Copper door handles and taps kill 95% of superbugs in hospitals
By Fiona Macrae
Last updated at 1:34 AM on 29th October 2008
Hope: Copper taps, toilet seats and push plates on doors all but eliminated common bugs, the study found
Making door handles, taps and light switches from copper could help the country beat superbugs, scientists say.
A study found that copper fittings rapidly killed bugs on hospital wards, succeeding where other infection control measures failed.
In the trial at Selly Oak hospital, in Birmingham, copper taps, toilet seats and push plates on doors all but eliminated common bugs.
It is thought the metal 'suffocates' germs, preventing them breathing. It may also stop them from feeding and destroy their DNA.
Lab tests show that the metal kills off the deadly MRSA and C difficile superbugs.
It also kills other dangerous germs, including the flu virus and the E coli food poisoning bug.
Although the number of cases of MRSA and C difficile is falling, the two bugs still claim thousands of lives a year.
During the ten-week trial on a medical ward, a set of taps, a lavatory seat and a push plate on an entrance door were replaced with copper versions. They were swabbed twice a day for bugs and the results compared with a traditional tap, lavatory seat and push plate elsewhere in the ward.
The copper items had up to 95 per cent fewer bugs on their surface whenever they were tested, a U.S. conference on antibiotics heard yesterday.
Professor Tom Elliott, the lead researcher and a consultant microbiologist at the hospital, said: 'The findings of 90 to 95 per cent killing of those organisms, even after a busy day on a medical ward with items being touched by numerous people, is remarkable.
'I have been a consultant microbiologist for several decades. This is the first time I have seen anything like copper in terms of the effect it will have in the environment.
'It may well offer us another mechanism for trying to defeat the spread of infection.'
Researcher Professor Peter Lambert, of Aston University, Birmingham, said: 'The numbers decreased always on copper but not on the steel surfaces.'
If further hospital-based trials prove as successful, the researchers would like copper fixtures and fittings installed in hospitals around the country.
Doorknobs, taps, light switches, toilet seats and handles and bathroom 'grab rails' could all be ripped out and replaced with copper versions.
Making door handles, taps and light switches from copper could help the country beat superbugs, scientists say
Although it is usually thought to be an expensive metal, copper is actually a similar price to stainless steel, the researchers said. Nursing homes and even our houses could also benefit from the metal's ability to wipe out dangerous bugs.
The healing power of copper has been recognised for thousands of years.
More than 4,000 years ago, the Egyptians used it to sterilise wounds and drinking water and the Aztecs treated skin conditions with the metal.
The ancient Greeks also knew of its benefits. Hippocrates, sometimes called 'the father of medicine', noted that it could be used to treat leg ulcers.
Today, copper is a common constituent in medicines including antiseptic and antifungal creams. It is also believed to have anti-inflammatory properties. Many of those with arthritis wear copper bangles.
Although they provide relief to many, there is no scientific evidence that they work.
Copper is present in our diet in trace amounts and plays an important role in the formation of red blood cells and in keeping our blood vessels, nerves and bones healthy.
The research was funded by the copper industry.
Wednesday, October 29, 2008
Tuesday, October 28, 2008
Sudden Cardiac Death No. 1 Risk for Patients on Dialysis
Sudden Cardiac Death No. 1 Risk for Patients on Dialysis
Study: Inflammation, malnutrition identified as key risk factors
By Eric Vohr
Johns Hopkins Medicine
In a 10-year study of more than a thousand kidney failure patients, sudden cardiac death emerged as the No. 1 cause of death for patients on dialysis, according to a Johns Hopkins researcher.
The study, already published online and appearing in the Nov. 2 issue of Kidney International, identified systemic inflammatory response and malnutrition as key risk factors for the fatal heart attacks.
"This is believed to be the first time anyone has taken a rigorous prospective look at why so many patients on dialysis die from sudden cardiac death, and the results could help doctors identify those at highest risk and potentially save lives," said Rulan S. Parekh, associate professor in the Department of Nephrology at the Johns Hopkins University School of Medicine.
Parekh and her team gathered their data from a cohort of 1,041 end-stage renal disease patients on dialysis who were part of Choices for Healthy Outcomes in Caring for ESRD, known as CHOICE. In a 9.5-year period, 658 of this group died. The largest number of these deaths, 146, was the result of sudden cardiac death, or SDC — in this case, unexpected deaths that occurred outside the hospital setting.
The researchers then looked at previously recorded blood test results from 122 of these 146 sudden cardiac death patients to search for a possible relationship between the deaths and levels of high-sensitivity C-reactive (hsCRP), interleukin-6 (IL-6) and albumin. The proteins IL-6 and hsCRP are both markers for widespread blood vessel and organ inflammation, while low albumin levels are associated with malnutrition.
Results showed that patients with high levels of either hsCRP or IL-6 were twice as likely to die from sudden cardiac death as those with low levels of these proteins. Low albumin levels were associated with a 1.35 times increase in the risk of dying of sudden cardiac death when compared with high levels, according to Parekh. In addition, those with low levels of albumin and high levels of hsCRP were four times more likely to die of sudden cardiac death than those with high levels of albumin and low levels of hsCRP.
"These results tell us that ESRD patients with low albumin and/or high levels of IL-6 and hsCRP are at a significantly higher risk of SCD," Parekh said.
The half-million people in the United States with ESRD are 10 to 100 times more likely than the general public to die from cardiovascular disease, depending on age, according to Parekh. They have an annual mortality rate of more than 20 percent, and one-fifth of these deaths are attributed to sudden cardiac death.
Systemic inflammatory response is common with ESRD patients and occurs when the body responds to an infectious or noninfectious attack. Parekh said that because those with kidney failure are quite ill, the chance of infection and chronic inflammation is higher. Also common with ESRD patients is malnutrition from the stress of kidney failure, loss of appetite and a highly restricted diet; compounding the issue, she said, is that Medicare does not cover oral nutritional supplements.
"When people think of heart attacks, they think of cholesterol and obesity," Parekh said, "but these are risk factors for hardening of the arteries and are not directly linked to sudden heart death among patients on dialysis."
Other researchers from Johns Hopkins who contributed to this study are Neil R. Powe, Josef Coresh, Lucy A. Meoni, Bernard G. Jaar and Nancy E. Fink, all of the School of Medicine; and Michael J. Klag, W.H. Linda Kao and Laura C. Plantinga, all of the Bloomberg School of Public Health.
Study: Inflammation, malnutrition identified as key risk factors
By Eric Vohr
Johns Hopkins Medicine
In a 10-year study of more than a thousand kidney failure patients, sudden cardiac death emerged as the No. 1 cause of death for patients on dialysis, according to a Johns Hopkins researcher.
The study, already published online and appearing in the Nov. 2 issue of Kidney International, identified systemic inflammatory response and malnutrition as key risk factors for the fatal heart attacks.
"This is believed to be the first time anyone has taken a rigorous prospective look at why so many patients on dialysis die from sudden cardiac death, and the results could help doctors identify those at highest risk and potentially save lives," said Rulan S. Parekh, associate professor in the Department of Nephrology at the Johns Hopkins University School of Medicine.
Parekh and her team gathered their data from a cohort of 1,041 end-stage renal disease patients on dialysis who were part of Choices for Healthy Outcomes in Caring for ESRD, known as CHOICE. In a 9.5-year period, 658 of this group died. The largest number of these deaths, 146, was the result of sudden cardiac death, or SDC — in this case, unexpected deaths that occurred outside the hospital setting.
The researchers then looked at previously recorded blood test results from 122 of these 146 sudden cardiac death patients to search for a possible relationship between the deaths and levels of high-sensitivity C-reactive (hsCRP), interleukin-6 (IL-6) and albumin. The proteins IL-6 and hsCRP are both markers for widespread blood vessel and organ inflammation, while low albumin levels are associated with malnutrition.
Results showed that patients with high levels of either hsCRP or IL-6 were twice as likely to die from sudden cardiac death as those with low levels of these proteins. Low albumin levels were associated with a 1.35 times increase in the risk of dying of sudden cardiac death when compared with high levels, according to Parekh. In addition, those with low levels of albumin and high levels of hsCRP were four times more likely to die of sudden cardiac death than those with high levels of albumin and low levels of hsCRP.
"These results tell us that ESRD patients with low albumin and/or high levels of IL-6 and hsCRP are at a significantly higher risk of SCD," Parekh said.
The half-million people in the United States with ESRD are 10 to 100 times more likely than the general public to die from cardiovascular disease, depending on age, according to Parekh. They have an annual mortality rate of more than 20 percent, and one-fifth of these deaths are attributed to sudden cardiac death.
Systemic inflammatory response is common with ESRD patients and occurs when the body responds to an infectious or noninfectious attack. Parekh said that because those with kidney failure are quite ill, the chance of infection and chronic inflammation is higher. Also common with ESRD patients is malnutrition from the stress of kidney failure, loss of appetite and a highly restricted diet; compounding the issue, she said, is that Medicare does not cover oral nutritional supplements.
"When people think of heart attacks, they think of cholesterol and obesity," Parekh said, "but these are risk factors for hardening of the arteries and are not directly linked to sudden heart death among patients on dialysis."
Other researchers from Johns Hopkins who contributed to this study are Neil R. Powe, Josef Coresh, Lucy A. Meoni, Bernard G. Jaar and Nancy E. Fink, all of the School of Medicine; and Michael J. Klag, W.H. Linda Kao and Laura C. Plantinga, all of the Bloomberg School of Public Health.
A Rise in Kidney Stones Is Seen in U.S. Children
October 28, 2008
A Rise in Kidney Stones Is Seen in U.S. Children
By LAURIE TARKAN
To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.
While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.
“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”
Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”
In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.
The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.
Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.
Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.
“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.
Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.
“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.
The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.
“It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”
The median age of children with stones is about 10.
Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”
Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”
Dr. Pope, in Nashville, agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.
“There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.
Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”
There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.
A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.
Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.
One Saturday last February, 11-year-old Tessa Cesario of Frederick, Md., began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.
The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.
“I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.
“I thought older men get kidney stones, not kids,” Ms. Cesario said.
The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.
Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.
Tessa Cesario is taking a wait-and-see approach. Her stone is not budging, so her parents are putting off surgery until they can work it into her dance schedule. In the meantime, she has vastly reduced her salt intake by cutting back on sandwich meats, processed soups and chips.
And, her mother said, “she drinks a ton more water.”
Copyright 2008 The New York Times Company
A Rise in Kidney Stones Is Seen in U.S. Children
By LAURIE TARKAN
To the great surprise of parents, kidney stones, once considered a disorder of middle age, are now showing up in children as young as 5 or 6.
While there are no reliable data on the number of cases, pediatric urologists and nephrologists across the country say they are seeing a steep rise in young patients. Some hospitals have opened pediatric kidney stone clinics.
“The older doctors would say in the ’70s and ’80s, they’d see a kid with a stone once every few months,” said Dr. Caleb P. Nelson, a urology instructor at Harvard Medical School who is co-director of the new kidney stone center at Children’s Hospital Boston. “Now we see kids once a week or less.”
Dr. John C. Pope IV, an associate professor of urologic surgery and pediatrics at the Monroe Carell Jr. Children’s Hospital at Vanderbilt in Nashville, said, “When we tell parents, most say they’ve never heard of a kid with a kidney stone and think something is terribly wrong with their child.”
In China recently, many children who drank milk tainted with melamine — a toxic chemical illegally added to watered-down milk to inflate the protein count — developed kidney stones.
The increase in the United States is attributed to a host of factors, including a food additive that is both legal and ubiquitous: salt.
Though most of the research on kidney stones comes from adult studies, experts believe it can be applied to children. Those studies have found that dietary factors are the leading cause of kidney stones, which are crystallizations of several substances in the urine. Stones form when these substances become too concentrated.
Forty to 65 percent of kidney stones are formed when oxalate, a byproduct of certain foods, binds to calcium in the urine. (Other common types include calcium phosphate stones and uric acid stones.) And the two biggest risk factors for this binding process are not drinking enough fluids and eating too much salt; both increase the amount of calcium and oxalate in the urine.
Excess salt has to be excreted through the kidneys, but salt binds to calcium on its way out, creating a greater concentration of calcium in the urine and the kidneys.
“What we’ve really seen is an increase in the salt load in children’s diet,” said Dr. Bruce L. Slaughenhoupt, co-director of pediatric urology and of the pediatric kidney stone clinic at the University of Wisconsin. He and other experts mentioned not just salty chips and French fries, but also processed foods like sandwich meats; canned soups; packaged meals; and even sports drinks like Gatorade, which are so popular among schoolchildren they are now sold in child-friendly juice boxes.
Children also tend not to drink enough water. “They don’t want to go to the bathroom at school; they don’t have time, so they drink less,” said Dr. Alicia Neu, medical director of pediatric nephrology and the pediatric stone clinic at Johns Hopkins Children’s Center in Baltimore. Instead, they are likely to drink only once they’re thirsty — but that may be too little, too late, especially for children who play sports or are just active.
