Showing posts with label Blood-Cells. Show all posts
Showing posts with label Blood-Cells. Show all posts

Tuesday, April 15, 2008

Health Tip: Donating Blood

(HealthDay News) - Donating blood is a safe and easy procedure that can help save lives.

Here is information on what to expect when you donate blood, courtesy of the American Red Cross:

  • You'll have a mini-physical exam, where your blood pressure, pulse and temperature will be checked. You also will be asked questions about your lifestyle and health.

  • The injection site on your arm will be sterilized, then a sterile needle will be inserted. Some minor stinging or discomfort is common when the needle enters the skin.

  • It takes about 10 minutes to collect a pint of blood.

  • You may need to lie still for a few minutes after the donation, and have a snack or a drink.
    If you donate to the Red Cross, you'll be given a form with follow-up instructions and a phone number to call in case you realize that your blood may not be safe to give to another person.

  • A small number of donors may experience dizziness, fatigue or bruising at the injection site.

Sunday, April 06, 2008

My Immune System Confronts a Virus






















After a stem cell transplant, it's a little scary to run into a familiar old enemy
by Jason Carpenter

As I reached Day 21 of my stem cell transplant, my recovery hit a very scary wall. I woke up with a fever of 102 and could barely lift my head off my pillow. I felt that little tingle in the back of my throat and knew right away what it was: the common cold.

For a stem-cell-transplant patient, though, a cold is anything but common. Quoth the International Myeloma Foundation: “Even a minor infection...can lead to serious problems because the body’s immune system is so weakened by the effects of the high-dose chemotherapy and the loss of blood cells.”

Translation: I could die. Continue reading »

Monday, March 24, 2008

A Bone Marrow Disease With a Brighter Prognosis

(HealthDay News) -- Blood is life. And the rare disease known as aplastic anemia robs the body of life by robbing the body of blood.

The aplastic anemia patient's blood thins as the bone marrow slows its production of blood cells. The results can range from chronic fatigue to heart disease or from endless infections to cuts that won't clot, depending on the type of blood cells that are lacking.

But there's hope: Considered fatal as recently as two decades ago, aplastic anemia is becoming a far more manageable disease. Advances in drug therapies and improvements in the field of transplantation have slashed the death toll, allowing patients to live longer, fuller lives.

"We are getting better at treating aplastic anemia, either in getting rid of it or treating its symptoms," said Dr. Jaroslaw P. Maciejewski, with the Cleveland Clinic's Department of Hematologic Oncology and Blood Disorders.

And those advances are helping doctors gain greater insights into other, more prevalent, health conditions, such as heart disease and leukemia.

An estimated 50,000 people develop aplastic anemia in the United States each year, according to the U.S. National Institutes of Health. (A related blood disorder, myelodysplastic syndrome, or MDS, occurs when the bone marrow begins to produce poorly functioning or immature blood cells. About 20,000 to 30,000 new cases of MDS occur each year.)

It's important to note that many symptoms of aplastic anemia, such as fatigue and infection, can also be caused by other diseases, said Dr. Ronald Paquette, a blood disease researcher with the University of California, Los Angeles' Jonsson Comprehensive Cancer Center.

"If everyone who was fatigued thought they had aplastic anemia, we'd be swamped," Paquette said.

Bone marrow -- the spongy material inside bones -- produces stem cells that normally develop into the three main types of blood cells -- red blood cells, white blood cells, and platelets.

"Essentially, the bone marrow is a factory of blood," Maciejewski said.

In patients with aplastic anemia, the stem cells have been damaged, slowing or stopping the production of all blood cells.

The cause of the damage to stem cells remains unknown in more than half of people with aplastic anemia. Some research has suggested that stem cell damage occurs when the immune system attacks the body's own cells by mistake, according to the National Institutes of Health.

Aplastic anemia has also been linked to exposure to toxins such as pesticides, arsenic and benzene. Some infectious diseases also can cause the disorder, including hepatitis, Epstein-Barr virus, cytomegalovirus, parvovirus B19, and HIV, as well as autoimmune diseases like lupus and rheumatoid arthritis. Finally, some genetic disorders have been linked to it.

Symptoms vary depending on the type of blood cells in shortage:

  • Too few red blood cells can mean not enough oxygen is carried to the body, according to the NIH. People who have a low red blood cell count often feel tired. Because the heart has to work harder to pump blood to get enough oxygen to the body's organs and tissues, heart disease can develop over time.
  • Too few white blood cells weaken the body's defense against infection. The patient may become ill more often, and the illness can be severe.
  • Too few platelets hamper the blood's ability to clot. Patients with a low platelet count may bruise or bleed easily, and their bleeding may be hard to stop.
  • Once aplastic anemia is detected, swift treatment is essential, Paquette said. "Because it's a rare disease, it's important to be treated at a specialized center," he said. "The most important thing is to be seen by someone with a lot of experience treating the disease early on."

For patients younger than 30, stem cell transplantation is often the preferred treatment. For those with a matched sibling donor, stem cell transplantation replaces the defective bone marrow with healthy cells, and as many as 80 percent of patients enjoy a complete recovery, according to the Aplastic Anemia & MDS International Foundation Inc.

Advances in stem cell research and anti-rejection drugs have meant that transplantations from unrelated donors also are becoming more successful, Paquette said.

One promising avenue of treatment involves transplantation using stem cells harvested from the umbilical cord of new mothers. "The cells can be cryopreserved [frozen] and saved, then given to unrelated donors," Paquette said. "It's quite encouraging."

For these patients, again, speed is of the essence. "The data show the earlier you do a transplant, the better the outcome," Paquette said.

Patients whose transplants fail, or for whom transplantation is not an option, often receive successful immunosuppressive therapy with agents like anti-thymocyte globulin and cyclosporine. Response rates typically range from 70 percent to 80 percent, according to the Aplastic Anemia & MDS International Foundation Inc.

Blood transfusions from matched donors also are used to keep blood counts high and help relieve symptoms, although they are not an effective long-term treatment.

"Whether we cure the disease or not, patients are getting better across the board," Maciejewski said. "We now can maintain life, keep these patients alive longer."

More information
To learn more, visit the Aplastic Anemia & MDS International Foundation Inc.

Tuesday, February 12, 2008

Scientists Reprogram Human Skin Cells Into Embryonic Stem Cells

(HealthDay News) -- U.S. scientists say they've reprogrammed human skin cells into ones with the same blank-slate properties as embryonic stem cells, a breakthrough that could aid in treating many diseases while sidestepping controversy.

Human embryonic stem cells have the ability to become every cell type found in the human body. Being able to create these cells en masse and without using human eggs or embryos could generate a potentially limitless source of immune-compatible cells for tissue engineering and transplantation medicine, said the scientists, from the University of California, Los Angeles.

The researchers genetically altered human skin cells using four regulator genes, according to findings published online in the Feb. 11 edition of the journal Proceedings of the National Academy of the Sciences.

The result produced cells called induced pluripotent stem cells, or iPS cells, that are almost identical to human embryonic stem cells in function and biological structure. The reprogrammed cells also expressed the same genes and could be coaxed into giving rise to the same cell types as human embryonic stem cells, the researchers said.

"Our reprogrammed human skin cells were virtually indistinguishable from human embryonic stem cells," lead author Kathrin Plath, an assistant professor of biological chemistry and a researcher with the Eli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research, said in a prepared statement. "Our findings are an important step towards manipulating differentiated human cells to generate an unlimited supply of patient specific pluripotent stem cells. We are very excited about the potential implications."

The UCLA findings confirm similar work first reported in late November by researcher Shinya Yamanaka at Kyoto University and James Thompson at the University of Wisconsin. Together, the studies demonstrate that human iPS cells can be easily created by different laboratories and are likely to mark a milestone in stem cell-based regenerative medicine, Plath said.

Reprogramming adult stem cells into embryonic stem cells has significant implications for disease treatment. A patient's skin cells, for example, could be reprogrammed into embryonic stem cells that could be prodded into becoming beta islet cells to treat diabetes, hematopoetic cells to create a new blood supply for a leukemia patient, or motor neuron cells to treat Parkinson's disease, the researchers said.

