March 12, 2007
March 7, 2007
Costs Of Long-Course Palliative Radiotherapy Acceptable In Late-Stage Lung Cancer
A longer, less intense course of radiotherapy provides better value for the money than a shorter, more intense regimen when given to ease pain and other complaints in patients with late-stage non-small-cell lung cancer (NSCLC), according to a study in the Journal of the National Cancer Institute.
Patients with late-stage NSCLC are often too ill to receive intensive treatment for their cancer. Palliative radiotherapy is given to ease symptoms such as chest pain and difficulty breathing and swallowing. In 1999, Wilbert B. van den Hout, Ph.D., of Leiden University Medical Center in the Netherlands, and colleagues conducted a randomized clinical trial in 297 patients with inoperable stage IIIA/B or stage IV NSCLC to compare two palliative radiotherapy regimens - a short course, two treatments of 8 gray (Gy) of radiation each, with a long course, 10 treatments of 3 Gy each. They found that the long course better eased symptoms over time and improved 1-year survival compared with the short course.
However, that study did not take into account the higher costs of the longer treatment and the continued medical costs of the patients who survive longer with their cancer. For this new study, van den Hout and colleagues conducted a cost-utility analysis of the two treatments to see which offers the best value for the money. Using data from a patient questionnaire on factors such as their mobility, ability to perform usual activities, and pain and anxiety levels, the authors calculated that quality of life was roughly equal in both treatment groups. However, because life expectancy was longer in the long-course treatment group, that group’s overall quality-of-life benefit was greater than that in the short-course group.
The researchers also estimated the costs associated with the treatment and other nontreatment costs, such as medical care for people who survived their cancer. They estimated that the lifetime societal costs of the long-course radiotherapy were $16,490 and the short-course radiotherapy costs were $11,164, a $5,326 difference. In their final calculations, the authors found that, although the dollar costs of the long-course radiotherapy were higher than those of the short course, the benefit in improved survival meant that the long-course treatment yielded benefit at an acceptable cost by current economic standards.
"In our group of poor-prognosis non-small-cell lung cancer patients, the additional costs of the protracted radiotherapy schedule were justified by longer survival rather than by improved quality of life," the authors conclude.
The authors point out that their study does not show that long-course radiotherapy reduces costs. In addition, areas with limited radiotherapy facilities may find it more efficient to treat patients with the shorter course. Finally, different countries and regions may have different economic factors that influence the decision of which radiotherapy regimen to use.
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Contact:
• Leiden University Medical Center Communications Department
Citation:
• van den Hout WB, Kramer GWPM, Noordijk EM, Leer JWH. Cost-utility analysis of short- versus long-course palliative radiotherapy in patients with non-small-cell lung cancer. J Natl Cancer Inst 2006; 98:1786-94.
Note: The Journal of the National Cancer Institute is published by Oxford University Press and is not affiliated with the National Cancer Institute. Attribution to the Journal of the National Cancer Institute is requested in all news coverage. Visit the Journal online at http://jncicancerspectrum.oxfordjournals.org/.
Contact: Andrea Widener
Journal of the National Cancer Institute
Minimum Legal Age To Purchase Tobacco To Rise From 16 To 18, UK
The UK government is to raise the legal minimum age to purchase tobacco from 16 to 18 years old, Public Health Minister Caroline Flint announced today.
Raising the age of buying tobacco which will come into effect from 1 October 2007, will follow closely on the heels of the introduction of smokefree public places and workplaces on 1 July 2007. A campaign to raise awareness of the imminent change in age will be launched in the New Year.
About nine per cent of young people aged between 11 and 15 smoke, and government is determined to reduce this figure further. Raising the legal age to 18 will make it easier for retailers to spot under-age smokers and lead to a fall in the number of teenagers who get addicted to nicotine and continue to smoke into adulthood.
Bringing the legal age for the purchase of tobacco into line with that of alcohol will reinforce the dangers of smoking to young people, as well as helping retailers comply with the law. It would also bring England and Wales into line with Canada, Australia, New Zealand and the US.
Despite the reduction in the number of underage smokers from 13 per cent in 1996 to 9 per cent in 2005, tobacco is still too easy for older children and young people to buy. Only 23 per cent of those under 16 who tried to buy tobacco found it difficult to do so. Evidence shows that nearly 70 per cent of 11 to 15 year old smokers say they buy their cigarettes from small shops such as newsagents and corner shops.
Public Health Minister Caroline Flint said:
"Smoking is dangerous at any age, but the younger people start, the more likely they are to become life-long smokers and to die early. Someone who starts smoking aged 15 is three times more likely to die of cancer due to smoking than someone who starts in their late twenties.
"Buying cigarettes has been too easy for under 16s and this is partly due to retailers selling tobacco to those under the legal age.
"The law change demonstrates our determination to stop this and to reduce the number of teenagers who smoke. This, in turn, will reduce the number of people with preventable diseases and the incidence of health inequalities.
"The law change also sits well with our smokefree public spaces legislation which comes into effect from 1 July 2007, and it shows our commitment as a country to protecting our children."
The Government has made the law change after consulting with the public, the retail industry, the NHS, local authorities and other stakeholders.
Paul Ramsden, Deputy Chief Executive of the Trading Standards Institute, said:
"The Trading Standards Institute supports the change to the legal age limit on sales of tobacco. The Institute has previously called for such action based upon the growing concerns about the health risks of smoking among children and teenagers.
"The Institute also believe that changing the age of sale in line with the age limit on, for example, alcohol sales will help eliminate confusion among retailers.
"Across the country, trading standards colleagues already do an enormous amount of work to help educate and inform retailers of their responsibilities to comply with the law across the whole range of age-restricted products.