“Drinking more water is the most important step in the prevention of kidney stones,” Dr. Neu said.
The incidence of kidney stones in adults has also been rising, especially in women, and experts say they see more adults in their 20s and 30s with stones; in the past, it was more common in adults in their 40s and 50s.
“It’s no longer a middle-aged disease,” Dr. Nelson said. “Most of us suspect what we’re seeing in children is the spillover of the overall increase in the whole population.”
The median age of children with stones is about 10.
Many experts say the rise in obesity is contributing to kidney stones in children as well as adults. But not all stone centers are seeing overweight children, and having a healthy weight does not preclude kidney stones. “Of the school-age and adolescent kids we’ve seen, most of them appear to be reasonably fit, active kids,” Dr. Nelson said. “We’re not seeing a parade of overweight Nintendo players.”
Dr. Slaughenhoupt has seen more overweight children at his clinic. “We haven’t compared our data yet,” he said, “but my sense is that children with stones are bigger, and some of them are morbidly obese.”
Dr. Pope, in Nashville, agreed. His hospital lies in the so-called stone belt, a swath of Southern states with a higher incidence of kidney stones, and he said doctors there saw two to three new pediatric cases a week.
“There’s no question in my mind that it is largely dietary and directly related to the childhood obesity epidemic,” he said.
Fifty to 60 percent of children with kidney stones have a family history of the disease. “If you have a family history, it’s important to recognize your kids are at risk at some point in their life,” Dr. Nelson said. “That means instilling lifelong habits of good hydration, balanced diet, and avoiding processed high-salt, high-fat foods.”
There is also evidence that sucrose, found in sodas, can also increase risk of stones, as can high-protein weight-loss diets, which are growing in popularity among teenagers.
A common misconception is that people with kidney stones should avoid calcium. In fact, dairy products have been shown to reduce the risk of stones, because the dietary calcium binds with oxalate before it is absorbed by the body, preventing it from getting into the kidneys.
Children with kidney stones can experience severe pain in their side or stomach when a stone is passing through the narrow ureter through which urine travels from the kidneys to the bladder. Younger children may have a more vague pain or stomachache, making the condition harder to diagnose. Children may feel sick to their stomach, and often there is blood in the urine.
One Saturday last February, 11-year-old Tessa Cesario of Frederick, Md., began having back pains. An aspiring ballerina who dances en pointe five nights a week, she was used to occasional aches and strains. But this one was so intense that her parents took her to the doctor.
The pediatrician ordered an X-ray, and when he phoned with the results, her parents were astonished.
“I was afraid he was calling to say she pulled something and wouldn’t be able to dance,” said her mother, Theresa Cesario. Instead, they were told that Tessa had a kidney stone.
“I thought older men get kidney stones, not kids,” Ms. Cesario said.
The treatment for kidney stones is similar in children and adults. Doctors try to let the stone pass, but if it is too large, if it blocks the flow of urine or if there is a sign of infection, it is removed through one of two types of minimally invasive surgery.
Shock-wave lithotripsy is a noninvasive procedure that uses high-energy sound waves to blast the stones into fragments that are then more easily passed. In ureteroscopy, an endoscope is inserted through the ureter to retrieve or obliterate the stone.
Tessa Cesario is taking a wait-and-see approach. Her stone is not budging, so her parents are putting off surgery until they can work it into her dance schedule. In the meantime, she has vastly reduced her salt intake by cutting back on sandwich meats, processed soups and chips.
And, her mother said, “she drinks a ton more water.”
Copyright 2008 The New York Times Company
Sunday, October 26, 2008
'Flying syringe' mosquitos funded by Bill Gates
'Flying syringe' mosquitos, other ideas get Gates funding
The Bill and Melinda Gates Foundation awarded 100,000 dollars each on Wednesday to scientists in 22 countries including funding for a Japanese proposal to turn mosquitos into "flying syringes" delivering vaccines.
The charitable foundation created by the founder of software giant Microsoft said in a statement that the grants were designed to "explore bold and largely unproven ways to improve global health."
The grants were awarded for research into preventing or curing infectious diseases such as HIV/AIDS and tuberculosis and limiting the emergence of drug resistance.
They are the first round of funding for the Gates Foundation's "Grand Challenges Explorations," a five-year 100-million-dollar initiative to "promote innovative ideas in global health."
The funding was directed to projects that "fall outside current scientific paradigms and could lead to significant advances if successful," the Gates Foundation statement said.
"We were hoping this program would level the playing field so anyone with a transformational idea could more quickly assess its potential for the benefit of global health," said Tachi Yamada, president of global health at the Gates Foundation.
The Gates Foundation said 104 grants were awarded from nearly 4,000 proposals. The recipients included universities, nonprofit organizations, government agencies, and six private companies.
"It was so hard for reviewers to champion just one great idea that we selected almost twice as many projects for funding as we had initially planned," Yamada said.
Among the proposals receiving funding was one from Hiroyuki Matsuoka at Jichi Medical University in Japan.
"(Matsuoka) thinks it may be possible to turn mosquitoes that normally transmit disease into 'flying syringes,' so that when they bite humans they deliver vaccines," the Gates Foundation said.
It said Pattamaporn Kittayapong at Mahidol University in Thailand received a grant to "explore new approaches for controlling dengue fever by studying bacteria with natural abilities to limit the disease."
Founded in 1994, the Seattle, Washington-based Gates Foundation is the largest private philanthropical organization in the world.
© 2008 AFP
This news is brought to you by PhysOrg.com
The Bill and Melinda Gates Foundation awarded 100,000 dollars each on Wednesday to scientists in 22 countries including funding for a Japanese proposal to turn mosquitos into "flying syringes" delivering vaccines.
The charitable foundation created by the founder of software giant Microsoft said in a statement that the grants were designed to "explore bold and largely unproven ways to improve global health."
The grants were awarded for research into preventing or curing infectious diseases such as HIV/AIDS and tuberculosis and limiting the emergence of drug resistance.
They are the first round of funding for the Gates Foundation's "Grand Challenges Explorations," a five-year 100-million-dollar initiative to "promote innovative ideas in global health."
The funding was directed to projects that "fall outside current scientific paradigms and could lead to significant advances if successful," the Gates Foundation statement said.
"We were hoping this program would level the playing field so anyone with a transformational idea could more quickly assess its potential for the benefit of global health," said Tachi Yamada, president of global health at the Gates Foundation.
The Gates Foundation said 104 grants were awarded from nearly 4,000 proposals. The recipients included universities, nonprofit organizations, government agencies, and six private companies.
"It was so hard for reviewers to champion just one great idea that we selected almost twice as many projects for funding as we had initially planned," Yamada said.
Among the proposals receiving funding was one from Hiroyuki Matsuoka at Jichi Medical University in Japan.
"(Matsuoka) thinks it may be possible to turn mosquitoes that normally transmit disease into 'flying syringes,' so that when they bite humans they deliver vaccines," the Gates Foundation said.
It said Pattamaporn Kittayapong at Mahidol University in Thailand received a grant to "explore new approaches for controlling dengue fever by studying bacteria with natural abilities to limit the disease."
Founded in 1994, the Seattle, Washington-based Gates Foundation is the largest private philanthropical organization in the world.
© 2008 AFP
This news is brought to you by PhysOrg.com
Saturday, October 25, 2008
Even mild sleep apnea increases cardiovascular risk
Public release date: 24-Oct-2008
Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Even mild sleep apnea increases cardiovascular risk
People with even minimally symptomatic obstructive sleep apnea (OSA) may be at increased risk for cardiovascular disease because of impaired endothelial function and increased arterial stiffness, according to a study from the Oxford Centre for Respiratory Medicine in the UK.
"It was previously known that people with OSA severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people—some of whom may be completely unaware that they even have OSA—are at risk than previously thought," said lead author of the study, Malcolm Kohler, M.D.
The study will be published in the first issue for November of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
"Only one out of approximately five subjects with [clinically defined OSA] complains of excessive daytime sleepiness in population studies," wrote Geraldo Lorenzi-Filho, M.D., Ph.D. in an editorial in the same issue of the Journal. "[I]t is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system."
To determine the exact nature of some of these effects, Dr. Kohler and colleagues performed a controlled, cross-sectional study to assess differences in endothelial function (often a harbinger for cardiovascular problems to come), arterial stiffness and blood pressure in patients with minimally symptomatic OSA. They compared 64 patients who had proven OSA to matched control subjects without OSA.
Their findings suggested that minimally symptomatic OSA is a cardiovascular risk factor to a degree not previously known.
"In our study, the augmentation index, a measure of central arterial stiffness that independently predicts cardiovascular events in high-risk populations, was significantly higher in patients with minimally symptomatic OSA compared to matched controls," said Dr. Kohler. "We also found impaired endothelial function as indicated by decreased vascular reactivity of their arteries compared to control subjects without OSA."
The difference in arterial stiffness between OSA patients and control subjects, Dr. Kohler said was "comparable in size to the effect seen after four weeks' continuous positive airway pressure (CPAP) therapy in patients with moderate to severe symptomatic OSA."
This suggests that asymptomatic or minimally symptomatic patients with OSA may enjoy a cardiovascular benefit from CPAP therapy.
Dr.Kohler and colleagues from the Oxford Centre for Respiratory Medicine are currently investigating the effects of 6 month CPAP therapy on arterial stiffness and endothelial function as part of an international randomized controlled trial (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular Trial; MOSAIC) which will show the impact of CPAP therapy on cardiovascular risk in patients with minimally symptomatic OSA.
###
Full Text of Original Article Available Here: http://www.thoracic.org/sections/publications/press-releases/resources/110108Kohler.pdf
Full Text of Original Editorial Available Here: http://www.thoracic.org/sections/publications/press-releases/resources/OSAed110108.pdf
Contact: Keely Savoie
ksavoie@thoracic.org
212-315-8620
American Thoracic Society
Even mild sleep apnea increases cardiovascular risk
People with even minimally symptomatic obstructive sleep apnea (OSA) may be at increased risk for cardiovascular disease because of impaired endothelial function and increased arterial stiffness, according to a study from the Oxford Centre for Respiratory Medicine in the UK.
"It was previously known that people with OSA severe enough to affect their daytime alertness and manifest in other ways are at increased risk of cardiovascular disease, but this finding suggests that many more people—some of whom may be completely unaware that they even have OSA—are at risk than previously thought," said lead author of the study, Malcolm Kohler, M.D.
The study will be published in the first issue for November of the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine.
"Only one out of approximately five subjects with [clinically defined OSA] complains of excessive daytime sleepiness in population studies," wrote Geraldo Lorenzi-Filho, M.D., Ph.D. in an editorial in the same issue of the Journal. "[I]t is now recognized that OSA triggers a cascade of biological reactions, including increased sympathetic activity, systemic inflammation, oxidative stress, and metabolic alterations that are potentially harmful to the cardiovascular system."
To determine the exact nature of some of these effects, Dr. Kohler and colleagues performed a controlled, cross-sectional study to assess differences in endothelial function (often a harbinger for cardiovascular problems to come), arterial stiffness and blood pressure in patients with minimally symptomatic OSA. They compared 64 patients who had proven OSA to matched control subjects without OSA.
Their findings suggested that minimally symptomatic OSA is a cardiovascular risk factor to a degree not previously known.
"In our study, the augmentation index, a measure of central arterial stiffness that independently predicts cardiovascular events in high-risk populations, was significantly higher in patients with minimally symptomatic OSA compared to matched controls," said Dr. Kohler. "We also found impaired endothelial function as indicated by decreased vascular reactivity of their arteries compared to control subjects without OSA."
The difference in arterial stiffness between OSA patients and control subjects, Dr. Kohler said was "comparable in size to the effect seen after four weeks' continuous positive airway pressure (CPAP) therapy in patients with moderate to severe symptomatic OSA."
This suggests that asymptomatic or minimally symptomatic patients with OSA may enjoy a cardiovascular benefit from CPAP therapy.
Dr.Kohler and colleagues from the Oxford Centre for Respiratory Medicine are currently investigating the effects of 6 month CPAP therapy on arterial stiffness and endothelial function as part of an international randomized controlled trial (Multicentre Obstructive Sleep Apnoea Interventional Cardiovascular Trial; MOSAIC) which will show the impact of CPAP therapy on cardiovascular risk in patients with minimally symptomatic OSA.
###
Full Text of Original Article Available Here: http://www.thoracic.org/sections/publications/press-releases/resources/110108Kohler.pdf
Full Text of Original Editorial Available Here: http://www.thoracic.org/sections/publications/press-releases/resources/OSAed110108.pdf
Scientists create organic wires for use inside the human body
Trendwatch
By Rick C. Hodgin
Friday, October 24, 2008 11:30
Baltimore (MD) - Research chemists at Johns Hopkins University (JHU) have developed a water-soluble, organic, self-assembling electronic wire suitable for use inside the human body. Derived from carbon materials, the lightweight, flexible wires can power pacemakers, reconnect damaged nerve tissues, while also interacting with real electronic device that could augment or stimulate organic function. But do not worry, for this is only step one of the long process of turning us all into Borg-like drones.
