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June 1, 2009, 7:07 PM CT
Genes, smoking and rheumatoid arthritis
Recent genetic studies have revealed several new sites of genes that are risk factors for developing rheumatoid arthritis (RA). The strongest association with anti-citrullinated protein antibody (ACPA)-positive RA (ACPAs are autoantibodies detected in RA that are used as a major diagnostic tool) has been found for the HLA-DRB1 gene, and this site seems to play a central role in susceptibility to the disease in Caucasian populations. Prior studies have shown a high increase in the risk of ACPA-positive RA linked to smoking in those who have certain variations of the HLA-DRB1 gene. There are several types of such alleles correlation to a particular amino acid sequence known as shared epitope (SE). ACPAs occur in about 60 percent of RA patients and are closely associated with the presence of SE alleles. In fact, SE alleles are the strongest genetic risk factor for ACPA-positive RA.
Of several environmental factors that predispose people toward developing RA, smoking has been found to be the main risk factor and a strong gene-environment interaction between smoking and SE alleles for ACPA-positive patients has been shown in prior studies in Europe. Results in North America have not been as conclusive, however. A new large population-based study examined the gene-environment interaction between smoking and SE alleles in RA and observed that all SE alleles strongly interact with smoking in conferring an increased risk of ACPA-positive RA. The study was reported in the recent issue of Arthritis & Rheumatism
Posted by: Mark Read more Source
June 1, 2009, 7:00 PM CT
Tai chi helps to improves arthritis pain
The results of a new analysis have provided strong evidence to suggest that Tai Chi is beneficial for arthritis. Specifically, it was shown to decrease pain with trends towards improving overall physical health, level of tension and satisfaction with health status.
Musculoskeletal pain, such as that experienced by people with arthritis, places a severe burden on the patient and community and is recognized as an international health priority. Exercise treatment including such as strengthening, stretching and aerobic programs, have been shown to be effective for arthritic pain. Tai Chi, is a form of exercise that is regularly practiced in China to improve overall health and well-being. It is commonly preformed in a group but is also practiced individually at one's leisure, which differs from traditional exercise treatment approaches used in the clinic.
Recently, a newly released study examined the effectiveness of Tai Chi in decreasing pain and disability and improving physical function and quality of life in people with chronic musculoskeletal pain. The study is reported in the recent issue of Arthritis Care & Research
(http://www3.interscience.wiley.com/journal/77005015/home). Led by Amanda Hall of The George Institute in Sydney, Australia, scientists conducted a systematic review and meta-analysis. They analyzed seven eligible randomized controlled trials that used Tai Chi as the main intervention for patients with musculoskeletal pain. The results demonstrate that Tai Chi improves pain and disability in patients suffering arthritis.........
Posted by: Mark Read more Source
June 1, 2009, 5:22 AM CT
Drug combination improves outcome for advanced non-small cell lung cancer
A new, international study observed that the combination of two drugs delays disease progression for patients with advanced non-small cell lung cancer (NSCLC). Results from the Phase III "ATLAS" trial were presented today by Dr. Vincent Miller of Memorial Sloan-Kettering Cancer Center (MSKCC) at the American Society of Clinical Oncology Annual Meeting.
The goal of the study was to determine whether adding erlotinib (Tarceva), a targeted agent, to maintenance treatment with bevacizumab (Avastin), an agent usually used as a component of therapy for advanced NSCLC would delay disease progression. Maintenance treatment involves using one or more agents of a chemotherapy regimen, but not the entire regimen, to delay disease progression and possibly improve survival after patients have previously received stronger standard chemotherapy, which can have significant side effects.
"This is the first study to show the addition of erlotinib to maintenance treatment prolongs progression-free survival in patients with advanced non-small cell lung cancer," said Dr. Miller, a thoracic oncologist at MSKCC and one of the study's main authors. "Knowing which patients will get the greatest benefit from this combination, based on the identification of biomarkers, will be an important next step in this research," Dr. Miller added.........
Posted by: Scott Read more Source
June 1, 2009, 5:18 AM CT
Surgery for late-stage colon cancer
A newly released study shows that a great majority of patients who present with advanced colorectal cancer that has spread to other organs (stage IV) don't require immediate surgery to remove the primary tumor in the colon. Scientists from Memorial Sloan-Kettering Cancer Center (MSKCC) presented their data today at the American Society of Clinical Oncology Annual Meeting.
"For this population with metastatic disease that cannot be cured by surgery, undergoing colon surgery is not always necessary," said Philip Paty, a surgical oncologist at MSKCC and one of the study's main authors. "If the colon tumor is not causing obstruction, perforation, or bleeding we've found these patients are best treated with chemotherapy. By moving straight to chemotherapy, patients can avoid the risk of surgical complications and can start therapy for all sites of disease without delay".
For this retrospective study, a multidisciplinary team looked at 233 metastatic colorectal cancer cases treated at MSKCC from 2000 to 2006. Their analysis showed that 217 of the 233 patients, or 93 percent, did not have complications that mandatory resection of the primary tumor. Only 16 patients mandatory colon surgery for symptom management.
