPA.
Later one group of MPA-treated mice was treated with apigenin. Cancerous tumors grew
rapidly in the mice, which did not receive apigenin. In the apigenin-treated mice, breast
cancer cell growth dropped to that of the control group, and the tumors shrank.
"We don't know exactly how apigenin does this on a chemical level," Hyder said.
"We do know that apigenin slowed the progression of human breast cancer cells in three
ways: by inducing cell death, by inhibiting cell proliferation, and by reducing expression
of a gene associated with cancer growth. Blood vessels responsible for feeding cancer
cells also had smaller diameters in apigenin-treated mice compared to untreated mice.
Smaller vessels mean restricted nutrient flow to the tumors and may have served to starve
the cancer as well as limiting its ability to spread," he stated.
The mice in Hyder's study were injected with apigenin. In the future, apigenin injections
could be a safe alternative or supplement to the highly toxic chemotherapy drugs now in
use.
"Chemotherapy drugs cause hair-loss, extreme fatigue and other side effects. Apigenin
has shown no toxic side-effects even at high dosages. People have eaten it since prehistory in fruits and vegetables," Hyder explained.
Finding funding for clinical testing of apigenin in humans may be difficult, according to
Hyder.
"Clinical trials of apigenin with humans could start tomorrow, but we have to wait for
medical doctors to carry out that next step," Hyder said.
"One problem is, because apigenin doesn't have a known specific target in the cancer cell,
funding agencies have been reticent to support the research. Also, since apigenin is easily
extracted from plants, pharmaceutical companies don't stand to profit from the treatment;
hence the industry won't put money into studying something you can grow in your
garden."
The research was recently published online in the journal Hormones and Cancer. (ANI)
Breast Cancer
Untangling the Development of Breast Cancer: Evolution of 21 Breast
Cancers (Science Daily:18 May 2012)
The team created a catalogue of all the mutations in the genomes of the 21 breast cancer
genomes. They identified entirely new mutational processes that drive breast cancer
development, including one remarkable process defined by localised regions of
hypermutation found in most of the breast cancers. This phenomenon has never been seen
before. They also found that, once many mutations have accumulated in a cell, the cell
then diverges into different subgroups, one of which is destined to become the
aggressive, dominant, breast cancer tumour. These findings have implications for our
understanding of how breast cancers develop over the decades before diagnosis in adults.
In two back-to-back reports published online on 17 May in Cell, researchers have
sequenced the genomes of 21 breast cancers and analysed the mutations that emerged
during the tumours' development. The individual results are described below.
Led by researchers from the Wellcome Trust Sanger Institute, the team created a
catalogue of all the mutations in the genomes of the 21 cancer genomes and identified the
mutational processes that lead to breast cancer. They found that these mutations
accumulate in breast cells over many years, initially rather slowly, but picking up more
and more momentum as the genetic damage builds up.
By the time the breast cancers are large enough to be diagnosed, they are made up of a
number of genetically related families of cells, with one such family always dominating
the cancer.
All cancers are caused by mutations, called somatic mutations, acquired throughout a
person's lifetime in the DNA of initially normal cells. Little is known about the processes
that underlie the development of many somatic mutation patters. These studies delve
more deeply into the evolution of breast cancers, discovering a number of new mutation
processes that can cause many thousands of mutations in a tumour, and drive its
development.
Nearly 1.5 million people are diagnosed with breast cancer each year in the world. The
UK and the USA have the highest rates of incidence in the world, making these countries
a priority for breast cancer awareness. Breast cancer is the most common cause of all
deaths in women aged over 40 and is the second biggest cause of death from cancer for
women in the USA and the UK.
"To be able to deal with breast cancer in the most effective way, we need to understand
fully the processes that cause it," explains Dr Peter Campbell, Head of Cancer Genetics
and Genomics from the Wellcome Trust Sanger Institute. "Whole genome sequencing
from cancers is not a new concept, but this is the first time that we've been able to delve
fully into breast cancer genomes in such a thorough way. This has given us a full
panoramic view of the cancer genome and has allowed us to identify mutational patterns
rather than individual mutations in specific genes."
To determine the processes that underlie breast cancer, the team catalogued all the
mutations that had arisen in the 21 breast cancers. One of the processes they found was
characterized by pockets of massively mutated regions in the genome. This sudden
'downpour' of mutations is frequently seen in breast cancers. The team called this
phenomenon, which has never been seen before, kataegis after the Greek for
thunderstorm.
The team found that different mutational processes act at different times in the lifespan of
a breast tumour. Some mutational processes act throughout the evolution of the cancer
and some processes only emerge late on in the development of the cancer. One particular
mutational signature was indicative of a form of inherited breast cancer, and is linked to
an inability to correctly repair breaks in DNA.
"These findings have implications for our understanding of how breast cancers develop
over the decades before diagnosis in adults and might help to find possible targets for
improved diagnosis or therapeutic intervention in the future," says Professor Mike
Stratton, author and Director of the Wellcome Trust Sanger Institute. "Harnessing the
power of whole genome sequencing, we were able to access the entire genome rather
than focusing on mutations in specific regions."
Similar analyses will be undertaken in 1000s of cancer genomes, under the full
programme of the International Cancer Genome Consortium, and the team expect many
more mutational processes will be defined along the way.
"We are used to thinking about Darwinian evolution of species by natural selection taking
place over centuries and millennia. But in cancer and infectious disease similar processes
can be observed over much shorter periods," says Sir Mark Walport, Director of the
Wellcome Trust. "These studies, which follow from the human genome project, are
untangling the evolutionary processes that eventually lead to breast cancer, in a way that
would have been impossible only a few years ago.
"We are starting to see the landscape of mutation that characterises this disease in
something approaching its full complexity for the first time. As this work continues, we
can hope to understand how breast cancer develops and thus how it might be treated more
effectively."
Mutational processes behind 21 breast cancers:
The team found almost 200,000 mutations in the genomes of the 21 breast cancers. By
examining the mutations from each cancer, they could discern different patterns of
mutation, which appear to represent traces of past mutational mechanisms that have acted
on the genomes of individual cells during the life of the patient. These traces are like
archaeological imprints left in the DNA of the cancer cell by mutational processes which
could have been active many years before the cancer came to attention. Previously, there
was little, if any, knowledge about most of these processes and the 21 breast cancer
samples seem to have been assaulted by different combinations of them.
"What emerges is a really complex landscape of mutation, where each cancer seems to
have been generated by a different combination of mutation processes," says Professor
Mike Stratton.
"In our analyses, we have excavated these cancer genomes, in a similar manner to an
archaeological dig, and uncovered patterns of mutation that had never been seen before.
We do not know for sure what the underlying biological mechanisms causing these
mutation patterns are. However, we suspect certain processes in normal cells that
generate mutations have been overactive and simply caused too many mutations, hence
leading to cancer.
"We do not think that these mutation patterns are due to external exposures like tobacco
smoke or sunlight, which are known to cause mutations and cancer, but more likely are
due to defective internal cellular machinery. However, further work needs to be
conducted to confirm this view."
One of the novel mutation mechanisms is a remarkable process that leads to large
numbers of mutations in small regions of the genome. The authors call this "kataegis‟
(from the Greek for thunderstorm): although never described before, kataegis was
remarkably common occurring, to some extent, in the genomes of 13 of the 21 breast
cancers. The dense bursts of mutations in each patch of kataegis are likely to have
occurred at one point in time rather than accumulated in a step-wise fashion over the
lifetime of the cancer.
"In kataegis, a large number substitution mutations occur very close together in the
genome," says Dr Serena Nik-Zainal, first author from the Wellcome Trust Sanger
Institute. "They show a distinguishing mutational motif and frequently co-occur with
large-scale rearrangements: it is a unique mutational pattern.
"We expect that this phenomenon is not restricted to breast cancer and might operate in
other cancers. Current sequencing technologies allow us to make these discoveries which
were hidden from us before. "
The pattern of mutations in kataegis is highly distinctive, and the team speculate that
there is a relationship between kataegis and a protein family, APOBEC. Members of this
family can induce similar mutational changes in experimental systems and are thought to
play a role in defence against viruses.
The mutational processes identified by the researchers allowed them to distinguish
cancers from women with known BRCA1 and BRCA2 mutations from other, more
common or sporadic, breast cancers. The team speculate that these distinguishing
mutational patterns might be present in other types of cancer and could help to predict
response to treatments such as PARP inhibitors to which BRCA1/BRCA2 cancers are
particularly sensitive.
Life history of 21 breast cancers
"We wanted to see if we could decipher this history encrypted in the genome of each of
the cancers," explains Dr Peter Campbell. "All cancers are made up of a collection of
families of cells. Whole genome sequences reveal the genetic record of their emergence
over time and allow us to trace the divergence of a cell to form the different families."
As cells divide and multiply, mutations accumulate naturally: the team found that, as
these mutations accumulate in a cell, the changes drive divergence of the cancer into
different subgroups or clones. The scientists showed that emergence of different clones
was universal in the breast cancers they examined.
They also showed that one sub-clone becomes the dominant population of cancer cells.
This dominant sub-clone accounts for more than 50 per cent of tumour cells in all of the
breast cancers analysed, and it is only when this sub-clone has grown sufficiently
populous that the tumour becomes clinically detectable. It differs from the other clones
present in a tumour by many hundreds to thousands of mutations, indicating that this final
stage in a cancer's emergence may take quite some time.
"We undertook a deep excavation of the tumour DNA," says Dr Serena Nik-Zainal,
"revealing for the first time the fine structure of breast cancer genomes. We took all this
data and integrated it to build an evolutionary tree of the cancers.
"This method allowed us to determine when divergence occurs, what processes are
involved in the different stages of cancer evolution and the proportion of each sub-clone
present in the tumours."
The team found that some mutational processes act throughout the evolution of the
cancer and some processes are present only quite late in the development of the cancer
once divergence has occurred.
For example, four of the cancers had many extra copies of the gene that is the target of
the Herceptin drug. The team found that the first few extra copies of the gene were
gained very early in the development of the breast cancer, but it took the cancer a much
longer period of time than expected to accumulate all of the extra 20-30 copies.
"Current cancer treatments do not take sub-clonal diversity into account and often target
only the dominant sub-clone," explains Professor Mike Stratton. "This leaves the
possibility that one of the minor sub-clones will then replicate and become dominant,
leading to re-occurrence of the tumour.
"Understanding sub-clonal diversity in breast cancer is a pivotal part of treating this
destructive cancer in the most efficient way. This study forms the basis to identify subclones both minor and dominant."
These findings have significant implications for our understanding of how breast cancers
develop over the decades prior to diagnosis. The next step for this research is to sequence
more genomes and cancer types, and also to refine current methods.
Breast Cancer
HDAC Inhibitor Successfully Targets and Destroys Triple Negative
Breast Cancer (New Kerala: 22.5.2012)
A new study published in the journal Breast Cancer Research reveals that using histone
de-acetylase (HDAC) inhibitor panobinostat can target and destroy triple negative breast
cancer.
Researchers from Tulane University Health Sciences Center have shown that
panobinostat was able to destroy breast cancer cells and reduce tumor growth in mice.
Approximately 15% of breast cancers are found at diagnosis to be triple negative. These
aggressive tumours are missing both the estrogen receptor and progesterone receptor,
which means that they do not respond to hormonal therapies such as antiestrogens or
aromatase inhibitors. They also test negative for the growth factor receptor HER2 and
cannot be treated with monoclonal therapy such as Herceptin, so there is a desperate need
for treatment options to complement surgery and chemotherapy.
Whether DNA is active or not in cells is tightly controlled. DNA in the nucleus is wound
around histones and effectively shut down. When a gene is required the cell acetylates the
histone, relaxing the tight control over DNA and allowing the cells machinery access to
the gene, eventually leading to protein production.
HDACs have the opposite effect and reduce DNA activity. Aberrant HDACs are possibly
responsible for the lack of production of normal cellular controls which allow the
uncontrolled growth of cancer cells. The researchers from New Orleans hoped that by
blocking HDACs they could restore normal cell function.
The HDAC inhibitor panobinostat was able to increase histone acetylation in triple
negative breast cancer cell lines. There was also a concurrent decrease in cell division
and increase in apoptosis (programmed cell death). Additionally, a marked increase in the
epithelial cell marker E-cadherin was observed, indicative of a less aggressive cell type.
Dr. Bridgette Collins-Burow, who led the study, described the results, "Panobinostat
selectively targeted triple negative breast cancer cells and decreased tumor growth in
mice. It was also able to partially reverse the morphological changes in cells to a more
epithelial type. These results show a potential therapeutic role for HDAC inhibitors,
especially panobinostat, in targeting the aggressive triple negative breast cancer."
Breast cancer
Botanical formula 'may slow down breast cancer metastasis'(New
Kerala; 28.5.2012)
Modified Citrus Pectin (MCP), a highly researched natural compound, can boost the anticancer effects of two poly-botanical formulas, according to a new study.
It was found that when co-administered with formulas that attack breast and prostate
cancer, MCP significantly increased their anti-cancer action, further cutting down the
metastasis in highly invasive breast and prostate cancer cells.
The study was led by researchers at the Cancer Research Laboratory at Indiana
University Health and Indiana University School of Medicine.
'We asked a simple question of whether one plus one can equal more than two,' said lead
investigator Dr. Daniel Sliva, associate professor at the Indiana University School of
Medicine.
'We know that certain molecules in cancer cells are responsible for their aggressive
behavior. The synergistic effects seen in this study show that we can further suppress
these molecules and significantly reduce the cancer cells' aggressiveness,' said Sliva.
In the study, low concentrations of the anti-breast cancer formula reduced breast cancer
cell adhesion to human fibronectin by 21 percent.
However, when co-administered with Modified Citrus Pectin, researchers observed a 40
percent decrease in the malignant cells.
In addition, the anti-prostate cancer formula, when administered alone, reduced prostate
cancer cell adhesion by 9 percent.
And when MCP was added, adhesion was suppressed by up to 40 percent.
The study also showed that cancer cell migration was also decreased by combining MCP
with the prostate and breast formulas.
'This new study is particularly important because it demonstrates that when MCP is
combined with either the prostate or breast formula, lower dosages provided more
powerful synergistic anti-cancer effects than were observed when these supplements were
studied on their own,' added Dr. Isaac Eliaz, co-author and formulator.
This study has been published in the peer review journal Integrative Cancer Therapies.
(ANI)
Breast cancer
Night shifts raise risk of breast cancer in women’ (The Times of India:
30.5.2012)
London: Women who regularly work into the early hours can be nearly four times as
likely
to
develop
breast
cancer,
scientist
have
warned.
The risk is highest among women who are naturally early risers. But even night owls are
in danger. The threat rose with the more night shifts they did, the study found. And
overall there was a 40% bigger risk compared to women who worked days.
“The results indicate frequent night shift work increases the risk for breast cancer and
suggest a higher risk with longer duration of night shift,” the Mirror quoted Dr Johnni
Hansen, of the Danish Cancer Society that did the study, as saying.
“Those with morning preference tended to have a higher risk than those with evening
preference,” Dr Hansen stated. Women who worked nights three or more times a week
for over six years were more than twice as likely to have the disease as those who had
not.
The risk almost quadrupled if they were early bird types — possibly because they are
more
susceptible
to
body
clock
disruption,
said
the
study.
Night owls were twice as likely to have breast cancer, according to the findings published
online in Occupational and Environmental Medicine. The results were based on 692
responses, of which 141 were from women with the disease. . AN
Breast Cancer
Blood Test in Early Stage Breast Cancer May Predict Recurrence And
Survival (Medical News Today: 7 June 2012)
Testing the blood of early stage breast cancer patients for circulating tumor cells (CTCs)
may predict their chance for recurrence and survival, and help identify which ones may
need additional treatment, according to a new study published on Wednesday. However,
the findings need to be confirmed by larger trials before such a method can be considered
for clinical use.
Writing about their findings in an early online issue of The Lancet Oncology, researchers
from The University of Texas MD Anderson Cancer Center note that, thanks partly to
research they had done before, we already know the presence of CTCs in the blood
correlates with a poor prognosis once breast cancer has spread to other parts of the body
(metastatic breast cancer).
Now their latest study, one of the first and largest of its kind, shows CTCs may have a
similar predictive value in the early stages of the disease.
Many patients who have treatment for early stage breast cancer that has not spread, have
the tumor and lymph nodes surgically removed and then undergo chemotherapy and
radiotherapy to remove all traces of the disease.
But, around two years later, a peak time for recurrence, says first author Anthony Lucci,
professor in MD Anderson's Department of Surgical Oncology, around one third of these
patients will experience a return of the cancer in another part of the body.
Lucci told the press, "we wanted to understand why".
He said they found that "cancer cells can break free of the primary tumor very early on,
and even the earliest stage cancers can shed these dangerous cells."
"We can now reliably detect circulating tumor cells in 25 percent of non-metastatic breast
cancer patients with no evidence of disease, and know that their risk of recurring or dying
is around four times higher than those without these cells in their blood circulation," said
Lucci.
In their background notes, the researchers write that in the case of metastatic breast
cancer, the presence and higher numbers of CTCs links strongly with earlier time to
recurrence and poor overall survival. And studies have shown this is also the case in
metastatic colorectal and prostate cancers.
The push to discover if this is true of earlier stage cancer has been going on for a while.
Currently, axillary lymph node dissection is the one of the best predictors of prognosis
for women with early stage breast cancer.
Lucci and colleagues collected CTCs from blood and bone samples of 302 breast cancer
patients of average age 54, and whose cancer was in Stage I, Stage II and Stage III. All
patients were being treated at MD Anderson, and none had undergone chemotherapy
before giving the samples.
Patients with cancer in more than one breast, or who had another cancer within five years
of their breast cancer diagnosis, were not included.
For this study, the researchers only used data on the blood CTCs, not the bone marrow
CTCs.
They used a system called Veridex Cell Search to detect and measure the CTCs. They
then correlated the results with tumor characteristics, such as size and grade; hormone
status (estrogen, progesterone and HER2); and the extent of lymph node involvement.
They followed the patients for a median period of 35 months, and carried out statistical
tests to find any links between CTC measurements and progression-free and overall
survival.
They found:
Detection of one or more CTCs predicted both decreased progression-free survival, or
early disease recurrence, and overall survival.
15% of patients who had at least one CTC, relapsed (that is 11 out of 73 women).
This compared with a relapse rate of 3% among those who had no detected CTCs (7 out
of 229).
The more CTCs detected, the lower the progression-free survival and overall survival.
After two years of follow-up, the progression-free survival in patients with no CTCs was
98%.
This compared with 87% for patients with 1 or more CTCs, 79% for those with 2 or more
CTCs, and 69% for those with 3 or more CTCs.
Lucci and colleagues conclude:
"The presence of one or more circulating tumour cells predicted early recurrence and
decreased overall survival in chemonaive patients with non-metastatic breast cancer.
These results suggest that assessment of circulating tumour cells might provide important
prognostic information in these patients."
Lucci said it was interesting that none of the other primary tumor characteristics,
including size, accurately predicted whether they would find CTCs.
He said they are now going to try and find out which CTCs establish metastasis away
from the primary site, and which do not survive outside of this area.
It is early days to start changing practice based on these findings. More research, such as
a larger, multi-center trial must now be done to confirm these results. Only then can work
begin to see if detecting CTCs is a valid test for deciding what type of treatment early
stage breast cancer patients should undergo, said Lucci.
Funds from the Society of Surgical Oncology Clinician Investigator Award, The Morgan
Welch Inflammatory Breast Cancer Program, The Institute for Personalized Cancer
Therapy and the State of Texas Rare and Aggressive Breast Cancer Research Program,
helped pay for the study.
Breast Cancer
Blood Test in Early Stage Breast Cancer May Predict Recurrence and
Survival (Medical News Today: 8.6.2012)
Testing the blood of early stage breast cancer patients for circulating tumor cells (CTCs)
may predict their chance for recurrence and survival, and help identify which ones may
need additional treatment, according to a new study published on Wednesday. However,
the findings need to be confirmed by larger trials before such a method can be considered
for clinical use.
Writing about their findings in an early online issue of The Lancet Oncology, researchers
from The University of Texas MD Anderson Cancer Center note that, thanks partly to
research they had done before, we already know the presence of CTCs in the blood
correlates with a poor prognosis once breast cancer has spread to other parts of the body
(metastatic breast cancer).
Now their latest study, one of the first and largest of its kind, shows CTCs may have a
similar predictive value in the early stages of the disease.
Many patients who have treatment for early stage breast cancer that has not spread, have
the tumor and lymph nodes surgically removed and then undergo chemotherapy and
radiotherapy to remove all traces of the disease.
But, around two years later, a peak time for recurrence, says first author Anthony Lucci,
professor in MD Anderson's Department of Surgical Oncology, around one third of these
patients will experience a return of the cancer in another part of the body.
Lucci told the press, "we wanted to understand why".
He said they found that "cancer cells can break free of the primary tumor very early on,
and even the earliest stage cancers can shed these dangerous cells."
"We can now reliably detect circulating tumor cells in 25 percent of non-metastatic breast
cancer patients with no evidence of disease, and know that their risk of recurring or dying
is around four times higher than those without these cells in their blood circulation," said
Lucci.
In their background notes, the researchers write that in the case of metastatic breast
cancer, the presence and higher numbers of CTCs links strongly with earlier time to
recurrence and poor overall survival. And studies have shown this is also the case in
metastatic colorectal and prostate cancers.
The push to discover if this is true of earlier stage cancer has been going on for a while.
Currently, axillary lymph node dissection is the one of the best predictors of prognosis
for women with early stage breast cancer.
Lucci and colleagues collected CTCs from blood and bone samples of 302 breast cancer
patients of average age 54, and whose cancer was in Stage I, Stage II and Stage III. All
patients were being treated at MD Anderson, and none had undergone chemotherapy
before giving the samples.
Patients with cancer in more than one breast, or who had another cancer within five years
of their breast cancer diagnosis, were not included.
For this study, the researchers only used data on the blood CTCs, not the bone marrow
CTCs.
They used a system called Veridex Cell Search to detect and measure the CTCs. They
then correlated the results with tumor characteristics, such as size and grade; hormone
status (estrogen, progesterone and HER2); and the extent of lymph node involvement.
They followed the patients for a median period of 35 months, and carried out statistical
tests to find any links between CTC measurements and progression-free and overall
survival.
They found:
Detection of one or more CTCs predicted both decreased progression-free survival, or
early disease recurrence, and overall survival.
15% of patients who had at least one CTC, relapsed (that is 11 out of 73 women).
This compared with a relapse rate of 3% among those who had no detected CTCs (7 out
of 229).
The more CTCs detected, the lower the progression-free survival and overall survival.
After two years of follow-up, the progression-free survival in patients with no CTCs was
98%.
This compared with 87% for patients with 1 or more CTCs, 79% for those with 2 or more
CTCs, and 69% for those with 3 or more CTCs.
Lucci and colleagues conclude:
"The presence of one or more circulating tumour cells predicted early recurrence and
decreased overall survival in chemonaive patients with non-metastatic breast cancer.
These results suggest that assessment of circulating tumour cells might provide important
prognostic information in these patients."
Lucci said it was interesting that none of the other primary tumor characteristics,
including size, accurately predicted whether they would find CTCs.
He said they are now going to try and find out which CTCs establish metastasis away
from the primary site, and which do not survive outside of this area.
It is early days to start changing practice based on these findings. More research, such as
a larger, multi-center trial must now be done to confirm these results. Only then can work
begin to see if detecting CTCs is a valid test for deciding what type of treatment early
stage breast cancer patients should undergo, said Lucci.
Funds from the Society of Surgical Oncology Clinician Investigator Award, The Morgan
Welch Inflammatory Breast Cancer Program, The Institute for Personalized Cancer
Therapy and the State of Texas Rare and Aggressive Breast Cancer Research Program,
helped pay for the study.
Cervical cancer
Cervical cancer
Cervical cancer virus is a threat to the men, too (World Newspapers:
6.2.2012)
The Human Papillomavirus (HPV) is known to be one of the major causes of cervical
cancer in India. Doctors now say that it can cause cancer in men as well. The strain of
HPV that causes cervical cancer gets transmitted sexually — primarily through oral sex
— and cause oropharangeal as well as oral cavity cancer in men.
“Poor genital hygiene is the reason. If a man or a woman has multiple sexual partners,
chances of transmission increase,” says Dr Anand Vijay Bakshi, senior consultant,
oncology at LH Hiranandani hospital.
Bisexual men are particularly prone to this form of cancer, according to Dr Prasad Raj
Dandekar, consultant radiation oncologist at LH Hiranandani hospital. “Men who have
oral sex with other men tend to be more vulnerable than men who have it with women.
The virus is more easily transferred through homosexual relations,” he says.
Cases of HPV-related oral cancer are much higher in the West as the incidence of oral
sex is higher there, according to Dr Vedang Murthy, consultant radiation oncologist at
Tata Memorial Centre. He adds that the incidence in India is thought to be rising, but no
extensive data has been collected on the matter.
“The problem in India is that the rate of tobacco-related oral cancer is so high that it often
masks the HPV-related oral cancer. We don’t regularly check for HPV, but we will start
soon. Tata Memorial Centre is going to launch a large-scale study into the incidence of
this form of cancer in India,” says Murthy.
However, there is some good news too. “The HPV-related oral cancer is more responsive
to radiation and chemotherapy than other forms of oral cancers,” says Dr Boman Dhabar,
oncologist at Fortis Hospital.
The only precautions that can be taken against the occurrence of this type of cancer are
vaccination of women and safe sex.
“Women should take the HPV vaccine… Not only will this stop the spread of oral cancer
in men, but also reduce the risk of cervical cancer.” “In the West, many men also take the
HPV vaccine in the hope that it will shield them from HPV-related oral cancer. As of
now, there isn’t any conclusive evidence to prove that the vaccine works on men, but
clinical trials are on to check the same,” he adds.
Cervical Cancer
Regular Screening Boosts Survival Chances in Cervical Cancer Patients
(Med India: 2.3.2012)
Regular smear tests can substantially boost survival chances in women who are suffering
from cervical cancer, claims a study published on BMJ.
The authors from the Centre for Research and Development in Gävle and the Karolinska
Institutet, Stockholm, Sweden, studied all 1230 women diagnosed with cervical cancer
nationwide between 1999 and 2001.
In the study, which is the first to estimate chances of surviving cervical cancer, both
screen-detected cancers (those with an abnormal smear result one to six months before
cancer diagnosis) and symptomatic cancers (all remaining cases) were tested. The
objective of the paper was to see if the detection of cervical cancer by screening resulted
in better prognosis or just resulted in earlier diagnosis, without postponing the time of
death.
For women of screening age there was a 92% cure rate after a screen-detected diagnosis,
which decreased to 66% for symptomatic diagnosis. This result shows a substantial
increase in chances of cure for women who attended cervical screening compared to
those who did not. The chances of cure were also higher for women who attended
screening following an invitation, compared to those who were overdue for an
examination.
Furthermore, three quarters of the 373 women who died from cervical cancer had not had
a cervical smear in the recommended time frame.
The authors conclude that screening both reduces the risk of cervical cancer and is
associated with improved cure. They state that “detection of invasive cancer by screening
implies a very favorable prognosis compared to cases detected by symptoms”. The
authors recommend that the effect on the cure for cervical cancer should be included
when evaluating screening programs.
Cervical Cancer
Regular Screening Boosts Survival Chances in Cervical Cancer Patients
(Med India: 2.3.2012)
Regular smear tests can substantially boost survival chances in women who are suffering
from cervical cancer, claims a study published on BMJ.
The authors from the Centre for Research and Development in Gävle and the Karolinska
Institutet, Stockholm, Sweden, studied all 1230 women diagnosed with cervical cancer
nationwide between 1999 and 2001.
In the study, which is the first to estimate chances of surviving cervical cancer, both
screen-detected cancers (those with an abnormal smear result one to six months before
cancer diagnosis) and symptomatic cancers (all remaining cases) were tested. The
objective of the paper was to see if the detection of cervical cancer by screening resulted
in better prognosis or just resulted in earlier diagnosis, without postponing the time of
death.
For women of screening age there was a 92% cure rate after a screen-detected diagnosis,
which decreased to 66% for symptomatic diagnosis. This result shows a substantial
increase in chances of cure for women who attended cervical screening compared to
those who did not. The chances of cure were also higher for women who attended
screening following an invitation, compared to those who were overdue for an
examination.
Furthermore, three quarters of the 373 women who died from cervical cancer had not had
a cervical smear in the recommended time frame.
The authors conclude that screening both reduces the risk of cervical cancer and is
associated with improved cure. They state that “detection of invasive cancer by screening
implies a very favorable prognosis compared to cases detected by symptoms”. The
authors recommend that the effect on the cure for cervical cancer should be included
when evaluating screening programs.
Cervical Cancer
Cervical Cancer Screening Guidelines Issued (Med India: 15.3.2012)
Health groups issue new guidelines for prevention and early detection of cervical cancer.
The guidelines issued by The American Cancer Society (ACS), the American Society for
Colposcopy and Cervical Pathology (ASCCP), and the American Society for Clinical
Pathology (ASCP) generally advise a reduction in the number of tests women get over
their lifetime to better ensure that they receive the benefits of testing while minimizing
the harms, and include a preference for co-testing using the Pap test and HPV test for
women age ages 30 to 65.
The finalized updated guidelines recommend:
Women should not be screened before age 21
Women 21 to 29 should be screened with the Pap test alone (conventional or liquidbased) every three years. HPV testing should NOT be used for screening in this age
group.
For women 30 and over, the preferred approach is the Pap test plus HPV testing ("cotesting") every five years. Continued screening with the Pap test alone (without HPV
testing) every three years is an acceptable alternative. While screening with HPV testing
alone is promising, at this time it is not recommended for most clinical settings.
Screening is not recommended for women over age 65 who have had at least three
consecutive negative Pap tests or at least two negative HPV tests the last 10 years, with
the most recent test in the last 5 years. Women in this age group who have a history of
pre-cancer (CIN2 or a more severe diagnosis) should continue routine screening for at
least 20 years.
Women who have undergone a hysterectomy (with removal of the cervix) for reasons not
related to cervical cancer or pre-cancer should not be screened.
Women who have been vaccinated against HPV should follow the age-specific
recommendations in these guidelines (for unvaccinated women).
The new guidelines are not intended for women with a history of cervical cancer,
exposure to DES in utero, or women who are immunosuppressed (e.g. HIV positive).
Costs and other financial issues were not considered in creating the guidelines.
"Pap tests have been done yearly in the past, but we now know that annual screening is
not needed and in fact can lead to harm from treatment of cell changes that would never
go on to cause cancer," said Debbie Saslow, PhD, director of breast and gynecologic
cancer for the American Cancer Society. "Since 1980, organizations including the ACS
have recommended less frequent screening. With the addition of the HPV test, we can
test even less frequently, as the risk of pre-cancer and cancer when both tests are negative
is so low. With these recommendations, our groups are helping to make sure women get
the full lifesaving benefits of screening while minimizing its known harms."
Other new recommendations included in the guideline:
Women at any age should NOT be screened annually by any screening method.
Women with a slightly abnormal Pap test result (called "ASC-US") and a negative HPV
test can be screened again with co-testing in 5 years or with the Pap test alone in 3 years.
Women with a negative Pap result but a positive HPV test can either be rescreened with
co-testing in one year, or tested with a test for specific types of HPV (HPV16 and HPV
18).
The updated guidelines were first released in draft form in late 2011. The working groups
that created the draft guidelines then met with delegates from 25 organizations to further
discuss and finalize the recommendations, which were then adapted into this final
guideline.
"Our process resulted in guidelines that are focused on collectively presenting the best
patient-centered cervical cancer screening strategies," said Mark Stoler, MD, pastpresident of the American Society for Clinical Pathology. "These final recommendations
are based on a broad and emerging body of literature, and meld the very latest knowledge
on the interplay between new molecular tests and traditional cytology."
"While these new guidelines reflect relatively small changes over previous screening
recommendations, they are important," said Alan Waxman, M.D., incoming president of
the American Society for Colposcopy and Cervical Pathology. "The addition of HPV
testing to the Pap test in women 30 and over has been shown in recent studies to provide
better protection for longer intervals from cancer and pre-cancerous changes than the use
of the Pap test alone."
The guidelines are being published jointly in CA: A Cancer Journal for Clinicians (ACS),
Journal of Lower Genital Tract Disease (ASCCP), and American Journal of Clinical
Pathology (ASCP).
Cervical cancer
Now, a home test kit for Cervical cancer in Asia (World Newspapers:
27.3.2012)
A Singapore-Dutch joint venture has launched a home test kit for cervical cancer to make
the process more convenient and help women, particularly in Asia, overcome fear of the
traditional pap smear.
Cervical cancer, with about 500,000 new cases and 250,000 deaths each year, is the
second most common cancer among women after breast cancer, the World Health
Organization says.
"We are still struggling with reaching out to women for cervical cancer screening in
Asia," Singapore gynaecological oncologist Tay Eng Hseon said at a media briefing on
Monday, citing factors such as shyness, culture, fear and lack of time.
Delphi Bioscience Asia Pte Ltd is a collaboration between Delphi Bioscience BV, a life
sciences company based in the Netherlands, and its Singapore partners Tay and
businessman David Tan. The Delphi screener, with a cylindrical shape and round tip, can
be inserted to the top of the cervix by the user to collect cells with a sterile, saline liquid.
This is then used to test for high-risk Human Papilloma Virus (HPV), which could cause
cervical cancer. In a pap smear, cells are scraped from the opening of the cervix with a
speculum and then examined under a microscope. The recommended retail price for the
screener is S$79.90, including the laboratory test.
This compares with S$30-40 for a pap smear in a clinic and more than S$100 for an HPV
test, Tay said. Delphi expects the screener to be available at about 100 family physician
clinics in Singapore over the next three months and hopes to use the Southeast Asian
city-state as a regional launchpad.
Tan, executive managing director (commercial) at Delphi Bioscience Asia, said its
Indonesian distributor has committed to 1.5 million units over the next 12 months and
Malaysia is next in the company's sights. But China, the world's second-largest economy,
poses significant regulatory hurdles, Tan said.
"China is not on our immediate radar for obvious reasons," he said. "Regulatory
approvals take a long time and they are very complicated."
Cervical cancer
Cervical cancer leading cancer-killer among Indian women(New
Kerala: 29.3.2012)
Cervical cancer is the leading cause of cancer deaths among women in India with
mortality being three times higher in rural areas than in urban areas, a study by the
medical journal Lancet said Wednesday.
"The study found that 17 percent of cancer deaths among women were due to cervical
cancer, followed by 14 percent due to stomach cancer and 10 percent due to breast
cancer. The study spanned across geographical and social variation in specific cancers,
and the degree to which the cancers might be avoided by controlling their risk factors or
causative agents," said Prabhat Jha, co-author of the study released in Mumbai said.
"The rate of cervical cancer deaths was nearly the same in rural and urban areas. A
similar pattern of mortality rate was seen for breast cancer in both the areas," Jha, director
of the Toronto-based Centre for Global Health Research, added.
The study found cancer mortality in 2010 in India to be at a high 71 percent (3,95,400)
deaths in people between 30 and 69 years. The authors assessed cancer mortality in the
Million Death Study (MDS), led by the Office of the Registrar General of India.
According to the World Health Organisation (WHO), which has been advocating early
detection and prevention among women, personal hygiene and public health education
are keys for early diagnosis of cervical cancer.
"Cervical cancer is the leading cause of cancer death in Indian women, killing more than
33,000 women every year in India. The risk of a woman dying from cervical cancer is
higher than her risk of dying during child birth (0.8 percent vs 0.6 percent respectively),"
Poonam Khetrapal Singh, deputy regional director at the WHO regional office for
Southeast Asia in New Delhi, told IANS.
Cervical cancer starts in the cervix, the lower part of the uterus (womb), caused by
human papilloma virus (HPV). The virus spreads through unsafe sexual intercourse.
Routine pap smear tests are advised so the disease is diagnosed at an early stage.
Reacting to the study, the WHO official said: "Public health education advocating
personal hygiene and periodic screening can reduce cervical cancer deaths. Early
detection of treatable cancers would save many lives in India, particularly in the rural
areas which are under served by cancer screening and treatment."
Oral, stomach and lung cancers leading the causes of death in Indian men.
Interestingly, the study highlights the high variation in the age group affected by cancer
in developed and developing countries.
"Cancer accounted for 8 percent of the 2.5 million total male deaths and 12 percent of the
1.6 million total female deaths in the same age group. This is unlike the developed
countries where cancer deaths occur during old age," Jha pointed.
The study said: "Tobacco-related cancers represented 42 percent of male and 18.3 percent
of female cancer deaths at ages 30-69 years." (IANS)
Cervical cancer
Cervical cancer hits more Hindu women than Muslim (World
Newspapers: 30.3.2012)
For a long time the city gynaecologists and cancer surgeons have been claiming that
cervical cancer is becoming the leading cancer in women. This was confirmed in the
study, led by the centre for global health research, in close collaboration with Tata
Memorial Hospital, published in Lancet on Wednesday. It revealed that 17% of the total
cancer deaths in women are because of cervical cancer.
In women, cervical cancer was the leading fatal cancer in both rural and urban areas, with
somewhat higher rates in rural areas. The cervical cancer death rate of 16 per 1 lakh
population suggests that a 30-year-old Indian woman has about 0.7% risk of dying from
cervical cancer before 70 years of age, in the absence of other diseases. By contrast, the
risk of deaths during pregnancy for Indian women aged 15- 49 years is about 0.6%.
The study pointed out strategies to reduce cervical cancer deaths. This included
vaccination against human papillomavirus before marriage, and for married women a
once-only-testing or screening followed by visual inspection with acetic acid and further
referral for treatment.
According to experts, simple precautions like better hygiene, use of copper-T (birth
control measure for women) and regular screening can help bring down this cancer
considerably.Dr Rajendra Badwe, director of Tata Memorial Hospital said, “The
incidence of cervical cancer is coming down every year by 15- 20%. Early detection is
one of the key factors to bring down the cervical cancer mortality rate.”
The study also shows mortality deaths were higher in Hindu women than in Muslim
women and experts feel this is because of circumcision among Muslim men, which
reduces the sexual transmission of human papillomavirus. “Studies have proved that
circumcision reduces the risk of transfer of HIV virus,” said Badwe.
Ashwini Bhalerao Gandhi, consulting gynecologist, PD Hinduja Hospital said, “I ensure
that women coming to me are made aware of what is cervical cancer and the how it can
be prevented. If they have daughters, we persuade them to go for vaccination. I have kept
a pamplet with all the information on cervical cancer and I make the patient read it.”
Cervical cancer
One out of four cervical cancer patients is an Indian (The Times
of India: 22.6.2012)
Mumbai: A joint team of American and Singapore scientists announced recently that they
had found the origin of cervical cancer, raising hopes of its early detection and treatment.
They found that the human papilloma virus, the main cause for cervical cancer, initially
infects only a tiny colony of cells in the woman’s cervix.
Although it is too early to forcefully say this, the scientists from Brigham and Women’s
Hospital at Harvard Medical School and Singapore’s Agency for Science Technology
and Research believe that the cancer threat to the woman could be nullified if these
affected cells are removed.
In India, the discovery underlines the poor statistics with respect to cervical cancer. Here,
every seven minutes, one woman dies due to complications arising out of cervical cancer.
And, every fourth patient of cervical cancer is an Indian, say statistics from the country’s
hospital-based cancer registry.
It is the number one cancer killer of Indian women, but in metro cities it lags behind
breast cancer. “It still affects a significant number of women in urban areas as well,” says
Hinduja Hospital’s Dr Hemant Toangaonkar, one of the seniormost surgical oncologists
in the country. Urban slum sprawls, with low awareness about the origin of the disease,
are at high risk of the disease, say doctors.
“Barely 5-6% of women in India undergo pap smear test. In slums, the corresponding
figure is much lower,” says Dr Donta Balaiah from the National Institute for Research in
Reproductive Health, an ICMR (Indian Council for Medical research) laboratory located
in central Mumbai’s Parel locality. Pap smear is one of the best known diagnostic tests to
detect cervical cancer.
The
latest
research
underlines
the
need
for
early
detection.
The Boston team has found that only cells in a part of the cervix — called the ‘squamocolumnar junction’ — become cancerous when infected with HPV; the rest of the cervix
is not affected initially.
In an interview to international media, Dr Christopher Crum has been quoted as saying
that his team’s discovery could help doctors differentiate between benign and potentially
dangerous cancerous lesion in the cervix and thus guide effective therapy.
The potential is immense, considering that the World Health Organisation estimates that
nearly 530,000 women are diagnosed with cervical cancer annually across the world and
275,000 die from it.
The study was published online in Proceedings of the National Academy of Sciences.
A briefing session will be held tomorrow at NCUI Auditorium to share details on cervical
cancer. To participate, log on to www.guardyourangel.in
Cervical cancer
Husbands key to cervical cancer prevention: Study (The Times of India:
27.6.2012)
Mumbai: When scientists from the National Institute of Research in Reproductive Health
(NIRRH) fanned out in two slum pockets in Central Mumbai to find out the level of
awareness about cervical cancer, they were shocked at how little people knew about one
of the largest killers of women.
“Over 97% of the people we spoke to had a vague idea about the term cancer. But the
minute we got specific and asked about cervical cancer, they hadn’t a clue,’’ said
NIRRH’s Dr Donta Balaiah, the principal investigator of the study which was aimed at
finding the best way to educate women.
NIRRH is a laboratory of the Indian Council of Medical Research in Mumbai. The study,
which is being carried out in partnership with the Mumbai civic administration, began in
2008 and still continues. Funded by the central health ministry, it is going to serve as a
model for intervention in communities across the country. The study’s importance can be
gauged form the fact that cervical cancer kills approximately 72,000 women every year in
India. It is believed that one in four deaths due to cervical cancer occurs in India.
The first study which took a year to complete found that the best way to reach out to
women was by educating their husbands. “We had divided the community into three
groups — one in which couples were addressed about the disease, the second in which
only husbands were addressed and the third group was treated as a control (no particular
group was addressed),’’ said Dr B N Mali, a cytologist from NIRRH who was a part of
the study.
Results showed that husband’s involvement yielded the best result. “If he was convinced,
then he would send his wife for a cervical screening programme at the health post,’’ said
the scientists. Couple intervention came a close second. The message that experts want to
convey is that every woman should undergo a pap smear test after two years of marriage.
Cervical cancer is mainly caused by the human papilloma virus, which spreads mainly
through sexual contact. Cervical cancer is also one of the slowest growing cancers, with
women infected with the virus developing the cancer two decades later.
Pledge to protect daughters T he Times of India, in association with a pharma major,
has launched Guard Your Angel initiative which urges mothers to take pledges to guard
themselves and their loved ones from cervical cancer, the leading cancer killer among
Indian women. A fashion show will be held in Delhi on June 30 where women and their
daughters will walk the ramp to create awareness. Leading designers such as Namrata
Joshipura, Anju Modi and Poonam Bhagat will showcase their collection. Visit
www.guardyourangel.in for more information.
Liver Cancer
Liver Cancer
Value of Liver Cancer Screening Doubtful Says Danish Study (Medical
A new study from Denmark finds that people with alcoholic cirrhosis are no more likely
to die from liver cancer than other people. The researchers conclude screening such
patients is unlikely to save lives and would not be cost-effective.
Lead author Dr Peter Jepsen of Aarhus University Hospital and the University of
Copenhagen, and colleagues, write about their findings in the June issue of Annals of
Internal Medicine.
Alcoholism can lead to cirrhosis or scarring of the liver, such that over time scar tissue
replaces healthy tissue and prevents the liver from working properly. The damage is
permanent and irreversible and eventually leads to liver failure.
Jepsen and colleagues note that while some studies suggest people with alcoholic
cirrhosis have a higher risk of developing liver cancer, and there is a belief screening for
the disease can reduce deaths in this population, this is not backed up by evidence from
randomized trials because there haven't been any.
So he and his colleagues decided to investigate further by examining a nationwide Danish
registry of patients who were admitted to hospital with a first-time diagnosis of alcoholic
cirrhosis between 1993 and 2005.
They found that of 8,482 patients diagnosed with alcoholic cirrhosis, 169 developed liver
cancer and 5,734 died, 151 of whom had liver cancer.
But they found that the incidence of, and rate of death from, liver cancer was no greater
among the alcoholic cirrhosis patients than in the general population.
Jepsen and colleagues conclude that Danish patients with alcoholic cirrhosis have a low
risk for liver cancer, and this disease has little impact on the high rate of death in this
group.
They note that a potential weakness of the study is that the diagnoses were made by
hospital doctors without using a standard set of criteria, and because the analysis used
registry data only, there was no information on the clinical care of patients, for instance
whether they had undergone screening for liver cancer.
The researchers do not preclude the possibility that a randomized controlled study
(comparing, for instance, alcoholic cirrhosis patients randomly assigned to screening and
non-screening) might find a different answer, but imply, that for the time being, this is the
best answer from the data available.
Thus, on the basis of their findings, they suggest screening for liver cancer "would be
expected to have a minimal effect on mortality and is unlikely to be cost-effective".
If there are no clear benefits, then the downsides of screening are heightened. For
instance there is always a risk of a false positive, which can then lead to further
unnecessary and invasive tests.
In email correspondence with Reuters Health, Jepsen said ultrasound was often the
preferred tool for initial liver cancer screening, and if that suggests there could be a tumor
present, the patient is referred for a CT scan, which carries the risk of radiation exposure.
Note: this article has been reissued to clarify the first paragraph and remove a confusing
point that is already well explained in paragraph 4.
Lung Cancer
Lung Cancer
Lung Cancer Screening Saves Lives and Is Cost-Effective (Medical
A study published in the April issue of Health Affairs reveals that thousands of lives
could be saved at a fairly low cost if commercial insurers routinely covered lung cancer
screening.
In the United States, lung cancer is the leading cause of cancer deaths each year - killing
over 150,000 individuals. However, the majority of insurance companies do not provide
coverage for lung cancer screening for people at high-risk, despite the fact that these tests
can detect early stage tumors.
Lead author of the study, Bruce Pyenson, an actuary and principal at the New York office
of Milliman, a consulting and actuarial firm, explained:
"These results demonstrate the cost efficiency of offering this benefit to people who are
at high risk of lung cancer.
The evidence of the value of advanced screening technology for lung cancer has
accumulated to the point where we can show very strong cost-effectiveness for the
commercial population. We can also jump the needle on cancer mortality for the first
time in years, and do so in a cost-effective manner."
The researchers conducted the study in order to examine the costs and benefits of
providing lung cancer screening through low-dose computed tomography (CT) to
individuals who smoke, and long-term former smokers, aged between 50 to 64 years old.
These individuals are considered to be at high risk of developing lung cancer.
Until now, there has been insufficient or conflicting evidence regarding the cost-benefit
front and as a result the majority of private insurers do not cover lung cancer screening.
The team modeled insurer costs on the assumption that approximately 18 million
individuals are at high-risk and about half of these people would undergo screening if it
were a covered benefit. For instance, managed care reimbursement for a spiral CT can be
as low as $180. Using this figure, the team discovered that lung cancer screening would
cost insurance companies around $247 per member tested each year.
In addition, when the team spread the total cost of lung cancer screening over the
commercially insured population, they found that the cost was under $1 per insured
member per month.
Results from the study indicate that if lung cancer screening was covered by insurers, it
would save the lives of 130,000 individuals under the age of 65 during a 15 year period.
Furthermore, the cost per life-year saved would be lower than breast or cervical cancer
screening and similar to the cost per life-year saved of screening for colorectal cancer.
Pyenson said:
"This screening process offers a good value for the money and it saves lives. Late stage
lung cancer is deadly, but if treated at early stage, survival is very good - that's what
makes early detection so promising."
For instance, in 2011, results from a large, randomized controlled trial were published by
the National Cancer Institute demonstrating that screening with CT scans can reduce the
risk of lung cancer mortality. Over the last 15 years, CT technology has quickly evolved
and can now identify small, suspicious nodules and also be used to determine growth
patterns that indicate likely malignancies.
The researchers note study limitations, for instance, the benefits of screening could be
lower, and the cost more expensive, if the tests are not performed according to the best
practice guidelines for follow-up and price.
The team highlights the importance of efficient implementation of lung cancer screening
including:
insurer's selection of high-quality providers
rigorous tracking of outcomes
use of best practices for managing clinical aspects of screening, especially is lesions are
detected.
Pyenson explained:
"Rolling out lung cancer screening with embedded continuous quality improvement can
prove how care breakthroughs and advanced technology do not have to feed cost
escalation."
Lung cancer
Lung cancer: CT screening only for heavy smokers (The Hindu:
26.4.2012)
Low dose CT screening for lung cancer is recommended only for 55-74-year-olds who
have smoked a pack daily for 30 years
On April 23, 2012, the American Lung Association (ALA) released its interim guidance
recommending low dose computed tomography (CT) screening for diagnosing lung
cancer among smokers. The recommendation is based on the first report of the ALA lung
cancer screening committee, chaired by Dr. Jonathen Samet from the University of
Southern California.
The recommendation
ALA recommends screening only for a limited group. These are current or former
smokers, aged 55 to 74 years with a smoking history of at least 30 pack-years and no
history of lung cancer.
Smoking history of 30 pack years means smoking a pack of cigarettes daily for thirty
years or two packs daily for 15 years etc.
ALA notes that while CT screening for lung cancer may save lives, it should not be
recommended for everyone due to many known and unknown risks that may be
associated with the screening and subsequent medical evaluation and follow-up.
Radiation risk is one of them.
In spite of this caution, Auntminnie.com, a trade journal, stated that the move is a major
step toward the development of a population-based CT screening programme in the U.S.
The U.S. National Cancer Institute's National Lung Screening Trial (NLST), found that
low-dose CT can reduce mortality by at least 20 per ecnt compared to chest x-ray, and
other reports have pushed the estimated mortality gains even higher. The ALA guidelines
followed the results of NLST of smokers at-risk, released in November 2010.
Even in this high risk group, 320 persons had to be screened with CT to prevent one lung
cancer death.
The benefit of CT screening for lung cancer cannot be easily estimated for populations
with risk profiles that are different from those of the NLST participants.
Can cause cancer
According to Centers for Disease Control and Prevention, screening with CT scans is not
risk-free. Radiation exposure from repeated CT scans is cumulative and can lead to
cancer.
Average effective radiation dose in “low dose” CT in NLST was 1.5 mSv as against 7
mSv in a full diagnostic helical CT.
Specialists have criticised low-dose CT screening due to the large number (as high as 25
per cent) of false-positive results, meaning that the positive finding did not prove to be
lung cancer following diagnostic investigations. People who receive false-positive results
may be subjected to unnecessary testing, including more radiation exposure, invasive
diagnostic and surgical procedures, complications, and even death, diminishing the
benefit of early cancer detection.
Over-diagnosis due to screening must have revealed indolent cancers which may never
progress into full blown cancer. They may end up undergoing an invasive intervention
that they would not otherwise need.
According to ALA, individuals should not receive a chest X-ray for lung cancer
screening as it has low sensitivity.
ALA Committee suggested that ALA should ask hospitals and screening centres to:
establish ethical policies for advertising and promoting lung cancer CT screening
services; develop educational materials to assist patients in having careful and thoughtful
discussions between patients and their physicians regarding lung cancer screening and to
provide lung cancer screening services with access to multidisciplinary teams that can
deliver the needed follow-up for evaluation of nodules.
Smoking, major cause
Lung cancer is a fatal disease. Currently, specialists believe that smoking causes up to 8090 per cent of lung cancer cases.
The significance of the guidance is evident as the five-year survival rate for lung cancer
presently stands at 15.6 percent as compared to an over 90 percent survival rate for
breast, colon and prostate cancers.
ALA recommendation may lead to many undesirable developments. Hospitals may start
direct-to-consumer advertising to recruit patients who might have resources to pay out-of
pocket for low-dose CT screening.. “…the promotion of such services should not prey
upon the public's fear of lung cancer while leading them to believe that low-dose CT
screening will eliminate all risk from lung cancer,” ALA warned.
“Unfortunately, even before the NLST results were released, CT screening for lung
cancer was being offered by some institutions and subsequent to the release an increasing
number of well-respected medical centres throughout the country are offering lung cancer
screening to their constituents at markedly reduced prices.” ALA observed.
Public cautioned
“Never starting smoking and quitting smoking still remains the best way to prevent lung
cancer”, Dr Norman H. Edelman, Chief Medical Officer, American Lung Association
cautioned the public.
Individuals have to take their own decisions on screening based on inputs from
allreputable sources. Do not trust advertisements glorifying CT screening.
Lung cancer
Who can have lung cancer?(The Tribune: 2.5.2012)
Lung cancer is among the five main types of cancer causing about 1.3 million deaths
every year globally. According to the WHO, it leads to about 75,000 deaths per year in
India.
How does one get lung cancer?
Lung cancer is most commonly associated with smoking. However, certain people may
have a genetic predisposition to cancer. Even if you do not smoke, you may be exposed
to smoke through your smoking colleague/spouse (passive smoking) or your
environment. Several workplace substances have also been associated with an increased
risk for lung cancer, including arsenic, asbestos, beryllium, silica, radon, etc.
What are the signs and symptoms of lung cancer?
Most patients with lung cancer will have one or more of the following symptoms:
n Persistent cough and coughing up of blood
n Wheezing and shortness of breath
n Discomfort during breathing
n Chest pain
n Pneumonia symptoms such as fever and mucus-producing cough
n Discomfort during swallowing
n Hoarseness
n Weight loss and poor appetite
Surgical options
For patients with early stage lung cancer, surgical removal of the tumour and the lung
tissue surrounding the tumour is the standard care. If the tumour is too large for surgery
at diagnosis, many lung cancer patients may receive radiation or chemotherapy in an
attempt to shrink the tumour before surgery is performed. The type of surgery performed
depends upon the location and size of the lung tumour.
The decision for surgery is made by the cardio-vascular and thoracic surgeon taking
several factors into consideration. These include over-all medical condition and lung
function; the size of the tumour; the location of the tumour; whether there is any sign of
spread to lymph nodes; and the type of the tumour.
Frequently asked questions about surgery
Q: How much of the lung is removed during surgery?
There are three lobes of the right lung and two lobes of the left lung. Lobectomy involves
removing the tumour along with the lobe of the lung from which the tumour arises. In
some cases, lobectomy may not be sufficient to remove the entire tumour. In this case,
removal of the entire lung may be recommended. This operation is called
pneumonectomy.
Q: Is it possible to breathe normally after a part of your lung is removed?
Patients with healthy lungs will be able to breathe normally after the removal of a lobe, or
even an entire lung. Pulmonary function tests are used to determine how much lung can
be removed without limiting your ability to breathe.
Q: What can be expected during and following surgery?
Patients are generally out of bed and walking the first day after the operation. A yoga
therapist and physiotherapist instructs patients in deep breathing and coughing exercises,
which are important to help prevent infection in the lungs.
Q: Is there pain following surgery?
The operation itself is done under full general anaesthesia. An epidural catheter is used
successfully for pain control post-operation.
Q: Will I need follow-up care?
Yes, follow-up care is essential for the patients who have undergone lung cancer surgery.
Q: Are there things the patient can do to increase his chances of living a “normal” life
after lung surgery?
Yes, these include totally quitting smoking, eating well, and exercising (walking for 30
minutes to an hour per day). Chest physiotherapy and yoga exercises are mandatory.
Q: What does the rehabilitation consist of?
Formal pulmonary rehabilitation consists of professionally monitored sessions, occurring
three-four days per week for 1-2 hours per day. A new technique being used with great
success at Christian Medical College & Hospital in Ludhiana has been the use of yoga
therapy by a trained full-time yoga therapist. This technique has been presented to
international experts in various international conferences and, in fact, won the first prize
for the best paper at the 1st International Yoga Conference in Jan 2011. An innovative
new technique has been devised in Punjab to reduce the complications of surgery and
make the operation safer. This was presented and discussed with an elite group of
international experts and has been much appreciated by them.
Prevention of lung cancer
Total abstinence from tobacco is the surest way of preventing lung cancer.
The writer is Head of Cardio Vascular & Thoracic Surgery at Christian Medical College
& Hospital, Ludhiana, and was earlier with the Escorts Heart Institute , New Delhi and
the St Vincents Hospital in Sydney. E-mail:
[email protected]
Lung cancer'
Persistent cough 'could signal lung cancer'(New Kerala: 8.5.2012)
A new government advertising drive has warned the public to be vigilant about persistent
coughs as they could be a sign of lung cancer.
The campaign, which is being run in TV, radio, print and online media, recommends
people with coughs lasting three weeks visit their GP.
Research has shown that the public are much more aware that lumps and bleeding are
warning signs of cancer than a cough, but the ads make clear persistent coughs should
also raise alarm bells.
The push is being backed by celebrities including comedian and actor Ricky Gervais, TV
star Linda Robson and Manchester United manager Sir Alex Ferguson.
'It is vital that cancer patients get treated quickly so they have the best chance of
surviving,' the BBC quoted Mike Richards, Cancer tsar Professor as saying.
Lung cancer affects 33,000 people in England every year, with the majority of cases
occurring in people over the age of 55.
But when diagnosed at an early stage, as many as 80 percent are alive five years after
diagnosis compared with 7 percent if it is spotted late on.
Lung Cancer
Lung Cancer CT Screening Guidelines Revised (Medical News Today:
23.5.2012)
Older, current and former heavy smokers should receive annual, low-dose CT screening,
according to revised guidelines published in the Journal of the American Medical
Association on Sunday. The revised guidelines follow, and in the JAMA paper are
accompanied by, a systematic review of evidence on the role of CT screening for
individuals at higher risk of lung cancer.
CT (computerised tomography) or CAT scans are a type of x-ray that can detect early
signs of lung cancer, but they can give false-positive results. They use a computer to
create detailed images of the inside of the body.
Regular chest x-rays produce less detailed images than CT scans and can also give falsepositives. They are not recommended as a lung cancer screening test because there is no
evidence they save lives.
Several groups collaborated in the systematic review, namely the American College of
Chest Physicians (ACCP), the American Society of Clinical Oncology (ASCO), the
American Cancer Society, and the National Comprehensive Cancer Network, with input
from the American Thoracic Society (ATS).
The review concludes that:
"Low-dose computed tomography screening may benefit individuals at an increased risk
for lung cancer, but uncertainty exists about the potential harms of screening and the
generalizability of results."
The review forms the basis of clinical practice guidelines developed by the ACCP and
ASCO and was endorsed by ATS.
The revised guidelines recommend that current and former smokers aged 55 to 74 who
have smoked for 30 pack years or more, and either are still smoking or have quit in the
past 15 years, should be offered low-dose CT screening over both annual screening with
chest x-ray or no screening.
And, this offer should only be made in settings that can deliver the comprehensive care
provided to National Lung Screening Trial participants, which essentially means only
centers with specialist radiologists and surgeons.
The guidelines say CT screening should not be performed on current or former smokers
who have not accumulated 30 pack years of smoking, or who are outside the 55 to 74 age
range.
Sick people with limited life expectancy or whose illness is not likely to be cured should
also be excluded.
The JAMA report has a full account of guideline remarks and explanations.
30 pack years is the equivalent of smoking one pack of 20 cigarettes a day for 30 years.
For instance, two packs per day for 15 years is equivalent to 30 pack years.
The review included a large National Cancer Institute study involving more than 53,000
people with a 30 pack year history.
The study showed that CT screening prevented about 80 deaths from lung cancer over 6
years, but 16 participants died after CT screening, including 6 who did not have lung
cancer.
Lung cancer is the leading cause of cancer death both globally and in the United States,
where it causes as many deaths as the next 4 most deadly cancers combined: breast,
prostate, colon, and pancreatic.
Although lung cancer deaths in the US have fallen slightly since 1990, the disease is
likely to kill more than 160,000 Americans in 2012.
The survival rate for lung cancer is poor, the current 5-year survival rate stands at 16%,
and most people diagnosed with the disease are at an advanced stage (40% at stage IV,
30% at stage III).
Lung Cancer
New compound 'may prove to be successful for lung cancer patients'
(New Kerala:4 June 2012)
Washington, June 3 : In a new study, researchers including one of Indian-origin, have
revealed that a new compound that targets anaplastic lymphoma kinase-positive (ALK+)
non-small cell lung cancer (NSCLC) is well tolerated by patients and is already showing
early signs of activity.
Additionally, the compound has also shown results on patients who no longer respond to
crizotinib, which is the only approved ALK inhibitor.
LDK378, developed by Novartis, targets ALK - a key cancer gene in a subset of lung
cancer, lymphoma and the childhood cancer neuroblastoma, and may be associated with
other cancers, including breast and colorectal cancer.
The study's authors looked at patients with ALK+ lung cancer, as well as other ALK+
solid tumours. Early data from the phase I study shows that the majority of patients
treated with active doses of LDK378 responded, including those who had progressed
after treatment with crizotinib.
"These results are encouraging," Ranee Mehra, medical oncologist at Fox Chase, said.
"They offer hope to patients who have tumours with alterations involving ALK, even if
they have relapsed from previous treatments," she said.
In its first test in people, designed to determine the compound's safety and optimal dose,
56 people with various types of ALK+ solid tumours (primarily lung cancer) were
enrolled, receiving doses between 50 to 750 milligrams per day (mg/day).
LDK378 was well tolerated in most patients up to 750 mg per d, with the most common
side effects being nausea, vomiting, and diarrhea.
"Whenever you do a trial with a drug, even if it's just designed to look for safety and
dosage, you are interested in whether patients responded.
"These results are definitely encouraging, and mean we can go forward with additional
research looking at whether LDK378 is effective in various types of cancers that have
alterations involving ALK," Mehra said.
The fact that patients appeared to tolerate LDK378 at doses up to 750 mg/d is also
encouraging, she adds, since preclinical research has suggested this dose would have
therapeutic effects.
The results of the study will be presented during the 2012 Annual Meeting of the
American Society of Clinical Oncology on June 3. (ANI)
Pancreatic Cancer
Pancreatic Cancer
Pancreatic Cancer - Drug May Target Faulty Gene In 15% Of
Patients(Medical News Today:1.5.2012)
A new class of cancer drug which targets a faulty gene might be effective in treating
some aggressive pancreatic cancers, researchers from Cancer Research UK's Cambridge
Research Institute and the Wellcome Trust Sanger Institute reported in the journal
Nature.
Pancreatic cancer kills approximately 37,000 people in the USA and 8,000 in the UK
every year. Even though survival rates have been steadily getting better, fewer than 20%
of patients survive for at least 12 months after diagnosis, the authors explained.
In this study, the researchers demonstrated that in human cancer cells and mice, USP9x a gene - switches off through chemical tags located on the surface of DNA.
Professor David Tuveson believes that 15% of all patients with pancreatic cancer may
have this faulty gene, and that medications might be created which strip away the
chemical tags. Put simply, it might be possible to create drugs to treat 15% of pancreatic
cancer cases.
The gene has not been identified in traditional gene-hunting approaches, Tuveson
explains, which only look at DNA sequence changes.
Prof. Tuveson said:
"The genetics of pancreatic cancer has already been studied in some detail, so we were
surprised to find that this gene hadn't been picked up before. We suspected that the fault
wasn't in the genetic code at all, but in the chemical tags on the surface of the DNA that
switch genes on and off, and by running more lab tests we were able to confirm this.
Drugs which strip away these tags are already showing promise in lung cancer and this
study suggests they could also be effective in treating up to 15 per cent of pancreatic
cancers."
In this study, scientists used a technique known as "sleeping beauty transposon system"
to screen for genes that accelerate the growth of pancreatic tumors.
A transposable element (TE) is a piece of DNA (DNA sequence) that can self-transpose
(change its relative position) within the genome of a single cell - i.e. it can hop about the
cell's DNA from one location to another, sometimes landing in the middle of the gene. If
it lands in the middle, the gene can stop working.
They were able to screen for tumor suppressor genes that would usually protect against
cancer, by introducing the sleeping beauty transposon into mice with cancer of the
pancreas.
When the genes are working properly, they act as brakes, when they are faulty they start
multiplying out of control.
The scientists have already discovered several genes association with pancreatic cancer
with this approach. Surprisingly, the most common genetic fault was one with no prior
association to any type of cancer.
Co-lead author Dr David Adams, said:
"The human genome sequence has delivered many new promising leads and transformed
our understanding of cancer. Without it, we would have only a small, shattered glimpse
into the causes of this disease. This study strengthens our emerging understanding that we
must also look into the biology of cells to identify all the genes that play a role in cancer."
Senior Science Information Manager at Cancer Research UK, Dr Julie Sharp, said:
"These results raise the posility that a class of promising new cancer drugs may be
effective at treating some pancreatic cancers.
Fewer than 20 per cent of people survive pancreatic cancer for a year after diagnosis - a
situation that has improved little in the last 20 years. Studies like this one are part of
Cancer Research UK's commitment to invest more in hard-to-treat cancers like pancreatic
cancer, hopefully improving treatment to save more lives in the future."
Pancreatic cancer
Cure for pancreatic cancer found? (The Times of India: 1.5.2012)
Scientists Identify Gene That Slows Down Spread Of Cancerous Tumours
Scientists have identified a gene that slows the spread of pancreatic cancer tumours,
paving the way for targeted treatment of one of the deadliest forms of the disease, said a
paper published on Sunday.
After discovering the gene dubbed USP9X at work in a study of pancreatic cancer in
mice, the international research team found it also played a role in humans. “We looked
in human tumour specimens and we found that it was missing in a fraction of patients —
the patients that did very poorly... the people who died fastest,” researcher David
Tuveson said.
“Patients that had a low level of the gene expressed ... they died very quickly after their
operation and the patients who at the end of their life had lots of metastasis (spreading of
the cancer), they had also a very low level of this protein.”
The existence of the gene, which is found in all of our cells but goes missing in some
tumours, was known before but not its role as a cancer suppressor, said Tuveson.
Three other pancreatic tumour suppressor genes are known to exist, but this is the one
whose absence “probably causes metastasis — that is what kills people with pancreas
cancer,” said the scientist. The discovery means that “we can wake up the gene by using
drugs” known as epigenetic modulators, he added.