Inter-cellular wiring
The self-assembly process produces wires which are notably thinner than a human hair. They can be manufactured so small, in fact, that they could interact with individual cells. And therein lies significant potential for paralytics.
Researchers believe a procedure could eventually be developed whereby the severed portions of nerve fibers are reconnected with these new organic wires. Such patients could theoretically regain at least some of their former mobility, if not all of it, once the science is perfected and applied.
In fact, John D. Tovar, assistant professor, Department of Chemistry at Zanvyl Krieger School of Arts and Sciences, spoke of this very possibility. He said, "Can we use these materials to guide electrical current at the nanoscale? Can we use them to regulate cell-to-cell communication as a prelude to re-engineering neural networks or damaged spinal cords? These are the kinds of questions we are looking forward to being able to address and answer in the coming years."
The big prize
As Tovar indicates, perhaps the biggest benefit from this research is the mechanism which now exists. This team essentially overcame all of the problems associated with developing this kind of application. And now, they've presented unto the world what will be just another tool in a researcher's arsenal.
No longer will other scientists in other labs have to ponder over how they could create self-assembling wires for their needs. Now they can simply operate from within the mindset, "If we used their self-assembling wires here, then this new ability would be possible. Yes, it's all so clear now."
Summary
In short, with this powerful new ability added to the scientist's “toolbox,” now they can think in terms of the goal or destination rather than how to go about building the road to get there. Somebody else has done the hard work. And now, the application of the thing should quickly move to the realm of "Oh, how extremely beneficial. Thank you so much, doctor."
By Rick C. Hodgin
Friday, October 24, 2008 11:30
Baltimore (MD) - Research chemists at Johns Hopkins University (JHU) have developed a water-soluble, organic, self-assembling electronic wire suitable for use inside the human body. Derived from carbon materials, the lightweight, flexible wires can power pacemakers, reconnect damaged nerve tissues, while also interacting with real electronic device that could augment or stimulate organic function. But do not worry, for this is only step one of the long process of turning us all into Borg-like drones.
Inter-cellular wiring
The self-assembly process produces wires which are notably thinner than a human hair. They can be manufactured so small, in fact, that they could interact with individual cells. And therein lies significant potential for paralytics.
Researchers believe a procedure could eventually be developed whereby the severed portions of nerve fibers are reconnected with these new organic wires. Such patients could theoretically regain at least some of their former mobility, if not all of it, once the science is perfected and applied.
In fact, John D. Tovar, assistant professor, Department of Chemistry at Zanvyl Krieger School of Arts and Sciences, spoke of this very possibility. He said, "Can we use these materials to guide electrical current at the nanoscale? Can we use them to regulate cell-to-cell communication as a prelude to re-engineering neural networks or damaged spinal cords? These are the kinds of questions we are looking forward to being able to address and answer in the coming years."
The big prize
As Tovar indicates, perhaps the biggest benefit from this research is the mechanism which now exists. This team essentially overcame all of the problems associated with developing this kind of application. And now, they've presented unto the world what will be just another tool in a researcher's arsenal.
No longer will other scientists in other labs have to ponder over how they could create self-assembling wires for their needs. Now they can simply operate from within the mindset, "If we used their self-assembling wires here, then this new ability would be possible. Yes, it's all so clear now."
Summary
In short, with this powerful new ability added to the scientist's “toolbox,” now they can think in terms of the goal or destination rather than how to go about building the road to get there. Somebody else has done the hard work. And now, the application of the thing should quickly move to the realm of "Oh, how extremely beneficial. Thank you so much, doctor."
Culprit unmasked in multiple myeloma
PDF link to the article
Culprit unmasked in multiple myeloma
Multiple myeloma is caused by the
recently discovered Kaposi’s sarcoma-
associated herpesvirus, US
researchers have found (Science
1997;276:1851-4). Multiple myeloma
is the second most common type of
blood cancer in the US. Research had
focused on why it develops in only
25% of patients with a precursor
condition (MGUS). The researchers
believe that both MGUS and the
virus, which infects the dendritic cells
in the bone marrow, may be needed
for multiple myeloma. The virus
does not infect the actual cancer cells,
leading researchers to suspect that it
causes cancer by producing a protein
(interleukin-6) that stimulates the
growth of myeloma cells.
News and analysis
14827 Sept 1/97 CMAJ /Page505
CAN MED ASSOC J • SEPT. 1, 1997; 157 (5) 505
In the news...
Culprit unmasked in multiple myeloma
Multiple myeloma is caused by the
recently discovered Kaposi’s sarcoma-
associated herpesvirus, US
researchers have found (Science
1997;276:1851-4). Multiple myeloma
is the second most common type of
blood cancer in the US. Research had
focused on why it develops in only
25% of patients with a precursor
condition (MGUS). The researchers
believe that both MGUS and the
virus, which infects the dendritic cells
in the bone marrow, may be needed
for multiple myeloma. The virus
does not infect the actual cancer cells,
leading researchers to suspect that it
causes cancer by producing a protein
(interleukin-6) that stimulates the
growth of myeloma cells.
News and analysis
14827 Sept 1/97 CMAJ /Page505
CAN MED ASSOC J • SEPT. 1, 1997; 157 (5) 505
In the news...
Friday, October 24, 2008
Medline article on Multiple Myeloma
Medline Link
From the article:
Exams and Tests
Blood tests can help diagnose this disease. Such tests may include:
Blood chemistry (CHEM 20) shows increased levels of calcium, total protein, and abnormal kidney function.
Complete blood count (CBC) reveals low number of red and white blood cells and platelets.
Freelite diagnostic assay measures immunoglobulin pieces called light chains.
Protein electrophoresis - serum is abnormal.
From the article:
Exams and Tests
Blood tests can help diagnose this disease. Such tests may include:
Blood chemistry (CHEM 20) shows increased levels of calcium, total protein, and abnormal kidney function.
Complete blood count (CBC) reveals low number of red and white blood cells and platelets.
Freelite diagnostic assay measures immunoglobulin pieces called light chains.
Protein electrophoresis - serum is abnormal.
Multiple Myeloma: Recognition and Management
Multiple Myeloma: Recognition and Management
Link to the page.
Link to the page.
What is Multiple Myeloma? How Is It Treated?
What is Multiple Myeloma? How Is It Treated?
What is multiple myeloma?
Multiple myeloma (say: mull-tip-ul my-el-oh-ma) is a kind of cancer. It's caused when cells in the bone, called "plasma cells," grow too much. When this happens, the plasma cells kill the bone around them. The plasma cells also make too much of something called "immunoglobulins." The immunoglobulins cause problems in the blood.
What causes myeloma?
We don't know what causes myeloma. This cancer usually happens in people older than 55 years of age. Slightly more men than women get it. It doesn't usually run in families. Myeloma is more common in blacks than in whites. Fertilizers and insecticides might cause myeloma. This may be why myeloma is more common in farmers.
How does my doctor know I have myeloma?
Several tests can tell if you have myeloma. First, you'll need x-rays to check the areas where you feel pain. Your doctor might take some blood tests. One test measures the kind of immunoglobulins in your blood. Other tests tell if you're anemic (low iron in your blood), if your calcium level is high and how well your kidneys are working.
If the myeloma is in a later stage, you may need more tests. Your doctor might want you to have a magnetic resonance imaging scan of your bones (also called an MRI scan). This scan shows if the myeloma is in your spine.
The only way to be sure you have myeloma is if your doctor uses a needle to take a very small sample of the inside of a bone. This is called "bone marrow aspiration." It can be done in your doctor's office. This procedure hurts a little, but no special care is needed afterward.
How is myeloma treated?
There is no cure for myeloma. However, medicines can help with the pain and make you feel better. You need treatment if you have severe pain, broken bones, a low blood count, many infections or kidney damage. Even with treatment, sometimes your symptoms will be better and sometimes they'll be worse. The two medicines most often used are melphalan (brand name: Alkeran) and prednisone (a steroid medicine).
If you have multiple myeloma, you should try to stay active. Staying active helps keep the calcium in your bones instead of in your blood. Keeping calcium in your bones helps keep your bones strong. You should eat a balanced diet and drink plenty of fluids, too.
Are there side effects of myeloma medicine?
Yes, as with most cancer medicines. You and your doctors will keep an eye on your side effects. You'll probably have blood tests about once a month while you're taking the medicines. When melphalan kills the cancer cells, it also kills some of your body's "good" cells. These good cells are in your bones, lungs and skin. You'll probably lose some hair, but it will grow back after you stop taking the medicine. However, if you have fever, bleeding (like nosebleeds or bleeding gums or bruising), a skin rash or a cough that doesn't go away, call your doctor right away. These are the more serious side effects of melphalan. While you're taking melphalan, you must not get pregnant. Melphalan might hurt the baby.
If the cancer doesn't respond to melphalan and prednisone, your doctor may talk with you about other treatments. These include other medicines, radiation treatments or a bone marrow transplant.
Where can I get more information about multiple myeloma?
You can get information about multiple myeloma from the following group:
The International Myeloma Foundation (IMF)
2129 Stanley Hills Dr.
Los Angeles, CA 90046
Telephone: 1-800-452-CURE (1-800-452-2873)
Internet: http://www.myeloma.org
This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.
Visit familydoctor.org for information on this and many other health-related topics.
Copyright © 1999 by the American Academy of Family Physicians.
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.
What is multiple myeloma?
Multiple myeloma (say: mull-tip-ul my-el-oh-ma) is a kind of cancer. It's caused when cells in the bone, called "plasma cells," grow too much. When this happens, the plasma cells kill the bone around them. The plasma cells also make too much of something called "immunoglobulins." The immunoglobulins cause problems in the blood.
What causes myeloma?
We don't know what causes myeloma. This cancer usually happens in people older than 55 years of age. Slightly more men than women get it. It doesn't usually run in families. Myeloma is more common in blacks than in whites. Fertilizers and insecticides might cause myeloma. This may be why myeloma is more common in farmers.
How does my doctor know I have myeloma?
Several tests can tell if you have myeloma. First, you'll need x-rays to check the areas where you feel pain. Your doctor might take some blood tests. One test measures the kind of immunoglobulins in your blood. Other tests tell if you're anemic (low iron in your blood), if your calcium level is high and how well your kidneys are working.
If the myeloma is in a later stage, you may need more tests. Your doctor might want you to have a magnetic resonance imaging scan of your bones (also called an MRI scan). This scan shows if the myeloma is in your spine.
The only way to be sure you have myeloma is if your doctor uses a needle to take a very small sample of the inside of a bone. This is called "bone marrow aspiration." It can be done in your doctor's office. This procedure hurts a little, but no special care is needed afterward.
How is myeloma treated?
There is no cure for myeloma. However, medicines can help with the pain and make you feel better. You need treatment if you have severe pain, broken bones, a low blood count, many infections or kidney damage. Even with treatment, sometimes your symptoms will be better and sometimes they'll be worse. The two medicines most often used are melphalan (brand name: Alkeran) and prednisone (a steroid medicine).
If you have multiple myeloma, you should try to stay active. Staying active helps keep the calcium in your bones instead of in your blood. Keeping calcium in your bones helps keep your bones strong. You should eat a balanced diet and drink plenty of fluids, too.
Are there side effects of myeloma medicine?
Yes, as with most cancer medicines. You and your doctors will keep an eye on your side effects. You'll probably have blood tests about once a month while you're taking the medicines. When melphalan kills the cancer cells, it also kills some of your body's "good" cells. These good cells are in your bones, lungs and skin. You'll probably lose some hair, but it will grow back after you stop taking the medicine. However, if you have fever, bleeding (like nosebleeds or bleeding gums or bruising), a skin rash or a cough that doesn't go away, call your doctor right away. These are the more serious side effects of melphalan. While you're taking melphalan, you must not get pregnant. Melphalan might hurt the baby.
If the cancer doesn't respond to melphalan and prednisone, your doctor may talk with you about other treatments. These include other medicines, radiation treatments or a bone marrow transplant.
Where can I get more information about multiple myeloma?
You can get information about multiple myeloma from the following group:
The International Myeloma Foundation (IMF)
2129 Stanley Hills Dr.
Los Angeles, CA 90046
Telephone: 1-800-452-CURE (1-800-452-2873)
Internet: http://www.myeloma.org
This handout provides a general overview on this topic and may not apply to everyone. To find out if this handout applies to you and to get more information on this subject, talk to your family doctor.
Visit familydoctor.org for information on this and many other health-related topics.
Copyright © 1999 by the American Academy of Family Physicians.
Permission is granted to print and photocopy this material for nonprofit educational uses. Written permission is required for all other uses, including electronic uses.
Mass. General transplant method prevents organ rejection
HARVARD UNIVERSITY, MASS GENERAL
Mass. General transplant method prevents organ rejection
By Patricia Wen, Globe Staff
A Massachusetts General Hospital research team is reporting a major advance in the years-long effort to overcome the rejection of organ transplants.
