Month: September 2021

Categories : CancerTags :

Cancer Follow-up Care Needs Improvement

On By ModernMedia

With greater long-term cancer survival, previous standards of cancer follow-up care and support may no longer meet current needs.

The side-effects of anticancer medicines and impacts of the illness itself that sometimes persist after the end of treatment can hinder  a return to normal life after beating cancer. A study presented at the ESMO Congress 2021 showed that a significant proportion of survivors continue to suffer from burdensome symptoms for several years and reveal widespread dissatisfaction with the assistance provided.

Prof Dorothy Keefe, CEO of Australia’s national cancer agency, Cancer Australia, chair of the congress’s supportive and palliative care track, not involved in the study, underlined its importance in a context where survivorship research has lagged behind research on cancer treatment. “This is probably due to the increase in survival rates itself lagging behind the introduction of new therapies, but also to a lack of prioritisation compared to the need to develop a cure,” Keefe said, and highlighted the scale of the issue today: “We now have millions of cancer survivors in Australia, hundreds of millions around the world – and an ever-increasing number who could potentially have long-term side-effects.”

One of the most common symptoms experienced by patients and survivors alike is cancer-related fatigue (CRF), a persistent sense of exhaustion, not alleviated by sleep or rest and significantly interferes with the person’s usual functioning. The FiX study initially evaluated the patterns, severity and management of CRF among 2508 patients with 15 different types of cancer two years after the discovery of their illness. In a follow-up survey, 36 potential long-term problems, completed by participants around four years after diagnosis, almost 40% of survivors continued to report fatigue that they rated as a moderate or severe burden. As well as fatigue, over 40% of patients reported loss of physical capacity as a burden and over one third suffered from trouble sleeping, sexual problems, joint pains and anxiety.

Although there are recommendations for managing side-effects like CRF, study author Dr Martina Schmidt from the German Cancer Research Centre (DKFZ) in Heidelberg, Germany, drew attention to their lack of implementation and reported that more than one in three affected individuals in the study evaluated the support they were offered for fatigue as poor. “Despite increasing awareness of the effectiveness of mitigating measures like exercise to reduce fatigue, patients are still too often left alone to seek help for symptoms that cannot be directly addressed with medicines in the same way as something like pain, for which satisfaction with the support received was high in our study.”

Prof Keefe commented on the results, saying: “This research shows that a staggeringly high number of patients still suffer from significant health issues years after being declared disease-free. Their dissatisfaction with the care available is a wake-up call that we should be paying more attention to these individuals, trying to understand the mechanisms at play in order to identify interventions that could help them to better recover.”

According to Dr Schmidt, cancer follow-up care should therefore also incorporate more systematic screening for additional symptoms that can burden patients. “The first step should be to make sure that patients themselves are better informed about these potential issues early on, so they know that conditions like CRF are not only expected, but often manageable and that they should not wait for symptoms to disappear on their own,” she said.

Recognising that possible models of long-term support remain largely untested, Keefe further advocated that all patients should be provided with a survivorship care plan when they reach the end of their treatment. “Going forward, we need to develop these models of care in a way that minimises the burden on healthcare systems, implement them and research their impact so that we can come back in five years’ time and evaluate whether they have made a difference for cancer survivors,” she concluded.

Source: European Society for Medical Oncology

Categories : AllergiesTags :

New Allergen Pathway Discovery Could Yield New Meds

On By ModernMedia
Photo by Britanny Colette on Unsplash

Researchers have uncovered the mechanism by which the innate immune system is triggered by allergens, such as insects, mites, and fungi.

In Nature Immunology, researchers revealed new details about how the body’s “type 2 innate immune response” system works, which could yield a new medication for allergy control.