"The Trading Standards Institute believe that the change in the age of sale for tobacco, will make it more difficult for young people to purchase cigarettes."
And also from today, 1 January 2007, the NHS and government buildings will become smokefree.
The raising of the minimum age for buying tobacco from 16 to 18 will be effective from 1 October 2007.
The legal age for the purchase of tobacco products has been 16 since 1908. The current law controlling the sale of tobacco to children under 16 is set out in the Children and Young Persons Act 1933 as amended by the Children and Young Persons (Protection from Tobacco) Act 1991.
The Smoking, Drinking and Drug Use Among Young People in England Survey 2004 showed that nearly 70 per cent of 11 to 15 year old smokers say they buy their cigarettes from small shops such as newsagents and corner shops. The decision to increase the age from 16 to 18 follows a public consultation this summer. Click here to see the consultation document (PDF) Other EU countries to recently increase their minimum age for sale of tobacco products include Irelans, Malta and Spain.
The new measures will be supported with education for retailers on better compliance with underage sales law; guidance for magistrates and a communications programme for local authority enforcement.
Department of Health, UK
Oxymetazoline As An Anti-inflammatory Drug In Nose Sprays: Mode Of Action Now Clear
Scientists from the GSF - Research Center for Environment and Health in Neuherberg near Munich have shown how oxymetazoline inhibits inflammation. The active ingredient in nose sprays has so far mainly been known as a substance reducing the swelling of the mucous membrane. The GSF experts have now elucidated the exact mechanism of an anti-inflammatory effect. This is an important contribution by the GSF to the transfer of knowledge from fundamental research to practical application.
When a patient has a cold (rhinitis), the body reacts to a viral infection by showing inflammatory reactions. Oxymetazoline interferes with this process in different ways: on the one hand it inhibits the enzyme 5-lipoxygenase, which is involved in the production of proinflammatory substances - so-called leukotrienes. The scientists from the GSF Institute of Inhalation Biology have shown this in vitro, i.e. in cell-free systems, and in body cells from lung tissue (alveolar macrophages). On the other hand oxymetazoline reduces the oxidative stress due to inflammatory reactions accompanying a cold, which damages the cells. This was shown by the scientists using stress marker substances in the alveolar macrophages.
The effects mentioned occurred even with relatively low concentrations, which - as the scientists think - are achieved by nose sprays. Preliminary studies had shown that high doses of oxymetazoline can inhibit inflammation. The exact mechanisms, however, were not yet known.
“The special feature of the mode of action is that proinflammatory processes are inhibited, but anti-inflammatory processes are not influenced,” says Dr. Ingrid Beck-Speier from the Institute of Inhalation Biology of the GSF. Thus, laboratory experiments have shown that 15-lipoxygenase is not inhibited. This is an enzyme involved in the production of anti-inflammatory substances.
The GSF - Research Center for Environment and Health investigates the foundations of a medicine of the future for the development of new approaches in prevention, diagnosis and therapy. The aim is to closely link research and application. This is also what this research project, cofunded by Merck Selbstmedikation, stands for. Merck uses oxymetazoline in nose sprays.
Beck-Speier, I., Dayal, N., Karg, E., Maier, K. L., Schumann, G., Semmler, M. and Koelsch, S. M.
"Oxymetazoline inhibits proinflammatory reactions: Effect on arachidonic acid-derived metabolite"
Journal of Pharmacology and Experimental Therapeutics 316, p 843-851 (2006)
www.gsf.de/neu/Aktuelles/Presse/2006/oxymetazolin_en.php
Tuberculosis Risks For Health Workers In Developing Countries
Latent infection with tuberculosis is common and some infected people develop the active form of the disease. Health-care workers (HCWs) can become infected, develop active disease, and can pass their infection on to patients and others. Research published in PLoS Medicine shows that HCWs in developing countries are at particularly high risk. Over half were found to have latent TB.
One third of the world's population is infected with Mycobacterium tuberculosis, the bacterium that causes TB. In most people, the bug causes no health problems and it remains latent. But about 10% of infected people develop active, potentially fatal TB disease, most commonly in their lungs. More than 90% of the world's cases of TB occur in low- and middle-income countries. The researchers Rajnish Joshi at University of California Berkeley and colleagues conducted a systematic review, which involved a comprehensive search for studies that had collected data on TB infection in health-care workers in these countries. Averaged out over the 51 studies which they found, 54% of health workers had latent TB. The TB disease rates in health-care workers were also substantially higher than those in the general population of the same countries.
In high-income countries, measures are in place to reduce the TB infection risk faced by health workers. In contrast, most of the hospitals in the studies found by the researchers reported no or minimal TB control measures. The researchers say that research is needed to establish whether the control measures that have reduced TB transmission to health workers in high-income countries will work elsewhere, and whether they will be affordable.
"Tuberculosis among health-care workers in low- and middle-income countries: A systematic review"
Joshi R, Reingold AL, Menzies D, Pai M
(2006) PLoS Med 3(12): e494.
LINK TO ARTICLE ONLINE
About PLoS Medicine
PLoS Medicine is an open access, freely available international medical journal. It publishes original research that enhances our understanding of human health and disease, together with commentary and analysis of important global health issues. For more information, visit http://www.plosmedicine.org
About the Public Library of Science
The Public Library of Science (PLoS) is a non-profit organization of scientists and physicians committed to making the world's scientific and medical literature a freely available public resource. For more information, visit http://www.plos.org
Underground (subway) Air Might Cause DNA Damage
Our everyday environments are full of airborne particles that are harmful to varying degrees when inhaled. Particularly damaging to our cellular DNA are the particles from the underground system in Stockholm, Sweden, according to a new doctoral thesis from Karolinska Institutet.