These new techniques to develop stem cells could potentially replace a controversial method to reprogram cells called somatic cell nuclear transfer (SCNT), sometimes referred to as therapeutic cloning. To date, therapeutic cloning has not been successful in humans.

"Reprogramming normal human cells into cells with identical properties to those in embryonic stem cells without SCNT may have important therapeutic ramifications and provide us with another valuable method to develop human stem cell lines," study first author William Lowry, an assistant professor of molecular, cell and developmental biology, said in a prepared statement. "It is important to remember that our research does not eliminate the need for embryo-based human embryonic stem cell research, but rather provides another avenue of worthwhile investigation."

However, top stem cell scientists worldwide stress further research comparing reprogrammed cells with stem cells derived from embryos -- considered the gold standard -- is necessary.

More information
The U.S. National Institutes of Health has more about stem cells.

Friday, December 14, 2007

Fibers in Semen Help HIV Penetrate Cells

(HealthDay News) -- In a discovery that perplexes HIV experts, an international team reports that tiny fibers commonly found in semen drastically enhance the ability of the virus to do its damage.

According to a study in the Dec. 14 issue of Cell, the fibers capture the virus and then ferry it to target cells, increasing its ability to infect someone by more than 50 times in some cases and more than 100,000 times in others.

The findings could help scientists better understand how AIDS is transmitted. But Rowena Johnston, director of research with the Foundation for AIDS Research (amfAR), noted that the value of the research is limited, because it doesn't "necessarily reflect transmission in the 'real world.' "

"This is intriguing, and it's worth further investigation," said Johnston. "But there's nothing yet that makes me have a 'Eureka' moment."

While scientists have long known about the basics of AIDS transmission, it's not clear why the virus travels more easily through some routes than others.

For example, male-to-female sexual transmission is usually more common than the other way around but not always. And it's also not clear why the virus has become so prevalent even though it has a tiny presence in blood.

In the new study, led by a German team, scientists tried to figure out if components of human semen might affect transmission of the AIDS virus.

"We were not expecting to find an enhancer and were even more surprised about the strength," study author Dr. Frank Kirchhoff, of the University Clinic of Ulm, said in a statement. "Most enhancers have maybe a two- or threefold effect, but here, the effect was amazing, more than 50-fold, and, under certain conditions, more than 100,000-fold. At first, I didn't believe it, but we ran the experiment over and over, always with the same result."

Dr. Jeffrey Laurence, a professor of medicine and director of the Laboratory for AIDS Virus Research at Weill Medical College of Cornell University, said there could be something similar at play in cervical fluid that affects transmission. "In a lot of situations in the real world, women transmit HIV quite easily...," Laurence said.

He added that many other factors affect transmission of HIV, from bodily abrasions to menstrual cycles and use of oral contraceptives.

Could this latest finding bring scientists closer to an AIDS vaccine? Laurence, who thinks a vaccine is decades off, is doubtful. Prevention, however, might be another matter.

Laurence said it might be possible to develop an "antidote" for the virus-boosting powers of semen and put it in a microbicide that people could use before sex.

More information
Learn more about the basics of AIDS from aids.org.

Tuesday, December 11, 2007

Hypertension Linked to Risk of Mild Cognitive Impairment

(HealthDay News) -- High blood pressure may be associated with increased risk for mild cognitive impairment, says a study by researchers at the Columbia University Medical Center in New York City.

Mild cognitive impairment, which causes learning and thinking difficulties, has "attracted increasing interest during the past years, particularly as a means of identifying the early stages of Alzheimer's disease as a target for treatment and prevention," the study authors wrote.

They followed 918 Medicare recipients aged 65 and older (average age 76.3) who were assessed every 18 months for an average of 4.7 years. None of the participants had mild cognitive impairment at the start of the study, but 334 of them developed the condition during the study period.

Of those, 160 developed amnestic mild cognitive impairment (which involves low scores on memory portions of neuropsychological tests), and 174 developed non-amnestic mild cognitive impairment. Hypertension was associated with an increased risk of all types of mild cognitive impairment, especially non-amnestic mild cognitive impairment, the researchers said.

The findings are published in the December issue of the Archives of Neurology.

"The mechanism by which blood pressure affects the risk of cognitive impairment or dementia remains unclear. Hypertension may cause cognitive impairment through cerebrovascular disease. Hypertension is a risk factor for subcortical white matter lesions found commonly in Alzheimer's disease. Hypertension may also contribute to a blood-brain barrier dysfunction, which has been suggested to be involved in the cause of Alzheimer's disease.

Other possible explanations for the association are shared risk factors," including the formation of cell-damaging compounds known as free radicals, the study authors wrote.

"Our findings support the hypothesis that hypertension increases the risk of incident mild cognitive impairment, especially non-amnestic mild cognitive impairment," the researchers concluded. "Preventing and treating hypertension may have an important impact in lowering the risk of cognitive impairment."

More information
The Alzheimer's Association has more about mild cognitive impairment.

Wednesday, November 21, 2007

Urine Test Results Can Point to Heart Dangers

(HealthDay News) -- Even a small amount of a protein called albumin in the urine of patients with stable coronary artery disease increases their risk of cardiovascular death, say U.S. researchers.

The findings from this study of almost 3,000 patients, age 50 and older, with stable coronary artery disease (CAD) have implications for assessing and perhaps treating patients with vascular disease.

The study was published in the current issue of the journal Circulation.

Albumin is normal and necessary in blood, but its presence in urine indicates leakage in the kidney filtration system and possible damage to cells that line the kidney's blood vessels, according to background information in the study.

"We found that virtually any degree of albuminuria, even albumin below the level we call microalbuminuria, placed a patient at significantly higher risk of cardiovascular events," lead author Dr. Scott D. Solomon, associate professor of medicine at Harvard Medical School and director of Noninvasive Cardiology at Brigham and Women's Hospital in Boston, said in a prepared statement.

He and his colleagues also found that the hypertension drug trandolapril (an ACE inhibitor) lowered albumin levels in patients' urine.

The findings of this study and previous research by the same team indicate that "we cardiologists need to pay more attention to kidney function in our patients, and we need to look at two aspects -- filtration and albuminuria," Solomon said.

"It is important for cardiologists to understand that these are not patients who will even come to dialysis or even necessarily see a nephrologist," he said. "But they do have mild kidney disease that puts them at increased risk for a cardiovascular event."

More information
The U.S. National Institute of Diabetes and Digestive and Kidney Diseases has more about protein in urine.
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Tuesday, August 28, 2007

Food for the Aging Mind

Agricultural Research
08-27-07
Originally Published:20070801.

Scientists know that certain nutrients and other key chemical compounds are essential to human brain function. Serious deficiencies in some of these, such as vitamin B12 and iron, can lead to impaired cognitive function due to neurological, or nerve fiber, complications.

Cognition can be defined as the ability to use simple-to-complex information to meet the challenges of daily living.

So, could careful attention to diet help protect the aging brain from problems with nerve cell signals involved in memory and cognition? A clear-cut answer could greatly affect the 77 million baby boomers who are now facing retirement. Their independence, quality of life, and even economic status will largely be defined by their ability to traffic information signals as they age.

In researching the nutrition-brain connection, new technologies are being used, such as those that take images of the brain or actually count individual brain cells. Behavioral tests that measure motor and cognitive skills-or lack thereof-are also providing insights. Yet the science of nutrition and brain function is relatively new and evolving.

Agricultural Research Service scientists at several locations nationwide are contributing to a growing body of research that explores the effect of diet and nutrition on the brain and its function across the lifespan.

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Boosting Neuronal Function
The brain's billions of neurons "talk" to one another through chemical neurotransmitters that convey signals through neural pathways. These chemical transporters- which include norepinephrine, serotonin, and dopamine-are key to signal movement.