“Disrupting this allergen sensing pathway could provide a unique opportunity to counteract type 2 immunity and alleviate allergic inflammation,” said senior author Marc Rothenberg, MD, PhD, Director, Division of Allergy and Immunology, Cincinnati Children’s Hospital Medical Center

In addition to Rothenberg, the research team included , Mark Rochman, PhD, Yrina Rochman, PhD, Julie Caldwell, PhD. Lydia Mack, MS, Jennifer Felton, PhD, Jeff Habel, PhD, Aleksey Porollo, PhD and Chandrashekhar Pasare, DVM, PhD.

Multiple allergens had been shown to induce a similar IL-33 response upon breaching the epithelial layer of mucosal membranes, a process which the researchers pinned down.

“This breakthrough was made possible by new insights into the role of ripoptosome signaling and caspases in allergic inflammation,” said Michael Brusilovsky, MMedSc, PhD, who was the first author of the study.

Specifically, the allergens trigger activity among an interlocked set of cell death-inducing signals called the ripoptosome. This signaling “platform” includes numerous components, but for allergic inflammatory reactions, the key player appears to be a molecular switch called caspase 8. The investigators named the pathway, “RipIL-33” as IL-33 is processed (ripped) by the ripoptosome.

How allergens are sensed has remained a mystery.

“The discovery of this surprising mechanism is the most important breakthrough in understanding how the innate immune system senses allergens to initiate a type 2 response and subsequent allergic inflammation,” said Pasare, one of the senior authors of the study.

In mice, inhibiting caspase 8 reduced the IL-33 response to allergens and limited bronchial inflammation in the lungs. Analysis revealed a similar process in humans/ 
“In the human allergic disease eosinophilic esophagitis (EoE), we found that ripoptosome activation markers and mature IL-33 levels dynamically correlated with the degree of esophageal eosinophilia and disease activity,” the study states.

The next steps include studying the RipIL-33 pathway in human allergic reaction and determining whether existing or new drugs could disrupt it.

Source: News-Medical.Net

Categories : Diseases, Syndromes and Conditions UncategorizedTags :

Diabetes Drug Could Halve Glaucoma Risk

On By ModernMedia
Source: Pixabay CC0

GLP-1R agonists, a popular class of diabetes drugs, may also have a protective effect against glaucoma in diabetic patients, according to a new study published in the British Journal of Ophthalmology.

The researchers examined retrospective data of 1961 diabetic patients who were new users of this class of drugs and matched them to 4371 unexposed control subjects. After 150 days on average, 10 patients in the medicated group were newly diagnosed with glaucoma (0.5%) compared to 58 patients (1.3%) in the control group. These results indicate that GLP-1 receptor agonists could halve a diabetic patient’s risk of developing glaucoma.

The findings are supported by a Penn Medicine study from 2020, which found that GLP-1R agonists reduced neuroinflammation and prevented retinal ganglion cell death in mice. This class of drugs has also shown similarly protective effects against Alzheimer’s and Parkinson’s diseases in animal models, and clinical trials are underway to test the medications against neurodegenerative diseases in humans.

Glaucoma is the second leading cause of blindness worldwide, and people with diabetes are twice as likely to develop the condition.

“It was very encouraging to see that a popular diabetes medication could significantly reduce the risk of developing glaucoma, and our study suggests that these medications warrant further study in this patient population,” said Qi N. Cui, MD, PhD, with Brian VanderBeek, MD, MPH, both assistant professors of Ophthalmology at Penn.

Source: EurekAlert!

Categories : VaccinesTags :

Are Combination COVID Vaccines the Wave of the Future?

On By ModernMedia
Image source: NCI on Unsplash

An article in MedPage Today examines the potential for combination COVID vaccines.

Novavax and Moderna have recently announced the development of combination vaccines that would protect not only against COVID, but also against influenza. In the case of Moderna, they are testing a combination vaccine that also includes protection against respiratory syncytial virus (RSV) — a viral illness for which no vaccine is currently available, which would be a major advancement Because COVID vaccines can be administered simultaneously with other vaccines, albeit in separate injections, the next step would be to co-formulate them in the same injection with other vaccinations.