Four out of five patients who underwent an experimental kidney transplant were able to stop taking powerful immunosuppressive drugs, and they have so far lived between 15 months and almost five years without experiencing rejection. At the time of their transplant, the patients received bone marrow from the same donor.
The report in tomorrow's New England Journal of Medicine is considered particularly significant because the patients received kidneys that were different from their own tissue type. Transplants of such mismatched organs are the most common, and the most likely to be rejected, even when patients take immunosuppressive drugs.
One of the five patients rejected the kidney during the experimental program, and researchers ultimately concluded that was due to an unexpected antibody reaction. The team later tweaked their protocol to include a new drug to prevent such a scenario from happening again.
Dr. David H. Sachs, a 66-year-old Harvard Medical School professor who has spent his career trying to induce tolerance for organ transplants, said he was encouraged by his team's "initial success" with the procedure.
"While we need to study this approach in a larger group of patients before it is ready for broad clinical use, this is the first time that tolerance to a series of mismatched transplants has been intentionally and successfully induced," said Sachs, who co-authored the study with two transplant surgeons, Dr. Tatsuo Kawai and Dr. Benedict Cosimi, as well as a dozen other researchers at Mass. General.
Sachs, director of Mass. General's Transplantation Biology Research Center, has long believed that a donor's bone marrow -- from which immune cells originate -- could play a pivotal role in giving transplant patients "induced tolerance" to a donated organ.
Under Sachs' approach, five days prior to transplant surgery, patients begin low-dose chemotherapy to kill off some of their own marrow cells and make room for the injection of the donor's bone marrow.
The patients also receive a drug and radiation to the thymus to eliminate a type of immune system cell, known as a T cell, that typically attacks any tissue perceived as foreign.
On the day of the procedure, surgeons attach the new kidney while injecting the donor's bone marrow into a blood vessel in the patient's arm. The donor's bone marrow mixes with the patient's, creating a temporary state called "mixed chimerism." This tricks the patient's immune system into recognizing for years -- and possibly forever -- the donated organ as part of the "self."
After the surgery, the immune system is still in a period of adjustment, and doctors give patients anti-rejection drugs that are gradually tapered off. Most patients were off the drugs by the ninth month.
Sachs first tried this approach successfully on mice, pigs, then monkeys. In 1998, he won approval to try his treatment on a select group of Mass. General patients with severe kidney failure, all of whom were offered matching kidneys from close relatives. When these six patients did well, Sachs moved on to the most ambitious test of his method, trying it out on patients with mismatched donors.
Sachs' study represents a pivotal moment in organ transplantation, organ transplant researchers say. It shows that it may be feasible to eliminate immunosuppressive drugs with their debilitating side effects, such as skin warts, cataracts and increased risks of heart disease, diabetes and serious infections. Also, patients may no longer need to live with the fear of organ rejection. Within 10 years, half of all transplanted kidneys fail because of chronic rejection, a bleak predicament in this era of organ shortages.
"This is landmark work," said Dr. Joshua Miller, an organ transplant researcher from Northwestern University's Feinberg School of Medicine in Chicago. "It gives us hope that recipients of organ transplants will be relieved of being on chronic immunosuppressive drugs for the rest of their lives."
Researchers cautioned, though, that only the healthiest patients may be able to endure the rigorous pre-transplant treatments.
Mass. General transplant method prevents organ rejection
By Patricia Wen, Globe Staff
A Massachusetts General Hospital research team is reporting a major advance in the years-long effort to overcome the rejection of organ transplants.
Four out of five patients who underwent an experimental kidney transplant were able to stop taking powerful immunosuppressive drugs, and they have so far lived between 15 months and almost five years without experiencing rejection. At the time of their transplant, the patients received bone marrow from the same donor.
The report in tomorrow's New England Journal of Medicine is considered particularly significant because the patients received kidneys that were different from their own tissue type. Transplants of such mismatched organs are the most common, and the most likely to be rejected, even when patients take immunosuppressive drugs.
One of the five patients rejected the kidney during the experimental program, and researchers ultimately concluded that was due to an unexpected antibody reaction. The team later tweaked their protocol to include a new drug to prevent such a scenario from happening again.
Dr. David H. Sachs, a 66-year-old Harvard Medical School professor who has spent his career trying to induce tolerance for organ transplants, said he was encouraged by his team's "initial success" with the procedure.
"While we need to study this approach in a larger group of patients before it is ready for broad clinical use, this is the first time that tolerance to a series of mismatched transplants has been intentionally and successfully induced," said Sachs, who co-authored the study with two transplant surgeons, Dr. Tatsuo Kawai and Dr. Benedict Cosimi, as well as a dozen other researchers at Mass. General.
Sachs, director of Mass. General's Transplantation Biology Research Center, has long believed that a donor's bone marrow -- from which immune cells originate -- could play a pivotal role in giving transplant patients "induced tolerance" to a donated organ.
Under Sachs' approach, five days prior to transplant surgery, patients begin low-dose chemotherapy to kill off some of their own marrow cells and make room for the injection of the donor's bone marrow.
The patients also receive a drug and radiation to the thymus to eliminate a type of immune system cell, known as a T cell, that typically attacks any tissue perceived as foreign.
On the day of the procedure, surgeons attach the new kidney while injecting the donor's bone marrow into a blood vessel in the patient's arm. The donor's bone marrow mixes with the patient's, creating a temporary state called "mixed chimerism." This tricks the patient's immune system into recognizing for years -- and possibly forever -- the donated organ as part of the "self."
After the surgery, the immune system is still in a period of adjustment, and doctors give patients anti-rejection drugs that are gradually tapered off. Most patients were off the drugs by the ninth month.
Sachs first tried this approach successfully on mice, pigs, then monkeys. In 1998, he won approval to try his treatment on a select group of Mass. General patients with severe kidney failure, all of whom were offered matching kidneys from close relatives. When these six patients did well, Sachs moved on to the most ambitious test of his method, trying it out on patients with mismatched donors.
Sachs' study represents a pivotal moment in organ transplantation, organ transplant researchers say. It shows that it may be feasible to eliminate immunosuppressive drugs with their debilitating side effects, such as skin warts, cataracts and increased risks of heart disease, diabetes and serious infections. Also, patients may no longer need to live with the fear of organ rejection. Within 10 years, half of all transplanted kidneys fail because of chronic rejection, a bleak predicament in this era of organ shortages.
"This is landmark work," said Dr. Joshua Miller, an organ transplant researcher from Northwestern University's Feinberg School of Medicine in Chicago. "It gives us hope that recipients of organ transplants will be relieved of being on chronic immunosuppressive drugs for the rest of their lives."
Researchers cautioned, though, that only the healthiest patients may be able to endure the rigorous pre-transplant treatments.
HLA-Mismatched Renal Transplantation without Maintenance Immunosuppression
New England Journal of Medicine
Link to the full Article
PubMed Citation
SUMMARY
Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.
Link to the full Article
PubMed Citation
SUMMARY
Five patients with end-stage renal disease received combined bone marrow and kidney transplants from HLA single-haplotype mismatched living related donors, with the use of a nonmyeloablative preparative regimen. Transient chimerism and reversible capillary leak syndrome developed in all recipients. Irreversible humoral rejection occurred in one patient. In the other four recipients, it was possible to discontinue all immunosuppressive therapy 9 to 14 months after the transplantation, and renal function has remained stable for 2.0 to 5.3 years since transplantation. The T cells from these four recipients, tested in vitro, showed donor-specific unresponsiveness and in specimens from allograft biopsies, obtained after withdrawal of immunosuppressive therapy, there were high levels of P3 (FOXP3) messenger RNA (mRNA) but not granzyme B mRNA.
Scientist triumphs after setback in kidney transplant method
Rejecting defeat
Scientist triumphs after setback in kidney transplant method
By Patricia Wen, Globe Staff | January 24, 2008
Dr. David H. Sachs was full of optimism when the third patient in his $1 million study was wheeled into the recovery room at Massachusetts General Hospital after an experimental kidney transplant.
The first two patients had thrived, adding credibility to an unorthodox idea that Sachs had pioneered over his career, that transplanting a donor's bone marrow along with the kidney could solve the problem of organ rejection, sparing patients a lifetime of powerful antirejection drugs.
But 10 days after the third patient's surgery, Sachs's phone rang at his spacious lab overlooking Boston Harbor. A colleague reported that William Andrews, a 43-year-old father of two, was rejecting the kidney.
Sachs and his research team remember the darkness of the ensuing months in 2003, when they abruptly suspended their transplants for nearly two years. Andrews was demoralized and on dialysis, his sister's donated kidney seemingly wasted. Over and over, Sachs paced the corridors of his lab asking himself, "What did we miss?"
Today, capping a comeback from the crisis, Sachs and his team are reporting that they unraveled the explanation for Andrews's rejection. After they tweaked their protocol, adding a drug to avert what happened to Andrews, two new patients have thrived without the long-term need for antirejection drugs, according to a paper published in the New England Journal of Medicine.
Overall, four of Sachs's five patients have experienced no organ rejection, a particularly striking accomplishment because they all received kidneys that were different from their own tissue type. Transplants of such mismatched organs are the most common and the most likely to be rejected, even when patients take immunosuppressive drugs.
"I had confidence we would figure it out," said the 66-year-old Harvard Medical School professor, who has dedicated more than three decades to conquering organ rejection. He said the results restored his faith that his once-radical idea will eventually become mainstream, making organ transplants safer and more available.
Transplant surgeons said Sachs's study represents a pivotal moment in organ transplantation, demonstrating that it is feasible to eliminate immunosuppressive drugs with their debilitating side effects, such as skin warts, cataracts, and increased risks of heart disease, diabetes, and serious infections. If the results are borne out in a larger group of patients, the Mass. General technique has the potential to help transplant recipients live longer. Within 10 years, half of all transplanted organs fail because of chronic rejection, a bleak predicament in this era of organ shortages.
"This is landmark work," said Dr. Joshua Miller, an organ transplant researcher at Northwestern University's Feinberg School of Medicine in Chicago.
Other researchers cautioned that only the healthiest patients may be able to endure the rigorous treatments, including chemotherapy and radiation, that precede the transplant.
Andrews said that going through the experimental protocol was not easy and that being an example of a failed case was even harder. But he sees his difficult experience as a contribution to medical research, saying how impressed he was that the Mass. General staff worked tirelessly on his case.
"They did not want to accept defeat," said Andrews, who ultimately received a replacement kidney in 2004 using conventional treatment with antirejection drugs.
Sachs is no stranger to the emotional roller coaster of experimental medicine and the intellectual nimbleness required to overcome setbacks. Since he was a young Harvard medical student in the mid-1960s, hearing his first lecture on organ transplantation, Sachs has set out to tackle "the most important problem that could be solved." In his mind, that was the persistent problem of organ rejection.
Sachs, director of the Transplantation Biology Research Center at Mass. General, had faith that a donor's bone marrow, from which immune cells originate, could play a pivotal role in giving transplant patients "induced tolerance" to a donated organ.
Under Sachs's approach, five days prior to transplant surgery, patients begin to undergo low-dose chemotherapy to kill off some of their marrow cells and make room for injection of the donor's bone marrow.
The patients also receive a drug and radiation to the thymus to eliminate a type of immune system cell, known as a T cell, that typically attacks any tissue perceived as foreign.
On the day of the procedure, surgeons attach the new kidney while injecting the donor's bone marrow into a blood vessel in the patient's arm. The donor's bone marrow mixes with the patient's, creating a temporary state called mixed chimerism. This tricks the patient's immune system into recognizing for years - and possibly forever - the donated organ as part of the self.
After the surgery, the immune system is still in a period of adjustment, and doctors give patients antirejection drugs that are gradually tapered off. Most patients were off the drugs by the ninth month.
Sachs first tried this approach successfully on mice, pigs, then monkeys. In 1998, he won approval to try his treatment on a select group of Mass. General patients with severe kidney failure, all of whom were offered matching kidneys from close relatives. When these six patients did well, Sachs moved on to the most ambitious test of his method, trying it out on patients with mismatched donors.
Starting in 2002, the method worked nearly flawlessly on Jennifer Searl, 28, a librarian from Peabody, and Christopher McMahon, 26, a retail store manager from Tewskbury.
Sachs and his colleagues felt something close to restrained euphoria. At a New Year's Eve party in 2002, Sachs and the chief surgeon on the research team, Dr. Benedict Cosimi, who share a small boat that they years ago named "Tolerance," gave a toast to the initial success of the experiment.
Then in October 2003, Andrews, a software engineer with polycystic kidney disease, went in for his experimental procedure. When the surgery was complete, spirits were high.
"Everybody thought it was a success," Andrews recalled.
But within two weeks of the surgery, Dr. Tatsuo Kawai, one of Sach's research colleagues, was handed test results showing that Andrews's urine output had dropped and that his blood contained high levels of toxins. An ultrasound scan showed the new organ was losing blood flow.
"The kidney's rejecting," Kawai remembered saying to himself.