“Our observation allows us to potentially treat people that have lost this gene in the
pancreas tumours. It allows us to offer a therapy for the patients that actually have the
worst prognosis.”
Tuveson said these kinds of drugs have already been developed, “but people haven’t
figured out where exactly they would be useful. We are proposing that these drugs would
be useful in this subset of pancreas cancer patients.”
Pancreatic cancer kills about 96% of its victims within five years of diagnosis, one of
the lowest cancer survival rates. Early diagnosis is difficult, so the disease is often
discovered only after it has already spread. AFP
‘Mum’s milk protects baby against cancer’
Breastfeeding has many health benefits. Moms, now, add one more to the list — it
protects babies against various forms of cancer, say researchers. A new study found high
levels of cancer-fighting TNF- related apoptosis inducing ligand (TRAIL) in human milk,
which the researchers say may be one of the sources of breast milk’s anti-cancer activity.
For the study in the ‘Journal of Human Lactation’, published by SAGE, the researchers
took samples of colostrum, the first milk available to newborns, and of mature breast
milk from new mothers. The researchers found that colostrum and breast milk contained
400 and 100-fold, respectively, higher levels of TRAIL than blood. No TRAIL was
detected in the formula. PTI
Pancreatic Cancer
Pancreatic Cancer May Be Detected With Simple Intestinal Probe
By simply shining a tiny light within the small intestine, close to that organ's junction
with the pancreas, physicians at Mayo Clinic's campus in Florida have been able to detect
pancreatic cancer 100 percent of the time in a small study. The light, attached to a probe,
measures changes in cells and blood vessels in the small intestine produced by a growing
cancer in the adjoining pancreas.
This minimally invasive technique, called Polarization Gating Spectroscopy, will now be
tested in a much larger international clinical trial led by the Mayo Clinic researchers. The
preliminary study suggests it may be possible, one day, to use a less invasive endoscope
to screen patients for early development of pancreatic cancer.
The findings are being highlighted in a special address by Mayo Clinic gastroenterologist
Michael Wallace, M.D., at the international Digestive Disease Week 2012.
The pancreas is notoriously hard to reach and see due to its very deep location in the
abdomen, surrounded by intestines. The study investigators theorized that there may be
changes in the nearby "normal appearing" tissue of the small intestine which is much
more accessible.
"No one ever thought you could detect pancreatic cancer in an area that is somewhat
remote from the pancreas, but this study suggests it may be possible," says Dr. Wallace,
the chairman of the Division of Gastroenterology at Mayo Clinic in Florida. "Although
results are still preliminary, the concept of detection field effects of nearby cancers holds
great promise for possible early detection of pancreatic cancer."
Pancreatic cancer is one of the most deadly of human tumors. It is only curable in 5
percent of cases, and even when it is surgically removed, 70 percent of patients have a
recurrence that is fatal, Dr. Wallace says. There are no ways currently to detect the cancer
early enough to cure a substantial number of patients, he says.
Pancreatic cancer is now usually detected through an imaging scan, followed by an
invasive biopsy. Tumors found in this way are usually at an advanced stage.
In this study, the Mayo Clinic physicians tested a light probe developed by their longtime collaborators at Northwestern University.
The light, attached to a small fiber-optic probe known as an endoscope, measures the
amount of oxygenated blood as well as the size of blood vessels in tissue near the duct
where the pancreas joins the small intestine. Because a growing tumor requires a
heightened supply of blood, normal tissue in the vicinity of the cancer reveals evidence of
enlarged blood vessels and changes in the amount of oxygen within the blood.
Such "field effects" from cancer can be measured in other areas of the GI tract, says Dr.
Wallace. "With this technology, others studies have shown that cancerous polyps can be
detected more than 11 inches from the polyp itself. Early studies are evaluating if
esophageal cancers can also be detected remotely," he says.
The probe acts "a bit like a metal detector that beeps faster and louder as you get close to
cancer," he says. The researchers are measuring within six to 10 inches of the pancreas in
the small intestine immediately next to the pancreas.
Dr. Wallace and his team tested the probe on 10 patients who were later determined to
have pancreatic cancer, and on nine participants who did not have pancreatic cancer.
They found that testing both measures -- blood vessel diameter and blood oxygenation -detected all 10 pancreatic cancers. But the probe was less precise (63 percent accurate) in
determining which of the healthy volunteers did not have pancreatic cancer.
"There is room for improvement in this instrument, and our group is working on that," he
says. "If the studies confirm the early results, it would make the pancreas accessible to a
much simpler upper endoscope and that would be a real advance in the treatment of
pancreatic cancer."
Patients now often undergo an endoscopic examination of the upper intestine to search
for the cause of heartburn or stomach pain, Dr. Wallace says. An endoscopic probe could
be easily outfitted to explore for evidence of pancreatic cancer in patients at heightened
risk, he says.
Mihir Patel, M.D., a gastroenterologist who worked with Dr. Wallace on the study, says
that despite of intense research, we haven't been successful in significantly improving the
overall survival associated with pancreatic cancer in the past several decades. That's
because we haven't been able to detect the cancer early enough. Developing a technique
to screen the patients and detect pancreatic cancer at an early stage would be a potential
breakthrough. In our preliminary data, this technology has shown to hold similar
potential.
The study's co-authors include Vadim Backman, Ph.D., a professor in the biomedical
engineering department at Northwestern University and Hemant Roy, M.D., a
gastroenterologist at Northwestern University.
Prostate cancer
Prostate cancer
Annual prostate cancer test fails to save lives (New Kerala: 9.1.2012)
Annual prostate cancer screening does not reduce deaths from the disease, even among
men in their 50s and 60s and those with underlying health conditions, a new study has
claimed.
A longer follow-up of more than 76,000 men in a major U.S. study, led by Washington
University School of Medicine in St. Louis, shows that six years of aggressive, annual
screening for prostate cancer led to more diagnoses of tumours but not to fewer deaths
from the disease.
"The data confirm that for most men, it is not necessary to be screened annually for
prostate cancer," Newswise quoted Gerald Andriole, the study leader as saying.
"A large majority of the cancers we found are slow-growing tumours that are unlikely to
be deadly," he said.
The PLCO study involved men aged 55 to 74, who were randomly assigned to receive
either annual PSA tests for six years and digital rectal exams for four years or "routine
care," meaning they had the screening tests only if their physicians recommended them.
The new research updates an earlier report of the data published in 2009 in the New
England Journal of Medicine. At that time, when nearly all men had been followed for
seven years, Andriole and his colleagues did not find a mortality benefit from prostate
cancer screening.
Since so few men in the study had died from any causes, the researchers said then that it
would be premature to make broad generalizations about whether men should continue to
be screened. However, they did recommend against prostate cancer screening for men
with a life expectancy of seven to 10 years or less.
"Now, based on our updated results with nearly all men followed for 10 years and more
than half for 13 years, we are learning that only the youngest men — those with the
longest life expectancy — are apt to benefit from screening. We need to modify our
current practices and stop screening elderly men and those with a limited life
expectancy," he said.
"Instead, we need to take a more targeted approach and selectively screen men who are
young and healthy and particularly those at high risk for prostate cancer, including
African-Americans and those with a family history of the disease," he added.
Andriole recommends that men get a baseline PSA test in their early 40s because recent
studies have indicated that elevated levels at that age can predict the risk of prostate
cancer in later years. Men in their 40s with low PSA levels are very unlikely to develop
lethal prostate cancer and could potentially avoid additional testing.
The researchers detected 12 percent more prostate tumours among men screened annually
compared to those who received routine.
However, deaths from prostate cancer did not differ significantly between the groups.
There were 158 deaths from prostate cancer in the screening group and 145 deaths in the
routine-care group.
Annual screening tests also did not reduce deaths from prostate cancer among men in
their 50s and 60s, as the researchers had hoped.
The study has been published online in the Journal of the National Cancer Institute.
Prostate Cancer
Aggressive Prostate Cancer Risk Increased in Men Who Gain Weight
During Adulthood (Med India: 20.1.2012)
Putting on weight during adult life can increase the risk of aggressive prostate cancer
among men, a new study reveals.
Researchers from University of Melbourne in Australia observed more than 17,000 men
aged between 40 to 69 years and found that the risk of deaths due to prostate cancer
increased among those who put on an additional 20 kgs or more during their adult life.
"'This study and other similar studies have shown that obesity is related to aggressive and
fatal cancer," Dallas English, co-author the study told the Sydney Morning Herald.
"'Maintaining a healthy weight during adult life is really the bottom line.”
The study is published in the latest issue of the International Journal of Cancer
'Natural formula'
'Natural formula' offers hope to treat prostate cancer (New Kerala:
18.1.2012)
An all-natural, doctor-designed formula that combines botanical extracts, phytonutrients,
botanically enhanced medicinal mushrooms, and antioxidants shows promise to fight
aggressive prostate cancer tumours, researchers say.
A xenograft model is when tissue or organs from an individual of one species are
transplanted or grafted onto an organism of another species, genus, or family. So human
prostate cancer cells (tissue) are grafted onto a laboratory animal, which in this case were
mice.
Lead investigator, Dr. Daniel Sliva presented the results of this in vivo (live animal)
study, demonstrating the significant effects of the formula in suppressing the proliferation
and metastasis of human hormone refractory (androgen independent) prostate cancer
cells.
In addition, the toxicology analysis proved that this formula is non-toxic and poses no
risk of side effects.
"Dietary supplements are used as an alternative or adjuvant therapies. However, rigorous
scientific verification of their biological activity in vitro and in vivo is necessary for the
acceptance of dietary supplements in conventional cancer treatment and prevention," said
Dr. Sliva.
This in vivo study is significant because hormone refractory prostate cancer (androgen
independent) is especially hard to treat.
It's the more aggressive, advanced form of prostate cancer that often leads to metastasis
and progression of the cancer.
The ingredients were selected based on scientific research demonstrating their abilities to
fight prostate abnormalities and provide broad-spectrum prostate support.
Results of the study showed that the oral administration of this formula produced a
statistically significant suppression of tumour growth, compared to controls.
In addition to a significant reduction in tumour volume, results of this study showed the
formula also worked to inhibit a number of genes involved in cancer proliferation and
metastasis.
"In summary, this dietary supplement is a natural compound for the possible therapy of
human hormone refractory (independent) prostate cancer," added Dr. Sliva. (ANI)
Prostate Cancer
Aggressive Prostate Cancer Risk Increased in Men Who Gain Weight
During Adulthood (Med India: 20.1.2012)
Putting on weight during adult life can increase the risk of aggressive prostate cancer
among men, a new study reveals.
Researchers from University of Melbourne in Australia observed more than 17,000 men
aged between 40 to 69 years and found that the risk of deaths due to prostate cancer
increased among those who put on an additional 20 kgs or more during their adult life.
"'This study and other similar studies have shown that obesity is related to aggressive and
fatal cancer," Dallas English, co-author the study told the Sydney Morning Herald.
"'Maintaining a healthy weight during adult life is really the bottom line.”
The study is published in the latest issue of the International Journal of Cancer
Prostate Cancer
Prostate Cancer - Evidence Not Beliefs Matter Regarding Screening and
Treatment (Medical News Today: 27.1.2012)
According to Beth Israel Deaconess Medical Center and prostate expert Marc B. Garnick,
MD, physicians who advise PSA tests for men being screened for prostate cancer must
base their decision more on available evidence when recommending screening, biopsies
and treatments, instead of holding on to long held beliefs that PSA-based testing benefits
all.
Garnick wrote in the February issue of Scientific American, stating that the current
system of relying on prostate-specific antigens levels in the blood is "deeply flawed," and
physicians must consider that "the PSA test does not tell you if a man has cancer, just that
he might have it."
According to the latest US Preventative Services Task Force's evaluation of studies
published in 2009, PSA testing demonstrates more harm than good in terms of results.
Furthermore, the report shows that in light of the evidence, a more cautious,
individualized approach should be taken towards patient treatment, instead of aggressive
early treatment for all. The approach is currently underway at BIDMC.
Garnick, who is also an editor-in-chief of Harvard Medical School's Annual Report on
Prostate Diseases and related website, states:
"Most people outside the medical community do not realize how flimsy evidence has
been in favor of the PSA screening data. In a perfect world, a screening test would
identify only cancers that would prove lethal if untreated. Then, men who had small,
curable cancers would be treated, and their lives would be saved. Ideally, the treatments
would not only be effective, they would have no serious side effects. Such a scenario
would justify massive screening and treatment of everyone with a positive test."
At present, however, there is no reliable approach for doctors to determine which of these
small cancers identified by biopsy are potentially dangerous and which remain harmless
throughout life. Additionally, all treatments currently available pose substantial risks and
long-term side effects.
Garnick says that the number of men who would need to receive treatment, and
potentially suffer the consequences of the treatment to successfully prevent just one
single prostate cancer death, has prompted the Task Force to recommend against wide
spread PSA testing for all those without symptoms of prostate cancer.
Two 2009 studies, one in Europe and one in the US, randomly divided healthy men in
their 50s and 60s into two groups. One group was periodically screened for prostate
cancer using PSA testing, adigital rectal exam or both, whilst the other group received
standard medical care as required without being offered routine testing.
The European study revealed that only those tested and treated for prostate cancer had a
mortality risk of 20%, although such a decrease was not observed in the U.S. study.
Neither study demonstrated whether those who were tested and treated had a longer life
expectancy, compared with those not offered routine testing.
The researchers in the European study established that about 1,400 men would have to be
screened to prevent one single person from dying of prostate cancer, and result in 48
others needing to undergo treatment, whilst the other 47 men would be likely to suffer
serious side effects, like incontinence and impotence, due to the radiation or surgery.
Garnick explains:
"The overall death rate from all causes was not statistically different in both the screened
and unscreened groups. Unfortunately, the mortality data collected over the past 25 years
shows that the natural history of prostate cancer is not as straightforward as my
colleagues and I once believed. Many cancers will never cause problems during the
patient's lifetime, and hence do not need to be treated, at least immediately."
According to findings from a long-term Canadian study, the prostate cancer mortality rate
for those men who chose active surveillance or delayed treatment following PSA testing
resulted in a cancer diagnosis of 1% over 10 years in comparison to a 0.5% mortality risk
due to post prostate cancer surgery complications within one month after surgery.
Garnick declares:
"The point is that the initial decision to forgo treatment is not necessarily the final one.
Surgery, radiation and other therapies are still available later on, and most current data
indicate that the outcome will not be negatively affected by the delay. Such an approach
is improving our ability to tailor treatments for individuals rather than always treating
everyone the same."
The results of this decision suggests that doctors, as well as patients both need a precise
scientific understanding about these issues, in particular during a doctor-patient
discussion. Garnick comments: "We need to have the courage to act on the evidence and
not just our beliefs."
Prostate Cancer
Telomere Failure, Telomerase Activation Drive Prostate Cancer
Progression (Science daily: 21.2.2012)
Genomic instability caused by an erosion of the protective caps on chromosomes,
followed by activation of an enzyme that reinforces those caps, allows malignant cells to
evade destruction and acquire more deadly characteristics, researchers report in an Online
Now article at the journal Cell.
In a strain of mice engineered to develop prostate cancer, all mice that went through this
two-step process developed lethal cancer and 25 percent had the disease spread to the
spine. Two groups of mice that avoided this cycle developed only precancerous lesions or
localized prostate cancer.
A comparative analysis of genetic changes in the metastatic mouse tumors and those
found in metastatic human prostate cancer identified the Smad4 gene as a driver in bone
metastasis. Fourteen other genes were found to be associated with human prostate cancer
prognosis.
The research focused on telomeres -- repeat nucleotide sequences at the tips of
chromosomes that prevent genomic damage during cell division. Telomeres shorten with
each cell division, eventually permitting genomic instability in the cells that normally
causes these abnormal cells to die.
In cancer the enzyme telomerase becomes activated and lengthens telomeres, preserving
damaged cells to survive and reproduce. Telomerase is inactive in normal cells.
Telomerase activation confers new strengths on tumors
"These in vivo mouse studies, together with human and mouse prostate cancer genomic
data, provide evidence that telomere dysfunction plays a critical role in prostate cancer
initiation and progression," said co-senior author Lynda Chin, M.D., professor and chair
of The University of Texas MD Anderson Cancer Center's Department of Genomic
Medicine.
"Our studies also show that telomerase activation after genomic instability caused by
telomere dysfunction enables evolving cancers to progress and acquire new biological
properties, including central features of advanced human prostate cancer," Chin said.
Chin, co-senior author and MD Anderson President Ronald DePinho, M.D., and
colleagues conducted this research while at Dana-Farber Cancer Institute in Boston.
Telomere dysfunction, fired-up telomerase, cause bone metastasis
The team took a strain of mice with both the p53 and pten tumor-suppressing genes
knocked out that normally develop nonmetastatic prostate cancer and engineered some to
express telomerase. They were cross-bred for several generations.
•Control mice with intact telomeres (either wild-type mice or those with telomerase
expressed) avoided the genomic instability caused by telomere shortening. All of these
mice developed locally invasive, nonmetastatic prostate cancer.
•Mice without telomerase were subject to telomere dysfunction and genetic changes and
developed precancerous high-grade prostate intraepithelial neoplasia (HPIN) but 60
percent of them did not progress to prostate cancer. Signs of programmed cell death
triggered by genetic abnormalities abounded in this group.
•Mice subject to telomere dysfunction, genomic instability and telomerase activation also
developed HPIN but then progressed to lethal bulky tumors, with 5 of 20 developing
spinal metastases that were not seen in the genome-stable mice.
"Not only did telomerase reactivation bypass the cancer progression block that arises
with telomere dysfunction, it also conferred a new property -- bone metastasis -- that was
not seen in tumors that did not go through telomere dysfunction followed by telomerase
reactivation," said first author Zhihu Ding, Ph.D., formerly of Dana-Farber and now with
Sanofi-Aventis, Inc.
"This provides the first genetic evidence that telomerase reactivation and genome
stabilization are necessary to drive full malignant progression in epithelial cancers," Ding
said.
Aligning genetic alterations in mice and humans
Chin, Ding and colleagues analyzed gene copy number aberrations -- genes deleted or
amplified -- in 18 advanced tumors from the mice and 194 human prostate tumors.
They found 22 of the 94 copy number alterations involving deletion or amplification of
741 genes identified in mice were similar to those found in humans. A series of analyses
of changes found in bone metastases pointed to deletions of the Smad4 tumor-suppressor
gene, which regulates the transforming growth factor beta (TGF-ß) pathway.
The team took this finding back to the mouse model with tumor suppressors p53 and pten
knocked out. These mice don't develop bone metastasis, but when the researchers also
knocked out Smad4, more aggressive tumors developed, including bone metastasis in
three of 24 mice.
Genes prognostic for human prostate cancer
Next, they looked at 14 genes in nine molecular pathways found to be enriched in bone
metastasis to see if they were prognostic for recurrence (as measured by PSA levels after
surgery) among 140 prostate cancer patients.
The 14-gene set was significantly prognostic of biochemical recurrence, providing
evidence of their biological relevance to human prostate cancer, but the researchers noted
that their individual contributions and mechanisms of action will require further research.
"Overall, our findings validate the integrative approach of employing genotypephenotype correlations found in the mouse model with the power of genomic and
bioinformatic analyses to discover and explain molecular mechanisms that drive prostate
cancer," said co-first author Chang-Jiun Wu, Ph.D., a postdoctoral fellow in MD
Anderson's Department of Genomic Medicine.
This research was funded by grants from the National Cancer Institute, the Prostate
Cancer Foundation, the U.S. Department of Defense, the Damon Runyon Cancer
Research Foundation, the Multiple Myeloma Research Foundation, an American Cancer
Society and the Robert A. and Renee E. Belfer Foundation.
Prostate cancer
Circumcision 'may lower prostate cancer risk'(New Kerala: 13.3.2012)
Circumcision before a male's first sexual intercourse may help protect against prostate
cancer, a new study has found.
The study, conducted by researchers at Fred Hutchinson Cancer Research Center,
suggests that circumcision can hinder infection and inflammation that may lead to this
malignancy.
Infections are known to cause cancer, and research suggests that sexually transmitted
infections may contribute to the development of prostate cancer.
Additionally, certain sexually transmitted infections can be prevented by circumcision.
Therefore, it stands to reason that circumcision should protect against the development of
some cases of prostate cancer.
This is what lead author Jonathan L. Wright, MD, an affiliate investigator in the
Hutchinson Center's Public Health Sciences Division, and his colleagues set out to test.
For their study, the investigators analysed information from 3,399 men (1,754 with
prostate cancer and 1,645 without). Men who had been circumcised before their first
sexual intercourse were 15 percent less likely to develop prostate cancer than
uncircumcised men.
This reduced risk applied for both less aggressive and more aggressive cancers.
(Specifically, men circumcised before their first sexual intercourse had a 12 percent
reduced risk for developing less aggressive prostate cancer and an 18 percent reduced
risk for developing more aggressive prostate cancer.
Sexually transmitted infections may lead to prostate cancer by causing chronic
inflammation that creates a hospitable environment for cancer cells.
Other mechanisms may also be involved. Circumcision may protect against sexually
transmitted infections, and therefore prostate cancer, by toughening the inner foreskin
and by getting rid of the moist space under the foreskin that may help pathogens survive.
"These data are in line with an infectious/inflammatory pathway which may be involved
in the risk of prostate cancer in some men," Wright said.
"Although observational only, these data suggest a biologically plausible mechanism
through which circumcision may decrease the risk of prostate cancer. Future research of
this relationship is warranted," he added.
The study has been published online in Cancer.
Prostate cancer
Circumcision 'may lower prostate cancer risk'(New Kerala: 13.3.2012)
Circumcision before a male's first sexual intercourse may help protect against prostate
cancer, a new study has found.
The study, conducted by researchers at Fred Hutchinson Cancer Research Center,
suggests that circumcision can hinder infection and inflammation that may lead to this
malignancy.
Infections are known to cause cancer, and research suggests that sexually transmitted
infections may contribute to the development of prostate cancer.
Additionally, certain sexually transmitted infections can be prevented by circumcision.
Therefore, it stands to reason that circumcision should protect against the development of
some cases of prostate cancer.
This is what lead author Jonathan L. Wright, MD, an affiliate investigator in the
Hutchinson Center's Public Health Sciences Division, and his colleagues set out to test.
For their study, the investigators analysed information from 3,399 men (1,754 with
prostate cancer and 1,645 without). Men who had been circumcised before their first
sexual intercourse were 15 percent less likely to develop prostate cancer than
uncircumcised men.
This reduced risk applied for both less aggressive and more aggressive cancers.
(Specifically, men circumcised before their first sexual intercourse had a 12 percent
reduced risk for developing less aggressive prostate cancer and an 18 percent reduced
risk for developing more aggressive prostate cancer.)
Sexually transmitted infections may lead to prostate cancer by causing chronic
inflammation that creates a hospitable environment for cancer cells.
Other mechanisms may also be involved. Circumcision may protect against sexually
transmitted infections, and therefore prostate cancer, by toughening the inner foreskin
and by getting rid of the moist space under the foreskin that may help pathogens survive.
"These data are in line with an infectious/inflammatory pathway which may be involved
in the risk of prostate cancer in some men," Wright said.
"Although observational only, these data suggest a biologically plausible mechanism
through which circumcision may decrease the risk of prostate cancer. Future research of
this relationship is warranted," he added.
The study has been published online in Cancer.
Prostate Cancer
New Mechanism of Prostate Cancer Cell Metabolism Identified (Med
India: 26.3.2012)
Scientists have uncovered a novel mechanism of prostate cancer cell metabolism. Study
results are published in Cancer Discovery, a journal of the American Association for
Cancer Research.
Almut Schulze, Ph.D., a group leader in the Gene Expression Analysis Laboratory at
Cancer Research U.K., and colleagues analyzed three metastatic prostate cancer cell lines
and compared those findings with those of a nonmalignant prostate epithelial cell line.
"Cancer metabolism is a new and emerging target that can be exploited as a potential
therapeutic, and our study identified one of the components for the growth of these
cancer cells," she said.
The researchers analyzed the effects of gene silencing of 222 metabolic enzymes,
transporters and regulators on the survival of the cell lines.
"This approach revealed a significant complexity in the metabolic requirements of
prostate cancer cells and identified genes selectively required for their survival," said
Schulze.
Researchers determined that the gene PFKFB4 was vital in many of these processes.
Specifically, it was required to balance glycolytic activity and antioxidant production to
maintain cellular redox balance in the cancer cells. When levels of this gene were
depleted in laboratory models, tumor growth was inhibited. Higher levels of this gene
were found in the metastatic prostate cancer cell lines.
Schulze concluded that this gene is required for tumor growth and thus could be
manipulated with targeted therapies. Although this study was confined to prostate cancer,
she believes the findings could be applicable in other cancers as well.
The study was funded by Cancer Research U.K.
Prostate Cancer
Noninvasive Imaging of Prostate Cancer via New Technology (Med
India: 3.4.2012)
Researchers were able to measure free prostate-specific antigen in prostate cancer models
thanks to a new, noninvasive imaging tool. They were also able to visualize bone
metastasis in a tumor-specific manner.
The results are published in Cancer Discovery, a journal of the American Association for
Cancer Research.
Results of this paper were presented here at an AACR Annual Meeting 2012 press
conference on Saturday, March 31, 2012, at 4:00 p.m. CT in Room 20 A/B/C of the Hyatt
Conference Center, adjacent to McCormick Place.
If further validated, the use of this tool, a prostate cancer-specific radiotracer, could
potentially aid in treatment planning on an individualized patient basis, according to
Michael J. Evans, Ph.D., research fellow in the Human Oncology and Pathogenesis
Program at Memorial Sloan-Kettering Cancer Center in New York, N.Y., and colleagues.
A radiotracer is a small amount of a compound that has been "tagged" with a
radionuclide. Patients are injected with the radiotracer, which aids in visualizing the
tumor using positron emission tomography (PET).
In this study, Evans and colleagues examined the effects of 89Zr-5A10, the first
radiotracer designed specifically to target free prostate-specific antigen (PSA), a known
biomarker of prostate cancer that provides a more accurate measure of risk when
compared with serum PSA.
"Once injected, the use of 89Zr-5A10 allows physicians to measure different biological
properties among metastatic lesions within the same patient, which a serum biomarker
cannot achieve," Evans said.
Researchers tested the utility of 89Zr-5A10 in a group of male mice with PSA-positive
prostate cancer. The radiotracer localized to the tissue of castration-resistant prostate
cancer, a state of the disease where serum PSA does not always reflect clinical outcomes,
and sensitively measured declines in PSA expression induced by therapeutic intervention
with the antiandrogen drug MDV3100.
The radiotracer also helped researchers identify metastatic bone lesions related to the
primary prostate cancer. Traditional bone scans are unable to discriminate between
malignant and nonmalignant lesions.
If translated to humans, this PET agent could help to stage prostate cancer, streamline the
evaluation of prostate cancer therapies and aid in clinical trial management.
"The ultimate goal is to be able to predict the response of patients to new and existing
therapies at an early stage, thereby personalizing their treatment and improving
outcomes," Evans said.
Given the success of this preclinical work, Evans and colleagues hope to translate the
89Zr-5A10 platform for a human trial by 2013.
Prostate cancer
Inherited-genetic variations up risk of aggressive prostate cancer (new
Kerala: 11.4.2012)
Scientists have discovered two inherited-genetic deletions in the human genome linked to
development of aggressive prostate cancer.
The findings by an international research team led by Weill Cornell Medical College
investigators indicate a man's risk of developing prostate cancer either triples or
quadruples, depending on the genetic variant they inherit.
In the study, one genetic deletion is shown to affect the functioning of a known gene,
while the other, found in a non-coding area of the genome once considered to be "junk
DNA," seems to be regulating a cascade of genes.
According to the lead co-authors, the study is potentially groundbreaking because it
demonstrates that so-called copy number variations (CNVs) in either protein coding or
non-coding areas of the human genome play a significant role in the development of
cancer in general, and in aggressive prostate cancer, specifically.
"We used to think that only genes that made proteins were responsible for disease, but
this study shows us that there is inherited information in the non-coding areas of the
genome that appear to play a strong role in development of cancer," said study co-author,
Dr. Mark A. Rubin, the Homer T. Hirst Professor of Oncology in Pathology at Weill
Cornell Medical College.
Other researchers have linked CNVs to Alzheimer's and Parkinson's disease, mental
retardation, autism, schizophrenia and neuroblastoma, a type of brain cancer.
"This study suggests there are other cancers that might be associated with CNVs. It's an
exciting new field of research," stated Dr. Rubin.
"The study shows that copy number variations matter in cancer," added co-lead
investigator, Dr. Francesca Demichelis, who is now an Assistant Professor at the Center
of Integrative Biology at the University of Trento in Italy and an Adjunct Assistant
Professor in the Institute for Computational Biomedicine at Weill Cornell Medical
College.
The two genetic variants identified by the research team are not the only cause of
aggressive prostate cancer, Dr. Demichelis noted.
"These variants likely collaborate with other factors early in a man's life leading to
development of prostate cancer," she said.
Molecular studies were performed in the U.S. on more than 1900 blood samples from
Tyrolean men (867 unrelated cancer patients and 1,036 controls). Researchers discovered
two CNVs that were significantly different between Tyrolean individuals with aggressive
prostate cancer and those without cancer, and then reproduced that finding in another
group of 800 U.S. patients.
The researchers then tested the effect of the two variants in laboratory cells and
discovered they increase the ability of cancer cells to grow and to invade.
Both of these variants are small deletions in DNA that lead to over-expression of genes,
Dr. Demichelis said.
She and her colleagues found that one gene that is over-expressed due to the variant
deletion is MGAT4C, which leads to the ability of cells to grow and migrate.
"A man with the variant is four times more likely to develop prostate cancer if he
inherited this variant than if he did not," Dr. Demichelis said.
"Interestingly, MGAT4C was found to be significantly over-expressed in metastatic
versus localized prostate cancer," she added.
The role of the other genetic variant, located in the "junk" region of the human genome,
is not yet known, but the researchers believe it activates a cascade of other genes. They
calculated a man is three times more likely to develop prostate cancer if he has inherited
this variant.
The investigators calculated these two newly identified variants occur at a frequency of
between 1.5-3 percent of the overall population, but are found at a significantly higher
percentage in men diagnosed with aggressive prostate cancer.
Now researchers are looking for other variants they hope to be able to build into a
comprehensive DNA test to be used as a diagnostic tool to help clinicians identify men
whose prostate cancer will likely progress to advanced stages.
The discovery has been published online in the Proceedings of the National Academy of
Sciences (PNAS). (ANI
Prostate cancer
New treatment for prostate cancer gives `perfect results` sans side
effects`(New Kerala: 17.4.2012)
A new treatment for prostate cancer can free the disease for nine in ten men without
debilitating side effects, say scientists.
The result offers new hope for tens of thousands of men with prostate cancer.
It is hoped the new treatment, which involves heating only the tumours with a highly
focused ultrasound, will mean men can be treated without an overnight stay in hospital
and avoiding the distressing side effects associated with current therapies.
In a study, the scientists found that focal HIFU, high-intensity focused ultrasound,
provides the 'perfect' outcome of no major side effects and free of cancer 12 months after
treatment, in nine out of ten case," the Telegraph reported.
Traditional surgery or radiotherapy can only provide the perfect outcome in half of cases
currently.
Experts have said the results are 'very encouraging' and were a 'paradigm' shift in
treatment of the disease.
It is hoped that large-scale trials can now begin so the treatment could be offered
routinely on the NHS within five years.
The National Institute for Health and Clinical Excellence will say in new guidance next
week that the treatment is safe and effective and larger scale trials should go ahead.
Focal HIFU involves careful selection of tumours, as small as a grain of rice, within the
prostate gland and targeting them with highly focused ultrasound to heat them and
destroy them.
The advantage over previous HIFU and other treatments is that damage to surrounding
tissue is minimised, meaning there are far fewer side effects.
In the study, 41 men were treated with focal HIFU. After 12 months, none were
incontinent and one in ten suffered impotence. The majority, 95 per cent, were free of
cancer after 12 months.
"This changes the paradigm. By focusing just on the areas of cancer we reduce the
collateral damage to surrounding tissue," said Dr Hashim Ahmed, who led the study at
University College London Hospitals NHS Foundation Trust and University College
London.
"Our results are very encouraging. We're optimistic that men diagnosed with prostate
cancer may soon be able to undergo a day case surgical procedure, which can be safely
repeated once or twice, to treat their
condition with very few side-effects. That could mean a significant improvement in their
quality of life.
"This study provides the proof-of-concept we need to develop a much larger trial to look
at whether focal therapy is as effective as the current standard treatment in protecting the
health of the men treated for prostate cancer in the medium and long term," he stated.
He said after Nice guidance is issued next week, he expected other doctors to consider
using the treatment.
The study was published in the journal Lancet Oncology. (ANI)
New Prostate Cancer
New Prostate Cancer Ultrasound Treatment Shows Promise (Medical
A new experimental treatment for localized prostate cancer that uses high intensity
focused ultrasound (HIFU) promises to be more effective and have fewer side effects
than conventional treatments, according to a new study published early online in The
Lancet Oncology on Tuesday.
HIFU, which involves removing small lumps of cancerous prostate tissue, is being
investigated as an alternative to conventional treatments such as radical whole-gland
removal (radical prostatectomy) in men with localized prostate cancer. In this respect it is
similar to the option of a "lumpectomy" as an alternative to a full mastectomy in breast
cancer.
The treatment focuses soundwaves to millimetre accuracy, causing targeted tissue to heat
up to around 80 to 90 degrees Celsius, which kills cells instantaneously.
The first author of the study is Hashim Uddin Ahmed, a Medical Research Council
Clinical Research Fellow in the Division of Surgery and Interventional Science at
University College London (UCL), who is conducting a series of world-first trials into
HIFU as an alternative treatment for prostate cancer.
Prostate cancer is the most common cancer affecting men in the UK where 250,000 are
currently living with the disease, and 37,000 cases are diagnosed every year.
Conventional treatments such as surgery and radiotherapy can cause many distressing
side effects that affect everyday life, work and relationships.
This is because they treat the whole prostate and risk damaging the nerves that supply the
penis, muscles that control urine flow, and the lining of the rectum. Damage to these
nerves leads to incontinence and difficulty having erections.
Thus there is a need for new kinds of treatment that safely remove cancerous tissue
without damaging surrounding nerves.
For this latest phase 1 study, between June 2007 and June 2010, Ahmed and colleagues
recruited 42 men, of age 45 to 80 years, with low to high risk localized prostate cancer
who had not yet undergone any cancer treatment.
The men received HIFU to all known cancer lesions (some had only one, others had
several lesions).
One man died of causes unrelated to the cancer three months after treatment, so only 41
were included in the analyses.
12 months after the start of HIFU treatment (some men had it more than once), none of
the 41 men had incontinence, only one in 10 suffered from poor erections, and the
majority (95%) were free of cancer.
Ahmed and colleagues conclude:
"Focal therapy of individual prostate cancer lesions, whether multifocal or unifocal, leads
to a low rate of genitourinary side-effects and an encouraging rate of early absence of
clinically significant prostate cancer."
Ahmed told the press the results are "very encouraging" and he and his colleagues are
"optimistic" that in the not too distant future, men diagnosed with localized prostate
cancer will be able to undergo HIFU as a day case surgical procedure, which can safely
be repeated once or twice, with few side effects.
"That could mean a significant improvement in their quality of life," Ahmed said in a
report by the Press Association.
Ahmed said the findings furnish the necessary "proof of concept" that gives the go-ahead
to much larger trials to investigate the effectiveness of HIFU as a standard treatment for
men with localized prostate cancer.
Funds from the Medical Research Council (UK), Pelican Cancer Foundation, and St
Peters Trust helped pay for the study.
Prostrate cancer'
Bald men 'more prone to developing prostrate cancer'(New Kerala:
31.5.2012)
Bald men may be more at risk of developing prostate cancer, a new research has
revealed.
Researchers found that men who underwent prostate biopsies were more likely to be
diagnosed with cancer if they had lost significant amounts of hair.
The reasons why are not clear, but researchers think it may be connected to higher levels
of testosterone, the hormone which can trigger the development of cancerous cells but
also inhibit hair growth.
Dr Neil Fleshner, who led the study at the University of Toronto, said that although the
findings need to be replicated in further research, they could sound an alarm bell for men
with receding hair lines.
"The more bald men were, the more likely they were to have prostate cancer," the Daily
Mail quoted him as saying.
"Bald men should be aware that they may benefit from being screened earlier and
perhaps, if necessary, from being biopsied sooner," he said.
However, since the results come from a relatively small study, involving just 214 men, it
does not prove that baldness actually triggers cancer.
Nearly 32,000 cases of prostate cancer are diagnosed every year in the UK and 10,000
men die from it - the equivalent of more than one an hour.
The researchers recruited 214 men aged between 59 and 70 who had been referred for a
biopsy as they had raised levels of prostate specific antigen (PSA), a marker in the blood
that hints at an increased risk of cancer.
They judged baldness on a four-point scale, beginning with slight hair loss at the front of
the scalp, up to severe loss on the top and sides.
The findings, presented at the annual meeting of the American Urological Association in
Atlanta, Georgia, exemplified that the more severe a man's balding pattern, the more
likely he was to have a tumour.
The results corroborates a 2010 study which showed that bald men are also more at risk
of another prostate condition, called benign prostatic hyperplasia, or BPH.
This is where the prostate becomes enlarged, usually as a result of the ageing process,
until it presses on the urethra, the tube that carries urine from the bladder out of the body.
The initial sign of the condition, which affects around 2.5million men in the UK, is
usually trouble in passing urine, or difficulty starting even when the bladder is full.
Untreated BPH can cause kidney damage if it becomes impossible to urinate. It can also
lead to bladder stones, depression and daytime tiredness due to constant broken sleep.
High levels of testosterone are thought to be a major factor by stimulating the growth of
abnormally high numbers of prostate cells.
But in baldness, high testosterone levels have an adverse affect on the hair follicles,
acting on a hormone receptor on the hair follicle to slow down hair production.
Spanish scientists found that men who went bald in their twenties and thirties had larger
prostate volume and reduced urinary flow - two key signs that BPH is developing compared to men who had not suffered hair loss. (ANI)
Prostrate Cancer
Intermittent therapy inferior to hormone therapy for prostrate cancer
Many men with metastatic, hormone-sensitive prostate cancer live longer on continuous
androgen-deprivation therapy, also known as hormone therapy, than on intermittent
therapy, a 17-year study has revealed.
Men with newly diagnosed metastatic prostate cancer are usually either surgically
castrated or given medications to suppress the production of male hormones that drive
their cancer.
The treatment can help keep the disease at bay temporarily, but in the majority of patients
the cancer will relapse and contribute to the patient's death.
Surgical castration is permanent but "medical castration" provides men the potential
advantage of receiving therapy intermittently. A halt in this therapy is followed in time
by a rise in testosterone levels.
Scientific data suggested that intermittent treatment may delay the cancer relapse, and
that the rise in testosterone may result in an improvement in the patient's quality of life.
These data provided the rationale for the phase III clinical trial SWOG-9346, the largest
such study to date in men with metastatic, hormone-sensitive disease.
Results of this study, led by SWOG, a cancer research cooperative group funded by the
National Cancer Institute (NCI), demonstrate that intermittent androgen-deprivation (AD)
therapy is not as good as continuous hormone therapy with regard to patient longevity.
The findings are to be presented today at the plenary session of the American Society for
Clinical Oncology's (ASCO's) annual meeting by the study's principal investigator, Maha
Hussain, M.D., F.A.C.P., of the University of Michigan Comprehensive Cancer Center.
"Based on these results," Maha Hussain, principal investigator of the study from the
University of Michigan Comprehensive Cancer Center, said.
"We can conclude that intermittent AD is not as effective as continuous AD in men with
metastatic prostate cancer," he said.
Clinical researchers from the SWOG network, with funding from the NCI, led an
international team in conducting the study at more than 500 sites, enrolling 3,040 men
with hormone-sensitive, metastatic prostate cancer between 1995 and 2008.
All men got an initial course of androgen-deprivation treatment for seven months. The
1,535 eligible men whose prostate-specific antigen (PSA) level dropped to 4 ng per mL
or less by the end of those seven months were then assigned at random to stop therapy
(the intermittent therapy group) or continue therapy (the continuous therapy group).
Those randomized to the intermittent therapy arm had their treatment suspended until
their PSA rose to a predetermined level, at which time they started another seven-month
course of androgen-deprivation therapy, cycling on and off therapy in this way as long as
their PSA levels continued to respond appropriately during the "on" cycle.
Men on continuous therapy had a median overall survival time of 5.8 years from the time
of randomization, with 29 percent of these men surviving at least 10 years.
Those on intermittent therapy had a median overall survival time of 5.1 years, with 23
percent surviving at least 10 years from the time they were randomly assigned to a
treatment arm.
The researchers found, in additional analyses, that men with "minimal disease" (disease
that had not spread beyond the lymph nodes or the bones of the spine or pelvis) did
significantly better on continuous therapy, while men with "extensive disease" (disease
that had spread beyond the spine, pelvis, and lymph nodes or to the lungs or liver)
seemed to do about as well using either treatment approach.
Additional analyses indicated that the median overall survival time for those with
minimal disease was 7.1 years on continuous androgen-deprivation therapy compared to
only 5.2 years on intermittent treatment.
Patients with extensive disease had median overall survival times of 4.4 years on
continuous therapy and 5.0 years on intermittent therapy.
"In the past when it came to using hormone therapy in this disease, doctors viewed the
disease as one entity and adopted a 'one size fits all' approach.
"Based on this study's findings, it seems that one size does not necessarily fit all,"
Hussain said.
Trial researchers also compared quality-of-life measures across the two study arms
during the first 15 months following patient randomization, including measures of sexual
function (impotence and libido), physical and emotional function, and energy level.They
found improved sexual function in men who received intermittent therapy as compared to
those on continuous therapy.
"Though we see potential quality-of-life benefits with IAD.
"From a medical perspective, the primary findings of the study demonstrating that IAD is
inferior with regard to overall survival should be the primary consideration in counseling
all patients who are interested in intermittent therapy and particularly those with minimal
disease," Hussain added.
The findings of the study will be presented at the plenary session of the American Society
for Clinical Oncology's (ASCO's) annual meeting. (ANI)
Prostate Cancer
Prostate Cancer Risk Higher For Heavy Tea Drinkers(Medical News
Today:21.6.2012)
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A new study from Scotland has found that men who are heavy tea drinkers may be at
higher risk for prostate cancer. However, the researchers point out their study was not
designed to find causes, so all they can say is that heavy tea drinking is linked to a higher
risk for prostate cancer and not necessarily the cause of it.
Study leader Dr Kashif Shafique of the Institute of Health & Wellbeing at the University
of Glasgow, told the media:
"We don't know whether tea itself is a risk factor or if tea drinkers are generally healthier
and live to an older age when prostate cancer is more common anyway."
"Most previous research has shown either no relationship with prostate cancer for black
tea or some preventive effect of green tea," said Shafique.
He and his colleagues write about the findings of their prospective study in a paper that
was published online in the journal Nutrition and Cancer on 14 June.
The data they used covered 6,016 Scottish men aged from 21 to 75 years who were
enrolled on the Midspan Collaborative study between 1970 and 1973 and were followed
for up to 37 years.
The men had filled in questionnaires about their general health, smoking habits, and usual
consumption of tea, coffee, and alcohol, and they also attended a screening examination.
When they analyzed the data the researchers found a statistically significant link (P=0.02,
so unlikely to be due to pure chance) between tea drinking and overall risk of developing
prostate cancer.
After water, tea is the most widely consumed drink in the world. They found the men
who drank the most tea (more than seven cups a day, just under a quarter of all the men)
had a 50% higher risk of developing prostate cancer than those who drank the least (0 to
3 cups a day).
Overall, 6.4% of the men who drank the most tea developed prostate cancer during the
study period, compared with 4.6% of those who consumed the least.
The researchers found no significant link between tea drinking and low or high grade
cancer incidence:
"Men with higher intake of tea are at greater risk of developing prostate cancer, but there
is no association with more aggressive disease," write the authors, who conclude:
"Further research is needed to determine the underlying biological mechanisms for the
association."
Shafique said:
"We found that heavy tea drinkers were more likely not to be overweight, be non alcoholdrinkers and have healthy cholesterol levels. However, we did adjust for these differences
in our analysis and still found that men who drank the most tea were at greater risk of
prostate cancer."
Dr Kate Holmes, Head of Research at The Prostate Cancer Charity, said in a statement
released on Tuesday:
"Whilst it does appear that - of the 6,000 men who took part in this study - those who
drank seven or more cups of tea each day had an increased risk of developing prostate
cancer, this did not take into consideration family history or any other dietary elements
other than tea, coffee and alcohol intake. It is therefore unclear as to whether there were
other factors in play which may have had a greater impact on risk."
"We would therefore not wish any man to be concerned, as a result of this study, that
drinking a moderate amount of tea as part of a healthy diet will put them at an increased
risk of developing prostate cancer," she added.
Dr Carrie Ruxton is a dietician who sits on the Tea Advisory Panel, a health information
group funded by the tea industry's UK Tea Council. On Tuesday, the Telegraph reported
her saying:
"The study doesn't show a cause and effect relationship between tea drinking and cancer
risk."
"Tea drinking is simply a marker for some other issue. That may be down to issues with
stress, or perhaps diet," said Ruxton.
In the ten years leading up to 2010, the incidence of prostate cancer in Scotland went up
by 7.4%. It is the most common cancer amongst Scottish men.
Skin Cancer
Skin Cancer
Skin Cancer Cases on the Rise (Med India: 2.4.2012)
Dramatic rise of skin cancer among people under 40 has been reported in a recent study
conducted by Mayo Clinic researchers.
"We anticipated we''d find rising rates, as other studies are suggesting, but we found an
even higher incidence than the National Cancer Institute had reported using the
Surveillance, Epidemiology and End Result database, and in particular, a dramatic rise in
women in their 20s and 30s," says lead investigator Jerry Brewer, M.D., a Mayo Clinic
dermatologist. Researchers conducted a population-based study using records from the
Rochester Epidemiology Project, a decades-long database of all patient care in Olmsted
County, Minn. They looked for first-time diagnoses of melanoma in patients 18 to 39
from 1970 to 2009. The study found the incidence of melanoma increased eightfold
among young women and fourfold among young men. The lifetime risk of melanoma is
higher in males than females, but the opposite is true in young adults and adolescents, Dr.
Brewer says.
Researchers also found mortality rates from the disease have improved over the years,
likely due to early detection of skin cancer and prompt medical care.
"People are now more aware of their skin and of the need to see a doctor when they see
changes," Dr. Brewer says. "As a result, many cases may be caught before the cancer
advances to a deep melanoma, which is harder to treat."
The researchers speculate that the use of indoor tanning beds is a key culprit in the rising
cancer rate in young women.
"A recent study reported that people who use indoor tanning beds frequently are 74
percent more likely to develop melanoma, and we know young women are more likely to
use them than young men," Dr. Brewer says. Despite abundant information about the
dangers of tanning beds, he adds, young women continue to use them. "The results of this
study emphasize the importance of active interventions to decrease risk factors for skin
cancer and, in particular, to continue to alert young women that indoor tanning has
carcinogenic effects that increase the risk of melanoma."
Janey Helland, of Mapleton, Minn., didn''t think twice when tanning in high school and
college.
"I used tanning beds to get ready for homecoming and prom," she says. "In college, I
tanned before a trip to Barbados because I didn''t want to get sunburned." At age 21,
Helland noticed an abnormal spot on her leg. It was melanoma, and the diagnosis
changed Helland''s life. "I really didn''t know what my future was going to look like, or if
I''d even have one."
Two years later, she is cancer-free and dedicated to educating others. "I would advocate
that it''s better to be safe than sorry," she says. "My advice is to educate yourself and
research the risk factors."
Childhood sunburns and ultraviolet exposure in adulthood may also contribute to
melanoma development, the researchers say.
The study was funded in part by the National Institutes of Health. Other authors include
Kurtis Reed, M.D., Christine Lohse, Kariline Bringe, Crystal Pruitt, and Lawrence
Gibson, M.D. all of Mayo Clinic.
Thyroid Cancer
Thyroid cancer
Thyroid cancer curable if detected early (World Newspapers: 28.5.2012)
Lack of awareness and a delay in diagnosis can prove costly for those suffering from
thyroid cancer, a condition that has till date affected about 42 million people in India,
according to medical experts.
Thyroid cancer proves a paradox to the medical fraternity because it is one of the
deadliest yet most curable form of cancer in the world according to doctors.
"According to official statistics, the number of thyroid patients in India is one-tenth of
48,000 Americans who are suffering from thyroid cancer. So, we can officially put
around 5000 to 6000 patients in India are suffering from thyroid cancer," says Dr C S
Bal, Professor in Nuclear Medicine at the All India Institute of Medical Science.
Bal points out that this is simply the data that has been made available to doctors by
government hospitals.
"The unaccounted number of patients who are being treated in private hospitals may be
even more which puts the number at one to two cases per 10,000 Indians," says Bal.
Thyroid cancer starts in the thyroid gland that produces thyroid hormones which are
important in the normal regulation of the metabolism of the body.
The exact cause of thyroid cancer remains unknown and the common symptoms include
a lump or thyroid nodule in the neck, trouble with swallowing, throat or neck pain,
swollen lymph nodes in the neck, persistent cough and vocal changes.
"Initially I saw small nodules in my neck and later when I was pregnant I went to the
Amritsar Cancer Hospital to get it checked thoroughly where the doctor declared that I
had thyroid cancer," says 40-year Kuldeep Kaur whose life was turned upside down after
she discovered small nodules on her neck after she underwent surgery after a bike
accident and was diagnosed with thyroid cancer.
A delay in the investigation procedure proved detrimental for Kaur, mother to a young
child who found that she was already in the second stage of the cancer.
"It was quite shocking for me. I did not want to go in for an operation as I was thinking
about my child. For a year I opted for ayurvedic treatment which did not help me and the
condition got worse.
Tumor Cancer
New operation technique to cure brain tumor (New Kerala: 20.6.2012)
An 18-year-old student was cured of brain tumor through a new operation techniqueAwake Craniotomy procedure- in Kolkata.
Moubani Karmakar, a resident of Palashi, underwent Awake Craniotomy at Kolkata's
Fortis Hospitals under Dr Amitabha Chanda.
Awake Craniotomy is an operation performed in the same manner as a conventional
craniotomy| but with the patient staying awake during the procedure.
This is a preferred technique for operations to remove lesions close to, or involving,
functionally important regions of the brain, like area responsible for speech, for
movement of limbs.
This allows surgeons to test regions of the brain before they are incised or removed and
patient’s functions continuously throughout the operation which helps minimize the risks
of such operations.
Dr Chanda said, “Awake Craniotomy is done rarely as all patients cannot be cooperative
enough with the doctors and patient’s cooperation along with great coordination between
the anesthesia team and surgeons are of utmost importance for this kind of surgeries.
"The anesthetist should know when the patient needs to be sedated and when he/she
needs to be in senses to communicate with the doctors.
"After brain surgeries in spite of being cured many female patients become emotionally
unstable as their head is shaved off, so I ensure that I make a minimum cut and don’t
shave the head completely.”
“The Awake Craniotomy performed by Dr Chanda has been a commendable effort and
we are very pleased with its all round success,” said Richa S. Debgupta, Facility Director,
Fortis Hospitals.
Moubani suffered from a seizure (epileptic fit) in July 2011 and was put under a
neurophysician’s medication. In spite of the medication she got no respite from the
seizures.
After undergoing several clinical tests, a CT scan revealed a tumor located on the motor
area on the left side of the brain. This part of the brain is responsible for movement of the
right side of the body. Moubani needed a surgery to remove the tumor as it had chances
to become malignant.
For this she consulted many doctors, who warned that post-operation she might become
paralytic on her right side and she might lose her speech too.
Then she came to Dr. Amitabha Chanda, neurosurgeon, Fortis Hospitals.
A functional MRI revealed that the tumor was exactly on the motor area of the brain.
Dr Chanda realized that if the operation was done in a conventional manner, she would
become paralytic on her right side. So he chose a unique method where the surgery was
done by Neuronavigation.
The term neuronavigation is a term used to describe the set of computer-assisted
technologies used by neurosurgeons to guide or "navigate” within the confines of the
skull or vertebral column during surgery
“Another significant point is that the surgery was not done under general anesthesia.
Instead local anesthesia and some sedation were used for the surgery so that the patient
could interact with the surgeon during the operation. It might seem bizarre to think about
brain surgery under local anesthesia.
"It sounds odd that somebody’s head is being opened up and the surgeon is fiddling in the
brain, while the patient is awake. But that was the need of the hour,” Dr Chanda added.
Moubani was explained well before the operation about the whole procedure. Unless she
was fully aware of the procedure, she would not have been able to cooperate during the
procedure.
She was explained that unnecessary movement by her during the operation could be
disastrous. The coordination between the operative team and the anesthesia team also had
to be impeccable.
The patient needed some kind of sedation during some parts of procedure. The level of
sedation was titrated closely and was kept under tight control.
Dr Chanda further said: “Neuronavigation was used to mark out the incision and instead
of shaving the head a very small amount of hair was clipped along the line of incision.
During cutting of the skin and cutting of the bone the level of sedation was deepened.
"When the brain was exposed, the level of sedation was lightened, because at this time
the doctors needed to communicate with the patient. Also while operating, intermittently
Moubani was asked to move her limbs or count from one to hundred, which she did
well.”
The tumor was removed completely in about four hours, without affecting right side of
her body or speech.
After removal of tumor the patient was sedated again and the bone flap was replaced and
the wound was closed. Post operation radiation was suggested for a couple of months and
now Moubani is absolutely fit.
There has been no threat of paralytic attack also, the doctor said.
“I have got a new life here. The operation was serious and lengthy. But I had faith on my
doctor and he has given me a new life. I am grateful to Fortis also for the way I have been
taken care of,” Moubani said, after the operation. (IBNS)
Child Mortility
Newborn Mortality
70% of infants die in 1st month (The Times of India: 3.4.2012)
Among States, J&K Tops List With 82%, Followed By Maharashtra At 78%
Nearly 70% of infant deaths (within the first year of birth) in the country in 2010 took
place during the first 29 days of life (neonatal).
While Jammu & Kashmir has the dubious distinction of leading the list with 82.1% infant
deaths being neonatal, it is followed by Maharashtra (78%), Himachal Pradesh (77.5%),
Punjab (74.2%), West Bengal (74%), Rajasthan (73.4%) and Madhya Pradesh (70.8%).
The Registrar General’s latest data Sample Registration System 2010 says India saw
nearly 32,000 fewer children dying in 2010 before reaching one month of life, compared
to the previous year. This also means 88 fewer deaths per day. But even then, 8.62 lakh
children died in 2010 within 29 days of life. This, however, is just a 3.6% dip from 2009.
At the national level, the neonatal mortality rate dipped by just one point to 33, but ranges
from 19 in urban areas to 36 in rural areas.
Among the bigger states, neonatal mortality ranges from as high as 44 in Madhya
Pradesh to 7 in Kerala. Neonatal mortality rate in UP and Odisha was 42, Rajasthan 40,
Chhattisgarh 37, Assam and Haryana 33 each.
In comparison, states with lower neonatal mortality included Tamil Nadu 16, Delhi 19,
Maharashtra 22, West Bengal 23, Karnataka and Punjab 25 each. In absolute numbers,
UP recorded the highest number of neonatal deaths (2.3 lakhs) followed by Madhya
Pradesh (85,000), Bihar (84,000), Andhra (45,000) and Maharashtra (42,000). Three
states have actually recorded an increase in neonatal deaths — Delhi by 6.6%, Jharkhand
4% and Kerala 1.5%.
Himachal Pradesh has recorded the biggest dip — 14% in neonatal deaths in 2010
followed by Andhra Pradesh 10.2%, Maharashtra 10%, Gujarat 9.5% and West Bengal
9%. Bihar recorded the lowest dip in neonatal mortality in 2010 over the previous year —
0.1% followed by Assam 0.4%, Karnataka 0.5%, Rajasthan 2.6% and Odisha 3.8%.
Under the country’s flagship National Rural Health Mission, neonates are now a major
focus of child health both for mortality and morbidity reduction.
Speaking to TOI, NRHM chief Anuradha Gupta said “Decline in India’s under five
mortality rate has been steady and consistent. The Infant mortality rate, too, has seen a
sharp decline in rural areas which is highly encouraging. Neonatal care is now our focus.
A new home-based newborn scheme that we have rolled out will be a real game changer.
We are also promoting better child care practices including better hygiene.”
The scheme envisages Accredited Social Health Activists (ASHAs) to visit homes of new
mothers six times within 42 days to encourage safe practices and early detection and free
referral of sick babies. During this time, ASHAs will have to record the birth weight of
the child in the maternal and child protection cards (MCP), immunize newborns with
BCG vaccine, the first dose of the oral polio vaccine and the DPT vaccine and make the
entries in the MCP card. They will also have to register the births and both the mother
and child will have to be safe at the end of the 42nd day.
47% of global measles deaths
47% of global measles deaths in India (The Times of India: 24.4.2012)
With 65,500 Casualties In 2010, India’s Record Is Poorer Than Africa’s, Says WHOSpearheaded Study
Nearly half of all deaths due to measles globally occurred in India in 2010.
While mortality due to measles dipped from 5.35 lakh in 2000 to 1.39 lakh globally in
2010, India recorded 47% of those deaths in comparison to 16% of global deaths in 2000.
New research by the World Health Organization (WHO), Penn State University and
the US Centers for Disease Control and Prevention (CDC) has found that while globally,
measles mortality fell by 74% between 2000 and 2010 that is still short of the 90% target,
in India the numbers dipped by 26% during the same period.
Published in the British medical journal, The Lancet, the study blamed India’s
relatively low measles vaccine coverage (74%) as the reason why the disease remained a
major cause of death in the country.
Saying that India lags behind even Africa (76%), the study — spearheaded by Dr Peter
Strebel, department of immunization, vaccines and biologicals of WHO — says “Delayed
implementation of accelerated disease control in India stalled momentum towards the
2010 global measles mortality reduction goal.”
India in 2010 recorded nearly 30,000 new cases of measles, and recorded 65,500
deaths.
The study added, “Our findings suggest that the goal of reducing measles mortality by
90% from 2000 to 2010 has not yet been met. The highly infectious nature of measles
virus requires maintenance of very high levels of population immunity through high
routine coverage. Measles remains widespread in India because of delayed
implementation of mass vaccination campaigns. We expect planned vaccination rounds
targeting 134 million children and the introduction of a routine second dose in some
states of India during 2011–13 to substantially reduce measles mortality by 2015.”
Union health ministry officials say India has introduced the second dose of measles
vaccine in 2010. “India started giving a second dose of vaccine to children through
routine immunization in 21 better performing states where coverage for measles
vaccination was more than 80%.
In the remaining 14 highrisk states, we are carrying out the campaign in a phased
manner. These 14 states also include second dose of measles vaccination under the
routine immunization programme, six months from completion of the campaign,” a
ministry official said.
According to him, the second dose is expected to prevent estimated 60,000-100,000
child deaths annually.
The WHO study says measles mortality has been reduced by more than threequarters
in all regions of the world except in south-east Asia. Dr Strebel had earlier said that antimeasles efforts had suffered from inadequate funding and lack of political commitment
since 2008.
Most children in India are immunized against measles at the age of nine months, as
part of routine immunization programme, which includes polio, DTP and BCG vaccines.
South-east Asia, excluding India, had 79% vaccine coverage in 2010. The global
coverage for measles vaccination overall was 85%.
Over 1 billion doses of measles vaccine were delivered through supplementary mass
vaccination campaigns in the last decade, and were the main driver behind the huge fall
in mortality.
According to Dr Strebel, Millennium Development Goals that aims to reduce child
mortality by two-thirds by 2015 will be missed if measles outbreaks continue to spread.
The challenges, however, include competing public health priorities, weak
immunization systems, sustaining high routine vaccination coverage and plugging the
$298 million funding gap for global anti-measles efforts.
GRIM PICTURE
Globally, measles mortality has fallen 74% between 2000 and 2010, but falls short of
the 90% target
Estimated global measles
mortality decreased from 5.35L in 2000 to 1.39L in 2010
India called a concern as it recorded 47% of estimated measles mortality in 2010
followed by the African region’s 36%
Southeast Asia, excluding India, accounted for
8% of measles deaths in 2010
India’s relatively low measles vaccine coverage (74%) is blamed for measles
remaining a major cause of deaths in the country
1 billion doses of vaccine were delivered through mass vaccination campaigns in the last
decade
Measles, a highly infectious viral disease, begins with fever and is followed by cough,
running nose, conjunctivitis and rashes all over the body
Measles spreads through contact with fluids from a person’s nose and mouth and is 90%
contagious
Fatality rate from measles in developing countries is 10%
Girl child
Girl child cash sop in dowry storm(Hindustan Times: 30.4.2012)
The National Advisory Council (NAC) has cast serious doubts on the government’s cashincentive scheme to check female foeticide and correct India’s skewed sex ratio, saying
the money given out under the plan is indirectly promoting dowry. The Centre and 13
states have been offering cash incentives to poor families with the twin aim of saving the
girl child and supporting her after she turns 18.
The scheme was introduced after the 2001 census showed the child sex ratio had dipped
to 927 girls for 1,000 boys.
But according to the NAC, the scheme has failed to check this dipping number that now
stands at 914 for 1,000 boys, the lowest since Independence.
“Giving lump sum cash when the girls turn 18 or 21 may be perceived as a subliminal
message in favour of the practice of giving dowry,” an NAC working group jointly
headed by Farah Naqvi and AK Shiva Kumar said.
The NAC, which is headed by UPA chief Sonia Gandhi, did not rule out the possibility of
parents using the money on their daughter’s marriage and dowry instead of education.
While Punjab and Delhi offer Rs. 1 lakh to the girl child, Madhya Pradesh gives Rs. 1.18
lakh.
The money is deposited in a government or a post-office account opened in the name of
the girl child at the time of birth.
They can withdraw it after they turn 18.
Gender ratio
Discrimination begins before birth (The Tribune: 8.5.2012)
The poor gender ratio continues to challenge planners
and experts because women are assigned a peripheral
role in the success story of the nation.
It is time to change strategies and approaches
The world needs their smiles — up to 25 per cent more births of boys, approximately 117
million girls are missing across Asia
Since Amartya Sen first brought global attention in the 1990s to Asia's "missing women,"
the problem of prenatal sex selection has worsened in a number of countries in the region,
with some reporting up to 25 per cent more births of boys than girls.
In recent decades, the issue of increasingly imbalanced sex ratios at birth has caused
concern, starting in a number of Asian countries, but now also spreading beyond that
region. Today, an estimated 117 million women across Asia are "missing." Although this
trend is concentrated in countries of South Asia and South-east Asia (India, Nepal,
Pakistan, Bangladesh, China and Vietnam), we are now seeing an emerging prevalence of
the problem in some countries of Eastern Europe and the Caucasus.
Prenatal sex selection is driven by deep-rooted cultural norms that favour sons and place
a low value on girls. Son preference stems in part from socioeconomic influences and
traditions where only sons inherit property and are expected to care for ageing parents,
conduct funeral rites and carry on the family name. Daughters are considered a burden by
some as they may require dowries and "be of no benefit" to their families once they are
married. These cultural and economic forces create huge pressures on women to produce
sons, which ultimately affect women's sexual and reproductive lives with implications for
their health and survival. It also puts women in a position where they are forced to
perpetuate the lower status of girls through son preference.
Regardless of its origins or the forces that perpetuate it, prenatal sex selection is gender
discrimination at its worst.
Tens of millions of female foetuses have been aborted over the past generation, as new
technologies have made it easier for parents to identify the sex of a foetus. The resulting
skewed sex ratios at birth have been especially pronounced in countries, such as India,
even though such prenatal sex screening is illegal.
In addition to being a symptom and perpetuator of extreme gender inequality, prenatal
sex selection brings many other ills to society. For example, many men in India and
China will soon face the prospect of not finding brides. The sex imbalance in these and
other countries threatens to increase trafficking of women, and this in turn increases
women's vulnerability to domestic and sexual violence, all of which reinforce inequalities
and can propel discrimination for generations.
Much has been undertaken in affected regions, by governments, civil society,
communities and academia, to halt the trends and address the human rights, social policy
and public health dimensions. At the international level, the issue was addressed in the
Programme of Action of the 1994 Cairo International Conference on Population and
Development. UNFPA, the United Nations Population Fund, has focused on the issue
since the 1991, first at country and then, regional levels.
UNFPA has been working with a broad spectrum of stakeholders, including community
networks that advocate against sex selection and sensitize health-care providers, and
faith-based organizations that help raise awareness of the problem and how it reinforces
discriminatory attitudes towards women and girls.
Many countries have undertaken extensive measures to meet the challenge through
actions to reduce the preference of sons. For example, conditional cash transfers for
parents of daughters, advocacy campaigns, or policies to empower women and improve
their access to social security schemes, including pension systems.
Improving gender equality and enforcing national laws and policies on banning sexselective procedures requires urgent concerted efforts by all segments of government and
society as a matter of rights and for charting each country's own development process. It
requires strong political commitment as well as actions downstream at the community
level to address complex socio-economic and cultural realities. And we must thank the
groups and partners that have led and rallied to India's campaign against sex selection.
We must accelerate our efforts and give priority to actions and policies that foster norms
of gender equality and demonstrate a zero tolerance for prenatal sex selection.
Gender equality is at the very heart of each country's development process. Empowered
women and girls contribute to the health and productivity of families and communities
and improve prospects for the next generations. Empowered women also propel
economic growth. Therefore, we must all join forces to ensure that sex selection is
understood as discrimination against women and girls and to put a stop to it once and for
all. I reaffirm UNFPA’s commitment to join hands with governments, civil society and
other partners in their efforts to reduce and ultimately eliminate this harmful,
discriminatory practice. (Courtesy: UN Information Centre for India and Bhutan)
— Dr. Babatunde Osotimehin is an Under-Secretary-General of the United Nations and
Executive Director, UNFPA, the United Nations Population Fund.