Combination vaccines are extremely valuable for several reasons, chief among them is convenience. If, during one visit to a provider, a person can get multiple vaccinations, it ensures uptake of all those vaccines without the need to schedule multiple visits or use multiple injections. A single needle puncture is better than multiple punctures, even for those who are not needle phobic. As more vaccines are developed, combination vaccines become critical in getting doses into arms with the minimum number of injections.

Combination vaccines have been around for a long time, and are the mainstay of routine vaccination. Today, children receive several combination vaccinations including the well-known MMR (measles, mumps, rubella) and DTap (diphtheria, tetanus, acellular pertussis). These types of vaccines have a long history with DTP, the first combination vaccine used in humans, dating to the 1940s. Pentacel immunises against five different pathogens at once. Such convenience, especially with hard-to-reach populations, is invaluable. Adults also receive combination vaccinations, most prominently the Tdap (tetanus, diphtheria, acellular pertussis) boosters. Many physicians wish there were more combination vaccination products available because they have the potential to significantly increase vaccination rates.

It is of course necessary to determine that combination vaccines are safe and effective. Because they contain more antigen, reactions at injection sites might be more pronounced, fever might be slightly higher, and tolerability lower. To avoid the risk of febrile seizures, infants do not get the MMRV (measles, mumps, rubella, varicella) vaccine, instead getting varicella separately.
A combination vaccine’s components should not interfere with each other or blunt the immune response. This immune interference was a concern with vaccines combining Hib with DTap. For instance, vaccines with different storage conditions or delivery mechanisms (eg, subcutaneous vs intra-muscular; lipid nanoparticle encased) may not be the best candidates to combine. It is also important to combine vaccines that have compatible age or time-based schedules for administration.

As scientists explore a combination flu and COVID vaccine, they will be looking closely at all of these safety and efficacy considerations.

It’s important to emphasize, considering widespread disinformation from the anti-vaccine movement, that there is no “antigen overload” risk with combination vaccines. The human immune system is bombarded with antigens every day. We even become bacteremic, when we brush our teeth, or eat. The antigens contained in a combination vaccine are miniscule by comparison. In fact, the first ever vaccine, for smallpox, was packed with particles and impurities but was still incredibly efficacious and led to control and eventual elimination of one of humanity’s deadliest scourges.

It is likely to see individual attacks on COVID combination vaccines long before they are even available. We’ve previously seen such attacks on the MMR vaccine — these attacks became so pervasive that manufacturers started to produce the single vaccines again to placate people who were the victims of a concerted disinformation campaign. But we can learn from these past challenges. It will be important to fight disinformation about the COVID-19 combination vaccines early on, and encourage their uptake when they become available.

But one thing is certain: we should aim to make COVID vaccination convenient, normal, and easy. Proactively working on next generation vaccines that do this by combining with other vaccinations, altering the mode of delivery (eg, oral or nasal vaccines), or simplifying storage requirements are important tasks.

Source: MedPage Today

Categories : Cardiovascular DiseaseTags :

New Approach to Address Cardiac Disease in Rheumatoid Arthritis

On By ModernMedia
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A new approach to address cardiac disease in rheumatoid arthritis (RA) patients has been developed.

Currently patients suffering from RA are also particularly susceptible to diastolic dysfunction, a type of cardiac deficiency which may lead to heart failure, resulting in a higher mortality rate among such patients.
To address this unmet clinical need, researchers from Queen Mary’s William Harvey Research Institute (WHRI) responded by developing an experimental model of cardiomyopathy in inflammatory arthritis.

After several attempts, the researchers finally hit upon the right model by characterising experimental animals with arthritis. The animals developed cardiac diastolic dysfunction, recapitulating the symptoms presented by RA patients. Diastolic dysfunction means the heart is able to contract as normal but unable to dilate properly, ultimately leading to heart failure over time.