Although people naturally lose brain cells throughout their lives, the process of neuronal death does not necessarily accelerate with aging. "There is a lot of individual difference," says ARS neuroscientist James Joseph. "Loss of mental agility may be less due to loss of brain cells than to the cells' failure to communicate effectively."

Joseph heads the Neuroscience Laboratory at the Jean Mayer USDA Human Nutrition Research Center on Aging (HNRCA) at Tufts University in Boston. There, researchers are looking at the beneficial effects of certain dietary plant compounds to learn how they affect brain function.

"Vitamins and minerals in plant foods provide protective antioxidants," says Joseph. "But fruits, vegetables, nuts, seeds, and grains contain thousands of other types of compounds that contribute significantly to the overall dietary intake of antioxidants.

"A partial measure of the antioxidant effect is called 'ORAC,' for Oxygen Radical Absorbance Capacity. ORAC scores are now showing up in charts and on some food and beverage packages. They may be helpful in choosing foods to include in your diet."

Perhaps there is no better place in which to gauge the power of antioxidants than between the minute connections of the nerve cells.

Bucking Long-Held Dogma
Eight years ago, Joseph and colleagues began publishing a series of studies, done in rodents, that shed light on the relationship between various diets and the mechanisms behind cognitive losses in specific neighborhoods of the aging brain.

Many in the series are groundbreaking in that they challenge the long-accepted belief that the central nervous system, which includes the brain, is not capable of regenerating itself. Other published studies in the series echo similar findings based on primate and human brain research at the Salk Institute for Biological Studies, San Diego, California. Scientists there, using new technologies, disputed the notion that the brain does not make new neurons-a process called "neurogenesis"-into old age: It does, but at a much slower rate.

One of the first of Joseph's studies, published in the Journal of Neuroscience, showed a protective effect of consuming antioxidants. Study rats were fed-from adulthood to middle age-vitamin E, strawberry extracts, or spinach extracts, all with similar ORAC values. Animals receiving the high-antioxidant diets did not experience the age-related cognitive performance losses seen in control rats fed standard chow.

A later study, also published in the Journal of Neuroscience, showed a reversal of functional loss among rats on special diets. Each of three groups of rats, equivalent in age to 63-year-old humans, was fed a different high-antioxidant extract. A control group was fed standard chow.

After 8 weeks-equivalent to about 10 years in humans-the rats' performance levels were measured.

The rats fed the spinach, strawberry, or blueberry extracts effectively reversed age-related deficits in neuronal and cognitive function. In addition, the blueberryfed group far outperformed their peers while traversing a rotating rod to test balance and coordination.

"Despite their status as 'senior citizens,' those rats showed remarkable stamina on neuromotor function tests," says psychologist and coauthor Barbara Shukitt-Hale, also with the Neuroscience Laboratory.

Examination of the brain tissue of those blueberry-fed rats showed much higher levels of dopamine than were found in the other groups. Dopamine has many functions within the brain. In particular, it can affect the way the brain controls movements.

"We suspected that the combined antioxidant potency of compounds in blueberry extract may have reduced inflammatory compounds in the brains of these older animals," says Joseph.

"Inflammation ordinarily contributes to neuronal and behavioral shortfalls during aging."
Tests have since shown that blueberry compounds cross the blood-brain barrier and localize in rodent brain tissue.

Hard News: Brain Plaques
Later, the lab's researchers published an Alzheimer's disease model study in Nutritional Neuroscience. They studied mice that carried a genetic mutation for promoting increased amounts of amyloid beta, a protein fragment found within the telltale neuritic plaque, or "hardening of the brain," seen in Alzheimer's disease.

Although the exact cause of Alzheimer's is not completely understood, experts have recently identified one mechanism involving the insufficient breakdown and recycling of amyloid protein in the brain. That mechanism is both genetic and physiological. In those individuals, normally harmless amyloid protein turns into fragments of amyloid beta, which build up as plaque in the brain rather than being escorted into cellular recycling. That action leads to cell death and weakened neuronal communication.

In the mouse study, beginning at age 4 months-early adulthood-half the brainplaqued group was fed a diet that included blueberry extract for 8 months. The other half was fed standard rat chow and so was a control group of mice that didn't carry the amyloid-plaque mutation.

At 12 months-early middle age-all groups were tested for their performance in a maze.

The brain-plaqued mice that were fed the blueberry extract performed as well as the healthy control mice and performed much better than their brain-plaqued peers fed standard chow.

A look at the plaqued brains of both the blueberry-fed and chow-fed mice after death revealed no difference in the number of brain plaques in either group. "Amyloid-beta-induced plaques are only one aspect of Alzheimer's disease," says Joseph. "But the fact that we saw a dietinduced behavioral difference, despite a similarity in plaque density in both these animal groups, is significant."

The team found increased activity of a family of enzymes called "kinases" in the brains of the amyloid-plaqued mice that were fed blueberry extract. Two kinases found in particular, ERK and PKC, are important in mediating cognitive function, such as converting short-term memory to long-term.

"These kinase molecules are involved in signaling pathways for learning and memory," says Joseph. "It could be that the increased kinase activity within the plaque-ridden brains of the blueberry-fed mice enhanced the signaling in certain receptors."

Brain Cells Are Born
Another HNRCA rat study looked at the aged brain's ability to change physiologically- a condition scientists refer to as "neuronal plasticity." In addition to cell division and differentiation, or "mission assignment," brain tissue undergoes many other changes throughout aging.

For example, a newborn sprouts billions of nerve cells while soaking up information from the environment. But lower levels of synapse growth continue in waves throughout the lifespan.

Littleused synapses are eliminated, while others are strengthened in a neuronal pruning process, of sorts.

Repair mechanisms involve neural immune cells, called "microglia," that seek to heal and protect injured brain tissue; enzymes that regulate safe chemical levels; and genes that are expressed in response to inflammation.

The neuronal-plasticity study investigated the physiological link between nutrition and the memory-control hippocampal area of the aged brain. That region, in the center of the brain, is essential for what's called "working" or "short-term" memory. It receives and processes data, and then, if needed, passes it on for storage.

Neurogenesis also plays a role in the formation of new memories. The capacity of the hippocampus to produce new neurons is thought to be greatly diminished during aging. But this study suggested that old rats fed blueberry extracts for a short time had increased neurogenesis in the dentate gyrus area of their brain's hippocampus. The dentate gyrus is one of the few regions of the brain where neurogenesis occurs.

"We found changes in the proliferation of neurons in blueberry-fed rats," said Gemma Casadesus, formerly a graduate student with the Neuroscience Laboratory and now with Case Western Reserve University. In maze tests, blueberry-fed aged lab rats showed improvement in cognition over chow-fed peers. "There was an association between the proliferation of neuronal precursor cells and better performance of spatial memory," she says.

The researchers don't yet know whether the cognitive improvements seen in the aged blueberry-fed rats translate to humans. "But it's an important step in learning about the brain's ability to rescue itself from age-associated declines in physiological function," Casadesus says.

Can You Hear Me Now?
Neurons that can't get their messages through signaling pathways are like cell phones that can't get their signals through to other cell phones. Why does this happen?

As the brain matures, cell division becomes largely restricted to specific regions of the brain, and brain cells tend to become more vulnerable to two partners in crime: oxidative stress and inflammation.

In the body, free radicals-weakened atoms formed during activities of daily living-are missing an electron and want to bond with neighboring biomolecules to stabilize. The problem is that unless neutralized, free radicals cause cellular damage known as "oxidative stress."

Cellular antioxidant defense systems counterbalance these rogue molecules, but they're not 100 percent effective-particularly as the body and brain mature. And the brain is thought to be especially vulnerable to oxidative stress.

"Weighing just 3 pounds, the brain accounts for only 2 percent of the body's total mass, yet it uses up to half of the body's total oxygen consumed during mental activity," says Joseph.

"Phytochemicals, together with essential nutrients in foods, provide a health-benefits cocktail of sorts. It is feasible that continued research in this area will point to dietary regimens that are effective in boosting neuronal function."