Three strategies to win the battle
Harpal Singh
Over the last several decades the only social indicator that is relentlessly refusing to
respond positively to the concerted actions is the gender ratio. The number of girls to
1,000 boys has consistently reduced since Independence,in spite of a host of initiatives
taken up by the government, both at the centre and in the states, as also by NGOs to
reverse the trend. The last census saw child sex ratio dropping to a disturbing low at 914
from 976 in 1961. It is surprising to learn that of the 7 parliamentary districts of Delhi,
South Delhi, has the worst gender ratio even though it is the wealthiest and the most
educated. Similarly, Chandigarh, one of the cities with highest social indices, has one of
the lowest child sex ratio at 818 girls to 1,000 boys. The trend cuts across communities
and geographies.
To change this trend, firstly, we need to turn around the current PNDT (Pre-Natal
Diagnostic Techniques) Act by changing a fundamental premise of the act, which
prohibits the disclosure of the sex of the unborn child whenever ultrasonography is done
for whatever reason. Currently, the law invokes penal action against anyone who
discloses the gender of the unborn foetus, arguing that by not disclosing the gender of the
foetus, the chances of protecting the girl are greater. Whilst the intent behind the law was
good, the ground reality is that through a variety of ingenious methods ultra sound clinics
inform expecting parents the sex of the child. In a dramatically different approach, what
is now being suggested is that since confidentiality has not worked, it is time that we
changed the approach to one of complete disclosure and transparency. By disclosing the
sex of the child, the family, the community and the administration would then have to
accept responsibility of ensuring that the child is protected, particularly, if it happens to
be a girl. Let penal provisions be activated on whosoever is responsible for eliminating
the unborn or infant girl.
Secondly, the government must ensure that the laws are gender-neutral. A thought that
merits consideration is to ask the Attorney Generals of every state to submit a compliance
report to the Supreme Court or to the Law Ministry that such equality exists within the
laws of their respective states. What, in fact must be confirmed is that there is no law that
even minimally allows for any form of gender inequality.
Lastly, if we are to turn the terms of trade in favour of girls and women, it is about time
that we brought work done by women at home into the economic model that measures
economic activity and, in turn, GDP. As a society we have decided to put no economic
worth on homemaking as an activity and thereby undervalue the enormous contribution
of women in raising families.Unless economists, social planners and governments
recognize the importance of this critical activity and find ways of putting an economic
value to it, the contribution of women will continue to be unfairly underestimated. When
a woman's contribution is correctly recognized, the economic terms of trade will shift in
her favour, and she will then be viewed as an economic asset, which will be her best
protection.
— The writer is Chairman of Nanhi Chhaan Foundation and Save the Children,
India.
Sex ratio
State to seek Aamir’s help to check skewed sex ratio (The Tribune:14
May 2012)
As the first episode of television show “Satyamev Jayate” had generated a lot of debate in
society regarding female foeticide, the state authorities have decided to approach actor
Aamir Khan to seek his help to change the mindset of people so as to check the alarming
decline in male-female ratio in Jammu and Kashmir. This television show, in its first
episode, had featured some heart-rending true stories about female foeticide.
Authorities in the state have reasons to seek help from Aamir because Jammu and
Kashmir is one of the three states where sex ratio has declined drastically over the last
decade. The other two states are Bihar and Gujarat. The state's overall sex ratio is
currently pegged at 883 females per 1000 males indicating a fall of 9 points compared to
the 2001 census, says the provisional 2011 census. While the overall sex ratio has come
down to 883, the child sex ratio has further dipped to 859. This disturbing development
has forced the authorities to take some steps on a war-footing.
“We will love to have support of people like Aamir Khan, whose television programme
has generated a debate to stop this menace,” the Director, National Rural Health Mission,
Dr Yashpal Sharma, told The Tribune. “We will approach Aamir Khan and other
celebrities to create awareness and to change the mindset of the people,” Sharma said and
admitted that the declining sex ration has emerged as a big problem in the state.
Besides creating awareness in society, the authorities have also decided to take other
steps keep a check on female foeticide. “We have devised a comprehensive strategy to
conduct sting operations in different parts of the state to nab doctors and owners of ultrasound clinics who are involved in this crime,” Sharma said and disclosed that the
authorities have decided to assign the job of conducting the sting operations to officials of
the Health Department.
The Health Department has already announced that any person giving information on
illegal sex-determination tests by ultrasound clinics would be rewarded.
The decline in sex ratio was worrisome but now the juvenile sex ratio (0-6 years) has
given sleepless nights to the Health Department. “The juvenile sex ratio is the most
realistic indicator of trends in female foeticide and the continuing discrimination against
the girl child,” a senior officer of the Health Department said.
An alarming trend
During the last decade, the state has witnessed a steep fall in the male-female sex ratio,
especially the juvenile sex ratio. In 2001, the juvenile sex ratio (0-6 years) was 941
females against 1000 males; it came down to 859 females against 1000 males in 2011.
The national average juvenile sex ratio is 914
Sex ratio
Rocking the cradle of hope (The Hindu: 19.6.2012)
Against the backdrop of a poor sex ratio in Rajasthan, Mahesh Ashram in Udaipur has
been saving the lives of abandoned baby girls and rehabilitating them
Much before the eye-opening first episode of Aamir Khan's chat show Satyamev Jayate,
which brought the reality of sex-selective abortions to our drawing rooms and triggered a
national debate, an initiative in Rajasthan's Udaipur has been doing its bit to save
newborn girls.
In August 2006, within a span of two weeks, two female foetuses were reported to be
found floating in the city’s famed Fatehsagar Lake. Almost simultaneously, another
similar incident was reported from the neighbouring district of Chittorgarh. Those
incidents changed the life of a city businessman forever.
An inquiry into Rajasthan’s child sex ratio revealed that there were only 909 girls in the
0-6 age group for every 1,000 boys, according to the 2001 Census. Unfortunately, this
number has only declined over the last decade — the 2011 Census reports just 883 girls
for 1,000 boys.
Where have all those missing girls gone? What can be done to turn this dismal situation
around? Devendra Agarwal had no answers to these questions that were troubling him.
But he was determined to do something to salvage the situation.
Once a successful marketing professional, Mr. Agarwal recalls: “I was moved by the
visuals of foetuses floating on the water. I thought if someone could take care of the
unwanted girls, they would neither be killed nor abandoned or dumped in hedges and
dustbins.”
He started out by putting up a cradle outside his home in the city’s busy Surajpole area.
Within a week, he had three baby girls in his home. He smiles, “We were looking for a
sister for my two sons, and suddenly we had three.”
The three girl child gave a new direction to Mr. Agarwal’s life plans. When the Udaipur
Child Welfare Committee (CWC) came to know that he had abandoned newborns in his
home, it decided to take them away, saying that they needed to be put up for adoption.
When he tried to stop the CWC, legal hassles followed. “I fought the case right up to the
Supreme Court where, too, I lost. I couldn’t save these girls. In the meantime, I was
charged with contempt by the Rajasthan High Court and arrest warrants were issued
against me twice.”
Those were tough times for him and his family but that was when he decided that saving
newborn girls was going to be his new calling. Mr. Agarwal set up an organisation, the
Maa Bhagwati Vikas Sansthan, under which the Mahesh Ashram was set up. Built with a
loan of Rs. 23 lakh, this home based in Udaipur’s Bhuwada locality, today has 19
abandoned baby girls who are getting quality professional care.
Says Mr. Agarwal: “I realise that a lot of women are compelled to give up their daughters
because of family and social pressures. In fact, many a time, the mother is not even aware
that the girl she gave birth to has been taken away from the hospital bed and dumped. We
want to save such lives. All we say is ‘Don’t throw them, give them to us’.”
The Mahesh Ashram has put up two cradles — one outside the busy MB Hospital and the
other at the ashram’s doorstep. In the five years the ashram has been functional, Mr.
Agarwal and his team have been able to save 67 girls. “Unfortunately, we lost six girls,
who were very sick when we found them. One of them was thrown from a running car.
She was bleeding profusely when my team found her. We rushed her to the hospital,
where three units of blood were given, but she couldn’t survive. Another one was left
under a running tap in a hospital’s bathroom on a cold winter night. She was on ventilator
support for nine hours before she succumbed,” Mr. Agarwal recounts with sadness.
To give the children the best of healthcare, the ashram has acquired photo-therapy
machines, warmers and oxygenators besides a dedicated staff of 20 ayahs (local nurses)
and one general nurse and midwife (GNM).
Saving the little ones, however, is not Mr. Agarwal’s only mission. The Mahesh Ashram
has also taken up the responsibility of finding loving, stable homes for them. Says Mr.
Agarwal, “I failed in my first attempt because I had no knowledge of what the law said
regarding the adoption of abandoned babies. But once we started the ashram, we are more
organised in our approach.” He formed a childcare committee, comprising senior
government officials — an IPS officer, an IRS officer, the Vice-Chancellor of a
university, a chartered accountant and Mr. Agarwal himself on the board — to conduct
the ashram’s adoption-related activities.
In fact, in 2009, Mahesh Ashram became a specialised adoption agency after getting a
licence from the Social Justice and Empowerment Department of the Government of
Rajasthan. To date, they have found homes for 41 babies, although Mr. Agarwal admits
that it’s not easy to find homes for them because people in the State are still fixated on
boys.
Keywords: Satyamev Jayate, sex ratio, sex-selective abortions, 2011 Census, Udaipur
Child Welfare Committee, Empowerment Department
Depression
Depression
Fast food can push you into depression (new Kerala: 2.4.2012)
Eating fast food such as hamburgers, hotdogs and pizza and even baked items could send
you into a tailspin of blues.
A recent study by scientists from the universities of Las Palmas de Gran Canaria and
Granada, Spain, revealed that consumers of fast food were 51 percent more likely to
develop depression, compared to those who ate little or none.
"The more fast food you consume, the greater the risk of depression," Almudena
Sanchez-Villegas, who led the study, told SINC, (Spanish Foundation for Science and
Technology) the journal Public Health Nutrition reports.
The study demonstrated that those participants who ate the most fast food and
commercial baked goods were more likely to be single, less active and had poor dietary
habits, which include eating less fruit, nuts, fish, vegetables and olive oil.
Smoking and working more than 45 hours per week were other prevalent characteristics
of this group, according to a statement of Granada and Las Palmas.
Regarding baked goods, the results were equally conclusive. "Even eating small
quantities is linked to a significantly higher chance of developing depression," pointed
out Sanchex-Villegas from Las Palmas University.
The study sample under SUN Project (University of Navarra Diet and Lifestyle Tracking
Program), comprised 8,964 participants, who had never been diagnosed with depression
or taken anti-depressants.
They were assessed for an average of six months and 493 were diagnosed with
depression or started to take anti-depressants.
Depression affects 121 million people worldwide. (IANS)
Depression
Walking may help treat depression (The Tribune: 18.4.2012)
London: Taking a brisk walk could play an important role in fighting depression,
according to researchers in Scotland. Vigorous exercise has already been shown to lessen
symptoms of depression, but the effect of less strenuous activities was unclear. A study in
the journal Mental Health and Physical Activity showed walking had a “large effect” on
depression. One in 10 people may suffer from depression at some point in their lives.
The condition can be treated with drugs, but doctors for mild symptoms commonly
prescribe exercise.
Researchers at the University of Stirling scoured academic studies to find data on one of
the mildest forms of exercise — walking. They found eight studies, on a total of 341
patients, which fitted the bill. The report’s authors showed “walking was an effective
intervention for depression” and had an effect similar to other more vigorous forms of
exercise. “Walking has the advantages of being easily undertaken by most people,
incurring little or no financial cost and being relatively easy to incorporate into daily
living,” the BBC quoted the authors as saying. However, they cautioned that much more
research needed to be done. There are still questions over how long, how fast and
whether walking should take place indoor or outdoors.
Depressed Adolescents
Depressed Adolescents May Benefit From Computer Therapy
SPARX(Med India: 20.4.2012)
A computerized self help intervention may help adolescents who suffer from depression.
The specialized computer therapy acts much the same way as they do from one-to-one
therapy with a clinician, according to a study published on BMJ.
Depression is common in adolescents, but many are reluctant to seek professional help.
So researchers from the University of Auckland, New Zealand, set out to assess whether
a new innovative computerized cognitive behavioral therapy intervention called SPARX
could reduce depressive symptoms as much as usual care can.
SPARX is an interactive 3D fantasy game where a single user undertakes a series of
challenges to restore balance in a virtual world dominated by GNATs (Gloomy Negative
Automatic Thoughts). It contains seven modules designed to be completed over a four to
seven week period. Usual care mostly involved face-to-face counseling by trained
clinicians.
The research team carried out a randomized controlled trial in 24 primary healthcare sites
across New Zealand. All 187 adolescents were between the ages of 12 and 19, were
seeking help for mild to moderate depression and were deemed in need of treatment by
primary healthcare clinicians. One group underwent face-to-face treatment as usual and
the other took part in SPARX.
Participants were followed up for three months and results were based on several widely
used mental health and quality of life scales.
Results showed that SPARX was as effective as usual care in reducing symptoms of
depression and anxiety by at least a third. In addition significantly more people recovered
completely in the SPARX group (31/69 (44%) of those who completed at least four
homework modules in the SPARX group compared with 19/83 (26%) in usual care).
When questioned on satisfaction, 76/80 (95%) of SPARX users who replied said they
believed it would appeal to other teenagers with 64/80 (81%) recommending it to friends.
Satisfaction was, however, equally high in the group that had treatment as usual.
The authors conclude that SPARX is an “effective resource for help seeking adolescents
with depression at primary healthcare sites. Use of the program resulted in a clinically
significant reduction in depression, anxiety, and hopelessness and an improvement in
quality of life.” They suggest that it is a potential alternative to usual care and could be
used to address unmet demand for treatment. It may also be a cheaper alternative to usual
care and be potentially more easily accessible to young people with depression in primary
healthcare settings.
Depression
Link between Depression and Risk of Vascular Dementia(Med
India:8.5.20120
Lifelong depression associated with an increased risk of developing vascular dementia,
say University of California at San Francisco and Kaiser Permanente researchers.
The study, which appears in the current issue of the Archives of General Psychiatry, is
the first to examine whether midlife or late-life depression is more likely to lead to either
Alzheimer's disease or vascular dementia in the long term. The researchers explain that
vascular dementia, the second most common type of dementia, develops when impaired
blood flow to parts of the brain deprives cells of nutrients and oxygen.
"People who had depressive symptoms in both midlife and late life were much more
likely to develop vascular dementia, while those who had depressive symptoms in late
life only were more likely to develop Alzheimer's disease," said the study's lead author
Deborah E. Barnes, PhD, MPH, with the UCSF Departments of Psychiatry and
Epidemiology & Biostatistics and the San Francisco Veterans Affairs Medical Center.
"The findings have important public health implications because they raise hope that
adequate treatment of depression in midlife may reduce dementia risk, particularly
vascular dementia, later in life," added Rachel Whitmer, PhD, a research scientist at the
Kaiser Permanente Northern California Division of Research and the principal
investigator of the study.
UCSF and Kaiser Permanente investigators examined the association between depressive
symptoms and dementia over the course of 45 years in a longitudinal study of more than
13,000 long-term members of the Kaiser Permanente Northern California integrated care
delivery system. The study population consisted of members who participated in a
voluntary health examination called the Multiphasic Health Checkup in San Francisco
and Oakland during 1964-1973 when they were 40-55 years old.
Participants were evaluated for depressive symptoms in midlife as part of the Multiphasic
Health Checkup and again in late life between 1994-2000. Between 2003-2009, 3,129
participants were diagnosed with dementia.
Though more research is needed, the findings suggest that depression that begins in late
life may be an early symptom of Alzheimer's disease, while chronic depression over the
life course may reflect a long-term process of changes to blood flow in the brain
associated with increased risk of vascular dementia.
Depression
Depression -How Effective Is Collaborative Care Intervention?(Medical
A study published in the May issue of Archives of General Psychiatry, reveals that
individuals with depression and poorly controlled diabetes mellitus, coronary heart
disease, or both, can benefit from a collaborative care intervention.
The intervention, which includes a team-centered care approach, was shown to improve
the number of depression-free days in these patients, as well as quality-adjusted lifeyears.
The researchers explained:
"Patients with depression and poorly controlled diabetes mellitus, coronary heart disease
(CHD) or both have higher medical complication rates and higher health care costs,
suggesting that more effective care management of psychiatric and medical disease
control might also reduce medical service use and enhance quality of life."
A randomized controlled trial was conducted by Wayne Katon, M.D., of the University
of Washington School of Medicine, Seattle, and his team in order to examine a
systematic intervention designed to enhance disease control of depression, systolic blood
pressure (SBP), low-density lipoprotein cholesterol (LDL-C) and hemoglobin A1c
(HbA1c) in individuals suffering from depression and poorly controlled diabetes mellitus,
CHD or both.
The researchers randomly assigned participants to either the intervention group or the
controlled group. Participants in the control group received usual care and were advised
to consult with their primary care provider to receive care. Those assigned to the
intervention group received patient-centered, team-based collaborative care management
that included nurse care managers who worked together with the participants and their
primary care physician in order to improve the systematic management of chronic illness.
During the first 12 months, the researchers found that improvements in depression scores
HbA1c, LDL-C and SBP levels were considerably greater among participants assigned to
the intervention group compared with those in the control group.
In addition, at 18 and 24 months follow-up, the team found that depression scores
remained considerable lower among patients in the intervention group vs. the control
group. However, they found no significant differences in HbA1c, LDL-C and SBP levels
between the intervention and control group.
According to the researchers, patients in the intervention group had an average of 114
additional depression free days over a 24 month period, compared with patients assigned
to the control group, as well as an estimated 0.335 additional quality-adjusted life-years
(QALYs).
The team based QALYs on changes in depression-free days, HbA1c, LDL-C and SBP
levels over 24 months.
Furthermore, results showed that the average outpatient health care costs were lower
($594 per patient) in the intervention group than in the control group.
Depression
Ketamine Improved Bipolar Depression Within Minutes, Study
Suggests(Science Daily:1.6.2012)
ScienceDaily (May 30, 2012) — Bipolar disorder is a serious and debilitating condition
where individuals experience severe swings in mood between mania and depression. The
episodes of low or elevated mood can last days or months, and the risk of suicide is high.
Antidepressants are commonly prescribed to treat or prevent the depressive episodes, but
they are not universally effective. Many patients still continue to experience periods of
depression even while being treated, and many patients must try several different types of
antidepressants before finding one that works for them. In addition, it may take several
weeks of treatment before a patient begins to feel relief from the drug's effects.
For these reasons, better treatments for depression are desperately needed. A new study
in Biological Psychiatry this week confirms that scientists may have found one in a drug
called ketamine.
A group of researchers at the National Institute of Mental Health, led by Dr. Carlos
Zarate, previously found that a single dose of ketamine produced rapid antidepressant
effects in depressed patients with bipolar disorder. They have now replicated that finding
in an independent group of depressed patients, also with bipolar disorder. Replication is
an important component of the scientific method, as it helps ensure that the initial finding
wasn't accidental and can be repeated.
In this new study, they administered a single dose of ketamine and a single dose of
placebo to a group of patients on two different days, two weeks apart. The patients were
then carefully monitored and repeatedly completed ratings to 'score' their depressive
symptoms and suicidal thoughts.
When the patients received ketamine, their depression symptoms significantly improved
within 40 minutes, and remained improved over 3 days. Overall, 79% of the patients
improved with ketamine, but 0% reported improvement when they received placebo.
Importantly, and for the first time in a group of patients with bipolar depression, they also
found that ketamine significantly reduced suicidal thoughts. These antisuicidal effects
also occurred within one hour. Considering that bipolar disorder is one of the most lethal
of all psychiatric disorders, these study findings could have a major impact on public
health.
"Our finding that a single infusion of ketamine produces rapid antidepressant and
antisuicidal effects within one hour and that is fairly sustained is truly exciting," Dr.
Zarate commented. "We think that these findings are of true importance given that we
only have a few treatments approved for acute bipolar depression, and none of them have
this rapid onset of action; they usually take weeks or longer to have comparable
antidepressant effects as ketamine does."
Ketamine is an N-methyl-D-aspartate (NMDA) receptor antagonist, which means that it
works by blocking the actions of NMDA. Dr. Zarate added, "Importantly, confirmation
that blocking the NMDA receptor complex is involved in generating rapid antidepressant
and antisuicidal effects offers an avenue for developing the next generation of treatments
for depression that are radically different than existing ones."
Depression
Party drug 'special K' may help relieve depression (New Kerala:
8.6.2012)
Common anaesthetic Ketamine, which is also found in a recreational drug dubbed
'Special K,' could be the answer in the fight against depression.
University of NSW researcher Prof Colleen Loo said the drug prompted improvements in
people suffering clinical depression from within hours to a day later, News.com.au
reported.
Given intravenously to people with moderate to severe clinical depression, the drug has
been trialled in a handful of patients as part of the Australian-first study.
Researchers hope to recruit up to 40 patients as part of the ongoing trial, which is
comparing people with depression given ketamine with those given a placebo.
Prof Loo said several international studies had produced similar instantaneous results.
Although the drug is approved for medical use in Australia for anaesthesia, sedation, and
pain relief, the research is investigating the safety and effectiveness of the drug to treat
depression before it can be widely used.
However, the research is still in its very early stages with fewer than 100 patients
involved in placebo-controlled trials worldwide, Prof Loo said.
But if studies proved ketamine to be effective it could provide another avenue to treat
depression sufferers within years, she said.
Prof Loo, from the university's School of Psychiatry and the Black Dog Institute, said
ketamine worked in a completely different way in the brain than other treatments.
All other anti-depressant medications work on serotonin, noradrenaline and dopamine,
but Ketamine works on a different neurotransmitter system, involving the chemical
glutamate.
Prof Loo said studies in animals showed ketamine worked by promoting the regrowth
and regeneration of brain cells.
'When people are depressed, cells in some parts of the brains ... become unhealthy and
shrink. Ketamine reverses those kinds of changes. It's promoting the growth of new nerve
projections and new synapses between nerve cells,' she explained.
Participants in the trial are given up to six ketamine treatments intravenously, under strict
medical supervision in hospital, a week apart.
The carefully-controlled doses are low - about one-tenth of the level used in anaesthesia.
Depression
Party drug 'special K' may help relieve depression (New Kerala:
8.6.2012)
Common anaesthetic Ketamine, which is also found in a recreational drug dubbed
'Special K,' could be the answer in the fight against depression.
University of NSW researcher Prof Colleen Loo said the drug prompted improvements in
people suffering clinical depression from within hours to a day later, News.com.au
reported.
Given intravenously to people with moderate to severe clinical depression, the drug has
been trialled in a handful of patients as part of the Australian-first study.
Researchers hope to recruit up to 40 patients as part of the ongoing trial, which is
comparing people with depression given ketamine with those given a placebo.
Prof Loo said several international studies had produced similar instantaneous results.
Although the drug is approved for medical use in Australia for anaesthesia, sedation, and
pain relief, the research is investigating the safety and effectiveness of the drug to treat
depression before it can be widely used.
However, the research is still in its very early stages with fewer than 100 patients
involved in placebo-controlled trials worldwide, Prof Loo said.
But if studies proved ketamine to be effective it could provide another avenue to treat
depression sufferers within years, she said.
Prof Loo, from the university's School of Psychiatry and the Black Dog Institute, said
ketamine worked in a completely different way in the brain than other treatments.
All other anti-depressant medications work on serotonin, noradrenaline and dopamine,
but Ketamine works on a different neurotransmitter system, involving the chemical
glutamate.
Prof Loo said studies in animals showed ketamine worked by promoting the regrowth
and regeneration of brain cells.
'When people are depressed, cells in some parts of the brains ... become unhealthy and
shrink. Ketamine reverses those kinds of changes. It's promoting the growth of new nerve
projections and new synapses between nerve cells,' she explained.
Participants in the trial are given up to six ketamine treatments intravenously, under strict
medical supervision in hospital, a week apart.
The carefully-controlled doses are low - about one-tenth of the level used in anaesthesia.
(ANI)
Depression
Doubts cast over benefits of physical activity in treating depression
Washington, June 16 : A new study has disapproved the current clinical guidance, which
recommends physical activity to alleviate the symptoms of depression.
The new research suggests that adding a physical activity intervention to usual care did
not reduce symptoms of depression more than usual care alone, even though it increased
levels of physical activity.
Depression is one of the most common reasons for seeking GP help and reportedly
affects one in six adults in Britain at any one time.
Until now, most of the evidence for the positive effect of physical activity in treating
depression has originated from studies of small, non-clinical samples using interventions
that would not be practicable in an NHS setting.
The TREAD study, led by researchers from the Universities of Bristol, Exeter and the
Peninsula College of Medicine and Dentistry, is the first large-scale, randomised
controlled trial to establish whether a physical activity intervention should be used in
primary health care to help treat adults with depression.
Researchers recruited 361 patients aged 18-69 years who had recently been diagnosed
with depression.
Trial participants were then split into two groups to receive either the physical activity
intervention in addition to usual care or usual care on its own and were followed up for
12 months to assess any change in their symptoms.
"Numerous studies have reported the positive effects of physical activity for people
suffering with depression but our intervention was not an effective strategy for reducing
symptoms. However, it is important to note that increased physical activity is beneficial
for people with other medical conditions such as obesity, diabetes and cardiovascular
disease and, of course, these conditions can affect people with depression," Melanie
Chalder, from University of Bristol's School of Social and Community Medicine, said.
"Many patients suffering from depression would prefer not to have to take traditional
antidepressant medication, preferring instead to consider alternative non-drug based
forms of therapy. Exercise and activity appeared to offer promise as one such treatment,
but this carefully designed research study has shown that exercise does not appear to be
effective in treating depression," John Campbell, Professor of General Practice and
Primary Care at Peninsula College of Medicine and Dentistry (University of Exeter),
said.
"An important finding however, is the observation that the approach we were using did
result in a sustained increase in activity in people who were working with our activity
facilitators. Although their increased activity did not result in improved depression, the
approach we used offers potential in areas other than depression, and we hope to explore
this in due course," he said.
Adrian Taylor, Professor of Sport and Health Sciences at the University of Exeter, said
that reducing depression using non-drug forms of therapy is a huge challenge.
"We were pleased that people responded to the tailored physical activity intervention,
which focused on increasing sustainable moderate intensity physical activity. However,
reducing depression more than is possible through usual care is clearly a huge challenge,"
Taylor added.
New research was recently published in the BMJ. (ANI)
Depression
An electric patch for fight depression (The Asian Age:20.6.2012)
Scientists have unveiled a new feel good “patch” which they say could help fight
depression while you sleep.
Developed by researchers at the University of California in Los Angeles, the device when
stuck on to the forehead uses tiny electrical impulses to stimulate the trigeminal nerve in
the head. This nerve, which sits just beneath the forehead and often described as the
“USB port into the brain”, leads to areas in the brain which are thought to control mood,
the Daily Mail reported.
The device, which contains electrodes, is linked by two wires to a generator the size of a
mobile phone, which can be worn around the waist. In a trial on a small group of patients
suffering from depressive disorder, the researchers found the patients reported a 50 per
cent reduction in symptoms after using the patch for eight hours a night for eight weeks.
The patients, who had all suffered from major depressive symptoms for more than four
months and not responded to at least one antidepressant, report
ed feeling better after just two weeks, the researchers said. The device didn’t disrupt the
patients’ sleep, but they did report a tingling sensation when it was first turned on.
Dr Christopher DeG-iorgio, a neurologist at UCLA who had originally devised the device
called the Neurosigma to treat epileptic seizures, said: “One of the patients on the original
epilepsy trial said his epilepsy symptoms hadn’t improved but his wife told us he was
more alert and more communicative.” — PTI
Loneliness
How loneliness can kill(World Newspapers:20.6.2012)
Loneliness — the unpleasant feeling of emptiness or desolation — can be especially
debilitating to older adults and may predict serious health problems and even death, say
researchers.
A UCSF researcher team analysed data in the Health and Retirement Study, a nationally
representative study by the National Institute on Aging conducted on 1,604 older adults
between 2002 and 2008.
The research focused specifically on the question of loneliness and its impact.
“In our typical medical model, we don’t think of subjective feelings as affecting health.
It’s intriguing to find that loneliness is independently associated with an increased rate of
death and functional decline,” said first author Carla Perissinotto, MD, MHS, assistant
professor in the UCSF Division of Geriatrics.
One of the more surprising findings of the team’s analysis is that loneliness does not
necessarily correlate with living alone. The study found 43% of surveyed older adults felt
lonely, yet only 18% lived alone.
“We are interested in identifying the different factors that cause adults to become
functionally impaired and ultimately at risk for nursing home admission,” Perissinotto
said.
“The ageing of our population and the greater odds of institutionalisation make it
important for us to think about all the factors that are putting elders in danger, including
social and environmental risks,” she explained.
Researchers at UCSF focused on death and a decrease in the ability to perform daily
activities such as upper extremity tasks, climbing stairs, and walking.
People who identified themselves as lonely had an adjusted risk ratio of 1.59 or a
statistically significant 59% greater risk of decline. For death, the hazard ratio was 1.45
or 45% greater risk of death.
“This is one of those outcomes you don’t want to see because it was terrible to find out it
was actually true. We went into the analysis thinking that there was a risk we could find
nothing, but there actually was a strong correlation,” Perissinotto noted.
Perissinotto and her colleagues believe the impact of loneliness on an elderly patient is
different from the effects of depression. While depression is linked with a lack
enjoyment, energy and motivation, loneliness can be felt in people who are fully
functional but feel empty or desolate.
The “baby boomer” generation — those born between 1946 and 1964 — represents the
largest population growth in US history. Some of them now are part of the 39.6 million
population of people older than 65. That number is expected to more than double to 88.5
million by 2050.
As that population continues to expand, Perissinotto said she hopes to be able to start to
integrate social and medical services for elderly patients more comprehensively, and be
more mindful of what kinds of social interventions they require.
“Asking about chronic diseases is not enough. There’s much more going on in people’s
homes and their communities that is affecting their health. If we don’t ask about it, we are
missing a very important and independent risk factor,” she said.
“We don’t think we can change genetics, but we can intervene when someone is lonely
and help prevent some functional decline,” she added.
The research has been published in the Archives of Internal Medicine.
Diseases
Rare diseases
Rare diseases are now highlighted by Indian cinema (new Kerala:
11.4.2012)
Progeria, autism, dyslexia, Alzheimer's, Asperger syndrome -- movies on these rare
diseases would have typically been the themes of documentaries until a few years ago.
But not any more.
Bollywood, so associated with escapist fare, is opening its heart and investing money in
creating awareness about such diseases through commercial scripts, with successful stars
and effective marketing.
Filmmaker Anurag Basu's upcoming "Barfi!" is a case in point. At its heart, the movie is
said to be a romantic comedy, but the story is woven around how love blooms between a
deaf, mute yet happy-go-lucky man essayed by Ranbir Kapoor, and an autistic girl,
played by Priyanka Chopra.
Talking about the film, Ranbir said: "It's about two dysfunctional people who bond
together in the nicest of relationships, one that is sweet, touching and heart-warming."
Most Bollywood products in the past showcased the visually and physically challenged as
well as the deaf as comical or pitiable characters except films like "Koshish". But the
approach, treatment and prominence to the characters have undergone a mature change
over the years.
In 2003, "Koi... Mil Gaya" showcased Hrithik Roshan in the role of a developmentally
disabled man, while Aparna Sen's National award-winning film "15 Park Avenue" put the
spotlight on schizophrenia.
Konkona Sen Sharma, as the schizophrenic Meethi in "15 Park Avenue", drove the
complexities of the disease with ease to the audience's heart.
The film was in English.
"That's because it deals with schizophrenia and we need a more discerning audience,"
Sen had told IANS earlier.
Nevertheless, she made sure all the nitty-gritty were taken care of before setting out to
entertain viewers.
"We know someone very close to us who's schizophrenic... a very close relative. So
Konkona got to study the traits very carefully. We also had professional medical
assistance to get the nuances right. But ultimately after getting all the details right I made
sure it was a human interest story," said Sen.
Schizophrenia was also highlighted with Arshad Warsi in "Krazzy 4", but not so
effectively.
Another disease, Alzheimer's, which affects memory, thinking and behaviour, was
brought alive on screen by Kajol in "U Me Aur Hum" and by megastar Amitabh
Bachchan in Sanjay Leela Bhansali's "Black".
The latter also proved to be an inspirational story for the deaf and blind, with Rani
Mukerji in the role of a girl, who overcomes her disabilities with the help of her teacher,
and shines academically.
In 2007, Aamir Khan's directorial debut "Taare Zameen Par" narrated the problems faced
by an eight-year-old boy suffering from dyslexia, a learning disability. The heartwarming
movie was a window to worried parents, who push their children to achieve academic
excellence without trying to understand their problems.
The film was not only a huge commercial hit, it also spread the word and many parents
learnt an important lesson from it.
"Taare Zameen Par" was instrumental in bringing about a shift in the mindset for films
dealing with diseases, says film critic Omar Qureshi.
"Earlier, Bollywood films used to show how characters who used to behave strange due
to some ailment were slapped or mocked at. 'Taare...' and 'Koi... Mil Gaya' changed that a
lot," he said.
"Years back, in 1974, there was a Mehmood movie 'Kunwara Baap'. It moved everyone
to tears with the story on polio vaccination. What a forward vision he had back then. But
it's great to see how mainstream heroes are taking up roles creating awareness about
diseases," Qureshi told IANS.
In 2008, viewers got a taste of amnesia on screen. Aamir Khan was shown as a patient of
amnesia, a state of short-term memory span, in the superhit film "Ghajini".
The following year, action film "Luck" saw heartthrob Imran Khan with dextrocardia, a
rare medical condition in which a person is born with his heart on the right side.
The same year, Amitabh gave a noteworthy performance as Auro, an innocent child
suffering from progeria in "Paa". Progeria causes premature ageing among children and is
a rare disease; so the movie managed to create a buzz about it across the country.
The year 2010 saw superstar Shah Rukh Khan as Rizwan Khan suffering from Asperger
syndrome, which causes difficulty in social interaction.
Later, Hrithik essayed a paraplegic, who appeals for euthanasia in Bhansali's
"Guzaarish".
Polycystic ovarian disease
Beat polycystic ovarian disease (The Times of India: 13.4.2012)
You can prevent and control polycystic ovarian disease through regular practice of yoga,
writes yoga exponent Umesh Dwivedi
In India, around 35% women including young girls, suffer from polycystic ovarian
syndrome (PCOS), also known as polycystic ovarian disease (PCOD). Studies show that
yoga is very helpful in controlling and preventing these symptoms.
PCOS in a nutshell
Polycystic means multiple or many cysts. These cysts are under-developed follicles in the
ovaries. “Syndrome" simply means a set of symptoms like irregular or absence of
menses, infertility, high BP, obesity, depression, sleep apnea, insulin resistance and
imbalances of other hormones. More weight and insulin resistance can lead to
cardiovascular disease and diabetes. Although, causes of PCOS are unknown, heredity
and sedentary lifestyle may be contributing factors.
Yogic treatment
Yoga aids in weight loss and correcting the digestive system. It cures constipation and
helps in better absorption of food. While practising yoga, you should avoid consuming
processed food. Fat intake should ideally be from unsaturated fat. Unhealthy substances
like chips, cookies, baked foods, breakfast cereals and candy are full of trans fats or
hydrogenated oil which raise LDL, the bad cholesterol, and lower protective HDL, the
good cholesterol.
Asattvic yogic diet is recommended, besides fruits, fibre-rich vegetables and whole
grains. Intake of Omega 3 present in walnuts, flaxseed, and soya products is good to
control insulin and blood pressure.
Practise a s a n as
Yoga poses like m a h a m u d r a stimulates the thyroid gland which regulates
metabolism. S a r w a n g a s a n aor shoulder stand pose corrects uterine displacement,
menstrual and urinary disorders. B a d d h a k o n a - s a n aor bound angle pose
strengthens the bladder and uterus. The pituitary and pineal glands are stimulated and
toned through m a t y a s a n a(fish pose). M a nja r a s a n aor cat pose tones the female
reproductive system. K a p a alb h a ti(breath purifying) activates the pancreas that
generates insulin.
Yoga has been found to lower fasting blood sugar in people with diabetes. Depression,
anxiety and emotional disorders are corrected by a n ulo m vilo m p r a n a y a m a.
Awareness of the self gives a feeling of contentment as a whole and acceptance of the
way we are. Meditation makes the mind and body stable and helps a woman conceive and
normalize cortisol levels, which are released as response to stress.
Fungal Diseases
Spreading Fungal Diseases Threaten Food Security, Biodiversity
(Medical News Today: 16.4.2012)
The spread of existing and emerging fungal diseases in plants and animals poses a threat
to global food security and biodiversity, according to a new study whose authors suggest
halting fungal rot in the most important crops could feed an extra 600 million people a
year.
Writing in the 11 April online issue of Nature, researchers from the University of Oxford
and Imperial College London in the UK, together with colleagues from several
institutions in the US, say the fungal threat is largely the result of human activity, and call
for more funds to tighten biosecurity worldwide.
The last 20 years or so have seen an increase in virulent infectious diseases, both in the
wild and managed landscapes.
But more recently, there has been an unprecedented number of fungal and fungal-like
diseases, causing some of the most severe die-offs ever witnessed among wild plant and
animal species, write Dr Matthew Fisher, from Imperial's School of Public Health, Dr
Sarah Gurr, Professor of Molecular Plant Pathology at the University of Oxford, and
colleagues.
In 70% of cases where infectious disease leads to the extinction of a type of plant or
animal, behind the scenes is an emergent species of fungus, and this percentage is rising,
say the researchers.
Fisher, who with Gurr is a corresponding author, told the press:
"The alarming increase in plant and animal deaths caused by new types of fungal disease
shows that we are rapidly heading towards a world where the 'rotters' are the winners."
Fisher, Gurr and colleagues suggest changes in the natural envinronment caused by
human activity create new opportunities for fungal diseases to evolve and spread, thereby
reducing biodiversity and jeopardizing crops and food systems.
Most of the calories people around the world consume come from just five food crops:
rice, wheat, maize, potatoes and soybeans. Fungal diseases like rice blast, stem rust in
wheat, corn smut in maize, late blight in potatoes, and soybean rust, are right now
destroying 125 million tonnes of these crops.
The authors say the damage inflicted on rice, wheat and maize alone, costs global
agriculture $60 billion a year, with catastrophic consequences in the developing world,
where 1.4 billion people, existing on less than $1.25 a day, rely on these cheap foods.
In a worst case scenario, the researchers calculate that 900 million tonnes of food would
be wiped out if fungal disease epidemics were to strike all the top five food crops in the
same year.
Although the odds of this happening are extremely small, Fisher, Gurr and colleagues say
if it were to happen, the result would be a global famine with 4.2 billion starving people.
Fungal diseases affect the environment as well. Trees do an important job of removing
carbon dioxide from the atmosphere and reducing the greenhouse effect. But loss and
damage due to fungal diseases have prevented the absorbtion of around 230 to 580
megatonnes of atmospheric CO2, say the researchers. This is about 0.07% of global
atmospheric CO2, enough to increase the greenhouse effect.
In the animal kingdom, over 500 species of amphibians are at risk from new fungal
diseases, plus many species of sea turtles, bees, and even coral.
Fisher said:
"We need to strive to prevent the emergence of new diseases as we currently lack the
means to successfully treat outbreaks of infection in the wild."
"Crop losses due to fungal attack challenge food security and threaten biodiversity, yet
we are woefully inadequate at controlling their emergence and proliferation," added Gurr.
The researchers also mention a topic that has been much in the news recently, the decline
in US bat populations caused by white nose fungus infection. This will lead to a rapid rise
in crop pests, resulting in an additional $3.7 billion of agricultural costs per year or more,
they suggest.
Fisher, Gurr and colleagues explain how human activity has shaped these trends: since
the mid-20th Century, fungal diseases have risen largely as a result of increased trade and
travel.
They estimate the threat from fungal diseases now outstrips that caused by bacteria and
viruses, and is set to increase even further.
They urge for tighter control of processes that help the spread of fungal diseases, such as
trade in plant and animal products.
More funding to develop tools that can predict new fungal diseases is also needed, they
add.
Gurr said:
"We must have better funding channelled into the fight against fungal disease."
The National Science Foundation and the National Institutes of Health in the US, plus the
BBSRC, NERC, the Wellcome Trust, the Leverhume Trust, Google.org, and the ERA-net
project BiodivERsA, provided financial support for the study.
Stomach infections
Blood type A may make us more vulnerable to some stomach infections
(New Kerala: 17.4.2012)
Your blood type may determine whether you become infected by some strains of
rotavirus, according to a new study including an Indian origin scientist.
Some strains of rotavirus find their way into the cells of the gastrointestinal tract by
recognizing antigens associated with the type A blood group, a finding that represents a
new paradigm in understanding how this gut pathogen infects humans, said Baylor
College of Medicine researchers.
Rotavirus is a major intestinal pathogen that is the leading cause of severe dehydration
and diarrhoea in infants around the world. An estimated 500,000 people worldwide die
from the infection annually.
The structure of a key part of a strain of the virus known as P[14] provides a clue to how
the virus infects human cells, said Dr. B. V. Venkataram Prasad, professor of
biochemistry and molecular biology at BCM and the report's corresponding author. In
strains of rotavirus that infect animals, the top of a spike on the virus attaches to the cell
via a glycan (one of many sugars linked together to form complex branched-chain
structures) with a terminal molecule of sialic acid.
The same did not appear to be true of virus strains that infect humans, and scientists
believed the human rotavirus strains were bound to glycans with an internal sialic acid
molecule, but they did not know how this occurs.
"We wondered how this genotype of rotavirus recognized a cellular glycan," said Prasad.
"With colleagues at Emory (University School of Medicine), we did a glycan array
analysis to see which glycans interacted with the top of the virus spike (called VP8*)."
The only type of glycan that interacted with VP8* was type A histo-blood group antigen,
he said.
"That was surprising," he said.
"We thought it had to be a glycan with sialic acid."
The histo-blood group antigen A does not have sialic acid.
However, when Dr. Liya Hu, a post-doctoral researcher in Prasad's laboratory,
determined the structure of the VP8* domain, she found that the type A glycan bound to
the rotavirus spike protein at the same place as the sialic acid would have in an animal
rotavirus.
Histo-blood group antigens are known to promote binding of norovirus and Helicobacter
pylori cells to intestinal cells, but this had never been demonstrated in rotavirus.
Hu's structural study, using crystallography, showed subtle changes in the structure of the
VP8* domain of the virus that allowed it to use the histo-blood group antigen A as a
receptor.
In collaboration with the laboratory of Dr. Mary Estes, professor of molecular virology
and microbiology at BCM, Prasad and his colleagues found that laboratory cells modified
to express the histo-blood group antigen A were easily infected by this rotavirus strain.
Cells that lacked this antigen were not easily infected.
An antibody to the histo-blood group antigen A blocked infection by the virus into human
intestinal cells in culture.
"No one expected this," said Prasad.
"Is there an emerging theme here with these intestinal pathogens? Do other viruses use
these blood group antigens as a door to enter the cell?"
Further studies identified a second rotavirus strain P[9] that uses the histo-blood group
antigen as a receptor, he said.
"The question now is do different strains use other histo-blood group antigens in this
way?" he said.
"These studies are significant because they provide a novel mechanism of transmission
for a rotavirus strain that jumps from ungulates (such as horses, zebras, pigs, sheep) into
humans," Estes said.
The authors found humans infected with the P[14] strain had type A blood, but more
studies are needed to confirm the connection.
"Larger populations of infected individuals need to be studied to determine if there is a
clear association of these virus strains using histo-blood group antigens as a receptor,"
they said.
This finding raises questions about why humans developed different blood groups, Prasad
said. It may be an evolutionary change that occurred after the pathogen first invaded
human cells.
The study appears online in the journal Nature. (ANI
Brain disease
Blocking protein could halt debilitating brain disease (New Kerala:
1.5.2012)
Blocking a protein that contributes to acute nerve damage could halt the development of
debilitating Multiple Sclerosis (MS), says a new study.
Some of MS symptoms are blurred vision, eye ache, blindness, partial or mild paralysis,
jerking and twitching muscles, tingling, buzzing and vibration sensations, male and
female impotence, irregular bowel movements, swallowing problems, etc.
MS is estimated to affect up to 2.5 million people worldwide. The disease tends to strike
early in adulthood, with women three times more likely than men to be diagnosed for it,
the journal Brain reported.
Scientists from the Monash University's Immunology and Stem Cell Lab (MISCL),
Universities of Toronto, Yale and Western Australia, have demonstrated the key role
played by the collapsin response mediator protein 2 (CRMP-2) in the development of
MS.
Led by reserachers Steven Petratos from MISCL and Claude Bernard, the research team
found that a modified version of CRMP-2 is present in active MS lesions, which indicate
damage to the nervous system, in a lab model of MS, said a university statement.
The modified CRMP-2 interacts with another protein to cause nerve fibre damage that
can result in numbness, blindness, difficulties with speech and motor skills, and cognitive
impairments in sufferers.
When either the modified CRMP-2 or the interaction between the two proteins was
blocked, the progression of the disease was halted.
Richard Boyd, director MISCL, said the discovery could lead to new treatments for MS,
"Blocking the same protein in people with MS could provide a ‘handbrake’ to the
progression of the disease."
Petratos said the method used to block the protein was approved for the treatment of
other disease conditions by both the US Food and Drug Administration and Australia’s
Therapeutic Goods Administration.
"This should mean that clinical trials - once they start - will be fast tracked as the form of
administration has already been approved," Petratos said. (IANS)
Chronic Diseases
Study: Team Care of Chronic Diseases Seems Cost-effective (New
Kerala: 10.5.2012)
According to a UW Medicine and Group Health Research Institute report in the May 7
Archives of General Psychiatry the collaborative TEAMcare program for people with
depression and either diabetes, heart disease, or both appears at least to pay for itself. It
may save as much as $594 per patient in outpatient costs in two years, after accounting
for the $1,224 per patient that the program cost.
"Also, over the course of two years, people who received the TEAMcare intervention had
a mean of 114 more days free from depression than did the people who received usual
care," said the leader of this randomized controlled trial, Wayne J. Katon, MD. Dr. Katon
is a University of Washington (UW) professor of psychiatry and behavioral sciences and
an affiliate investigator at Group Health Research Institute. Because of individual
variability, the trial was not large enough to assess the program's effect on inpatient costs.
"TEAMcare is a 'high-value intervention,' because the odds are 99.7 percent that it would
cost less than $20,000 per quality-adjusted life year," Dr. Katon said. People who
received the TEAMcare intervention were estimated to have a third of an additional
quality-adjusted life year (QALY). The QALY measure estimates how much time an
intervention would add to a person's quality of life. One QALY is an extra year of life in
good health that the intervention would add. The standard is that if an intervention costs
less than $20,000 per QALY, it is "high value" and should be spread quickly into health
care systems.
"This is important because more and more people have multiple physical and mental
chronic conditions, and caring for them is difficult—and costly," Dr. Katon said. The one
in four U.S. adults with two or more chronic illnesses now account for two-thirds of
health care spending, he added.
At Group Health, health care and coverage are integrated, with clinicians paid a salary.
Most Americans get care from fee-for-service practices, and the researchers estimate that
in such settings TEAMcare may have a higher return on investment: If diabetes nurses
bill for their services at $54 per visit for up to 10 visits, the 24-month mean outpatient
cost savings would be $1,116, with a cost savings per QALY of $3,297.
Earlier, Dr. Katon and his colleagues published the clinical results of the same
randomized controlled trial in the New England Journal of Medicine. They reported that
TEAMcare resulted in less depression and better-controlled blood pressure, sugar, and
cholesterol levels for 214 Group Health Cooperative patients with depression and
diabetes and/or heart disease.
With Michael Von Korff, ScD, a senior investigator at Group Health Research Institute,
the same research group also published in the British Medical Journal that patients
receiving the intervention had better quality of life and less disability than did patients
with usual care.
With Elizabeth H.B. Lin, MD, MPH, the group published in the Annals of Family
Medicine that the TEAMcare program works through primary-care doctors starting and
adjusting medications sooner and more often to reach goals ("treating to target"); and
motivating patients to participate in their own care and monitor their illnesses. Dr. Lin is
a Group Health family physician and an affiliate investigator at Group Health Research
Institute.
TEAMcare is a patient-centered program that is based on the Chronic Care Model.
Nurses work with patients and health teams to manage care for depression and physical
diseases together, using evidence-based guidelines. Together, the nurse and patient set
realistic step-by-step goals: improving function and quality of life and reducing
depression and blood sugar, pressure, and cholesterol levels. To reach these goals, the
nurse regularly monitored the patient's mental and physical health. Based on guidelines
that promoted incremental improvements, the multidisciplinary care team offered
recommendations to the patient's primary care doctor to consider treatment changes to
manage blood pressure, blood sugar, lipids, or depression.
Interest is high in spreading integrated, coordinated, team-based care for patients with
depression and poorly controlled physical diseases. Dr. Lin is leading a project to
implement TEAMcare as part of usual primary care at Group Health, and there is also
interest in spreading the program to other organizations.
Lung Disease
First, Do No Harm: Danger in Standard Treatment for a Serious Lung
Disease (Science Daily: 21.5.2012)
A combination of three drugs used worldwide as the standard of care for a serious lung
disease puts patients in danger of death or hospitalization, and should not be used
together to treat the disease, called idiopathic pulmonary fibrosis, according to the
surprising results of a rigorous independent study.
The study, which appeared online May 20 in the New England Journal of Medicine to
coincide with a presentation at the annual meeting of the American Thoracic Society, was
conducted by IPF Clinical Research Network, funded by the National Heart, Lung, and
Blood Institute of the National Institutes of Health.
"The findings show the importance of testing even those treatments that doctors give
routinely for any type of condition -- to see if they truly help, and don't harm, patients,"
says University of Michigan Health System lung specialist Fernando Martinez, M.D.,
who will present the results.
Martinez and his colleagues report that patients in the mild to moderate stages of the
progressive lung-scarring disease had a far higher chance of dying or being hospitalized
if they were taking a three-drug combination used worldwide, compared with those
taking a placebo.
What's more, the three-drug combo yielded no improvement in lung function, or even
slowing of loss of lung function, compared with placebo. Results from a group taking the
single drug, N-acetylcysteine (NAC), are still being gathered and analyzed.
This evidence is from a randomized, placebo-controlled, double-blind trial that included
patients with a definitive diagnosis of IPF who were treated at 25 centers taking part in
the IPF Clinical Research Network or IPFNet. The study was stopped early when an
interim analysis showed signs of harm from the three-drug combination of prednisone,
azathioprine and NAC.
The findings should cause physicians worldwide to stop using this combination to treat
IPF patients similar to those in the trial, say the authors.
And, the dramatic finding of harm from a standard treatment should cause physicians to
apply rigorous testing methods to other types of treatment, and highlights the importance
of independent federal funding for such studies, says Martinez.
The authors salute the volunteer IPF patients who agreed to be randomly assigned to a
treatment or placebo for 60 weeks.
Martinez, an internationally known IPF researcher and clinician in the U-M Medical
School's Division of Pulmonary Medicine, remarks that results will soon be known for
the group taking NAC alone, compared with those taking placebo. The current paper and
presentation do not include results from this group.
In the results presented this week, the authors report that eight patients in the group of 77
assigned to the three-drug combination died, compared with one in the placebo group. A
total of 23 of the three-drug patients were hospitalized during the trial, compared with 7
in the placebo group. There was no sign that the three-drug combination slowed the
progression of IPF or improved lung function, as measured by forced vital capacity.
The study is called PANTHER-IPF, for Prednisone, Azathioprine, and N-Acetylcysteine:
a Study That Evaluates Response in Idiopathic Pulmonary Fibrosis. Except for a donation
of NAC and a matched placebo by the company that makes the drug, there was no
industry support for the work.
IPF, which affects nearly 100,000 Americans, slowly steals the ability to breathe freely.
Its cause or causes are not clear, which is why it is called "idiopathic." Over time it leads
to the buildup of scar tissue in the lungs that accumulates in a distinctive honeycomb
pattern that can be seen on biopsy or CT scan. It is known as an interstitial lung disease
because it affects the tissue around the air sacs in the lungs.
IPF patients live an average of five years after diagnosis, though a lung transplant at a
center such as U-M's Transplant Center can extend life for years beyond. Most patients
are over the age of 65 when diagnosed, but IPF can strike younger people as well.
Because lung transplants are such a dramatic and rarely available therapy, researchers at
U-M and other centers are working to find new treatments while also studying the
underlying biological factors in the disease. The PANTHER-IPF trial was designed to
test a standard therapy in a rigorous way.
In addition to Martinez, who serves as corresponding author, the research paper was
written by Ganesh Raghu, M.D., University of Washington; Kevin J. Anstrom, Ph.D.,
Duke Clinical Research Institute, Duke University; Talmadge E. King, Jr., M.D.,
University of California at San Francisco; and Joseph A. Lasky, M.D., Tulane University.
AIDS-HIV Infection
HIV 'Superinfection'
HIV 'Superinfection' Boosts Immune Response(Medical News Today:
2.4.2012)
Women who have been infected by two different strains of HIV from two different sexual
partners - a condition known as HIV superinfection - have more potent antibody
responses that block the replication of the virus compared to women who've only been
infected once. These findings, by researchers at Fred Hutchinson Cancer Research Center
in Seattle, are published online March 29 in PLoS Pathogens.
"We found that women who had been infected twice not only had more potent antibody
responses, but some of these women had 'elite' antibody activity, meaning that they had a
broad and potent ability to neutralize a wide variety of strains of HIV over a sustained
period of time," said senior author Julie Overbaugh, Ph.D., a member of the Hutchinson
Center's Human Biology Division. It is estimated that only about 1 percent of people with
HIV are so-called "elite neutralizers" who are able to potently neutralize multiple
subtypes of the virus.
"Individuals who become superinfected with a second virus from a different partner
represent a unique opportunity for studying the antibody response and may provide
insights into the process of developing broad neutralizing antibodies that could inform
HIV-vaccine design," she said.
The study suggests that harboring a mixture of different viral strains may be one way to
promote a robust antibody response. The findings also suggest that being infected with
two different HIV strains not only leads to a strong response, but also a more rapid
response that is capable of recognizing many other HIV strains.
The researchers tracked the immune activity of 12 superinfected women from Mombasa,
Kenya, over a five-year period and compared each to a control group of three singly
infected women. Overbaugh and lead author Valerie Cortez, a doctoral student in her lab,
assessed the ability of antibodies present in superinfected and singly infected women to
neutralize a spectrum of circulating HIV-1 variants. In doing so they were able to
determine whether the presence of two viruses compared to one made a difference in
immune response. The researchers controlled for variables such as antibody response
prior to superinfection and biomarkers of immunity such as CD4+ T cell count and viral
load.
The study found that superinfected women had, on average, 1.68 times more neutralizing
antibodies than non-superinfected women, and they scored much higher in their ability to
neutralize the virus - superinfected women had 1.46 times greater potency than the singly
infected women.
More than 1.1 million Americans are estimated to be living with HIV today, and every
nine-and-a-half minutes someone in the U.S. becomes infected, according to the U.S.
Department of Health and Human Services. An HIV vaccine is considered the best
approach to long-term protection from HIV infection, but attempts to develop such a
vaccine so far have meet with limited success.
"The holy grail of an HIV vaccine is to elicit antibodies to the virus because antibodies
have been shown to block virus infection. But there has been little progress in
determining how to elicit such antibodies with a vaccine. The study of individuals HIV
infected who have developed strong antibody responses to the virus may shed light on the
best approach to design a vaccine that will induce an effective immune response,"
Overbaugh said.
HIV-hit kick
The HIV-hit kick for their cause (The Tribune: 2.4.2012)
The stigma and discrimination, trauma and helplessness have made a few HIV/AIDSinfected people stand up for themselves as well as for the cause. Many such
representatives participated in a soccer tournament organised to raise funds for the
treatment, care and support of those living with HIV and AIDS here yesterday.
The three-day edutainment platform, "Football4Hope", aims at bringing together
international support and participation to redirect the process of rehabilitation of HIVaffected people through medication, finance and self-empowerment programmes.
This is the third edition of the annual joint initiative of Delhi-based NGOs, The Touch of
Hope Foundation and The New Delhi United Football Club for generating awareness
about the disease by the people who have been living through it.
For Loongangte, member of the Delhi Network of Positive People, life was difficult after
he had been diagnosed with HIV in 1997 in Manipur. But today 12 years have passed by
and he has made himself capable of helping others through awareness programmes.
"In the nineties, there was a lot of discrimination. Treatment was available but access was
limited. Situation has completely changed now though much support is required from
people and government at large. At our level, we can spread the information about the
disease as we have faced it. With the family support and security, they can lead a normal
life. This event is a way to reach out to people," said Loongangte, who is captaining the
Hope Team.
The players as well as organisers looked happy with the crowd response at a packed
stadium. "The United Cup in 2010 and 2011 were successful events, which brought joy,
fun and the spirit of goodwill among the various missions and embassies of several
countries in India," said co-founder of Football4Hope Haroon James.
"The initiative spreads the message of hope of a better life while fighting the spread of
the virus and stigma associated with the disease. It demonstrates that sports and
community services do enhance the quality of life and make positive difference in
people's life," said Dr Chinkholal Thangsing, the initiative's co-founder and founder
president of The Touch of Hope Foundation.
Starting at Thayagaraj Sport Complex, the United Cup (2012), has 14 teams playing this
time, including two Indian teams-Team India and Hope Team (comprising the people
living with HIV/ AIDS), with representatives of last year's winner United Nations and
embassies of China, Spain, France, Denmark, Egypt, Saudi Arabia, Indonesia, the
Netherlands and Israel, and the High Commission of Republic of Botswana and
Tanzania.
The proceeds of the soccer event will be utilised to set up a centre in New Delhi.
HIV Infection
HIV Infection from Two Strains Increase Immune Response (Medical
The March 29 issue of the online Open Access journal PLoS Pathogens reveals that
women with HIV superinfection, i.e. who have been infected by two different strains of
HIV from two different sexual partners have more potent antibody responses that inhibit
the virus from replicating compared to women who have only been infected once.
The finding by researchers from the Fred Hutchinson Cancer Research Center may
provide insight to developing an HIV-1 vaccine, which offers protection against various
circulating strains.
Senior researcher, Julie Overbaugh commented:
"We found that women who had been infected twice not only had more potent antibody
responses, but some of these women had 'elite' antibody activity, meaning that they had a
broad and potent ability to neutralize a wide variety of strains of HIV over a sustained
period time."
According to estimations, only 1% of HIV-infected people are "elite neutralizers", which
means they are able to potently neutralize multiple subtypes of the virus.
The team tracked the immune activity of 12 superinfected women from Mombasa,
Kenya, over a five-year period and compared each woman to a control group of three
women who were infected with a single strain of the HIV virus. By evaluating the ability
of antibodies to neutralize a range of circulating HIV-1 variants in both groups, the team
was able to establish what impact two viruses had on immune response compared to one
virus.
After accounting for variables, including antibody response prior to superinfection and
biomarkers of immunity like CD4+ T cell count and viral load, the findings indicate that
having a mixture of different viral strains may be one approach to encourage a robust
antibody response.
Furthermore the study results show that in addition of achieving stronger response rates
in superinfections, they also lead to a more rapid response that has the ability of
identifying many other HIV strains.
AIDS
'Fight AIDS with zeal of Quit India movement'(World Newspaper
Today: 118.4.2012)
With Karnataka being one of the six states with a high prevalence of HIV infected
persons, the arrival of Red Ribbon Express in the city on Monday has instilled hope
among organisations working towards prevention of AIDS and eradication of myths
associated with it.
After inaugurating the Express, state law minister Suresh Kumar said, “We need to take
up the issue like Indians took to the Quit India movement in 1942, especially considering
that we have three districts in our state with a chronic prevalence of HIV (Belgaum,
Bijapur and Bagalkote).”
There are certain myths about AIDS due to lack of adequate knowledge about the
disease. “Those affected by AIDS need our support and help and not face discrimination
based on ignorance,” he added.
Karnataka State AIDS Prevention Society, the National AIDS Control Society and other
organisations working for those affected by the disease hope this campaign will provide
some perspective towards prevention of the dreaded disease, as well as addressing the
discrimination faced by the affected persons.
Such a long journey
Cited as the world’s biggest mid media campaign on AIDS, the Red Ribbon Express is a
specially designed exhibition train on HIV and AIDS. It began its journey on Dec 2007
and in the first phase covered 180 stations across 24 states and directly reached out to 6.2
million people, spreading the message of AIDS prevention and treatment.
Phase 2 began on Dec 1, 2009, covering 25,000 km, and it stopped at 152 stations, across
22 states.
During the current phase 3, the train will stop at 162 stations across 23 states. The train
arrived in the city after touching five districts of Belgaum, Harihara (Davangere),
Dharwad, Gadag and Bidar. It will be at the Cantonment station till 6 pm on Tuesday,
after which it will leave for Ashokapuram in Mysore and Kolar.
In the five districts of the state, more than 2.25 lakh people visited the exhibition and
3,148 voluntarily underwent the AIDS tests.
Student push for exhibition
The third phase of the train’s journey through the country began this year on January 12
(National Youth Day). The speakers at the inaugural function called on the youth to be
careful in their daily behaviour.
Over 100 students of the Karnataka Vidhyarthi Koota (KVK) organised a signature
campaign and a procession in Shivajinagar area to spread the message of blood donation
and the need to undergo AIDS tests.
HIV positive
India urged to scale up treatment for HIV positive mothers(World
Newspapers: 27.4.2012)
Lauding India's efforts in providing treatment to HIV affected people, UNAIDS on
Thursday urged the country to scale up its healthcare services for the benefit of HIV
positive mothers and children.
"If we want zero AIDS-related deaths, India needs massive scale up of treatment and care
services. By 2015, we need at least 15 million people on treatment world-wide," Charles
Gilks, country coordinator for UNAIDS, said.
Gilks was speaking at the summit on good practices, innovations and impact of National
AIDS Control Programme-III organised by National AIDS Control Organisation
(NACO).
The second day of the three-day Summit brought together experts and community leaders
who stressed on concrete strategies that are required to strengthen care, support and
treatment in the next phase of the National HIV programme.
"We have an unfinished agenda. Stigma, discrimination and denial faced by HIV positive
people is still very high," Aradhana Johri, Additional Secretary, Department of AIDS,
said.
While Gilks said India should focus to improve services for pregnant mothers,
Mohammed Shaukat, Deputy Director General of NACO, said though the number of
Antiretroviral Therapy (ART) centres increased from 107 in 2007 to 355 in 2012, HIV
positive people are accessing them at a very late stage.
"It is important for HIV positive people to start ART soon to improve the quality of life,"
he said.
NACO has directed all ART centres to provide ART for anyone who has a CD4 count of
350 from 250 earlier. The CD4 count determines the immunity levels of a person living
with HIV.
Manoj Paradesi, living with HIV for 18 years, said there is an urgent need to listen to
voices of the community.
Time has come to make drug dispensing units (ART centres) as complete Health
Resource Centres which can provide quality counselling and information to HIV positive
people, he said.
HIV
WHO calls for early treatment to stop HIV from spreading (New
Kerala: 1.5.2012)
Any HIV infected person should be given immediate treatment to reduce the risk of
transmission of the virus to his/her partner, suggests World Health Organization.
The recommendation is part of a global crackdown on the spread of HIV.
Last year, a clinical trial found that giving antiretroviral drugs to an infected partner
earlier reduces the risk of transmission by 96 per cent.
The new strategy is part of a drive to stop HIV spreading, even if it means treating people
whose immune systems are not yet depleted to the levels that usually require therapy.
"This is the first time people would get treatment not necessarily for their own benefit,
but to protect their partners," New Scientist quoted Bernhard Schwartlander, director of
evidence, innovation and policy at UNAIDS in Geneva, Switzerland, as saying.
Andrew Ball of the WHO's HIV/AIDS department added. "The big question is to what
extent reducing the viral load in a community impacts the HIV epidemic overall." (ANI)
HIV/AIDS
UNDERSTANDING AIDS
The latest HIV drugs can contain the multiplication of the virus and hence
minimise the attack on the body’s immune system, thereby improving longevity
and quality of life(The Tribune:3.5.2012)
Dr Sukarma S.S. Tanwar
THE Acquired Immunodeficiency Syndrome (AIDS) was first
described by clinicians in US in 1981 among men having sex with
men (MSM). According to 2011 UNAIDS estimates, around 30.6
million adults and 3.4 million children are living with HIV/AIDS
worldwide. Of these, approximately 2.4 million patients are in India
and out of them nearly 1.5 million (including 97,800 children)
patients are registered for HIV care at Government antiretrovial
therapy (ART) centres across India. Out of these 0.5 million
patients (28,000 children) are receiving antiretroviral therapy.
Exactly how the HIV was first transmitted to humans is not definite
but a commonly accepted explanation lies in the African practice of
hunting and butchering chimpanzees. Probably a form of virus not harmful to these non- human primates,
simian immunodeficiency virus (SIV) was transferred to humans while hunting or dressing a kill, or by eating
uncooked contaminated meat and then by multiple mutations over a period of years, it became infectious to
humans and is now termed as Human Immunodeficiency Virus (HIV).
HIV is different from AIDS
HIV infection generally progresses through various stages and weakens the immune system significantly. The
most severe stage is termed as Acquired Immunodeficiency Syndrome, or AIDS (the condition of lowered
immunity caused by the virus). HIV is the virus that causes AIDS but this progression to AIDS may be
preceded by a period during which the person may or may not have symptoms (average around eight to nine
years for adults). The introduction of highly active antiretroviral therapy (HAART) halts the progression of
HIV infection to AIDS stage. And it is now possible for someone with HIV infection receiving HAART to live for
years without developing full-blown AIDS. The success of HAART has helped to destigmatise the HIV, and it
has now come to be recognised as a chronic manageable disease.