Professor Mauro Perretti, lead study author and Professor of Immunopharmacology at Queen Mary University of London said, “As is often the case, the description of a valid model of disease can open new vistas on pathogenic mechanisms as well as on novel therapeutic approaches. At present, the cardiomyopathy of patients affected by rheumatoid arthritis is not treated, and on top of this, current anti-rheumatic drugs (eg biologics or steroids) may even worsen it. As such there is an urgent therapeutic need to intervene and treat, if not cure, the cardiomyopathy of patients affected by rheumatoid arthritis.”

“The broad area of cardiac inflammation is largely unexplored. At the WHRI we have several groups addressing experimental and translational work on several syndromes of the heart. Thus, there is work on myocarditis, on diabetes-induced cardiomyopathy and now with this study, the cardiomyopathy of inflammatory arthritis. The WHRI at Queen Mary University of London is a place of excellence to study cardiac inflammation in all its multiple faces, thanks also to our partnership with the Barts Heart Centre at Barts Health NHS Trust.”

The study was published in PNAS.

Source: EurekAlert!

Categories : Immune SystemTags :

How Vitamin A Enters into Gut Immune Cells

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Source: Pixabay

Researchers have reported in Science how vitamin A enters immune cells in the intestines – findings that could offer insight to treat digestive diseases and perhaps help improve the efficacy of certain vaccines.

“Now that we know more about this important aspect of immune function, we may eventually be able to manipulate how vitamin A is delivered to the immune system for disease treatment or prevention,” said Lora Hooper, PhD, Chair of Immunology at UT Southwestern, Howard Hughes Medical Institute Investigator.

Vitamin A is a fat-soluble nutrient which is converted to retinol and then to retinoic acid before it is used. It is important for every tissue in the body, said Dr. Hooper, Professor of Immunology, Microbiology, and in the Center for the Genetics of Host Defense at UT Southwestern. It is particularly crucial for the adaptive immune system, a subset of the broader immune system that reacts to specific pathogens based on immunological memory, the type formed by exposure to disease or vaccines.

Although researchers knew that some intestinal immune cells called myeloid cells can convert retinol to retinoic acid, how they acquire retinol to perform this task was a mystery, said Dr. Hooper, whose lab investigates how resident intestinal bacteria influence the biology of humans and other mammalian hosts.

Lead author Ye-Ji Bang, PhD, a postdoctoral fellow in the Hooper Lab, and colleagues focused on serum amyloid A proteins, a family of retinol-binding proteins that some organs produce during infections. They used biochemical techniques to determine which cell surface proteins they attached to, and identified LDL receptor-related protein 1 (LRP1).

Drs. Bang, Hooper, Herz, and colleagues showed that LRP1 was present on intestinal myeloid cells, where it seemed to be transferring retinol inside. When the researchers deleted the gene for this receptor in mice, preventing their myeloid cells from taking up the vitamin A derivative, the adaptive immune system in their gut virtually disappeared, said Dr Hooper. T and B cells and the molecule immunoglobulin A, critical components of adaptive immunity, were significantly reduced. Researchers then compared the response to Salmonella infection between mice with LRP1 and those without. Those without the receptor quickly succumbed to the infection.

The findings suggest that LRP1 is what conveys retinol into myeloid cells. If a way could be developed to inhibit this process, explained Dr Hooper, it could calm down the immune response in inflammatory diseases that affect the intestines, such as inflammatory bowel disease and Crohn’s disease. Alternatively, boosting LRP1 activity could boost immune activity, making oral vaccines more effective.

Source: UT Southwestern Medical Center

Categories : Diseases, Syndromes and ConditionsTags :

Discovery of Cell Type Linked to Skin Conditions

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Researchers have found a cell type in human skin that contributes to inflammatory skin diseases such as atopic dermatitis (AD) and psoriasis (PSO). Their study findings were published in the Journal of Experimental Medicine. The team hails from A*STAR’s Singapore Immunology Network (SIgN).