Inflammation is thought to be stoked by the overactivation of microglia-the neural immune cells mentioned earlier.

Microglia are usually dormant, but they migrate to the site of any brain injury. These sentries make up about 20 percent of the cell population in certain regions of the brain.

While seeking to protect and repair tissue, microglia cells produce and send out molecular stress signals, some by way of defensive cytokines, as a bugle call to other cells. Those signals begin a cascade of reactions, including the activation of genes that express proteins and other stress chemicals to help clear away cellular debris.

Microglial activation by amyloid beta is thought to be a key event in the progression of Alzheimer's disease. "When microglia are stuck in an always-on loop in response to plaque buildup in the brain, they become problematic in and of themselves," says Joseph.

This year, Francis Lau, a molecular biologist in the Neuroscience Laboratory, published a study that investigated whether blueberry extracts could have a preventive effect on inflammatory signals coming from activated microglia cells.

Microglial activation is considered the hallmark of inflammation in the central nervous system. For this study, Lau used a rodent microglial cell line that has previously served as a model to study plaqueinduced microglial activation.

Lau exposed groups of those test cells to various levels of blueberry extracts. He then challenged the cells with oxidative stress by exposing them to a toxin-lipopolysaccharide- that triggers secretion of inflammatory chemicals.

Neuroinflammation has been linked to the expression of genes that spew two inflammatory enzymes, iNOS and COX-2, and two cytokines, IL-1b and TNF-a.

Lau used real-time PCR (polymerase chain reaction) to find and measure expression of genes that produce iNOS and COX-2 in the stress-induced cell cultures. He found that the blueberry treatment significantly reduced that expression.

The blueberry extract also markedly lessened secretion of the two inflammatory cytokines. In fact, says Lau, "In cells exposed to the highest blueberry extract concentration, the amount of TNF-a cytokine found was next to nothing- essentially identical to that found in the control cells."

Looking to the Future
The food industry is now using a range of new and existing product ingredients to gain entrance into the emerging brainhealth market. Some are producing food labels that list ORAC values-for example, for use on containers of polyphenol-rich fruit juices and teas. So far, however, there has been no review conducted by the U.S. Food and Drug Administration on health benefits from eating berries.

Future studies at HNRCA will ideally include use of new diagnostic tools as well as human clinical trials. Neuroimaging equipment, for example, could be used to monitor the influence of various dietary factors on development of plaque within the human brain. Such studies aim to find the best dietary regimens to help adults preserve their mental capabilities while aging.-By Rosalie Marion Bliss, ARS.

This research is part of Human Nutrition, an ARS national program (#107) described on the World Wide Web at www. nps.ars.usda.gov.

James A. Joseph is with the USDA-ARS Human Nutrition Research Center on Aging at Tufts University, 711 Washington St., Boston, MA 02111; phone (617) 556-3178, fax (617) 556-3222, e-mail jim.joseph@ ars.usda.gov.

Friday, June 08, 2007

New Biomarkers Classify Outcomes of Non-Small Cell Lung Cancers

(HealthDay News) -- New algorithms that use mass spectrometry techniques to classify outcomes of non-small cell lung cancer (NSCLC) patients are outlined in two studies in the June 6 issue of the Journal of the National Cancer Institute.

Currently, doctors do not have adequate methods for determining the prognosis of NSCLC patients or for identifying which patients will benefit from certain treatment options. These new algorithms could prove helpful in both areas, according to background information in a news release about the studies.

In one study, a team of international researchers developed an algorithm to predict the outcomes of NSCLC patients treated with two tyrosine kinase inhibitors -- gefitinib and erlotinib. The algorithm is based on the pattern of a group of proteins in a patient's blood serum.
A test of the algorithm showed that patients predicted to have a good survival outcome after treatment survived for a median of 306 days, while patients predicted to have a poor outcomes survived for a median of 107 days.

"In the clinical development of biomarkers for the individualization of therapy, it is important to distinguish between those that can accurately classify patients according to whether they will benefit from an intervention and those that simply portend a favorable or unfavorable prognosis, independent of the planned intervention. Biomarkers predictive for survival benefit from an intervention are much more useful for guiding management," the study authors wrote.

In the second study, Japanese researchers collected and analyzed protein patterns in NSCLC tumor tissue and normal lung tissue. They identified a pattern that was associated with increased survival among NSCLC patients and which may help differentiate patients with a good prognosis and a poor prognosis.

"Consequently, use of the (protein) signature to identify high-risk patients could reduce rates of both over-treatment and under-treatment and improve survival for NSCLC patients," the study authors wrote.

More information
The American Cancer Society has more about non-small cell lung cancer.

Friday, February 02, 2007

The Cardiovascular Cure: How to Strengthen Your Self-Defense Against Heart Attack and Stroke - Book Review

BY JOHN P. COOKE, M.D., PH.D., AND JUDITH ZIMMER; B
ROADWAY BOOKS; $25

SOME MAINSTREAM DOCTORS are bucking the system and suggesting that surgery or drugs may not be the best treatment for stroke, heart disease, and atherosclerosis (hardening of the arteries). One of these doctors, John P. Cooke, M.D., Ph.D., director of the vascular medicine section at Stanford University Medical School in Palo Alto, Calif., has written a book to help us trigger our body's remarkable capacity to heal itself.

Cooke and co-author medical journalist Judith Zimmer explain that a healthy endothelium, the innermost single-cell-thick lining of human blood vessels, releases a substance that packs benefits galore. Called nitric oxide (NO), this substance keeps blood vessels supple, prevents platelets from snagging on vessel walls, hinders the buildup of plaque, and even helps to reduce existing plaque deposits. Cooke says people with heart disease or the risk factors for it have elevated levels of an amino acid that impedes NO production.

To ensure that your endothelium pumps out plenty of NO, Cooke recommends a modified Mediterranean-style diet supplying 1,800 calories a day. The evidence-based diet features whole grains, beans, nuts, legumes, fruits, and vegetables, and emphasizes foods rich in L-arginine, an amino acid used by the endothelium to make NO. His book includes a two-week eating plan with recipes, and detailed information on supplemental nutrients and phytochemicals.

The other component of Cooke's simple plan is aerobic exercise, which increases blood flow through your vessels. Increased blood flow stimulates the production of NO and keeps the endothelium smooth so plaque accumulation is less likely. He advocates at least 30 minutes of aerobic exercise four days a week.
This book manages to be both comprehensive and lively. Cooke presents just the right amount of detail about the scientific underpinnings of his conclusions, which are based on a Nobel-prize-winning theory. He claims you will have vascular improvement in just two weeks--and I believe him.
COPYRIGHT 2002 Weider Publications
COPYRIGHT 2002 Gale Group

Monday, January 29, 2007

Researching Alternatives: A Talk With Donald Abrams

By Bob Huff
June 2003
You have a reputation as being a rigorous clinical researcher and tough advocate for making evidence-based treatment decisions.

Yet you've also been very open to studying a number of alternative and complementary therapies that have been used in the HIV patient community. How did all these concerns come together and what are you involved with these days?

I was training in oncology at UC San Francisco just as the first AIDS cases were reported. I helped found the AIDS program there and I've been participating in academic clinical research for over 20 years. More recently I've become an associate fellow of the Program in Integrative Medicine at the University of Arizona that was founded by Andrew Weil.

This is a two-year program, mostly online, that is increasing my training and background in integrative medicine, including things like botanical medicine, manual medicine, and spirituality. It's been a stimulating experience so far and I'm really enjoying it.

I've been interested in complementary medicine since the very beginning of my career, so one of the reasons I'm doing the fellowship is to learn more that I can integrate into my own healthcare discussions with my patients. Of course another impetus is to see what other things we might want to do clinical research on.

My intention is to continue to investigate the complementary and alternative approaches that our patients are using. We want to determine whether or not they may be beneficial, but also determine whether or not they may be harmful, particularly in how they interact with the conventional medications that patients are taking.