“Luckily, most of them do not remain in the underground for any length of time,” says scientist Hanna Karlsson. “However, particle levels are often very high. My results show that there is every reason to speed up the work being done to clean the air in the underground.”
Every year, some 5,300 Swedes die premature deaths from inhaling the microscopic particles of coal, asphalt, iron and other materials that pollute the city’s air. These particles, which are the result of incomplete combustion, road surface attrition, etc. could be reduced if the right steps were taken; the problem is that it is not known which particle sources pose the greatest threat to human health.
To build up a picture of which particles are the most harmful, Dr Karlsson has compared how particles from a variety of sources affect cultured lung cells. The results, which are presented in her thesis Particularly harmful particles show that particles from the Stockholm underground are much more damaging to cellular DNA than the other sources tested (e.g. wood smoke and cars).
The airborne particles in the underground system largely comprise iron, and are formed by the abrasion of the train wheels against the rails. The damage is caused when these particles enter the body and form free radicals in the body’s cells. Free radicals are highly reactive molecules that can prove harmful to the cell’s DNA; although such damage can often be repaired by the cell, it can sometime remains untreated, and this increases the risk of cancer.
Another type of particle that stood out in the studies was that caused by the friction between car tyres and the road surface. The report shows that these particles trigger a powerful inflammatory response (i.e. a general defence reaction in the body). Levels of these particles are particularly high in the spring, when road surfaces dry out and cars are still fitted with studded winter tyres.
“It’s a serious problem, as these particles exist in large concentrations in environments that people remain in for long periods,” says Dr Karlsson.
Apart from particles from the underground and the roads, the study also examined those released by the combustion of wood, pellets and diesel. None of the other types of particle tested were totally harmless. Modern wood- and pellet-burning boilers gave off much fewer emissions than old ones, but the particles produced were no less harmful.
Karolinska Institutet is one of the leading medical universities in Europe. Through research, education and information, Karolinska Institutet contributes to improving human health. Each year, the Nobel Assembly at Karolinska Institutet awards the Nobel Prize in Physiology or Medicine. For more information, visit http://www.ki.se.
Language Styles
British English
Underground refers to the underground, urban train system.
Subway вЂ" a pedestrian tunnel used for crossing streets and city squares
American English
Underground refers to anything that is under the ground вЂ" not a train system.
Subway refers to the underground, urban train system.
http://diss.kib.ki.se/2006/91-7140-972-6
Change In Guidelines Could Help Eliminate TB In U.S.
To eliminate tuberculosis (TB) in the United States, current guidelines should be changed to reclassify all foreign-born residents from high-incidence countries as "high-risk," regardless of the amount of time they have lived in the U.S.
These findings appear in the first issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Kevin P. Cain, M.D., of the Division of Tuberculosis Elimination at the Centers for Disease Control and Prevention in Atlanta, and seven associates collected data on all 2004 TB cases listed in the U.S. National TB Surveillance database. The investigators’ aim was to understand why the number of annual cases of TB reported in U.S.-born persons declined by 93 percent from 1993 to 2004, while foreign-born cases increased by five-percent.
"For example, in 2004, a total of 14,517 cases of TB were reported," said Dr. Cain. "Of these, 3,444 or 24 percent were foreign-born persons who had entered the United States more than five years previously."
Present guidelines recommend only those residing in the U.S. for five years or less be targeted for tuberculin skin testing and treatment of latent TB infection.
The following countries of origin of U.S. immigrant residents had the largest number of TB cases in 2004: Mexico (1,976), Philippines (829), Vietnam (619), India (557), China (352), Haiti (248), South Korea (219), Guatemala (190), Ethiopia (169) and Peru (159).
"Twenty-five percent of all reported TB cases in the United States are among foreign-born persons who have lived in the U.S. for more than five years," said Dr. Cain. "There is no policy to test foreign-born persons for latent TB infection before entering the U.S., or to test them after they have lived here for more than five years. As such, present guidelines do not currently address the burden of latent TB infection in the foreign-born subgroup."
According to the authors, the goal of TB control efforts in the U.S. is eliminating the disease. They define elimination as less than one case reported per million in a given population. If achieved, the number of TB cases diagnosed in 2004 would have been less than 300, as contrasted to the 14,517 reported.
"Until we address the burden of latent TB infection in the foreign-born group, achieving TB elimination will not be possible," said Dr. Cain.
He noted that controlling and eliminating TB will require a comprehensive strategy, with varying approaches for immigrant populations from high-risk countries.
Founded in 1905, the American Thoracic Society is the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 18,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.
American Thoracic Society
61 Broadway, 4th Floor
New York, NY 10006-2755
www.thoracic.org
See you at ATS 2007-the 103rd International Conference, May 18-23 San Francisco, CA
Cough And Phlegm Cause Fourfold Increase In COPD Incidence
Young adults (ages 20 to 44) with normal lung function who later develop chronic cough and phlegm have a fourfold higher risk of developing chronic obstructive pulmonary disease (COPD).
The results of this 10-year respiratory study appear in the first issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Isa Cerveri, M.D., of the Division of Respiratory Diseases at San Matteo Hospital and University of Pavia in Italy, and 19 associates showed that the presence of chronic cough and phlegm among study participants was an independent and statistically significant predictor of COPD. Of the 5,002 individuals in the study cohort, 123 were diagnosed with COPD. All participants had normal lung function at baseline.
COPD is the fourth leading cause of death in the United States, killing 122,283 Americans in 2003. It results from chronic bronchitis and emphysema, two lung diseases which frequently co-exist and cause obstruction to airflow that interferes with normal breathing. Smoking is the primary cause of COPD.