He phoned Sachs, who was in his lab at one of Mass. General's research facilities in the Charlestown Navy Yard, with the news.
"It hurt," Sachs recalled. "You want to see everyone succeed."
For several months, Sachs and his team tried various drugs on Andrews, hoping to reverse the rejection. But by spring 2004, doctors began dialysis, conceding defeat in saving Andrews's new kidney. Because of the failure, Andrews was no longer eligible for another try with the experimental treatment.
The outcome for Andrews hit everyone on the research team hard.
"It was the lowest moment," Sachs recalled.
He said these studies put "people's lives in your hands" and are full of unpredictability.
Sachs and his dozen colleagues on the project began brainstorming about what went wrong, trying to salvage a lesson, if not Andrews's kidney. After intensive study, they concluded that another type of immune cell, the B cells, played a critical role in his organ rejection. They theorized that Andrews's body harbored B cells that ultimately produced antibodies against his sister's kidney, a scenario they did not anticipate because B cells had played no role in organ rejection in any of their previous studies.
To prevent rejection in new cases, the team revised the protocol to give all patients a drug prior to surgery that depletes B cells. Before they could proceed with the study, they had to win approvals from several regulatory agencies, which ensure patient safety.
Meanwhile, Sachs was delighted when he heard that Andrews's cousin had stepped forward to offer a kidney.
In August 2004, that conventional transplant surgery went smoothly, and Andrews went back to work "feeling great," while accepting his fate of being on antirejection drugs.
By 2005, the regulatory agencies approved the revised plan. In February 2005, surgeons operated on Derek Besenfelder, 28, a communications specialist from Los Angeles, and then in January 2006, they did transplant surgery on Matthew Knowles, 48, of Marshfield. Both have returned to their normal lives.
"I'm in perfect health," said Knowles, a supervisor for a gas company. "I don't take a pill a day. It's a miracle."
The four successful transplant patients have so far lived between 15 months and nearly five years without antirejection drugs.
Other researchers are also experimenting with ways to create permanent tolerance to donated organs, using slightly different approaches. Today's New England Journal includes two case studies from these other groups.
Sachs hopes to expand the study to include 20 new patients with mismatched donors. His greatest hope is that someday his novel treatment will extend to other organs.
"It's a wonderful feeling when you see people returning to their normal lives," he said.
Patricia Wen can be reached at wen@globe.com.
http://www.boston.com/news/local/articles/2008/01/24/rejecting_defeat?mode=PF
Scientist triumphs after setback in kidney transplant method
By Patricia Wen, Globe Staff | January 24, 2008
Dr. David H. Sachs was full of optimism when the third patient in his $1 million study was wheeled into the recovery room at Massachusetts General Hospital after an experimental kidney transplant.
The first two patients had thrived, adding credibility to an unorthodox idea that Sachs had pioneered over his career, that transplanting a donor's bone marrow along with the kidney could solve the problem of organ rejection, sparing patients a lifetime of powerful antirejection drugs.
But 10 days after the third patient's surgery, Sachs's phone rang at his spacious lab overlooking Boston Harbor. A colleague reported that William Andrews, a 43-year-old father of two, was rejecting the kidney.
Sachs and his research team remember the darkness of the ensuing months in 2003, when they abruptly suspended their transplants for nearly two years. Andrews was demoralized and on dialysis, his sister's donated kidney seemingly wasted. Over and over, Sachs paced the corridors of his lab asking himself, "What did we miss?"
Today, capping a comeback from the crisis, Sachs and his team are reporting that they unraveled the explanation for Andrews's rejection. After they tweaked their protocol, adding a drug to avert what happened to Andrews, two new patients have thrived without the long-term need for antirejection drugs, according to a paper published in the New England Journal of Medicine.
Overall, four of Sachs's five patients have experienced no organ rejection, a particularly striking accomplishment because they all received kidneys that were different from their own tissue type. Transplants of such mismatched organs are the most common and the most likely to be rejected, even when patients take immunosuppressive drugs.
"I had confidence we would figure it out," said the 66-year-old Harvard Medical School professor, who has dedicated more than three decades to conquering organ rejection. He said the results restored his faith that his once-radical idea will eventually become mainstream, making organ transplants safer and more available.
Transplant surgeons said Sachs's study represents a pivotal moment in organ transplantation, demonstrating that it is feasible to eliminate immunosuppressive drugs with their debilitating side effects, such as skin warts, cataracts, and increased risks of heart disease, diabetes, and serious infections. If the results are borne out in a larger group of patients, the Mass. General technique has the potential to help transplant recipients live longer. Within 10 years, half of all transplanted organs fail because of chronic rejection, a bleak predicament in this era of organ shortages.
"This is landmark work," said Dr. Joshua Miller, an organ transplant researcher at Northwestern University's Feinberg School of Medicine in Chicago.
Other researchers cautioned that only the healthiest patients may be able to endure the rigorous treatments, including chemotherapy and radiation, that precede the transplant.
Andrews said that going through the experimental protocol was not easy and that being an example of a failed case was even harder. But he sees his difficult experience as a contribution to medical research, saying how impressed he was that the Mass. General staff worked tirelessly on his case.
"They did not want to accept defeat," said Andrews, who ultimately received a replacement kidney in 2004 using conventional treatment with antirejection drugs.
Sachs is no stranger to the emotional roller coaster of experimental medicine and the intellectual nimbleness required to overcome setbacks. Since he was a young Harvard medical student in the mid-1960s, hearing his first lecture on organ transplantation, Sachs has set out to tackle "the most important problem that could be solved." In his mind, that was the persistent problem of organ rejection.
Sachs, director of the Transplantation Biology Research Center at Mass. General, had faith that a donor's bone marrow, from which immune cells originate, could play a pivotal role in giving transplant patients "induced tolerance" to a donated organ.
Under Sachs's approach, five days prior to transplant surgery, patients begin to undergo low-dose chemotherapy to kill off some of their marrow cells and make room for injection of the donor's bone marrow.
The patients also receive a drug and radiation to the thymus to eliminate a type of immune system cell, known as a T cell, that typically attacks any tissue perceived as foreign.
On the day of the procedure, surgeons attach the new kidney while injecting the donor's bone marrow into a blood vessel in the patient's arm. The donor's bone marrow mixes with the patient's, creating a temporary state called mixed chimerism. This tricks the patient's immune system into recognizing for years - and possibly forever - the donated organ as part of the self.
After the surgery, the immune system is still in a period of adjustment, and doctors give patients antirejection drugs that are gradually tapered off. Most patients were off the drugs by the ninth month.
Sachs first tried this approach successfully on mice, pigs, then monkeys. In 1998, he won approval to try his treatment on a select group of Mass. General patients with severe kidney failure, all of whom were offered matching kidneys from close relatives. When these six patients did well, Sachs moved on to the most ambitious test of his method, trying it out on patients with mismatched donors.
Starting in 2002, the method worked nearly flawlessly on Jennifer Searl, 28, a librarian from Peabody, and Christopher McMahon, 26, a retail store manager from Tewskbury.
Sachs and his colleagues felt something close to restrained euphoria. At a New Year's Eve party in 2002, Sachs and the chief surgeon on the research team, Dr. Benedict Cosimi, who share a small boat that they years ago named "Tolerance," gave a toast to the initial success of the experiment.
Then in October 2003, Andrews, a software engineer with polycystic kidney disease, went in for his experimental procedure. When the surgery was complete, spirits were high.
"Everybody thought it was a success," Andrews recalled.
But within two weeks of the surgery, Dr. Tatsuo Kawai, one of Sach's research colleagues, was handed test results showing that Andrews's urine output had dropped and that his blood contained high levels of toxins. An ultrasound scan showed the new organ was losing blood flow.
"The kidney's rejecting," Kawai remembered saying to himself.
He phoned Sachs, who was in his lab at one of Mass. General's research facilities in the Charlestown Navy Yard, with the news.
"It hurt," Sachs recalled. "You want to see everyone succeed."
For several months, Sachs and his team tried various drugs on Andrews, hoping to reverse the rejection. But by spring 2004, doctors began dialysis, conceding defeat in saving Andrews's new kidney. Because of the failure, Andrews was no longer eligible for another try with the experimental treatment.
The outcome for Andrews hit everyone on the research team hard.
"It was the lowest moment," Sachs recalled.
He said these studies put "people's lives in your hands" and are full of unpredictability.
Sachs and his dozen colleagues on the project began brainstorming about what went wrong, trying to salvage a lesson, if not Andrews's kidney. After intensive study, they concluded that another type of immune cell, the B cells, played a critical role in his organ rejection. They theorized that Andrews's body harbored B cells that ultimately produced antibodies against his sister's kidney, a scenario they did not anticipate because B cells had played no role in organ rejection in any of their previous studies.
To prevent rejection in new cases, the team revised the protocol to give all patients a drug prior to surgery that depletes B cells. Before they could proceed with the study, they had to win approvals from several regulatory agencies, which ensure patient safety.
Meanwhile, Sachs was delighted when he heard that Andrews's cousin had stepped forward to offer a kidney.
In August 2004, that conventional transplant surgery went smoothly, and Andrews went back to work "feeling great," while accepting his fate of being on antirejection drugs.
By 2005, the regulatory agencies approved the revised plan. In February 2005, surgeons operated on Derek Besenfelder, 28, a communications specialist from Los Angeles, and then in January 2006, they did transplant surgery on Matthew Knowles, 48, of Marshfield. Both have returned to their normal lives.
"I'm in perfect health," said Knowles, a supervisor for a gas company. "I don't take a pill a day. It's a miracle."
The four successful transplant patients have so far lived between 15 months and nearly five years without antirejection drugs.
Other researchers are also experimenting with ways to create permanent tolerance to donated organs, using slightly different approaches. Today's New England Journal includes two case studies from these other groups.
Sachs hopes to expand the study to include 20 new patients with mismatched donors. His greatest hope is that someday his novel treatment will extend to other organs.
"It's a wonderful feeling when you see people returning to their normal lives," he said.
Patricia Wen can be reached at wen@globe.com.
http://www.boston.com/news/local/articles/2008/01/24/rejecting_defeat?mode=PF
Avoiding Organ Rejection
Avoiding Organ Rejection
Audio
Professor Megan Sykes, Harvard University
One of the biggest breakthroughs in the transplantation field has been the discovery of immuno-suppressants. These are drugs that can partially switch off the immune system to prevent it from rejecting what the body sees as foreign tissue or non-self in a donor organ. But this comes at a cost because the drugs are quite toxic and immuno-suppressed patients are also quite vulnerable to infections and cancers.
Instead scientists have been searching for ways to persuade the immune system to accept the new foreign tissue in a donor organ as its own. Harvard’s professor Megan Sykes and her colleagues have now managed to do that by giving patients a partial bone marrow transplant collected from the same donor as the kidney they’re receiving. Somehow the new bone marrow re-educates the immune system so that it ignores the new kidney and the patients no longer require any kind of immuno-suppression.
Megan - Since the very first time allogeneic transplants were performed, that means transplants that were done one individual to another, we’ve known that there is this rejection response that will destroy the graft unless something is done to prevent it. So the success of allogeneic transplantation in patients in the last quarter century or so has depended on the use of immuno-suppressant drugs that suppress the immune system in a way that prevents the rejection of the graft.
Chris - There are some consequences of doing that though, aren’t there?
Megan - Yes. The trouble with that is these immuno-suppressive drugs suppress all immune responses so that the immune system is very generally compromised. What that means is that the recipient is predisposed to developing infections and also cancers, diseases because it turns out the immune system is needed to protect us from developing cancers. These are very serious side-effects and in addition there are a number of metabolic side-effects associated with these drugs and other unpleasant side-effects that people would like to avoid.
Chris - Why can’t we re-programme the immune system to try to ignore what we’re putting into the body and say ‘this kidney I’m putting in is friend, not foe, don’t attack it?’
Megan - Well, that’s exactly what we have been attempting to do for quite a long time now and that we seem to have achieved in a small group of patients in a pilot study. The approach that we have used involves use of bone marrow which contains cells that can form all of the blood-forming cells in the body. It’s been known for quite some years now that if bone marrow of two different individuals exists in one recipient that the donor bone marrow will educate the immune system in a way that allows the immune system to regard the donor as self and so the situation that you just described is created. Any graft from that same donor is ignored because it looks like self. The immune system has been educated to think that graft is self.
Chris - So what you’re saying is that if you gave someone a kidney transplant, if you gave them a bone marrow transplant at the same time you can change what the immune system recognises as friend and foe.
Megan - That’s right. That’s the idea. Now what I’ve just described has been well-established in animal models for a while now and we have a pretty good understanding of how it works in the animal models. The problem is, how do you go to an animal model from patients? Patients who get organ transplants in general do quite well early on, especially in the first two years. Another problem that I haven’t mentioned yet with organs transplants that are performed is that despite all the chronic non-specific immuno-suppressive therapy there’s a late phase of graft rejection called chronic rejection that really hasn’t been improved by all this immuno-suppressive therapy so many grafts are lost in the 5, 10, 15 year period. If we had this state where the immune system is re-educated as we’ve described, not only would we not need immuno-suppressive drugs but this more chronic type of rejection would also be prevented.