In the earliest days of AIDS we didn't have any treatment for this new disease; people were dying and everybody was frightened. Being here in San Francisco, we were near the Linus Pauling Research Institute in Palo Alto, so there were a number of people in the city who were proponents of high doses of Vitamin C.

One of the first responses we saw in the early '80s were storefront clinics opening up where people went to receive intravenous injections of very high doses of Vitamin C.

At that point in time we didn't even know that it was a virus causing the disease. So I used to go around on the lecture circuit with someone who would talk to audiences of concerned people who listened to him while hooked up to intravenous infusions of Vitamin C.

Then I would speak as the academician who cautioned people that we really don't know if this is beneficial and there may be some dangers to being hooked up to intravenous vitamin C, and so on. Ultimately, this led to me to write a grant proposal in collaboration with the Linus Pauling Institute.

It was right about the time we learned that HIV was the cause of AIDS so we wrote a proposal to the NIH to study the in vitro effects of Vitamin C on HIV. That grant didn't get funded.

In San Francisco at that time there were also a number of DNCB proponents. DNCB, dinitroclorobenzene, is actually a photographic chemical used for developing pictures, but it is also a skin sensitizer that had been used to test for delayed hypersensitivity reactions.

There were people who believed that somehow it might be useful in restoring some of the T-cell immunity that patients with this new disease were lacking. So there were people who would paint themselves weekly or so with DNCB until they developed these skin reactions, thinking that the skin reaction was some sort of improved T-cell immune response that would help combat the virus.

And again, seeing that people were using this and seeing that we really didn't have much else happening, I worked with some of the DNCB proponents, as well as some experts from the University of California -- I remember Jay Levy was involved, as was Marcus Conant and others -- and we wrote a protocol that we submitted to the FDA for funding. That also was rejected.

Around the time that AZT first became available in 1986, I went to a conference in Japan where I was introduced to some investigators from the Ueno Fine Chemicals company who told me that they had the cure for this disease. They said it was something that was very commonly used in Japan but they couldn't tell me about it until I signed a confidentiality agreement.

That turned out to be dextran sulfate. Not long after I was going through the process of filing the paperwork to get approval from the FDA to do a phase I study of dextran sulfate in the United States when evidently some people heard about it.

They realized that it was a product that was widely available in Japan -- I believe it was used for lowering cholesterol -- so they started an importation scheme similar to what had happened in earlier days with isoprinosine and ribavirin, which were brought across the Mexican border.

But people had now become more sophisticated in their methods and began to import dextran sulfate from Japan to sell in the underground AIDS therapy market.

I remember that activists stormed the offices of a Japanese drug distributor in New York for refusing to make dextran sulfate more widely available. Ultimately it became such a political issue that, even though my clinical trial here in San Francisco didn't show much benefit, Congress got involved and the AIDS Clinical Trial Group (ACTG) was asked to do a study of dextran sulfate through the NIH-funded mechanism. It turned out the drug was not even absorbed into the blood.

Another Japanese product I worked with was lentinin, which was an intravenously administered extract of shiitake mushroom. In Japan it was felt to be an immune booster for patients with cancer. Although it was being used by mainstream doctors in Japan, it was an alternative therapy here because it was not something that we had ever learned about or used in hospitals in the U.S. That's David Eisenberg's description of what an alternative therapy is -- that it's not taught about in medical schools or widely available in U.S. hospitals -- and certainly shiitake mushroom extracts qualified. Again, that's another study we did that had negative findings;

there was no benefit to the intravenous infusions of lentinin. Since I've learned more about botanicals, it would seem to me that if there were immune enhancing benefits to shiitake mushrooms then they are more likely to be obtained by eating them rather than by injecting an extract intravenously.

During that time I was also involved with studies of conventional therapies. Even in the days of early AZT monotherapy, which I was not a big supporter of, I was involved in trying to put some evidence behind the claims of the proponents for these various agents. And since that time, I've had a constant history of investigating conventional therapies through the federally-funded CPCRA (Community Programs for Clinical Research on AIDS), and more recently through the ESPRIT study of interleukin 2, as well as in other, sometimes pharmaceutical industry-sponsored trials. But always ongoing with those studies, I've been involved with clinical trials of complementary and alternative interventions.

When we first became aware of immune thrombocytopenic purpora (ITP) in AIDS, I worked with a nurse who was very interested in therapeutic touch and we studied men with low platelet counts to see if therapeutic touch could decrease their stress and increase their platelet counts. That was another study that turned out to be fairly negative.

I then became interested in traditional Chinese medicine (TCM) and, in fact, one of the colleges of TCM here in San Francisco sent me to China in 1989 just to learn about Qigong (Chi Kung) -- that exercise that's felt to improve the immune system -- to see if it was something that I wanted to study here. Although I never studied Qigong I collaborated with Misha Cohen from the Quan Yin Healing Arts Center here in San Francisco. We did three studies of traditional Chinese herbal interventions for, first, symptomatic HIV, then for patients with diarrhea without a pathogenic source, and then another study for patients with anemia.

The last two were hindered by the fact of being initiated about the time that HAART became available, so patients with diarrhea as well as anemia became scarce. There were also a lot of pills that needed to be taken in these Chinese herbal investigations and patients at that time were taking huge amounts of pills with their antiretroviral regimens, so the studies weren't very attractive. None of these studies had spectacular results and the anemia study was terminated for poor enrollment.

Have "soft endpoints" such as life satisfaction created a problem for designing and conducting credible studies?

The TCM herbal study that we published in 1996 investigated herbs versus placebo in symptomatic HIV infection. At the time of the study in 1993, we had patients with about 14 symptoms on average and we found that there was a significant decrease of symptoms in the herb-treated group -- they decreased from 14 to 12 -- whereas the other group still had 14 symptoms. We also found that they had improved "life satisfaction" which improved by a factor of +0.86 or thereabouts.

Yet, if you look at the rest of the results, the Chinese herbal patients actually lost weight over 12 weeks compared to the placebo group, and their CD4 counts also dropped -- not statistically significant, but it was a trend. So that was an example of where their symptoms improved and their life satisfaction increased, but the parameters that we would normally look at to see if a patient is doing well (i.e., weight and CD4 count) went in the wrong direction. So, although I was also first author on a study that showed that epoetin alfa improves quality of life in HIV patients who are anemic, I'd have to say that a study whose main endpoint is quality of life is something I would find difficult to interpret.

The CPCRA actually did a large study of acupuncture for patients with HIV-related peripheral neuropathy that was published in JAMA. That was a landmark, having the NIH support an acupuncture study, although, again, it turned out to have negative results; acupuncture didn't appear to be effective in treating peripheral neuropathy.

About this time I began trying to study another botanical, which has consumed my efforts for the past decade, and that would be cannabis, or marijuana. Starting in 1992 I began proposing and developing clinical trials to investigate first the effectiveness -- but then I realized that that wasn't going to happen -- so subsequently, the safety of smoked marijuana in patients with HIV.

We finally completed a study in the year 2000, that we hope will soon be published, that looked at the safety of marijuana in patients taking protease inhibitor regimens. And since that time we have obtained funding from the State of California that allows us now to conduct clinical trials to look at the potential effectiveness of smoked marijuana in patients with various syndromes. We have also just completed a pilot study in patients with HIV peripheral neuropathy, which allowed us to ascertain that there was some effectiveness of marijuana. But an open-label pilot study is not going to prove that, so we're now in the process of continuing on with a randomized, placebo controlled, double-blind trial in patients with HIV-related peripheral neuropathy. We're also doing marijuana studies in patients with cancer who have pain who are on opioid analgesics, and another study to look at the effect of smoked marijuana in patients who have delayed nausea and vomiting from breast cancer chemotherapy.

It was working with marijuana and all the problems that are inherent in studying a plant as a therapy that has led me to a broader interest in botanicals and the use of substances that come from nature as medicinal agents. Certainly, for thousands of years, people have depended primarily on these things. Whether or not they worked is unclear, but as an oncologist I know that many of my most potent chemotherapeutic agents were derived from plants. So right now we are waiting to hear if a protocol we submitted to the National Center for Complementary and Alternative Medicine (NCCAM) to investigate the lipid lowering effects of oyster mushrooms in patients on Kaletra is being funded. There's good evidence that mushrooms, including oyster mushrooms in particular, have some activity for lowering blood lipids and cholesterol.