“In a large international cohort of individuals from ages 20 to 44, the 10-year cumulative incidence of COPD was 2.8 percent,” said Dr. Cerveri. “It was 4.6 percent in adults aged 40 to 44. This finding points out that COPD is a major health problem even in young adults who are usually not considered to be at risk. In agreement with previous research, we found that the progression toward airflow obstruction is a continuous and gradual process, where sudden changes are extremely unlikely.”
Among the study group, about 77 percent of the 123 COPD cases were smokers. In the sample as a whole, about 55 percent smoked.
The authors noted their results confirm that, from a public health perspective, the prevention of smoking and smoking cessation are the most effective strategies to deter the occurrence of COPD and reduce its burden.
“Our results show that the presence of chronic cough and phlegm is not an innocent symptom, but is an early marker of airflow obstruction,” said Dr. Cerveri.
In addition to cough and phlegm in participants, researchers considered such factors as sex, age, dyspnea (breathlessness), smoking habits and level of education. All participants received lung function tests and blood workups at the beginning and end of the study.
In an editorial on the research in the same issue of the journal, JГёrgen Vestbo, M.D., of Hvidovre University Hospital in Denmark and the University of Manchester in the United Kingdom, wrote: “The virtue of the study by Drs. Cerveri and colleagues lies in its size and thus the ability to calculate estimates with acceptable reliability. In this respect, it adds to previous work from the same group and indicates that the statement вЂ˜15 percent of smokers will develop COPD’ is wrong and that lifetime risk of COPD in smokers is significantly higher, probably about 35 to 50 percent.”
He continued: “The predictive value of chronic cough and phlegm is probably more surprising given the fact that this cohort was young and had normal lung function at baseline.”
Dr. Vestbo concluded: “How does the study impact our understanding of the natural history of COPD? As recently reported in this journal, it has taken the respiratory community a painstakingly long time to do properly sized studies in young adults with sound methodology and state-of-the-art analysis. With COPD epidemiology growing in the European Community Respiratory Health Survey and other cohorts of young adults, we may get a better picture of early events in COPD---although our colleagues in pediatric epidemiology will probably continue to claim that we are still only looking at вЂ˜the elderly’!”
Founded in 1905, the American Thoracic Society is the world’s leading medical association dedicated to advancing pulmonary, critical care and sleep medicine. The Society has more than 18,000 members who prevent and fight respiratory disease around the globe, through research, education, patient care and advocacy.
American Thoracic Society
61 Broadway, 4th Floor
New York, NY 10006-2755
www.thoracic.org
See you at ATS 2007-the 103rdВ International Conference, May 18-23 San Francisco, CA
7 Things To Know About Preventing, Treating Winter Laryngitis
With most cases of viral laryngitis occurring during the winter cold and flu season, a vocal health expert at the University of Michigan Health System is offering tips for preventing and treating the inflammation of the voice box.
"The type of voice change that can accompany the common cold and upper respiratory infection is something that is quite common, and I’m sure most everyone has experienced it at some point in their life," says Norman D. Hogikyan, M.D., F.A.C.S., director of the U-M Health System’s Vocal Health Center and associate professor of otolaryngology and music.
Hogikyan notes that viral laryngitis is contagious and passes the same way as common colds and flu bugs. He suggests ways to avoid getting laryngitis in the first place, ways to treat it and not to aggravate it further, and offers suggestions for caring for your voice even when it’s healthy.
7 things to know about laryngitis
Viral laryngitis is contagious as contagious, in fact, as a typical upper respiratory infection, Hogikyan says. "Avoiding getting viral laryngitis is really accomplished through the same ways you avoid getting a cold or a bug, and that means things like hand washing and avoiding direct contact with somebody who already has a cold or respiratory infection."
Causes of other types of laryngitis include acid reflux, which can cause an inflammation in the vocal cords; bacterial infections; fungal or yeast infections; smoking; chemical irritants; and even excessively loud or prolonged use of the voice.
Symptoms of a viral infection with laryngitis can include hoarseness, swollen glands in the neck and sometimes fever.
Treatment for viral laryngitis focuses on limiting the amount of injury caused to the voice, Hogikyan notes. "We can’t necessarily affect the viral infection itself, but we can try to limit the amount of irritation that it will cause to the voice, or, even more importantly, we can limit further injury that might occur by pushing the voice at a time when it’s already hoarse," he says. The best advice, he says, is to rest your voice during this time.
Another important aspect of treatment is hydration. Drink a lot of water and non-caffeinated beverages, Hogikyan says, because "moist is always good for the voice." A humidifier may also help.
Drinking warm beverages and gargling salt water don’t have any specific medicinal benefit, but they can feel soothing and comforting, Hogikyan says. "Also, having a good comfort level in your throat will prevent you from maybe using some voice or throat muscles in a way that might be more straining," he notes.
While most viral laryngitis cases get better without lasting damage, some can lead to further health problems, such as vocal cord bleeding or the development of a "hemorrhagic polyp," a lesion on the vocal cords. The risk for further problems is increased by not resting your voice when you have laryngitis.
Hogikyan is a proponent of caring for your voice even when not caring for conditions such as laryngitis. Most people take their voices for granted until they have a problem, he notes.
"It’s important for you to take care of your voice all of the time," he says. "It is your natural instrument."
He recommends staying well hydrated, not screaming or yelling, using microphones and other amplification when speaking or performing in front of a crowd, not smoking, using good breath support when you speak by filling your lungs with air regularly, and warming up the voice before using it with exercises such as tongue trills and humming.