Chronic inflammatory skin diseases such as AD and PSO are characterised by the presence of an activated T cell subtype which secretes pro-inflammatory cytokines in the skin. This immune dysregulation mediated by T cells is central to the pathogenesis of a wide range of inflammatory skin diseases. Thus, understanding the factors modulating T cell priming and activation in healthy and diseased skin is key to developing effective treatments for these diseases.

Recently, a single-cell RNA sequencing (RNA-seq) approach has been used to analyse immune cells in human skin, including dendritic cells (DCs) and macrophages, which are cells that can T cell activation. To tease out the role of DCs and macrophages in chronic inflammatory skin diseases, the team used a combination of complex approaches to yield an unbiased profile/ landscape of DCs and macrophages, and to describe their distinct molecular signatures and proportions in skin lesions of AD and PSO patients.

The researchers found an increase in the proportion of CD14+ DC3s in PSO lesional skin, where they were one of the major cell types co-expressing IL1B and IL23A, two cytokines essential for PSO pathogenesis. This finding suggests that targeting CD14+ DC3 might represent a novel therapeutic option in the treatment of PSO, and demonstrates the potential for the single-cell myeloid cell landscape database to provide important insights into skin biology in health and disease.

Last author Dr Florent Ginhoux, Senior Principal Investigator, SIgN said: “The findings from this study are significant as it will allow the design of new strategies to target or modulate myeloid cell populations for better health outcomes for patients of atopic dermatitis and psoriasis.”

“The roles of antigen-presenting cells in the development of inflammatory skin diseases remain unclear. This study clearly revealed the functions of each antigen-presenting cell subset, which is very informative and valuable to understand the pathogenesis of atopic dermatitis and psoriasis. We expect that this study will lead to the design of new treatment for refractory inflammatory skin diseases.” said Prof Kenji Kabashima, Adjunct Principal Investigator from SIgN and SRIS.

Source: EurekAlert!

Categories : Diet and Nutrition Mental HealthTags :

Fruit and Vegetable Consumption Directly Increases Happiness

On By ModernMedia
Photo by Brad West on Unsplash

Fruit and vegetable consumption and exercise can directly increase levels of self-reported happiness, according to findings from a new study.

Public health campaigns encourage healthier diets and exercise by virtue of the well-studied link between lifestyle and wellbeing, and will benefit from new findings published by the Journal of Happiness Studies showing that there is also a positive causation from lifestyle to life satisfaction.

This research is the first to identify the causation of happiness, the consumption of fruit and vegetables and exercising are related, rather than generalising a correlation. The researchers, Dr Adelina Gschwandtner (Kent’s School of Economics), Dr Sarah Jewell and Professor Uma Kambhampati (both from the University of Reading’s School of Economics), used an instrumental variable approach to filter out any effect from happiness to lifestyle. This approach revealed that it is the effect of fruit and vegetables and exercising that makes people happy and not the other way round.

The findings show individuals’ ability to delay gratification and apply self-control plays a major role in influencing lifestyle decisions, which in turn has a positive impact on wellbeing. The research also shows that men appear to exercise more, and women eat more fruit and vegetables.

Dr Gschwandtner said: ‘Behavioural nudges that help the planning self to reinforce long-term objectives are likely to be especially helpful in maintaining a healthy lifestyle. If a better lifestyle not only makes us healthier but also happier, then it is a clear win-win situation.’

Professor Kambhampati said: ‘There has been a bigger shift in recent years for healthier lifestyle choices. To establish that eating more fruit and vegetables and exercising can increase happiness as well as offer health benefits is a major development. This may also prove useful for policy campaigns around environment and sustainability.’

Source: University of Kent

Categories : Cardiovascular DiseaseTags :

Strong Adherence to Stroke Medication is Crucial

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A new study emphasises the importance of survivors of first-time stroke or transient ischaemic attack (TIA) to take medications on an ongoing basis, highlighting long-term associations with survival.