We're also just finishing a three-year NCCAM grant studying the effects of DHEA, dehydroepiandrosterone, which is an over-the-counter adrenal steroid that people are taking for many reasons. We received a grant to investigate it as an antiviral and to see what impact it has on the immune system. Hopefully that data will be available by the end of the year and we will know if DHEA had any impact, positively or negatively, in our patients.

The goal, ultimately, would be to submit a center grant to the NCCAM, to allow us to establish a center here for the study of botanicals in HIV because there are still a number of herbal preparations and mushroom extracts that warrant further investigation for their potential benefit -- and to make sure that they're not harmful in our patients.

Safety keeps coming up again and again as one of the inarguable justifications for doing this research.

There's not a huge amount that we know about some of these botanical products and how they're metabolized, but there's probably more than people think. There are a number of textbooks available that talk about herb-drug interactions. That was the question in our marijuana study: is there an interaction between cannabinoids and protease inhibitors, which are both metabolized by cytochrome P450 enzymes in the liver, that may alter the activity of the protease inhibitors such that patients lose their viral suppression when they mix cannabis with their treatments?

And in fact, in our article that was already published in AIDS, we saw no such effect. We've all heard about garlic and St. John's Wort and their interactions, and I think there are many other agents that we would like to study to make sure that they are not having significant interactions with protease inhibitors. We don't want people to either lose control of their viremia (through underdosing) or experience toxicity (through overdosing) because of antiretroviral concentrations that have been affected by herb-drug interactions.

You had to be enormously persistent to accomplish your marijuana study. In the current political climate, is it going to be more difficult to do marijuana studies?

I think we're blessed to live in the State of California, which is somewhat of a freestanding republic in and of itself. In 1996, the people of California voted to allow physicians to talk to their patients about the medicinal use of cannabis. Then, through the work of Senator John Vasconcellos, one of our state senators, appropriations were made to the University of California that established the Center for Medicinal Cannabis Research (http://www.cmcr.ucsd.edu/). And that Center has had funds for the past three years that allows it to support clinical trials to investigate the use of marijuana for medicinal purposes.

Whereas the NIH and NIDA, via their congressional mandate, could only give marijuana to clinical trials that show that it was harmful (they are the National Institute on Drug Abuse, not for Drug Abuse, as NIDA's director Alan Leshner always reminded me), they were not really able to provide us with marijuana to study the benefits. But now, they have modified their system so they can provide marijuana for peer reviewed clinical trials that will look at its effectiveness as a therapeutic agent -- as long as they are not funding it. So they have now created this ability for us to obtain government marijuana.

Is there a need to increase provider knowledge about these issues?

I think a part of the problem is a lack of communication from both sides. Patients don't really perceive that these substances are something that they need to tell their doctor about -- in fact many studies show they don't want to tell their doctor because they're afraid they're going to be reprimanded or told that they're wasting their money. And many physicians never even think about asking about these things as potential confounders or as things that are causing clinical symptoms.

There also may be a variable of where in the country you are. I know many surveys show that we in the West have the highest percentage of people in the population who are using complementary and alternative interventions. So many of my colleagues here might be more familiar with how to ask the question and what to be looking for.

I remember once seeing a patient at our drop-in clinic who clearly had a drug rash. I looked through his chart -- this was when we had paper charts -- and he had a high CD4 count and a low viral load but he wasn't taking any medications.

So I said to the guy, "You're not taking any medications, huh?" And he said, "No."
"Are you taking any vitamins?" And he said, "Yeah."

So I asked him what he took and he listed about four or five vitamin preparations. Then I asked, "Do you take any herbs?" And he said, "Sure."

And so I listed the three or four herbal substances th
at he took.
"Do you take any minerals?" And he said, "Yeah."
By the time I finished I had a list of 12 different things he was taking.
So I asked, "Well, how come everybody else wrote down that you don't take anything?" And he said, "Well, nobody ever asked me before."


more info at:
http://www.dreddyclinic.com/integrated_med/integrated_med.htm

Wednesday, January 10, 2007

Hypnosis Eases Breast Cancer Biopsy Pain

(HealthDay News) -- Tea extracts can help reduce skin damage caused by cancer radiation therapy, according to a study by American and German researchers.

They examined the effects of green tea and black tea extracts and found that they reduced the duration of radiation-induced skin damage by five to 10 days. The tea extracts work at the cellular level to inhibit inflammatory pathways and reduce inflammation, said the team from the University of California, Los Angeles, and the University of Freiburg.

As well as testing the extracts on patients, the researchers studied the effects of green and black tea extracts on human and mouse white blood cells in laboratory cell cultures.

They found that the extracts reduced the release of pro-inflammatory cytokines, such as IL-1beta, IL-6, IL-8, TNF-alpha and PGE2, in human white blood cells. Green tea extract appeared to have higher anti-inflammatory properties than black tea extract.

Both green and black tea extracts inhibited one major inflammatory pathway in mouse white blood cells.

The researchers said that the high amount of polyphenols in tea is likely responsible for its anti-inflammatory activity, but added that other pathways are likely involved in its clinical effectiveness.

The study is published in the journal BMC Medicine.

More information
The American Cancer Society has more about the effects of radiation therapy.

Sunday, December 17, 2006

HIV-Infected Intestinal Immune Cells Never Rebound

(HealthDay News) -- Within a few weeks of being infected by HIV, most of a person's memory T-cells vanish and are not likely to return even after years of antiretroviral treatment, a new study finds.

Previous research has shown that HIV infection depletes memory T-cells -- which are mostly found in the intestinal tract -- within days. In contrast, T-cells circulating in the blood typically decline over several years, according to background information in the article.

It's known that T-cells in the blood can return to normal levels when HIV patients take antiviral drugs. But it wasn't clear whether intestinal memory T -cell levels returned to normal.

In this study, researchers at the Aaron Diamond AIDS Research Center in New York City and elsewhere performed intestinal biopsies on HIV patients who had started treatment shortly after they were infected.

Reporting in the journal PLoS Medicine, the researchers found that intestinal T-cell levels remained low in 70 percent of patients even after several years of HIV treatment.
The findings indicate the doctors treating HIV patients need to watch for infections or other gastrointestinal problems that could result from prolonged impairment of intestinal immune function, the researchers said.

The study results also suggest the need to conduct studies on treatments to preserve immune function in people newly infected with HIV.

More information
The U.S. National Center for HIV, STD and TB Prevention offers advice about living with HIV/AIDS.

Penicilliosis and HIV

HIV InSite Knowledge Base ChapterMarch 2006
Woraphot Tantisiriwat, MD, Srinakharinwirot University, Bangkok, Thailand Judith A. Aberg, MD, New York University, New York

Introduction

Penicilliosis is an infection caused by Penicillium marneffei, a dimorphic fungus endemic to Southeast Asia and the southern part of China.(1) Rarely noted before the AIDS epidemic, P marneffei infections have become more prevalent in the endemic areas in conjunction with the AIDS epidemic.(2,3)

Persons affected by penicilliosis usually have AIDS with low CD4 lymphocyte counts, typically <100 href="javascript:openWindow(" page="kb-05-02-07&rf=2,4','References')">2,4) Patients with penicilliosis occasionally are seen outside endemic areas, but most have a history of travel to an endemic area.(5-8)

The most common presentation is a disseminated infection manifested by fever, skin lesions, anemia, generalized lymphadenopathy, and hepatomegaly.(2) Localized infection such as pneumonia also has been reported.(7)

Patients with penicilliosis have a poor prognosis without treatment.(2) P marneffei demonstrates in vitro susceptibility to multiple antifungal agents including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9)

Response rates of up to 97% have been reported with amphotericin B therapy for the first 2 weeks followed by 10 weeks of itraconazole.(4) Relapse occurs in the absence of prophylaxis in approximately 50% of patients after discontinuation of successful therapy.(10,11) Maintenance therapy with itraconazole is effective for prevention of relapse.(11)

Microbiology and Epidemiology

P marneffei appears in tissue as a unicellular yeastlike organism that reproduces by planate division.(12) The fungus is a mold at room temperature and it coverts to the yeast form if incubated at 37° C. This dimorphism is not found in other known members of the genus Penicillium.