Chris - Could you talk us through, step-by-step, what you did in the pilot study with these patients?
Megan - Yes. What it involves is giving the recipient some chemotherapy but at a dose that that is well below the dose that is used in a conventional bone marrow transplant and giving the drug that is the antibody that causes depletion of the rejecting lymphocytes, the T cells in the recipient and also affects the T cells in the donor bone marrow graft.
Chris - So you end up with a patient who, for a while at least has got 2 types of bone marrow. They’ve got the donor who’s going to give them, say the kidney, and they’ve got their own bone marrow as well.
Megan - Right, that’s exactly right.
Chris - Then you put in the donor organ and at that time the immune system now is being told because the bone marrow is the same, don’t reject this organ.
Megan - Right, so the kidney and the bone marrow are given at the same time and the bone marrow is present in the circulation for a period of just a few weeks. Together the bone marrow derived cells in the kidney itself are doing some complex things that we’re still trying to understand to re-educate the immune system and allow it to regard the kidney as self.
Chris - In the patients that you’ve tested this on so far what’s been the outcome and are things still working for them now?
Megan - We’ve done five patients in this pilot study and four of them are currently doing very well. They’ve been off immuno-suppression for a number of years. One is approaching five years. Their kidneys are being accepted despite the lack of any immuno-suppressant drugs.
Chris - So you’ve proved that this can work, at least on a small scale, with kidney transplants. What about other organs, livers, hearts, lungs things like that.
Megan - The timing of the protocol is such that the organs and the bone marrow need to be transplanted at exactly the same time. Yet the preparation of the recipient has to begin five or six days beforehand. You need to know ahead of time that you’re going to do the transplant. At the moment this protocol limits us to live donors and the types of organs that are transplanted from living donors right now include kidneys, partial livers and sometimes lungs but hearts at the moment would not be relevant with this protocol. However, the overall idea does work in animal models for any type of graft from the donor. One of the things that we’re working on in our animal models is modifying the regiment so that it will be possible to time it in a way that any organ can be transplanted.
February 2008
Audio
Professor Megan Sykes, Harvard University
One of the biggest breakthroughs in the transplantation field has been the discovery of immuno-suppressants. These are drugs that can partially switch off the immune system to prevent it from rejecting what the body sees as foreign tissue or non-self in a donor organ. But this comes at a cost because the drugs are quite toxic and immuno-suppressed patients are also quite vulnerable to infections and cancers.
Instead scientists have been searching for ways to persuade the immune system to accept the new foreign tissue in a donor organ as its own. Harvard’s professor Megan Sykes and her colleagues have now managed to do that by giving patients a partial bone marrow transplant collected from the same donor as the kidney they’re receiving. Somehow the new bone marrow re-educates the immune system so that it ignores the new kidney and the patients no longer require any kind of immuno-suppression.
Megan - Since the very first time allogeneic transplants were performed, that means transplants that were done one individual to another, we’ve known that there is this rejection response that will destroy the graft unless something is done to prevent it. So the success of allogeneic transplantation in patients in the last quarter century or so has depended on the use of immuno-suppressant drugs that suppress the immune system in a way that prevents the rejection of the graft.
Chris - There are some consequences of doing that though, aren’t there?
Megan - Yes. The trouble with that is these immuno-suppressive drugs suppress all immune responses so that the immune system is very generally compromised. What that means is that the recipient is predisposed to developing infections and also cancers, diseases because it turns out the immune system is needed to protect us from developing cancers. These are very serious side-effects and in addition there are a number of metabolic side-effects associated with these drugs and other unpleasant side-effects that people would like to avoid.
Chris - Why can’t we re-programme the immune system to try to ignore what we’re putting into the body and say ‘this kidney I’m putting in is friend, not foe, don’t attack it?’
Megan - Well, that’s exactly what we have been attempting to do for quite a long time now and that we seem to have achieved in a small group of patients in a pilot study. The approach that we have used involves use of bone marrow which contains cells that can form all of the blood-forming cells in the body. It’s been known for quite some years now that if bone marrow of two different individuals exists in one recipient that the donor bone marrow will educate the immune system in a way that allows the immune system to regard the donor as self and so the situation that you just described is created. Any graft from that same donor is ignored because it looks like self. The immune system has been educated to think that graft is self.
Chris - So what you’re saying is that if you gave someone a kidney transplant, if you gave them a bone marrow transplant at the same time you can change what the immune system recognises as friend and foe.
Megan - That’s right. That’s the idea. Now what I’ve just described has been well-established in animal models for a while now and we have a pretty good understanding of how it works in the animal models. The problem is, how do you go to an animal model from patients? Patients who get organ transplants in general do quite well early on, especially in the first two years. Another problem that I haven’t mentioned yet with organs transplants that are performed is that despite all the chronic non-specific immuno-suppressive therapy there’s a late phase of graft rejection called chronic rejection that really hasn’t been improved by all this immuno-suppressive therapy so many grafts are lost in the 5, 10, 15 year period. If we had this state where the immune system is re-educated as we’ve described, not only would we not need immuno-suppressive drugs but this more chronic type of rejection would also be prevented.
Chris - Could you talk us through, step-by-step, what you did in the pilot study with these patients?
Megan - Yes. What it involves is giving the recipient some chemotherapy but at a dose that that is well below the dose that is used in a conventional bone marrow transplant and giving the drug that is the antibody that causes depletion of the rejecting lymphocytes, the T cells in the recipient and also affects the T cells in the donor bone marrow graft.
Chris - So you end up with a patient who, for a while at least has got 2 types of bone marrow. They’ve got the donor who’s going to give them, say the kidney, and they’ve got their own bone marrow as well.
Megan - Right, that’s exactly right.
Chris - Then you put in the donor organ and at that time the immune system now is being told because the bone marrow is the same, don’t reject this organ.
Megan - Right, so the kidney and the bone marrow are given at the same time and the bone marrow is present in the circulation for a period of just a few weeks. Together the bone marrow derived cells in the kidney itself are doing some complex things that we’re still trying to understand to re-educate the immune system and allow it to regard the kidney as self.
Chris - In the patients that you’ve tested this on so far what’s been the outcome and are things still working for them now?
Megan - We’ve done five patients in this pilot study and four of them are currently doing very well. They’ve been off immuno-suppression for a number of years. One is approaching five years. Their kidneys are being accepted despite the lack of any immuno-suppressant drugs.
Chris - So you’ve proved that this can work, at least on a small scale, with kidney transplants. What about other organs, livers, hearts, lungs things like that.
Megan - The timing of the protocol is such that the organs and the bone marrow need to be transplanted at exactly the same time. Yet the preparation of the recipient has to begin five or six days beforehand. You need to know ahead of time that you’re going to do the transplant. At the moment this protocol limits us to live donors and the types of organs that are transplanted from living donors right now include kidneys, partial livers and sometimes lungs but hearts at the moment would not be relevant with this protocol. However, the overall idea does work in animal models for any type of graft from the donor. One of the things that we’re working on in our animal models is modifying the regiment so that it will be possible to time it in a way that any organ can be transplanted.
February 2008
Utah tests may lead to stem-cell treatment of kidney failure
Utah tests may lead to stem-cell treatment of kidney failure
By Heather May
The Salt Lake Tribune
Article Last Updated: 09/30/2008 03:14:55 PM MDT
Utah researchers are testing whether they can safely inject adult stem cells into patients to prevent and treat acute kidney failure.
Intermountain Medical Center and AlloCure, a Utah-based biotech company, have teamed up to test AlloCure's patented cells in patients who have had open-heart surgery. That kind of major operation can lead to acute kidney injury, which can be deadly.
"These cells enable an organ to defend itself against injury," said Christof Westenfelder, AlloCure's chief medical officer.
The researchers are recruiting 15 patients in what they say is the first use of adult stem cells for such kidney problems.
The cells are obtained from healthy adult donors' bone marrow. AlloCure grows and processes them in a lab, making them essentially invisible to the patient's immune system so that the patient and donor don't have to match blood or tissue types.
The cells are injected through a catheter into the bloodstream. Chemical signals lead the cells to the kidney, where, according to AlloCure, animal studies have shown they promote the survival and growth of kidney cells so that the organ can repair itself.
After that work is done, Westenfelder said, the stem cells enter the circulatory system, where they self-destruct. That's important so that the cells don't create bone, fat or muscle - which is what bone marrow stem cells do - in the wrong place.
The clinical trial is in the first of three phases, which means researchers are studying whether or not the cells are safe in humans. If the study proceeds, researchers will determine if the stem cells protect and heal kidneys.
Two Utah patients have been injected so far with "no obvious complications," said John Doty, a cardiovascular surgeon at IMC and the study's principal investigator. AlloCure is funding the study.
Possible side effects include complications with the catheter and blood vessel blockages from the stem cells.
The researchers said doctors need a better way to treat kidney damage after heart surgery. For the serious cases, patients must go on dialysis. But half of those dialysis patients will die before leaving the hospital, Doty said.
hmay@sltrib.com
By Heather May
The Salt Lake Tribune
Article Last Updated: 09/30/2008 03:14:55 PM MDT
Utah researchers are testing whether they can safely inject adult stem cells into patients to prevent and treat acute kidney failure.
Intermountain Medical Center and AlloCure, a Utah-based biotech company, have teamed up to test AlloCure's patented cells in patients who have had open-heart surgery. That kind of major operation can lead to acute kidney injury, which can be deadly.
"These cells enable an organ to defend itself against injury," said Christof Westenfelder, AlloCure's chief medical officer.
The researchers are recruiting 15 patients in what they say is the first use of adult stem cells for such kidney problems.
The cells are obtained from healthy adult donors' bone marrow. AlloCure grows and processes them in a lab, making them essentially invisible to the patient's immune system so that the patient and donor don't have to match blood or tissue types.
The cells are injected through a catheter into the bloodstream. Chemical signals lead the cells to the kidney, where, according to AlloCure, animal studies have shown they promote the survival and growth of kidney cells so that the organ can repair itself.
After that work is done, Westenfelder said, the stem cells enter the circulatory system, where they self-destruct. That's important so that the cells don't create bone, fat or muscle - which is what bone marrow stem cells do - in the wrong place.
The clinical trial is in the first of three phases, which means researchers are studying whether or not the cells are safe in humans. If the study proceeds, researchers will determine if the stem cells protect and heal kidneys.
Two Utah patients have been injected so far with "no obvious complications," said John Doty, a cardiovascular surgeon at IMC and the study's principal investigator. AlloCure is funding the study.
Possible side effects include complications with the catheter and blood vessel blockages from the stem cells.
The researchers said doctors need a better way to treat kidney damage after heart surgery. For the serious cases, patients must go on dialysis. But half of those dialysis patients will die before leaving the hospital, Doty said.
hmay@sltrib.com
Ultrasound cuff to stop internal bleeding on battlefield
October 22, 2008 6:00 AM PDT
Ultrasound cuff to stop internal bleeding on battlefield
Posted by Mark Rutherford Post a comment
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(Credit: DARPA)
Internal bleeding can cause irreversible haemorrhagic shock within 30 seconds or progressive shock within eight hours, either way, it's not good and the military wants a portable, noninvasive way to detect and stop it right on the battlefield.
To that end, the Defense Advance Research Projects Agency (DARPA) has contracted with Siemens Healthcare, the University of Washington's Centre for Industrial and Medical Ultrasound and Texas A&M to develop something called the Deep Bleeder Acoustic Coagulation cuff (DBAC). The cuff is a semi-automated, ultrasound device designed to cut blood loss and shock resulting from combat limb injuries, one that can be operated by any GI with minimal training.
As it stands now, a wounded soldier can quickly lose 25 percent of blood volume while waiting to be evacuated. This can lead to progressive shock and death. On the spot treatment with the cuff would curtail these needless combat deaths and amputations, according to the military.
A medic applies the cuff to the injured limb, the DBAC automatically locates the bleeding and triggers a dose of high-intensity, focused ultrasound toward it, this prompts quick coagulation and an end to the bleeding.
The system uses doppler-based "automated bleed detection algorithms," according to DARPA. The software used is based on "unique spectral and power Doppler bleeder signatures that, when coupled to volumetric data, allows for automated bleed detection and localization."(PDF)
Blood mimicking fluids and heat resistant, tissue mimicking phantoms were custom created to allow DBAC testing on a full-sized leg mockup. DARPA hopes to be able to have a prototype in 18 months.
Mark Rutherford is a West Coast-based freelance writer. He is a member of the CNET Blog Network, and is not an employee of CNET. Email him at markr@milapp.com. Disclosure.