Stroke is the second leading risk of death worldwide, with In 2016, the average lifetime risk of stroke after 25 for the global population was 24.9%. Nearly half of all survivors of stroke are expected to experience a recurrent cardiovascular event within 10 years. Specific medications help to prevent this long-term risk, but adherence to these agents is often suboptimal among patients.

The study, published in Stroke, demonstrates the importance of medication adherence after stroke to maximise survival, even for patients with near-perfect adherence. These findings are in support of targeted initiatives to maximise medication adherence after stroke/TIA, such as implementation of medication reminder systems, mobile health technologies, increased follow-up by clinicians or complex behaviour change programs.

Drawing from Australian databases, the study enrolled 8363 adult patients who survived a first stroke or TIA between July 2010 and June 2014, with follow-up for a further three years. For patients with one-year adherence above 60%, each 10% improvement in adherence was associated with a 13-15% reduction in mortality risk. These results suggest that aiming for an arbitrary adherence target of 80% may be inappropriate as maximal survival benefits were observed closer to 100% adherence.

The study’s lead author, Associate Professor Monique Kilkenny, said continued use of secondary prevention medications can be improved with several factors: provision of medication on hospital discharge, regular contact with a primary care physician, and specialist physician contact.

“These findings represent important implications for practice by highlighting the value of efforts to improve medication adherence post-stroke/TIA, even among patients with near-perfect adherence,” said Associate Professor Kilkenny.

“Our findings provide evidence in support of targeted initiatives to maximise medication adherence after stroke/TIA and there is considerable scope for further interventions to improve medication adherence.”

Source: Monash University

Categories : COVIDTags :

COVID Variants Evolving to Improved Airborne Transmission

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A new study found that people infected with SARS-CoV-2 shed significant numbers of virus particles in their breath – and those infected with the Alpha variant put 43 to 100 times more virus into the air than people infected with the original strains. 

The researchers also found that loose-fitting cloth and surgical masks reduced the amount of virus that gets into the air around infected people by about half. The study was published in Clinical Infectious Diseases.

“Our latest study provides further evidence of the importance of airborne transmission,” said Dr Don Milton, Professor, Environmental Health, University of Maryland School of Public Health. “We know that the Delta variant circulating now is even more contagious than the Alpha variant. Our research indicates that the variants just keep getting better at traveling through the air, so we must provide better ventilation and wear tight-fitting masks, in addition to vaccination, to help stop spread of the virus.”

The numbers of airborne virus particles coming from infections with the Alpha variant (the dominant strain circulating at the time this study was conducted) was much more (18 times more) than could be explained by the increased amounts of virus picked up in nasal swabs and saliva. 
Doctoral student Jianyu Lai, a lead author of the study, explained: “We already knew that virus in saliva and nasal swabs was increased in Alpha variant infections. Virus from the nose and mouth might be transmitted by sprays of large droplets up close to an infected person. But, our study shows that the virus in exhaled aerosols is increasing even more.” These major increases in airborne virus from Alpha infections occurred before the arrival of the Delta variant, suggesting that the virus is evolving to have improved airborne transmission.

To test the efficacy of masks in reducing transmission, the researchers measured how much SARS-CoV-2 is exhaled into the air with and without wearing a cloth or surgical mask. They found that face coverings significantly reduced virus-laden particles in the air around the person with COVID by about 50%.

Co-author Dr Jennifer German said, “The take-home messages from this paper are that the coronavirus can be in your exhaled breath, is getting better at being in your exhaled breath, and using a mask reduces the chance of you breathing it on others.” This means that a layered approach to control measures (including improved ventilation, increased filtration, UV air sanitation, and tight-fitting masks, in addition to vaccination) is critical to protect people in public-facing jobs and indoor spaces.

Source: University of Maryland