In the mycelial form on culture, the mold grows relatively fast, producing a grayish-white and downy or woolly colony in 2-3 days. The underside of the fungus appears either pink or red due to the production of a characteristic soluble red pigment that diffuses into the agar. Over time, the colony becomes more rugose while the aerial mycelia become pink.

The color of the colony changes from white to light brown to light green after 10 days. The yeastlike cells are oval or cylindrical and are about 3-6 microns in length. Unlike the mold, the colonies of yeast do not produce a red pigment. The organism can be cultured from various clinical specimens including blood, bone marrow, skin, sputum, bronchoalveolar lavage fluid, and lymph nodes.

P marneffei is endemic to Southeast Asia and the southern part of China, where it has been isolated from 4 species of bamboo rats and from soil.(1,13,14)

Infection seems to be more frequent in the rainy season.(15) Recent history of occupational or other exposure to a potential environmental reservoir of organisms in the soil has been shown to be the predominant risk factor for infection in susceptible persons.(16)

Infection rarely was documented before the AIDS epidemic. The first report of natural infection with P marneffei was in a person with Hodgkin lymphoma who had lived in Southeast Asia.(17) Only 8 cases of infection with P marneffei were reported between 1964 and 1983.(18)

The prevalence of infection has increased substantially, especially in persons who are infected with HIV.(2) There were 92 cases diagnosed from 1987 to 1992 in Chiang Mai University Hospital, involving 86 patients who also were infected with HIV.

Currently, this infection is the third most common opportunistic pathogen in patients with AIDS in Thailand, after tuberculosis and cryptococcosis, despite the fact that it is endemic only to the northern part of Thailand.(3)

Infections with P marneffei occasionally are seen outside the endemic area. Sporadic cases have been reported, all of which involved patients with a history connected to the endemic area.(5-8) The diagnosis should be considered in HIV-infected patients with fever, compatible clinical manifestations, and a history of travel to an endemic area.

Clinical Presentation
The clinical features of infection with P marneffei are shown in Table 1.(2) The most common presentation is fever and weight loss, occurring in more than 75% of patients. The average duration of symptoms prior to presentation is 4 weeks.(1,2)

Other common manifestations include skin lesions, anemia, lymphadenopathy, and hepatomegaly with or without splenomegaly. Skin lesions are present in approximately two thirds of cases and can be varied in appearance. Generalized papular eruptions, central umbilicated papules resembling those of molluscum contagiosum, acnelike lesions and folliculitis all may occur. Skin lesions commonly occur on the face, trunk, and extremities.

Pharyngeal and palatal lesions also can be seen.(19) Subcutaneous nodules occasionally can be seen.(2) Pulmonary symptoms (such as cough and dyspnea) occur in about 50% of cases. Chest radiographic abnormalities typically manifest as diffuse reticulonodular infiltrates, though 50% of cases have normal chest radiographs.

Cavitary lesions also have been reported, particularly in patients with hemoptysis.(20) Laboratory findings include anemia, elevated transaminases (alanine and aspartate aminotransferase), and elevated alkaline phosphatase levels. Fungemia is observed in >50% of cases.

Diagnosis
Diagnosis usually is made by identification of fungi from clinical specimens. Biopsies of skin lesions, lymph nodes, and bone marrow demonstrate the presence of organisms on histopathology.(2) The fungi are spherical or oval in shape with basophilic intracellular or extracellular yeastlike appearance on Wright stain, often with clear central septation.

The organism also can be identified on peripheral blood smear or bone marrow aspirate.(21) Blood cultures are positive frequently, while bone marrow culture is positive in nearly all cases.(2) The lysis centrifugation culture system may improve the yield of blood cultures.

Histopathologic features include granulomatous, suppurative, or necrotizing inflammation.(22) Immunologic techniques to identify organisms on tissue samples are under evaluation with promising results.(23-30)

A specific polymerase chain reaction (PCR) assay is under evaluation and might be useful as an alternative test for rapid diagnosis of P marneffei infection.(31-32)

Therapy and Prevention

Patients with penicilliosis have poor prognosis without treatment.(2) Even with treatment, mortality is approximately 20%. Treatment with amphotericin B with or without flucytosine, or itraconazole, is the treatment of choice.(10,33)

P marneffei demonstrates in vitro susceptibility to many of the currently available antifungal agents, including ketoconazole, itraconazole, miconazole, flucytosine, and amphotericin B.(9,34) Fluconazole appears to be less active in vitro.(9)

Clinical failure is more common in treatment with fluconazole (63.8%) compared with amphotericin B (22.8%) or itraconazole (25%).(9) Newer azoles (posaconazole, ravuconazole, and voriconazole) have demonstrated good in vitro activity against P marneffei.(35)
There are no randomized, controlled trials of the treatment of penicilliosis.

One open-label study of amphotericin B 0.6 mg/kg/day intravenously for 2 weeks followed by 10 weeks of itraconazole 400 mg/day showed excellent results.(4) This regimen was effective in 97% of 74 HIV-infected patients treated. All patients had cleared fungemia by the end of their second week of treatment. Patients tolerated the regimen without any major adverse reactions.

After completing initial treatment, patients with P marneffei infection should receive secondary prophylaxis to prevent relapse of infection. A randomized controlled trial demonstrated that secondary prophylaxis with itraconazole 200 mg daily is effective.(11)

None of the patients receiving itraconazole had a relapse, whereas 57% of those in the placebo group had a relapse within 1 year after completing initial treatment. Although this study was not powered to detect a survival difference, 15% of the patients who had a relapse died.

Primary prophylaxis can prevent the occurrence of penicilliosis. A randomized placebo-controlled study from Chiang Mai University suggests that primary prophylaxis with itraconazole 200 mg daily can prevent the occurrence of penicilliosis among patients with AIDS and CD4 counts <200>36)

Of 129 patients enrolled, penicilliosis occurred in only 1 case in the itraconazole arm compared with 11 cases in the placebo arm, a statistically significant difference (p = .008 in those who had CD4 counts <100 name="S6X">References
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Pfaller MA, Messer SA, Hollis RJ, Jones RN. Antifungal activities of posaconazole, ravuconazole, and voriconazole compared to those of itraconazole and amphotericin B against 239 clinical isolates of Aspergillus spp. and other filamentous fungi: report from SENTRY Antimicrobial Surveillance Program, 2000. Antimicrob Agents Chemother 2002; 46:1032-7.
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Thursday, December 07, 2006

Health Tip: What's an A1c Test?

(HealthDay News) -- Even though many diabetics check their blood sugar at home each day, it's important for a doctor to monitor a person's long-term control of the disease.

The A1c test, also called a glycated hemoglobin or HbA1c, gives doctors a view of the patient's blood sugar levels over the prior 120 days -- the approximate lifespan of a red blood cell.

Results of an A1c can help a doctor understand if a prescribed diabetes treatment plan is working as intended, according to the American Diabetes Association.

The test should be given at least twice a year, the ADA says. Your doctor may want the test done more frequently if you've had trouble controlling your blood sugar, or if the physician has made a recent change in your treatment plan.

Friday, December 01, 2006

Tea Soothes Skin Damage Linked to Cancer Treatment

(HealthDay News) -- Tea extracts can help reduce skin damage caused by cancer radiation therapy, according to a study by American and German researchers.

They examined the effects of green tea and black tea extracts and found that they reduced the duration of radiation-induced skin damage by five to 10 days. The tea extracts work at the cellular level to inhibit inflammatory pathways and reduce inflammation, said the team from the University of California, Los Angeles, and the University of Freiburg.