For more information, visit these Web sites
Vocal Health Center at the University of Michigan Health System http://www.med.umich.edu/oto/vocalhealthcenter
UMHS Health Tips A-Z: Laryngitis http://www.med.umich.edu/1libr/aha/aha_chronlar_crs.htm
MedlinePlus Medical Encyclopedia, information about laryngitis from the National Institutes of Health and U.S. National Library of Medicine http://www.nlm.nih.gov/medlineplus/ency/article/001385.htm
University of Michigan Health System
2901 Hubbard St., Ste. 2400
Ann Arbor, MI 48109-2435
United States
http://www.med.umich.edu/
After Drug-resistant Tuberculosis, Now XDR
Studies of extensively drug-resistant (XDR) tuberculosis in an HIV-positive population in Kwazulu-Natal in South Africa have shown alarmingly high mortality rates.
If this were to become a durable phenomenon, the progress made year after year against tuberculosis could be jeopardized, not only as regards tuberculosis control, but also HIV/AIDS, as together they form a fearsome enemy.
World Health Organization (WHO)
Aerovance Announces Positive Top-Line Results From Phase 2a Trial Of Inhaled AEROVANT(TM) In Asthma Patients
Aerovance, Inc. today announced positive top-line results from a Phase 2a trial of inhaled AEROVANT(TM) in asthma patients.
The 30-patient antigen challenge study met its primary endpoint of reducing the severity of late asthmatic response by a statistically significant 72 percent (p<0.001) compared to baseline following the twice- daily use of inhaled AEROVANT(TM) (IL-4 and IL-13 antagonist) for 27 days. The study also met the secondary endpoint of decreasing the forced expiratory nitric oxide in patients, indicating a reduction in airway inflammation. Aerovance plans to present the full study results at a scientific conference later this year.
"These are very promising data that show the clear-cut effects of inhaled AEROVANT(TM) in asthma patients," said Rick Fuller, M.D., Ph.D., Aerovance's executive vice president and chief operating officer. "Through the inhibition of the IL-4 and IL-13 receptors, AEROVANT(TM) targets the mechanism that is one of the root causes of asthma and other atopic diseases. We plan to initiate a Phase 2b study with a dry powder inhalation formulation in uncontrolled asthma patients later this year."
Mark Perry, Aerovance's executive chairman, added: "We are pleased with the results of this study and look forward to advancing our development of AEROVANT(TM). Based on these data, we are initiating strategic partnership discussions for this product."
Conducted in London, the Phase 2a trial was a randomized, double-blind, parallel-group, placebo-controlled study designed to assess the safety and efficacy of a 28-day treatment course of inhaled AEROVANT(TM). Thirty patients with mild to moderate asthma were randomized to receive 60 mg of nebulized AEROVANT(TM) or volume-matched placebo administered twice daily.
AEROVANT(TM) is a recombinant human IL-4 variant that is a potent inhibitor of both the IL-4 and IL-13 receptors. Aerovance acquired the worldwide rights to the drug candidate when the company was formed as a spin-out of Bayer Pharmaceuticals Corp. in 2004.
Aerovance, Inc. is a Berkeley, Calif.-based biopharmaceutical company focused on the development and commercialization of breakthrough therapies for the treatment of respiratory and inflammatory diseases. For more information, visit http://www.aerovance.com.
Aerovance, Inc.
http://www.aerovance.com
In-shell Vaccine For Chick Disease
Infectious bronchitis virus (IBV) causes losses of ВЈ23.6M a year to the UK poultry industry but scientists are now developing a new way to vaccinate chicks against the disease one that can be delivered while they are still in their egg.
A pre-hatching prototype vaccine virus which provides immunity to IBV has been developed by scientists at the Institute for Animal Health (IAH) and vaccine company Intervet UK. It can be delivered to chicks still in the egg (in-ovo) using robotic 'vaccinators'.
IBV is the worst infectious disease in terms of economic loss to the UK poultry industry. Infection can lead to severe respiratory disease, dramatically reduce egg production and affect the quality and hatchability of eggs.
The researchers, funded by the Biotechnology and Biological Sciences Research Council (BBSRC), Department of the Environment, Food and Rural Affairs (Defra) and Intervet UK, used a 'reverse genetic' system to produce new vaccine strains. Existing strains, which are usually delivered by less efficient spray or drinking water dosage, can prevent chicks hatching if delivered in the egg.
The scientists have extracted a so-called spike protein from a pathogenic virus strain which triggers an immune response, and incorporated it into a harmless non-pathogenic strain. Dr Paul Britton, Head of the Coronavirus Group at IAH Compton, explained, "This hybrid virus was able to induce immunity when inoculated before hatching. When hatched chicks were exposed to the virulent M41 strain, we observed protection rates of up to 100 percent. With the UK poultry industry sustaining losses of ВЈ23.6M a year to infectious bronchitis virus we hope that our research could have a real impact on improving yields for UK farmers."
"We are currently trying to modify the vaccine further, in collaboration with Intervet, to make it suitable for commercial use," said Dr Britton.
Professor Julia Goodfellow, Chief Executive of BBSRC, said: "BBSRC research into endemic UK animal disease has the potential to save UK farmers and consumers millions of pounds each year. IBV is one of the severe animal diseases that BBSRC supports research into, and the work at the Institute for Animal Health shows real promise in delivering tangible improvements on the farm."
The Biotechnology and Biological Sciences Research Council (BBSRC) is the leading funding agency for academic research and training in the biosciences at universities and institutes throughout the UK.
Biotechnology and Biological Sciences Research Council (BBSRC)
http://www.bbsrc.ac.uk
Should Smokers Be Refused Surgery? BMJ
Last year a primary care trust announced it would take smokers off waiting lists for surgery in an attempt to contain costs. In this week's BMJ, two experts go head to head over whether smokers should be refused surgery.
Denying operations is justified for specific conditions, argues Professor Matthew Peters from the Concord Repatriation General Hospital in Australia.