Previously, in the conventional approach to treating stage IV disease, patients underwent colon surgery immediately following their diagnosis and would typically start chemotherapy therapys three to six weeks later. The rationale for immediate colon resection was to prevent future symptoms and complications from the primary tumor. It was assumed that the majority of colorectal cancers would have little response to chemotherapy.........
Posted by: Sue Read more Source
June 1, 2009, 5:17 AM CT
Predicting response to melanoma treatment
Genes that help predict a melanoma patient's response to therapy. The new findings are being presented at the 45th annual meeting of the American Society of Clinical Oncology (ASCO), May 29 to June 2, in Orlando, Fla.
"Approximately 70,000 people will be diagnosed with metastatic melanoma this year," said principal investigator Hussein Tawbi, M.D., M.Sc., assistant professor of medicine, University of Pittsburgh School of Medicine, and with UPCI's Melanoma Program. "This form of cancer is aggressive and often resistant to chemotherapy. In fact, only 7 to 10 percent of patients are likely to respond to the current standard of care. We wanted to see if there was a way to predict which patients would respond to therapy and which ones would not".
Dr. Tawbi and colleagues examined the tumor tissues of 21 patients with metastatic melanoma, some of whom responded to chemotherapy and some who did not. Once the cases were divided, the scientists used a mathematical tool called Neural Network Analysis to survey over 25,000 genes and the regulators that turn the genes on and off to see if they could identify ones that could distinguish responders from nonresponders.
"Cancer cells contain massive amounts of information that, if analyzed appropriately, may inform us how to kill them," said Dr. Tawbi. "They contain thousands of genes, and every gene has a switch that turns it on or off. Neural Network Analysis, which utilizes pattern recognition algorithms, helped us identify a signature of eight genes and their switches that predict a patient's likelihood of responding to therapy for metastatic melanoma".........
Posted by: George Read more Source
June 1, 2009, 5:13 AM CT
Individualized treatment for heart failure
Telemonitoring systems, by which the symptoms of heart failure can be remotely assessed, now provide a strategy for the improved personalised care of patients, as per Professor John Cleland from the University of Hull, UK.1 He told Heart Failure Congress 2009 that the management of heart failure is complex but most effective when tailored to the individual patients' needs and condition.2 "Unfortunately," he added, "the resources mandatory to offer this tailored therapy outside a hospital setting are generally not available. Current services provide, at best, only a crude attempt to deliver long-term, personalised healthcare, but telemonitoring provides a strategy which could radically change this situation".
Professor Cleland explained that the first generation of home monitoring devices for heart failure were relatively simple. They were designed to measure symptoms, weight, heart rate and rhythm, and blood pressure. But, he said, "from the patient's perspective, they were relatively unrewarding since the systems provide little in the way of advice or feedback. Nonetheless, a series of randomised controlled trials have shown a reduction in mortality and in days spent in hospital, eventhough not in the rate of hospitalisation."
Ongoing trials of second generation equipment, he continued, reflect the same measure of symptom evaluation but a more interactive experience for the patient. "These newer systems," he explained, "provide education, feedback to patients on their results, therapy and appointment reminders and a limited amount of advice on adjusting treatment. They are likely to deliver even greater health gains than first generation systems".........
Posted by: Daniel Read more Source
June 1, 2009, 5:10 AM CT
Obesity and diabetes double risk of HF
The twin epidemics of obesity and type 2 diabetes will continue to fuel an explosion in heart failure, already the world's most prevalent chronic cardiovascular disease, as per John McMurray, professor of cardiology at the Western Infirmary, Glasgow, and President of the Heart Failure Association. He reported that around one-third of patients with heart failure have evidence of diabetes, and for them the outlook is very serious. For doctors, he added, effective therapy is "very difficult".
Obesity, like diabetes, is increasing in prevalence. The latest report from Euroaspire, Europe's largest survey of cardiovascular risk factors in coronary patients, observed that the prevalence of obesity had increased from 25 per cent in 1997 to 38 per cent in just ten years and this in people who had already had at least one heart attack.
Now, a session at Heart Failure 2009 emphasises that obesity is not just linked to an increased risk of heart attack, but also and particularly - with an increased risk of heart failure.1,2 "Obesity is at least as great a risk factor for heart failure as it is for heart attack or stroke," says Professor McMurray. "Obesity more than doubles the risk".
The pathways by which obesity plays such a role in heart failure are still not fully understood, but have been shown to have an indirect effect via hypertension, or heart attack, or diabetes and a direct effect on the heart muscle itself. "We know that the underlying changes in the structure and function of the heart appears to be different in obese and non-obese patients with heart failure," says Professor McMurray. An even more "intriguing" suggestion, he added, is that adipose cells might act as an endocrine tissue, secreting substances which may have a harmful effect on heart tissue and blood vessels.........
Posted by: JoAnn Read more Source
June 1, 2009, 5:07 AM CT
Stem cell-gene therapy approach cures human genetic disease
Shown in green are genetically-corrected fibroblasts from Fanconi anemia patients are reprogrammed to generate induced pluripotent stem cells, which, in turn, can be differentiated into disease-free hematopoietic progenitors, capable of producing blood cells in vitro.