As well as testing the extracts on patients, the researchers studied the effects of green and black tea extracts on human and mouse white blood cells in laboratory cell cultures.

They found that the extracts reduced the release of pro-inflammatory cytokines, such as IL-1beta, IL-6, IL-8, TNF-alpha and PGE2, in human white blood cells. Green tea extract appeared to have higher anti-inflammatory properties than black tea extract.

Both green and black tea extracts inhibited one major inflammatory pathway in mouse white blood cells.

The researchers said that the high amount of polyphenols in tea is likely responsible for its anti-inflammatory activity, but added that other pathways are likely involved in its clinical effectiveness.

The study is published in the journal BMC Medicine.

More information
The American Cancer Society has more about the effects of radiation therapy.

Sunday, November 19, 2006

Anemone, Shrub Compounds Battle Rheumatoid Arthritis

(HealthDay News) -- Natural compounds from a sea anemone extract and from the rue shrub plant block autoimmune disease responses in both type 1 diabetes and rheumatoid arthritis, U.S. researchers report.

Scientists at the University of California, Irvine, conducted tests on rats and on blood samples from people with type 1 diabetes and on joint fluid from rheumatoid arthritis patients. They found that these compounds worked to deter the effects of destructive T-cells.

Both SL5 (from the sea anemone) and PAP-1 (from the rue shrub) block an ion channel in the T-cells, which prevents these cells from proliferating and producing chemicals called cytokines. These cytokines can attack healthy cells in people with autoimmune diseases.

The findings were published this week in the early online edition of the journal Proceedings of the National Academy of Sciences.

The researchers say it may be possible to use the compounds to develop new autoimmune disease treatments that target the destructive T-cells but still allow other white blood cells to fight disease and infection in the body.

"Autoimmune diseases affect millions of Americans, and any new therapies that can aid them will have great significance," researcher George Chandy of the university's School of Medicine, said in a prepared statement.

"What's promising about this study is that we identified a protein target on the T-cells that promotes autoimmune activity and the compounds that can selectively block the target and shut down the destructive cells," Chandy said.

He and his colleagues are currently conducting preclinical safety studies on PAP-1 and SL5 in collaboration with AIRMID, a San Francisco-area biotech company.

More information
The U.S. National Women's Health Information Center has more about autoimmune diseases.

Friday, November 17, 2006

Post-Surgery Radiation Boosts Prostate Cancer Results

(HealthDay News) -- A series of studies in this week's Journal of the American Medical Association offers good news to men battling prostate cancer or concerned about healthy prostate function.

One trial found that the use of radiation therapy after prostate removal improves results for men at high risk for prostate cancer recurrence.

"The benefit of adjuvant radiation is now confirmed in prostate cancer, like it is in many other cancers. Finally, we have the data to show that these patients can be helped further after their surgery," said Dr. Gregory Swanson, associate professor of radiation oncology at the University of Texas Health Science Center, San Antonio.

A second study, focused on the biology of prostate tissue in older men, found that links between testosterone replacement therapy (TRT) and prostate cancer "may not be as great as once feared," according to the trial's lead author, Dr. Leonard Marks, medical director of the Urological Sciences Research Foundation in Culver City, Calif. His team found no changes in the prostate tissue of older men after six months of TRT.

Both researchers presented their findings Tuesday at an American Medical Association news briefing in New York City that was timed to the release of the Nov. 15 issue of JAMA, which is focused on men's health.

Despite advances in early detection and treatment, prostate cancer remains a leading killer of American men. Most fatal cases of the disease occur when it is allowed to migrate beyond the gland, sparking disease recurrence.

According to Swanson, about one-third of the 230,000 new prostate cases diagnosed in the United States each year are treated with radical prostatectomy -- surgical removal of the organ. In up to half of those cases -- 30,000 men -- post-surgical tests reveal traces of lingering cancer cells that boost the risk of a recurrence.

Post-surgical ("adjuvant") radiation has a long record of "mopping up" these stray cells and improving the survival of patients with other types of cancer. However, the jury has been out as to whether the same might be true for prostate cancer.

In its study, the largest and longest of its kind to date, Swanson's team compared 10-year outcomes in a group of 425 older prostate cancer patients who had undergone radical prostatectomy but who still showed suspicious cells in the surrounding margins. His group randomly assigned half of the men to adjuvant radiation therapy, while the other half did not receive the treatment.

Ten years later, 35.5 percent of men who received radiation had developed fatal or nonfatal metastatic disease, compared to 43 percent of those who didn't get irradiated. Overall survival rates were similar between the two groups -- 71 of 214 men who received radiation died vs. 83 of 211 men who did not get the treatment.

Both of these results came very close to -- but did not meet -- so-called statistical significance, meaning that definite proof of treatment benefit is still lacking. However, Swanson believes "there is a compelling, although not conclusive" trend toward better survival in the irradiated group.

He also noted that about one-third of patients in the group who originally did not receive radiation eventually did receive it once they encountered a recurrence.

"People recognized that there was a benefit to radiation and said, 'Let's treat those patients,' " Swanson said. This probably caused more patients in the control group to survive than normally would have, confounding the results, he said.

Swanson said changes in other prostate cancer "markers" -- such as elevated blood levels of prostate specific antigen (PSA), a harbinger of cancer -- did meet statistical significance and were much more prevalent in men who did not undergo radiation, compared with those who did. Men who did not have radiotherapy were also 38 percent more likely to suffer disease recurrence that those who had had the adjuvant therapy, the study found.

The bottom line, according to Swanson: "The message to the urological community is that, yes, your patients will do better [with radiation] than with just surgery alone."

Prostate cancer risk was the focus for Marks' group of researchers, as well. He said recent media hype on the power of testosterone to boost aging males' libido and muscle tone have pushed annual U.S. sales of testosterone replacement therapy (TRT) to more than $700 million.

However, doctors have long known that testosterone can also raise a man's risk for prostate malignancy. So, Marks' team decided to look at the biological effect of six months of standard TRT, given in injections every two weeks, on the prostate tissue of 44 men ranging from 44 to 78 years of age.

All of the men had relatively low levels of circulating testosterone upon entering the study, with no sign of prostate malignancy. Forty of the men agreed to provide the researchers with prostate tissue biopsies at the beginning and end of the six-month trial.

The researchers said they found no detectable change in prostate tissue after six months of TRT, despite the fact that the therapy caused blood levels of circulating testosterone to rise to mid-normal levels. Concentrations of male hormones in prostate tissues differed only slightly after therapy, and the team saw no changes in cells -- for example, alterations in gene expression or cell proliferation -- that might point to an increased risk for cancer.

While this is good news for men who are taking or might take TRT, Marks stressed that the study only examined the prostate tissue biology of a select group of men with no prior signs of cancer.

"These data do not assure prostate safety for populations of older men harboring highly prevalent subclinical disease," said Marks, who is also clinical professor of surgery/urology at the University of California, Los Angeles. "We know that if you do thorough studies of the prostate glands of aging men, microscopic [traces] of cancer are present in many of them."

So, while this tissue sampling of 44 men found testosterone therapy to have no cancer-promoting effects, those results might not be borne out in larger epidemiological studies, he said. Until such studies are done, Marks said, "My concern is that some physicians may misinterpret these data and start using testosterone willy-nilly. My hope is that it won't be used that way."

A third study in the same issue of JAMA offered some guidance to millions of men bothered by urinary incontinence triggered -- at least in part -- by an enlarged prostate.

The study of more than 700 men found that a combination of two widely used medications, tolterodine (Detrol LA) and tamsulosin (Flomax), worked better in combination at reducing urinary trouble than either drug alone.

"In those men who don't respond to a single therapy -- and that's a host of men -- we're able to now, with this combination, provide a real improvement in their quality of life," said lead researcher Dr. Stephen Kaplan, professor of urology at Weill Medical College of Cornell University, in New York City.

More information
Find out more about prostate health at the U.S. Food and Drug Administration.

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