Professor Peters says that smoking up to the time of any surgery increases cardiac and pulmonary complications, impairs tissue healing, and is associated with more infections.
These effects increase the costs of care and also mean less opportunity to treat other patients, he writes. In healthcare systems with finite resources, preferring non-smokers over smokers for a limited number of procedures will therefore deliver greater clinical benefit to individuals and the community.
He believes that, as long as everything is done to help patients to stop smoking, it is both responsible and ethical to implement a policy that those unwilling or unable to stop should have low priority for, or be excluded from, certain elective procedures.
But Professor Leonard Glantz from Boston University School of Public Health believes it is unacceptable discrimination. "It is astounding that doctors would question whether they should treat smokers," he says.
"Doctors should certainly inform patients that they might reduce their risks of post-surgical complications if they stop smoking before the procedure. But should the price of not following the doctor's advice be the denial of beneficial surgery?"
Cost arguments are made to support the discriminatory non-treatment of smokers. But why focus our cost saving concerns on smokers? Patients are not required to visit fitness clubs, lose 25 pounds, or take drugs to lower blood pressure before surgery. And many non-smokers cost society large sums of money in health care because of activities they choose to take part in.
Discriminating against smokers has become an acceptable norm, he writes. It is shameful for doctors to be willing to treat everybody but smokers in a society that is supposed to be pluralistic and tolerant. Depriving smokers of surgery that would clearly enhance their wellbeing is not just wrong - it is mean, he concludes.
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Contact: Catherine Binnie
BMJ-British Medical Journal
'Red Tide Toxins' Leave Beachgoers Breathless
The ecological phenomenon, known as Florida red tide, can be harmful for people with asthma. Florida red tides, an annual event in areas along the Gulf of Mexico, are blooms of the ocean organism, Karenia brevis (K brevis), that are concentrated along shorelines and produce highly potent aerosolized toxins. New research reported in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), shows that Florida red tide toxins (known as brevetoxins) can impact respiratory function and increase respiratory symptoms in patients with asthma.
"In the normal population, inhaled aerosolized red tide toxins can lead to eye irritation, rhinorrhea, nonproductive cough, and wheezing. However, these symptoms usually subside after leaving beach areas," said study author Lora E. Fleming, MD, PhD, University of Miami Rosenstiel School of Marine and Atmospheric Science, Miami, FL. "Our study shows that Florida red tide toxins may have a greater impact on patients with asthma, who experienced respiratory problems and decreased lung function after just one hour of beach exposure to the toxins."
Dr. Fleming and a team of researchers from seven academic, environmental, and government institutions evaluated the exposures and effects of aerosolized Florida red tide brevetoxins in 97 subjects with asthma. Participants, who were all residents of Sarasota, FL, spent at least one hour at Sarasota's Siesta Beach during active K brevis bloom (exposure period) and during a period when there was no bloom (nonexposure period). Detailed baseline information was collected, and all participants underwent pre- and post-beach evaluations, including medical history questionnaires, nasal swab sampling, and lung function testing (spirometry). Each participant also carried a personal air monitor while at the beach. Throughout exposure and nonexposure periods, researchers collected water and air samples and monitored air temperature, relative humidity, and wind speed and direction.
During active K brevis bloom exposure periods, significant differences were found for all participants between pre- and post-beach report of symptoms and pre- and post-spirometry. During exposure periods, participants reported a significant increase in symptoms, predominantly chest tightness, and differences were measured objectively on lung function testing. In contrast, no significant differences were observed between pre- and post- beach symptoms or spirometry during nonexposure periods.
Researchers further evaluated subpopulations based on area of residence and the use of asthma medication within 12 hours prior to the study. Inland residents were more likely than coastal residents to be severe asthmatics and had more reported symptoms and decreased respiratory function after toxin exposure. However, inland residents had higher baseline spirometry scores, compared with coastal residents, suggesting that coastal residents were already affected by the toxins through their environmental residential exposure even prior to study exposure, and, therefore, reacted less to the one-hour beach exposure. Furthermore, participants who reported using asthma medication within 12 hours prior to the study had similar post-exposure differences in spirometry and respiratory symptoms compared with those who did not use medication - even though a sheep model asthma study indicated that these medications have been shown to block the effects of the Florida red tide toxins.
"It is possible that coastal residents, who had less of a reaction to the toxins, have learned not to get exposed or may use more asthma medications to deal with red tides," said study coauthor Barbara Kirkpatrick, EdD, Mote Marine Laboratory, Sarasota, FL. "People with asthma, whether residents or tourists, need to be aware of the Florida red tides and their potential to exacerbate asthma, as well as their own personal reaction to Florida red tides." Florida residents and tourists can stay informed of Florida red tide conditions by checking with local environmental groups, including the Florida Department of Health and the Florida Marine Research Institute.
Other institutions that participated in the National Institute of Environmental Health Sciences (NIEHS)-funded study include Centers for Disease Control and Prevention, Atlanta, GA; Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; Florida Department of Health, Tallahassee, FL; Harbor Branch Oceanographic Institution, Fort Pierce, FL; Lovelace Respiratory Research Institute, Albuquerque, NM; and the University of North Carolina, Wilmington, NC.
"Environmental asthma triggers, such as Florida red tide, can greatly impact the health of patients with asthma," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "It is important for patients with asthma or other chronic respiratory illness to understand their personal limitations regarding red tide toxins and take steps to reduce exposure during times when red tide levels are at their highest."
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at http://www.chestjournal.org. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org .