How is it contracted
The highest concentration of the HIV in the body is found in blood, semen and vaginal secretions. So, any
contact with these bodily fluids from an infected person may be a route of transmission. This includes
heterosexual or same-sex contact with an infected person, as well as sharing of used needles. HIV is also
present in sweat, saliva and tears but in very small concentration and there is no documented evidence of
transmission through these body fluids. The most common modes of transmission of HIV are: unprotected
sexual intercourse with an infected person, injecting drug (sharing needles), blood transfusion and motherto-child transmission
Affects on the body
Patients recently infected with the HIV may experience symptoms of acute retroviral syndrome. Some of the
common symptoms during this phase are fever or flu-like symptoms, rash, mucocutaneous ulcers,
oropharyngeal candidiasis etc which will later settle down. The mean time from suspected exposure to
appearance of these symptoms is two to four weeks. After this there is a long asymptomatic phase where a
person may be totally healthy or may have certain mild illnesses. As the HIV infection progresses, it weakens
a person’s immune system and the person starts falling ill with diseases that a healthy person will be able to
fight.
Diagnosis
A person has HIV if there are detectable levels of the virus on a blood test, or (with the exception of babies
born to HIV-positive mothers) a positive blood test for antibodies (infection-fighting proteins) against the
virus. The criteria for HIV diagnosis is slightly different in infants because HIV antibodies can be passed to
the baby from mother before or during birth, but the infant may not actually be infected with the virus. The
earliest time when the HIV status of a person can be ascertained is between seven and 12 days from the
suspected date of exposure by fourth-generation enzyme linked immunosorbent assay (Elisa) test but should
again be confirmed at three months through a rapid HIV test kit.
Symptoms
It is possible to live with HIV infection for years, without any significant related symptoms. Some of the more
frequently seen symptoms are significant weight loss, prolonged fever, unexplained fatigue, recurrent
diarrhoea in the absence of any other illness that may cause these symptoms. The two factors that indicate
the severity of infection are; a decrease in the CD4 ((cluster of differentiation 4) cell count and the presence
of one of the AIDS-defining illnesses. The most common are cryptococossis (fungal infections), TB,
pneumonia, candidiasis, herpes etc.
Treatment
For HIV treatment, a combination of three or more antiretroviral drugs (ART) is given and the therapy is
called highly active antiretroviral therapy (HAART). These drugs prevent the virus from multiplying inside our
body. As a result, fewer CD4 cells are destroyed and the body’s immune system is maintained. However, the
virus also mutates quickly and becomes resistant to medicine. It is, thus, essential that the treatment
regimen for HIV contains three or more drugs. Besides this, the adherence of more than 95 per cent is
essential for the drugs to act optimally and prevent the emergence of resistant strains of HIV in the body.
These drugs only contain the multiplication of the virus, and hence minimise the attack on the body’s
immune system thereby improving longevity and quality of life but not cure the HIV as the virus is known to
persist in certain sanctuaries like lymph nodes and brain.
Side-effects
Some common side-effects of HAART are nausea, vomiting, diarrhoea and headache. Some drugs may also
cause abnormal dreams and difficulty to concentrate. However, most of these are not serious and improve in
the first one or two months.
First-line & second-line ART
The initial combination of ARV drugs taken to treat HIV is called first-line ART. When this combination of
drugs is not able to contain the multiplication of the virus, then another combination of drugs is started (from
different class) and this is called second-line ART. A person can be stable on first-line regimen for around
eight to 10 years if taken as per instructions from the doctor (primarily adherence >95 per cent).
Post-exposure prophylaxis for HIV
Post-exposure prophylaxis (PEP) for HIV refers to measures taken to prevent infection in a person, who may
have been exposed to HIV infection. The various measures include first-aid care, counselling and risk
assessment, followed by initiation of short-course ART, if required. The PEP is a combination of two or three
ARV drugs and should be initiated as soon as possible but definitely within 72 hours from the suspected time
of exposure. The treatment has to continue for 28 days. During this period, the person may suffer from
various side-effects like diarrhoea, vomiting, headache and myalgia.
Government initiative
The Government of India has set up around 9,500 integrated testing and counselling centres (ICTCs) across
the country where free of charge HIV testing is done with confidentiality. Besides this, there are 340 ART
centres (HIV treatment centres) across the country where investigations and ART is provided free of charge
to all the patients. Currently 4,87,000 patients are receiving free ART at these centres.
— The writer is Senior Lecturer, Public Health Foundation of India, and Technical Consultant
(Care, Support & Treatment), National AIDS Control Organisation, Government of India
Dr Sudhir Srivastava, writer of “When robot plays surgeon”, is the Chairman, CEO and Managing
Director, International Centre for Robotic Surgery, New Delhi. He is not the Chairman, CEO and
Managing Director, Fortis Healthcare, as was inadvertently mentioned on April 25, 2012.
HIV IS NOT TRANSMITTED BY



Through air or by coughing and sneezing.
Through food or water.
Sharing cups, plates, and utensils with an infected person.





Touching & hugging an infected person.
Sharing clothes or shaking hands with an infected person.
Sharing toilets and bathrooms with an infected person.
Living with an infected person.
Mosquitoes, fleas, or other insects.
HEALTHY LIVING





Make sure you have a healthcare provider who knows how to treat HIV.
Begin treatment promptly once your doctor tells you to and follow your doctor’s instructions. Better
the adherence (>95 per cent), better would be long-term response.
If you get side-effects from your medicine, visit your doctor for advice; don’t make changes in your
medicine on your own or because of advice from friends.
Get immunisation (shots) to prevent infections such as pneumonia and flu but only as per your
doctor’s advice.
Practise safe sex to reduce your risk of getting a sexually transmitted disease (STD) or another strain
of HIV.
ART CENTRES IN NORTH INDIA












IGMC, ARTC , Department of Medicine Opposite Blood Bank,
Shimla
Room No 501, Regional Hospital, Hamirpur
Guru Nanak Dev College & Government Medical College,
Amritsar
Civil Hospital, Near Pathology Lab, 1st Floor, Jalandhar city
OPD Complex, Govt Medical College & Rajindra Hospital,
Patiala
Lord Mahavir Civil Hospital, Ludhiana
Civil Hospital, Pathankot
Civil Hospital, Bathinda
Room No 2021, New O.P.D.Complex, PGIMER., Chandigarh
Ward No 26, PGIMS, Rohtak
Dept of Medicine, Govt Medical College Bakshi Nagar,
Jammu
Sher-i-Kashmir Institute of Medial Science, Soura, Srinagar
HIV/AIDS
HIV pill 'may help prevent healthy people from contracting AIDS'(New
Kerala: 10.5.2012)
Federal drug regulators on Tuesday confirmed that a popular HIV-fighting pill could also
thwart healthy people from becoming infected with the virus that leads to AIDS in the
first place.
While the pill seems safe and effective for prevention, scientists insisted that it only
works when taken on a daily basis.
The Food and Drug Administration will hold a meeting on Thursday to discuss whether
Truvada should be approved for people who are at risks of contracting HIV through
sexual intercourse, CBS News reported.
The agency's positive review posted on Tuesday indicates that the daily pill will become
the first drug approved to prevent HIV infection in high-risk patients.
FDA reviewers concluded that taking Truvada pre-emptively could spare patients
"infection with a serious and life-threatening illness that requires lifelong treatment."
Despite the positive results, reviewers asserted that patients must be diligent about taking
the pill every day.
Adherence to the prescription was less than perfect in clinical trials, and reviewers said
that patients in the real world might forget to take their medication even more than those
in clinical studies.
First announced in 2010, Truvada's preventive ability was considered a breakthrough in
the 30-year campaign against the AIDS epidemic.
Because Truvada is already on the market to tackle HIV, some doctors presently
prescribe it as a preventive measure. FDA approval would allow the drugmaker Gilead
Sciences to formally market its drug for the new use.
However, support for FDA approval is not unanimous. Some researchers insisted that
condoms remain the best weapon against AIDS, and a prevention pill is not the chemical
equivalent.
Researchers are also apprehensive about Truvada's mixed success rate in preventing
infection among women.
Yet, a number of HIV patient advocacy groups say the drug should be a prescribing
option to prevent HIV, alongside condoms, counselling and other measures. (ANI)
AIDS
What Is AIDS? What Is HIV? (Medical News Today:14 May 2012)
AIDS (Acquired immune deficiency syndrome or acquired immunodeficiency syndrome)
is a disease caused by a virus called HIV (Human Immunodeficiency Virus). The illness
alters the immune system, making people much more vulnerable to infections and
diseases. This susceptibility worsens as the disease progresses.
HIV is found in the body fluids of an infected person (semen and vaginal fluids, blood
and breast milk). The virus is passed from one person to another through blood-to-blood
and sexual contact. In addition, infected pregnant women can pass HIV to their babies
during pregnancy, delivering the baby during childbirth, and through breast feeding.
HIV can be transmitted in many ways, such as vaginal, oral sex, anal sex, blood
transfusion, and contaminated hypodermic needles.
Both the virus and the disease are often referred to together as HIV/AIDS. People with
HIV have what is called HIV infection. As a result, some will then develop AIDS. The
development of numerous opportunistic infections in an AIDS patient can ultimately lead
to death.
According to research, the origins of HIV date back to the late nineteenth or early
twentieth century in west-central Africa. AIDS and its cause, HIV, were first identified
and recognized in the early 1980s.
There is currently no cure for HIV/AIDS. Treatments can slow the course of the disease some infected people can live a long and relatively healthy life.
Estimated HIV/AIDS prevalence among young adults (15-49) by country as of 2008.
UNAIDS 2008 report
What is the difference between HIV and AIDS?
HIV is the virus which attacks the T-cells in the immune system.
AIDS is the syndrome which appears in advanced stages of HIV infection.
HIV is a virus.
AIDS is a medical condition.
HIV infection causes AIDS to develop. However, it is possible to be infected with HIV
without developing AIDS. Without treatment, the HIV infection is allowed to progress
and eventually it will develop into AIDS in the vast majority of cases.
HIV testing can identify infection in the early stages. This allows the patient to use
prophylactic (preventive) drugs which will slow the rate at which the virus replicates,
delaying the onset of AIDS.
AIDS patients still have the HIV virus and are still infectious. Someone with AIDS can
pass HIV to someone else.
What are the signs and symptoms of HIV/AIDS?
What is the difference between a sign and a symptom? A sign is something other people,
apart from the patient can detect, such as a swelling, rash, or change in skin color. A
symptom is something only the patient feels and describes, such as a headache, fatigue,
or dizziness.
For the most part, the symptoms of HIV are the result of infections caused by bacteria,
viruses, fungi and parasites. These conditions do not normally develop in individuals with
healthy immune systems, which protect the body against infection.
Signs and symptoms of early HIV infection
Many people with HIV have no symptoms for several years. Others may develop
symptoms similar to flu, usually two to six weeks after catching the virus. The symptoms
can last up to four weeks.
Symptoms of early HIV infection may include:
fever
chills
joint pain
muscle ache
sore throat
sweats (particularly at night)
enlarged glands
a red rash
tiredness
weakness
weight loss
Asymptomatic HIV infection
In many cases, after the initial symptoms disappear, there will not be any further
symptoms for many years. During this time, the virus carries on developing and damages
the immune system. This process can take up to 10 years. The infected person will
experience no symptoms, feel well and appear healthy.
Late-stage HIV infection
If left untreated, HIV weakens the ability to fight infection. The person becomes
vulnerable to serious illnesses. This stage of infection is known as AIDS.
Signs and symptoms of late-stage HIV infection may include:
blurred vision
diarrhea, which is usually persistent or chronic
dry cough
fever of above 37C (100F) lasting for weeks
night sweats
permanent tiredness
shortness of breath
swollen glands lasting for weeks
weight loss
white spots on the tongue or mouth
During late-stage HIV infection, the risk of developing a life-threatening illness is much
greater. Examples include:
esophagitis (an inflammation of the lining of the lower end of the esophagus)
infections to the nervous system (acute aseptic meningitis, subacute encephalitis,
peripheral neuropathy)
pneumonia
some cancers, such as Kaposi's sarcoma, invasive cervical cancer, lung cancer, rectal
carcinomas, hepatocellular carcinomas, head and neck cancers, cancers of the immune
system known as lymphomas
toxoplasmosis (a disease caused by a parasite that infects the brain. It can also cause
disease in the eyes and lungs)
tuberculosis
Life-threatening illnesses may be controlled and treated with proper HIV treatment.
What causes HIV/AIDS?
HIV is a retrovirus that infects the vital organs of the human immune system. The disease
progresses in the absence of antiretroviral therapy. The rate of disease progression varies
widely between individuals and depends on many factors (age of the patient, body's
ability to defend against HIV, access to health care, existence of coexisting infections, the
infected person's genetic inheritance, resistance to certain strains of HIV).
HIV can be transmitted through:
Sexual transmission. It can happen when there is contact with infected sexual secretions
(rectal, genital or oral mucous membranes). This can happen while having unprotected
sex, including vaginal, oral and anal sex or sharing sex toys with someone infected with
HIV.
Perinatal transmission. The mother can pass the infection on to her child during
childbirth, pregnancy, and also through breastfeeding.
Blood transmission. The risk of transmitting HIV through blood transfusion is nowadays
extremely low in developed countries, thanks to meticulous screening and precautions.
Among drug users, sharing and reusing syringes contaminated with HIV-infected blood is
extremely hazardous.
Thanks to strict protection procedures the risk of accidental infection for healthcare
workers is low.
Individuals who give and receive tattoos and piercings are also at risk and should be very
careful.
Myths: There are many misconceptions about HIV and AIDS. The virus CANNOT be
transmitted from:
shaking hands
hugging
casual kissing
sneezing
touching unbroken skin
using the same toilet
sharing towels
sharing cutlery
mouth-to-mouth resuscitation
or other forms of "casual contact"
How is HIV/AIDS diagnosed?
A 2011 report issued by the CDC (Centers for Disease Control and Prevention), USA,
found that about 1 in every 5 HIV-positive Americans is unaware of their HIV-status, and
only 49% of those who are aware receive ongoing medical care and treatment. (Link to
article)
HIV blood test
Diagnosis is made through a blood test that screens specifically for the virus.
If the HIV virus has been found, the test result is "positive". The blood is re-tested several
times before a positive result is given to the patient.
For those whose tests came back positive, they will be asked to undergo some other tests
to see how the infection has progressed, and also to decide when to start treatment.
If a person has been exposed to the virus, it is crucial that they get tested as soon as
possible. The earlier HIV is detected, the more likely the treatment will be successful.
Also, precautions can be taken to prevent the virus from spreading to other people.
After infection with HIV, it can take up from three weeks to three months for the virus to
show up in testing. Re- testing may be necessary.
If a patient's most at risk moment of becoming HIV infected was within the last three
months, he/she can have the test immediately. However, a good doctor will urge that
another test be carried out within a few weeks.
What are the treatment options for HIV/AIDS?
Currently, there is no vaccine or cure for HIV/AIDS. But treatments have evolved which
are much more efficacious - they can improve patients' general health and quality of life
considerably.
Emergency HIV pills. If an individual believes they have been exposed to the virus
within the last 72 hours (three days), anti-HIV medication, called PEP (post-exposure
prophylaxis) may stop infection. The treatment should be taken as soon as possible after
contact with the virus.
PEP is a very demanding treatment lasting four weeks. It is also associated with
unpleasant side effects (diarrhea, malaise, nausea, weakness and fatigue).
After a positive HIV diagnosis, regular blood tests are necessary to monitor the progress
of the virus before starting treatment. The therapy is designed to reduce the level of HIV
in the blood.
Antiretroviral drugs. HIV is treated with antiretrovirals (ARVs). The treatment fights the
HIV infection and slows down the spread of the virus in the body. Generally, patients
take a combination of medications called HAART (highly active antiretroviral therapy).
The combination of drugs is adapted to each individual. HIV treatment is usually
permanent and lifelong. HIV treatment is based on routine dosage. Pills must be taken on
a regular schedule, every time. Common side effects include nausea, fatigue, diarrhea,
skin rashes, moodiness, alterations to the adipose (fat) tissue, birth defects.
Complementary
or
alternative
medicine.
Although
widely
used,
alternative/complementary medications, such has herbal ones, have not been proven to be
effective or ineffective. According to some limited studies, mineral or vitamin
supplements may provide some benefits. Patients are urged to discuss these options with
their doctors.
Prevention
Unprotected sex. Having sex without a condom can put a person at risk of being infected
with HIV and other sexually transmitted infections (STIs). HIV can be spread by having
unprotected sex (vaginal, oral and anal sex). It can also be caught from sharing sex toys
with someone infected with HIV.
Drug abuse and needle sharing. Intravenous drug use is an important factor in HIV
transmission in developed countries. Sharing needles can expose users to HIV and other
viruses, such as hepatitis C.
Strategies such as needle-exchange programs are used to reduce the infections caused by
drug abuse.
Body fluid exposure. Exposure to HIV can be controlled by employing precautions to
reduce the risk of exposure to contaminated blood. At all times, health care workers
should use barriers (gloves, masks, protective eyewear, shields, and gowns). Frequent and
thorough washing of the skin immediately after being contaminated with blood or other
bodily fluids can reduce the chance of infection.
Pregnancy. Anti-HIV medicines can harm the unborn child. But an effective treatment
plan can prevent HIV transmission from mother to baby. Precautions have to be taken to
protect the baby´s health. Delivery through caesarean section may be necessary.
Breastfeeding may have to give way to bottle-feeding if the mother is infected. A study
by scientists from Columbia University, New York, found that breastfeeding for 6+
months with antiretroviral therapy could help reduce mother-to-child HIV transmission as
well as improve chances of infant's survival. (Link to article)
Education. Health education is an important factor in reducing risky behavior.
Managing HIV
Adherence. HIV treatment is effective if the patient is committed and constant in taking
the medication on time. Missing even a few doses will jeopardize the treatment. A daily
methodical routine has to be programmed to fit the treatment plan around the patient's
lifestyle and schedule. "Adherence" is sometimes known as "compliance".
General Health. It is crucial for patients to take medication correctly and take steps to
avoid illness. Patients should seek to improve their general health and reduce the risk of
falling ill by practicing regular exercise, healthy eating, and not smoking.
Additional precautions. HIV-infected people should be extra cautious to prevent exposure
to infection. They should be careful around animals, avoid coming into contact with cat
litter, animal feces. Meticulous and regular washing of hands is recommended.
Long-term condition. HIV is a lasting condition, and therefore patients have to be in
regular contact with their healthcare team. Treatment plan is reviewed regularly.
Psychological. Common misconceptions about AIDS/ HIV are diminishing. However,
the stigma of the disease persists in many parts of the world. People infected with the
virus may feel excluded, rejected, discriminated and isolated.
Being diagnosed with HIV can be very distressing, and feelings of anxiety or depression
are common. If you feel anxious or have symptoms of depression, seek medical help
immediately.
HIV
Will home HIV tests become a reality? (The Hindu:17 May 2012)
Experts have said that a ground-breaking over-the-counter HIV test that can be taken at
home is reasonably “safe and effective” for determining whether one has the AIDS virus.
The 17-member US Food and Drug Administration advisory committee voted
unanimously for the OraQuick In-Home HIV Test and said that its potential to prevent
infections outweighed the risk of false results.
The Food and Drug Administration regulators will decide later this year whether to
approve it; it does not have to follow the recommendations of the advisory panel, though
it usually does, the ‘BBC' reported. The 20-minute test is 93 per cent accurate for positive
results and 99.8 per cent for negative, the manufacturer said.
To take the test, the user swabs the outer gum area so the oral fluid, which is not the same
as saliva, can be checked for the HIV virus. The test provides results within about 20
minutes, but the experts say the results should be confirmed with a blood test, which is
more accurate.
In fact, the experts on the Blood Products Advisory Committee voted 17-0 to back the
test, saying it would help people who are HIV-positive get access to healthcare and social
services.
The experts urged Pennsylvania-based OraSure, the company that manufactures the
product, to include highly visible warnings about false negative results. The panel also
advised that the packaging should carry a toll-free phone number offering counselling to
those testing positive.
OraSure said the home test could retail for less than US dollars 60 if approved.
Carl Schmid, deputy director of the AIDS Institute, has welcomed the panel's approval on
Tuesday of the home test.
“We are always looking for game changers, and we believe this is one of them. Not only
will it help reduce the number of infections but it will bring more people into care and
treatment,” he was quoted as saying.
HIV-inhibiting
New HIV-inhibiting protein identified (New Kerala: 31.5.2012)
Researchers have discovered a new HIV-suppressing protein in the blood of people
infected with the virus.
In laboratory studies, the protein, called CXCL4 or PF-4, binds to HIV such that it cannot
attach to or enter a human cell.
The research was led by Paolo Lusso, M.D., Ph.D., chief of the Section of Viral
Pathogenesis in the Laboratory of Immunoregulation at the National Institute of Allergy
and Infectious Diseases (NIAID), part of NIH.
CXCL4 belongs to a family of molecules called chemokines that help regulate the
movement of immune cells around the body. In the mid-1990s, four
chemokinesâEuro"three discovered by Dr. Lusso, Robert Gallo, M.D., and their
colleaguesâEuro"were found in laboratory experiments to function as HIV inhibitors.
These chemokines as well as CXCL4 may regulate the level of virus replication in
infected individuals and thus the pace at which HIV disease progresses.
According to Dr. Lusso, the site where CXCL4 binds to the outer coat of HIV seems to
be different from other known vulnerable sites targeted by HIV-blocking antibodies and
drugs.
His team is working with scientists at the NIAID Vaccine Research Center to define the
atomic-level crystal structure of this binding site, which potentially may play a role in the
future development of HIV treatments or vaccines.
CXCL4 differs from the other four major HIV-suppressive chemokines in several
respects. The other four chemokines inhibit HIV infection by binding to either one of two
cell receptorsâEuro"called CCR5 and CXCR4âEuro"used by the virus to attach to and
enter immune cells, whereas CXCL4 binds directly to the outer surface of the virus.
While the other chemokines bind to forms of HIV that use either the CCR5 or the
CXCR4 receptor, CXCL4 can bind to and block infection by a wide variety of HIV
strains, no matter what their receptor specificity.
Finally, while the other chemokines are made primarily by immune cells, CXCL4 is
made by platelets, the blood cells involved in clotting.
Dr. Lusso and his colleagues are pursuing further research to better understand CXCL4's
role in HIV disease and to determine whether the chemokine has a protective effect not
only in laboratory studies, but also in people.
Alternative International AIDS Conference
India to host alternative International AIDS Conference (The Hindu:
11.6.2012)
When stakeholders from across the world converge at Washington next month to
participate in the International AIDS Conference (IAC) to share their experience and
evaluations and to influence both popular and official perceptions and practices for
curbing HIV/AIDS, India will host a parallel event for those who cannot make it there.
The event will be organised inKolkata by Durbar Mahila Samanway Samiti (DMSS) —
an umbrella organisation of over 65,000 sex workers of West Bengal in collaboration
with the Global Network of Sex Work Project (NSWP).
The U.S. conference is being held from July 22 to 27 at the Walter E. Washington
Convention Center. For the first time in more than 20 years, the U.S, which leads the
anti-sex-worker campaign, is hosting the conference. However, the U.S. government's
strict travel restrictions for sex workers will bar many of them from attending the event,
Samarjit Jana, chair of the International AIDS Conference in India and founder member
of the DMSS told The Hindu.
Therefore, Kolkata conference, known as International AIDS Conference (Hub) was
being held, he said.
The Kolkata meet is expected to be attended by over 900 delegates from across the world,
including the U.S. There will be satellite communication between the two conferences so
the Conference Hub in Kolkata will complement the main conference by facilitating sex
workers' and other stakeholders' participation. This was made possible after long-drawnout negotiations with the International AIDS Society (IAS), members of the IAC 2012
Conference Coordinating Committee and donors.
The Global Village in Kolkata will also host events and activities where the participants
can interact and exchange views and opinions round-the-clock. In addition to formal
sessions and informal meets, there will be cultural programmes by the participants. An
International Advisory Board, consisting of renowned experts from across the world, has
been formed to guide the conference.
South Africa had organised a similar event for its sex workers during the last IAC, but it
was confined to its participants only.
The DMSS is a community based organisation of sex workers in West Bengal. Over the
last two decades it has been running 11 HIV/AIDS targeted intervention programmes in
51 sex worker sites. It runs the SHIP (Sonagachi HIV Intervention Programme), which
has been adjudged a model project by the World Health Organisation.
The DMSS turned a conventional bio-medical intervention for health into a communityled structural intervention that perceived sex work as a legitimate profession and sex
workers as human beings entitled to basic rights and capable of responsibilities. Over the
years, it has developed an environment where sex workers can represent their own
realities and participate in dialogues on issues that affect them.
The NSWP was established as an informal alliance in 1990 by a group of sex worker
rights activists working within sex work projects around the world. Despite lacking
resources and recognition, it has influenced policy and built leadership among sex
workers and facilitated the development of regional and national networks of sex workers
and sex work projects.
Significantly, its participation in the global response to HIV/AIDS was largely
responsible for the term ‘sex worker' replacing ‘prostitute.' More than mere political
correctness, this shift in terminology has had the profound effect of moving the global
understanding of sex work towards a labour framework, which acknowledges sex
workers' rights.
Keywords: International AIDS Conference, Durbar Mahila Samanway Samiti, Global
Network of Sex Work Project
HIV: Newborn
HIV: Newborn Transmission Rate Halved By Adding Nevirapine To
HIV Regimen(Medical News Today:22.6.2012)
Adding the drug nevirapine to the regimen given to newborns of women diagnosed with
HIV shortly before or during labor halves the newborns' risk of contracting the virus,
according to findings by a National Institutes of Health research network.
The researchers found that the rate of mother-to-child HIV transmission around the time
of delivery was 2.2 percent among infants who received the standard drug zidovudine
combined with nevirapine, compared with 4.8 percent among infants treated with
zidovudine alone.
The researchers also found a reduced rate of transmission (2.4 percent) among infants
treated with a three-drug combination: zidovudine, nelfinavir and lamivudine. However,
infants given the two-drug combination were less likely to have neutropenia than were
those on the three drug regimen. (Neutropenia is a blood disorder consisting of low levels
of neutrophils, a type of infection fighting white blood cell.) The two drug combination is
also less expensive and easier to administer than the three drug combination.
"Pregnant women who don't know they have HIV or those who don't come in for prenatal
care may not get the early treatment needed to keep the virus from being passed on to the
baby," said study author Heather Watts, M.D., of the Pediatric, Adolescent and Maternal
AIDS Branch at the Eunice Kennedy Shriver National Institute of Child Health and
Human Development (NICHD). "Our findings show that even in these situations, many,
many infant cases of HIV can be prevented with the two drug combination treatment."
The study included more than 1,600 infants born between 2004 and 2010. All had
received one of three treatments:
the standard twice daily zidovudine alone for six weeks,
twice daily zidovudine for six weeks plus three doses of nevirapine in the first six days
after birth
twice daily zidovudine for six weeks plus two weeks of treatment with nelfinavir and
lamivudine. Newborns are most susceptible to HIV in the two weeks following birth.
To reduce the risk of HIV transmission through breast milk, mothers were counseled to
formula feed their infants. The researchers tested the infant's HIV status at three months.
About 8 percent of all the infants were HIV positive.
Within 48 hours after birth, the researchers tested the infants for HIV. Overall, about 6
percent tested positive, indicating that infection occurred before birth.
The researchers calculated the overall infection rates for all the infants in the study those infected at birth, and later, after 6 weeks of treatment. In addition to acquiring HIV
during their time in the womb, infants may also become infected during the labor and
delivery process. The study evaluated the effectiveness of the treatments in reducing HIV
transmission during this latter interval (intrapartum transmission). So the researchers
calculated the transmission rate around the time of delivery - the proportion of infections
among infants who tested negative at birth, but later tested positive after six weeks of
treatment. In the different drug treatment groups, infection rates were 7.1 percent in the
zidovudine-nevirapine group (which had a 2.2 percent transmission rate), 7.4 percent in
the three-drug arm (which had a 2.4 percent transmission rate), and 11 percent in the
zidovudine-only group (which had a 4.8 percent transmission rate).
The researchers also found that mothers with more severe HIV infections were more
likely to transmit HIV to their infants than were other mothers in the study. Illegal drug
use during pregnancy also increased the transmission rate.
"The two-drug combination is relatively easy to administer and well tolerated by the
babies," Dr. Watts said. "Now that this alternative has been shown to be effective, it is
increasingly being adopted worldwide to prevent transmission in these hi
AIDS
Breast milk antibodies help neutralize HIV (New Kerala: May 24, 2012)
Washington, May 23 : Antibodies isolated from infected mothers' breast milk can inhibit
the virus that causes AIDS, says a new discovery.
HIV-1 can be transmitted from mother to child via breastfeeding, posing a challenge for
safe infant feeding practices in areas of high HIV-1 prevalence. But only one in 10 HIVinfected nursing mothers is known to pass the virus to their infants.
"That is remarkable, because nursing children are exposed multiple times each day during
their first year of life," said senior author Sallie Permar, assistant professor of paediatrics
and infectious diseases at Duke University Medical Centre (DUMC).
"We are asking if there is an immune response that protects 90 percent of infants, and
could we harness that response to develop immune system prophylaxis (protection)
during breastfeeding for mothers infected with HIV-1," Permar, who led the study, was
quoted as saying in the journal Public library of Science.
"Our work helped establish that these B-cells in breast milk can produce HIVneutralizing antibodies, so enhancing the response or getting more mucosal B-cells to
produce those helpful antibodies would be useful, and this is a possible route to explore
for HIV-1 vaccine development," Permar said, according to a university statement.
"This is important work that seeks to understand what a vaccine must do to protect babies
from mucosal transmission during breastfeeding," said Barton Haynes, M.D., study coauthor and a national leader in AIDS/HIV research who is also director of the Intre for
HIV/AIDS Vaccine Immunology (CHAVI), as well as director of the Duke Human
Vaccine Institute (DHVI).
"The antibodies isolated are the first HIV antibodies isolated from breast milk that react
with the HIV-1 envelope, and it important to understand how they work to attack HIV-1,"
added Haynes. (IANS)
HIV/AIDS
Failed war on Drugs is fuelling HIV/AIDS (The Asian Age: 27.6.2012)
The report accused the US, Russia and Thailand of ignoring evidence about the ties
between law enforcement policies and HIV rates
A pressure group that includes six former Presidents called on Tuesday for the United
Nations to acknowledge that “repressive drug law enforcement” was driving an
HIV/AIDS pandemic.
The global “war on drugs” was forcing users away from treatment and into environments
where the risk of contracting HIV was high, the Global Commission on Drug Policy
(GCDP) argued.
In a report published on Tuesday, the panel urged the UN to “acknowledge and address
the causal links between the war on drugs and the spread of HIV/AIDS and drug market
violence”. It also presented evidence that aggressive law enforcement policies created
barriers to HIV treatment.
“The public health implications of HIV treatment disruptions resulting from drug law
enforcement tactics have not been appropriately recognised as a major impediment to
efforts to control the global HIV/AIDS pandemic,” it argued.
The GCDP is a panel of politicians, writers and businessmen that advocates
decriminalising drug use by those who “do no harm to others”.
Members of the GCDP include six former
Presidents, four of whom are from Latin America: Mexico’s Ernesto Zedillo, Fernando
Henrique Cardoso of Brazil, Ricardo Lagos of Chile and Colombia’s Cesar Gaviria.
It was Gaviria who led Colombia when police gunned down the notorious drug-runner
Pablo Escobar in 1993.
Other supporters include the European Union’s former foreign policy chief Javier Solana
and George Shultz, the who served as US secretary of state during Ronald Reagan’s
presidency.
The report accused the US, Russia and Thailand of ignoring scientific evidence about the
relationship between law enforcement policies and HIV rates “with devastating
consequences.” The increased availability of drugs worldwide proved that the strategy
was failing, it added. “The war on drugs has failed, and millions of new HIV infections
and AIDS deaths can be averted if action is taken now,” it concluded.
Allergy
Allergy
Experts Warn of Allergy Risk from New Nickel-plated Coins(Med
India: 20.4.2012)
Medindia on - Allergy - Causes - Symptoms - Diagnosis - Treatment - FAQs - Videos
People who are known to be allergic, respond to harmless allergens in an exaggerated
manner thus resulting in irritations and discomfort to the body. There are several types of
allergies like: Hay Fever, Asthma, Eczema, Hives, Contact Dermatitis (Skin Reactions),
Conjunctivitis (Red eye), Sinusitis, Anaphylaxis (Life-Threatening Reaction).
Experts have expressed concern over the health risk from nickel-plated coins to be
introduced by Royal Mint which they claim could affect people with nickel allergy.
In a letter published today on BMJ the authors say that there has been no assessment of
the new coinage which is being brought in to save costs. Furthermore, there has been no
consideration (by HM Treasury officials or the Royal Mint) given to the potential costs to
health in terms of skin disease, financial implications to the NHS or other costs to the
taxpayer.
The Royal Mint has in fact confirmed that they have “no information on nickel-release
from the new coins” and that no studies or assessments have been undertaken on how it
may affect those with a nickel allergy.
In comparison, The Treasury’s Swedish counterparts, Swedish Riksbank have recently
concluded that nickel-plated coins “pose unacceptable risks to health” and they will “not
be using nickel containing alloys in their coinage”.
The Royal Mint may have followed all the rules with regards to the introduction of new
coinage, but there is still no proof that those with hand eczema (dermatitis) or nickel
contact allergies will not suffer.
The authors suggest that Sir John Beddington, Chief Scientific Adviser to HM
Government, gives his opinion on the matter. The letter ends with the last thought that
public records should show that “competent risk assessment has formally considered the
concerns”.
Allergies
Allergies? Some Pollens Are Much More Aggressive Than Others(Science
Daily:22.5.2012)
There are pollens -- and there are pollens, as scientists from across Europe discovered
while investigating the allergic potential of pollens from the three main triggers of hay
fever in Europe: birch, grass and olive. Different people can have very different allergic
reactions to a particular type of pollen, however, and as the Hialine study researchers
have now found, the allergenicity of the pollens also varies. Depending on the time of
year and region, the pollens produce different quantities of protein compounds. These are
ultimately responsible for the allergic immune reaction.
From Finland to Italy and from Spain to Lithuania, thirteen research institutes from
eleven European countries took part in the three-year Hialine study. The coordinator was
Professor Dr Jeroen Buters of TUM's Chair of Molecular Allergology and the Center of
Allergy & Environment (ZAUM). The mission was to study the three main causes of hay
fever in Europe, i.e. the pollen (germ cells) of birch trees, grass and olive plants.
Sufferers develop allergic symptoms when they come in contact with the allergen to
which they are sensitized. Up until now, the only way to ascertain how seriously patients
will be affected is by measuring the airborne pollen concentration.
However, this method gives very little indication of how aggressive the pollens are.
Depending on their level of maturation, the pollens of a particular plant species not only
produce different allergens, but the number of allergenic proteins present also varies. The
researchers were therefore keen to find the connection between pollen count and amount
of allergens released. They focused on the main allergen found in each of the three plant
species: Bet v 1 (birch), Phl p 5 (grass) and Ole e 1 (olive). They discovered that the
pollen count aligns closely with the number of allergens released.
However, some striking differences were noticed on certain days and at particular
measuring stations, as study director Jeroen Buters explains: "The allergic potential
varied by a factor of 10. In other words up to ten times more allergens were released on
the 'intense' days than at other times." On comparison of the levels at the various
measuring locations in Europe, the researchers noticed the greatest fluctuations in the
grass pollens. With seven times the number of Phl p 5 allergens, the grass pollens in
France were significantly more aggressive than those in Portugal. The birch pollens, by
contrast, showed smaller variations. Interestingly, geographical distance seems to have
played only a minor role: At two olive measuring stations located only 400 kilometers
apart, the scientists observed that the allergen level was four times greater at one of the
locations.
The weather was influential too, as Buters relates: "At the measuring station in Portugal,
we found a high concentration of the Ole e 1 allergen, even though there was hardly any
airborne pollen in Portugal at that time. We did some meteorological calculations and
concluded that the allergen had blown in from Spain, where pollens have a significantly
higher allergic potential."
According to the study's findings, measuring the allergens would be more useful to
allergy sufferers than forecasting the pollen count. "By combining allergen
measurements, airborne pollen forecasts and weather data, we can significantly improve
the allergy models used to date." Buters also sees new hope for the treatment of allergy
sufferers: "The only true therapy for an allergy is hyposensitization, i.e. the sufferer must
become accustomed to the allergen over a long period of time. So instead of pollen
extracts, doctors could vaccinate patients with allergenic proteins -- the real triggers of an
allergy. This would be much more effective in targeting the cause of the problem."
Alzheimer's disease
Alzheimer's disease
New drug may help detect marker for Alzheimer's disease early (new
Kerala: 17.4.2012)
Scientists believe use of a new drug to detect the beta-amyloid plaques in the brain that
are hallmark signs of Alzheimer's disease may help doctors diagnose the disease earlier.
Currently, Alzheimer's disease can only be definitively confirmed through the detection
of amyloid plaques and/or tangles in the brain during autopsy after death or with a brain
tissue biopsy.
The new method uses the drug florbetaben as a tracer during a PET scan of the brain to
visualize amyloid plaques during life.
In order to prove that the florbetaben PET scan detects beta-amyloid in the brain, the
global phase III study directly compared brain regions in the PET scan to respective brain
regions after death during autopsy.
For the study, more than 200 participants nearing death (including both participants with
suspected Alzheimer's disease and those without known dementia) and who were willing
to donate their brain underwent MRI and florbetaben PET scan.
The amount of plaque found in the 31 participants who reached autopsy was then
compared to the results of the scans. A total of 186 brain regions from these donors were
analyzed along with 60 brain regions from healthy volunteers.
Based on these 246 brain regions the study found florbetaben to detect beta-amyloid with
a sensitivity of 77 percent and a specificity of 94 percent.
Comparison of the visual assessment method proposed for florbetaben for clinical
practice with the post mortem diagnosis revealed a sensitivity of 100 percent and a
specificity of 92 percent. Sensitivity is the percentage of actual positives that are correctly
identified as positive, and specificity is the percentage of negatives that are correctly
identified.
"These results confirm that florbetaben is able to detect beta-amyloid plaques in the brain
during life with great accuracy and is a suitable biomarker," said study author Marwan
Sabbagh, MD, director of Banner Sun Health Research Institute in Sun City, Ariz., and a
Fellow of the American Academy of Neurology.
"This is an easy, non-invasive way to assist an Alzheimer's diagnosis at an early stage.
Also exciting is the possibility of using florbetaben as tool in future therapeutic clinical
research studies where therapy goals focus on reducing levels of beta-amyloid in the
brain," he added.
The study will be presented as part of the Emerging Science program (formerly known as
Late-Breaking Science) at the American Academy of Neurology's 64th Annual Meeting
in New Orleans April 21 to April 28, 2012. (ANI)
Alzheimer's disease
Alzheimer'sDisease-Causes-Symptoms-Diagnosis-TreatmentPrevention-FAQs (Med India: 20.4.2012)
"If any one faculty of our nature may be called more wonderful than the rest, I do think it
is memory. There seems something more speakingly incomprehensible in the powers, the
failures, the inequalities of memory, than in any other of our intelligences," wrote Jane
Austen, the English writer.
Previous research has shown that dementia is a frequent complication of Parkinson's
disease (PD). However, it is clinically impossible to distinguish PD dementia (PDD).
This is because the latter develops from the progression of the Lewy body pathology that
underlies PD, from PD with coexistent Alzheimer's disease (PDAD). Both have similar
characteristics. A team of scientists has found that PDAD patients have much denser
accumulations of amyloid plaques in the striatal area of the brain than PDD patients. The
results suggest that recently developed imaging techniques may be able to identify striatal
amyloid plaques in the living brain and could be useful for distinguishing PDD from
PDAD. Their results are published in the April issue of the Journal of Parkinson's
Disease.
"We sought to determine if the presence, density, or type of striatal plaques were
predictive of the presence of a clinicopathological diagnosis of Alzheimer's disease in
subjects with PD and dementia," say lead investigators Thomas G. Beach, MD, PhD, of
Banner Sun Health Research Institute, and Charles H. Adler, MD, PhD, of the Mayo
Clinic. Dr. Brittany Dugger, first author, notes the ability to determine the cause of
dementia in patients with PD is a crucial objective if effective treatments are to be
developed.
Researchers performed autopsies on the brains of elderly subjects who had volunteered to
be part of the Arizona Parkinson's Disease Consortium and Banner Sun Health Research
Institute Brain and Body Donation Program, a longitudinal clinicopathological study of
normal aging, dementia, and parkinsonism. They evaluated the brains of patients with a
diagnosis of PD without dementia (PDND), PDD without pathological AD, and PDAD.
For comparative purposes, subjects from a previously published study of patients with
AD without PD (AD), as well as non-demented normal control subjects without
parkinsonism (NC), were also included. Amyloid plaque densities were graded at several
sites in the brain and scored by the researchers as none, sparse, moderate, or frequent.
Scores were derived by considering all types of plaques together – cored, neuritic, and
diffuse – as well as separately for cored and neuritic plaques, without diffuse plaques.
Investigators found that the AD and PDAD cases had significantly higher cerebral cortex
total and neuritic plaque density scores when compared to PDD, PDND, and NC. In
patients with PD, the presence of any type of striatal plaques predicted the
clinicopathological diagnosis of AD with 80% sensitivity and 80% specificity. In
comparison, the presence of cerebral cortex plaques was 100% sensitive but only 48%
specific when PDND, PDAD, and PDD were included; and only 55% specific when only
the PDAD and PDD groups were included.
Alzheimer’s
Never too Late to Prevent Alzheimer’s, Says Study (Med India:
20.4.2012)
Alzheimer Care in India 24/7 Care, ideal for Alzheimers,
Osteoporosis
Dementia, Arthritis,
Medindia on - Alzheimer's Disease-Causes-Symptoms-Diagnosis-Treatment-PreventionFAQs
"If any one faculty of our nature may be called more wonderful than the rest, I do think it
is memory. There seems something more speakingly incomprehensible in the powers, the
failures, the inequalities of memory, than in any other of our intelligences," wrote Jane
Austen, the English writer. This most wonderful gift, if you lose, can make your life
chaotic.
A new study published in the journal Neurology suggests that it is never late to try and
avoid Alzheimer’s disease and even people over 80 years of age can indulge in physical
exercise to reduce the risk of the disease.
Around 716 people with an average age of 81 years, who were part of Memory and
Aging Project at Rush University Medical Center in Chicago, were involved in the study
and wore a device called an actigraph on their wrist 24 hours a day for over a period of
nine days. The device recorded the daily physical activity levels of the participants.
The researchers followed up on the participants after 3.5 years and found that 71 of them
had been diagnosed with Alzheimer’s disease. On correlating with the physical activity
data, the researchers found that 10 percent of those who recorded least levels of physical
activity were 2.3 times more likely to be diagnosed with the disease compared to those
with most levels of exercise.
“In a world that is becoming progressively sedentary, and in the context of very limited
success of the currently available medications to treat or delay AD, physical activity
provides a promising, low-cost, easily accessible, and side-effect–free means to prevent
AD”, the researchers wrote in their study.
Alzheimer's Disease
New Compounds That Block the Pathway Leading to Alzheimer's
Disease Identified(Med India: 1.5.2012)
Researchers have discovered spin-labeled fluorene compounds that disrupt the formation
of amyloid - the clumps of protein in the brains of people with Alzheimer's disease.
The study, published today in the online journal PLoS ONE, is entitled "The influence of
spin-labeled fluorene compounds on the assembly and toxicity of the Aβ peptide."
"We have found these small molecules to have significant beneficial effects on cultured
neurons, from protecting against toxic compounds that form in neurons to reducing
inflammatory factors," said John C. Voss, professor of biochemistry and molecular
medicine at the UC Davis School of Medicine and the principal investigator of the study.
"As a result, they have great potential as a therapeutic agent to prevent or delay injury in
individuals in the earliest stages of Alzheimer's disease, before significant damage to the
brain occurs."
Amyloid is an accumulation of proteins and peptides that are otherwise found naturally in
the body. One component of amyloid − the amyloid beta (Aβ) peptide − is believed to be
primarily responsible for destroying neurons in the brain. Fluorene compounds, which are
small three-ringed molecules, originally were developed as imaging agents to detect
amyloid with PET imaging. In addition to being excellent for detecting amyloid,
fluorenes bind and destabilize Aβ peptide and thereby reduce amyloid formation,
according to previous findings in mice by Lee-Way Jin, another study author and
associate professor in the UC Davis MIND Institute and Department of Medical
Pathology and Laboratory Medicine.
The current research studied the effects of fluorene compounds by attaching a special
molecule to make their activity evident using electron paramagnetic resonance (EPR)
spectroscopy. This technology allows researchers to observe very specific activities of
molecules of interest because biological tissues do not emit signals detectable by EPR.
Since Voss was interested in the activity of fluorenes, he added a nitroxide "spin label," a
chemical species with a unique signal that can be measured by EPR.
The group found that spin-labeled compounds disrupted Aβ peptide formation even more
effectively than did non-labeled fluorenes. In addition, the antioxidant properties of the
nitroxide, which scavenge reactive oxygen species known to damage neurons and
increase inflammation, significantly contributed to the protective effects on neurons.
"The spin-labeled fluorenes demonstrated a number of extremely important qualities:
They are excellent for detecting amyloid in imaging studies, they disrupt Aβ formation,
and they reduce inflammation," said Voss. "This makes them potentially useful in the
areas of research, diagnostics and treatment of Alzheimer's disease."
Alzheimer's disease is the most common form of dementia and affects some 5 million
Americans. Current medications used to fight the disease usually have only small and
temporary benefits, and commonly have many side effects.
A major obstacle in developing Alzheimer's disease therapy is that most molecules will
not cross the blood-brain barrier, so that potential treatments given orally or injected into
the bloodstream cannot enter the brain where they are needed. Fluorene compounds are
small molecules that have been shown to penetrate the brain well.
"We have brought together expertise from diverse fields to get to this point, and what was
once a side interest has become a major focus," said Voss. "We are very excited and
hopeful that these unique compounds can become extremely important."
Voss' group next plans to study the safety of spin-labeled fluorene compounds as well as
their efficacy for treating models of Alzheimer's disease in small animals.
Alzheimer's
Compounds to help prevent brain damage in Alzheimer's found (New
Kerala: 2.5.2012)
Scientists have discovered a natural chemical cocktail that could slow or even prevent the
devastating brain damage caused by Alzheimer's disease.
Potent flourene compounds disrupt the formation of toxic deposits in the brains of
dementia victims.
The deposits are destructive amyloid fibres, proteins that kill off nerves in the brain,
leading to the symptoms of memory loss and confusion typical of Alzheimer's.
The breakthrough appears to suggest a way could be found to stop them from forming,
leading to the incurable condition being effectively wiped out.
Most drugs will not pass from the blood into the brain, but the flourene compounds will.
'We are very excited and hopeful that these unique compounds can become extremely
important,' the Daily Express quoted Professor John Voss, of the University of California,
as saying.
'They have great potential to prevent or delay injury in individuals in the earliest stages of
Alzheimer's, before significant damage to the brain occurs,' he added.
The finding has been published online in the journal PLoS ONE. (ANI)
Alzheimer’s disease
On trial, prevention drug for Alzheimer’s (The Indian Express:17 May
2012)
In a clinical trial that could lead to treatments that prevent Alzheimer’s, people who are
genetically guaranteed to develop the disease — but who do not yet have any symptoms
— will for the first time be given a drug intended to stop it, federal officials announced
late Tuesday.
Experts say the study will be one of the few ever conducted to test prevention treatments
for any genetically predestined disease. For Alzheimer’s, the trial is unprecedented, “the
first to focus on people who are cognitively normal but at very high risk for Alzheimer’s
disease,” said Dr. Francis S. Collins, director of the National Institutes of Health.
Most participants will come from the world’s largest family to experience Alzheimer’s,
an extended clan of 5,000 people who live in Medellín, Colombia. Family members with
a specific genetic mutation begin showing cognitive impairment around age 45, and full
dementia around age 51, debilitated in their prime working years as their memories fade
and the disease quickly assaults their ability to move, eat and speak.
Three hundred family members will participate in the initial trial. Those with the
mutation will be years away from symptoms, some as young as 30.
“Because of this study, we do not feel as alone,” said Gladys Betancur, 39, a family
member. Her mother died of Alzheimer’s, three of her siblings already have symptoms,
and she had a hysterectomy because of her fears that she has the mutation and would pass
it on to her children. “Sometimes we think that life is ending, but now we feel that people
are trying to help us.”
Alzheimer’s
Alzheimer’s gene makes blood vessels in brain leak (The Times of India:
21.5.2012)
Washington: Scientists have identified a gene linked to Alzheimer’s disease which they
say also causes a cascade of events that end with leaky blood vessels in the brain, pouring
toxic substances into brain tissue.
Researchers at the University of Rochester found that the gene, called ApoE4, works
through cyclophilin A, known to be bad for the cardiovascular system, causing
inflammation in atherosclerosis and other conditions.
Cyclophilin A opens the gates to the brain assault seen in Alzheimer’s, the researchers
found. “We are beginning to understand much more about how ApoE4 may be
contributing to Alzheimer’s disease,” lead researcher Robert Bell was quoted as saying
by LiveScience.
Scientists have already established that ApoE4 makes one more prone to developing
Alzheimer’s. And those who carry two copies of the gene have about eight times the risk
of getting Alzheimer’s compared to others.
“In the presence of ApoE4, increased cyclophilin A causes a breakdown of the cells
lining blood vessels in Alzheimer’s disease in the same way as in cardiovascular
disease,” Bell explained. PTI
Alzheimer’s
Eating too much of red meat, butter can cause Alzheimer’s (The Times
of India: 22.5.2012)
London: Love to eat red meat and butter?
Beware, they may increase the risk of Alzheimer’s disease, especially in older women,
a new study has claimed.
Researchers linked to Harvard University have found that older women who ate too
much red meat, butter and other foods that contain high levels of saturated fats had worse
memories than others.
But, those who ate more monounsaturated fats — found in olive oil, sunflower oil,
seeds, nuts and avocados — had better memories, the researchers said.
“When looking at changes in cognitive function, what we found is that the total
amount of fat intake did not really matter, but the type of fat did,” lead researcher Oliva
Okereke was quoted as saying by the Daily Telegraph.
Okereke, who is from the Brigham and Women’s Hospital in Boston which is affiliated
to Harvard Medical School, and her fellow researchers made their conclusions after
looking at results from 6,000 women aged over 65 years.
In the study, the participants subjected to a series of mental tests over four years and
answered questionnaires about diet and lifestyle. “Substituting in the good fat in place of
the bad fat is a fairly simple dietary modification that could help prevent decline in
memory,” he said. PTI
Alzheimer's Disease
Simple 10-Min Test to Diagnose Alzheimer's Disease and Prevent
Severe Brain Damage(Med India:23.5.2012)
A simple ten-minute CANTABmobile memory test will effectively screen patients for
early signs of Alzheimer's disease and other forms of dementia, thus enabling faster
treatment.
The CANTABmobile test distinguishes between normal forgetfulness and the more
dangerous memory lapses that can signal dementia.
The test has been made available for use in GPs' surgeries, according to the Daily Mail.
Early diagnosis would allow patients to receive drug treatment when it would help them
the most, letting them work and live independently for longer.
Barbara Sahakian, the Cambridge University professor who helped develop the test, said
that to catch people before the brain became too badly damaged, the computer program
should be used to screen everyone over 65.
Using a touch-screen computer or iPad, patients complete six tasks in which they
memorise the location of an object and then recall the position a few second later.
Questions on how well the patient manages in day-to-day life are included, as well as
some designed to pick up those who may be depressed, rather than on the road to
dementia.
The quick test is designed to identify memory lapses that occur very early in the onset of
dementia.
It produces its results instantly, and can be administered by practice nurses or other staff
to free up doctors' time.
A patient's score, which takes into account their age, sex and education, determines
whether they are referred on to a specialist memory clinic for further diagnosis and
treatment.
Research shows that despite its brevity, the test is highly accurate at spotting cases and
produces very few false alarms.
GPs who pay 250 pounds for a year's subscription will be able to use the test on patients.
NHS Walsall is piloting the software and hopes to have it in all its GPs' surgeries soon.
Alzheimer's
Alzheimer's
Protein
Structure
Directions(Science Daily:1.6.2012)
Suggests
New
Treatment
The molecular structure of a protein involved in Alzheimer's disease -- and the surprising
discovery that it binds cholesterol -- could lead to new therapeutics for the disease,
Vanderbilt University investigators report in the June 1 issue of the journal Science.
Charles Sanders, Ph.D., professor of Biochemistry, and colleagues in the Center for
Structural Biology determined the structure of part of the amyloid precursor protein
(APP) -- the source of amyloid-beta, which is believed to trigger Alzheimer's disease.
Amyloid-beta clumps together into oligomers that kill neurons, causing dementia and
memory loss. The amyloid-beta oligomers eventually form plaques in the brain -- one of
the hallmarks of the disease.
"Anything that lowers amyloid-beta production should help prevent, or possibly treat,
Alzheimer's disease," Sanders said.
Amyloid-beta production requires two "cuts" of the APP protein. The first cut, by the
enzyme beta-secretase, generates the C99 protein, which is then cut by gamma-secretase
to release amyloid-beta. The Vanderbilt researchers used nuclear magnetic resonance and
electron paragmagnetic resonance spectroscopy to determine the structure of C99, which
has one membrane-spanning region.
They were surprised to discover what appeared to be a "binding" domain in the protein.
Based on previously reported evidence that cholesterol promotes Alzheimer's disease,
they suspected that cholesterol might be the binding partner. The researchers used a
model membrane system called "bicelles" (that Sanders developed as a postdoctoral
fellow) to demonstrate that C99 binds cholesterol.
"It has long been thought that cholesterol somehow promotes Alzheimer's disease, but the
mechanisms haven't been clear," Sanders said. "Cholesterol binding to APP and its C99
fragment is probably one of the ways it makes the disease more likely."
Sanders and his team propose that cholesterol binding moves APP to special regions of
the cell membrane called "lipid rafts," which contain "cliques of molecules that like to
hang out together," he said.
Beta- and gamma-secretase are part of the lipid raft clique.
"We think that when APP doesn't have cholesterol around, it doesn't care what part of the
membrane it's in," Sanders said. "But when it binds cholesterol, that drives it to lipid
rafts, where these 'bad' secretases are waiting to clip it and produce amyloid-beta."
The findings suggest a new therapeutic strategy to reduce amyloid-beta production, he
said.
"If you could develop a drug that blocks cholesterol from binding to APP, then you
would keep the protein from going to lipid rafts. Instead it would be cleaved by alphasecretase -- a 'good' secretase that isn't in rafts and doesn't generate amyloid-beta."
Drugs that inhibit beta- or gamma-secretase -- to directly limit amyloid-beta production -have been developed and tested, but they have toxic side effects. A drug that blocks
cholesterol binding to APP may be more specific and effective in reducing amyloid-beta
levels and in preventing, or treating, Alzheimer's disease.
The C99 structure had some other interesting details, Sanders said.
The membrane domain of C99 is curved, which was unexpected but fits perfectly into the
predicted active site of gamma-secretase. Also, a certain sequence of amino acids
(GXXXG) that usually promotes membrane protein dimerization (two of the same
proteins interacting with each other) turned out to be central to the cholesterol-binding
domain. This is a completely new function for GXXXG motifs, Sanders said.
"This revealing new information on the structure of the amyloid precursor protein and its
interaction with cholesterol is a perfect example of the power of team science," said
Janna Wehrle, Ph.D., who oversees grants focused on the biophysical properties of
proteins at the National Institutes of Health's National Institute of General Medical
Sciences (NIGMS), which partially funded the work. "The researchers at Vanderbilt
brought together biological and medical insight, cutting-edge physical techniques and
powerful instruments, each providing a valuable tool for piecing together the puzzle."
"When we were developing bicelles 20 years ago, no one was saying, 'someday these
things are going to lead to discoveries in Alzheimer's disease,'" he said. "It was
interesting basic science research that is now paying off."
The Vanderbilt team included lead authors Paul Barrett and Yuanli Song, Ph.D., as well
as Wade Van Horn, Ph.D., Eric Hustedt, Ph.D., Johanna Schafer, Arina Hadziselimovic
and Andrew Beel. The research was supported by grants from NIGMS (GM080513) and
the Alzheimer's Association.
Allergic
Cross-Reactivity Between Peanuts and Other Legumes Can Lead to
Serious Allergic Reactions(Science Daily;1.6.2012)
Food allergies pose a serious and growing problem in the West. Many foods can lead to
allergic reactions and this situation is further complicated by so-called cross-reactions,
whereby an allergy to one particular food can trigger allergic reactions to another food.
There are no treatments available for food allergies, but the establishment of two mouse
models can be used to develop and test new forms of treatment, for example vaccines.
Around 4-8% of children and 1-4% of adults in the West suffer from food allergy. The
most common causes of food allergy are peanuts, nuts, soya, milk, fish, shellfish, flour
and eggs, but a total of over 170 different foods have been found to result in allergic
reactions. In addition, there are the allergies that arise as a result of cross reactions to
other types of food. The only form of treatment is to avoid all consumption of the food
that the person is allergic to. Allergenic substances that are hidden in processed foods
therefore pose a particular problem for people allergic to foods.
Nina E. Vinje's doctoral research has led to the establishment of two mouse models for
food allergy to the legumes lupin and Fenugreek (Trigonella foenum-graecum). These
models have been used to test whether legumes such as soya, peanuts, Fenugreek and
lupin can trigger allergic reactions in mice that are already allergic to lupin and
Fenugreek respectively. It is important to establish good animal models for food allergies
because the development of an allergic immune response depends on a complicated
interaction between types of cells in several different organs. Vinje has made every effort
to reduce the use of laboratory animals to a minimum during her project. For this reason,
she used an advanced statistical method to develop the models in order to gain as much
information as possible from the use of as few animals as possible.
Lupin and Fenugreek are examples of so-called "new" and "hidden" allergens which have
been introduced to Norway, for instance in ready-made meals, over the last 10-15 years.
Lupin was introduced as a supplement to wheat flour in various bakery products because
of its ability to promote good baking. Fenugreek is used as an ingredient in foods such as
curry, chutney and spiced tea and is well known in Asian dishes. Packaging often does
not show whether Fenugreek is an ingredient, as the consumer information merely says
"spices." Both lupin and Fenugreek can lead to serious cross-reactions in patients with
peanut allergy, in contrast to other legumes such as soya and peas. This fact was
discovered due to messages sent in to the Food Allergy Register
(www.fhi.no/matallergireg) and these discoveries contributed to the EU making it
obligatory to mark lupin as an ingredient in foods.
The established mice models can be used to try out new treatments, for example vaccines
against food allergies. A vaccine must be tested on animals before it can be tested on
humans, both in order to find out whether it works and to make sure that it does not cause
serious side effects. New foods that are to be released onto the market will also be able to
be tested to see if they can cause allergies. Mice can be used for this purpose because
their immune system is well charted and is relatively similar to that of humans. This
means that researchers can study the clinical, anaphylactic (shock) reactions associated
with food allergy in mice in order to gain a greater understanding of the mechanisms that
cause allergic reactions in humans.
Vinje's doctoral project was carried out at the Norwegian Institute of Public Health and
researchers and fellows at the Norwegian Veterinary Institute and the Norwegian School
of Veterinary Science have been major collaborators.
Alzheimer's vaccine
Alzheimer's vaccine trial clears key hurdle(The Asian Age:8.6.2012)
P Pa ar ri is s, , J Ju un ne e 7 7: : A vaccine which revives a promising but longabandoned path to thwart Alzheimer’s disease has cleared a key safety hurdle in human
trials, researchers say. In a smallscale test, the formula was found to be safe and primed
the body’s frontline defences against protein deposits in the brain that are associated with
the catastrophic disease.
Swedish doctors report the results in Wednesday’s issue of the journal Lancet Neurology,
saying that the way is now open for wider trials. The prototype vac
cine, called CAD106, is a new exploration of traditional vaccine engineering. In this
approach, the pathogen that causes a disease is used to teach the immune system to
identify an intruder and attack it.
In Alzheimer’s, one of the enemies is a toxic protein called amyloid beta peptide, which
accumulates in plaques in the brain, although exactly how it works remains unclear. A
decade ago, doctors launched a first attempt at an amyloid beta vaccine, called AN1792.
But they were forced to
abandon it at the second of the three-phase trial process after six percent of the volunteers
fell ill with meningoencephalitis, an inflammation of the brain.
The suspected reason was that AN1792 activated white blood cells called T cells that
attacked the brain tissue.
The new vaccine uses a smaller fragment of the protein and combines it with a booster,
called an adjuvant, intended to prevent T-cell activation.
After lengthy trials in the lab, a team led by Bengt Winblad of the Karolinska Institutet’s
Alzheimer’s Disease Research Centre, tested the vaccine on 46
volunteers aged 50 to 80, diagnosed with mild to moderate Alzheimer’s. A “control”
group of 12 patients received a harmless formula, called a placebo, as a comparison. The
group was studied over 52 weeks and given a followup examination two years later.
Eighty-two percent of the patients who received CAD106 developed antibodies, a sign
that the immune defences had responded to the dangerous protein.
Overall, nine patients had episodes of ill health during the trial, but inves
tigations showed these were unrelated to the drug, and none entailed
meningoencephalitis. The next step after this Phase 1 safety trial should be a larger test,
possibly with modifications of the dose, to see if the vaccine works, says the study.
Around 26 million people around the world have Alzheimer’s, which remains an
incurable and progressive disease characterised by memory loss and dementia. The toll
by 2050 is likely to be 115 million, according to figures cited in the journal.
— AFP
The formula was found to be safe and primed the body's frontline defences against
protein deposits in the brain that are associated with Alzheimer's
Alzheimer's Risk
Alzheimer's Risk Gene Disrupts Brain Function in Healthy Older
Women, but Not Men(Science Daily:13.6.2012)
ScienceDaily (June 12, 2012) — A team led by investigators at the Stanford University
School of Medicine has found that the most common genetic risk factor for Alzheimer's
disease disrupts brain function in healthy, older women but has little impact on brain
function in healthy, older men. Women harboring the gene variant, known to be a potent
risk factor for Alzheimer's disease, show brain changes characteristic of the
neurodegenerative disorder that can be observed before any outward symptoms manifest.
Both men and women who inherit two copies (one from each parent) of this gene variant,
known as ApoE4, are at extremely high risk for Alzheimer's. But the double-barreled
ApoE4 combination is uncommon, affecting only about 2 percent of the population,
whereas about 15 percent of people carry a single copy of this version of the gene.
The Stanford researchers demonstrated for the first time the existence of a gender
distinction among outwardly healthy, older people who carry the ApoE4 variant. In this
group, women but not men exhibit two telltale characteristics that have been linked to
Alzheimer's disease: a signature change in their brain activity, and elevated levels of a
protein called tau in their cerebrospinal fluid.
One implication of the study, published June 13 in the Journal of Neuroscience, is that
men revealed by genetic tests to carry a single copy of ApoE4 shouldn't be assumed to be
at elevated risk for Alzheimer's, a syndrome afflicting about 5 million people in the
United States and nearly 30 million worldwide. The new findings also may help explain
why more women than men develop this disease, said Michael Greicius, MD, assistant
professor of neurology and neurological sciences and medical director of the Stanford
Center for Memory Disorders. Most critically, identifying the prominent interaction
between ApoE4 and gender opens a host of new experimental avenues that will allow
Greicius' team and the field generally to better understandhow ApoE4 increases risk for
Alzheimer's disease.
For every three women with Alzheimer's disease, only about two men have the
neurodegenerative disorder, said Greicius, the study's senior author. (The first author is
Jessica Damoiseaux, PhD, a postdoctoral scholar in Greicius' laboratory. They
collaborated with colleagues at the University of California-San Francisco and UCLA.)
True, women live longer than men do, on average, and old age is by far the greatest risk
factor for Alzheimer's, Greicius said. "But the disparity in Alzheimer's risk persists even
if you correct for the difference in longevity," he said. "This disparate impact of ApoE4
status on women versus men might account for a big part of the skewed gender ratio."
Besides age, another well-studied major risk factor is genetic: possession of a particular
version of the gene known as ApoE. This gene is a recipe for a protein involved in
transporting cholesterol into cells -- an important job, as cholesterol is a crucial
constituent of all cell membranes including those of nerve cells. And nerve cells are
constantly responding to experience by developing or enhancing small, bulblike
electrochemical contacts to other nerve cells, or diminishing or abolishing them. For all
these processes, efficient cholesterol transport is critical.
The ApoE protein comes in three versions, each the product of a slightly differing version
of the ApoE gene: E2, E3 or E4. Most people have two copies of the E3 version of ApoE.
A small percentage carries one copy of E3 and one of E2, and even fewer two copies of
E2. The protein specified by the E4 gene version seems to be somewhat defective in
comparison to the one encoded by either E2 or the much more common E3. Thus, while
only about 10-15 percent of the population carries one copy of E4 (or, much less
commonly, two), more than 50 percent of people who develop Alzheimer's are E4
carriers.
But, as it turns out, the heightened risk E4 imposes may be largely restricted to women.
To demonstrate this, the scientists first obtained functional MRI scans of 131 healthy
people, with a median age of 70, to examine connections in the brain's memory network.
They used sophisticated brain-imaging analysis to show that in older women carrying the
E4 variant, this network of interconnected brain regions, which normally share a
synchronized pattern of activity, exhibit a loss of that synchrony -- a pattern typically
seen in Alzheimer's patients. In healthy, older women (but not men) with at least one E4
allele, activity in a brain area called the precuneus appeared be out of synch with other
regions whose firing patterns generally are closely coordinated.