Combined kidney and bone marrow transplantation allows patients to discontinue anti-rejection drugs
Combined kidney and bone marrow transplantation allows patients to discontinue anti-rejection drugs
Researcher reports progress of clinical trial to International Transplantation Society
AUGUST 26, 2002
Megan Sykes, head of the bone marrow transplantation section of the Massachusetts Transplantation Biology Research Center and professor of surgery at Harvard Medical School, recently described how infusing kidney transplant recipients with bone marrow from their donors immediately after the transplant surgery induced a state of mixed chimerism, a blending of donor and recipient immune systems. All of the patients Sykes described had developed kidney failure as a result of multiple myeloma, a cancer of the bone marrow. Traditionally, such patients had no good treatment options. They were not eligible for kidney transplantation because of their cancer, and the kidney failure made them unable to tolerate the toxic aspects of standard bone marrow transplantation, which has been used for some myeloma patients. For many years Sykes and her colleagues at MGH -- along with collaborators at BioTransplant Inc. of Charlestown, Mass. -- have been studying mixed chimerism and its application for both treatment of blood-cell cancers and for inducing tolerance, a state in which an organ recipient's immune system no longer recognizes the donor's tissues as foreign.
Contributed by Massachusetts General Hospital
http://harvardscience.harvard.edu/medicine-health/articles/combined-kidney-and-bone-marrow-transplantation-allows-patients-discontinue
Researcher reports progress of clinical trial to International Transplantation Society
AUGUST 26, 2002
Megan Sykes, head of the bone marrow transplantation section of the Massachusetts Transplantation Biology Research Center and professor of surgery at Harvard Medical School, recently described how infusing kidney transplant recipients with bone marrow from their donors immediately after the transplant surgery induced a state of mixed chimerism, a blending of donor and recipient immune systems. All of the patients Sykes described had developed kidney failure as a result of multiple myeloma, a cancer of the bone marrow. Traditionally, such patients had no good treatment options. They were not eligible for kidney transplantation because of their cancer, and the kidney failure made them unable to tolerate the toxic aspects of standard bone marrow transplantation, which has been used for some myeloma patients. For many years Sykes and her colleagues at MGH -- along with collaborators at BioTransplant Inc. of Charlestown, Mass. -- have been studying mixed chimerism and its application for both treatment of blood-cell cancers and for inducing tolerance, a state in which an organ recipient's immune system no longer recognizes the donor's tissues as foreign.
Contributed by Massachusetts General Hospital
http://harvardscience.harvard.edu/medicine-health/articles/combined-kidney-and-bone-marrow-transplantation-allows-patients-discontinue
Bone-marrow-derived stem cells can reverse genetic kidney disease
Bone-marrow-derived stem cells can reverse genetic kidney disease
APRIL 24, 2006
The discovery that bone-marrow derived stem cells can regenerate damaged renal cells in an animal model of Alport syndrome provides a potential new strategy for managing this inherited kidney disease and offers the first example of how stem cells may be useful in repairing basement membrane matrix defects and restoring organ function.
Led by researchers at Beth Israel Deaconess Medical Center (BIDMC), the findings are described in the Proceedings of the National Academy of Sciences (PNAS), which appeared on-line the week of April 24, 2006.
Symptoms of Alport syndrome, the second-most common genetic cause of kidney failure, usually appear in children, affecting the kidneys' filtration system and typically leading to end-stage renal disease in the patient's teens, 20s or 30s. The disease additionally causes deafness in some patients.
"This is one of 31 human diseases that occur because of genetic defects in the body's extracellular matrix and basement membrane proteins," explains the study's senior author, Raghu Kalluri, PhD, chief of the division of matrix biology at BIDMC and associate professor of medicine at Harvard Medical School.
Contributed by Beth Israel Deaconess Medical Center
http://harvardscience.harvard.edu/medicine-health/articles/bone-marrow-derived-stem-cells-can-reverse-genetic-kidney-disease
The Stink in Farts Controls Blood Pressure
The Stink in Farts Controls Blood Pressure
By Amelia Tomas, LiveScience Staff
posted: 23 October 2008 02:52 pm ET
A smelly rotten-egg gas in farts controls blood pressure in mice, a new study finds.
The unpleasant aroma of the gas, called hydrogen sulfide (H2S), can be a little too familiar, as it is expelled by bacteria living in the human colon and eventually makes its way, well, out.
The new research found that cells lining mice’s blood vessels naturally make the gas and this action can help keep the rodents’ blood pressure low by relaxing the blood vessels to prevent hypertension (high blood pressure). This gas is “no doubt” produced in cells lining human blood vessels too, the researchers said.
“Now that we know hydrogen sulfide’s role in regulating blood pressure, it may be possible to design drug therapies that enhance its formation as an alternative to the current methods of treatment for hypertension,” said Johns Hopkins neuroscientist Solomon H. Snyder, M.D., a co-author of the study detailed in the Oct. 24th issue of the journal Science.
Snyder and his colleagues compared normal mice to mice that were missing a gene for an enzyme known as CSE, long suspected as being responsible for making hydrogen sulfide. As they measured hydrogen sulfide levels taken from tissues of the CSE-deficient mice, the scientists found that the gas was depleted in the cardiovascular systems of the altered mice. By contrast, normal mice had higher levels of the gas, thereby showing that hydrogen sulfide is naturally made by mammalian tissues using CSE.
Next, the mice were subjected to higher blood pressures comparable to serious hypertension in humans. Scientists had them respond to a chemical called methacholine that relaxes normal blood vessels. The blood vessels of the CSE-lacking mice hardly relaxed, indicating that hydrogen sulfide is a huge contender for regulating blood pressure.
Hydrogen sulfide is the most recently discovered member of a family of gasotransmitters, small molecules inside our bodies with important physiological functions.
This study is the first to reveal that the CSE enzyme that triggers hydrogen sulfide is activated itself in the same way as other enzymes when they trigger their respective gasotransmitter, such as a nitric oxide-forming enzyme that also regulates blood pressure, Dr. Snyder said.
Because gasotransmitters are common in mammals all over the evolutionary tree, these findings on the importance of hydrogen sulfide are thought to have broad applications to human diseases, such as diabetes and neurodegenerative diseases.
The research was supported by grants from the U.S. Public Health Service and the Canadian Institutes of Health Research as well as a Research Scientist Award.
By Amelia Tomas, LiveScience Staff
posted: 23 October 2008 02:52 pm ET
A smelly rotten-egg gas in farts controls blood pressure in mice, a new study finds.
The unpleasant aroma of the gas, called hydrogen sulfide (H2S), can be a little too familiar, as it is expelled by bacteria living in the human colon and eventually makes its way, well, out.
The new research found that cells lining mice’s blood vessels naturally make the gas and this action can help keep the rodents’ blood pressure low by relaxing the blood vessels to prevent hypertension (high blood pressure). This gas is “no doubt” produced in cells lining human blood vessels too, the researchers said.
“Now that we know hydrogen sulfide’s role in regulating blood pressure, it may be possible to design drug therapies that enhance its formation as an alternative to the current methods of treatment for hypertension,” said Johns Hopkins neuroscientist Solomon H. Snyder, M.D., a co-author of the study detailed in the Oct. 24th issue of the journal Science.
Snyder and his colleagues compared normal mice to mice that were missing a gene for an enzyme known as CSE, long suspected as being responsible for making hydrogen sulfide. As they measured hydrogen sulfide levels taken from tissues of the CSE-deficient mice, the scientists found that the gas was depleted in the cardiovascular systems of the altered mice. By contrast, normal mice had higher levels of the gas, thereby showing that hydrogen sulfide is naturally made by mammalian tissues using CSE.
Next, the mice were subjected to higher blood pressures comparable to serious hypertension in humans. Scientists had them respond to a chemical called methacholine that relaxes normal blood vessels. The blood vessels of the CSE-lacking mice hardly relaxed, indicating that hydrogen sulfide is a huge contender for regulating blood pressure.
Hydrogen sulfide is the most recently discovered member of a family of gasotransmitters, small molecules inside our bodies with important physiological functions.
This study is the first to reveal that the CSE enzyme that triggers hydrogen sulfide is activated itself in the same way as other enzymes when they trigger their respective gasotransmitter, such as a nitric oxide-forming enzyme that also regulates blood pressure, Dr. Snyder said.
Because gasotransmitters are common in mammals all over the evolutionary tree, these findings on the importance of hydrogen sulfide are thought to have broad applications to human diseases, such as diabetes and neurodegenerative diseases.
The research was supported by grants from the U.S. Public Health Service and the Canadian Institutes of Health Research as well as a Research Scientist Award.
Stem Cell Transplant Succeeds in Curing Kidney Failure in Rats
Stem Cell Transplant Succeeds in Curing Kidney Failure in Rats
Mainichi Daily News
21 June 2005
A research team led by the University of Tokyo has succeeded in curing renal failure in rats by transplanting somatic stem cells of kidneys from healthy rats.
The team announced the results of their research in the June 20 issue of a U.S. science magazine, "Journal of Cell Biology."
Somatic stem cells are a type of cell in an organ that can multiply and develop into a variety of other cells of that specific organ. Such cells cannot, however, transform into cells of other organs.
Experts have expressed hope that the method can be applied to cure renal failure in humans, noting that human kidneys have similar somatic stem cells.
"It's been confirmed that somatic stem cells in kidneys are capable of not only creating new cells but also restoring damaged organs. We may be able to develop drugs aimed at (activating) somatic stem cells," said University of Tokyo Associate Prof. Keiichi Hishikawa, a member of the research team.
The research team has identified the gene of somatic stem cells in rat kidneys, and confirmed that such cells exist only in parts of rat kidneys called stroma. The team has also discovered that somatic stem cells in kidneys are capable of developing into blood vessels and renal tubules.
In the experiment, the team transplanted 10,000 kidney somatic stem cells into the ailing kidney of each laboratory rat with renal failure.
Blood tests conducted on the rats seven days later found that their kidney functions had returned to normal.
Researchers said they believe that the transplanted somatic stem cells restored the damaged kidney cells, noting that the number of somatic stem cells in the rats had decreased to about 30 percent of that in healthy rats' kidneys.
The research team also found somatic stem cells in human kidneys extracted from kidney disease sufferers after examining the organs with the consent of the patients and the University of Tokyo Hospital's ethics committee.
The researchers are poised to study how to multiply somatic stem cells extracted from human kidneys in a bid to develop a method for returning artificially multiplied cells back to the patients' kidneys. It will also study medication aimed at activating genes that cause somatic stem cells to restore damaged kidney cells.
As of the end of 2003, about 237,000 patients with chronic renal failure were regularly undergoing artificial dialysis. (Mainichi)
Mainichi Daily News
21 June 2005
A research team led by the University of Tokyo has succeeded in curing renal failure in rats by transplanting somatic stem cells of kidneys from healthy rats.
The team announced the results of their research in the June 20 issue of a U.S. science magazine, "Journal of Cell Biology."
Somatic stem cells are a type of cell in an organ that can multiply and develop into a variety of other cells of that specific organ. Such cells cannot, however, transform into cells of other organs.
Experts have expressed hope that the method can be applied to cure renal failure in humans, noting that human kidneys have similar somatic stem cells.
"It's been confirmed that somatic stem cells in kidneys are capable of not only creating new cells but also restoring damaged organs. We may be able to develop drugs aimed at (activating) somatic stem cells," said University of Tokyo Associate Prof. Keiichi Hishikawa, a member of the research team.
The research team has identified the gene of somatic stem cells in rat kidneys, and confirmed that such cells exist only in parts of rat kidneys called stroma. The team has also discovered that somatic stem cells in kidneys are capable of developing into blood vessels and renal tubules.
In the experiment, the team transplanted 10,000 kidney somatic stem cells into the ailing kidney of each laboratory rat with renal failure.
Blood tests conducted on the rats seven days later found that their kidney functions had returned to normal.
Researchers said they believe that the transplanted somatic stem cells restored the damaged kidney cells, noting that the number of somatic stem cells in the rats had decreased to about 30 percent of that in healthy rats' kidneys.
The research team also found somatic stem cells in human kidneys extracted from kidney disease sufferers after examining the organs with the consent of the patients and the University of Tokyo Hospital's ethics committee.
The researchers are poised to study how to multiply somatic stem cells extracted from human kidneys in a bid to develop a method for returning artificially multiplied cells back to the patients' kidneys. It will also study medication aimed at activating genes that cause somatic stem cells to restore damaged kidney cells.
As of the end of 2003, about 237,000 patients with chronic renal failure were regularly undergoing artificial dialysis. (Mainichi)
B.C. man paralyzed after flu shot warns of risks
B.C. man paralyzed after flu shot warns of risks
Last Updated: Wednesday, October 22, 2008 | 3:58 PM ET Comments94Recommend94
CBC News
Health officials say the benefits of the influenza vaccine outweigh the risks, especially for the very young and old, and those with health problems. (Chuck Stoody/CP)
A New Westminster man is raising a warning flag after he contracted a rare and debilitating condition linked to the flu shot that left him paralyzed for almost five months.
Every fall, health care workers across Canada distribute 10 million influenza vaccinations, and for the vast majority of people, the flu shot causes no major problems.
Within two weeks of getting his annual flu shot in 2007, however, Richard Ryan, 44, went from being happy and healthy to being in excruciating pain.