American College of Chest Physicians
http://www.chestnet.org
Annual Gulf Coast Phenomenon May Trigger Respiratory Symptoms
The ecological phenomenon, known as Florida red tide, can be harmful for people with asthma. Florida red tides, an annual event in areas along the Gulf of Mexico, are blooms of the ocean organism, Karenia brevis (K brevis), that are concentrated along shorelines and produce highly potent aerosolized toxins. New research reported in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians (ACCP), shows that Florida red tide toxins (known as brevetoxins) can impact respiratory function and increase respiratory symptoms in patients with asthma.
"In the normal population, inhaled aerosolized red tide toxins can lead to eye irritation, rhinorrhea, nonproductive cough, and wheezing. However, these symptoms usually subside after leaving beach areas," said study author Lora E. Fleming, MD, PhD, University of Miami Rosenstiel School of Marine and Atmospheric Science, Miami, FL. "Our study shows that Florida red tide toxins may have a greater impact on patients with asthma, who experienced significant respiratory problems and decreased lung function after just one hour of beach exposure to the toxins."
Dr. Fleming and a team of researchers from seven academic, environmental, and government institutions evaluated the exposures and effects of aerosolized Florida red tide brevetoxins in 97 subjects with asthma. Participants, who were all residents of Sarasota, FL, spent at least one hour at Sarasota's Siesta Beach during active K brevis bloom (exposure period) and during a period when there was no bloom (nonexposure period). Detailed baseline information was collected, and all participants underwent pre- and post-beach evaluations, including medical history questionnaires, nasal swab sampling, and lung function testing (spirometry). Each participant also carried a personal air monitor while at the beach. Throughout exposure and nonexposure periods, researchers collected water and air samples and monitored air temperature, relative humidity, and wind speed and direction.
During active K brevis bloom exposure periods, significant differences were found for all participants between pre- and post- beach report of symptoms and pre- and post- spirometry. During exposure periods, participants reported a significant increase in symptoms, predominantly chest tightness, and differences were measured objectively on lung function testing. In contrast, no significant differences were observed between pre- and post- beach symptoms or spirometry during nonexposure periods.
Researchers further evaluated subpopulations based on area of residence and the use of asthma medication within 12 hours prior to the study. Inland residents were more likely than coastal residents to be severe asthmatics and had more reported symptoms and decreased respiratory function after toxin exposure. However, inland residents had higher baseline spirometry scores, compared with coastal residents, suggesting that coastal residents were already affected by the toxins through their environmental residential exposure even prior to study exposure, and, therefore, reacted less to the one-hour beach exposure. Furthermore, participants who reported using asthma medication within 12 hours prior to the study had similar post-exposure differences in spirometry and respiratory symptoms compared with those who did not use medication - even though a sheep model asthma study indicated that these medications have been shown to block the effects of the Florida red tide toxins.
"It is possible that coastal residents, who had less of a reaction to the toxins, have learned not to get exposed or may use more asthma medications to deal with red tides," said study coauthor Barbara Kirkpatrick, EdD, Mote Marine Laboratory, Sarasota, FL. "People with asthma, whether residents or tourists, need to be aware of the Florida red tides and their potential to exacerbate asthma, as well as their own personal reaction to Florida red tides." Florida residents and tourists can stay informed of Florida red tide conditions by checking with local environmental groups, including the Florida Department of Health and the Florida Marine Research Institute.
"Environmental asthma triggers, such as Florida red tide, can greatly impact the health of patients with asthma," said Mark J. Rosen, MD, FCCP, President of the American College of Chest Physicians. "It is important for patients with asthma or other chronic respiratory illness to understand their personal limitations regarding red tide toxins and take steps to reduce exposure during times when red tide levels are at their highest."
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Other institutions that participated in the National Institute of Environmental Health Sciences (NIEHS)-funded study include Centers for Disease Control and Prevention, Atlanta, GA; Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH; Florida Department of Health, Tallahassee, FL; Harbor Branch Oceanographic Institution, Fort Pierce, FL; Lovelace Respiratory Research Institute, Albuquerque, NM; and the University of North Carolina, Wilmington, NC.
CHEST is a peer-reviewed journal published by the ACCP. It is available online each month at http://www.chestjournal.org/. The ACCP represents 16,500 members who provide clinical respiratory, sleep, critical care, and cardiothoracic patient care in the United States and throughout the world. The ACCP's mission is to promote the prevention and treatment of diseases of the chest through leadership, education, research, and communication. For more information about the ACCP, please visit the ACCP Web site at http://www.chestnet.org/.
Contact: Jennifer Stawarz
American College of Chest Physicians
March 5, 2007
ICU Quality Measure Easily Biased
New research suggests that the standardized mortality ratio (SMR), the outcome-based measure of intensive care unit (ICU) performance, may be easily biased. Overall, an SMR greater than one indicates a higher than expected mortality and less than one indicates a lower than expected mortality. However, researchers from the University of Washington in Seattle speculated how hospital transfers might affect the SMR. A baseline SMR of 1.06 В± 0.19 was calculated for 85 ICUs and compared with an adjusted SMR that was based on a simulation of a set number of patients being transferred out of the ICU alive. In the simulation, increasing the number of transfers by 2 percent and 6 percent over baseline decreased the SMR by 0.10 В± 0.03 and 0.14 В± 0.03, respectively. In addition, results showed that transferring as few as one patient out of the ICU per month can create a bias greater than 0.1 in 27 ICUs. Researchers conclude that a greater understanding of the factors affecting the SMR is needed before it should be widely used to benchmark ICU outcomes.