The brain-imaging technique Greicius and his colleagues used is known as functionalconnectivity magnetic resonance imaging, or fcMRI. Performed on "resting" subjects,
who remain in the scanner awake but not focusing on any particular task, fcMRI can
discern on the order of 20 different brain networks, each consisting of a set of dispersed
brain regions that are physically connected by nerve tracts and whose pulses of activity
are synchronized, or in phase. Greicius, Damoiseaux and their associates have previously
shown that the synchronous firing pattern of one network in particular, critical to memory
function and known as the "default mode network," is specifically targeted by
Alzheimer's and deteriorates as the disease progresses.
To independently confirm their imaging-based observations, the scientists assessed
records from a large public database compiled from the Alzheimer's Disease
Neuroimaging Initiative, a multi-site study of healthy aging and Alzheimer's disease. The
Stanford study focused on the healthy 55- to 90-year-old volunteers who had agreed to
undergo a spinal tap and have their cerebrospinal fluid analyzed.
From this database the Greicius team extracted the records of 91 subjects, with an
average age of 75, and divided them into four groups representing women with or
without a copy of the E4 variant, and men with or without a copy. For each group, they
checked recorded concentrations of a protein named tau in these subjects' cerebrospinal
fluid. Elevated tau levels in cerebrospinal fluid are a key biomarker of Alzheimer's
disease. The results -- the CSF of women, but not men, who carried at least one E4 allele
was substantially enriched in tau -- confirmed the brain-imaging findings.
The tau findings constitute another first. "It was only possible to see these differences in
tau levels when we separated the patients by gender," Greicius said.
Notably, all the men and women participating in the Journal of Neuroscience study were
screened for cognitive status. Only those whose ability to think and remember appeared
normal for their age were admitted. Thus, the observed changes in brain activity and CSF
composition were occurring well before the onset of classic Alzheimer's symptoms such
as memory loss, disorientation and dementia. It may someday be practical to substitute
fcMRI, which is noninvasive, for a spinal tap as a diagnostic tool, Greicius said.
Alzheimer's disease
Immune system may help protect against Alzheimer's changes in
humans (New Kerala:18 June 2012)
Washington, June 16 : The immune system, which removes beta-amyloid, the main
Alzheimer's-causing substance in mice's brain, may also do so in humans, researchers
say.
Researchers at the Peninsula College of Medicine and Dentistry, University of Exeter
with colleagues in the National Institute on Aging in the USA and in Italy screened the
expression levels of thousands of genes in blood samples from nearly 700 people.
The telltale marker of immune system activity against beta-amyloid, a gene called CCR2,
emerged as the top marker associated with memory in people.
The team used a common clinical measure called the Mini Mental State Examination to
measure memory and other cognitive functions.
The previous work in mice showed that augmenting the CCR2-activated part of the
immune system in the blood stream resulted in improved memory and functioning in
mice susceptible to Alzheimer's disease.
"This is a very exciting result. It may be that CCR2-associated immunity could be
strengthened in humans to slow Alzheimer's disease, but much more work will be needed
to ensure that this approach is safe and effective," Professor David Melzer, who led the
work, said.
Dr Lorna Harries, co-author, said that this discovery would help scientists get a better
understanding of such disorders.
"Identification of a key player in the interface between immune function and cognitive
ability may help us to gain a better understanding of the disease processes involved in
Alzheimer's disease and related disorders," Harries said.
Alzheimer's disease is the most common form of dementia and affects around 496,000
people in the UK. (ANI)
Metabolic Syndrome
Metabolic Syndrome May Cause Alzheimer's(Med India:18.6.2012)
Metabolic disorders have been found to cause Alzheimer's, according to a research.
There is no effective treatments are currently available for the prevention or cure of
Alzheimer's disease (AD), the most frequent form of dementia in the elderly. Hence, has
stressed the need for new lines of research to identify effective therapeutic targets.
The most recognized risk factors, advancing age and having the apolipoprotein E 4 gene,
cannot be modified or treated. Increasingly, scientists are looking toward other risk
factors to identify preventive and therapeutic strategies. Much attention recently has
focused on the metabolic syndrome (MetS), with a strong and growing body of research
suggesting that metabolic disorders and obesity may play a role in the development of
dementia.
Now, a new supplement to the Journal of Alzheimer's Disease has provided a state-ofthe-art assessment of research into the link between metabolic syndrome and cognitive
disorders.
The supplement is guest edited by Vincenza Frisardi, of the Department of Neurological
and Psychiatric Sciences, University of Bari, and the Geriatric Unit and GerontologyGeriatrics Research Laboratory, IRCCS, Foggia, Italy, and Bruno P. Imbimbo, Research
and Development Department, Chiesi Farmaceutici, Parma, Italy.
The prevalence of MetS and obesity has increased over the past several decades. MetS is
a cluster of vascular and metabolic risk factors including obesity, hypertension, an
abnormal cholesterol profile, and impaired blood glucose regulation.
"Although molecular mechanisms underlying the relationship between MetS and
neurological disorders are not fully understood, it is becoming increasingly clear that
cellular and biochemical alterations observed in MetS may represent a pathological
bridge between MetS and various neurological disorders," explained Dr. Frisardi.
Type 2 diabetes (T2D) has been linked with cognitive impairment in a number of studies.
The risk for developing both T2D and AD increases proportionately with age, and
evidence shows that individuals with T2D have a nearly twofold higher risk of AD than
nondiabetic individuals.
Paula I. Moreira, Faculty of Medicine and Center for Neuroscience and Cell Biology,
University of Coimbra, Portugal, outline some of the likely mechanisms.
Both AD and T2D present similar abnormalities in the mitochondria, which play a pivotal
role in cellular processes that impair their ability to regulate oxidation in the cell. Human
amylin, a peptide that forms deposits in the pancreatic cells of T2D patients, shares
several properties with amyloid-beta plaques in the Alzheimer's brain.
Insulin resistance is another feature shared by both disorders. Impairment of insulin
signalling is directly involved in the development of tau tangles and amyloid beta
plaques.
"Understanding the key mechanisms underlying this deleterious interaction may provide
opportunities for the design of effective therapeutic strategies," Dr. Moreira noted.
Alzheimer’s and related disorders
FORGETFUL, NOT FORGETTABLE
The present number of 3.7 million patients suffering from Alzheimer’s
and related disorders is expected to double by 2030. The cost of caring,
estimated at Rs 14,700 crore, will increase three times. But new
technology makes it possible to slow down the disease(The
Tribune21.6.2012)
INDIA has about 3.7 million persons suffering from
dementia and this figure will double by 2030 to about 7
million persons. The number of persons with dementia
doubles every five years and so India will have the largest
number of elders with this problem. The cost of caring
that has been conservatively estimated at present is Rs
14,700 crore. While the number is expected to double by
2030, the cost will increase three times. The study was
done by Alzheimer’s and Related Disorders Society of
India (ARDSI), a non-profit organisation established in
1992.
With a large number of people being affected by Alzheimer’s and related disorders and
their numbers increasing at an alarming rate because people are living longer and have
more stressful lives, the National Brain Research Centre (NBRC) at Manesar, Haryana,
the Neurology Department of AIIMS and HelpAge India are collaborating for early
detection and ‘treatment’ of Alzheimer’s. The good news is that thanks to the high field
3-Tesla MRI scanner, provided to the NBRC by the Department of Biotechnology, it is
now possible to detect and diagnose early signs of the disease.
Early detection
According to Dr Pravat Mandal, an MR physicist and
additional Professor at NBRC, a simple non-invasive
magnetic resonance imaging (MRI) or brain mapping can
track or detect changes in the brain. “Early detection can
help in improving the quality of life of people suffering
from Alzheimer’s and related disorders. Reliable biomarkers have been identified which
could indicate mild cognitive impairment or early signs of Alzheimer’s.”
There is just a 3 per cent chance of Alzheimer’s being genetic. However, Dr Mandal has
seen a 38-year-old patient of genetic Alzheimer’s. It was an unusual case where the
parents as well as a sibling had the ailment.
According to Dr Manjari Tripathi, Additional Professor Neurology, AIIMS, and
President of the ARDSI, when family members or relatives bring in patients with
symptoms like forgetfulness, disorientation etc, these patients have already had
Alzheimer’s for five to six years. Dr Tripathi said although 50 per cent of those over 85
suffered from Alzheimer’s and related disorders like dementia, 3 to 4 per cent persons
over 65 also had Alzheimer’s. Under an arrangement between the AIIMS and the NBRC,
based on her clinical diagnosis, Dr Tripathi refers patients to Dr Mandal. The NBRC then
picks up these clients or patients and brings them to Manesar for the scan.
It is important for a family member or a friend to accompany the patient and share history
and other information of those affected. To encourage a wider cross section of society to
get the benefits of scanning, the poor are even paid Rs 500. Pick up and drop back home
facility is provided for all those willing to undergo a brain scan. More than 115 persons
have been scanned for Alzheimer’s over the past two years. The scans are analysed for
changes in the brain and the results are sent back to Dr Tripathi for treatment. Certain
chemical changes can be found on the left side of the hippo campus (the GPS of the
brain) indicating pre-Alzheimer’s, says Dr Mandal. The chemical changes are much more
in advanced cases.
“We are investigating what causes these chemical changes, and if they can be
controlled,” says Mandal. Associated with the NBRC’s Alzheimer’s studies are half a
dozen electrical engineers and IIT graduates.
Based on his two years’ of study at the NBRC, Dr Mandal has published scientific papers
in the Journal of Alzheimer’s Disease, USA; the European Journal of Radiology and in
the Biochemical, Biophysical Research Communication journal, USA. In India, the
NBRC is the only institute involved in brain study for Alzheimer’s. It is also a leader in
the world for such studies.
Dr Tripathi and Dr Mandal agree that an early diagnosis helps patients take medicines
that can slow down the pace of the ailment. Last year, HelpAge, India, and ARDSI
conducted memory tests on residents of many old-age homes in New Delhi and the NCR
(national capital region). There are three stages of Alzheimer’s — mild, moderate and
severe. In the last stage, the patients forget everything and there is no control over mental
and bodily functions.
Silent epidemic
Because of the large number of cases now knocking on the doors of AIIMS, Dr Tripathi
maintains Alzheimer’s is a “silent tsunami” for senior citizens resulting in chronic
functional disabilities. There are different kinds of dementia. It is no longer just a
problem of the elderly. Many suffering from hypertension had memory loss leading to
dementia. This is a silent epidemic, said Dr Tripathi.
Dementia is not easy to diagnose. You may not realise the person has dementia until it is
too late. However, the risk factors are preventable. Factors like hypertension, diabetes,
smoking, stress, eating preserved food and alcohol consumption could be controlled. “We
go out and buy diseases. If we look after ourselves, lead a healthy life, dementia can be
prevented,” Dr Tripathi stated.
The Alzheimer’s & Related Disorders Society of India has been running a day-care
centre for persons with dementia and AD (Alzheimer’s related disorders) at Tughlakabad
on the premises of the Panchvati home for senior citizens. The other centre is in
Faridabad. With the PICA (parents in India and children abroad) syndrome increasing,
understandably stress levels for the seniors are high. So a 24-hour helpline and free
medicines are also available for those with dementia.
Caregivers’ problems
Caring for those with dementia is really tough. One person with dementia is equal to 12
normal patients, says Dr Tripathi. To deal with the flood of cases being reported, a
Chronic Care Facility for those with dementia has been proposed.
Mathew Cherian, CEO of HelpAge India and member of the Sub-Group that prepared the
National Policy for Senior Citizens 2011, says the new policy has also recommended the
setting up of a national centre for the older persons suffering from dementia and mental
diseases at New Delhi. It also sought a budgetary allocation of Rs 120 crore in the
Twelfth Plan for setting up such a centre. The policy is itself in doldrums because though
it has been accepted by the Ministry for Social Justice and empowerment, it still awaits
Cabinet approval.
Since older persons are often victims of abuse, ill treatment, exploitation, desertion and
violence, to ensure their dignity and security, they need prompt and reliable support in
times of need and distress, says Cherian. This is why the sub-group had recommended
the:



Setting up of a national helpline for older persons based on the model of Child
Line.
Setting up of Helplines in each state to provide different types of services by joint
effort of an NGO and the local police department.
Helplines in old age homes set up under the Maintenance and Welfare of Parents
and Senior Citizens Act, 2007.
The writer is a senior journalist who writes on development issues like environment,
education and health
Alzheimer's
Stress as Risk Factor for Alzheimer's Under Investigation (Medical
A UK research team is poised to begin a new study funded by the Alzheimer's Society to
investigate chronic stress as a risk factor for developing dementia.
Anne Corbett, research manager for the Society told the press on Tuesday that the
researchers, who will be led by Clive Holmes, Professor of Biological Psychiatry at the
University of Southampton, will be investigating the role that chronic stress plays in the
progression of Mild Cognitive Impairment (MCI) to Alzheimer's Disease.
MCI is a recent term used to describe the signs people show when they begin to
experience thinking and memory problems, but do not actually have dementia.
Alzheimer's Disease is the most common type of dementia, and is where the chemistry
and structure of the brain changes, causing brain cells to perish. About 60% per cent of
people with MCI are known to go on to develop Alzheimer's Disease.
A lot of research has been done on the link between stress and diseases like heart disease,
diabetes, cancer and multiple sclerosis, showing that chronic stress can speed up the
progression, or make the symptoms worse.
However, surprisingly little research has been done on the link between stress and MCI
or Alzheimer's.
Corbett said:
"We feel this is a really important area of research that needs more attention. The results
could offer clues to new treatments or better ways of managing the condition."
"It will also be valuable to understand how different ways of coping with stressful life
events could influence the risk of developing Alzheimer's Disease", she added.
Stressful experiences such as a bereavement or house move could speed up the
development of Alzheimer's, say researchers. By better understanding how stress,
something everyone experiences, might be a risk factor for Alzheimer's, including what
the underlying biology might be, the researchers hope to offer new information that can
help develop better psychological treatments and drugs that can be used earlier in the
progression of the disease.
Holmes said there is a lot of variability in how quickly the progression from MCI to
Alzheimer's happens, for some people the progression is slow, for others it is much faster.
But we know from other studies that one possible factor is stress.
"That could be driven by a big change - usually negative - such as a prolonged illness,
injury or a major operation," said Holmes.
"We are looking at two aspects of stress relief - physical and psychological - and the
body's response to that experience. Something such as bereavement or a traumatic
experience - possibly even moving home - is also a potential factor," he explained.
For the study, Holmes and colleagues will be observing 140 volunteers aged 50 and over
who have MCI, assessing their levels of stress and any progression to dementia over an
18 month period.
The researchers will compare the data they collect on this group with that of 70 other
people, the "controls", who do not have MCI.
At the start of the study, all the participants will complete tests of memory and thinking
skills and fill in questionnaires that help researchers assess personality type, style of
coping with stressful events, and their perceived mood and level of social support.
Then at the end, 18 months later, they will repeat these assessments, so the researchers
can see how many progress from MCI to Alzheimer's Disease, and also record any
stressful life events.
The participants will also give blood and saliva samples every six months, from which
the researchers will be able to trace any biomarkers of stress. Stress affects the immune
system, and this can be tracked in the blood samples. Saliva samples are used to measure
levels of cortisol, a chemical that the body releases in response to chronic stress.
The study will be funded by one of six grants, worth a total of £1.5 million, that the
Alzheimer's Society is awarding to find a cause, cure and way to prevent Alzheimer's
Disease.
Anemia
5cr Indian teens anaemic
Over 5cr Indian teens anaemic (The Times of India: 25.4.2012)
Acute anemia is crippling India’s youngsters, especially those aged between 15 and 19
years.
Union health minister Ghulam Nabi Azad on Tuesday said more than five crore
adolescents are anemic in India. Adolescent girls are more vulnerable to anaemia due to
the rapid growth of the body and loss of blood during menstruation.
Unicef’s State of the Adolescents report 2012, says nearly 50% of Indian adolescent
girls (15-19 years) are underweight, with a body mass index of less than 18.5.
Anaemia, most commonly irondeficiency anemia, increases the maternal risk of
hemorrhage and sepsis during childbirth.
It causes cognitive and physical deficits in young children and reduces productivity in
adults. Women and young children are most vulnerable to anemia due to insufficient iron
in their diets.
Alarmed by the trend, the Union health ministry has decided to roll out a weekly iron
and folic acid supplementation (WIFS) programme for adolescents.
It will be implemented in both rural and urban areas and will cover school going
adolescent girls and boys from Standard VI to XII enrolled in government/governmentaided/ municipal schools.
Azad said over 55% of adolescent boys and girls in the 15-19 age group are anemic.
The National Family Health Survey-III says almost 56% of adolescent girls (aged 15-19
years) suffer from some form of anaemia. Of these, 39% are mildly anaemic, while 15%
and 2% suffer from moderate and severe anemia, respectively.
“In India, the highest prevalence of anaemia is reported among the 12-13-year olds,
which also coincides with the average age of menarche. With increase in age, the
prevalence of anemia among girls remains stagnant, while among boys, the prevalence
rate reduces,” Azad added.
A health ministry note says, “India has a very high prevalence of adolescent anaemia.
Out of the 12.2 crore adolescents in India, approximately 5.7 crore are girls out of which
3.2 crore are anaemic. There are 6.5 crore boys in this age out of which approximately 2
crore are anaemic. Addressing anaemia is critical. WIFS will cover 12.72 crore
adolescents, 5.74 crore girls and boys enrolled in class VI-XII of government and
government-aided schools and 6.97 crore out of school girls. Fixed day in a week,
preferably a Monday, will be earmarked as the day when Iron and Folic Acid tablet will
be provided to adolescent.”
Anxiety
Anxiety
Anxiety a very modern malaise (World Newspaper: 16.4.2012)
Life was flying along for Zoe Brook. At 23, she had a fast-paced job she loved, in public
relations, and had just moved into her first home with her then-partner. It was, she says,
all that she had dreamt of.
That was until the night she sank to the floor, paralysed by fear, her own voice sounding
muffled and as though on a time delay, while her view of the room darkened into the
narrowest tunnel vision.
She thought she was dying. In fact, it was the start of an anxiety disorder that was to
become her new reality, and to dominate her twenties. After finally sleeping, she awoke
disorientated and petrified - a state that continued for more than three years, in which
waves of panic attacks were "punctuated with glimpses of the real world".
Looking back, she believes the anxiety was her body's response to a pace of life she could
not sustain. "When everything is busy and going well, you just keep on going. Then
suddenly you look down and see that there is nothing anchoring you; and so you fall."
She is not alone. Last year, close to 7 ?million prescriptions were issued by the NHS for
anti-anxiety drugs. As economic woes have worsened, and job and mortgage worries
become rife, the numbers being treated in hospital for such disorders have soared - with
more than 17,000 outpatients' appointments last year, four times as many as in 2007.
As Britain enters the Age of Anxiety, great swaths of the population appear to be nearing
the end of their tether.
However, Dr Linda Blair, a clinical psychologist, believes that economic pressures are
aggravating a far deeper problem; that modern technology, with its ability to bombard us
with messages 24/7, has rendered many of us unable to "switch off".
"We have actually created a more anxious state," she says. "When our brain is expecting
some kind of news, we prime ourselves to be on alert. With texts, emails and social
media, on top of images from TV news, we are constantly on alert, and that can make
people chronically anxious, and chronically exhausted." She advises her patients to take
some time away from their gadgets at least once a day - even if it is just for 10 minutes.
Dr Joanna Moncrieff, a consultant psychiatrist and senior lecturer at University College
London, agrees and is concerned that Britain is following the path trodden by America in
medicalising a social problem instead of examining the values behind it.
"We live in a culture that makes people anxious," she says. "It encourages the idea that
everything can be achieved or bought, that 100 per cent is not enough, that you have to be
the perfect wife and mother, and succeed in your career."
Meanwhile, too much faith has been invested in scientific progress, therapy and a pill for
every human ill. "And we have become less able to tolerate and endure life's ordinary
difficulties."
There has certainly been a distinct shift in the public image of anxiety disorders and the
drugs used to treat them. While Valium earned a reputation as "mother's little helper"
among 1960s housewives, by the 1980s the group of benzodiazepines had become better
known as "jellies" and "benzos" by recreational users seeking a high.
Today, the same group of drugs are being discussed in far glossier circles.
Earlier this month, Alexandra Shulman, the editor of Vogue, admitted she has regularly
suffered panic attacks - and always carries some Xanax in her handbag as her "lucky
charm".
British supermodel Jodie Kidd and her sister Jemma, the Countess of Mornington, have
both undergone successful treatment for anxiety and panic attacks which they described
as "crippling".
"The attacks felt like that split-second before a car crash, when the adrenalin whooshes
through your body and you think you are going to die," says Jemma. "From the outside, I
might have looked sorted, but on the inside, I was thinking 'if only you knew… '?"
Both checked into the Linden retreat, in Worcestershire, also the choice of British
novelist Plum Sykes.
Ms Sykes's anxiety followed the onset of a rare migraine disorder that left her so dizzy
she couldn't care for her children. Though treatment for the condition was successful, the
fear of such attacks left her virtually housebound, unable to take even the few steps from
her home into a taxi unassisted.
"Life became a series of 'what-ifs'." she says. "I would imagine every possible worst-case
scenario which could occur. In the end I became too frightened to do anything at all."
In an article for US Vogue this month, she wrote about her stay at the retreat, and the
dinner conversations with 11 other anxiety sufferers, including a 23-year-old
policewoman who experienced panic attacks when her baby refused food.
"You must be terrified at work then," Ms Sykes sympathised, "dealing with criminals and
everything?"
Asthma
Asthma
Asthma: A Vaccination That Works Using Intramuscular Injection
Asthma is a chronic inflammatory and respiratory disease caused by an abnormal
reactivity to allergens in the environment. Of the several avenues of exploration that are
currently being developed, vaccination appears to be the most promising approach. In a
publication soon to appear in the review Human Gene Therapy, the research scientists at
Inserm and CNRS ( Institut du thorax, CNRS/Inserm/University of Nantes) reveal an
innovative vaccine against one of the allergens most frequently encountered in asthma
patients.
After vaccine was directly injected into the muscle of an asthmatic mouse, a nanovector
significantly reduced both the hypersensitivity to the allergen and the associated
inflammatory response.
Allergic asthma is a chronic respiratory disease that affects 300 million people
throughout the world. The number of people suffering from asthma has doubled over the
last ten years and almost 250, 000 people die prematurely from this problem each year. In
most cases, asthma is caused by an abnormal reaction to substances in the environment
known as allergens. From a physiological point of view, this hypersensitivity results in
serious inflammation of the bronchial tubes and the bronchioles in sensitive persons. This
alters their ability to breathe correctly.
Current treatment consists in administering corticoids that treat the symptoms and
temporarily relieve the disorder, but without curing it. An alternative, long-lasting
treatment for allergic asthma is based on a specific immunotherapeutic protocol
commonly known as desensitization. Repeated, increased doses of the allergen are
administered in order to decrease the hypersensitivity and reduce the symptoms in the
event of subsequent exposure. However, the efficiency of this protocol is limited and
varies greatly from one patient to another.
Then the research scientists came up with the idea of a vaccination technique using the
DNA of the allergenic substance. Rather than administering repeated doses of allergen
extract in order to reduce sensitivity, we worked on specific DNA sequences of the
allergen responsible for the allergy. "Several studies demonstrated the therapeutic
potential of this strategy, but we still had to find techniques that were reliable in human
beings", explains Bruno Pitard, Director of the Biotherapy Innovations team at the
Institut du thorax (CNRS/Inserm/University of Nantes). Using these techniques on
human subjects meant that the treatment had to be efficient when only a small dose of
DNA was injected.
The researchers first tried proving the efficiency of this DNA-based vaccination against
the specific allergen Derf1, using a relevant animal model developed by the Bronchial
and Allergic Pathologies team led by Antoine Magnan. In Europe, Dermatophagoides
farinae 1 (Derf1) is a very common allergen carried by the dust mite Dermatophagoides
farinae. More than half of patients presenting allergies to dust mites produce specific IgE
type antibodies (Derf1) against this substance that are characteristic of asthma.
In practice, the researchers associated useful genetic sequences of the allergen Derf1 with
a nanovector consisting of a synthetic polymer. This DNA sequence, transported by a sort
of "molecular taxi" into the muscle cells that ensure protein synthesis of the allergen,
modulated the allergic response in asthmatic animals.
The vaccine developed in a healthy mouse model was then optimized in a model
composed of asthmatic mice. In the asthmatic mice, the vaccine triggers the production of
specific anti Derf1 antibodies and a specific cellular response to Derf1, so that the
immune system reacts with a protective non-allergizing response when the body comes
into contact with the allergen. Two injections were administered at 3 weekly intervals.
They significantly reduced the hypersensitivity of the airways and the levels of
inflammatory cytokines, that were found in the lungs of asthmatic mice that had not been
vaccinated.
These new results validate the whole potential for the use of this new nanovector in DNA
vaccination. It is currently undergoing regulatory pre-clinical development with a view to
future clinical trials in humans.
Asthma & allergies:
Asthma & allergies: proper treatment can help lead normal life (The
Tribune: 23.5.2012)
Asthma prevalence is increasing the world over. The mortality rate has declined to some
extent, though morbidity has not, in spite of wonderful scientific advances. It is possible
to prevent mortality and keep the disease under control by making lifestyle comfortable
provided people follow the treatment advice and avoid myths. There is nothing
asthmatics can miss out, provided they keep their disease under control by scientific
practices. Several children keep suffering mainly due to the myths prevalent even among
doctor parents.
Many doctor couples bring their little ones to me who are on several antibiotics, cough
syrups and antihistamines. Off and on they take steroids for chronic cough. Children,
however, need inhalers to manage their asthma, and not antibiotics, etc.
In spite of being doctors, it is difficult to convince them. They are not ready to accept the
label ASTHMA “just for chronic cough”. They are not ready to accept the everyday use
of inhalers. They are not willing to accept that cough syrups are not needed, and even
unnecessary vitamins, etc, are a burden on the system.
It is not surprising that after the cough disappears the parents are each day worried about
stopping the inhalers. It is feared that the child will become addicted to inhalers and these
are steroids. I pull out scientific literature to show to the parents that inhalers, though they
were steroids, are safe even in long-term use. They would not retard growth. In fact, the
disease-free state would result in better growth and development, and also proper
puberty.
Parents are not ready to give their child cold water, curd, banana, rice, oranges, lime and
chocolates freely. One has to again convince the parents that there is no doubt that FOOD
ALLERGY can be the culprit but there is no general rule to avoid any food for all
asthmatics. If at all there is doubt, tests are possible.
It is again difficult to convince them that allergy tests need not be a battery of standard
tests for everyone. Which test to apply and what to test would depend upon the detailed
history of the patient by a qualified doctor.
Some children are forced into advanced breathing exercises in the name of yoga, which
results in exercise-induced asthma attacks. Yoga is undoubtedly beneficial for healthy
people and useful for asthmatics as an adjunct to pharmacotherapy and should be done
under medical supervision.
Asthma can manifest in many ways, and even chronic cough can be due to asthma. At the
same time, all that wheezes may not be asthma. Therefore, expert advice is needed.
Detailed history and clinical examination by an expert clinches the diagnosis and not the
blood sent to some lab for allergy tests. Once diagnosed, treatment is simple and aims at
making the patient independent and have good quality of life. Inhalers are the cornerstone
of asthma management. They are needed as long-term management.
The rescue inhalers are for emergencies only. Preventive inhalers are needed even when
you feel you are alright. Inhalers are the state-of-the-art research molecules which do not
retard growth even on long-term use. Stopping the inhaler at your own will can be
harmful.
Pushing oneself into an emergency and using nebulisers again and again is really
harmful. The inhaler is the surest and safest device for drug delivery into the airway, but
the salts needed are different for different purposes.
The steroids in inhalers are the state-of-the-art molecules of research which give benefits
without side-effects. Leukotrein inhibitors, antihistamines and mast cell stabilizers are
needed only for specific situations. Every medicine is not needed by every patient.
Allergy tests are needed only for difficult asthmatics, occupational asthmatics, seasonal
asthmatics where immunotherapy is planned, and also for patients in whom food allergy
is suspected.
Tests are never useful if done just by sending a blood sample to a particular lab. This
causes more confusion and has to be discouraged.
The obsession of avoiding dust and white food articles, etc, result in personality disorders
in children besides leading to nutrition deprivation. Frequent monitoring is needed.
Parents must not be anxious to stop the inhalers their children are using. They also must
not focus on stopping food based on myths for growing children. If at all food has to be
avoided it must only be done after allergy to food is proved by double-blind placebocontrolled food challenge rather than just by a blood test.
It’s heartening to see children achieve full growth, puberty, excellence in academics,
music and sports if they take scientific treatment for asthma. And keep away from myths.
The writer is a Chandigarh-based allergy specialist.
Asthma
Elderly Asthmatics Observe Inflammation and Mortality (Med India:
23.5.2012)
Elevated mortality toll amid elderly adult asthma people in contrast to their younger
counterparts is probably due, at least in part, to an augmented airway inflammation, states
a study conducted by researchers in Canada. They noted that their results imply that
elderly patients are either less likely to follow asthma medication dosing instructions, or
that the underlying airway inflammation in elderly patients is relatively resistant to
current anti-inflammatory therapies.
The study will be presented at the ATS 2012 International Conference in San Francisco.
"We found that asthmatic patients over the age of 65 have a higher proportion of airway
inflammation when compared to younger patients, despite the fact that both groups
received similar asthma treatment regimens," said study lead author Richard Leigh, MD,
PhD, associate professor of medicine at the University of Calgary. "The fact that the
majority of older patients were lifelong non-smokers indicates that asthma in the elderly
is unlikely to be due to misclassification of chronic obstructive pulmonary disease
(COPD)."
The Public Health Agency of Canada estimates that 7 percent of people over 65 have
asthma, a prevalence rate similar to that reported in the United States. However, asthmarelated mortality rates in both countries are about tenfold higher in asthmatics over 65
compared to any other age group.
"The reasons for this difference are unknown and, in this study, we sought to test the
hypothesis that airway inflammatory characteristics in older adults with asthma differ
from other age groups," said Dr. Leigh, who is also the GSK-CIHR Professor of
Inflammatory Lung Disease at the University of Calgary.
The researchers drew from information contained in the University of Calgary Asthma
Clinic for 1,046 asthma patients, including 930 patients under age 65 and 116 patients
who were 65 or older, treated between April 2005 and June 2011.
"Induced sputum cell counts are performed on all patients attending our hospital-based
outpatient asthma clinic to guide clinical management," Dr. Leigh said. "Patient data,
including medications, spirometry measurements and sputum cell counts are entered into
an electronic database. These are the data we used for our study."
Dr. Leigh and his colleagues performed a retrospective analysis to determine the nature
of the airway inflammation in patients who were 65 or older, compared to those who
were under age 65.
Patients were divided into four inflammatory types, based on the types and numbers of
leucocytes, or white blood cells, present in the sputum: eosinophilic, neutrophilic, mixed
granulocytic (both eosinophils and neutrophils) or pauci-granulocytic.
Leucocytes are primary components of the human immune system, responding to sites of
infection and inflammation; the presence of leucocytes, and the numbers of cells present,
can help clinicians objectively measure levels of airway inflammation.
At the conclusion of their study, the researchers found that 75 percent of older patients
had higher than normal levels of eosinophils in their sputum, while only 54 percent of
younger patients had elevated eosinophil counts in their sputum samples. In addition, the
median eosinophil count in the older group was 7 percent compared to 2 percent in the
younger group, indicating higher levels of inflammation in the older patients. Neutrophil
counts were not significantly different between older and younger patient groups. There
were no differences in gender, body-mass index or treatment regimens between the two
groups, and the majority (58 percent) of older patients were lifelong non-smokers. Older
patients also had more severe airflow obstruction than younger patients.
"The increased inflammation seen in older patients in this study may help explain the
reason why these patients tend to have worse clinical outcomes, including worse
symptoms and lung function and increased numbers of exacerbations, compared to
younger patients, and may be a potential explanation for the increased mortality seen in
these older folks," Dr. Leigh said.
Dr. Leigh said the results also identify knowledge gaps and research opportunities that
may ultimately lead to improved therapeutic approaches and healthcare outcomes in these
patients.
"We need to do additional studies to determine whether this increased inflammation in
these older patients is due to either the fact that they don''t take their medications, or that
the inflammation is relatively resistant to asthma treatment in some way," he said. "To
that end, we are now conducting a study to link airway inflammation in patients older
than 65 years of age to rates of medication adherence."
###
"Asthma In Older Adults; Potential Factors To Explain Increased Mortality Rates"
(Session B92, Monday, May 21, 3:05 p.m., Room 2020-2022, Moscone Center; Abstract
27261)
* Please note that numbers in this release may differ slightly from those in the abstract.
Many of these investigations are ongoing; the release represents the most up-to-date data
available at press time.
Abstract 27261
Asthma In Older Adults; Potential Factors To Explain Increased Mortality Rates
Type: Scientific Abstract
Category: 01.10 - Clinical Asthma (AII)
Authors: R. Leigh, Z.W. Meng, C.D. Greene, S.L. Traves, M.M. Kelly, D. Proud;
University of Calgary - Calgary, AB/CA
Abstract Body
Rationale: The Public Health Agency of Canada estimates that 7% of people over 65
have asthma, a prevalence rate similar to that reported in the United States. Of concern is
that asthma-related mortality rates in both countries are about 10-fold higher in
asthmatics over 65 compared to any other age group. Reasons for this difference are
unknown and, in this study, we sought to test the hypothesis that airway inflammatory
phenotypes in older adults with asthma differ from other age groups.
Methods: Induced sputum cell counts are performed on all patients attending our
hospital-based asthma clinic to guide clinical management. Patient data, including
medications, spirometry measurements and sputum cell counts are entered into an
electronic database. We therefore performed a retrospective analysis of these data to
determine the nature of the airway inflammation in patients > 65 years (older) compared
to those under 65 (younger) with physician-diagnosed asthma. Inflammatory phenotypes
were characterized as being 1/ eosinophilic (>2.0% eosinophil count) , 2/ neutrophilic
(>64.4% eosinophil count), 3/ mixed granulocytic and 4/ pauci-granulocytic. Patients
provided informed consent prior to study.
Results: Between April 2005 and June 2011, 1046 patients with physician-diagnosed
asthma had sputum analysis. Of these, 930 were under 65 and 116 were > 65 years old.
The majority (58%) of older patients were lifelong non-smokers. 75% of older patients
had sputum eosinophils >2.0% (54% eosinophilic; 21% mixed granulocytic), vs. 54%
(38%; 15%) of patients <65 (p<0.001). The median eosinophil count in the older group
was 7% (IQR 1.5-31%) vs. 2% (0.3-9%) in the younger group (p<0.001). Neutrophil
counts were not significantly different between groups. The older group had more severe
airflow obstruction (FEV1 75% predicted) vs the younger group (FEV1 85%) (p<0.001).
There were no differences in gender, BMI or treatment regimens between the two groups.
Conclusions: Asthmatic patients over the age of 65 have a higher proportion of
eosinophilic airway inflammation when compared to younger patients. This is despite the
fact that both groups received similar treatment regimens. These results indicate that the
asthma in the elderly is unlikely to be due to misclassification of COPD, and implies that
elderly patients are either less adherent to current asthma therapies or that the underlying
airway inflammation is relatively resistant to current anti-inflammatory therapies. The
results also identify knowledge gaps and research opportunities that may ultimately lead
to improved therapeutic approaches and health care outcomes in these patients.
Funded by: Alberta Health Services
Asthma
Why hot, humid air triggers breathing difficulty in patients with mild
asthma (New Kerala: 8.6.2012)
A new study has shed light on why patients with mild asthma have such difficulty
breathing during hot, humid weather.
The study found that patients who inhaled an asthma drug before breathing in hot, humid
air were able to prevent airway constriction that volunteers without asthma did not
experience in the same environment.
Ipratropium, a drug occasionally used for asthma, prevents airway muscle contraction
and increases airflow to the lungs. Its success in combating the air temperature response
suggests that hot, humid air triggers asthma symptoms by activating airway sensory
nerves that are sensitive to an increase in temperature.
'We know that breathing cold, dry air induces airway constriction in asthmatics. But the
effects that temperature increases have on airway function in these patients are generally
overlooked. We know very little about the mechanisms that cause symptoms when
asthmatic patients are exposed to hot, humid air,' said Don Hayes, MD, medical director
of the Lung and Heart-Lung Transplant Program at Nationwide Children's Hospital.
Dr. Hayes and his colleagues at the University of Kentucky Medical Center (where Dr.
Hayes was on staff prior to joining Nationwide Children's late last year) enrolled patients
with mild asthma and healthy controls in a study to assess their pulmonary reaction to
hot, humid air.
Six asthmatic patients (ranging from 21 years of age to 26) and six healthy subjects
(between 19 and 46) were asked to breathe into a device designed to deliver air at certain
desired temperatures and humidity levels. The device produced a humidified gas mixture
of air either hot or room temperature.
Subjects breathed via a mouthpiece into this free stream of air for four minutes and were
asked to pant. Investigators measured participants' airway resistance before and for 16
minutes immediately following the challenge. They also measured body temperature,
heart rate, arterial blood pressure and oxygen saturation before and afterward.
Results showed that breathing of hot, humid air triggered an immediate increase in
airway resistance in patients with mild asthma, but caused either only a very small or no
response in healthy subjects.
Breathing hot, humid air also triggered consistent coughs in those with asthma. When the
asthmatic participants used an ipratropium aerosol before the challenge, they did not
experience airway constriction.
'We don't fully understand the mechanisms underlying these responses,' said Dr. Hayes,
who is the study's primary author.
A recent study by the same research group found that airway sensory nerves called Cfiber nerves were activated with the temperature within the chest was elevated to about
102 degrees Fahrenheit.
These data were developed in Lu-Yuan Lee's, MD, laboratory at the University of
Kentucky using animal models. Dr. Lee's laboratory has a 20-year history of National
Institutes of Health funding to study C-fiber sensory nerves in the lung.
'When C-fiber sensory nerves are stimulated, a number of pulmonary defense reflex
responses can occur, including cough and bronchoconstriction,' said Dr. Hayes, also a
faculty member at The Ohio State University College of Medicine.
'This study is a good example of how we can translate findings from a research laboratory
into a better understanding and more in-depth knowledge about how to prevent and treat
diseases in patients,' said Dr. Lee.
Dr. Hayes said further research is needed to completely understand how patients' bodies
react to hot and humid air and is planning such studies at Nationwide Children's.
Overall, he stated that this data provides evidence to support that ambient air
temperatures and humidity levels are very important in asthma and this research
introduces potential new drug targets for the treatment of asthma.
The study appeared in the June print issue of the American Journal of Respiratory and
Critical Care Medicine. (ANI)
Asthma
Why hot, humid air triggers breathing difficulty in patients with mild
asthma (New Kerala: 8.6.2012)
A new study has shed light on why patients with mild asthma have such difficulty
breathing during hot, humid weather.
The study found that patients who inhaled an asthma drug before breathing in hot, humid
air were able to prevent airway constriction that volunteers without asthma did not
experience in the same environment.
Ipratropium, a drug occasionally used for asthma, prevents airway muscle contraction
and increases airflow to the lungs. Its success in combating the air temperature response
suggests that hot, humid air triggers asthma symptoms by activating airway sensory
nerves that are sensitive to an increase in temperature.
'We know that breathing cold, dry air induces airway constriction in asthmatics. But the
effects that temperature increases have on airway function in these patients are generally
overlooked. We know very little about the mechanisms that cause symptoms when
asthmatic patients are exposed to hot, humid air,' said Don Hayes, MD, medical director
of the Lung and Heart-Lung Transplant Program at Nationwide Children's Hospital.
Dr. Hayes and his colleagues at the University of Kentucky Medical Center (where Dr.
Hayes was on staff prior to joining Nationwide Children's late last year) enrolled patients
with mild asthma and healthy controls in a study to assess their pulmonary reaction to
hot, humid air.
Six asthmatic patients (ranging from 21 years of age to 26) and six healthy subjects
(between 19 and 46) were asked to breathe into a device designed to deliver air at certain
desired temperatures and humidity levels. The device produced a humidified gas mixture
of air either hot or room temperature.
Subjects breathed via a mouthpiece into this free stream of air for four minutes and were
asked to pant. Investigators measured participants' airway resistance before and for 16
minutes immediately following the challenge. They also measured body temperature,
heart rate, arterial blood pressure and oxygen saturation before and afterward.
Results showed that breathing of hot, humid air triggered an immediate increase in
airway resistance in patients with mild asthma, but caused either only a very small or no
response in healthy subjects.
Breathing hot, humid air also triggered consistent coughs in those with asthma. When the
asthmatic participants used an ipratropium aerosol before the challenge, they did not
experience airway constriction.
'We don't fully understand the mechanisms underlying these responses,' said Dr. Hayes,
who is the study's primary author.
A recent study by the same research group found that airway sensory nerves called Cfiber nerves were activated with the temperature within the chest was elevated to about
102 degrees Fahrenheit.
These data were developed in Lu-Yuan Lee's, MD, laboratory at the University of
Kentucky using animal models. Dr. Lee's laboratory has a 20-year history of National
Institutes of Health funding to study C-fiber sensory nerves in the lung.
'When C-fiber sensory nerves are stimulated, a number of pulmonary defense reflex
responses can occur, including cough and bronchoconstriction,' said Dr. Hayes, also a
faculty member at The Ohio State University College of Medicine.
'This study is a good example of how we can translate findings from a research laboratory
into a better understanding and more in-depth knowledge about how to prevent and treat
diseases in patients,' said Dr. Lee.
Dr. Hayes said further research is needed to completely understand how patients' bodies
react to hot and humid air and is planning such studies at Nationwide Children's.
Overall, he stated that this data provides evidence to support that ambient air
temperatures and humidity levels are very important in asthma and this research
introduces potential new drug targets for the treatment of asthma.
The study appeared in the June print issue of the American Journal of Respiratory and
Critical Care Medicine. (ANI)
Childhood Asthma
House Dust from Homes with Dogs Protects Against Respiratory
Infection Linked to Childhood Asthma(Med India:21.6.2012)
A mice study shows house dust from homes with dogs could protect against infection
with a common respiratory virus that is associated with the development of asthma in
children. Researchers from the University of California, San Francisco, present their
findings today at the 2012 General Meeting of the American Society for Microbiology.
"In this study we found that feeding mice house dust from homes that have dogs present
protected them against a childhood airway infectious agent, respiratory syncytial virus
(RSV). RSV infection is common in infants and can manifest as mild to severe
respiratory symptoms. Severe infection in infancy is associated with a higher risk of
developing childhood asthma," says Kei Fujimura, a researcher on the study.
In the study Fujimura and her colleagues compared three groups of animals: Mice fed
house dust from homes with dogs before being infected with RSV, mice infected with
RSV without exposure to dust and a control group of mice not infected with RSV.
"Mice fed dust did not exhibit symptoms associated with RSV-mediated airway infection,
such as inflammation and mucus production. They also possessed a distinct
gastrointestinal bacterial composition compared to animals not fed dust," says Fujimura.
Pet ownership, in particular dogs, has previously been associated with protection against
childhood asthma development, says Fujimura. Recently she and her colleagues
demonstrated that the collection of bacterial communities (the microbiome) in house dust
from homes that possess a cat or dog is compositionally distinct from house dust from
homes with no pets.
"This led us to speculate that microbes within dog-associated house dust may colonize
the gastrointestinal tract, modulate immune responses and protect the host against the
asthmagenic pathogen RSV," says Fujimura. "This study represents the first step towards
determining the identity of the microbial species which confer protection against this
respiratory pathogen."
Identification of the specific species and mechanisms underlying this protective effect
represents a crucial step towards understanding the critical role of microbes in defining
allergic disease outcomes and could lead to development of microbial-based therapies to
protect against RSV and ultimately reduce the risk of childhood asthma development,
says Fujimura.
Cholesterol
Cholesterol
Cholesterol Medication and Kidney Health (New Kerala: 18.4.2012)
A common cholesterol medication may impact kidney health, reveals study.
Fibrates are a group of medications commonly used to treat high cholesterol. Recent
evidence from clinical trials and case reports suggests fibrates can cause an increase to
serum creatinine, an indicator of kidney health measured by a blood test, which indicates
a loss of kidney health. After a number of similar experiences in their renal clinics, Dr.
Garg and his colleagues felt these events merited further examination.
In a large, "real practice" study, the team examined more than 20,000 older Ontario
residents with new prescriptions for fibrates. Throughout the first 90 days of their
prescription, they monitored the renal outcomes in this population, and compared them to
patients taking ezetimide, another cholesterol agent not known to have any renal effects.
Results show new fibrate users were more likely to experience an increase in serum
creatinine; one in 10 users experienced a 50 per cent increase in the first 90 days of their
prescription. As a result, these users were also more likely to consult a kidney specialist
or to be hospitalized during this time.
The exact mechanism by which fibrates influence kidney function remains unclear and
requires further research. This study proves that fibrates have important acute effects on
kidney function and/or its measurement, to a greater extent than described in existing
clinical trials data.
"At the end of the day, we want to prescribe medication with the highest benefit and the
least amount of adverse events," Dr. Garg says. "When a physician decides to start a
fibrate in a new patient, especially an older patient, given the information we have today
they should start the patient on a dose that's appropriate, closely monitor their kidney
function, and, if the kidney function goes off, either lower the dose or discontinue the
drug."
'Good' Cholesterol
'Good' Cholesterol, May Not Protect Against Heart Disease(Medical
A new study by Harvard School of Public Health (HSPH) researchers has found that a
subclass of high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol,
may not protect against coronary heart disease (CHD) and in fact may be harmful.
This is the first study to show that a small protein, apolipoprotein C-III (apoC-III), that
sometimes resides on the surface of HDL cholesterol may increase the risk of heart
disease and that HDL cholesterol without this protein may be especially heart protective.
The study was published online in the Journal of the American Heart Association.
"This finding, if confirmed in ongoing studies, could lead to better evaluation of risk of
heart disease in individuals and to more precise targeting of treatments to raise the
protective HDL or lower the unfavorable HDL with apoC-III," said Frank Sacks,
professor of cardiovascular disease prevention at HSPH and senior author of the study.
A high level of HDL cholesterol is strongly predictive of a low incidence of coronary
heart disease (CHD). But trials of drugs that increase HDL cholesterol have not
consistently shown decreases in CHD, leading to the hypothesis that HDL cholesterol
may contain both protective and non-protective components.
ApoC-III, a proinflammatory protein, resides on the surface of some lipoproteins - both
HDL and low-density lipoproteins, or LDL ("bad") cholesterol. The researchers, led by
Sacks and Majken Jensen, research associate in the Department of Nutrition at HSPH,
examined whether the existence or absence of apoC-III on HDL cholesterol affected the
"good" cholesterol's heart-protective qualities, and whether its existence could
differentiate HDL cholesterol into two subclasses - those which protect against the risk of
future heart disease and those which do not.
Blood samples collected in 1989 and 1990 from 32,826 women in the Brigham and
Women's Hospital-based Nurses' Health Study were examined, along with blood samples
collected from 1993 to 1995 from 18,225 men in the Health Professionals Follow-up
Study. During 10 to 14 years of follow-up, 634 cases of coronary heart disease were
documented and matched with controls for age, smoking, and date of blood drawing.
The researchers compared plasma concentrations of total HDL, HDL that has apoC-III,
and HDL without apoC-III as predictors of the risk of CHD.
After adjusting for age, smoking status and other dietary and lifestyle cardiovascular risk
factors, the researchers found that two different subclasses of HDL have opposite
associations with the risk of CHD in apparently healthy men and women. The major
HDL type, which lacks apoC-III, had the expected heart-protective association with
CHD. But the small fraction (13%) of HDL cholesterol that has apoC-III present on its
surface was paradoxically associated with a higher, not lower, risk of future CHD. Those
men and women who had HDL apoC-III in the highest 20% of the population had a 60%
increased risk of CHD.
The results suggest that measuring HDL apoC-III and HDL without apoC-III rather than
the simpler measure of total HDL may be a better gauge of heart disease risk (or of
HDL's protective capacity). "Reduction in HDL-apoC-III by diet or drug treatments may
become an indicator of efficacy," said Jensen.
'Good' Cholesterol
'Good' Cholesterol, May Not Protect Against Heart Disease(Medical
A new study by Harvard School of Public Health (HSPH) researchers has found that a
subclass of high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol,
may not protect against coronary heart disease (CHD) and in fact may be harmful.
This is the first study to show that a small protein, apolipoprotein C-III (apoC-III), that
sometimes resides on the surface of HDL cholesterol may increase the risk of heart
disease and that HDL cholesterol without this protein may be especially heart protective.
The study was published online in the Journal of the American Heart Association.
"This finding, if confirmed in ongoing studies, could lead to better evaluation of risk of
heart disease in individuals and to more precise targeting of treatments to raise the
protective HDL or lower the unfavorable HDL with apoC-III," said Frank Sacks,
professor of cardiovascular disease prevention at HSPH and senior author of the study.
A high level of HDL cholesterol is strongly predictive of a low incidence of coronary
heart disease (CHD). But trials of drugs that increase HDL cholesterol have not
consistently shown decreases in CHD, leading to the hypothesis that HDL cholesterol
may contain both protective and non-protective components.
ApoC-III, a proinflammatory protein, resides on the surface of some lipoproteins - both
HDL and low-density lipoproteins, or LDL ("bad") cholesterol. The researchers, led by
Sacks and Majken Jensen, research associate in the Department of Nutrition at HSPH,
examined whether the existence or absence of apoC-III on HDL cholesterol affected the
"good" cholesterol's heart-protective qualities, and whether its existence could
differentiate HDL cholesterol into two subclasses - those which protect against the risk of
future heart disease and those which do not.
Blood samples collected in 1989 and 1990 from 32,826 women in the Brigham and
Women's Hospital-based Nurses' Health Study were examined, along with blood samples
collected from 1993 to 1995 from 18,225 men in the Health Professionals Follow-up
Study. During 10 to 14 years of follow-up, 634 cases of coronary heart disease were
documented and matched with controls for age, smoking, and date of blood drawing.
The researchers compared plasma concentrations of total HDL, HDL that has apoC-III,
and HDL without apoC-III as predictors of the risk of CHD.
After adjusting for age, smoking status and other dietary and lifestyle cardiovascular risk
factors, the researchers found that two different subclasses of HDL have opposite
associations with the risk of CHD in apparently healthy men and women. The major
HDL type, which lacks apoC-III, had the expected heart-protective association with
CHD. But the small fraction (13%) of HDL cholesterol that has apoC-III present on its
surface was paradoxically associated with a higher, not lower, risk of future CHD. Those
men and women who had HDL apoC-III in the highest 20% of the population had a 60%
increased risk of CHD.
The results suggest that measuring HDL apoC-III and HDL without apoC-III rather than
the simpler measure of total HDL may be a better gauge of heart disease risk (or of
HDL's protective capacity). "Reduction in HDL-apoC-III by diet or drug treatments may
become an indicator of efficacy," said Jensen.
Cholesterol
Researchers Identify Changes in Cholesterol Metabolic Pathways
(Science Daily: 8.6.2012)
A new study from the Virginia Commonwealth University School of Medicine has
identified molecular changes responsible for abnormal cholesterol production and
metabolism in the livers of patients with a common liver condition, and these changes
may explain the severity of a patient's liver disease and risks to their heart health.
It is estimated that a third of Americans have a fatty liver. Nonalcoholic fatty liver
disease is a very common liver condition. Nonalcoholic steatohepatitis, or NASH, the
more aggressive form of nonalcoholic fatty liver disease, is associated with increased
cardiac risk and liver-related mortality.
The VCU findings may provide researchers with potential new targets for treatment and
also allow clinicians to further refine how they assess cardiovascular risk and develop
ways to reduce it in individuals with a more aggressive form of nonalcoholic fatty liver
disease called nonalcoholic steatohepatitis, or NASH.
In the study, published in the May issue of Cell Metabolism, the team has shown that
there is not only increased production of cholesterol but a decreased expression of the
receptor that takes up cholesterol from the blood. This would be expected to both
enhance cholesterol output from the liver and reduce its removal, thereby making it more
available to enter blood vessels and contribute to cardiovascular disease. The liver not
only makes cholesterol, but also takes up cholesterol from the blood.
"This indicates that there is excessive cholesterol production in the liver when one
develops fatty liver disease," said lead investigator Arun Sanyal, M.D., professor and
chair in the Division of Gastroenterology, Hepatology and Nutrition in the VCU School
of Medicine.
"This may be important both to drive the disease towards cirrhosis and to increase the
risks of heart disease in those with fatty liver disease," said Sanyal.
Sanyal collaborated with VCU colleagues in the VCU Division of Gastroenterology,
Hepatology and Nutrition, the Department of Surgery and the Department of Pathology.
The work was supported in part by grants from the National Institutes of Health, grant
numbers: 5R01DK081410-03, K24 DK 02755 and T32 DK-007150-33.
Diabetes
Common diabetes
Common diabetes drug 'may help prevent primary liver cancer'(New
Kerala: 2.4.2012)
Metformin, a drug that is widely used to treat Type II diabetes, may help to prevent
primary liver cancer, a new study has claimed.
According to researchers at the University of Maryland Marlene and Stewart
Greenebaum Cancer Center primary liver cancer, or hepatocellular carcinoma, is an
often-deadly form of cancer that is on the rise worldwide and is the fastest-growing cause
of cancer-related deaths among American men.
Patients with Type II diabetes have a two- to three-fold increased relative risk of
developing primary liver cancer.
Also at risk are people who are obese, have hepatitis or non-alcoholic fatty liver disease
(NAFLD). Metformin, which is derived from the French lilac, is used to treat NAFLD as
well as diabetes, and currently is being studied in connection with the prevention of a
variety of cancers.
"Our research demonstrated that metformin prevents primary liver cancer in animal
models. Mice treated with metformin had significantly smaller and fewer tumors than
those who did not receive the medication," Geoffrey D. Girnun, the study's senior author,
said.
"Based on these findings, we believe metformin should be evaluated as a preventive
agent in people who are at high risk. Many patients with diabetes already are taking this
medication, with few side effects.
"There have been several retrospective epidemiological studies linking metformin with
reduced risk of liver cancer, but our study is the first to formally test whether metformin
can protect against carcinogenesis – not just tumor growth and development, but actual
tumor formation in the liver," Girnun said.
Glucose is converted into fatty acids in the liver through a process called lipogenesis.
This process is increased in people who have diabetes, hepatitis, fatty liver disease as
well as cancer.
According to Girnun, metformin reduces the level of glucose and inhibits this fatty acid
synthesis.
"When you block this process, you prevent the cells from making more building blocks to
make more cells. There is also no energy to put the building blocks together, and the cells
are not able to proliferate, thereby preventing tumors from developing," he added.
In the study, the researchers found that mice treated with metformin in their food
developed 57 percent fewer liver tumours than the mice that did not receive the drug; the
size of the tumours was reduced by about 37 percent.
The study has been published in Cancer Prevention Research.
Insulin pumps
Here come smart insulin pumps for diabetic kids (New Kerala:
13.4.2012)
As many as a million children suffer from Type I diabetes in India and painful for them
are those insulin jabs. But smart insulin pumps are now changing things for these kids.
"Type 1 diabetes (commonly known as juvenile diabetes) is the most common form of
diabetes among children. According to the Juvenile Diabetes Research Foundation
(JDRF), in India, there are about 10 lakh children with Type I diabetes," Neeru Gera,
consultant endocrinologist, Max Hospital, Saket here, told IANS.
"The first and foremost advantage of insulin pump therapy is that it could help children
get relief from the daily pain of insulin shots," Gera added.
Diabetes is of different types. For instance, Type 2 is found in people who are above 40,
while gestational diabetes occurs during pregnancy. Usually diabetic patients have to take
insulin injections before a meal.
But an insulin pump brings more flexibility.
Costing between Rs.99,000 and Rs.350,000, the insulin pump comes in the shape of a
mechanical device, a little larger than a pager, which can be attached to a belt or a pocket.
It delivers fast-acting insulin into the body via an infusion set - a thin plastic tube ending
in a small, flexible plastic cannula (tube) or a very thin needle.
One has to insert the cannula beneath the skin at the infusion site, usually in the abdomen
or upper buttocks and insulin is delivered through this infusion set. A patient can keep the
infusion set in the same place for two to three days (sometimes more). It can then be
moved to a new location.
"With insulin pump therapy, the concept of multiple daily injections hardly exists. The
patient only needs to change his or her infusion set a maximum of 12 times per month,"
Shalini Jaggi, consultant diabetologist, Sri Balaji Action Medical Institute here, told
IANS.
When it comes to Type 1 diabetes, children in the age group of 10-14 years are at a
higher risk of developing it. Those aged between five and nine years have middle risk and
kids of 0-4 years have a lower risk of developing diabetes.
Those suffering from the condition have to follow a strict lifestyle. Parents have to
constantly keep a check on the children's diet and exercise.
Insulin pumps have flexible choices, says Anju Virmani, consultant endocrinologist, Max
Hospital.
"Pumps give you greater control over insulin delivery, thereby giving you more control
over the onset of insulin action. That means you can determine what and when you want
to eat, when and for how long you play sports, and even whether or not to skip a snack or
meal. In short, you control the insulin. It doesn't control you," Virmani said.
But there are certain precautions that need to be taken.
"An insulin pump is a mechanical device. Any malfunction of the device can have an
adverse effect on the patient," said Jaggi.
"Besides, insulin pump therapy uses only faster-acting insulin. Therefore, any
interruption in insulin delivery (due to infusion set clogs, leaks, loss of insulin potency, or
pump malfunction) may result in hyperglycemia (high blood glucose) within two to four
hours. Always carry an emergency kit to supply insulin in case you develop a problem
with your pump."
Diabetic
Diagnosed diabetic? Don’t fret, know how to control it (The Tribune:
18.4.2012)
The growing culture of fast food and leading a luxurious life are among the main causes
giving rise to the number of diabetes patients in India.
Sedentary lifestyle, lack of physical activity, stress and calory rich diet are some other
factors behind the high incidence of diabetes in India.
Diabetes is not a disease that comes with age, it can hit you anytime. Unfortunately, India
happens to be the diabetes capital of the world with more than 61.3 million people
suffering from this problem.
It is an acute condition when either our body does not produce enough insulin or has cells
that do not respond properly to the insulin the pancreas produces, resulting in too much
glucose build-up in the blood.
Insulin is a hormone that is produced by the pancreas, which the pancreas releases in
adequate quantity to help glucose move in the blood.
There are three main types of diabetes: Type 1 diabetes — Pancreas do not produce
insulin at all.
Type 2 diabetes — The insulin produced does not suffice the needs or does not work
properly
Gestational diabetes — When one develops diabetes during pregnancy.
While diabetes types 1 and 2 are chronic medical conditions — they are persistent and
last a lifetime — gestational diabetes usually goes away after childbirth.
Pre-diabetes, also referred to as borderline diabetes, represents a key stage when the
person is diagnosed between normal blood sugar and diabetic levels. It defines a stage
before the development of diabetes with normal glucose tolerance, but with an increased
risk of developing diabetes in the near future. Such individuals are at a much higher risk
of developing diabetes than the general population and are often recommended to
undergo a diabetes test at least once a year and follow a proper diet and exercise regime.
People who face a greater risk of acquiring diabetes can be identified as follows:
People who are overweight
Above 35-year-old individuals
Those who already have a family history of diabetes
Those who are not much physically active
Individuals on steroids
Individuals under a lot of stress
Suffering from hypertension
Have had diabetes during pregnancy
A few common symptoms for diabetes are:
Frequent urination
More thirst than usual
Intense hunger
Either drastic weight loss or weight gain
Blurred vision
Cuts and bruises take a much longer time than usual to heal
More frequent gum infections.
Usually people depend on orally-taken pills to control their sugar levels, delivery devises
like insulin pen, insulin injections and the smarter ones use insulin pumps.
An insulin pump is a small mechanical device which works more like a healthy pancreas.
It is programmed to deliver the correct dosages based on the individual’s needs.
If any of the above-mentioned symptoms are troubling you, seek professional help at the
earliest. Diabetes, if left undiagnosed, may damage organs of the body like the eyes,
kidneys, heart, feet, nerves and even the brain. Therefore regular screening for diabetes is
necessary to detect and treat the disease at its grassroot level itself.
The good news about diabetes is that most of the cases are preventable or can be
controlled if you alter your lifestyle and bring a few healthy changes.
Some of the main things that should be strictly managed are:
The glucose level needs to be checked frequently using a glucometer.
A continuous glucose monitoring system (CGMS) is a device that records blood sugar
levels throughout the day and night.
You can also use insulin pumps to keep your blood glucose levels within your target
range both during day and night. These pumps replace the need for periodic injections by
delivering rapid-acting insulin.
The insulin pump is superior over insulin injections as it delivers insulin more accurately
than injections, eliminates individual insulin injections (12-16 injections vs one prick/
every fourth day). Allows you to be flexible about when and what you eat and helps in
improving your quality of life.
Diet — healthy eating is the ultimate aim
Weight control — If you are obese you need to reduce your weight
Exercise — Regular physical activity helps improve your body’s response to insulin.
Regular medications and insulin injections — Effectiveness of the recommended
medications highly depend on the proper timing and size of the dose.
Regular check-ups with a primary doctor.
The writer is Consultant (Endocrinology), Alchemist Hospital, Panchkula.
Diabetes
25cr plan to fight diabetes in works (The Times of India: 27.4.2012)
Govt Plans Global Alliance For Research
India, home to over 61 million diabetics, is now putting together plans for massive global
scientific projects to find innovative ways to fight the disease, whose burden has gone up
in
the
country
by
50.8
million
since
2010.
To be called “India Programme XII on Diabetes Research”, the ministry of science plans
to invite proposals for this global alliance in diabetes research.
The ministry says, “Research needs to be conducted into diabetes through more novel
pathways, than the traditional paradigm that is related to an excess of energy in the body
either due to overeating or lowered physical activity.”
The International Diabetes Federation (IDF) says by 2030, India’s diabetes burden is
expected to cross the 100 million mark as against 87 million earlier envisaged. The
country is also the largest contributor to regional mortality with 9.83 lakh deaths
attributed to diabetes last year.
Dr Anoop Misra from Fortis Hospitals said, “Inter-country cooperation in diabetes
research, especially for south Asian population, is important since many such population
and ethnic groups share similar metabolic perturbations and high propensity to develop
metabolic syndrome and diabetes. Indian scientists would benefit immensely if they share
their research experience with counterparts from other nations.”
The science ministry proposal says Rs 25 crore will be set aside for global collaboration
with partial funding coming from participating countries.
Latest statistics revealed by the International Diabetes Federation’s (IDF) 5th Diabetes
Atlas say, India’s prevalence of diabetes among 20-79-year olds is 9.2%. In sheer
numbers, India, however, is only second to China. In 2011, China had 90 million
diabetics that will increase to about 130 million by 2030.
IDF says, “India will face one of the toughest struggles against diabetes in the region.
India also accounts for most of the 112,000 children in the region with Type-1 diabetes.”
Dhruba Lall Singh, chairperson of IDF’s southeast Asia region, said, “India is obviously
a large concern.”
Bariatric surgeon Dr Ramen Goel added, “One person is dying from diabetes every seven
seconds. According to the IDF, the total number of people with diabetes in 2011 reached
a staggering 366 million with 4.6 million deaths. Healthcare spending on diabetes has
reached $465 billion.”
IDF adds, “New figures indicate that the number of people living with diabetes is
expected to rise from 366 million in 2011 to 552 million by 2030, if no urgent action is
taken. This equates to approximately three new cases every 10 seconds or almost 10
million per year.”
The Atlas said, “Four in every five diabetics at present are between 40 and 59 years.
Around 78,000 children are developing Type-1 diabetes every year. By 2030, one in
every 10 adults will have diabetes.”
Diabetes
Metabolic Switch that may Help Diabetes Treatment Identified(Med
India: 27.4.2012)
Extensive research has shown that humans are built to hunger for fat. They are known for
packing it on during times of feast and burning it during periods of famine.
But when deluged by foods rich in fat and sugar, the modern waistline often far exceeds
the need to store energy for lean times, and the result has been an epidemic of diabetes,
heart disease and other obesity-related problems.
Now, scientists at the Salk Institute for Biological Studies have identified the linchpin of
fat metabolism, a protein known as fibroblast growth factor 1 (FGF1), which may open
new avenues in the treatment of diabetes.
In a paper published April 22 in Nature, the Evans lab reports that FGF1 activity is
triggered by a high-fat diet and that mice lacking the protein swiftly develop diabetes.
This suggests that FGF1 is crucial to maintaining the body's sensitivity to insulin and
normal levels of sugar in the blood.
"Because humans are good at storing fat during times of plenty, we are also excellent at
surviving times of famine," says Ronald M. Evans, a professor in Salk's Gene Expression
Laboratory and lead author of the paper. "The fat tissues of our body are like batteries,
providing us with a steady source of energy when food is scarce. FGF1 governs the
expansion and contraction of fat and thus controls the ebb and flow of energy throughout
our body."
Obesity rates have soared in the United States in recent decades, with more than one third
of U.S. adults and 17 percent of children and adolescents now considered obese,
according to the Centers for Disease Control and Prevention.
Diabetes
Metformin And Rosiglitazone Combo Best For Kids With Diabetes
Type 2 (Medical News Today:1.5.2012)
Controlling blood sugar in children and teenagers with diabetes type two is best achieved
with a metformin plus rosiglitazone combo, compared to just metformin or metformin
plus lifestyle changes, researchers reported in NEJM (New England Journal of
Medicine). Blood-sugar control is also known as glycemic control, or blood glucose
control.
There are very limited reliable data to guide treatment for young patients with diabetes
type 2, even though rates in this age group have been rising over the last ten years. Over
the last couple of decades, the prevalence of obesity among children in the USA has risen
considerably.