At first, Ryan thought he had injured his back, and he checked into the local hospital emergency room, he told CBC News on Wednesday.
But Ryan was also suffering some numbness, and when a neurologist tested his reflexes, he found Ryan had none, he said.
"The doctor asked me what was going on in my life. And as soon as I said I was feeling ill after getting a flu shot, he said, 'Stop right there, I know what you have,'" Ryan said.
Guillain-Barré syndrome linked to vaccine
The neurologist diagnosed Ryan with Guillain-Barré syndrome, an autoimmune disease that attacks the nervous system.
According to the B.C. Centre for Disease Control, the chance of developing that particular disease from a flu shot is one in a million.
But as Ryan learned the consequences can be severe. By the time the emergency room exam was over, he was unable to get up. He spent the next 10 weeks recovering in hospital, including three weeks in intensive care, barely able to breathe or eat for himself.
"My face was paralyzed. I had no feeling inside my mouth. I couldn't feel my tongue. My left eye wouldn't close so it had to be taped shut to sleep," he said.
The illness progressed into a lifelong condition known as chronic inflammatory demyelinating polyneuropathy (CIDP), and a year later he remains heavily medicated, unable to work, and has memory problems.
Although the disease is in remission, he is not expected to make a full recovery, and the chronic condition could return at any point in the future.
Worth the risk?
Now Ryan say he is concerned that public health officials are promoting the flu vaccine while most people are not fully aware of the risks.
However, Dr. Danuta Skowronski, an epidemiologist at the B.C. Centre for Disease Control, says the benefits of the flu vaccine still outweigh the risks for the vast majority of people.
"Nothing is completely risk-free," she told CBC News. "It is always a matter of weighing the benefits and the risks."
Medical information provided with flu shots does mention the one-in-a-million chance of getting Guillain-Barré syndrome.
But it is especially important for people with heart and lung problems, the elderly and the chronically ill, to get the influenza vaccine because it could save their lives, Skowronski said.
"Influenza itself can be life threatening, and it's those groups that we want to make sure are not put off from receiving influenza vaccine unnecessarily," said Skowronski.
There are more than 2000 flu-related deaths in Canada every year. Seniors, people with weak immune systems and some children are at highest risk.
More common possible side-effects of vaccinations can include fever, muscle pain and weakness.
For his part, Ryan maintains that he's a good example of the fact that the benefits of the vaccination don't always outweigh the risks.
"I think if people knew how serious the illness is, they would think twice about the flu shot," he said.
Last Updated: Wednesday, October 22, 2008 | 3:58 PM ET Comments94Recommend94
CBC News
Health officials say the benefits of the influenza vaccine outweigh the risks, especially for the very young and old, and those with health problems. (Chuck Stoody/CP)
A New Westminster man is raising a warning flag after he contracted a rare and debilitating condition linked to the flu shot that left him paralyzed for almost five months.
Every fall, health care workers across Canada distribute 10 million influenza vaccinations, and for the vast majority of people, the flu shot causes no major problems.
Within two weeks of getting his annual flu shot in 2007, however, Richard Ryan, 44, went from being happy and healthy to being in excruciating pain.
At first, Ryan thought he had injured his back, and he checked into the local hospital emergency room, he told CBC News on Wednesday.
But Ryan was also suffering some numbness, and when a neurologist tested his reflexes, he found Ryan had none, he said.
"The doctor asked me what was going on in my life. And as soon as I said I was feeling ill after getting a flu shot, he said, 'Stop right there, I know what you have,'" Ryan said.
Guillain-Barré syndrome linked to vaccine
The neurologist diagnosed Ryan with Guillain-Barré syndrome, an autoimmune disease that attacks the nervous system.
According to the B.C. Centre for Disease Control, the chance of developing that particular disease from a flu shot is one in a million.
But as Ryan learned the consequences can be severe. By the time the emergency room exam was over, he was unable to get up. He spent the next 10 weeks recovering in hospital, including three weeks in intensive care, barely able to breathe or eat for himself.
"My face was paralyzed. I had no feeling inside my mouth. I couldn't feel my tongue. My left eye wouldn't close so it had to be taped shut to sleep," he said.
The illness progressed into a lifelong condition known as chronic inflammatory demyelinating polyneuropathy (CIDP), and a year later he remains heavily medicated, unable to work, and has memory problems.
Although the disease is in remission, he is not expected to make a full recovery, and the chronic condition could return at any point in the future.
Worth the risk?
Now Ryan say he is concerned that public health officials are promoting the flu vaccine while most people are not fully aware of the risks.
However, Dr. Danuta Skowronski, an epidemiologist at the B.C. Centre for Disease Control, says the benefits of the flu vaccine still outweigh the risks for the vast majority of people.
"Nothing is completely risk-free," she told CBC News. "It is always a matter of weighing the benefits and the risks."
Medical information provided with flu shots does mention the one-in-a-million chance of getting Guillain-Barré syndrome.
But it is especially important for people with heart and lung problems, the elderly and the chronically ill, to get the influenza vaccine because it could save their lives, Skowronski said.
"Influenza itself can be life threatening, and it's those groups that we want to make sure are not put off from receiving influenza vaccine unnecessarily," said Skowronski.
There are more than 2000 flu-related deaths in Canada every year. Seniors, people with weak immune systems and some children are at highest risk.
More common possible side-effects of vaccinations can include fever, muscle pain and weakness.
For his part, Ryan maintains that he's a good example of the fact that the benefits of the vaccination don't always outweigh the risks.
"I think if people knew how serious the illness is, they would think twice about the flu shot," he said.
Scientists grow mouse prostate from a single cell
Scientists grow mouse prostate from a single cell
Molecular biologists reported Wednesday that they had grown prostates in mice from single cells, marking an important step forward in the quest to grow transplant tissue in the lab.
The four-person team at the Californian biotechnology firm Genentech said they achieved the feat after identifying a primitive, powerful cell called a stem cell in mouse prostates.
The cell, known by its marker CD117, was transplanted below the kidney in lab mice, according to their study, published online by the British-based science journal Nature.
Of 97 of these single-cell transplants, 14 functioning prostates developed.
Stem cells have unleashed enormous interest in recent years because of their theoretical potential to grow specific cells that can be used to replace tissue damaged by disease or accident.
The biggest focus has been on stem cells at the embryonic stage as these are "pluripotent", meaning that they can become any tissue in the body.
There are also "unipotent" adult stem cells, which are already programmed to divide into specific cells, which is the case in this research.
However, isolating these unipotent cells and getting them to regenerate successfully into the desired tissue in living animals has proven a major hurdle.
In 2006, two teams of scientists made a breakthrough in growing a mouse mammary gland from a single stem cell.
The Genentech researchers suspect that men also have a potential population of CD117 stem cells, although only further work will determine whether these cells can tracked down and used as a regenerative source.
The prostate is a small gland located just below the bladder that helps make seminal fluid and expel semen. Prostate cancer is a leading form of cancer in developed countries.
© 2008 AFP
This news is brought to you by PhysOrg.com
Molecular biologists reported Wednesday that they had grown prostates in mice from single cells, marking an important step forward in the quest to grow transplant tissue in the lab.
The four-person team at the Californian biotechnology firm Genentech said they achieved the feat after identifying a primitive, powerful cell called a stem cell in mouse prostates.
The cell, known by its marker CD117, was transplanted below the kidney in lab mice, according to their study, published online by the British-based science journal Nature.
Of 97 of these single-cell transplants, 14 functioning prostates developed.
Stem cells have unleashed enormous interest in recent years because of their theoretical potential to grow specific cells that can be used to replace tissue damaged by disease or accident.
The biggest focus has been on stem cells at the embryonic stage as these are "pluripotent", meaning that they can become any tissue in the body.
There are also "unipotent" adult stem cells, which are already programmed to divide into specific cells, which is the case in this research.
However, isolating these unipotent cells and getting them to regenerate successfully into the desired tissue in living animals has proven a major hurdle.
In 2006, two teams of scientists made a breakthrough in growing a mouse mammary gland from a single stem cell.
The Genentech researchers suspect that men also have a potential population of CD117 stem cells, although only further work will determine whether these cells can tracked down and used as a regenerative source.
The prostate is a small gland located just below the bladder that helps make seminal fluid and expel semen. Prostate cancer is a leading form of cancer in developed countries.
© 2008 AFP
This news is brought to you by PhysOrg.com
Half of Doctors Routinely Prescribe Placebos
October 24, 2008
Half of Doctors Routinely Prescribe Placebos
By GARDINER HARRIS
Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.
The study involved 679 internists and rheumatologists chosen randomly from a national list of such doctors. In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.
The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.
In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”
The study is being published in BMJ, formerly The British Medical Journal. One of the authors, Franklin G. Miller, was among the medical ethicists who said they were troubled by the results.
“This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception,” said Dr. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health.
Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.
But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”
But antibiotics and sedatives are not placebos, he said.
The American Medical Association discourages the use of placebos by doctors when represented as helpful.
“In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient,” the group’s policy states.
Controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain.
But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?
Some studies have hinted at answers, but experts say far more work is needed.
Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston, said the popularity of alternative medical treatments had led many doctors to embrace placebos as a potentially useful tool. But, Dr. Brody said, doctors should resist using placebos, because they reinforce the deleterious notion that “when something is the matter with you, you will not get better unless you swallow pills.”
Earlier this year, a Maryland mother announced that she would start selling dextrose tablets as a children’s placebo called Obecalp, for “placebo” spelled backward.
Dr. Ezekiel J. Emanuel, one of the study’s authors, said doctors should not prescribe antibiotics or sedatives as placebos, given those drugs’ risks. Use of less active placebos is understandable, he said, since risks are low.
“Everyone comes out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel, chairman of the bioethics department at the health institutes. “But ethical challenges remain.”
Copyright 2008 The New York Times Company Privacy Policy Search Corrections RSS First Look Help Contact Us Work for Us Site Map
Half of Doctors Routinely Prescribe Placebos
By GARDINER HARRIS
Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.
The study involved 679 internists and rheumatologists chosen randomly from a national list of such doctors. In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.
The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.
In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”
The study is being published in BMJ, formerly The British Medical Journal. One of the authors, Franklin G. Miller, was among the medical ethicists who said they were troubled by the results.
“This is the doctor-patient relationship, and our expectations about being truthful about what’s going on and about getting informed consent should give us pause about deception,” said Dr. Miller, director of the research ethics program in the department of bioethics at the National Institutes of Health.
Dr. William Schreiber, an internist in Louisville, Ky., at first said in an interview that he did not believe the survey’s results, because, he said, few doctors he knows routinely prescribe placebos.
But when asked how he treated fibromyalgia or other conditions that many doctors suspect are largely psychosomatic, Dr. Schreiber changed his mind. “The problem is that most of those people are very difficult patients, and it’s a whole lot easier to give them something like a big dose of Aleve,” he said. “Is that a placebo treatment? Depending on how you define it, I guess it is.”
But antibiotics and sedatives are not placebos, he said.
The American Medical Association discourages the use of placebos by doctors when represented as helpful.
“In the clinical setting, the use of a placebo without the patient’s knowledge may undermine trust, compromise the patient-physician relationship and result in medical harm to the patient,” the group’s policy states.
Controlled clinical trials have hinted that placebos may have powerful effects. Some 30 percent to 40 percent of depressed patients who are given placebos get better, a treatment effect that antidepressants barely top. Placebos have also proved effective against hypertension and pain.
But despite much attention given to the power of placebos, basic questions about them remain unanswered: Are they any better than no treatment at all? Must people be deceived into believing that a treatment is active for a placebo to work?
Some studies have hinted at answers, but experts say far more work is needed.
Dr. Howard Brody, director of the Institute for the Medical Humanities at the University of Texas Medical Branch, in Galveston, said the popularity of alternative medical treatments had led many doctors to embrace placebos as a potentially useful tool. But, Dr. Brody said, doctors should resist using placebos, because they reinforce the deleterious notion that “when something is the matter with you, you will not get better unless you swallow pills.”
Earlier this year, a Maryland mother announced that she would start selling dextrose tablets as a children’s placebo called Obecalp, for “placebo” spelled backward.
Dr. Ezekiel J. Emanuel, one of the study’s authors, said doctors should not prescribe antibiotics or sedatives as placebos, given those drugs’ risks. Use of less active placebos is understandable, he said, since risks are low.
“Everyone comes out happy: the doctor is happy, the patient is happy,” said Dr. Emanuel, chairman of the bioethics department at the health institutes. “But ethical challenges remain.”
Copyright 2008 The New York Times Company Privacy Policy Search Corrections RSS First Look Help Contact Us Work for Us Site Map
Why this blog.
The medical community has been thrust into my life, not for the first time. But this time in a quite dramatic fashion that will most likely be life long and immutable. I have often cited research, articles and received looks of pitiful disdain. I wanted a repository
of information. Here it is, Medicine is a science, not a religion.
of information. Here it is, Medicine is a science, not a religion.
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