Credit: Courtesy of Dr. Juan-Carlos Belmonte, Salk Institute for Biological Studies
A study led by scientists at the Salk Institute for Biological Studies, has catapulted the field of regenerative medicine significantly forward, proving in principle that a human genetic disease can be cured using a combination of gene treatment and induced pluripotent stem (iPS) cell technology. The study, reported in the May 31, 2009 early online edition of Nature
, is a major milestone on the path from the laboratory to the clinic.
"It's been ten years since human stem cells were first cultured in a Petri dish," says the study's leader Juan-Carlos Izpisa Belmonte, Ph.D., a professor in the Gene Expression Laboratory and director of the Center of Regenerative Medicine in Barcelona (CMRB), Spain. "The hope in the field has always been that we'll be able to correct a disease genetically and then make iPS cells that differentiate into the type of tissue where the disease is manifested and bring it to clinic".
Eventhough several studies have demonstrated the efficacy of the approach in mice, its feasibility in humans had not been established. The Salk study offers the first proof that this technology can work in human cells.
Belmonte's team, working with Salk colleague Inder Verma, Ph.D., a professor in the Laboratory of Genetics, and his colleagues at the CMRB, and the CIEMAT in Madrid, Spain, decided to focus on Fanconi anemia (FA), a genetic disorder responsible for a series of hematological abnormalities that impair the body's ability to fight infection, deliver oxygen, and clot blood. Caused by mutations in one of 13 Fanconi anemia (FA) genes, the disease often leads to bone marrow failure, leukemia, and other cancers. Even after receiving bone marrow transplants to correct the hematological problems, patients remain at high risk of developing cancer and other serious health conditions.........
Posted by: Scott Read more Source
June 1, 2009, 5:05 AM CT
Genetic risk factor for testicular cancer
(PHILADELPHIA) Scientists at the University of Pennsylvania School of Medicine have uncovered variation around two genes that are linked to an increased risk of testicular cancer. Testicular cancer is the most common cancer among young men, and its incidence among non-Hispanic Caucasian men has doubled in the last 40 years -- it now affects seven out of 100,000 white men in the United States each year. The discovery, reported in the May 31, 2009 online issue of Nature Genetics
, is the first step toward understanding which men are at high risk of disease.
"Despite being quite heritable, there really have not been any clear genetic risk factor that can account for most cases of testicular cancer," says Katherine L. Nathanson, MD, an assistant professor of Medicine and a specialist in medical genetics at the Abramson Cancer Center. "These variants are the first striking genetic risk factors found for this disease to date."
Nathanson and co-author Peter A. Kanetsky, PhD, MPH, an assistant professor of Epidemiology, observed that men who have two copies of the common version of the c-KIT ligand (KITLG) gene have a 4.5-fold higher risk of testicular cancer than men who have two copies of the less common or minor version of the gene. Additionally, men with two copies of the common version of variants next to another gene, sprouty 4 (SPRY4), have a 1.48-fold higher risk than men with two copies of the less common version of the gene.........
Posted by: Janet Read more Source
June 1, 2009, 5:04 AM CT
drug combination safe and active in kidney cancer
Fox Chase Cancer Center researchers report that a two-drug blockade of mTOR signaling appears safe in metastatic kidney cancer in a phase I trial. Early data suggests that a combination of temsirolimus and bryostatin appears to be active in patients with rare forms of renal cell cancer, which are less likely to respond to other targeted therapies.
Elizabeth Plimack, M.D., M.S., a medical oncologist and attending doctor at Fox Chase will report the trial results on Sunday, May 31 at the annual meeting of the American Society of Clinical Oncology.
"We have certainly seen sustained responses with this combination which are encouraging," Plimack says.
One of the patients with an extended response has papillary renal cell cancer, which is a rare form of the disease that does not respond well to standard therapies. "Patients with non-clear cell renal cell cancer, including papillary renal cancer, don't respond as well to tyrosine kinase inhibitors, such as sunitinib and sorafenib, as patients with clear cell renal cell. So there is an unmet need for treatment for these patients. We've seen that this combination appears to be active to some degree for them".
mTOR signaling promotes tumor cell proliferation and blood vessel development. Temsirolimus (Torisel), blocks signaling through one portion of the mTOR signaling complex, called TORC1, and slows tumor progression in patients with advanced kidney cancer. However, a second portion of the complex, called TORC2, is unaffected by temsirolimus and continues to promote cell proliferation. Therefore, Plimack and his colleagues suspect that blocking TORC2 signaling activity could improve patient outcomes. Bryostatin blocks a downstream effector of TORC2, called protein kinase C.........
Posted by: Janet Read more Source
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Did you know?
Studies in monkeys and women suggest that unlike traditional estrogen therapy, a diet high in the natural plant estrogens found in soy does not increase the risk of uterine cancer in postmenopausal women, according to Mark Cline, D.V.M., Ph.D., an associate professor of comparative medicine at Wake Forest University Baptist Medical Center.
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