In this study, the researchers compared the efficacy of three treatment regimes - they
focused on durable glycemic control in pediatric patients who had recently been
diagnosed with diabetes type 2.
699 patients aged from 10 to 17 years were initially treated with 1000 mg of metformin
alone twice daily, until they achieved glycated hemoglobin levels of <8%. They were
then randomly selected into three groups:
Monotherapy metformin group - they continued on just metformin
Combo metformin plus rosiglitazone (4 mg twice daily) group
Metformin plus lifestyle-intervention program group - patients focused on diet to achieve
ideal body weight, plus physical activity
The researchers were looking out for (primary outcome) loss of glycemic control at six
months of therapy.
The authors explained that the drug combo was considerably more effective than just
metformin therapy, even though Avandia (rosiglitazone) usage has dropped somewhat in
several parts of the world, mainly because of undesirable cardiovascular adverse events
linked to its use in combination with TZD (thiazolidinedione) in adult patients.
The study had been designed before concerns regarding TZD type drugs emerged.
The researchers found that metformin on its own appears to offer incomplete and
unsatisfactory therapy for many pediatric patients.
Lifestyle intervention also appeared not to be effective enough for a significant number
of patients.
However, finding the ideal combination of the two drugs is vital, because
thiazolidinediones are known to be associated with undesirable side effects in adults.
Over a mean follow-up of 3.86 years, the following percentages had treatment failure
(glycated hemoglobin level of at least 8% for 6 months or sustained metabolic
decompensation requiring insulin):
39% in the combination therapy group
52% in the monotherapy metformin group
47% in the metformin plus lifestyle intervention group
The authors say that their findings indicate that the majority of pediatric patients with
diabetes type two will need several oral agents or insulin therapy within a few years of
being diagnosed.
In an Abstract in the same journal, the researchers concluded:
"Monotherapy with metformin was associated with durable glycemic control in
approximately half of children and adolescents with type 2 diabetes. The addition of
rosiglitazone, but not an intensive lifestyle intervention, was superior to metformin
alone."
Diabetics
Diabetics should know the GI of foods (The Times of India: 2.5.2012)
Medical expert Geeta Sundar says diabetics and the obese should
know about the glycaemic index of the foods they eat
The glycaemic index (GI) is a term used to measure the glycaemic response of food, or
how quickly a food item gets converted into sugar and enters the blood stream in
comparison to an equivalent amount of sugar.
GI and diabetes
The GI of glucose is taken as 100. The closer the GI of different foods to glucose, the
more unsafe it is for diabetics.
• High GI value is 70 or more
• Medium GI value is 56-69
• Low GI value is less than 55 Carbohydrate, protein and fat content of the same foods
may vary in different parts of the world, so don’t check foreign sites on the net for
information on GI.
Rice and diabetes
Brown rice (GI 48) has the highest amount of fibre and contains selenium that prevents
aging; it has omega-3 fatty acids good for the heart and brain, vitamin E good for skin
and blood vessels, and vitamin B 1 good for nerves. Parboiled rice (GI 67) is boiled to 70
degrees and quickly cooled. This pushes all useful nutrients into the rice from the bran
before its removal. Such rice is nutrient-rich but lacks fibre. Basmati rice (GI of 65-70)
lacks nutrients but has a lower GI than white rice. Polished white rice (GI 90-100) has no
nutrients, and no fibre.
Bananas, mangoes, grapes and diabetes
Slightly unripe and smaller bananas have lower GI (around 32) and can be eaten. Riper
and larger ones have higher GI (54-70). Mangoes have GI of 50-70, depending on their
ripeness. Grapes have a GI of around 50.
High GI foods to avoid
Sugar, sweets, cakes, pastries, honey, g u r, sweetened juices, dates, white rice, riceflakes,
m a i d a items, s a b u - d a n a, arrowroot, potato, sweet potato, underground vegetables,
c h i c k o o sand s i t a p h a l.
Some low GI foods
Sprouts, whole pulses, legumes, salads, boiled eggwhite, chana, whole wheat, bajra, b e s
a n, isabgol, r a j m a, peanuts, kabuli chana, brown rice, low-fat milk and curd, apples,
pears, berries, citrus fruits. Once in a while when you eat a high GI food, combine it with
a large portion of low GI food to balance your blood sugar. The obese should be careful.
Sugar entering the blood stream rapidly, cannot be utilised fully for energy and the body
converts it into fat for storage.
Diabetes
Medication blunders 'putting diabetics' lives at risk' (New Kerala:18
May 2012)
London, May 17 : Medication mistakes by doctors are making thousands of hospital
patients suffering from diabetes vulnerable to potentially fatal low blood-sugar levels, a
recent report has revealed.
According to the report, hospitals in England and Wales made 3,700 medication errors in
a week.
If this one-in-three level of mistakes ' which can lead to dangerously high blood-glucose
levels ' continued for a year, it could affect 208,000 patients, the Daily Express reported.
During a seven-day period, patients with blunders suffered more than double the number
of severe hypoglycaemic ' or hypo ' episodes compared to those treated accurately.
Hypos occur when blood-glucose levels drop severely low ' and if left untreated can lead
to seizures, coma or death.
'It is unacceptable for any person in hospital to receive inadequate care,' Barbara Young,
chief executive of Diabetes UK, said.
'Urgent action is needed to make sure that general ward staff are competent in treating inpatients.'
The National Diabetes Inpatient Audit analysed data for 19,400 patients over seven days
last October.
Results revealed that 32.4 per cent of patients in England had experienced at least one
medication error during the previous seven days ' down from 36.6 per cent the previous
year.
The audit also found that 68 patients developed diabetic ketoacidosis, which can be fatal
if not detected. This occurs when blood-glucose levels are consistently high, indicating
insulin treatment was not given for a significant period.
'The majority of hospital doctors and ward nurses still do not have basic training in
insulin management and glucose control,' Audit lead clinician Dr Gerry Rayman said.
'Medicine management has improved since 2010 but there are still too many errors. We
will continue to work with clinicians to reduce these,' The Health Department said.
Diabetes and high-blood pressure worsening worldwide: UN (New
Kerala:18 May 2012)
United Nations, May 17 : A UN report has stated the number of people suffering from
diabetes and hypertension is on the rise.
Word Health Statistics 2012, the World Health Organization's report for this year,
includes data from almost all the countries. It said one in three suffers from high-blood
pressure and one in 10 is a victim of diabetes.
According to independent estimates, about 10 percent of India's 1.3 billion is afflicted
with diabetes.
"This report is further evidence of the dramatic increase in the conditions that trigger
heart disease and other chronic illnesses, particularly in low-and middle-income
countries," the Director-General of the World Health Organization (WHO) Margaret
Chan said yesterday. "In some African countries, as much as half the adult population has
high blood pressure." In high-income countries, widespread diagnosis and treatment with
low-cost medication have reduced blood pressure across populations, leading in turn to a
reduction in deaths from heart disease.
In Africa, however, more than 40 per cent of adults in many countries are estimated to
have high blood pressure - most of them remain undiagnosed, even though many of these
cases could be treated with low-cost medications, which would significantly reduce the
risk of death.
Diabetes
Diabetes Cases Could Raise by 64 Percent in the US by 2025(Med India:
22.5.2012)
Health experts in United States have warned that the spread of type II diabetes could see
a huge spike in the next 13 years with more than 53 million Americans likely to be
diagnosed with the condition by 2025.
The Diabetes 2025 Model for the U.S. projects a continuous and dramatic increase in the
diabetes epidemic and makes it possible to estimate the potential effects of society-wide
changes in lifestyle and healthcare delivery systems.
The model was developed by William Rowley, MD and Clement Bezold, PhD, Institute
for Alternative Futures (Alexandria, VA).
Predictions for individual states and population subgroups are highlighted in are
highlighted in an article published in Population Health Management, a peer-reviewed
journal from Mary Ann Liebert, Inc., publishers.
Their model can also be used to estimate the benefit of changes in lifestyle and specific
interventions in reducing the burden of diabetes, according to the article.
Diabetes
Diabetes Deaths Drop Substantially, US (Medical New Today:
28.5.2012)
In the decade leading up to 2006, the US saw a substantial drop in deaths for people with
diabetes, especially in connection with heart disease and stroke, according to a new study
from the Centers for Disease Control and Prevention (CDC) and the National Institutes of
Health (NIH).
Published online this month in the journal Diabetes Care, the researchers report that
although American adults with diabetes are still more likely to die younger than those
without diabetes, the gap is getting smaller.
However, they also conclude that: "These encouraging findings ... suggest that diabetes
prevalence is likely to rise in the future if diabetes incidence is not curtailed."
For the study, the researchers evaluated data from the 1997-2004 National Health
Interview Survey covering nearly 250,000 adults who were linked to the National Death
Index.
They suggest improved treatment for cardiovascular disease, better management of
diabetes, and healthier lifestyles have contributed to the decline in deaths among people
with diabetes.
They found people with diabetes were less likely to smoke and more likely to be
physically active than they were in the past.
Improved control of blood pressure and cholesterol may also have played a part in
improving health, although obesity levels are still rising among people with diabetes, they
report.
Ann Albright, director of CDC's Division of Diabetes Translation, told the press:
"Taking care of your heart through healthy lifestyle choices is making a difference, but
Americans continue to die from a disease that can be prevented."
"Although the cardiovascular disease death rate for people with diabetes has dropped, it
is still twice as high as for adults without diabetes," she added.
Previous studies have shown that rates of heart disease and stroke are falling for all adults
in the US. And they are falling faster for those with diabetes. In other recent studies CDC
researchers have also reported falling rates of kidney failure, leg and feet amputations,
and heart disease and stroke hospitalizations among people with diabetes.
However, because deaths are falling, and rates of newly diagnosed cases are still rising,
we can expect the number of Americans living with diabetes to continue rising.
Diabetes prevalence has tripled since 1980, mostly due to type 2 diabetes, which is
closely linked to rising obesity, inactivity and older age.
The CDC estimates there are 25.8 million Americans living with diabetes today,
including 7 million who don't know they have it.
Lead author Edward W. Gregg is chief of epidemiology and statistics in CDC's Division
of Diabetes Translation. He said:
"Diabetes carries significant personal and financial costs for individuals, their families,
and the health care systems that treat them."
"As the number of people with diabetes increases, it will be more important than ever to
manage the disease to reduce complications and premature deaths," he urged.
By controlling blood sugar, blood pressure and cholesterol, people with diabetes can
reduce their risk of serious complications such as heart disease, stroke, kidney disease
and blindness
Diabetics
Aggressively controlling glucose levels may not cut kidney failure in
diabetics (New Kerala: 30.5.2012)
Intensively controlling glucose (glycemic) levels in type-2 diabetes patients may not
reduce the risk of kidney failure, researchers have found
The result is based on a review of data from seven clinical trials.
To test the hypothesis that aggressive glycemic control can prevent renal disease in
patients with type 2 diabetes mellitus, Yale School of Medicine researchers searched
available medical literature and evaluated seven randomized trials involving 28,065 adult
patients who were monitored for two to 15 years.
First author Steven G. Coca of Yale and colleagues found that compared with those who
had usual treatment, intensively controlling glucose with higher doses of medication did
not definitively reduce the risk of impaired kidney function, the need for dialysis, or
death from kidney disease.
Coca said many researchers have presumed that such intensive treatment would benefit
patients by protecting the kidneys, but these results question whether patients truly are
better off with this approach.
"After pooling the results from the follow-up data in the seven studies examined, our
analysis shows that intensive glycemic control may improve some things about the
kidney that we measure, but did not affect patients' outcomes," said Coca, assistant
professor in the section of nephrology in the Department of Internal Medicine at Yale.
The study has been published in the May 28 issue of Archives of Internal Medicine.
(ANI)
Diabetes
Eating too fast could up diabetes risk by two-and-a-half times (New
Kerala: 9.5.2012)
People who wolf down meals are two-and-a-half times more likely to develop type 2
diabetes, say scientists.
This could be because eating very quickly encourages weight gain, which can trigger the
illness.
Scientists in Lithuania presented their finding at the International Congress of
Endocrinology and European Congress of Endocrinology in Florence, Italy, the Daily
Mail reported.
They looked at 702 people, including 234 who had just been diagnosed with type 2
diabetes.
They all filled in a detailed questionnaire about their lifestyles, which included sections
on diets, exercise and whether they smoked.
Overweight women miss out on jobs because of 'fat discrimination'
One question asked them if they ate faster, more slowly or at the same speed as others.
They were also measured and weighed to calculate their body mass index, which
determines whether they are obese.
The researchers found that those who admitted they ate more quickly than most other
people were two-and-a-half times more likely to develop type 2 diabetes.
They claimed that this trend existed even once they had accounted for other causes such
as obesity, smoking, diet and a family history of the illness.
"The prevalence of type 2 diabetes is increasing globally and becoming a world
pandemic. It appears to involve interaction between susceptible genetic backgrounds and
environmental factors," said lead researcher Dr Lina Radzeviciene from Lithuanian
University of Health Sciences.
"It's important to identify modifiable risk factors that may help people reduce their
chances of developing the disease," she noted.
The scientists did not explain why eating fast appeared to be linked to type 2 diabetes.
But obesity has long been recognised as one of the main causes of the illnesses.
Previous studies have found that people who eat quickly also eat more, and consequently
are more likely to be overweight.
Experts think this is because their digestive system doesn't have a chance to send a signal
to the brain that it is full.
But David Speigelhalter, a professor in the public understanding of risk at Cambridge
University, warned that the study was too small to be meaningful.
"This is one of those many small studies that raise an interesting question but don't prove
causation. It is a huge and unjustified jump to say that eating slower reduces your risk of
getting diabetes," he stated. (ANI)
Diabetes
Pioglitazone Raises Bladder Cancer Risk In Diabetes Patients (Mdical
News Today:4 June 2012)
Healthcare Prof: Patients with type 2 diabetes who take medication pioglitazone have a
higher risk of incident bladder cancer than diabetes patients who do not, researchers from
McGill University, Canada, reported in the BMJ. The authors added that bladder cancer
risk was also linked to pioglitazone usage duration and dosage.
The team set out to find out whether pioglitazone usage might raise the risk of incident
bladder cancer among type 2 diabetes patients.
They conducted a retrospective cohort study and used a nested case-control analysis. This
involved gathering and examining data from over 60 GP (general practitioner, primary
care physician) centers in Great Britain.
Patients on pioglitazone were compared to individuals newly treated with oral
hypoglycaemic agents between 1 January 1988 and 31 December 2009 - all individuals in
both groups had diabetes type 2.
They found that ever use of pioglitazone was linked to a higher risk of developing
bladder cancer (rate ratio 1.83, 95% confidence interval 1.10 to 3.05). They added that
cancer bladder risk went in line with pioglitazone use duration - the longer patients were
on pioglitazone, the higher their risk of bladder cancer.
Highest bladder cancer risk was found among those who had been on pioglitazone for
over two years. Patients on cumulative dosage of over 28,000 mg also had a higher risk,
than those on lower dosages.
The researchers concluded in an Abstract in the same journal: "The use of pioglitazone is
associated with an increased risk of incident bladder cancer among people with type 2
diabetes."
Diabetes
Link between Diabetes and Blood Cancer Risk (Med India: 8.6.2012)
Patients with type 2 diabetes are at an increased risk of developing blood cancers, say
researchers.
The findings add to the growing evidence base linking diabetes and certain types of
cancer.
"I think when most people think about diabetes-related illnesses, they think of heart
disease or kidney failure, but not necessarily cancer," said lead author Jorge Castillo,
M.D., a hematologist/oncologist with The Miriam Hospital.
"But when you consider that more than 19 million Americans have been diagnosed with
diabetes - not to mention the millions more who are either undiagnosed or will be
diagnosed in the future - a 20 percent increased risk of blood cancer is quite significant,"
Castillo stated.
While diabetes has been previously associated with other types of cancer, such as liver
and pancreatic cancer, there have been few connections to blood cancers. Researchers are
still unclear what causes the vast majority of these malignancies, which include cancers
of the blood, bone marrow, and lymph nodes and affect more than 100,000 Americans
each year.
Castillo and colleagues analyzed 26 previously published research articles on the
association between type 2 diabetes - the most common form of the disease - and the
incidence of lymphoma, leukemia and myeloma. The meta-analysis included more than
17,000 cases of type 2 diabetes and blood cancer worldwide.
They concluded patients with type 2 diabetes have increased odds of developing
leukemia, myeloma and non-Hodgkin lymphoma, as well as a subtype of non-Hodgkin
lymphoma known as peripheral T-cell lymphoma. They did not find any associations
with Hodgkin lymphoma.
Interestingly, researchers also said the odds of lymphoma, leukemia and myeloma appear
to differ depending on the geographic region of the original report. For example, the odds
of non-Hodgkin lymphoma were higher in Asia and Europe, while there was an increased
leukemia risk in the United States and Asia.
Although the study did not identify a cause for any of these associations, the findings
suggest type 2 diabetes could be associated with approximately five percent of all
incidents of leukemia, myeloma non-Hodgkin lymphoma.
"It's important to remember that type 2 diabetes can, to some degree, be prevented and
controlled through lifestyle modification, such as diet and exercise. So by preventing the
onset of type 2 diabetes, we could also prevent blood cancer," Castillo said.
The researchers say additional studies are needed to explain the potential relationship
between type 2 diabetes and blood cancers.
In particular, Castillo believes future research should focus on the role of behavioral
factors like obesity, physical activity and smoking, which have been linked to both
diabetes and cancer.
The findings were published online in the journal Blood.
Diabetes
Lifestyle changes can prevent type-2 diabetes (New Kerala:18 June
2012)
Washington, June 17 : Making lifestyle changes can prevent type-2 diabetes, simply,
effectively and cheaply, a new study says.
Diabetes is a chronic and complex disease marked by high levels of sugar in the blood
that arise due to problems with the hormone insulin, which regulates blood sugar levels.
It is usually caused by an inability to produce insulin (type 1) or an inability to respond
correctly to insulin (type 2).
The study involved 230 people in poor, urban neighbourhoods in the San Francisco Bay
Area cities. Contacted by phone about once a month, half of them received specific
dietary guidance and other lifestyle counselling.
After six months, those who had received the counselling had on average lost more
weight, were consuming less fat, were eating more fruits and vegetables and showed
more improvements in lowering in their blood triglycerides, a key risk measure for type 2
diabetes, the American Journal of Public Health reported.
"Diabetes is not something you are necessarily going to get just because it runs in your
family," said Alka Kanaya, associate professor of medicine at the University of
California, San Francisco (UCSF) and senior study author. "It is very preventable, and
lifestyle changes can really impact the onset of diabetes."
"You can do something about it," said Anita Stewart, professor at the UCSF Institute for
Health and Aging and the Centre for Aging in Diverse Communities, senior study coauthor, according to a university statement.
A major health concern in the US, diabetes of all types affect an estimated 8.3 percent of
the U.S. population -- some 25.8 million Americans -- and cost U.S. taxpayers more than
USD 200 billion annually.
Previous studies have shown that counselling and other lifestyle interventions are
effective at preventing type 2 diabetes, but those interventions have generally been
designed for clinical settings and include separate sessions with numerous health
professionals. (IANS
Diabetes
Finding holds potential for drug targeting to treat diabetes (The
Hindu:20.6.2012)
The HinduSchematic represenation of pancreatic islets from Wdr 13 gene intact mouse
(left) and Wdr 13 gene knockout mouse (right)
Scientists from the Centre for Cellular and Molecular Biology (CCMB) have found that
knocking out a gene in mice led to higher insulin production and better glucose tolerance.
The finding holds the potential for drug targeting to treat diabetes.
The team, led by Satish Kumar, serendipitously found that knocking out the WDR13
gene, resulted in hyper insulin secretion and improved glucose clearance. The team
genetically engineered a mouse by knocking out the gene, which is conserved in all
organisms from fishes to humans and encodes a protein. It is a member of the WD-repeat
proteins that have a wide range of cellular functions.
The increase in insulin production was caused by enhanced beta cell proliferation and
higher islet mass in pancreas. This gene was knocked out for the first time, said Vijay
Pratap Singh, lead author of the study, which was published online in science journal
PLoS ONE recently.
The test animals went on to develop mild obesity as they aged. Interestingly, however,
they continued to have better glucose clearance in spite of mild obesity. It was not yet
known if the obesity was due to higher insulin levels or some different function of the
gene.
Dr. Kumar told The Hindu that by inhibiting the functions of this protein, insulin
production could be enhanced.
“Indirectly, we discovered a drug target because now we know that if we interfere with
this protein, there is more insulin,” he said.
However, he noted that there was a flipside to the finding. While there was no problem
with the ‘knockout' mice up to one year, subsequently, their cell proliferation increased
— such phenomenon lead to tumours. The researchers were not aware of the WDR13's
function of regulating cell division.
The real challenge would be to develop a drug, which would interfere in a limited way
with the functioning of the gene, so as to avoid rapid cell proliferation.
Dr. Kumar said their research initially was not related to diabetes. “We were doing basic
biology. This is side implication with an interesting lead.”
Describing the finding as a “good and useful observation,” CCMB director Ch. Mohan
Rao said: “We are trying to decipher the cause for increase in fatty cells and the
pancreatic cells.” There was scope for drug development if the two could be separated.
Keywords: Centre for Cellular and Molecular Biology, diabetes treatment
Eye Disease
Eye strain
Eye strain with headache? See your doctor, don’t panic (The Tribune:
11.4.2012)
Seth, 66, entered an eye specialist’s chamber with anguish on his face. “I have a really
severe pain on right side of my head. I couldn’t sleep last night. Every thing I do bothers
me and my right eye ball hurts some times. It feels my head is going to explode. Can you
tell me doctor why the neurologist has referred me to an eye specialist instead of a
neurosurgeon, when I feel it could be a brain tumour?” questioned Seth while pushing a
bundle of MRI, CT and lumber puncture reports on the doctor’s table.
The doctor raised several questions and proceeded with his eye examination, refraction
and retina examination. “Does the pain get worsened with watching TV or working at
your laptop or reading your morning papers? Did you get your glasses checked in the
recent past? Any difficulty in night driving, reading paper in dim light, seeing two or
more moons instead of one, frequent change in glasses, glares or halos around the light,
inability to open one eye in the sun and reduction of power for near vision?”
When Seth nodded his head in the affirmative, the doctor pronounced, “You are
developing early cataract changes, which has caused change of power of your glasses.
You have to strain your eyes to see clearly, all the time, which results in eye strain and
headache. You may not be having any brain tumour! You may be helped with the
spectacles alone”, counseled the doctor while pushing back the plethora of investigations
back to Seth.
Common causes of eye pain with headache
Glaucoma, an important cause, entails increased pressure in the eye, and can cause
headache and eye pain. Inflammations and infections in and around the eye can also
produce eye pain. Iritis or uveitis is one such condition. The pains may also be related to
stress, depression, anxiety, a head injury, or holding your head and neck in an abnormal
position. The pain may feel dull or squeezing, like a tight band. Your shoulders, neck, or
jaw may feel tight or sore.
Migraine headaches are severe that usually occur with other symptoms such as vision
changes or nausea. The pain may be throbbing, pounding, or pulsating. It tends to begin
on one side of your head. You may have warning symptoms that start before your
headache.
Sinus headaches cause pain in the front of your head and face, and may involve one eye.
They are due to swelling in the sinus passages behind the cheeks, nose, and eyes. The
pain tends to be worse when you bend forward and when you first wake up in the
morning. Headaches may occur if you have a cold, flu or fever.
Headache may rarely be a sign of a serious cause such as brain infection like meningitis
or encephalitis, or abscess, brain tumour, very high blood pressure, etc.
When to see your doctor/ eye physician:
l The all cases of vision complaints and headache, consult an eye specialist first.
l When headache interferes with your daily activities.
l Your headache comes on suddenly and is explosive or violent.
l You describe this episode of headache as “your worst ever.”
l You also have slurred speech, a change in vision, problems moving your arms or legs,
loss of balance, confusion, or memory loss with your headache.
l Your headache gets worse over a 24-hour period.
l You also have a fever, stiff neck nausea and vomiting with your headache.
l Your headache occurs with a head injury or any associated ailment like hypertension,
diabetes, etc.
l Your headache is severe and just in one eye, with redness in that eye.
l You are over age 50, especially if you also have vision problems, and severe and
persistent pain in one or both eyes.
The writer is a Chandigarh-based eye specialist.
Glaucoma
Study Links Genes to Common Forms of Glaucoma(Science daily:
27.4.2012)
Results from the largest genetic study of glaucoma, a leading cause of blindness and
vision loss worldwide, showed that two genetic variations are associated with primary
open angle glaucoma (POAG), a common form of the disease. The identification of genes
responsible for this disease is the first step toward the development of gene-based disease
detection and treatment.
About 2.2 million people in the U.S. have glaucoma. POAG is often associated with
increased eye pressure but about one-third of patients have normal pressure glaucoma
(NPG). Currently, no curative treatments exist for NPG.
Researchers including lead author Janey Wiggs, M.D., Ph.D., and Lou Pasquale, M.D.,
Co-Directors of the Harvard Glaucoma Center of Excellence, analyzed DNA sequences
of 6,633 participants, half of whom had POAG. Participants were part of two NIH-funded
studies: GLAUGEN (GlAUcoma Genes and Environment) and NEIGHBOR (NEI
Glaucoma Human genetics collaBORation), conducted at 12 sites in the United States.
Dr. Pasquale is Director of the Glaucoma Service at Mass. Eye and Ear.
The results, reported online in PLoS Genetics (April 26, 2012), found that two variations
were associated with POAG, including NPG. These are the first variants commonly
associated with NPG. One variant is in a gene located on chromosome 9 called
CDKN2BAS whereas the other variant is in a region of chromosome 8 where it may
affect the expression of genes LRP12 or ZFPM2. These genes may interact with
transforming growth factor beta (TGF-beta), a molecule that regulates cell growth and
survival throughout the body. Previous studies have also implicated TGF-beta in
glaucoma.
"This research has provided important new insights into the disease pathogenesis and will
make future studies focused on translating this information into the clinic possible.
Ultimately we hope to prevent blindness caused by this very common eye disease," said
lead author Dr. Wiggs.
"This study has identified an important molecular pathway in the development of POAG.
Control of TGF-beta might lead to more effective therapies for this blinding disease,"
said Dr. Hemin Chin, associate director for Ophthalmic Genetics at the National Eye
Institute.
Funding sources for this research include the National Eye Institute, National Human
Genome Research Institute, Lions Eye Research Fund, Glaucoma Center of Excellence,
the Margolis Fund, and Research To Prevent Blindness.
Blindness
Donated spectacles may cause more harm than good (The Tribune: 17
May 012)
Gobal body issues advisory for poor, developing nations
India is among those nations worldwide that have been advised by a global body engaged
in the prevention of blindness to discourage receiving foreign donation of recycled
eyeglasses.
The International Agency for the Prevention of Blindness (IAPB) has issued an advice to
poor and developing nations’ non-governmental organisations and state-run hospitals not
to accept donation of recycled glasses. “Such glasses should not be used in eyecare
programmes,” the IAPB has cautioned.
India is home to the world’s largest number of blind people (about 20 million). And three
times more than this number are visually impaired. A large number of them require
reading glasses, but do not have access to them.
The USA and many European nations are a major source of thousands of recycled
eyeglasses being sent by social groups every month to India, Nepal, Venezuela, South
Africa, Guatemala, Honduras, Philippines, Kenya, Mexico, Haiti, Sudan, Guyana, Cuba
and others countries.
Before shipment, the power of the glasses is determined. This is done with a digital readout lensometer. Both lenses are read and recorded on the outside of a plastic shipping
bag. Metal frames are removed and only plastic frames are used for distribution in
foreign countries.
The donators feel good sending their old reading glasses to a developing country. But a
recent global study, led by the International Centre for Eyecare Education (ICEE), a
collaborating partner in the Vision CRC, in Sydney, suggests that it is far better to give
$10 for an eye examination and a new pair of glasses if you want to help someone in
desperate need.
Published recently in the ‘Optometry and Vision Science’ journal, the research showed
that only 7% of a test sample of 275 recycled glasses were usable and that this pushed the
delivery cost to over $20.49 per pair, close to twice that of supplying ready-made glasses.
Although well-intentioned, recycled glasses will not suit many of those affected by the
most common forms of vision impairment.
Prof Rajvardhan Azad, chief of the Dr Rajendra Prasad Centre for Ophthalmic Sciences,
All India Institute of Medical Sciences, told The Tribune that recycled glasses from
abroad have many inbuilt problems.
“If someone abroad makes a mistake in recording the exact power of a pair of spectacles,
it can do more harm to the person who will wear them,” said Azad.
Preventing Blindness
India is home to the world's largest number of blind people, about 20 million
It receives recycled glasses from the US and European countries
A global study shows that only 7% of a test sample of 275 recycled glasses was usable
Eye disease
New treatment for eye disease Pterygium(New Kerala:28.5.2012)
A Kolkata eye hospital on Saturday unveiled a new treatment for the Pterygium patients
which doctors claimed could cure the ailment.
Pterygium or Surfer's Eye is known as a benign growth of the conjunctiva caused by
ultraviolet-light exposure, low humidity, and dust.
Dr. Santanu Mitra, Senior Consultant of Disha Eye Hospital and Research Centre, on
Saturday introduced Autoblood Conjunctival Graft Fixation, a new way of treating
Pterygium patients.
Pterygium is a wing shaped fibro vascular tissue encroaching onto cornea from the nasal
or temporal side.
Exposure to ultraviolet radiation can have a great toll on eye, as it is seen more prevalent
around the equatorial countries. Apart from redness and irritation it also causes visual
disturbance.
Numerous surgical procedures for this condition have been enumerated in the past, but
mostly fell out due to high recurrence rate or blinding side effects, said Mitra.
Grafting with healthy conjunctiva harvested from other part of the same eye is currently
the procedure of choice with a low recurrence rate and no complication.
The surgery and post-operative recovery period is longer along with exaggerated
symptoms like pain, redness, watering.
In the last decade use of fibrin glue gained popularity in conjunctival graft fixation.
All the suture related problems are almost overcome, said Mitra. The glue is prepared
from two clotting factors derived from human blood. It is costly, not readily available
carries a potential risk of disease transmission.
In the Autoblood Conjunctival Graft Fixation technique, natural blood clot is used as a
tissue adhesive.
Mitra said: “The idea of using natural blood clot is to provide the benefits of glue glue
fixation to the patients without the drawbacks of the earlier techniques. This is an
innovative ‘no suture no glue’ graft fixation technique. The eye is patched for 6 hours.”
This new mode of treatment has achieved 97pc success rate, claimed the doctor.
Another Senior Consultant of Disha Eye Hospital and Research Centre, Dr. Saurabh
Sanyal said: “Ignoring Pterygium can lead to blindness. A person suffering from visual
disturbance coupled with redness and irritation of the eye should immediately consult an
Opthalmologist for the treatment.”
Disha Eye Hospital which has opened hospitals in West Bengal's Barrackpore,
Sheoraphuli and Durgapur, will be soon opening branches in Baguihati and Howrah.
(IBNS)
Heart Diseases
Heart attacks
In 5 yrs, a jab to stop heart attacks? (The Times of India: 2.4.2012)
Injection May Help Prevent Build-Up Of Fat To Stop Clogging Of Arteries
London: Scientists, including an Indian-origin researcher, claim that a vaccine against
heart attack is being developed, which could be available in the market within five years.
Coronary heart disease occurs when fatty plaques build up in the blood vessels feeding
the heart and over time become narrowed. Parts of the plaque may break off causing a
clot to form which can block the artery causing a heart attack.
Now, a team, led by professor Prediman Shah from Cedars-Sinai Heart Institute in US
and professor Nilsson from Lund University in Sweden, says experiments have shown it
is possible to alter the way immune system reacts to plaques in the arteries to reduce
inflammation and the severity of the build-up.
In fact, the scientists say that injections of antibodies could help prevent the build up of
fat in the arteries which cause narrowings and break off leading to heart attacks, ‘The
Daily Telegraph’ reported. The team has already formulated a vaccine that reduced
plaque build up by 60 to 70% in mice.
The resulting CVX-210 vaccine, currently in development as an injection by
CardioVax, is waiting regulatory clearance to start clinical trials, say the scientists. A
second vaccine using the same materials has been formulated as a nasal spray, Prof
Nilsson said.
Moreover, another approach, of directly injecting antibodies against bad low density
lipoprotein which carries cholesterol in the blood and forms the basis of the plaque, is
already in trials. Professor Nilsson said: “The rationale is that since oxidized LDL plays a
major role in the development of atherosclerotic plaques and harmful inflammatory
processes, directly targeting oxidised LDL should prevent plaque formation and reduce
inflammation.”
Early studies showed that the antibody, BI-204, developed jointly by BioInvent and
Genentech, reduced plaques by half and was well tolerated when tested in 80 healthy
people. A trial of BI-204 in 144 people with heart disease is underway in America and
Canada where body scans will measure plaques in the arteries over time, say the
scientists. Nilsson said it was unlikely that the products would be given as traditional
vaccines in early childhood and instead were more like drugs in that they would need to
be given repeatedly.
Heart disease
Nasal spray that could combat heart disease coming in 5 years (New
Kerala: 3.4.2012)
A nasal spray that could remove fat in arteries which dramatically raises the risk of heart
attacks could be on the market in five years, according to researchers.
Researchers found that the new treatment was much more effective in removing fat from
arteries than established methods.
The vaccine can be given as an injection or in a slightly different form as a nasal spray.
The product, as yet unnamed, is waiting for regulatory clearance.
A study by Lund University in Sweden found it could reduce plaque by 60 to 70 percent
during tests on mice, the Mirror reported.
A trial on 144 heart disease sufferers is under way in the US and Canada.
The British Heart Foundation medical director Prof Peter Weissberg said the vaccine was
"very promising".
It works by stimulating the body's immune system to produce antibodies which tackle the
build-up of fatty deposits in arteries called plaque.
The new vaccine or nasal spray could be licensed within five years, the Frontiers in
CardioVascular Biology conference in London heard.
"The antibody therapy is likely to be expensive so you could probably only afford to give
it to people at high risk rather than everyone," said Lund University's Prof Jan Nilsson.
The scientists' conference also heard of promising attempts to repair heart muscles
scarred by cardiac arrests in mice. Injections of a virus carrying three genes were
successful. (ANI)
Heart disease
Soon, 30-sec eye test to help combat heart disease (New Kerala:
11.4.2012)
A new eye test, being developed in Britain, could save millions of lives by diagnosing
deadly heart disease early.
The cheap and easy-to-use scan would take just seconds to detect signs of heart disease,
meaning it could spare heart patients the ordeal of lengthy and invasive procedures.
The test takes high-definition digital images of patients' retinas to check for telltale signs
of heart disease such as changes to blood vessel width or unusually branched blood
vessels.
The 30-second check is expected to become a vital NHS tool in the battle against heart
disease, the Daily Express reported.
"The eyes provide a unique window into the patient's blood supply and the effect it has
on the human system," said imaging expert Dr Tom MacGillivray, who is leading the
research team developing the idea.
"By examining blood vessels closely we are aiming to detect abnormalities, spot signs of
heart disease and then act accordingly.
"It's about prevention rather than cure but could potentially affect millions," Dr
MacGillivray added.
Experts hope the eye scan could become part of a nationwide heart disease screening
programme within five years.
The University of Edinburgh Clinical Research Imaging Centre project is currently
testing 1,000 patients with suspected heart disease as part of the three-year study, the first
of its kind in the world.
The researchers are collaborating with experts from world-renowned Moorfields Eye
Hospital in London, the University of Dundee, NHS Lothian's Princess Alexandra Eye
Pavilion and NHS Tayside's Ninewells Hospital.
Scientists are particularly interested in subtle changes to blood vessels, which are not
obvious to a human visually inspecting an image. Once a picture has been taken, experts
can use complex computer image processing to identify the blood vessels and spot subtle
changes.
A specialist would then make a diagnosis and, if necessary, an individual would be given
a programme to help them reach better health and fitness levels before any heart
problems develop.
"It is hoped this procedure will catch people early on and act as an opportunity for them
to change their lifestyle before it's too late," Dr MacGillivray said.
"We are really excited by this project. We know that problems in the eye are linked to
conditions such as diabetes and that abnormalities in the eyes' blood vessels can also
indicate vascular problems in the brain.
"If we can identify early problems in the blood vessels we might potentially pinpoint
signs of heart disease. This could help identify people who would benefit from
preventative therapies," he added. (ANI)
Heart disease
Heart disease cloud on those with uncontrolled diabetes (The Hindu:
17.4.2012)
Two-thirds of those under the age of 55 with uncontrolled diabetes need treatment for
heart diseases, shows a Delhi Diabetic Research Centre survey. On the other hand, only
half of all healthy adults need such treatment.
The survey of 3,200 people with uncontrolled diabetes aged
between 35 and 55 years showed that 77% (or 2,464 people) underwent angiography, a
test for blocks in the arteries. More than 66% (2,112) of those with signs of heart diseases
underwent angioplasty, a treatment where stents are implanted to prop blocked arteries.
While 188 underwent heart bypass surgery, 118 others opted for non-surgical
alternatives.
"Our data shows 14% of Delhi's population are diabetics and an equal number are
undiagnosed or pre-diabetics, which means they will develop the disorder over the next
few years. Our data supports WHO and International Diabetes Federation data that over
50% diabetics suffer from cardiac problems," said Dr Ashok Jhingan, the centre's
chairman.
"The survey establishes the tremendous health care burden associated with uncontrolled
diabetes. It is a major risk factor for increased cholesterol and triglyceride levels as it has
the potential to block arteries and spur heart attacks," he said. "Patient perception about
the disease is casual and lack of seriousness is the leading cause for the coronary artery
disease."
The survey also found that most diabetics get their blood sugar tested once in 3-4 months.
Advice on diet and exercise is usually ignored.
The survey that began in 2006 was conducted over a period of five years.
"More awareness is needed to arrest this epidemic of heart disease. Regular exercise and
change in food habits can have a preventive effect in early stages of diabetes," said Dr
Jhingan.
Arteries
Understanding How Arteries Control Blood Pressure (Medical News
Today: 17.4.2012)
Scientists at the University of Southampton in the UK, have made a discovery that
improves our understanding of how arteries control blood pressure. The finding is
expected to lead to better treatments for cardiovascular or heart disease.
Led by Dr Graham Burdge, Reader in Human Nutrition at Southampton, the scientists
report their study in the 3 April issue of PLoS ONE. The research was funded by the
British Heart Foundation (BHF), and BHF Professor Mark Hanson is one of the coauthors.
High blood pressure is a risk factor in developing heart disease, a growing public health
issue that was responsible for one in three deaths in the UK in 2009.
Burdge told the press:
"Discovering a new process which controls how arteries work, and finding that it can be
modified in the laboratory, raises a strong possibility for developing new medicines that
may lead to better ways of treating cardiovascular disease."
Arteries control blood pressure by balancing two processes: one that constricts the artery
wall and another that relaxes it.
But in people at risk of developing high blood pressure or atherosclerosis, there is more
constriction, impeding the free flow of blood, which increases the risk for heart attack
and stroke.
The process through which arteries constrict their muscle walls relies on molecules called
eicosanoids. These fat-like compounds are made with the help of enzymes that break
down polyunsaturated fats.
By studying what happens in rats, the team discovered that the polyunsaturated fats used
to make the eicosanoids are made by muscle cells in the arteries, and not taken from
blood, as previously thought.
They experimented with deactivating two enzymes that help make the polyunsaturated
fats. They found this reduced arterial constriction, leading to freer blood flow, thereby
lowering the risk for high blood pressure.
They also found "epigenetic switches" behind this process that may explain why some
arteries show early signs of causing high blood pressure.
One switch controls a key gene for making polyunsaturated fats, while another switch
over-compensates for this.
Epigenetics is the study of how changes in gene activity that do not change genetic code
still get passed on to the next generation. It has led to the concept of the "epigenome", an
additional layer of instructions in the cellular material that controls gene expression. Put
very crudely, it is as though the genome in DNA contains all the instructions for making
an individual, but the epigenome decides which instructions are obeyed.
Epigenetic influences start early in life, even before birth. The discoveries made in this
study, for instance, show that the amount and type of fat that the mother consumes in
pregnancy affects the future heart health of her offspring by changing the ability of their
arteries to control blood pressure.
Hanson said their findings add to the "substantial body of knowledge showing that a
pregnant mother's diet can have significant effects on the health of her children in later
life."
"However, pregnant women shouldn't be too worried - by eating a healthy, balanced diet
mums can help protect their own and their child's heart health in the future," he added.
Burdge said a test based on epigenetic changes could provide a new way of screening
people for risk of heart disease before symptoms develop, something we can't do at
present.
In time, it might also be possible to correct such epigenetic defects, he added.
Heart Disease
Have a healthy heart (The Tribune:7 June 2012)
Indians are susceptible to cardiovascular diseases. Almost 60 per cent of the world's heart
patients are in India. One-fifth of all deaths in India are due to heart disease, which, it is
estimated, will be responsible for one-third of all deaths by 2020
ABOUT 17 million of the world population dies annually from heart disease and stroke,
of which 80 per cent of deaths occur in developing countries like India. Indians tend to
develop heart disease at an average of 10 to 15 years earlier than the population in west.
Due to predilection towards the younger population, we are losing about a million people
from our productive work force. For an individual who suffers a heart attack, not only
there is physical disability, there is great emotional, psychosocial, vocational and
economical trauma for the family and the community as well. A potential bread earner is
either made ineffective or is lost due to the inability to practice simple lifestyle measures.
Thus, heart disease is a heath as well an economic issue.
Causes
What makes Indians different to be disadvantaged? There are indeed reasons for this
natural “unfair” selection. We may have certain genetic predispositions. Our genes have
made us vulnerable to develop this disease. We could be vegetarian, teetotaller or have
average cholesterol values, yet could succumb to the disease. One hypothesis proposed
by geneticist James Neel in 1962 was the “thrifty or starvation gene hypothesis”.
According to this hypothesis, early human civilisations experienced periodic famine or
abundant harvests to survive. The early human race developed a genetic mechanism to
store fat for "a rainy day" when there was abundance of food. Now even when this
abundance has become omnipresent, our bodies still keep accumulating belly fat for a
potential nonexistent future famine.
India is poised for an economic revolution. This has certainly improved the living
standards of masses, as it has brought new swanky cars, lap tops, video games and junkfood joints. Drinking water has been replaced by soft drinks, football by playstations and
aalu tikki by big Mac’s burger. Most children too, have less active lifestyles. The only
exercise most professionals do is typing on the keypad or going to the washroom. A
young patient, a rich married man, had abnormal cholesterol levels and severe
hypertension. He used to get breathless on minimal exertion. On questioning, he admitted
to have drunk only soft drinks and no water for past 10 years and had avoided home
cooked food for these many years. Another teenager having rich, famous and busy
parents, had a haemoglobin of 8 gm, as he was living on instant noodles and junk food
for months together.
Stress has slowly crept in to our lives as inevitable certainty. We are scared of failure. We
take pride in our super-human achievements and being workaholics. Sadly, for getting
these milestones, stress is as big a risk factor for heart disease as diabetes and high blood
pressure. Perhaps, the average urban Indian is now more comfortable but less happy.
Diabetes is perhaps the most important emerging risk factor for the rising heart disease
rates. It is very much a lifestyle disease due to poor eating habits, lack of exercise, taking
undue stress and eating excessive sweets. Diabetes and heart disease feed upon each other
and three out of four deaths in diabetic patients are due to cardiovascular disorders.
Experts report that diabetes decreases life expectancy by five to 10 years. With highest
number of cardiovascular disease and diabetic patients in the world, healthcare in India
would be extremely expensive and a substantial amount of our economy would be
exhausted in checking a disorder, which is preventable.
Consuming alcohol is another risk factor. Many believe that it is beneficial and start
consuming it on a regular basis. Though only two pegs are recommended but often this
advice is disregarded. Also most people consume alcohol, along with a variety of fried or
junk food, which also has unhealthy trans fats.
Modern scientific Indian research has proved that Indians do not metabolise alcohol as
efficiently and even small amounts of alcohol are detrimental for us.
Smoking is another common, but preventable, risk factor not only for heart disease, but
for many cancers as well.
High blood pressure and cholesterol are other major risk factors for heart disease.
Hypertension, often referred to as "the silent killer" is the first manifestation of this
disease. It affects various other body systems but hypertensive heart disease is the no. 1
cause of death associated with high blood pressure. Hypertension is the most common
cardiovascular disorder in India. It is a principle risk factor for stroke and a major risk
factor for heart disease. It is extremely important to keep blood pressure controlled as
even 2 mmHg population-wide decrease in blood pressure can prevent 1,51,000 stroke
and 1,53,000 coronary deaths annually in India.
High cholesterol in India has often a specific pattern as generally triglyceride levels are
high. Nonetheless, it is important to control blood cholesterol as it has been proved that
even 1 per cent increase in cholesterol level is equivalent to a 2 per cent rise in the
incidence of heart disease.
Obesity or being overweight is another major risk factor for heart disease. Even
osteoporosis, many cancers, gall bladder disease, diabetes and sleep apnoea disorders are
related to it.
Even apnoea in itself is fast becoming an important risk factor for heart disease.
Overweight people, who start snoring at a moment’s notice, are at risk of apnoea. Experts
have estimated that this disorder increases a person's risk of having a heart attack or
dying by 30 per cent over a period of four to five years.
Management
Perhaps no other disease epitomises the saying "prevention is better than cure" than heart
disease. It is important to make small changes in our lifestyle. Eating a heart-healthy diet
is easy. There is a need to swap over to good old satvic "slow food" cooked at home in
less oil with lots of vegetables and fruits and teach our children the same.
Eating with the family, away from television at the dining table not only improve
relationships but also curbs overeating.
Smoking and alcohol consumption should be discouraged.
It is extremely important to maintain a healthy weight and regular exercise is an
important way of doing so. Regular brisk walking for 40 minutes a day is the best regular
exercise.
Regular health checks, at least annually, too, are must.
To "know your numbers" is important as many disorders attack us silently. Everyone
should know his/her blood pressure, cholesterol levels, blood sugar levels, exercise
capacity and ideal body weight.
Sleep is as important as work to achieve our goals. At least six to eight hours of sleep is
essential for optimal functioning and health.
To keep stress away is impossible in this modern, competitive, target-oriented world. So,
it is helpful to take a break now and then to "recharge" your energy.
If risk factors like diabetes or hypertension or sleep apnoea are present, it is important to
meet your cardiologist regularly and to take medicines religiously.
Those who have already suffered an attack need to realise that modern medicine has
almost made their life longevity identical to those who have never suffered before.
Lastly, to get back to simple Indian lifestyle is perhaps more heart healthy than the
artificial, junk food-ridden modern existence.
Heart disease has emerged as a significant healthcare burden for India
BE HEALTHY
Eat healthy. Try being vegan. Eat more fruits, nuts and vegetables.
Count your calories and avoid soft drinks, French fries and bakery products.
Include whole grains, oatmeal, brown rice etc. in your diet. Also home-cooked food is
heart healthy.
Avoid alcohol and other addictions.
Limit saturated fats. Avoid trans fats. Choose oils over ghee as cooking media.
Walk every day. Every step would increase a breath of your life.
Be happy. That is the only best thing you can do with your mood.
HEARTY FACTS
Heart disease strikes those who are unaware. Sixty per cent of attacks occur in people
who never had any symptom before.
Almost 50 per cent of heart attacks are fatal in the very first hour.
In western countries, the death rate has fallen in heart patients. But in countries like India
there has been a phenomenal jump.
India is soon going to be the diabetic, hypertensive and heart-disease capital of the world
with the maximum number of patients.
Heart disease is the leading cause of death for both men and women globally.
Fiftytwo persons in USA die due to a heart attack every minute making it 1,259 per day,
8,843 per week and 459,840 per year.
In 2010, the cost of managing heart disease alone in USA was $108.9 billion.
Thityeight per cent of women die within a year after having a heart attack, as compared
to 25 per cent of men.
One can add up to five years to one's life expectancy by quitting smoking - the earlier the
age at which you quit the better
Heart Disease
Have a healthy heart (The Tribune:7 June 2012)
Indians are susceptible to cardiovascular diseases. Almost 60 per cent of the world's heart
patients are in India. One-fifth of all deaths in India are due to heart disease, which, it is
estimated, will be responsible for one-third of all deaths by 2020
ABOUT 17 million of the world population dies annually from heart disease and stroke,
of which 80 per cent of deaths occur in developing countries like India. Indians tend to
develop heart disease at an average of 10 to 15 years earlier than the population in west.
Due to predilection towards the younger population, we are losing about a million people
from our productive work force. For an individual who suffers a heart attack, not only
there is physical disability, there is great emotional, psychosocial, vocational and
economical trauma for the family and the community as well. A potential bread earner is
either made ineffective or is lost due to the inability to practice simple lifestyle measures.
Thus, heart disease is a heath as well an economic issue.
Causes
What makes Indians different to be disadvantaged? There are indeed reasons for this
natural “unfair” selection. We may have certain genetic predispositions. Our genes have
made us vulnerable to develop this disease. We could be vegetarian, teetotaller or have
average cholesterol values, yet could succumb to the disease. One hypothesis proposed
by geneticist James Neel in 1962 was the “thrifty or starvation gene hypothesis”.
According to this hypothesis, early human civilisations experienced periodic famine or
abundant harvests to survive. The early human race developed a genetic mechanism to
store fat for "a rainy day" when there was abundance of food. Now even when this
abundance has become omnipresent, our bodies still keep accumulating belly fat for a
potential nonexistent future famine.
India is poised for an economic revolution. This has certainly improved the living
standards of masses, as it has brought new swanky cars, lap tops, video games and junkfood joints. Drinking water has been replaced by soft drinks, football by playstations and
aalu tikki by big Mac’s burger. Most children too, have less active lifestyles. The only
exercise most professionals do is typing on the keypad or going to the washroom. A
young patient, a rich married man, had abnormal cholesterol levels and severe
hypertension. He used to get breathless on minimal exertion. On questioning, he admitted
to have drunk only soft drinks and no water for past 10 years and had avoided home
cooked food for these many years. Another teenager having rich, famous and busy
parents, had a haemoglobin of 8 gm, as he was living on instant noodles and junk food
for months together.
Stress has slowly crept in to our lives as inevitable certainty. We are scared of failure. We
take pride in our super-human achievements and being workaholics. Sadly, for getting
these milestones, stress is as big a risk factor for heart disease as diabetes and high blood
pressure. Perhaps, the average urban Indian is now more comfortable but less happy.
Diabetes is perhaps the most important emerging risk factor for the rising heart disease
rates. It is very much a lifestyle disease due to poor eating habits, lack of exercise, taking
undue stress and eating excessive sweets. Diabetes and heart disease feed upon each other
and three out of four deaths in diabetic patients are due to cardiovascular disorders.
Experts report that diabetes decreases life expectancy by five to 10 years. With highest
number of cardiovascular disease and diabetic patients in the world, healthcare in India
would be extremely expensive and a substantial amount of our economy would be
exhausted in checking a disorder, which is preventable.
Consuming alcohol is another risk factor. Many believe that it is beneficial and start
consuming it on a regular basis. Though only two pegs are recommended but often this
advice is disregarded. Also most people consume alcohol, along with a variety of fried or
junk food, which also has unhealthy trans fats.
Modern scientific Indian research has proved that Indians do not metabolise alcohol as
efficiently and even small amounts of alcohol are detrimental for us.
Smoking is another common, but preventable, risk factor not only for heart disease, but
for many cancers as well.
High blood pressure and cholesterol are other major risk factors for heart disease.
Hypertension, often referred to as "the silent killer" is the first manifestation of this
disease. It affects various other body systems but hypertensive heart disease is the no. 1
cause of death associated with high blood pressure. Hypertension is the most common
cardiovascular disorder in India. It is a principle risk factor for stroke and a major risk
factor for heart disease. It is extremely important to keep blood pressure controlled as
even 2 mmHg population-wide decrease in blood pressure can prevent 1,51,000 stroke
and 1,53,000 coronary deaths annually in India.
High cholesterol in India has often a specific pattern as generally triglyceride levels are
high. Nonetheless, it is important to control blood cholesterol as it has been proved that
even 1 per cent increase in cholesterol level is equivalent to a 2 per cent rise in the
incidence of heart disease.
Obesity or being overweight is another major risk factor for heart disease. Even
osteoporosis, many cancers, gall bladder disease, diabetes and sleep apnoea disorders are
related to it.
Even apnoea in itself is fast becoming an important risk factor for heart disease.
Overweight people, who start snoring at a moment’s notice, are at risk of apnoea. Experts
have estimated that this disorder increases a person's risk of having a heart attack or
dying by 30 per cent over a period of four to five years.
Management
Perhaps no other disease epitomises the saying "prevention is better than cure" than heart
disease. It is important to make small changes in our lifestyle. Eating a heart-healthy diet
is easy. There is a need to swap over to good old satvic "slow food" cooked at home in
less oil with lots of vegetables and fruits and teach our children the same.
Eating with the family, away from television at the dining table not only improve
relationships but also curbs overeating.
Smoking and alcohol consumption should be discouraged.
It is extremely important to maintain a healthy weight and regular exercise is an
important way of doing so. Regular brisk walking for 40 minutes a day is the best regular
exercise.
Regular health checks, at least annually, too, are must.
To "know your numbers" is important as many disorders attack us silently. Everyone
should know his/her blood pressure, cholesterol levels, blood sugar levels, exercise
capacity and ideal body weight.
Sleep is as important as work to achieve our goals. At least six to eight hours of sleep is
essential for optimal functioning and health.
To keep stress away is impossible in this modern, competitive, target-oriented world. So,
it is helpful to take a break now and then to "recharge" your energy.
If risk factors like diabetes or hypertension or sleep apnoea are present, it is important to
meet your cardiologist regularly and to take medicines religiously.
Those who have already suffered an attack need to realise that modern medicine has
almost made their life longevity identical to those who have never suffered before.
Lastly, to get back to simple Indian lifestyle is perhaps more heart healthy than the
artificial, junk food-ridden modern existence.
Heart disease has emerged as a significant healthcare burden for India
BE HEALTHY
Eat healthy. Try being vegan. Eat more fruits, nuts and vegetables.
Count your calories and avoid soft drinks, French fries and bakery products.
Include whole grains, oatmeal, brown rice etc. in your diet. Also home-cooked food is
heart healthy.
Avoid alcohol and other addictions.
Limit saturated fats. Avoid trans fats. Choose oils over ghee as cooking media.
Walk every day. Every step would increase a breath of your life.
Be happy. That is the only best thing you can do with your mood.
HEARTY FACTS
Heart disease strikes those who are unaware. Sixty per cent of attacks occur in people
who never had any symptom before.
Almost 50 per cent of heart attacks are fatal in the very first hour.
In western countries, the death rate has fallen in heart patients. But in countries like India
there has been a phenomenal jump.
India is soon going to be the diabetic, hypertensive and heart-disease capital of the world
with the maximum number of patients.
Heart disease is the leading cause of death for both men and women globally.
Fiftytwo persons in USA die due to a heart attack every minute making it 1,259 per day,
8,843 per week and 459,840 per year.
In 2010, the cost of managing heart disease alone in USA was $108.9 billion.
Thityeight per cent of women die within a year after having a heart attack, as compared
to 25 per cent of men.
One can add up to five years to one's life expectancy by quitting smoking - the earlier the
age at which you quit the better
Heart Disease
Scientists Discover A Stem Cell That Causes Heart Disease (Medical
UC Berkeley scientists published a report this week in the journal Nature
Communications saying that they have isolated a type of stem cell that causes heart
disease in later life.
The research is profound because it contradicts much of the generally accepted theories
of what causes arterial hardening, and the concept may also relate to many other diseases
could the associated stem cells be pinpointed.
What senior author Song Li, a bioengineering professor at UC Berkeley and a researcher
at the Berkeley Stem Cell Center, and his team have uncovered is a dormant stem cell in
blood vessel walls, that seems to sit inactive for most of a person's lifetime, before
coming to life and causing less functional cells to begin to grow. Li says these new types
of cells that start growing in later life, are the root cause of arterial hardening and
clogging that are associated with deadly strokes and heart attacks.
Originally, it was thought that the smooth muscle cells in the arteries lining become
scarred over time, and this leads to the narrow and brittle arteries that play a major part in
causing cardiovascular disease. Not so says Liu: Essentially, what the scientists are
saying is that the smooth muscle cells are not to blame. Rather a different kind of stem
cell, that Li calls multipotent vascular stem cells, kicks in, and begins growing cells that
look much like the smooth muscle cells, but don't function correctly. The cells were not
found previously, because there are so few of them, that they were hard to isolate.
Li continues:
"We call them sleeping beauty or sleeping evil cells, because they don't do anything when
they're dormant. The stem cells stay quiescent for decades before they start to grow and
they make the blood vessels harden."
It almost sounds like something from Blade Runner, where the replicant humans have
been deliberately designed to deteriorate and die at a much faster rate than the natural
ones. What purpose would it serve the body under standard evolutionary terms to have
cells activating later in life that effectively lead to its demise? With the arteries poorly
formed, with wrong cell types, the blood flow becomes slowed and can then stopped
completely. This causes strokes or heart attacks, depending on the location of the
blockage. Strokes and heart attacks are one of the leading causes of death in the United
States.
Creating drugs or other genetic treatments to shut down these stem cells or even
deactivate them while a person is still young has the potential in the future to prevent
arteriole hardening, reverse the damage already done, and even make this type of
cardiovascular disease a thing of the past. Perhaps the futuristic Woody Allen movie
"Sleeper" where people smoke tobacco and eat a high fat diet because it's healthier is not
so far fetched after all.
Li backs up his theory by pointing out that the current ideas, of smooth muscle cells in
the artery walls, "dedifferentiating", or basically reverting back to an earlier stage of
development and causing the scaring and degeneration seen in hardened arteries, actually
had no fundamental proven mechanism to back it.
Li traced the lineage of the cells back to the multipotent vascular stem cells, which are
able to form several types of cell, including the smooth muscle cells.
Dr. Deepak Srivastava, director of the Gladstone Institute of Cardiovascular Disease at
UCSF, who provided mouse tissue samples to the UC Berkeley scientists but was not
involved in the research commented on the dramatic findings:
These findings shift the paradigm ... If the new data holds up, the target for treating
vascular disease may be very different than what we've been aiming at ... Maybe the
reason we've met with limited success in treating heart disease is because we've been
going after the wrong target."
It is worth noting, of course, that the research is ground breaking and will need to be
repeated and confirmed by other research teams, and Li did most of his work on mouse
rather than human tissue. Nonetheless, it is an impressive work and one that will soon
give drug companies a target to begin preventing growth of these negative "death" cells.
Interestingly, the stem cells that form arteries are also capable of becoming nerve,
cartilage, bone and fat cells, suggesting why arteries become brittle or even filled with fat
deposits. Li says that trying to attack the problem with diets and lower cholesterol is just
attacking the symptoms, much like trying to stop a runny nose when you have a cold.
The research is certainly eye opening, and when we think back 100 years to some of the
more outlandish scientific theories that have long since been discarded, it doesn't require
much stretch of the imagination to realize that there must still be theories taken to be
practically a fact, that are at best misleading or at worse plain wrong. In the spirit of a
true scientist, Li has reminded us that we have so much more to understand about our
existence.
High Blood Pressure
High Blood Pressure
Changes in Gene Expression May Help Explain High Blood Pressure in
Pregnancy(Science daily: 16.4.2012)
Virginia Commonwealth University School of Medicine researchers have discovered that
changes in the gene expression of a key enzyme may contribute to high blood pressure
and increase susceptibility to forming blood clots in pregnant women with preeclampsia.
These findings could provide clues to the best treatment approaches for high blood
pressure and the formation of blood clots that can block blood flow to a pregnant
woman's internal organs and lead to organ failure.
Researchers have been working to determine the root cause of preeclampsia on the
molecular level and have now identified that epigenetic mechanisms may be at play.
Epigenetics refers to changes in gene expression that are mediated through mechanisms
other than changes in the DNA sequence.
In a study published online this week in Hypertension, a journal of the American Heart
Association, the VCU team reported that thromboxane synthase -- an important
inflammatory enzyme -- is increased in the blood vessels of expectant mothers with
preeclampsia. The thromboxane synthase gene codes for this enzyme, which is involved
in several processes including cardiovascular disease and stroke. This enzyme results in
the synthesis of thromboxane, which increases blood pressure and causes blood clots.
"The present work is unique because it opens up a new concept as to the cause and
subsequent consequences of preeclampsia relating to epigenetics," said corresponding
author Scott W. Walsh, Ph.D., professor in the VCU Department of Obstetrics and
Gynecology. "It is the first study to show that epigenetic alterations in the blood vessels
of the mother are related to preeclampsia."
According to Walsh, one of the main epigenetic mechanisms is methylation of the DNA,
which controls the expression of genes. The increase of this enzyme in the blood vessels
is related to reduced DNA methylation and the infiltration of neutrophils into the blood
vessels. Neutrophils are white blood cells that normally help fight infection.
In the future, Walsh said some potential treatments for preeclampsia may include
inhibition of thromboxane synthase, blockade of thromboxane receptors or dietary
supplementation with folate. He said that folate supplementation could increase
methylation donors to protect against adverse changes in DNA methylation that affect
expression of the thromboxane synthase enzyme.
This study builds on previously published work by the VCU team that appeared in the
November 2011 issue of Hypertension and in the January 2011 issue of the American
Journal of Pathology and demonstrated a significant role for neutrophils as causative
agents of high blood pressure in preeclampsia.
This work was supported by grants from the National Heart, Lung and Blood Institute
and the National Center on Minority Health and Health Disparities.
Walsh collaborated with Ahmad A. Mousa, Ph.D., graduate student in the Department of
Physiology and Biophysics, and Jerome F. Strauss III, M.D., Ph.D., dean of the VCU
School of Medicine.
BP
Additional BP screening may cut incidence of CVD events and death
(The Tribune: 25.4.2012)
A 25 per cent increase in high blood pressure screening in 19 developing countries would
reduce the number of cardiovascular disease (CVD) events and deaths that occur each
year by up to 3 per cent in these countries, a new study has suggested. The study by
scientists at the Harvard School of Medicine found that around 900 million people in
developing countries have high blood pressure but that only one-third are aware of their
disease.
Moreover, only 100 million of these people receive treatment, while only 5 per cent of
the total are controlled. Against this backdrop, this study was designed to assess the costeffectiveness of an intervention to increase screening by 25 per cent in developing
countries using a non-lab screening tool to treat those with a systolic blood pressure of
greater than 140 mmHg and CVD risk of greater than 20 per cent. — ANI
Kidney Diseases
Kidney Stone
Kidney Stone Mystery Solved: Why Some People Are More Prone to
Develop Kidney Stones (Science Daily: 19.4.2012)
Kidney stones strike an estimated 1 million Americans each year, and those who have
experienced the excruciating pain say it is among the worst known to man (or woman).
Now, new research by scientists at Washington University School of Medicine in St.
Louis provides evidence to explain why some people are more prone to develop the
condition than others. Their discovery opens the door to finding effective drug treatments
and a test that could assess a person's risk of kidney stones.
"Now, we finally have a more complete picture detailing why some people develop
kidney stones and others do not," says senior author Jianghui Hou, PhD, assistant
professor of medicine. "With this information, we can begin to think about better
treatments and ways to determine a person's risk of the condition, which typically
increases with age."
The research, in mice, is now available online in the EMBO Journal, published by the
European Molecular Biology Organization.
Because kidneys function the same way in mice as in humans, the new findings can help
scientists understand the root causes of kidney stones in patients. The mouse model used
in the study can also serve as a platform for the preclinical testing of novel treatments for
the condition, the researchers say.
Most kidney stones form when the urine becomes too concentrated, allowing minerals
like calcium to crystallize and stick together. Diet plays a role in the condition -- not
drinking enough water or eating too much salt (which binds to calcium) also increases the
risk of stones.
But genes are partly to blame. A common genetic variation in a gene called claudin-14
recently has been linked to a substantial increase in risk -- roughly 65 percent -- of getting
kidney stones. In the new study, the researchers have shown how alterations in the gene's
activity influence the development of stones.
Typically, the claudin-14 gene is not active in the kidney. The new research shows that
its expression is dampened by two snippets of RNA, a sister molecule of DNA, that
essentially silence the gene.
When claudin-14 is idled, the kidney's filtering system works like it's supposed to.
Essential minerals in the blood like calcium and magnesium pass through the kidneys and
are reabsorbed back into the blood, where they are transported to cells to carry out basic
functions of life.
But when people eat a diet high in calcium or salt and don't drink enough water, the small
RNA molecules release their hold on claudin-14. An increase in the gene's activity
prevents calcium from re-entering the blood, the study shows.
Hou and his team have found that claudin-14 blocks calcium from entering passageways
called tight junctions in cells that line the kidney and separate blood from urine.
Without a way back to the bloodstream, excess calcium goes into the urine. Too much
calcium in the urine can lead to stones in the kidneys or bladder. Intense pain develops
when a large stone gets stuck in the bladder, ureter or urethra and blocks the flow of
urine.
Hou's research supports the theory that people with a common variation in claudin-14
lose the ability to regulate the gene's activity, increasing the risk of kidney stones.
He is optimistic, however, that drugs could be developed to target the short stretches of
RNA that are intimately linked to claudin-14. Drugs that mimic these so-called
microRNAs could keep the activity of claudin-14 in check and reduce the likelihood that
stones would form.
Also, it may one day be possible to develop a diagnostic test to measure levels of the
claudin-14 protein excreted in urine. Elevated levels would indicate an increased risk of
stones, and people could take steps to prevent stones by modifying their diet.
"Many genes likely play a role in the formation of kidney stones," Hou says. "But this
study gives us a better idea of the way one of the major players work. Now that we
understand the physiology of the condition, we can start to think about better treatments
or even ways to prevent stones from developing in the first place."
The research was funded, in part, by the National Institutes of Health (NIH) and the
American Heart Association.
Hou is working with Washington University's Office of Technology Management on an
invention related to work described in the paper.
Kidney
Get tested for kidney problems to be sure(World Newspapers;15.6.2012)
There are certain health conditions where it becomes immediately obvious that something
is wrong. On the other hand, certain ailments tend to creep up and grow within us without
any apparent warning signs or symptoms. Kidney problems, fall into this dangerous
second category.
According to the AKF, kidney problems may have no symptoms until they are very far
along.The only way to be sure how your kidneys are working is to get tested.If you do
have symptoms, they might include:
Feeling sick to your stomach often
Feeling tired or dizzy often
Swelling in your feet, hands or face
Back pain
Bloody, foamy or dark-coloured urine
High blood pressure
A change in how often you go to the bathroom
If you think you may have a kidney problem, talk to your doctor.Kidney problems that
are caught early can be treated.Kidney problems that are left untreated may lead to
permanent damage or even kidney failure.
Your kidneys clean waste and extra fluid from your blood.They also do many other jobs
that you need in order to live.
Control chemicals and fluid in your body
Help control your blood pressure
Help keep your bones healthy
Help you make red blood cells
The term "chronic kidney disease" (CKD) means lasting damage to the kidneys that can
get worse over time.If the damage is very bad, your kidneys may stop working.This is
called kidney failure.If your kidneys fail, you will need dialysis or a kidney transplant in
order to live.
There is no limit to how long a person can live on dialysis.This can vary a lot depending
on a person's age, other health concerns and how well they follow the treatment
plan.With good care, it is very possible for a person to live for many years on dialysis.
CKD can be caused by many different diseases.The most common causes of CKD are
diabetes and high blood pressure.Some infections, inherited diseases and injuries can also
cause CKD.
Anyone can develop kidney problems, but you are more at risk if you:
Have diabetes
Have high blood pressure
Have heart disease
Have a family member with kidney disease
Are over 60 years old
If you have a family member with kidney failure, you may be at more risk for kidney
disease.Also, diabetes and high blood pressure, the two leading causes of kidney failure,
run in families.If you have a family member with kidney failure, diabetes or high blood
pressure, talk to your doctor about getting tested.
You may not need to drink a full eight glasses of water every day to stay healthy, as once
thought, but water is still a better choice than drinks that have caffeine, like soda, coffee
or tea.These drinks can actually make you thirstier.Avoiding sugary juices is also a good
idea, especially if you have diabetes.Drinking plenty of water may also help prevent
kidney stones and urinary tract infections.
Do keep in mind that if you have late stage kidney disease or are on dialysis, you may
need to limit how much you drink.Talk to your doctor about how much fluid you should
have each day.
Alcohol affects your liver more directly than your kidneys, but it can raise your blood
pressure.High blood pressure can damage the tiny filters in your kidneys.In fact, high
blood pressure is the second leading cause of kidney failure.
Leprosy
Leprosy-free State
Bihar is going to be a leprosy-free State” (The Hindu: 25.4.2012)
Bihar is going to be a leprosy-free State with the number of such patients declining to
0.89 per cent per 10,000 people by March 31, an official said on Tuesday.
“Bihar has almost become a leprosy-free State with the number of such patients declining
to less than one per cent of the population,” Bihar State Health Society Secretary-cumExecutive Officer Sanjay Kumar told journalists.
It is a significant achievement as the number of leprosy patients in Bihar stood at 1.2 per
cent of the population last year, he said. The number at present stands at 9,440 spread
over 10 districts of the State, and preventive and curative action are being taken to further
bring the figure down, Mr. Kumar said.
Adequate multi-drug therapy drugs have been made available at the government and
private hospitals in the State for free distribution among leprosy patients, he said.
Since 1996-97, many leprosy patients have been cured of the disease through MDT drugs
and therapy, he said. — PTI
Malaria
Malaria Parasite
Compound Halts Growth of Malaria Parasite (Science daily: 3.4.2012)
A drug candidate that has shown promise for neutralizing dangerous bacteria also
prevents growth of the parasite that causes malaria, new research by a Yale University
team headed by Nobel laureate Sidney Altman shows.
The compound created in the labs of Altman and co-senior author Choukri Ben Mamoun
at the Yale School of Medicine penetrates red blood cells and targets molecular
machinery that enables the parasite to grow within the cells, according to findings
published the week of April 2 in the Proceedings of the National Academy of Sciences.
Malaria sickens more than 200 million people and kills more than a million people
annually. The disease is caused by fives species of parasites of the genus Plasmodium,
which is transmitted to humans by mosquitoes.
"While we primarily looked at one species of parasite, it is clear the compound also
knocks out drug-resistant strains of malaria as well," Altman said. "This compound can
wipe out strains that are currently resistant to drugs such as chloroquine and
pyrimethamine."
The work is an outgrowth of the discovery by Yale immunobiology professor Alfred L.
M. Bothwell of a basic peptide that the Yale team showed can penetrate cell walls and
membranes. Altman and colleagues also added a piece of RNA to this peptide which then
attaches to messenger RNA produced by parasites within the blood cells. The presence of
this complex activates a molecular response that disables the parasite.
Altman's lab has already shown this compound can kill dangerous strains of bacteria and
is currently investigating its efficacy in combating infections in skin wounds. The current
paper illustrates the compound's effectiveness in red blood cell tissue culture. Altman
stressed that more tests must be conducted to make sure the compound works in animals
and people as well.
"It will be some time before this is commercially available," Altman said.
Altman was awarded the Nobel Prize in Chemistry in 1989 along with Thomas R. Cech
for their discoveries of the catalytic properties of RNA.
Other Yale authors of the study are Yoann Augagneur, Donna Wesolowski and Hyun
Seop Tae.
The National Institutes of Health and Burroughs Wellcome Fund were the primary
funding sources for the study.
Encephalitis
Culex menace: The sting that triggers encephalitis (The Times of India:
3.4.2012)
Suddenly, mosquitoes swarm city
is under attack from the Culex mosquito, persistent biters whose numbers are known to
grow exponentially at dawn and dusk. Alarm bells were rung after a “very high density”
of these mosquitoes was reported in the past two weeks.
The spurt, reported by the National Vector Borne Disease Control Programme, made
MCD call an emergency meeting on March 27 with officials from Delhi, Ghaziabad,
Faridabad, Gurgaon and Noida. They plan to launch a massive exercise to cover open
drains or “blast” them with the bio larvicide, BTI, with the help of pressure tanks.
Not considered as much of a threat as the Anopheles and Aedes mosquitoes that spread
malaria and dengue, respectively, Culex is a vector for an assortment of diseases that can
be transmitted to humans like filariasis and encephalitis. Thankfully, these diseases have
low prevalence in and around the capital. Culex menace: The sting that triggers
encephalitis
New Delhi: The sudden spurt in the number of Culex mosquito has sent alarms bells
ringing among the authorities concerned.
NVBDCP has deputed an eight-member team to visit different regions of Delhi
between 5am and 7am on Tuesday morning to collect female Culex specimens in order to
quantify its density.
NVBDCP says the male Culex mosquito feeds solely on plant nectar through its
twoweek existence. It’s the female Culex that requires a blood meal to nourish her eggs
before she lays them. The female lays 100 to 300 eggs at a time that hatch two days later.
A female lays a raft of eggs every third night during its life span.
MCD medical officer Dr N K Yadav told TOI, “Unlike mosquitoes like Aedes or
Anopheles that breed in fresh water, Culex breeds in stagnant dirty water in drains. As
part of our strategy finalized in our meeting last week with health officials and vets from
in and around Delhi, we will try and cover as many open drains as possible. We will use
BTI in drains we can’t shut to blast the larvae.”
An NVBDCP expert said Delhi at present has over 1,300 small and large drains, 90%
of which are open and are the best breeding grounds for the Culex mosquito.
NVBDCP chief Dr A C Dhariwal said surveillance carried out by a group of
entomologists reported a high density of Culex mosquitoes. “We refer to Culex as
nuisance mosquitoes. They swarm houses especially at dawn and dusk, which is the
feeding cycle of the female. The rest of the time they sit on the wall trying to digest the
blood. Culex is not considered as much of a threat as Anopheles and Aedes which cause
malaria and dengue,” Dhariwal said.
Union health minister Ghulam Nabi Azad has also written to the state governments to
immediately launch a drive against mosquito breeding. Experts say the present
temperature — 15-32 degrees Celsius — is perfect for Culex to breed. “Once it starts to
get hotter, these mosquitoes will start to disappear,” Dhariwal said.
BEWARE OF THE BITE
Culex mosquito, better known as 'nuisance mosquito' does not cause malaria or dengue,
but spreads filariasis & encephalitis STAY SAFE
Ensure there’s no
stagnant water
National Vector Borne Disease Control Programme has told MCD to take steps to control
menace
MCD held emergency meet with health officials and vets from Delhi, NCR
Larvae range indicator 0% in early March, rose to 2% last week
All open drains to be covered, pesticides to be sprayed QUICK FACTS ABOUT CULEX
Lives from 10 to 14 days Weak flier, prefers to bite at dawn or after dusk Breeds in dirty
water, unlike other mosquitoes Feeds on plant nectar Female Culex requires blood meal
to nourish eggs Eggs laid on stagnant water Culex deposits between 100 to 300 eggs at a
time
Malaria
New optical tool promises rapid and accurate diagnosis of malaria(New
Kerala: 20.4.2012)
A potential new optical imaging system may make the diagnosis of malaria much easier,
faster and more accurate, a new study has revealed.
The new system, developed by an international team of researchers, uses "speckle
imaging," an optical sensing technique that measures the differences in how laser light
bounces off the membranes of healthy and infected red blood cells.
By comparing the apparently random scattering (speckling) of light as it builds up from
multiple images, a clear statistical pattern emerges that identifies cells that harbor the
parasite responsible for malaria.
The team's preliminary results involved 25 cell samples (12 healthy, 13 infected).
"A new diagnostic tool is urgently needed," noted Dan Cojoc, Ph.D., lead author of the
study and a researcher at the Materials Technology Institute, National Research Council
in Trieste, Italy.
"With a fast, portable, low-cost, and accurate diagnostic tool, physicians can confidently
and quickly administer the correct therapy."
According to the researchers, this timely diagnosis maximizes the likelihood of
successful, life-saving treatment. It also minimizes the chances that inappropriate therapy
will be given, which would help combat the growing problem of drug resistant malaria.
The current diagnostic gold standard for malaria, Giemsa-stained blood smear, uses
optical microscopy to identify different species of the malaria agent, Plasmodium, in
blood samples.
This technique requires skilled medical professionals trained to identify the telltale signs
of the parasite throughout its life cycle and its population density in the bloodstream.
In an effort to find a more effective means of detection, Cojoc's team of biophysics
researchers in Italy joined forces with malaria experts from Israel and Spain.
Together they turned to speckle imaging, because of its ability to construct a statistically
significant picture, as a new way to improve the diagnosis of malaria. It's called speckling
because of light's wave-like ability to brighten as waves combine and fade as they cancel.
The resulting patterns have a distinctive speckled pattern.
The specific technique the researchers used is called Secondary Speckle Sensing
Microscopy.
By applying this imaging technique to an automated high-throughput system, the
researchers were able to deliver results in as little as 30 minutes.
They did so with a high rate of accuracy and without the need for highly trained
technicians and a well-equipped hospital laboratory. The current time to diagnosis in
most African medical centers is typically between 8-10 hours.
Secondary Speckle Sensing Microscopy begins with illuminating red blood cells with a
tilted laser beam. This produces a time-varied speckle pattern field based on the cells'
thermal vibration and the movement of their membranes - traits that differ in healthy and
diseased states.
The speckle patterns are inspected under the microscope and recorded on a camera at a
high frame rate.
Using two automated analytical methods - "fuzzy logic" and "principal component
analysis" - scientists scour a set of speckle parameters to extract statistical information
about changes in red blood cells' membranes and their flickering movements.
Scientists then make a diagnosis based on statistical correlations in speckle patterns
between healthy and diseased cells.
While these preliminary results are encouraging, the investigators noted that further study
is needed to validate the results and further refine the technique. If the positive outcomes
hold up, field studies or clinical trials of the new method might be deployed as early as
2013.
The study has been published in the Optical Society's (OSA) open-access journal
Biomedical Optics Express. (ANI)
Drug-resistant malaria
Drug-resistant malaria import under scrutiny (The Times of India:
25.4.2012)
New Delhi: India is stepping up surveillance against importing drug-resistant malaria.
The National Institute of Malaria Research (NIMR) has joined the global Tracking
Resistance to Artemisinin (TRAC) study, being spearheaded by the University of Oxford,
which will look at parasite clearance time, parasite reduction ratio and the time to achieve
a fall of 50%, 90% and 99% of the pre-treatment parasitaemia.
Malaria, resistant to the drug of choice, Artemisinin, was found along ThailandMyanmar border — 800km westward from where it was first confirmed in Cambodia.
Artemisinin Combination Therapies kills malaria in bloodstream within 24-36 hours.
With the drug-resistant strain, ACT needs 120 hours to kill the parasite.
Oxford researchers say as artemisinins are the most potent anti-malarial drugs, the
reduction in parasite numbers is rapid. Hence, measures of reducing parasite counts are
needed. NIMR’s Dr Neena Valecha said, “The main purpose of this study is to address
the question regarding artemisinin resistance for which there is no answer. Has
artemisinin resistant Plasmodium falciparum spread from western Cambodia? The main
methodology of the proposed research programme is to investigate parasite clearance rate
with artemisinin in falciparum malaria and understand molecular mechanisms of same.”
Malaria-control programs
Reduction of malaria-control programs could be behind disease
resurgence(New Kerala: 25.4.2012)
Since the 1930s, there have been 75 documented episodes of malaria resurgence
worldwide, most of which were associated with weakening of malaria control programs,
a new study has suggested.
The study found that the most common reason for weakening of malaria control
programs was funding disruptions.
Low cost treatment is available and simple solutions to prevent the diseases, like
insecticide treated mosquito nets and malaria prevention during pregnancy, have all been
shown to reduce the number of deaths due to malaria.
Initiatives like Roll Back Malaria, set up in 1998, aim to reduce child mortality due to
malaria by two thirds, by 2015, using large scale implementation of these simple
solutions.
Researchers from the Clinton Health Access Initiative, the Johns Hopkins Malaria
Research Institute, the Center for Disease Dynamics, Economics and Policy, and the
Global Health Group at the University of California, San Francisco (UCSF) conducted a
systematic review of the literature to identify all documented malaria resurgence events
where malaria had returned to an area previously under control.
The causes of malaria resurgence were categorized as being due to weakened malaria
control programs, increased intensity of malaria transmission (such movement of people
or mosquitoes, weather, or changes in land use), or technical obstacles including
resistance of the malaria parasite to drugs. 91 percent of the 75 resurgence events found
were blamed at least in part on the weakening of malaria control programs.
"Malaria control programs have been shown to be extremely successful in reducing the
number of cases of malaria to very low levels, but history demonstrates that gains can be
lost rapidly if financial and political support is not sustained," lead author Justin Cohen,
PhD, MPH of the Clinton Health Access Initiative explained.
"Finding ways to ensure continued funding for malaria control today will be crucial to
building on the gains of the past decade."
Investments in malaria control have created unprecedented momentum and yielded
remarkable returns in the past years.
However, the future of anti-malaria programs is uncertain as current funding is projected
to decline over the next few years.
Sir Richard Feachem, KBE, FREng, DSc(Med), PhD, who was the founding Executive
Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and current
Director of the UCSF Global Health Group, calls on the malaria community and donors
to heed these results in order to continue the fight against malaria.
"This work demonstrates the historical evidence on what happens when malaria control
efforts and funding streams prematurely turn their attention away from malaria. This
paradox of success needs greater attention to maximize our investments in malaria
control and elimination," Sir Feachem added.
Finding innovative ways to continue investing in successful malaria control and
elimination programs is necessary to ensure that the dramatic progress in the fight against
malaria is maintained and extended.
Maintaining support for these programs will allow them to continue to save thousands of
lives year after year.
The study has been published in BioMed Central's open access
Malaria control
Malaria control must be priority (The Tribune: 25.4.2012)
Malaria and tuberculosis are the diseases of antiquity, commonly found in developing
tropical and subtropical countries, with very high morbidity and mortality. Preventive and
therapeutic measures have been taken according to the prevailing knowledge about these
maladies century after century. As per an estimate, 216 million cases of malaria and
655,000 deaths were reported worldwide in 2010, a decrease of 17 per cent in malaria
incidence and 25 per cent reduction in global malaria mortality since 2000.
According to the WHO also, about half the world’s population is at risk from malaria.
Despite the fact of its being a preventable and treatable disease, it still claims the life of
one child every minute, with more than 90 per cent of all malaria deaths occurring in the
African continent. India’s share in South Asia is 83 per cent of the total cases reported in
this region. At present it is one of the major killers.
In India, deaths due to malaria could be more than 40 times higher than what is presently
estimated. Recent research published in the Lancet shows that malaria kills 1.2 million
people worldwide each year - twice as high as the figure in the World Malaria Report,
2011. An Indian study estimates that “4800 malaria deaths in children younger than five
years and 42,000 malaria deaths in those aged five years or older” for the year 2010 as
against “19,000 malaria deaths in children younger than five years and 87,000 malaria
deaths in those aged five years or older in 2002.” This means that malaria killed an
estimated 46,800 Indians in 2010. However, the National Vector-Borne Disease Control
Programme estimates that 1,023 people died of malaria infection in 2010. Therefore, due
to the discrepancy in the figures at the national and international levels, it became a very
debatable issue.
A large number of cases of malaria were treated in Chandigarh in 2010 and 2011, and
these patients came from the surrounding districts of Haryana and Punjab. Sometimes
malaria may be confused with viral fever and typhoid, but the latest outbreaks of the fatal
disease shows that the patients died due to multi-organ failure, an unusual feature of this
disease. Some of them were advancing towards renal failure and had to be put on dialysis
as well. A substantial number of these cases were caused by Plasmodium falciparum. In
such circumstances, an early diagnosis can lead to timely therapeutic intervention, which
can prevent mortality in complicated malaria cases.
The Roll Back Malaria is basically a global partnership initiated by the WHO, UNDP,
UNICEF and the World Bank in 1998. It seeks to work with governments, other
development agencies, NGOs and private sector companies to reduce the human and
socio-economic costs of malaria. It was promoting four main strategies to pursue its goal
of halving the world’s burden of malaria by 2010. The strategies are evidence-based,
outcome-focused and cost-effective: (a) Prompt access to treatment; (b) Insecticidetreated mosquito nets (ITNs); (c) Prevention and control of malaria in pregnant women
(d) Malaria epidemic and emergency response.
Globally, Africa has about 90 per cent burden of the fatal cases of malaria. Therefore,
realising the gravity of the situation in April 2000, delegations from 44 African nations
met in the largest ever summit of Heads of State focused on a single health issue in Abuja
(Nigeria) and committed their countries to cutting malaria-related deaths to half during
the next decade - by 2010. These African leaders, endorsing this Roll Back Malaria
(RBM) goal for 2010 in the Abuja Declaration, also set interim targets and drew up a
plan of action for expanding access to and use of effective interventions.
One year later, in 2001, the first Africa Malaria Day re-affirmed their commitment across
the continent with public events and health educational programs. Therefore, keeping in
view the progress made by these programmes, April 25 was designated as World Malaria
Day in 2007 by the 60th session of the World Health Assembly, the decision-making
body of the WHO, reiterating the Abuja Declaration. The day was essentially established
to globally provide education and understanding of malaria and disseminate information
on malaria-control strategies, including community-based activities for malaria
prevention and treatment in endemic areas.
The theme for World Malaria Day-2012 is “Sustain Gains, Save Lives: Invest in Malaria”
- this marks a decisive juncture in the history of malaria control. Whether the malaria
map will keep shrinking, as it has in the past decade, or be reclaimed by the malaria
parasites, depends, to a great extent, on the resources that will be invested in control
efforts in the coming years. In addition, the CDC conducts multidisciplinary strategic and
applied research globally to increase knowledge about malaria and develop safe and
effective interventions that can lead to the elimination and eventual eradication of
malaria. As a WHO Collaborating Center for Prevention and Control of Malaria, CDC
works closely with the WHO, which has just released new malaria surveillance manuals
and launched the T3 (Test, Treat, and Track) Initiative, urging increased investment in
national capacity for diagnostic testing, diagnosis-based treatment and the surveillance of
malaria.
Investments in malaria control have created unprecedented momentum and led to
remarkable results in the past. In Africa, malaria deaths have been cut by one-third within
the last decade; outside Africa, 35 out of the 53 countries, affected by malaria, have
reduced cases by 50 per cent in the same time period.
In countries where access to malaria control interventions has improved most
significantly, overall child mortality rates have fallen by approximately 20 per cent.
Therefore, sustaining malaria control efforts is an investment in development. This
continued investment in malaria control now would propel malaria-endemic countries
towards near-zero deaths by 2015 and achieving the Millennium Development Goals,
especially those relating to improving child survival and maternal health, eradicating
extreme poverty and expanding access to education.
However, these gains may be reversed unless malaria control becomes a priority for
global, regional and national decision-makers. Despite the current economic scenario,
development aid needs to continue flowing to national malaria control programmes to
ensure widespread population access to life-saving and cost-effective interventions.
The writer is Professor & Head, Department of Microbiology, Government Medical
College Hospital, Chandigarh.
Malaria
Disease control: Mosquitoes are target in battle to beat the scourge(The
Indian Express: 30.4.2012)
The scientific battle against malaria is being fought on three fronts. We need better drugs
to kill the plasmodium parasites; better vaccines to prime the human immune system to
resist infection in the first place; and better ways to control the anopheles mosquitoes that
transmit the disease.
The third front – against the insects – has been relatively neglected as a research topic in
recent years compared with drug and vaccine development.
IN FT Health: Combating Malaria
Opinion Time is not on our side
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Regulatory code Makers call for overhaul of regime for bed net sales
Knowlesi malaria Emergent strain poses threat to global containment efforts
“Part of the problem is there is a relative shortage of very good people in entomology and
insect biology,” says Sir Mark Walport, director of the Wellcome Trust, an important
funder of malaria research. “There has been less work in general on the development of
insecticides.”
But there are now signs of a renaissance in “vector control”, as the field is known, with
projects to attack mosquitoes not only with new chemicals but also using biological and
genetic approaches.
The biggest issue with today’s insecticides is the same as that facing anti-malarial drugs:
resistance.
Just as medical experts are alarmed by the emergence of parasites that do not respond to
artemisinin drugs, the vector control community faces a rapid increase in the number of
mosquitoes that survive pyrethroid insecticides. These are favoured for mosquito control
because they are environmentally less harmful and less dangerous to non-insect life than
persistent chemicals such as DDT.
A study by Senegal’s Institute of Research for Development found the proportion of
Anopheles gambiae mosquitoes with the genetic mutation that confers resistance to
pyrethroid insecticides – organic-based compounds that break down easily in the
atmosphere – rose from 8 per cent in 2007 to 48 per cent in 2010.
“These findings are of great concern, since they support the idea that insecticide
resistance might not permit a substantial decrease in malaria morbidity in many parts of
Africa,” the authors wrote in the Lancet Infectious Diseases journal
Alternatives to pyrethroids are in existence. Even the notorious DDT is still sprayed
occasionally. Bendiocarb – withdrawn from the US pesticide market because of safety
concerns – is still approved by the World Health Organisation for indoor spraying to
combat malaria.
A study in Benin, published in the American Journal of Tropical Medicine and Hygiene,
showed a large decrease in malaria transmission as a result of bendiocarb spraying.
“Our results should provide reassurance that, despite the rise in pyrethroid resistance,
indoor spraying can continue to play a vital role in reducing the burden of malaria across
Africa,” says Gil Germain Padonou, a co-author of the paper. But, he adds, researchers
are already seeing early evidence of bendiocarb resistance in neighbouring Burkina Faso,
demonstrating the need for multiple alternatives to pyrethroids.
“We need to intensify support for efforts to develop and test insecticides and seek better
strategies for using them, such as rotating among several compounds that make it harder
for mosquitoes to become resistant,” said Peter Hotez, president of the American Society
of Tropical Medicine and Hygiene.
An alternative insecticide is expected to reach the public health market this year in the
form of chlorfenapyr. BASF, the German chemical manufacturer that has been selling
chlorfenapyr since 1995 as an agricultural pesticide, has reformulated it for use against
malarial mosquitoes, both as a long-lasting insecticidal net and as an indoor spray for
walls.
Chlorfenapyr disrupts the energy-producing mitochondria in insect cells, whereas
pyrethroids attack insects’ nervous systems.
A different approach, still in the early stages of research, is to modify mosquitoes
genetically to prevent them transmitting the parasites. Scientists at Johns Hopkins
Malaria Research Institute in Baltimore have genetically engineered the immune system
of anopheles mosquitoes to produce high levels of a protein called ReI2 when they feed
on blood. This induces an immune attack on plasmodium parasites inside the insects.
The Johns Hopkins researchers showed that the GM insects lived as long and laid as
many eggs as wild-type mosquitoes, suggesting the modification had not impaired their
fitness.
Meanwhile, scientists at Imperial College London have demonstrated a way to accelerate
the introduction of genetic changes into a mosquito population. They bred a large number
of mosquitoes carrying a green fluorescent gene – a classic marker in genetics
experiments – and allowed them to mingle and mate with a small number of mosquitoes
genetically engineered in a different way. The latter made an enzyme that permanently
switches off the fluorescent gene. In an experiment that started with 99 per cent of
mosquitoes glowing green in ultraviolet light, more than half the insects had lost this
marker gene within 12 generations.
The trick was to use a homing endonuclease gene, a “selfish gene” that not only produces
the disruptive enzyme but also makes an extra copy of itself in the mosquitoes’ sperm
cells. This means that, when they mate, almost all the offspring receive the gene, which
spreads rapidly through the population. The next research step will be to disrupt a gene
that the mosquito needs either to reproduce or to transmit malaria.
Preparing anti-malarial genetically modified mosquitoes for release into the wild will
require five years or more research. Then, there will have to be a public-relations
campaign to persuade people to overcome any qualms about the genetically modified
insects for the sake of global health.
Malaria
Now, a garment can save you from malaria (The Times of
India:10.5.2012)
A collaboration between a scientist and a designer from Africa has resulted in the
creation of a fashionable hooded bodysuit embedded at the molecular level with
insecticides for warding off mosquitoes infected with malaria.
The disease is estimated to kill 655,000 people annually on the continent.
Though insecticide-treated nets are commonly used to drive away mosquitoes from
African homes, the Cornell prototype garment can be worn throughout the day to provide
extra protection and does not dissipate easily like skin-based repellants.
By binding repellant and fabric at the nanolevel using metal organic framework
molecules — which are clustered crystalline compounds - the mesh fabric can be loaded
with up to three times more insecticide than normal fibrous nets, which usually wear off
after about six months.
“The bond on our fabric is very difficult to break. The nets in use now are dipped in a
solution and not bonded in this way, so their effectiveness doesn’t last very long,” said
Frederick Ochanda, postdoctoral associate in Cornell’s department of fiber science and
apparel design and a native of Kenya. The colourful garment, fashioned by Matilda
Ceesay, a Cornell apparel design undergraduate from Gambia, debuted on runway at the
Cornell Fashion Collective spring fashion show April 28 on the Cornell campus.
It consists of an underlying one-piece body suit, handdyed in vibrant hues of purple,
gold and blue, and a mesh hood and cape containing the repellant. The outfit is one of six
in Ceesay’s collection, which she said “explores and modernizes traditional African
silhouettes and textiles by embracing the strength and sexuality of modern woman”.
Ochanda and Ceesay, from opposite sides of the continent, both have watched family
members suffer from malaria. Ceesay recalls a family member who was ailing and
subsequently died after doctors treated her for malaria when she had some other illness.
ANI
Malaria
WHO issues malaria alert for visitors to India (The Times of India:
11.5.2012)
Travelling to India this summer? Better be prepared against malaria.
The World Health Organization has alerted international travellers against the active
threat of malaria in India. In its latest ‘International Travel and Health Bulletin 2012’, the
WHO has said that malaria risk exists throughout the year in the whole country at
altitudes below 2,000 m.
The bulletin cautions travellers against malaria infections, especially while travelling
to the NE, the Andaman & Nicobar Islands, Chhattisgarh, Gujarat, Jharkhand, Karnataka,
MP, Maharashtra, Odisha and West Bengal.
Malaria
Potential malarial vaccine produced from edible algae (New Kerala:18
May 2012)
Washington, May 17 : Biologists have successfully engineered algae to produce potential
candidates for a vaccine that would prevent transmission of the parasite that causes
malaria.
Initial proof-of-principle experiments suggest that such a vaccine could prevent malaria
transmission.
The achievement could pave the way for the development of an inexpensive way to
protect billions of people from one of the world's most prevalent and debilitating
diseases.
Malaria is a mosquito-borne disease caused by infection with protozoan parasites from
the genus Plasmodium. It affects more than 225 million people worldwide in tropical and
subtropical regions, resulting in fever, headaches and in severe cases coma and death.
While a variety of often costly anti-malarial medications are available to travellers in
those regions to protect against infections, a vaccine offering a high level of protection
from the disease does not yet exist.
The new development resulted from an unusual interdisciplinary collaboration between
two groups of biologists at University of California, San Diego'one from the Division of
Biological Sciences and San Diego Center for Algae Biotechnology, which had been
engineering algae to produce bio-products and biofuels, and another from the Center for
Tropical Medicine and Emerging Infectious Diseases in the School of Medicine that is
working to develop ways to diagnose, prevent and treat malaria.
Part of the difficulty in creating a vaccine against malaria is that it requires a system that
can produce complex, three-dimensional proteins that resemble those made by the
parasite, thus eliciting antibodies that disrupt malaria transmission.
Most vaccines created by engineered bacteria are relatively simple proteins that stimulate
the body's immune system to produce antibodies against bacterial invaders. More
complex proteins can be produced, but this requires an expensive process using
mammalian cell cultures, and the proteins those cells produce are coated with sugars due
to a chemical process called glycosylation.
'Malaria is caused by a parasite that makes complex proteins, but for whatever reason this
parasite doesn't put sugars on those proteins,' said Stephen Mayfield, a professor of
biology at UC San Diego who headed the research effort.
'If you have a protein covered with sugars and you inject it into somebody as a vaccine,
the tendency is to make antibodies against the sugars, not the amino acid backbone of the
protein from the invading organism you want to inhibit. Researchers have made vaccines
without these sugars in bacteria and then tried to refold them into the correct three-
dimensional configuration, but that's an expensive proposition and it doesn't work very
well,' he stated.
Instead, the biologists looked to produce their proteins with the help of an edible green
alga, Chlamydomonas reinhardtii, used widely in research laboratories as a genetic model
organism, much like the fruit fly Drosophila and the bacterium E. coli.
Two years ago, a UC San Diego team of biologists headed by Mayfield, who is also the
director of the San Diego Center for Algae Biotechnology, a research consortium seeking
to develop transportation fuels from algae, published a landmark study demonstrating that
many complex human therapeutic proteins, such as monoclonal antibodies and growth
hormones, could be produced by Chlamydomonas.
That got James Gregory, a postdoctoral researcher in Mayfield's laboratory, wondering if
a complex protein to protect against the malarial parasite could also be produced by
Chlamydomonas. Two billion people live in regions where malaria is present, making the
delivery of a malarial vaccine a costly and logistically difficult proposition, especially
when that vaccine is expensive to produce.
So the UC San Diego biologists set out to determine if this alga, an organism that can
produce complex proteins very cheaply, could produce malaria proteins that would
inhibit infections from malaria.
'It's too costly to vaccinate two billion people using current technologies.
Realistically, the only way a malaria vaccine will ever be used is if it can be produced at
a fraction of the cost of current vaccines. Algae have this potential because you can grow
algae any place on the planet in ponds or even in bathtubs,' explained Mayfield.
Collaborating with Joseph Vinetz, a professor of medicine at UC San Diego and a leading
expert in tropical diseases who has been working on developing vaccines against malaria,
the researchers showed that the proteins produced by the algae, when injected into
laboratory mice, made antibodies that blocked malaria transmission from mosquitoes.
'It's hard to say if these proteins are perfect, but the antibodies to our algae-produced
protein recognize the native proteins in malaria and, inside the mosquito, block the
development of the malaria parasite so that the mosquito can't transmit the disease,' said
Gregory.
The scientists, who filed a patent application on their discovery, said the next steps are to
see if these algae proteins work to protect humans from malaria and then to determine if
they can modify the proteins to elicit the same antibody response when the algae are
eaten rather than injected.
The study has been published in the online, open-access journal PLoS ONE. (ANI)
Malaria
New technique accurately determines infants at malaria risk (New
Kerala:7 June 2012)
Washington, June 6 : A research team has developed a new molecular technology, which
will improve evaluation of malaria control methods and vaccine development.
The technique that accurately determines the risk of infants in endemic countries
developing clinical malaria could provide a valuable tool for evaluating new malaria
prevention strategies and vaccines.
The technique could even help to understand how anti-malarial vaccine and treatment
strategies act to reduce malaria, said researchers from the Walter and Eliza Hall Institute,
Swiss Tropical and Public Health Institute, University of Basel and the Papua New
Guinea Institute of Medical Research.
Professor Ivo Mueller from the Walter and Eliza Hall Institute's Infection and Immunity
division said the research team discovered that the number of new malaria parasites that
infants acquire over time is strongly linked to the risk that the child will develop clinical
disease.
'It was very clear that infection with new and genetically different malaria parasites was
the single biggest factor in determining the risk of an infant becoming sick from malaria,
more than any other factor including age, the use of bed nets or the risk of transmission in
the area. We were actually surprised by how clear the correlation was,' Professor Mueller
said.
The molecular technique to genetically differentiate Plasmodium falciparum parasites
was developed by Dr Ingrid Felger at the Department of Medical Parasitology and
Infection Biology, Swiss Tropical and Public Health Institute, Switzerland.
Professor Terry Speed from the Walter and Eliza Hall Institute's Bioinformatics division
helped to develop mathematical algorithms to process the data.
Dr Felger said the researchers used high-throughput screening to determine the number of
genetically-distinct Plasmodium falciparum malaria parasites that acquired by Papua
New Guinean children aged one to four over a period of 16 months.
'This new research tool is elegantly simple but very powerful, and easily applicable in
many circumstances, without a high level of technology or training,' Dr Felger said.
'We think it could have profound applications. This technology will be particularly useful
for assessing ideal vaccine candidates for preventing malaria, help to develop better ways
of performing future human trials of new potential malaria vaccines, and identifying the
mechanism of action for existing vaccines and treatments,' he added.
Each year more than 250 million people worldwide contract malaria, and up to one
million people die. Malaria is particularly dangerous for children under five and pregnant
women. Plasmodium falciparum is the most lethal of the four Plasmodium species, and is
responsible for most clinical disease.
Professor Mueller said the technology is already being used in the field, recently helping
to explain why people with sickle-cell anaemia are less at risk of malaria infection. He
said that accurately assessing the burden of malaria parasites acquired by children in
countries where the disease is endemic is invaluable.
'One of our biggest problems in developing useful vaccines, treatments and preventative
strategies for malaria is reliably predicting the distribution and risk of malaria at an
individual level. There is huge variation in the risk of developing clinical malaria within a
community or village, or within a particular age group, and we now have an accurate way
to measure this,' Professor Mueller said.
The research was published in the journal Proceedings of the National Academy of
Sciences of the United States of America. (ANI)
Migraine
Migraine
Four New Gene Loci Predisposing People to the Most Common Subtype
of Migraine(Science daily:11.6.2012)
An international research group from several European countries and Australia has
identified four new gene loci predisposing people to the most common subtype of
migraine, migraine without aura. About 2/3 of migraine sufferers belong to this group.
Researchers studied genetic data of more than 11,000 people and found altogether six
genes that predispose to migraine without aura. Four of these genes are new and two of
them confirm previous findings.
The new genes identified in this study provide further evidence for the hypothesis that
dysregulation of molecules important in transmitting signals between brain neurons
contribute to migraine. Two of the genes support the hypothesis of a possible role of
blood vessels and thus disturbances in blood flow.
The researchers carried out what is known as a genome-wide association study (GWAS)
to zoom in on genome variants that could increase susceptibility to migraine; they
compared genomes of 4800 migraine patients with more than 7000 non-migraine
individuals.
The project was performed by the International Headache Genetics Consortium
consisting of leading migraine researches from Europe and Australia.
This was the third report on genes predisposing people to common forms of migraine, but
the first one on the most common migraine subtype. "The study establishes for the first
time a specific gene that contributes to this common disease" said Professor Aarno
Palotie at FIMM and the Wellcome Trust Sanger Institute, the chair of the International
Headache Genetics Consortium. The carefully studied migraine patients collected from
specialized headache clinics were provided a strong basis for the success of this study.
Migraine affects approximately one in six women and one in eight men, making it a
leading cause of work absence and short-term incapacity: 25 million school or work days
are lost for migraine each year. A US report measures its economic costs as similar to
those of diabetes and WHO lists it as one of the top twenty diseases with the causes of
years lived with disability (YLDs). In up to one third of migraine patients, the headache
phase may be preceded or accompanied by transient neurological disturbances, the socalled aura (i.e. migraine with aura), while the majority of patients suffer from migraine
without aura.
"Studies of this kind are possible only through large-scale international collaboration -bringing together the wealth of data with the right expertise and resources. The identified
genes open new doors to investigate how this type of migraine comes about," said Dr.
Arn van den Maagdenberg, one of the senior authors on the paper.
Parkinson's
Parkinson's Patients
Parkinson's Patients Might Respond To 19th Century Vibration-Chair
Therapy(Medical News Today; 25.4.2012)
To relieve symptoms of Parkinson's disease, Jean-Martin Charcot, a famous neurologist
in the 19th century developed a "vibration chair" that showed improvements in his
patients. However, Charcot died soon afterwards, before being able to conduct a more
comprehensive evaluation of his therapy.
A team of neurological researchers from the Rush University Medical Center has
replicated Charcot's work to examine whether his observations were substantiated. Their
study, published in the April issue of Journal of Parkinson's Disease, suggests that even
though vibration therapy does significantly improve some symptoms of Parkinson's
disease, the effect was noted in both the treatment group and the control group, which
indicates other factors, aside from vibration, played a role.
Lead researcher Christopher G. Goetz, MD, director of the Parkinson's disease and
Movement Disorders Center at Rush, explains:
"We attempted to mimic Charcot's protocol with modern equipment in order to confirm
or refute an historical observation. Both the treated group and the control group improved
similarly, suggesting other factors had an effect on Parkinson's disease motor function."
Charcot obtained the idea for developing the vibration chair, which copied the continuous
jerking of a carriage or train after his patients informed him that their uncomfortable or
painful symptoms seemed to disappear during long carriage rides or train journeys, and
that the relief lingered for some time until after the journey.
Goetz and his team randomly assigned 23 patients to one month of 30 minute long daily
therapy sessions in either a vibrating chair or the same chair without vibration, with both
groups listening to a relaxation CD of nature sounds during their session.
The findings revealed that those in the vibration treatment group made a considerable
improvement in motor function after one month of daily 30-minute therapy sessions, but
that the 'non-vibration' group also noted a considerable improvement, although not as
high as the other group. In addition, both groups had similar and substantial
improvements in terms of anxiety, depression, fatigue and nighttime sleep and reported
similar high satisfaction with their therapy sessions.
Goetz explains:
"Our results confirm Charcot's observation of improvement in Parkinson's disease
symptomology with chronic vibration treatment, but we did not find the effect specific to
vibration. Instead, our data suggest that auditory sensory stimulation with relaxation in a
lounge chair or simply the participation in a research protocol has equivalent benefit as
vibration on motor function. While we can agree that our results may not change
scientific thinking on treatment mechanisms, our results will allow clinicians to guide
patients to at least one apparatus that is safe and associated with objective changes in
parkinsonian impairment scores."
Goetz concludes:
"Charcot's advice to colleagues resonates as one places vibration therapy in the context of
potential options for patients. 'It is no small gain to be able to relieve the sufferers of
paralysis agitans.'"
Parkinson's
Soon, therapy to freeze Parkinson's in its tracks (New Kerala:4.5.2012)
Researchers are developing a preventive therapy to halt symptoms in Parkinson's
patients.
Parkinson's disease is characterized by a gradual loss of neurons that produce dopamine.
Mutations in the gene known as DJ-1 lead to accelerated loss of dopaminergic neurons
and result in the onset of Parkinson's symptoms at a young age.
The ability to modify the activity of DJ-1 could change the progress of the disease, said
Dr. Nirit Lev, a researcher at Tel Aviv University's Sackler Faculty of Medicine and a
movement disorders specialist at Rabin Medical Center.
Working in collaboration with Profs. Dani Offen and Eldad Melamed, Dr. Lev has now
developed a peptide which mimics DJ-1's normal function, thereby protecting dopamineproducing neurons. What's more, the peptide can be easily delivered by daily injections
or absorbed into the skin through an adhesive patch.
Based on a short protein derived from DJ-1 itself, the peptide has been shown to freeze
neurodegeneration in its tracks, reducing problems with mobility and leading to greater
protection of neurons and higher dopamine levels in the brain.
Dr. Lev said that this method could be developed as a preventative therapy.
As we age, we naturally lose dopamine-producing neurons. Parkinson's patients
experience a rapid loss of these neurons from the onset of the disease, leading to much
more drastic deficiencies in dopamine than the average person.
Preserving dopamine-producing neurons can mean the difference between living life as a
Parkinson's patient or aging normally, said Dr. Lev.
The researchers set out to develop a therapy based on the protective effects of DJ-1, using
a short peptide based on the healthy version of DJ-1 itself as a vehicle.
'We attached the DJ-1-related peptide to another peptide that would allow it to enter the
cells, and be carried to the brain,' explained Dr. Lev.
In pre-clinical trials, the treatment was tested on mice utilizing well-established toxic and
genetic models for Parkinson's disease.
From both a behavioural and biochemical standpoint, the mice that received the peptide
treatment showed remarkable improvement.
Symptoms such as mobility dysfunctions were reduced significantly, and researchers
noted the preservation of dopamine-producing neurons and higher dopamine levels in the
brain.
Preliminary tests indicate that the peptide is a viable treatment option. Though many
peptides have a short life span and degrade quickly, this peptide does not. Additionally, it
provides a safe treatment option because peptides are organic to the body itself.
According to Dr. Lev, this peptide could fill a gap in the treatment of Parkinson's disease.
'Current treatments are lacking because they can only address symptoms ' there is nothing
that can change or halt the disease,' she said.
'Until now, we have lacked tools for neuroprotection.'
The researchers also note the potential for the peptides to be used preventatively. In some
cases, Parkinson's can be diagnosed before motor symptoms begin with the help of brain
scans, explained Dr. Lev, and patients who have a genetic link to the disease might opt
for early testing.
A preventative therapy could help many potential Parkinson's patients live a normal life.
The study has been published in a number of journals including the Journal of Neural
Transmission. (ANI)
Parkinson's disease
Gene variants that speed progression of Parkinson's disease identified
(New Kerala: 17.5.2012)
A new discovery may hold the key to determine which Parkinson's disease patients will
experience a more rapid decline in motor function, sparking hopes for the development of
new therapies and helping identify those who could benefit most from early intervention.
In a study, UCLA researchers have found that Parkinson's sufferers who possess two
specific variants of a gene known to be a risk factor for the disease had a significantly
speedier progression toward motor decline than patients without these variants.
'This is a relatively small study, with 233 patients, but the effects we're seeing are
actually quite large,' said Dr. Beate Ritz, vice chair of the department of epidemiology at
the UCLA Fielding School of Public Health and the study's primary investigator.
The SNCA gene is a well-known risk factor for Parkinson's disease, and higher levels of
the a-synuclein protein made from this gene are associated with greater disease severity
in familial cases of Parkinson's.
The researchers examined two risk variants, the REP1 263bp promoter and rs356165.
They recruited Parkinson's disease patients shortly after they were diagnosed from three
Central California counties and followed 233 of those patients for an average of 5.1
years.
They found that carriers of the Rep1 263bp variant had a four-fold higher risk of faster
motor decline. They observed an even stronger trend in progression toward motor decline
when both the Rep1 263bp and rs356165 variants were present in patients.
When doctors currently see Parkinson's disease patients, they can't predict how rapidly
their motor function will deteriorate ' how quickly, for instance, they will reach a point
when they need a wheelchair or other aids, said Dr. Jeff Bronstein, professor of
neurology at the David Geffen School of Medicine at UCLA.
'But if our results are confirmed,' Bronstein said, 'these gene variants can now identify
patients who are likely to have faster progression.'
And because of these differences in the rate of disease progression, researchers can test
potential therapies in individuals carrying the genetic variations, obtaining faster results
on the efficacy of those drugs, said co-author Shannon Rhodes, a researcher in
epidemiology at the UCLA Fielding School of Public Health. 'Plus,' she said, 'you're
helping the people who are the most affected.'
Ritz, who is also a professor of neurology at the David Geffen School of Medicine at
UCLA, said there are probably other markers that need to be identified, because not all
patients with the variants in question become fast progressors. In addition, the results
need to be replicated, so future studies with many more subjects are needed.
'Since motor symptom severity predicts increased mortality (in Parkinson's disease)
independent of age and disease duration, identifying genetic predictors of faster motor
decline is critical to pinpointing biological mechanisms as targets for therapies and
identifying patients who will most benefit from early interventions,' the researchers
wrote.
'While replication of our results in similarly well-characterized population-based
incidence PD cohorts that have been longitudinally followed is still needed, our findings
strongly suggest that a-synuclein and related pathogenic pathways have great promise as
potential disease modifying and therapeutic targets,' they added.
The study has been published in the peer-reviewed online journal PLoS ONE. (ANI)
Thyroid
Thyroid
Purified Lung and Thyroid Progenitors Derived From Embryonic Stem
Cells: BU Researchers (Med India: 11.4.2012)
A population of pure lung and thyroid progenitor cells in vitro has been derived that
successfully mimics the developmental milestones of lung and thyroid tissue formation.
The study was by researchers at Boston University School of Medicine (BUSM) and
Boston Medical Center (BMC). The research, which will be published in the April 6
edition of the journal Cell Stem Cell, identifies factors necessary for embryonic stem
cells to differentiate into lung progenitor cells and provides key information about how
the tissue engineering technology can be used to develop new gene and cell-based
therapies to treat lung diseases.
Darrell Kotton, MD, co-director of the Center for Regenerative Medicine (CReM) at
Boston University and BMC and attending physician in pulmonary, allergy and sleep
medicine at BMC, led this study. The findings represent years of research dedicated to
identifying how to generate an unlimited source of lung progenitor cells in vitro from
embryonic stem (ES) cells.
Since ES cells resemble the early developing embryo, CReM investigators studied
normal lung and thyroid development in the developing embryo. They used this
knowledge as a roadmap to induce the same sequence of developmental milestones in ES
cells in culture.
Previous research shows that progenitor cells from the embryo's gut tube (called
endoderm) give rise to the lungs, thyroid, pancreas, gastrointestinal tract and other
organs. This led the researchers to focus on that time of development in order to identify
what factors are responsible for how the cells differentiate.
The ES cells were engineered to include a fluorescent tag that glowed at the moment lung
or thyroid cells were generated from ES cells in culture. Using this approach, the
researchers differentiated the ES cells into gut tube endoderm and then identified growth
factors that induced lung and thyroid lineages. Ultimately, 160 lung or thyroid
progenitors could be generated per starting stem cell and these progenitors could be
purified using the fluorescent tag that glowed only once the cells had become lung or
thyroid cells.
"We succeeded in capturing a cell fate decision in cultured stem cells that is normally
very transient during the earliest stages of lung and thyroid development," said Kotton,
who also is an associate professor of medicine at BUSM. "Most importantly, our results
emphasize that the precise inhibition of certain pathways at defined stages is as important
as the addition of pathway stimulators at different developmental stages during lung and
thyroid specification."
To demonstrate that the cells purified by the investigators were lung progenitors, Kotton's
team studied the global gene expression profiles of the cells they derived and placed the
cells into a three-dimensional lung scaffold. The cells grew and multiplied, forming two
types of lung cells that normally coat the air sacs of the lungs.
The findings indicate that this technology can be used to grow new primordial lung
progenitors to study human disease in vitro, which could lead to novel therapies to treat
patients with end stage lung disease, such as emphysema and Cystic Fibrosis.
"The ability to generate a supply of progenitor cells with the potential to differentiate into
lung cells will be a huge boon to several research fields," said James Kiley, PhD, director
of the Division of Lung Diseases at the National Heart, Lung, and Blood Institute
(NHLBI), which funded the study. "It lays the groundwork for studying the mechanisms
and programming of cells during lung development, which, in turn, will help develop
new treatments."
Water-borne Disease
Water-borne Hepatitis E and A infections
Beware of water-borne Hepatitis E and A infections (The Tribune:
13.6.2012)
It’s peak summer time whenthere is a shap rise in the cases of water-borne infections like
gastroenteritis and dysentery. Although most gastrointestinal infections last a short while
and are mild, people need to beware of the faecally contaminated water-borne Hepatitis E
(HEV) and Hepatitis A (HAV) infections, which do cause high morbidity and a
significant mortality rate in the case of HEV infections.
Prodromal symptoms before the onset of jaundice of these water-borne Hepatitis
infections are non-specific and include fever, loss of appetite, vomiting, dark urine, chills,
abdominal pain, upper respiratory tract infection symptoms and joint pains, which could
easily be confused with any other viral infection. It is very important at this stage not to
take very strong drugs, including antibiotics, aspirin and non-steroidal anti-inflammatory
drugs (NSAIDS), which could have adverse effect on the liver. These drugs do not have
any role in the management of infection with Hepatitis A or E virus.
The majority of the patients infected with Hepatitis A or E recover. The clinical
symptoms of both HEV and HAV are indistinguishable from each other, and the correct
diagnosis is confirmed by a blood test.
The main mode of transmission for virus HEV and HAV is through faecally
contaminated water or food (faecal — oral transmission); the transmission through the
water being more common. Both diseases are closely associated with inadequate
sanitation, contaminated water and food and poor personal hygiene. In the case of HEV,
infections may also be spread by eating contaminated pork.
HEV affects almost 1/3rd of the world population — approximately two billion cases. An
estimated 14 million people globally suffer from symptomatic HEV infection with a
global annual mortality of 300,000 and 5,200 still births. In 1955 HEV epidemic in New
Delhi affected around 30,000 people. A point of note is rarity of secondary person to
person spread from infected person to their close contacts. Attack rates of 1-15% in
epidemics of HEV have been reported.
HAV accounts for 14 million cases worldwide annually with 3,000 deaths per year. Like
HEV, HAV also causes epidemics, the largest being in Shanghai, China, in 1988 when
300,000 people were affected.
Both HAV and HEV infections are endemic in Asia, Africa, the Middle-East and Central
America. HEV has 4 genotypes. Genotype 1 is mostly seen in Asia, Africa and South
America. Genotype 3 is seen in pigs and other wild animals and can be transmitted to
humans by eating infected pork (Zoonosis). HEV is being diagnosed in developed
countries also and is seen in people with no history of travel to endemic countries
suggestive of more widespread prevalence of HEV.
CLINICAL FEATURES
After the prodromal phase jaundice develops and could last two-four weeks. HAV virus
generally infects those in the younger age group. Jaundice in children under six years of
age is only seen in 10 per cent cases whereas it is present in more than 70 per cent of the
cases beyond six years of age. HAV may relapse and also may have led to a prolonged
cholestatic course, in which jaundice and severe itching may last months. HAV may
rarely cause acute liver failure with high mortality.
HEV is one of the most common causes of acute liver failure in developing countries.
HAV never causes chronic liver disease (cirrhosis) while cases of well-documented
chronic liver disease/cirrhosis caused by HEV are seen in immunosuppressed and posttransplant patients. HEV may also cause mild infections without jaundice.
When to refer a patient to a tertiary care hospital:
Rapidly rising jaundice
Repeated vomiting
High fever and headache
Drowsiness
Decreased urine output
Bleeding from nose and gums
The above mentioned symptoms are or may be indicative of acute liver failure.
TREATMENT
Treatment in most cases is symptomatic with rest, high-calorie and low-fat diet, oral
fluids, cold sponging and Paracetamol for fever. Avoid OTC drugs which could be
harmful to the liver.
How to diagnose HAV and HEV
A simple blood test can confirm the diagnosis
Igm Anti HEV
Igm Anti HAV
If positive, they confirm the diagnosis of acute viral Hepatitis A or E.
Costly, sophisticated and molecular-based PCR test of blood or stool is rarely needed,
except in immune-suppresion and HIV-positive cases where an IgM antibody test may be
falsely negative.
What is new in Hepatitis E infection?
HEV is more widely prevalent than previously thought. In the West more cases are being
diagnosed at an older age.
Autochthonous (locally acquired) infection is seen in the West.
HEV can rarely cause chronic liver disease (cirrhosis). In such cases Ribavirin can be
used for 12 — 24 weeks as part of the therapy.
If a patient has the pre-existing chronic liver disease (cirrhosis), the HEV infection can
cause acute on chronic liver failure (ACLF) which has a very high mortality rate both in
short-term and long-term cases. Up to 70 per cent mortality has been reported at the end
of one year.
HEV vaccine trials have been successfully completed in many countries with China being
the first in the world to approve of three doses of the HEV vaccine.
Complications
Acute liver failure (ALF) is the dreaded complication of HEV and HAV infections, more
commonly caused by HEV infection. Patients need ICU care and may very rarely require
a liver transplant.
Prevention
Improved sanitation, adequate supply of safe drinking water, proper sewerage disposal
combined with good personal hygiene practices such as regular hand-washing reduces the
spread of water-borne Hepatitis E and A.
Vaccines
An excellent vaccine is available for HAV. This has an excellent efficacy and safety
profile. Nearly 100 per cent people will develop protective antibodies within one month
after taking a single dose of this vaccine. The HAV vaccine is approved by the IAP for
childhood immunisation. The HAV vaccine should be taken by travellers to certain areas,
people with pre-existing chronic liver disease (cirrhosis) and in the case of epidemics of
HAV infection.
On January 12, 2012, the world’s first HEV vaccine was approved by the Chinese State
Food and Drug Administration. After a phase-3 clinical trial 112,604 healthy adults, aged
16-65 years, were given three doses of the HEV vaccine with almost 100 per cent
efficacy and the vaccine was well-tolerated. The target population for the HEV vaccine
includes women of child-bearing age and people with the pre-existing chronic liver
disease (cirrhosis).
In India, clearly more work is needed before an HEV vaccination programme can be
implemented. The cost factor and long-term efficacy of the HEV vaccine need to be
addressed.
Protective antibodies in the HAV infection are usually for a lifelong period whereas in
HEV they may last 1-4 years only.
Take-home messages
1. Both Hepatitis A and E spread by faecally contaminated water or food and are
preventable diseases.
2. Boiling of water will prevent the transmission of HEV and HAV, and must be
practised. Owing to the very small size of viral particles, water filters are not sufficient to
protect the spread of these viruses.
3. HEV is a more severe disease than HAV and may cause 20 per cent mortality in
pregnancy, especially in the 3rd trimester.
4. Worldwide two billion people have been infected with HEV.
5. Improved sanitation, adequate supply of safe drinking water, proper sewerage disposal
combined with good personal hygiene practices are needed to reduce the spread of HAV
and HEV infections.
6. Vaccination is not a substitute for improved basic hygiene and safe water supply.
7. HAV vaccine is excellent with very good efficacy and safety profile. Two doses with a
gap of six months are recommended.
8. HEV vaccine has been approved in China which is probably the only country in the
world using indigenously manufactured HEV vaccine, especially in women of childbearing age and patients with the pre-existing liver disease (cirrhosis).
9. Entire India is highly endemic for HEV and HAV infections.
The writer is Director-Gastroenterology, Fortis Hospital, Mohali.
Drugs and Medicine
Generic drugs
New Central scheme to supply free generic drugs (The Hindu: 2.4.2012)
Universal health coverage package planned on experimental basis
Moving towards major reforms, the Centre is in the process of rolling out a universal
health coverage package in at least one district in each State on an experimental basis.
This would include a clearly defined basket of services to those who come to any public
health facility for treatment or free supply of generic drugs, doing away with user charges
and upgrading public health infrastructure right from the primary to tertiary levels. The
private sector would have a role to play only when needed.
These recommendations had been made by the High Level Expert Group (HLEG) in its
report on universal health coverage. The panel had also recommended against any
insurance scheme as a mechanism for health coverage. The HLEG had been set up by the
Planning Commission and it submitted its report in November last.
The Union Health and Family Welfare Ministry will soon write to the States asking them
to put in place a professional and transparent mechanism for providing free generic drugs.
Talking to The Hindu, L.C. Goyal, Additional Secretary in the Ministry, said the scheme
will be included as a new initiative under the National Rural Health Mission (NRHM) at
a cost of Rs. 30,000 crore for the next five years.
The scheme will be implemented from sub-centres to district hospitals, but not in medical
college hospitals.
Potential for misuse
At present, the Ministry is involved in working out a process to implement the scheme by
taking States on board, as the scheme has enough potential for misuse.
“We need to work out a framework for implementation of the scheme. The States will
have to ensure a robust and credible mechanism,” Mr. Goyal said.
The Centre has already approved a Central Procurement Agency (CPA) for supplying
generic drugs to the States right up to the district level, from where the secondary and
primary centres will procure these drugs.
“The States have to ensure that the doctors in the public health facilities prescribe only
generic drugs and that there is a proper supply chain right up to the sub-centre level, in
addition to the IT-enabled procurement mechanism and a transparent tendering system.
We will have to work out a memorandum of understanding with the States like in the
case of the NRHM,” Mr. Goyal said.
Importantly, the States will have to draw up standard treatment guidelines as provided
under the Clinical Establishment (Registration and Regulation) Act, 2011. This will help
in ensuring checking the irrational use of drugs, and encourage use of generic drugs.
Maharashtra and Delhi already have such guidelines.
Keywords: universal health coverage, generic drugs
Pen injection
Pen injection for sclerosis patients (Hindustan Times: 2.4.2012)
For patients suffering from Multiple Sclerosis (MS), a disease of the nervous system,
treatment with long painful needles may soon be a thing of the past as shorter and thinner
needle injections are making their way to India.
The Drug Controller General of India (DCGI) has given approval for the first pen form
version of the most popular injection— interferon beta-1a (Avonex), which used to treat
people suffering from MS.
The single-use pen injection, which is administered intra-muscularly, is expected to
reduce pain and related anxiety among thousands of MS patients who depend on these
injections for treatment.
It is akin to relief that was brought to people suffering from diabetes, with the
introduction of pen-like insulin injections.
Doctors agree this will increase compliance in MS patients who otherwise may skip
treatment due to fear of the needle.
“With Avonex pen, patient’s adherence to the drug will considerably improve. At the
same time, the procedure being simple and painless will make the entire exercise much
more convenient for the patient,” said Dr Mukul Verma, senior consultant, department of
neurology, Indraprastha Apollo Hospital.
This treatment form is one of the most prescribed treatments for relapsing forms of MS
worldwide. Administered intramuscularly, it slows the progression of physical disability
and reduces relapses.
“One of the major benefits of Avonex pen lies in the concept of ‘self-injection’, which
will help the patient in getting rid of the fear of injection. The development from an
injection to pen will not only prove beneficial for the patients but also for the healthcare
industry as a whole. The earlier a patient takes up these therapies, lesser is his scope of
suffering from any disability that may develop over time,” said Dr CS Aggarwal,
consultant neurologist, Sir Gangaram Hospital.
MS is a severe auto-immune disorder caused by damage to the protective covering that
surrounds nerve cells. MS affects more than 2,00,000 people in India, physically as well
as psychologically.
Insulin
Free insulin shots for children (Hindustan Times: 2.4.2012)
Diabetic children from poor families in the city will be provided free insulin injections
under an initiative by the Delhi Diabetic Forum (DDF).
DDF, established more than 20 years ago to detect and educate people about the disease
and conduct research, has formed a separate unit to organise programmes for children
with Type I diabetes wherein pancreas stops producing insulin.
A committee of seven doctors and members of the forum will invite references of
children from economically weaker sections who need insulin daily.
"Under this one-year DDF programme, free insulin will be provided to poor and needy
children at their doorsteps. Special educational camps will be organised on a quarterly
basis to educate the kids and their parents," said Dr SK Wangnoo, senior consultant,
department of endocrinology, Apollo Hospital, and also a member of the diabetic forum.
"Type I diabetes is a chronic disease associated with insulin deficiency. Children with the
type of diabetes need insulin for survival as their pancreas does not produce the
hormone," he explained.
Type I, also known as juvenile diabetes, generally afflicts children at a young age and to
survive the patient needs doses of insulin.
There are more than a million juvenile diabetics in India. Every year, 27,000 diabetic
children (two to 14 years of age) around the world die of the disease, out of which more
than 12,000 are from India.
"There is no count of how many die undiagnosed. Among those who are diagnosed with
juvenile diabetes, 70% come from poor families," said Dr Ashok Damir, vice-president,
DDF.
Drugs
Nano-Factories Could Make Drugs at Tumor Sites (Medical News
Today: 11.4.2012)
A team of researchers at Massachusetts Institute of Technology (MIT) in the US has
designed nanoparticles that produce proteins when utraviolet (UV) light shines on them:
they suggest the idea could be used to create "nano-factories" that make protein-based
drugs at tumor sites to fight cancer.
They write about their work in the 20 March online issue of the journal Nano Letters, and
there is also a description of it in an article published on the MIT website this week.
Protein-based drugs that fight cancer exist, but they are limited by the fact the body
breaks them down before they can reach their destination.
The team, based in the lab of MIT's David H. Koch Institute Professor, Robert Langer,
appear to have overcome this problem by devising a way to make the proteins on
demand, in situ, using nanotechnology.
Scientists are increasingly turning to nanotechnology as a way to target therapy at the
cellular level.
For instance, another recently reported study led by Johns Hopkins University described
how to use harmless bacteria to "backpack" nano-wires, beads and other nanostructures to
targeted places in the human body. And scientists at Northwestern University have
developed a nanoparticle that can deliver drugs directly to the nucleus of a cancer cell.
The idea behind the MIT nanoparticles, is that when they reach their destination, you
shine a UV light on them, and they turn into protein factories, making the cancer drug
molecules right at the place where they are needed.
They came up with the idea when trying to think of ways to attack metastatic tumors,
those that grow from cancer cells that have migrated from the original cancer site. 9 out
of 10 cancer deaths is caused by such tumors.
For their inspiration, they turned to nature, where cells make their proteins by following
DNA blueprint instructions that they first copy into messenger RNA (mRNA).
The mRNA ferry the instructions to ribosomes, the cell structures that read the
instructions in order to assemble the amino acids in the correct sequence to make the
associated protein, rather like stringing beads to make a necklace.
First author Avi Schroeder, a postdoc in Langer's lab, said:
"We wanted to use machinery that has already proven to be very effective. Ribosomes are
used in nature, and they were perfected by nature over billions of years to be the best
machine that can produce protein."
The nanoparticles self-assemble, using lipids to form the particles' outer shells,
ribosomes, amino acids, and the enzymes needed for protein synthesis. And of course,
you need to include DNA sequences for the desired proteins.
Schroeder said their study is the "first proof of concept that you can actually synthesize
new compounds from inert starting materials inside the body".
The particles could be used to deliver small proteins that attack cancer cells, and
eventually large proteins like antibodies, to trigger the immune system to destroy tumors,
he said.
The clever part of the nanoparticle is how to turn the protein factory on: you don't want
the DNA to be released until you are ready for protein synthesis to start.
The DNA is trapped in a "chemical cage" compound called DMNPE, which reversibly
binds to it but releases it when exposed to UV light.
To test their idea, the researchers created a nanoparticle that was programmed to produce
either green fluorescent protein (GFP) or luciferase, both of which are easy to detect.
They tested them in mice and showed they produced the proteins once exposed to UV
light.
James Heath is a professor of chemistry at the California Institute of Technology and was
not involved in the study but appears very excited by the work. He says waiting until the
nanoparticles reach their target before switching them on could be a good way to
minimize side effects from say a particularly toxic drug.
However, it is one thing to demonstrate something like this successfully in mice, and
quite another to do so in humans. A lot more testing is needed before we can say that this
idea can deliver therapeutic proteins in human patients, said Heath.
"There are lots of details left to be worked out for this to be a viable therapeutic
approach, but it is a really terrific and innovative concept, and it certainly gets one's
imagination going," he said.
The team is now working on nanoparticles that can synthesize potential cancer drugs, and
new ways to activate the particles, for instance using acidity levels or other biochemical
conditions specific to certain regions of the body as triggers to switch on the "nanofactories".
Malaria drug
Millions at risk as main malaria drug loses potency (The Tribune:
11.4.2012)
The world’s most effective malaria drug is losing its power, threatening the lives of
millions of people around the globe. Tests on the border between Thailand and Burma
show that the most deadly form of the malaria parasite has developed resistance to
artemesinin, the gold standard treatment for the disease for more than a decade.
Experts described the development as “very worrying indeed” and warned the effects
could be “devastating”. Malaria claimed the lives of 655,000 people, mainly children, in
2010, according to the World Health Organisation, which warned that figure could rise
“dramatically”.
However, some estimates put the actual annual death toll at more than one million.
The development almost certainly puts the global strategy to end malaria deaths by the
UN’s target date of 2015 beyond reach. The world has been striving to eliminate the
disease for 50 years and a huge global effort in the past five years, galvanised by the
intervention of Bill Gates, has seen rates halved in many countries. Those gains are now
in danger of being reversed.
Artemesinin has long been regarded as a miracle cure for malaria because it works so
quickly, has few side-effects and, up to now, has been almost 100 per cent effective.
Resistance to it was first detected in western Cambodia in 2009, but has now spread
800km to the west. Efforts to contain the resistant parasites and wipe them out were made
following the earlier discovery but the latest findings suggest it may have been too little,
too late.
Experts are alarmed because, twice before, resistance to the then gold standard antimalarial drugs – chloroquine and sulfadoxine-pyrimethamine – has started in the same
region before spreading to South-east Asia and Africa, leading to the deaths of millions
of children.
Chloroquine, once given routinely to anyone with symptoms of malaria, is now
frequently ineffective against the disease.
The latest findings, published in The Lancet, come from the Shoklo Malaria Research
Unit which has been monitoring the disease on the Thai-Burmese border for more than a
decade. Studies in more than 3,000 patients show that artemesinin is taking a third longer
to clear malaria parasites from the blood than it did in 2001 (from 2.6 to 3.7 hours) – a
clear sign it is becoming less effective.
Professor François Nosten, director of the unit, said: “We have now seen the emergence
of malaria resistant to our best drugs, and these resistant parasites are not confined to
western Cambodia. This is very worrying indeed and suggests that we are in a race
against time to control malaria in these regions before drug resistance worsens, develops
and spreads further.
“The effect of that happening could be devastating. Malaria already kills hundreds of
thousands of people a year. If our drugs become ineffective, this figure will rise
dramatically.”
Professor Nick White, chairman of the Worldwide Antimalarial Resistance Network,
added: “Initially, we hoped we might prevent this serious problem spreading by trying to
eliminate all Plasmodium falciparum [the most lethal malaria parasite] from western
Cambodia. While this could still be beneficial, this new study suggests that containing the
spread of resistance is going to be even more challenging.”
The researchers said there was “compelling evidence” that genetic changes underlay the
emergence of resistance, based on a separate analysis of the genetic make up of the
parasites. Artemesinin is derived from an ancient Chinese herbal remedy. It is usually
given in combination with other medicines that last longer in the bloodstream. — The
Independent
Pills
Pills `better at curing appendix than surgery` (The Tribune: 11.4.2012)
London: Two out of three appendix removal operations may be unnecessary and could be
avoided by simply administering antibiotics, a new study has revealed. Doctors often
wrongly believe that surgery is the only way to treat appendicitis, researchers said. In
cases of uncomplicated appendicitis, where the organ has not become infected or
perforated, antibiotics are actually better than surgery, the study found.
A Nottingham University team studied 900 patients with appendicitis. About half were
given antibiotics while the rest underwent operations.The study reported a 63 per cent
success rate among patients who were given antibiotics. Just 20 per cent of cases require
an operation, the researchers said.
“The role of antibiotic treatment in acute uncomplicated appendicitis may have been
overlooked mainly on the basis of tradition rather than evidence,” the Sun quoted the
report.
“Antibiotics are both effective and safe as primary treatment for patients with
uncomplicated acute appendicitis,” the report said. An infected or inflamed appendix has
to be treated or removed before it bursts and causes a potentially deadly infection. —
ANI
Pesticides
Pesticides `may reduce pregnancy length and birth weight` (The
Tribune: 11.4.2012)
New Delhi: Exposure of pregnant women to organophosphate (OP) pesticides may be
associated with decreased gestational age and lower birth weight, a new study has
claimed. OP is a widely used class of pesticides in North American agriculture. The new
study, conducted by Vancouver-based Simon Fraser University (SFU) researchers, finds
that the decrement in birth weight for OP pesticide exposure was comparable with the
decrement seen for women who smoke cigarettes.
Although the findings need to be confirmed, it again raises people’s concern about the
harmful effects of low-level exposures to environmental toxicants. “For an individual
child, a decrement of 150-gram reduction in birth weight is of little consequence, but this
is just one of many risk factors that a pregnant woman might encounter,” English.news.cn
quoted Bruce Lanphear, the study’s senior author as saying.
Drug
New Drug Helps Detect Marker for Alzheimer's disease Earlier (Med
India: 16.4.2012)
A novel drug helps doctors detect beta-amyloid plagues in the brain earlier. Beta amyloid
plagues are the key signs of Alzheimer's disease, shows research.
Currently, Alzheimer's disease can only be definitively confirmed through the detection
of amyloid plaques and/or tangles in the brain during autopsy after death or with a brain
tissue biopsy. The new method uses the drug florbetaben as a tracer during a PET scan of
the brain to visualize amyloid plaques during life.
In order to prove that the florbetaben PET scan detects beta-amyloid in the brain, the
global phase III study directly compared brain regions in the PET scan to respective brain
regions after death during autopsy.
For the study, more than 200 participants nearing death (including both participants with
suspected Alzheimer's disease and those without known dementia) and who were willing
to donate their brain underwent MRI and florbetaben PET scan. The amount of plaque
found in the 31 participants who reached autopsy was then compared to the results of the
scans. A total of 186 brain regions from these donors were analyzed along with 60 brain
regions from healthy volunteers. Based on these 246 brain regions the study found
florbetaben to detect beta-amyloid with a sensitivity of 77 percent and a specificity of 94
percent.
Comparison of the visual assessment method proposed for florbetaben for clinical
practice with the post mortem diagnosis revealed a sensitivity of 100 percent and a
specificity of 92 percent. Sensitivity is the percentage of actual positives that are correctly
identified as positive, and specificity is the percentage of negatives that are correctly
identified.
"These results confirm that florbetaben is able to detect beta-amyloid plaques in the brain
during life with great accuracy and is a suitable biomarker," said study author Marwan
Sabbagh, MD, director of Banner Sun Health Research Institute in Sun City, Ariz., and a
Fellow of the American Academy of Neurology. "This is an easy, non-invasive way to
assist an Alzheimer's diagnosis at an early stage. Also exciting is the possibility of using
florbetaben as tool in future therapeutic clinical research studies where therapy goals
focus on reducing levels of beta-amyloid in the brain."
Caffeine
Caffeine intake may help improve treatment of dry eye syndrome (New
Kerala: 19.4.2012)
Researchers have found that consumption of caffeine can significantly increase the eye's
ability to produce tears, suggesting that it could offer relief for millions of people with
dry eye syndrome.
For many, dry eye syndrome is simply uncomfortable and annoying, but for others it
escalates into a vision-threatening disease.
Researchers at the University of Tokyo's School of Medicine found that all of the 78
participants in the new study produced significantly more tears after consuming caffeine
than after taking a placebo.
Dry eye syndrome involves malfunction of the rate of tear production, the quality of
tears, and/or the rate of evaporate from the surface of the eye.
Anyone can experience dry eye, though it is more common among women. Symptoms
can include gritty, scratchy or burning sensations, excessive tearing, and/or production of
stringy mucus.
The research team, by Reiko Arita, MD, PhD, was motivated by an earlier study that had
shown a reduced risk for dry eye in caffeine users: 13 percent of users had the syndrome
compared with nearly 17 percent of non-users.
The team knew that caffeine was likely to stimulate tear glands, since it is known to
increase other secretions, such as saliva and digestive juices. They also knew that people
respond differently to caffeine, so they analysed study participants' DNA samples for two
genetic variations that play important roles in caffeine metabolism.
Tear production proved to be higher in study subjects who had the two genetic variations.
"If confirmed by other studies, our findings on caffeine should be useful in treating dry
eye syndrome. At this point, though, we would advise using it selectively for patients
who are most sensitive to caffeine's stimulating effects," said Dr. Arita.
The study has been published in Ophthalmology, the journal of the American Academy
of Ophthalmology. (ANI)
Synthetic anti-malaria drug
Now, a synthetic anti-malaria drug (The Times of India: 24.4.2012)
India has developed a powerful new malaria drug — an alternative to the global drug of
choice Artemisinin — that promises to be a major boost to India’s pharmaceutical
research.
The new drug’s raw materiel is synthetic (derived chemically in the lab) while
Artemisinin is derived from a plant.
Union health minister Ghulam Nabi Azad and Ranbaxy will unveil India’s first new
chemical entity against the P falciparum malaria on Wednesday to commemorate World
Malaria Day.
Dr Neena Valecha of National Institute of Malaria Research said the new once-a-day
therapy for 3 days contains Arterolane and Piperaquine.
MEDICAL MARVEL
New malaria drug will be an alternative to global drug Artemisinin
Raw material for new drug is derived chemically in the lab
Artemisinin is derived from a plant
Synthetic nature will ensure constant supply and standardize costs Synthetic drug means
better supply
New Delhi: In a boost for the fight against malaria, India has developed a new malaria
drug with synthetic raw material which contains Arterolane and Piperaquine.
“Clinical trials conducted by National Institute of Malaria Research (NIMR)
comparing the Arterolane and Piperaquine combination has shown it to be as effective
and as safe as artemisinin combinations like Artesunate and Sulphadoxine which is used
in the national malaria programme,” said Dr Neena Valecha, who was the principal
investigator of the trials.
Artemisinin derivatives are most rapid acting and effective anti-malarial medicines,
according to her. It is the only high-volume drug that continues to be produced from a
plant-based source. China and Vietnam provide 70% and East Africa 20% of the raw
material. Seedlings are grown in nurseries and then transplanted into fields. It takes about
eight months for them to attain full size. It’s market price has fluctuated widely, between
$120 and $1,200 per kg from 2005 to 2008.
“However, they are plant derived and, therefore, there can be mismatch in demand and
supply. It is used in combination with different drugs (artemisinin-based combination
therapy). Now, five combinations are recommended by WHO. On the other hand, since
this new drug is synthetic, its raw materials are created chemically in the lab. This will
ensure constant supply of raw materiel and standardize costs,” added Dr Valecha.
India records 1.5 million cases of malaria every year, 50% of which are caused by the
falciparum malaria. Officially, an estimated 18,000 die of malaria in the country. The
number of malaria cases in India has dropped from two million a year to 1.5 million in
recent years, but the percentage of the more dangerous form, P falciparum infection, has
increased in some areas.
HIV drug
HIV drug for pregnant women (The Asian Age: 24.4.2012)
With an aim to reduce mother to child HIV transmission, the government is all set to
launch a new drug regimen for pregnant women.
Based on the recommendations of the World Health Organisation (WHO), the National
AIDS Control Organisation (Naco) is planning to put all pregnant women on antiretroviral drugs (ARV) for their treatment to prevent HIV infection to their infants.
The Naco has decided that the “three drug regimen” will be started in a phased wise
manner. “As of now ARV is not given to all pregnant women. Only women with less
CD4 count are put on it. The plan however is to change the existing drug regimen as
recommended by the WHO and put all pregnant women on antiretroviral therapy,” said
Dr BB Rewari, National Programme Officer, ART. The WHO had earlier recommended
the approach of starting all HIV infected pregnant women on lifelong treatment. The
WHO has also now begun a comprehensive revision of ARV guidelines for pregnant
women.
According to the available data, on an average approximately 700 women are infected
with HIV annually in India. The transmission of HIV is possible from an HIV-positive
mother to her child during pregnancy, labour, delivery or breastfeeding. “The new
regimen will be more efficacious. As of now only the advanced countries are following
the regimen,” added Dr Rewari.
The discussions to start the new drug regimen are underway,” added Dr Rewari.
To start with, the states reporting high incidence of mother to child transmission will be
started with the new drug regimen. The costs relating to the implementation will be borne
by the government and once the pilot project churn out good results, the new drug
regimen will then be introduced in the cities across the country.
For the effective implementation the government has identified the hospitals and
facilities in the select areas where women with HIV infection are registered and at present
undergoing treatment.
Officials say that the aim behind the programme is to prevent vertical transmission of
HIV/AIDS from mother to child, to provide timely counselling to the mother to ensure
zero transmission of the infection to the child.
Drug
Evaluating the First Drug to Show Improvement in Subtype of Autism
(25.4.2012)
In an important test of one of the first drugs to target core symptoms of autism,
researchers at Mount Sinai School of Medicine are undertaking a pilot clinical trial to
evaluate insulin-like growth factor (IGF-1) in children who have SHANK3 deficiency
(also known as 22q13 Deletion Syndrome or Phelan-McDermid Syndrome), a known
cause of autism spectrum disorder (ASD).
This study builds on findings announced by the researchers in 2010, which showed that
after two weeks of treatment with IGF-1 in a mouse model, deficits in nerve cell
communication were reversed and deficiencies in adaptation of nerve cells to stimulation,
a key part of learning and memory, were restored.
"This clinical trial is part of a paradigm shift to develop medications specifically to treat
the core symptoms of autism, as opposed to medications that were developed for other
purposes but were found to be beneficial for autism patients as well," said Joseph
Buxbaum, PhD, Director of the Seaver Autism Center at Mount Sinai. "Our study will
evaluate the impact of IGF-1 vs. placebo on autism-specific impairments in socialization
and associated symptoms of language and motor disability."
The seven-month study, which begins this month, will be conducted under the leadership
of the Seaver Autism Center Clinical Director Alex Kolevzon, MD, and will utilize a
double-blind, placebo-controlled crossover design in children ages 5 to 17 years old with
SHANK3 deletions or mutations. Patients will receive three months of treatment with
active medication or placebo, separated by a four-week washout period. Future trials are
planned to explore the utility of IGF-1 in ASD without SHANK3 deficiency.
The primary aim of the study is to target core features of ASD, including social
withdrawal and language impairment, which will be measured using both behavioral and
objective assessments. If preliminary results are promising, the goal is to expand the
studies into larger, multi-centered efforts to include as many children as possible affected
by this disorder.
IGF-1 is a US Food and Drug Administration-approved, commercially available
compound that is known to promote neuronal cell survival as well as synaptic maturation
and plasticity. Side effects of IGF-1 administration include low blood sugar, liver
function abnormalities, and increased cholesterol and triglyceride levels. Study subjects
will undergo rigorous safety screening before they are enrolled in the trial, and will be
carefully monitored every two to four weeks with safety and efficacy assessments.
"We are excited that the researchers at the Seaver Autism Center are undertaking this
pilot study to evaluate a possible treatment for SHANK3 deficiency, which may also help
everyone with ASD," said Geraldine Bliss, Research Support Chair of the PhelanMcDermid Foundation. "This will be the first clinical trial in Phelan-McDermid
Syndrome to emerge from convincing preclinical evidence in a model system."
The cause of autism has been debated for many years. Currently the best scientific
evidence indicates that genetic mutations are the most likely culprits, acting either
directly or indirectly, in upwards of 80 to 90 percent of individuals with ASDs. In the
past few years, gene mutations and gene copy number variations have been identified that
cause approximately 15 percent of cases of ASD. However, it is thought that hundreds of
genes may be involved in causing autism.
One copy of the q13 portion of chromosome 22 is either missing or otherwise mutated in
SHANK3 deficiency, also known as Phelan-McDermid Syndrome or 22q13 Deletion
Syndrome (22q13DS). The area in question contains the gene SHANK3, and there is
overwhelming evidence that it is the loss of one copy of SHANK3 that produces the
neurological and behavioral aspects of the syndrome. The SHANK3 gene is key to the
development of the human nervous system, and loss of SHANK3 can impair the ability
of neurons to communicate with one another.
Cocaine
Cocaine speeds aging of brain: (The Times of India: 26.4.2012)
Cocaine use may speed up brain’s ageing process, as those addicted to it lose twice the
brain volume each year as non-drug users, claims a new study. As the brain ages, it
inevitably loses gray matter, which is linked with declining cognitive abilities.
Anti-malaria drug
Ranbaxy launches anti-malaria drug(The Times of India: 26.4.2012)
Ranbaxy Laboratories, India’s top drug maker by sales, today launched a drug to treat
malaria. Claimed to be the first original drug developed by an Indian entity, Synriam, the
branded anti-malarial combination, will offer a more effective and shorter drug regimen
to patients. The drug has been approved for use on adults.
According to Ranbaxy, the product is undergoing final stages of clinical trials in Africa, a
region that accounts for 90 per cent of malaria-related deaths globally. India, however,
accounts for 75 per cent of the 2.5 million cases of malaria reported in the Southeast
Asia. Synriam would cost Rs 130 for a complete course (one tablet each for three days),
Arun Sawhney, chief executive officer and managing director of Ranbaxy, said
The company did not disclose the market potential of the medicine, as malaria medicines,
by and large, are supplied through government channels. Ranbaxy expects the product to
be included in government supplies soon. “We do not expect revenues from Synriam to
have a major impact on our balance sheet. It is our CSR (corporate social responsibility)
drug, as our prices will be the lowest among similar drugs,” Sawhney said.
Of the 17 medicines approved by the World Health Organisation for treatment of malaria,
more than half are supplied by Indian drug companies such as Cipla, Ipca Laboratories
and Ajanta Pharma. Other players include multinationals such as Sanofi Aventis and
Novartis. A WHO pre-qualification is essential for including a malaria drug under any
global programme. Ranbaxy also needs this international approval, if it has to supply its
medicine for the treatment of one of the most fatal forms of malaria, falciparum malaria
infection.
Ranbaxy got involved with the research project initiated by Medicines for Malaria
Venture (MMV), a Geneva-based not-for-profit foundation, when Swiss drug
multinational Roche, the original industry partner, decided to hand over the potential drug
candidate to it.
Four years later, MMV stopped funding the project and transferred the rights for
development and marketing of the medicine to Ranbaxy after it reviewed the progress of
clinical trials in November 2006. According to MMV’s annual report for 2006, the
decision was taken after “the review of the preliminary data and other portfolio
priorities”. Ranbaxy roped in the department of science and technology (DST) to part
fund the project.
Sawhney said the development cost of the drug was $30 million (Rs 150 crore). Of this,
Rs 5 crore came in as DST grant.
The Ranbaxy-DST agreement necessitates the company supplying the medicine for use
by government channels at a much lower rate. While Sawhney said the company was yet
to work out the pricing formula with DST, government sources said Ranbaxy had to
supply the drug at a price 10 per cent more than the actual cost of production. If the drug
is exported, DST would be entitled to three per cent of the net profit earned by Ranbaxy.
Sudershan Arora, president of R&D, Ranbaxy, said the company expected to complete
the final clinical trials by the first quarter of 2013.
Anti-malaria drug
It’s here: First ‘made in India’ anti-malaria drug (The Tribune:
26.4.2012)
Synriam costs less & reduces pill burden
India today got its first indigenously developed anti-malarial drug Synriam, which beats
all currently available options on the counts of affordability, compliance and relief.
The quick-relief treatment for uncomplicated malaria caused by Plasmodium falciparum
in adults is a major breakthrough as Plasmodium falciparum causes 50% malarial deaths
in India annually and 90% deaths annually worldwide.
The drug is the result of the first successful public-private partnership on pharmaceutical
research and development in India. Of the $30 million that the development of Synriam
cost Ranbaxy, the Ministry of Science paid Rs 5 crore. The government shared
investment costs on the condition of low pricing of the drug.
Accordingly, Synriam costs only Rs 130 for a simple dosage of one tablet a day for three
days. Most current options cost anywhere between Rs 170 and Rs 300 and require
patients to take two to four tablets twice daily for three or more days. Synriam reduces
the pill burden, leading to better compliance as the chances of patients missing the drug
due to high dosage reduce.
The new medicine that hit the markets today is also independent of dietary restrictions for
fatty foods or milk (as is the case with current traditional therapies). Most importantly, it
is a synthetic drug and not plant-based, like the currently available artemisinin-based
anti-malarials.
“Since it is a synthetic drug, it can be easily scaled up. Production is no issue,” Ranbaxy
CEO Arun Sawhney said after the launch today. Ranbaxy wants to introduce the drug in
government programmes.
The drug is a major R&D leap for India which accounts for 77% of all 2.5 million
malaria cases reported in South East Asia annually. So far as malarial mortality goes, the
government estimate of 1,000 deaths a year has been disputed by medical journal Lancet,
which estimates 2.05 lakh deaths annually.
“The expert committee we set up to estimate the correct mortality has pegged the deaths
at 40,000 a year but is waiting for the data to be validated by the ICMR,” Health Minister
Ghulam Nabi Azad said after launching the drug along with Science Minister Vilasrao
Deshmukh on the occasion of World Malaria Day today.
The benefits
Costs just Rs 130 for a three-day course; one tablet a day
Existing therapies have high dosage; patients tend to miss medicines
The malarial parasite has acquired resistance to available drugs
Availability of plant-based Artemesinin, main ingredient of existing drugs, limited and
unreliable
Synriam is synthetic and not plant-based and production can be scaled up easily
Drugs
Two Drugs Better Than One to Treat Youth With Type 2 Diabetes,
Study Suggests(Science daily: 30.4.2012)
Programs to prevent or delay type 2 diabetes in high-risk adults would result in fewer
people developing diabetes and lower health care costs over time, researchers conclude in
a new study funded by the National Institutes of Health.
Prevention programs that apply interventions tested in the landmark Diabetes Prevention
Program (DPP) clinical trial would also improve quality of life for people who would
otherwise develop type 2 diabetes. The analysis of costs and outcomes in the DPP and its
follow-up study is published in the April 2012 issue of Diabetes Care and online March
22.
The DPP showed that lifestyle changes (reduced fat and calories in the diet and increased
physical activity) leading to modest weight loss reduced the rate of type 2 diabetes in
high-risk adults by 58 percent, compared with placebo. Metformin reduced diabetes by
31 percent. These initial results were published in 2002. As researchers monitored
participants for seven more years in the DPP Outcomes Study (DPPOS), they continued
to see lower rates of diabetes in the lifestyle and metformin groups compared with
placebo. Lifestyle changes were especially beneficial for people age 60 and older.
The economic analysis of the DPP/DPPOS found that metformin treatment led to a small
savings in health care costs over 10 years, compared with placebo. (At present,
metformin, an oral drug used to treat type 2 diabetes, is not approved by the Food and
Drug Administration for diabetes prevention.) The lifestyle intervention as applied in the
study was cost-effective, or justified by the benefits of diabetes prevention and improved
health over 10 years, compared with placebo.
"Over 10 years, the lifestyle and metformin interventions resulted in health benefits and
reduced the costs of inpatient and outpatient care and prescriptions, compared with
placebo. From the perspective of the health care payer, these approaches make economic
sense," said the study's lead author William H. Herman, M.D., M.P.H., a co-investigator
of the DPP Research Group and director of the Michigan Center for Diabetes
Translational Research, Ann Arbor.
The DPP enrolled 3,234 overweight or obese adults with blood sugar levels higher than
normal but below the threshold for diabetes diagnosis. Participants were randomly
assigned to a lifestyle intervention aimed at a 7 percent weight loss and 150 minutes per
week of moderate intensity activity, metformin treatment, or placebo pills. The groups
taking metformin or placebo pills also received standard lifestyle recommendations.
"We don't often see new therapies that are more effective and at the same time less costly
than usual care, as was the case with metformin in the DPP. And while the lifestyle
intervention was cost-effective, we would see greater savings if the program were
implemented in communities," said Griffin P. Rodgers, M.D., director of the NIH's
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). "This has
already been demonstrated in other NIDDK-funded projects, including one in YMCAs,
where a lifestyle-change program cost $300 per person per year in a group setting,
compared to about $1,400 for one-on-one attention in the DPP."
In the DPP, direct costs over 10 years per participant for the lifestyle and metformin
interventions were higher than for placebo ($4,601 lifestyle, $2,300 metformin, and $769
placebo). The higher cost of the lifestyle intervention was due largely to the
individualized training those participants received in a 16-session curriculum during the
DPP and in group sessions during the DPPOS to reinforce behavior changes.
However, the costs of medical care received outside the DPP, for example
hospitalizations and outpatient visits, were higher for the placebo group ($27,468)
compared with lifestyle ($24,563) or metformin ($25,616). Over 10 years, the combined
costs of the interventions and medical care outside the study were lowest for metformin
($27,915) and higher for lifestyle ($29,164) compared with placebo ($28,236).
Throughout the study, quality of life as measured by mobility, level of pain, emotional
outlook and other indicators was consistently better for the lifestyle group.
"The DPP demonstrated that the diabetes epidemic, with more than 1.9 million new cases
per year in the United States, can be curtailed. We now show that these interventions also
represent good value for the money," said study chair David M. Nathan, M.D., director of
the Diabetes Research Center at Massachusetts General Hospital, Boston.
Homoeopathy
Homoeopathy gets a boost(world Newspapers:30.4.2012)
A slew of measures announced by the state minister for medical education, Dr
Vijaykumar Gavit, on Wednesday are set to change the face of homoeopathy in the state.
Speaking at a Maharashtra Council of Homoeopathy (MCH) function held to fete
homoeopaths in the state, Dr Gavit said, “The government will be sending a Rs200-crore
proposal for a college of homoeopathy on a 50-acre stretch soon.” The college will
double up as a research centre.
Gavit’s announcement came in response to fervent pleas by the gathered homoeopaths
who averred that “the state of the system of medicine was so bad that they would be
forced to commit suicide”. Gavit vowed he will introduce the proposal for a state-funded
college in the next assembly session in June.
Welcoming the move, MCH director Bahubali Shah said, “With the setting up of
government colleges, we will be able to standardise homoeopathy education and
practices. Also, we will be more involved in the public healthcare system of the state.”
Though there are 46 undergraduate and 12 post-graduate homeopathy colleges in the
state, not a single one is government-funded. In contrast, numerous ayurveda colleges get
full government aid.
Other demands conceded to by Gavit included allowing homoeopaths to administer
modern allopathic drugs in medical emergencies, especially in remote villages, after
training through a certificate course.
Further, Shah demanded the formation of a separate directorate for homeopathic
medicine. “As we are part of the directorate of ayurveda, in which we have only one
representative, hardly any decisions are taken to further the field of homoeopathy,” said
Shah and added, “While the ayurveda directorate last year got a state funding of Rs200
crore, we were given only Rs87 lakh.”
While seeking a time frame of six months for other demands, Gavit agreed to giving
independent charge to the deputy director of homoeopathy.
Diabetes 2 drugs
2 drugs better than 1 to treat type-2 diabetes in youth (The Tribune:
2.5.2012)
Washington: Researchers have found that a combination of two diabetes drugs,
metformin and rosiglitazone, is more effective in treating youth with recent-onset type-2
diabetes than metformin alone. But adding an intensive lifestyle intervention to
metformin provided no more benefit than metformin therapy alone.
They also found that metformin therapy alone was not an effective treatment for many of
these youth. In fact, metformin had a much higher failure rate in study participants than
has been reported in studies of adults treated with metformin alone. The Treatment
Options for type 2 Diabetes in Adolescents and Youth (TODAY) study is the first major
comparative effectiveness trial for the treatment of type-2 diabetes in young people. —
ANI
Painkiller Abuse
Painkiller Abuse by Mothers Sees Three-Fold Rise in Addicted
Babies(Med India: 2.5.2012)
Medindia on - Back Pain - Backache - Workplace - Prevention - Exercises
Back pain is a major ergonomic issue that is becoming increasingly common owing to
changing work pattern.Back pain, especially low back pain, is often associated with
functional disability as well as economic and social consequences.
American health officials are worried over the increasing rates of prescription painkiller
abuse among expectant mothers which has spiked the rate of babies born with opiate
addiction by nearly three times in the last decade.
The study published in the Journal of the American Medical Association showed a fivefold increase in maternal use of painkillers from 2000 to 2009, rising from 1.19 cases per
1,000 births to 5.63 per 1,000 annually.
Not all babies -- between 60-80 percent -- born to drug-using mothers develop neonatal
abstinence syndrome (NAS), which can include breathing problems, tremors and
seizures, feeding difficulties, low birthweight and irritability.
The rate of infants born with withdrawal syndrome rose from 1.2 cases per 1,000 births in
the year 2000 to 3.39 per 1,000 in 2009. Such babies typically required 16 days
hospitalization after birth.
Painkiller use by pregnant mothers not only causes health and developmental problems in
babies, but also raises costs in an already beleaguered health care system, said the
findings which were based on US public hospital records.
The medical costs rose exponentially, with average hospital charges spiking from
$39,400 in 2000 to $53,400 in 2009, a 35 percent increase after adjusting for inflation.
Babies with NAS were much more likely to be born to mothers covered by Medicaid (78
percent), the government-funded insurance program for the poor, and to live in zip codes
with the lowest incomes (36 percent).
The increases, noted as part of the first nationally representative study on babies born
with addiction syndrome across the United States, were generally in line with separate
studies on painkiller use in the general population.
Sales and deaths related to opiate pain relievers in the United States quadrupled from
1999 to 2008, according to a recent study by the Centers for Disease Control and
Prevention.
"These medications provide superior pain control for cancer and chronic pain, but have
been overprescribed, diverted and sold illegally, creating a new opiate addiction pathway
and a public health burden for maternal and child health," said an accompanying editorial
by Marie Hayes and Mark Brown, both doctors at the University of Maine.
Antibiotics
Researchers Find Pathways in Human Body that can Improve
Effectiveness of Antibiotics (2.5.2012)
Researchers at Brigham and Women’s Hospital in Boston have discovered new pathways
in the human body that has naturally occurring molecules which can improve the
antibiotic performance against bacteria.
The study will be electronically published on April 25, 2012 in Nature.
Mice infected with Escherichia coli (E. coli) or Staphylococcus aureus (S. aureus)
bacteria were given molecules called specialized pro-resolving mediators (SPMs) along
with antibiotics. SPMs are naturally found in our bodies, and are responsible for
mediating anti-inflammatory responses and resolve inflammation. An anti-inflammatory
response is the body's attempt to protect itself from infectious agents and initiate the
healing process.
The researchers found that specific types of SPM molecules, called resolvins and
protectins, were key in the anti-inflammatory response to limit tissue damage by
stimulating the body's white blood cells to contain, kill and clear the bacteria.
Administered with antibiotics, resolvins and protectins heightened immune response by
commanding white blood cells to attack and engulf the bacteria, thereby quickly reducing
the amount of bacteria in the blood and tissues.
RvD5—a type of resolvin—in particular was also helpful in regulating fever caused by
E.coli, as well as counter-regulating genes responsible for mounting excess inflammation
associated with infections; hence, limiting the collateral damage to the body while
fighting infection.
Serhan and colleagues are the first to demonstrate RvD5, as well as its actions against
bacterial invasion. The BWH team, collaborating with Fredrik Bäckhed, PhD of the
Sahlgrenska Center for Cardiovascular and Metabolic Research in Sweden, found that
germ-free animals produce high levels of resolvins.
When Nan Chiang, PhD, BWH Experimental Therapeutics and Reperfusion Injury
Center, and lead study author, added these natural mediators together with antibiotics,
less antibiotics were needed. This demonstrated for the first time that stimulating
resolution programs can limit negative consequences of infection.
"How the body responds to inflammation has been the subject of Dr. Serhan's work for
more than 20 years, and his new study is important for understanding that sequence of
events," said Richard Okita, PhD, National Institute of General Medical Sciences,
National Institutes of Health which funded the research. "One of the particularly exciting
findings is that SPMs can enhance the effectiveness of antibiotics, potentially lowering
the amount needed to treat infections and reducing the risk of bacteria developing
resistance."
According to the researchers, another advantage of SPMs is that, unlike antiinflammatory drugs (e.g. aspirin, steroids, ibuprofen), SPMs do not cripple the body's
normal immune response.
"Anti-inflammatory agents are widely known to be immunosuppressive," said Serhan.
"Now we have naturally occurring molecular pathways in our bodies that work like these
agents and stimulate bacterial containment and resolution of infections, but do not come
with the side effect of being immunosuppressive."
E. coli infections continue to be both a world- and nationwide concern. In the United
States, E. coli infections account for approximately 270,000 cases per year. S. aureus is
responsible for causing skin infections and a majority of hospital-acquired infections.
Anti-Malaria Drug
Ranbaxy Marks World Malaria Day by Unveiling “Indigenously”
Developed Anti-Malaria Drug(2.5.2012)
Indian pharmaceutical giant Ranbaxy announced at a conference in New Delhi that it has
developed a new “indigenous” anti-malaria drug.
The new drug, called Synriam, which is effective against the deadliest malaria microbe,
Plasmodium Falciparum, would be a boon for millions of malaria patients around the
globe, said Ranbaxy chief executive and managing director Arun Sawhney.
"Almost 77 percent of the 2.5 million malaria patients in South East Asia are in India.
Synriam will certainly become the preferred option in the hands of doctors to fight
malaria, which annually claims half a million lives globally," Sawhney said.
Speaking on the occasion, union Minister for Science, Technology and Earth Sciences
Vilasrao Deshmukh said he had been told (by Ranbaxy) that "Synriam is safe and
efficacious. I am sure they (Ranbaxy) will ensure that the drug is affordable, as malaria
affects the poor more".
"Globally, the Indian pharmaceutical industry is ranked third in volumes and 14th in
value. This is not because our quality is lower, but because our profit margins are
minimum. I congratulate our pharma companies for keeping the prices of lifesaving
medicines low," Deshmukh added.
Union Minister for Health and Family Welfare Ghulam Nabi Azad agreed with his
cabinet colleague, saying that the drug should be affordable "so that the poor and needy
can access it easily".
Malaria remains a major global health challenge, especially in developing and under
developed countries. The disease spreads through the bite of female Anopheles
mosquitoes.
Out of four malaria parasites Plasmodium Falciparum and Plasmodium Vivax are most
common with the former being responsible for almost 90 percent fatalities due to the
disease.
Anti-aging Pill
New Study Supports Life-extending Benefits of Red Wine, Reopens
Hope for Anti-aging Pill (Med India: 3.5.2012)
New findings from a study showed for the first time that the metabolic benefits of the red
wine ingredient resveratrol evaporate in mice that lack the famed longevity gene SIRT1.
The study in the May issue of the Cell Press journal Cell Metabolism appears to offer
vindication for an approach to anti-aging drugs that has been at the center of heated
scientific debate in recent years.
"Resveratrol improves the health of mice on a high-fat diet and increases life span," said
David Sinclair of Harvard Medical School. The question was how.
Resveratrol is a dirty molecule, he explained. Its benefits had been attributed largely to its
actions on SIRT1, based on studies in yeast, worms, and flies, but the naturally occurring
ingredient has other effects; it influences dozens of proteins, and some evidence had
pointed to the importance of another well-known gene (called AMPK) for resveratrol's
metabolic benefits. That called into question not only the biology, but also whether
SIRT1-targeted drugs in development were aimed in the wrong direction. (Those doubts
and other factors led the pharmaceutical company Sirtris to halt its last clinical trial of
resveratrol last year.)
Answers were hard to come by in mice, because animals lacking SIRT1 altogether don't
survive. Sinclair and his colleagues have now overcome that obstacle by producing mice
in which the SIRT1 gene can be completely turned off in adults. They've discovered that
those SIRT1-deficient adult mice don't enjoy the benefits of resveratrol.
The study also provides insight into another important aspect of the resveratrol
controversy. Doubts had arisen in part because the red wine ingredient seems to act in
different ways at different doses. The study by Sinclair and colleagues clears those details
up, too.
They show that resveratrol targets SIRT1 directly at moderate doses and hits other targets
at higher ones. Importantly, SIRT1 is required for resveratrol's benefits irrespective of
dose. Based on the findings, Sinclair emphasizes the value of finding the lowest effective
dose of resveratrol, and perhaps any drug, to avoid off-target effects.
George Vlasuk, CEO of Sirtris, who was not involved in the new study, says the findings
in Cell Metabolism offer the "first definitive evidence" for a direct link between SIRT1
and the metabolic benefits of resveratrol.
"The work by Price et al. strongly supports the basic rationale being pursued at Sirtris,
which focuses on the development of small-molecule compounds that directly activate
the enzymatic activity of SIRT1 as a new therapeutic approach to many diseases of
aging," Vlasuk wrote in an email.
Drug
Biased Evidence? Researchers Challenge Post-Marketing Drug Trial
Practices(Science daily:4.5.2012)
Current research ethics focuses on protecting study participants, but according to
bioethicists from Carnegie Mellon University and McGill University, these efforts fail to
prevent problems that undermine the social value of research.
Published in Science, CMU's Alex John London, and McGill's Jonathan Kimmelman and
Benjamin Carlisle argue that current research ethics frameworks do not flag drug trials
that, while not putting patients at risk, produce biased evidence. As an example, they
point to phase IV research -- when pharmaceutical companies test drugs and devices that
have been approved for marketing. They insist that without an adequate system of checks
in place, phase IV trials will continue to be used by drug companies to market products
without generating the information that clinicians and policy makers can use to improve
care and maintain a more cost-effective health system.
"Medical care isn't like most consumer products where the consumer can assess the
quality of the product from its performance and estimate its value for the money," said
London, associate professor of philosophy and director of CMU's Center for Ethics and
Policy. "In medicine we are forced to rely on what can at times be complex scientific
studies for this information. So it is difficult to overstate the importance of preserving the
integrity of this research."
London and Kimmelman point out how some phase IV studies have used questionable
designs and have been used by drug companies for producing "brand loyalty" among
physicians conducting the study. Some of the practices that result in bias, like selective
reporting of data, may be difficult for journal editors or clinicians to detect on their own.
Current review systems at drug regulatory agencies like the Federal Drug Administration
(FDA) or at universities have little authority to police post-marketing trials for bias. To
correct the problem, London and Kimmelman, who frequently collaborate on ways to
improve clinical research, point to several policy options, including expanding the review
authority of the FDA, academic medical centers and medical journals.
"Rigorously designed and executed research has a critical role in improving patient care
and restraining ballooning health care costs," said Kimmelman, associate professor of
biomedical ethics at McGill. "There is currently a push to streamline the ethical review of
research. In this process, oversight systems should be empowered to separate scientific
wheat from marketing chaff."
The Canadian Institutes of Health Research funded this research.
Cancer drug
Cancer drug prices cut by more than half(Hindustan Times:4.5.2012)
In a major relief for cancer patients, India’s second largest drug-maker Cipla on Thursday
announced a reduction ranging between 59-76% in the prices of its generic drugs used in
the treatment of cancers of lung, liver, kidney and brain.
“Drugs constitutes a significant proportion of the overall cost of cancer treatment and
reduction in costs can greatly relieve the burden,” said YK Hamied, CMD, Cipla.
The move comes in the wake of the government allowing domestic drug maker Natco
Pharma to manufacture and sell its generic version of German multinational Bayer’s
patent-protected cancer medicine, Nexavar.
In March, Indian Patent office had stripped Bayer of its exclusive rights to sell Nexavar, a
treatment for kidney and liver cancer, granting Natco Pharma a licence to sell the generic
drug at R8880 for a monthly dose. Bayer sells the branded Nexavar at R284428 a month.
According to World Health Organization, there are about 2.5 million cases of cancers
diagnosed in India every year. Most cases receive sub-optimal treatment due to the high
cost of drugs.
“These are generic chemotherapy drugs used for brain, lungs, liver and kidney cancer.
The kidney and liver drugs have to be taken four times a day, sometimes for up to a year.
These drugs will be more accessible to the public now,” said Dr Purvish Parikh, Mumbaibased cancer specialist. There are around 100 stockists of Cipla in India, according to a
company spokesperson.
Medicines
Health on mind,
Times:4.5.2012)
Rajasthan
gives
free
medicines(Hindustan
Around 800 million people in India — two-thirds of the population — lack access to
essential drugs, according to the World Health Organisation. What’s more, about 20
million Indians slip below the poverty line every year because of the money they lose for
falling ill.
Such alarming figures have prompted the Rajasthan government to pursue a programme
to make free medicine a part of inclusive growth.
In October last year, chief minister Ashok Gehlot launched a programme to provide 385
generic drugs free at government health centres.
Though not the first-of-its-kind of initiative, the expanse of the programme makes it
unique.
The medicines, distributed through 15,000 centres, include those for heart diseases,
cancer, hypertension, diabetes and respiratory infections. Several vaccines are also
provided.
The programme has led to a 40% increase in patient footfalls at government hospitals.
About 200,000 people are getting free medicines every day.
For Nirmala Lalwani of Ajmer, the programme has “come as great relief for poor people
like us”. Lalwani's husband suffers from diabetes, bronchitis and high blood pressure.
"Earlier, a fifth of our income was spent on medicines. Sometimes, I had to borrow from
neighbours,” she said.
Rajasthan ranks poorly on basic health indicators. About 44% children below the age of 3
suffer from malnutrition against the national average of 46%, while the corresponding
number for women in the age group of 15 to 49 years is alarmingly high at 53%
compared to the national average of 36%.
The programme, however, has had its share of problems. Government hospitals had
initially struggled to handle the rush of medicine seekers. Non-availability of medicines
continues to be reported from many places.
Satish Kumar, a retired government official in Sriganganagar, said, “The more expensive
medicines are difficult to get.” The government is also motivating doctors to break the
stranglehold of pharma firms. “Despite glitches, the scheme has been a success,” said Dr
Samit Sharma, MD, Rajasthan Medical Service Corp Ltd, the nodal agency for procuring
medicines in the state.
Drug
Clinically unprotected(The Financial Express:10.5.2012)
The systemic failure to check the usage of spurious/low-quality drugs in India is common
knowledge, but a new report paints an equally alarming picture of the primary
mechanism for licensing drugs itself. Over an 18-month investigation, the Parliamentary
Standing Committee on Health has identified a slew of irregularities. For instance, an
average of one drug every month is being approved by the Drugs Controller General of
India without the mandated clinical trials on Indian patients; in other cases, these trials
are being conducted without the mandated minimum of 100 patients or of three-four sites.
Some of the drugs that have been cleared without clinical trials in India are actually
banned in the countries where they were developed, among others. The sins are not just
those of omission, but also of commission, with the committee finding “sufficient
evidence” of a collusive nexus between drug manufacturers, experts and the drugs
controller, namely.
the Central Drugs Standard Control Organisation. Files for some drugs that are sold in
India but have been pulled off markets with more well developed regulatory systems
have simply disappeared. A majority of drugs are being approved on the basis of ‘expert’
opinions that, far from being based on scientific evidence, are “written by the invisible
hands of drug manufacturers”, with various ‘experts’ handing in opinions that are
identical word for word. At a time when India is going in for controversial measures like
compulsory licensing in the name of protecting patients, all of the above suggests that we
may be missing the wood for the trees.
Budget 2012 continued the 200% weighted deduction on in-house research and
development expenditures for this year, and we need measures like this to encourage
innovation in the interests of patients’ welfare. But manoeuvres like extending price
controls and capping profits are hardly likely...
to have a welfare impact as long as the drug approval process remains deeply flawed.
First, colluding experts and officials must be punished. Next, drug approval must be
properly monitored and reformed. Then, suboptimal drug use must be checked, inclusive
of the ayurvedic, homoeopathic and Unani sector. Targeting profits and instituting
compulsory licences cannot substitute for such essential groundwork when it comes to
promoting public health....
Drugs
Clinically at risk(The Financial Express:11.5.2012)
Statutory rules require that the applicant for New Drugs discovered outside India should
conduct Phase III trials on not less than 100 patients at 3-4 different hospitals in India.
This is to determine if there are any ethnic differences that can alter the metabolism,
efficacy and safety of the drug when administered to patients living in India—such as
Indo-Aryans, Dravidians, Mongoloids, Tribals.
To illustrate, the blood levels reached after intake of lipid-lowering rosuvastatin are far
higher in Asians, compared to European and North American Caucasians, Hispanics and
Blacks. Failure to lower dose in Indians can result in severe toxicity, including lifethreatening muscle injury leading to fatalities. Hence, testing drugs in the Indian ethnic
groups is of paramount importance before approving any drug of foreign origin.
In order to scrutinise new drug approvals, the Parliamentary Standing Committee on
Health and Family Welfare sought details for randomly selected 42 medicines from the
list of...
new drugs uploaded by the Central Drugs Standard Control Organisation (CDSCO) on its
website. These were approved between January 2001 and November 2010, during which
period 2,167 drugs were approved. Thus the sample size for random scrutiny was less
than 2%.
The Ministry could not provide any documents on three drugs on the grounds that files
were non-traceable. Strangely, all these cases also happened to be controversial drugs:
one was never marketed in the US, Canada, Britain, Australia and other countries with
well-developed regulatory systems while the other two were discontinued later on. In
India, all the three drugs are currently being sold.
On scrutiny of the 39 drugs on which information was available, the Committee found
that Phase III clinical trials were not conducted in 11 cases. In 2 cases, clinical trials were
conducted on just 21 and 46 patients respectively as against the statutory requirement of
at least 100 patients....
In 1 case, trials were conducted at just two hospitals as against the legal requirement of 34 sites.
For 25 drugs, the opinion of medically qualified experts was not obtained before
approval. For 4 drugs, neither were mandatory Phase III clinical trials conducted nor was
the opinion of experts sought. The decision to approve these drugs was taken solely by
the non-medical staff of CDSCO!
And 13 drugs did not have permission for sale in any of the major developed countries.
The Committee also found cases where approval had been given to drugs banned in
innovator countries. In the case of Buclizine, approved for appetite stimulation without
clinical trials and without consulting experts for use in children, when asked whether the
drug was approved in the US, Canada, Britain, the EU and Australia, instead of giving
“Yes” or “No” answers to each of the specified countries, the Ministry went out of the...
Bitterest pill
Bitterest pill (Business Standard: 11.5.2012)
A few proposals from overseas companies to invest in Indian drug makers are stuck with
the government, although 100 per cent foreign direct investment is allowed in the sector
under the automatic route. That's because domestic producers have argued that
multinational pharmaceutical corporations are buying local companies only to stifle
competition. The day is not distant, they say, when the Indian market will be controlled
by multinationals, and medicine will become prohibitively expensive for the aam admi.
So, guidelines are being framed that will enable the Competition Commission of India
(CCI) to vet all cases of acquisition of an Indian drug maker by an overseas company.
And permission will come with stringent riders: the acquired company will have to take
the CCI's permission before discontinuing production of an essential drug. Till the
guidelines are framed, the Foreign Investment Promotion Board has decided to play it
safe and put all foreign investment proposals on hold. This is in spite of the fact that, with
20,000 pharmaceutical companies, India's is the most fragmented market in the world
— and hence the most competitive. There are hundreds of brands for every
medicine, and a market share of five per cent to six per cent is good enough to become
the leader. The chances of collusion to ramp up prices are, thus, minimal: prices in India
are amongst the lowest in the world. So, instead of worrying too much about the
ownership of Indian pharmaceutical companies and its impact on prices, the government
had better address the other problems that afflict the sector.
A report of the Parliamentary Committee on Health and Family Welfare, tabled in the
Rajya Sabha on Tuesday, has found that expert opinions necessary for drug approvals
were ghostwritten by the companies that had sought the approvals. Reports sent in by
different experts on the same drug were found to be exact copies of each other —
with the same errors! These opinions are submitted to the Central Drugs Standard Control
Organisation, which, going by these opinions, approves or rejects the application to
launch the drug. This report said that there was "ample evidence&" to suggest that these
expert opinions were "actually written by the invisible hand of the drug companies and
experts merely obliged by putting their signatures&". The committee also found that
pharmaceutical companies were carrying out clinical trials of new drugs in noncosmopolitan Tier-II and Tier-III towns. The idea behind carrying out clinical trials in
large, diverse cities is to gauge the drug's effectiveness across various ethnic groups. It is
an open secret that pharmaceutical companies prefer to go to small towns because the
expenses are lower.
To raise the regulatory standards in the sector, the government must revisit the proposal
mooted by the industry some time back to become a member of the Pharmaceutical
Inspection Convention. This is an association of drug regulators who agree to stick to
certain standards. It is estimated that it will take India five years to raise its regulatory
ecosystem to that level. This will also help exports to the 40 countries that are its
members, as inspection from their regulators of Indian drug manufacturing units will no
longer be required. The flip-side is that this could push smaller drug makers, many of
whom operate out of garages and holes in the wall, out of business. That makes it a
political decision. But the clean-up will be substantial.
Anti-HIV drug tenofovir
Anti-HIV drug tenofovir 'safe to take during pregnancy'(New Kerala:
17.5.2012)
A new study has found that pre-birth exposure to the anti-HIV drug tenofovir does not
adversely affect pregnancy outcomes and does not increase birth defects, growth
abnormalities, or kidney problems in infants born to African women who are HIV
positive.
The finding supports the use of this drug during pregnancy.
A team of international researchers led by Diana Gibb from the MRC Clinical Trials Unit
in London, UK, analyzed data collected on pregnancy and infant outcomes among
Ugandan and Zimbabwean HIV-positive women who took Antiretroviral therapy (ART a combination of anti-HIV drugs) during pregnancy in the Development of
AntiRetroviral Therapy in Africa (DART) trial.
DART was a large randomised controlled trial that compared different approaches for
monitoring anti-retroviral therapy in over 3000 adults. As part of the trial, researchers
collected data on any pregnancies among women taking part, including drugs they
received; babies were followed for up to 4 years.
Most of the women who became pregnant were taking a tenofovir-containing
combination of anti-HIV drugs before and throughout their pregnancies and out of the
226 live births, the researchers recorded that there was no increase in the proportion of
infants who died soon after birth (3percent) or had birth defects (also 3 percent),
comparing those exposed and not exposed to tenofovir-containing anti-retroviral therapy
during pregnancy.
Of 182 surviving infants enrolled in a follow-up study, 14 subsequently died giving a 1year mortality rate of 5 percent, similar to the 2 percent infant mortality normally seen in
the region, and much lower than among babies born to severely HIV infected untreated
mothers.
Furthermore, the researchers found that none of the surviving infants who were tested for
HIV were positive and no bone fractures or kidney problems occurred during follow-up
and there was no effect on growth at 2 years.
'We observed no evidence that tenofovir versus non-tenofovir ART had any adverse
effects on pregnancy outcomes or on congenital, renal, bone, or growth abnormalities up
to age 4 y among children born to women with severe HIV immunodeficiency at ART
initiation and exposed throughout the intrauterine period,' the researchers said.
'Our findings suggest tenofovir-containing ART is a reasonable choice in pregnancy and
that tenofovir pre-exposure prophylaxis is also reasonable for women who are at high risk
of seroconverting during pregnancy.
'Detailed safety of tenofovir for pre-exposure prophylaxis will need confirmation from
longer term follow-up of larger numbers of exposed children,' they added.
The findings were published in this week's PLoS Medicine.
Antibiotic
Popular antibiotic is bad for heart, may lead to death (The Times of
India:18 May 2012)
An antibiotic that is widely prescribed in India to combat bacterial sinus infections and
bronchitis has been found to be bad for heart.
A study, published in the New England Journal of Medicine on Thursday, has found a
2.5-fold higher risk of cardiovascular death in the first five days of taking Azithromycin
— commonly called Z-pack — compared with another common antibiotic or no
antibiotic at all.
Though it was previously considered to carry little to no cardiac risk, researchers noted
well-documented reports linking azithromycin with serious arrhythmias.
When compared with another antibiotic like amoxicillin, there were about 47 more deaths
per million courses of therapy in those taking azithromycin.
That risk increased to 245 additional cardiovascular deaths per million in patients already
known to have heart problems.
For the study, about 348,000 recorded prescriptions of azithromycin were compared with
millions of similar records from people who were not treated with antibiotics or were
treated with other antibiotics.
The primary comparison was with amoxicillin, an antibiotic that is considered to be safe
for heart and is used in similar clinical circumstances as azithromycin.
Dr Anoop Misra, chairman of Fortis-C-DOC centre for diabetes and metabolic diseases,
said, “With wide variety of antibiotics currently available, Azithromycin (and other
antibiotics in this class) should be used with extreme caution and only when no
alternatives are available, and especially when there is history of cardiovascular problems
in patients using it.”
Drug expert C M Gulhati said, “Azithromycin is a very commonly used antibiotic that
belong to the group macrolides. When it was found that penicillin caused serious allergy,
Azithromycin became the most common alternative.” He said Azithromycin is primarily
used against lower respiratory tract infections, acute bacterial bronchitis, community
acquired pneumonia, upper respiratory tract infections, skin infections and uncomplicated
urethritis due to Chlamydia trachomatis.
Pills and shills
Drug regulation is a mess. Everyone who propped up this irresponsible
system is to blame(The Indian Express:21.5.2012)
Last week, a parliamentary standing committee on health delivered a thoroughly
damaging report on the state of drug regulation in India, and the collusion between the
regulator, industry and the medical profession that puts patients last. Over 118 pages, it
said that the Drug Controller General of India (DCGI) and the Drug Standards Control
Organisation (DSCO) have betrayed their regulatory responsibility in the manner in
which they granted approvals. Now, several senior doctors, rebuked for letting their
connections with pharmaceutical companies affect their drug endorsements, beg to differ.
According to them, regulation is not their problem, and doctors’ opinions are irrelevant to
the introduction of drugs in the Indian market.
Except not. The committee found that many drugs were being marketed before they had
been put through the required clinical trials (Novartis’s Everolimus, Eli Lilly’s
Pemetexid, for instance), and several drugs banned in other markets were bought and sold
here. The law mandates that any new drug introduced in India must be put through local
Phase 3 clinical trials, on at least 100 people. Instead, using a “public interest” escape
route, the DSCO had waived the clinical trial requirement without being able to back up
its decisions. Regulatory dossiers were missing for several drugs, and in many cases,
approvals were granted by non-technical staff. When expert opinion was consulted, it was
seemingly dictated by what the report calls the “invisible hand” of pharma companies,
sometimes the testimonials echoing each other word-for-word. In one case, with Thermis
Medicare Ltd, the regulator asked the company to select its own experts, and bring their
opinion to it. To be fair, there are reasons for this sloppiness — while the pharma
industry is exploding, and the DSCO’s workload is growing by 20 per cent every year, it
lacks the staff and infrastructure, advisers and independent testing labs to do its job.
This is not a moment to blame each other. Doctors have been part of this corrupt edifice,
along with companies and regulatory officials. Medicines, after all, are an area where
consumers are not equipped to make informed decisions. They rely on those who know
better to look out for their interests. And they have been sorely let down.
Arthritis Drug
Arthritis Drug Effective Against Amoebic Parasites(Med India:
21.5.2012)
A common drug that is used for arthritis proves as an effective weapon against parasitic
organisms, reveals study.
Researchers in California found that auranofin, an oral therapy for arthritis that has been
around since 1985, is highly effective against the parasite Entamoeba histolytica.
Carried in water and food, the parasite is a major but often neglected hazard in poor
countries, causing amoebic dysentery and liver abscesses.
Auranofin was found thanks to a hi-tech programme to screen potential drugs for
"orphan" diseases.
It was tested on parasites in a lab dish, then in mice with amoebic colitis and on hamsters
with amoebic liver cysts, according to the study, published in the journal Nature
Medicine.
The experiments suggest auranofin would be 10 times more effective than metronidazole,
the current medication for amoebic infection, which means that it could be used in very
small doses or even as a one-off tablet.
Better still, the drug has long been recognised as safe.
At recognised dosages, it has few side effects, whereas metronidazole can cause nausea,
vomiting, dizziness and headaches.
"This is a drug that you can find in every country," said Anjan Debnath of the University
of California at San Francisco in a press release.
"Based on the dosage we're seeing in the lab, this treatment could be sold at about $2.50
per dose, or lower. That cost savings could make a big difference to the people who need
it the most."
The discovery was made thanks in part to US federal funding to identify drugs which
tackle a neglected, or "orphan," disease.
This definition applies to a disease with fewer than 200,000 cases in the United States or
a drug which is effective but whose costs of development and marketing are unlikely to
be recovered.
Auranofin works by targeting an enzyme that protects the parasite from oxygen, to which
it is highly sensitive, the researchers said.
Malaria drugs
7% of malaria drugs in India fake (The Times of India:22.5.2012)
Tokyo:Over one in three anti-malarial drugs sold in southeast Asia are fake while a third
of samples in sub-Saharan Africa failed chemical testing for containing too much or too
little of the active ingredient, potentially encouraging drug resistance.
Around 7% of the drugs tested in India was found to be of poor quality with many
being fake.
A Lancet study to be announced on Tuesday says 3.3 billion people are at risk of
malaria, which is endemic in 106 countries. Every year, between 655,000 and 1.2 million
people die from Plasmodium falciparum infection.
“Much of this morbidity and mortality could be avoided if drugs available to patients
were efficacious, high quality and used correctly. Data from seven countries in southeast
Asia, including analysis of 1,437 samples of seven malaria drugs, showed that over a
third failed chemical testing, nearly half were incorrectly packaged, and about a third
were fake,” said Gaurvika Nayyar from the Fogarty International Center at the National
Institutes of Health (NIH) in the US, who led the research.
The study said poor-quality anti-malarial drugs lead to drug resistance and inadequate
treatment. Emergence of artemisinin resistance or tolerance in Plasmodium falciparum on
the Thailand-Cambodia border made protection of the effectiveness of the drug supply
imperative, the study said.
Poor quality drugs could spell doom for India’s malaria fight. According to the recent
World Malaria Report 2011, over 70% of India’s population, or 100.41 crore people, face
the risk of malaria infection. Around 31 crore, however, face the “highest risk” of getting
infected by the vector-borne disease. India records 1.5 million cases of malaria every
year. Experts warn that with people travelling far and wide all the time, it is possible that
the drug resistant parasite will start to spread outside Thailand and Cambodia. “In no
time, an infected person can bring the parasite into India,” an expert said.
Arthritis Drug
Dysentery May Be Treatable With Cheap Arthritis Drug(Medical News
Today:22.5.2012)
US researchers have discovered that an already approved arthritis drug may offer a cheap,
low-dose treatment for the amoebic infections that cause dysentery in humans worldwide.
So far they have only tested the drug in lab and animal studies, but they have applied for
approval to start clinical trials to test it as a treatment for both amebiasis and the parasite
Giardia in humans.
The researchers, from University of California - San Diego (UCSD), and University of
California - San Francisco (UCSF), write about their findings in the 20 May online issue
of Nature Medicine.
The antirheumatic drug is called auranofin, marketed as ridaura, and is a form of the
precious metal gold.
The researchers were screening already approved drugs to find new treatments for the
developing world when they made their discovery.
Co-senior author James McKerrow is a professor of pathology at UCSF's Sandler Center
for Drug Discovery. He told the press:
"When we're looking for new treatments for the developing world, we start with drugs
that have already been approved."
Using a high-throughput drug screen he and his colleagues found that auranofin was 10
times more potent against the parasite Entamoeba histolytica than the current treatment
metronidazole.
They said their study illustrates the importance of screening existing drugs for new
purposes, especially for neglected diseases.
McKerrow said that the combination of an off-patent drug and decades of clinical safety
data means we may have a global lower-cost solution, with fewer side effects or risks of
bacterial resistance, than the current therapy.
Every year, 50 million people around the world, most in developing countries, contract
amebiasis, a gastrointestinal infection by the parasite Entamoeba histolytica that causes
symptoms ranging from mild diarrhea to dysentery with blood and mucus in the stool.
The infection spreads through contaminated food and water, and kills around 70,000
people a year, with children being the ones most likely to become severely ill.
The parasite Giardia also infects 6-8% of all children in developing countries, causing
diarrhea, abdominal cramps and dehydration.
The current treatment for both amebiasis and giardiasis is the antibiotic metronidazole,
whose side effects include nausea, vomiting, dizziness and headache.
Auranofin has been used as a twice-daily tablet for adults with rheumatoid arthritis since
1985, and has been shown to be safe at that dosage.
Because the study's lab and animal test findings show auranofin is 10 times more potent
that the current therapy, they suggest it could be effective at a low dose, perhaps even on
a one-time or limited basis.
First author Anjan Debnath is a postdoctoral fellow at UCSF. He said:
"This is a drug that you can find in every country. Based on the dosage we're seeing in
the lab, this treatment could be sold at about $2.50 per dose, or lower. That cost savings
could make a big difference to the people who need it the most."
Debnath is a member of McKerrow's team at UCSF. They focus on infectious diseases in
the developing world that are not research priorities for pharmaceutical companies.
The team set out to create a screen to find small molecule drugs that would kill amoebas
safely. One key breakthrough came when Debnath developed a high-throughput screen
that could test the molecules in an oxygen-free, or anaerobic, environment, to mimic the
amoeba's natural environment.
Another key breakthrough was from a company going out of business. Iconix
Biosciences, of Menlo, California, offered the team its screening library of 900 approved
compounds, each in its own vial.
After testing auranofin in the lab, the researchers then tested it in two animal studies. One
test was in a mouse model of amebiasis in the colon, which is where the parasite first
takes hold, and the other was in a hamster model that shows the impact of infection in the
liver.
In both animal studies, the team said auranofin was the most effective drug they had ever
seen. At very low doses it markedly reduced the number of parasites, inflammation
damage and the size of liver abscesses.
Armed with this "proof of principle", Debnath has applied to the US Food and Drug
Administration (FDA) to grant auranofin Orphan Drug Status. This is a way of fasttracking new drugs that show promise in treating a neglected or orphan disease (ie one
that affects fewer than 200,000 people in the US, or one that is not expected to recover
the development and marketing cost).
Co-senior author Sharon L Reed, professor in the UCSD Departments of Pathology and
Medicine, said:
"Because auranofin has already been approved by the FDA for use in humans, we can
save years of expensive development."
"This new use of an old drug represents a promising therapy for a major health threat, and
highlights how research funded by the National Institutes of Health can benefit people
around the world," she added.
New Anti-Cancer Drug
New Anti-Cancer Drug Developed (Science Daily: 23.5.2012)
A team of University of Hawaii Cancer Center scientists led by James Turkson, Ph.D.
have created a new type of anti-cancer drug named BP-1-102. The drug, which can be
orally administered, targets a key protein that triggers the development of many types of
cancer including lung, breast and skin cancers.
The development of BP-1-102 was guided by the research teams computer based
molecular analysis of the cancer causing Stat 3 protein that causes cancer by promoting
abnormal cell growth in otherwise healthy cells.
"The molecular structure of the hyperactive Stat3 protein basically resembles two cars
that are joined together side-by-side," said Professor Turkson. "We then utilized a
computer program that creates molecular models of potential drugs engaging in binding
to the Stat3 protein to craft the BP-1-102 drug which literally pulls apart the Stat3 protein
rendering it ineffective in causing cancer."
A unique feature of BP-1-102 is that it remains highly effective against cancer even when
administered in oral form. Presently, most anti-cancer drugs require intravenous (IV)
administration in a clinic or hospital setting which increases the financial, physical and
emotional burdens on cancer patients. In its experimental form, BP-1-102 has shown
promise in treating breast and lung cancers.
Currently, breast and lung cancers are two of the most commonly diagnosed cancers
accounting for nearly half a million cases per year in the United States with over 200,000
deaths attributed to these diseases. In Hawaii, there is an average of 1500 cases diagnosed
and over 600 deaths attributed to breast and lung cancers every year.
Professor Turkson is a recent and welcomed addition to the UH Cancer Center faculty.
His innovative and ground breaking research focuses on developing novel anticancer
drugs based on targeting signal transduction and apoptosis pathways.
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Malaria drugs
‘A third of malaria drugs fake’(The Asian Age:223.5.2012)
A third of malaria drugs used around the world to keep the spread of the disease at bay
are counterfeit, recent data has suggested. According to a study published in the reputed
journal the Lancet, around 7 per cent of the drugs tested in India was found to be of poor
quality with many being fake.
Researchers who looked at 1,500 samples of seven malaria drugs from seven countries in
Southeast Asia said poor-quality and fake tablets are causing drug resistance and
treatment failure. “Much of this morbidity and mortality could be avoided if drugs
available to patients were efficacious, high quality, and used correctly,” said the Lancet.
Data from 21 countries in sub-Saharan Africa, including over 2,500 drug samples,
showed similar results. From 1999 to 2010, seven multi-country surveys with data from
seven countries in Southeast Asia included chemical assays or packaging analysis for
1,437 samples of seven anti-malarial drugs.
Of the total 437 samples of drugs, 497 (35 per cent) failed chemical analysis, 423 (46 per
cent) of 919 failed packaging analysis, and 450 (36 per cent) of 1,260 were classified as
falsified.
The study gains singnificance as according to the British medical journal, 3.3 billion
people are at risk of malaria, which is endemic in 106 countries.
“6,55,000 and 1.2 million people die every year from Plasmodium falciparum infection.
Children in sub-Saharan Africa and Southeast Asia have the highest risk of contracting
and dying from malaria,” it added.
Researchers add caution as they believe that poor-quality anti-malarial drugs are very
likely to jeopardise the unprecedented progress and investments in control and
elimination of malaria made in the past decade.
Anti-malarial drugs comprise 25 per cent of the drugs consumed in malarious countries,
and when these drugs are of poor quality, they afflict the most vulnerable populations.
Anti-psychotic drug
Anti-psychotic drug kills cancer stem cells without side-effects:
Study(World newspapers:28.5.2012)
A team of Canadian scientists have discovered that thioridazine, a drug used to treat
psychotic disorder, could successfully kill cancer stem cells in humans without the toxic
side-effects on normal cells.
The research, published Thursday in the science journal CELL, may pave the way for the
development of anticancer drugs for treatment of various cancers.
Conventional cancer treatments, like chemotherapy, work in a way that is toxic to cells,
which may also lead to side-effects such as hair loss, nausea and anemia, according to the
researchers from McMaster University.
Stem cells have long been believed to be the source of many cancers. In 1997, Canadian
researchers first identified cancer stem cells in certain types of leukemia. Cancer stem
cells have since been identified in blood, breast, brain, lung, gastrointestinal, prostate and
ovarian cancer.
"The unusual aspect of our finding is the way it kills cancer stem cells, by differentiating
them and changing them into cells that are non-cancerous," said Mick Bhatia, the
principal investigator for the study and scientific director of McMaster's Stem Cell and
Cancer Research Institute.
"We think this lack of toxicity is why it doesn't have effects on the normal cells, which
would be beneficial to the patients," Bhatia said
Bhatia said their next step was to test thioridazine in clinical trials, focusing on patients
with acute myeloid leukemia whose disease has relapsed after chemotherapy. He wants to
find out if the drug can put their cancer into remission, and prevent the cancer from
coming back by targeting the root of the cancer (cancer stem cells).
Bhatia's team also found that thioridazine works through the dopamine receptor on the
surface of the cancer cells in both leukemia and breast cancer patients.
The finding means it may be possible to use thioridazine as a biomarker that would allow
early detection and treatment of breast cancer and early signs of leukemia progression, he
said.
The research team would also look into the effectiveness of the drug in other types of
cancer. Bhatia said they will collaborate with academic groups as well as industry to
move forward.
"The goal for all of the partners is the same - to

Heath News Repository - English (April

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