This study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Contact: Jennifer Stawarz
American College of Chest Physicians
Beta Blockers Reduce Severity Of Central Sleep Apnea
Beta blockers, commonly used to treat high blood pressure and other heart conditions, may help to control central sleep apnea (CSA) in patients with congestive heart failure (CHF). Japanese researchers examined the relationship between use of beta blockers and severity of CSA in 45 patients with CHF and CSA. Results showed that patients using beta blockers (n=27) had lower apnea-hypopnea index (AHI) and central apnea index (CAI) scores than those not using beta blockers (n=18). AHI and CAI were also negatively correlated with the dose of the beta blocker carvedilol. In addition, no use of beta blockers was independently associated with CAI. Researchers conclude that beta blocker therapy may dose-dependently suppress CSA in patients with CHF.
This study appears in the January issue of CHEST, the peer-reviewed journal of the American College of Chest Physicians.
Contact: Jennifer Stawarz
American College of Chest Physicians
Use Of Corticosteroid Inhalers For The Treatment Of Asthma And COPD To Increase
Decision Resources, one of the world's leading research and advisory firms focusing on pharmaceutical and healthcare issues, finds that the use of corticosteroid inhalers will increase for the treatment of asthma and chronic obstructive pulmonary disease (COPD).
"Despite their criticisms of primary care physicians' use of inhaled corticosteroids, 39% of pulmonologists forecast that they will increase their use of these agents for treating COPD, presumably in large part because of the results of the TORCH study," said Decision Resources analyst Madhuri Borde, Ph.D. "For the treatment of asthma, physicians and experts concur that, over the next two years, they will likely increase their use of single-agent corticosteroid inhalers. Single-agent inhalers are becoming seen as the most appropriate first-line agent, though Advair use in this segment will continue to increase as well."
The findings come from two new reports from Decision Resources: Treatment Algorithms in Asthma and Treatment Algorithms in COPD. Information from the reports will be presented in a webinar on January 17th entitled "Using Patient-Level Data to Quantify Lines of Therapy within the Asthma and COPD Markets." For more information on how to attend the webinar, please contact Liz Marshall of Decision Resources at 781-296-2563.
About Treatment Algorithm Insight Series
Decision Resources combines in-depth primary research with the most extensive claims-based longitudinal patient-level data from PharMetrics(R) to provide exceptional insight into physicians' prescribing trends and the factors that drive therapy product choice, from diagnosis through multiple courses of treatment, for a specific disease.
For each disease examined, Decision Resources' Treatment Algorithm Insight Series provide the following:
-- Summary of U.S. medical practice based on interviews with leading experts in the field
-- Qualitative diagnosis/referral/treatment algorithm for the United States
-- Drug usage by lines of therapy (1st, 2nd, 3rd line)
-- Discussion of key freeform combinations by lines of therapy
-- Product share (class and specific compound level) within each line of therapy (1st, 2nd, 3rd line)
-- Progression of therapy from key 1st line products
-- Pathway to key therapies from previous therapies
-- Qualitative analysis of two-year forecast incorporating upcoming launches, changes in reimbursement, etc.
About Decision Resources
Decision Resources, Inc., (http://www.decisionresources.com) is a world leader in healthcare market research publications, advisory services, and consulting designed to help clients shape strategy, allocate resources, and master their chosen markets.
All company, brand, or product names contained in this document may be trademarks or registered trademarks of their respective holders.
Decision Resources, Inc.
http://www.decisionresources.com
New Diagnostics Help Fight Tuberculosis - FIND And Hain Lifescience Plan Worldwide Demonstration Projects
The Foundation for Innovative New Diagnostics (FIND) and Hain Lifescience (Hain) announced today that the Hain "GenoType® MTBDR plus" test, a new improved molecular test for multidrug-resistant tuberculosis (MDR-TB), has been approved in Europe and that they have signed an agreement to begin large-scale demonstration projects of the test in high burden countries.
The announcement came just two months after an initial agreement between FIND and Hain Lifescience to fast-track the development of a new tool to address the recent outbreaks of MDR-TB and extensively drug resistant tuberculosis (XDR-TB). In the case of MDR-TB, the TB-bacilli are resistant to rifampicin and isoniazid, two of the most important drugs used to treat TB. XDR-TB organisms are also resistant to at least three "second-line" TB drugs used when "first-line" treatment has failed.
The new Hain "GenoType® MTBDR plus" test, which is CE marked, can be used both on culture-based isolates and directly on smear positive sputum samples from patients with pulmonary TB. Preliminary data suggest that the test can detect at least 90% of MDR-TB cases in only a few hours. Conventional methods of detecting drug resistance can take as long as two to three months to produce results. Consequently, this new test may revolutionize TB diagnostics.
According to the World Health Organization, two billion people or one-third of the world's total population are infected with the TB bacillus. Nearly nine million people develop TB disease each year, and an estimated 5,000 people die of the disease every day. TB is also the main cause of death among persons with HIV-infection. In Africa, Asia and Eastern Europe tuberculosis is becoming a major threat to public health and economy as it affects mostly young adults in their productive years.
"Efficient medical treatment depends on rapid and reliable diagnostics at an affordable price", says David Hain, General Manager of Hain Lifescience. "With FIND we are happy to have a partner who will help us to successfully roll out our "GenoType® MTBDR plus" test in high endemic regions of the world. We are very confident that we can soon supply local TB laboratories with our new test as well as with the required training and service. It is needed."
FIND will now organize and manage the new demonstration trials planned to be implemented in South Africa, Russia, Uzbekistan and Nepal, exemplifying its role as bridge between industry and the health system of developing countries. As part of the agreement, both Hain Lifescience and FIND have worked to make this test affordable for countries who are most affected by the disease.
"It is imperative to introduce effective and inexpensive tools as soon as possible for diagnosing MDR-TB, and by extension, XDR-TB, before this epidemic reaches unfathomable proportions," said Dr Giorgio Roscigno, FIND CEO. "We look forward to collaborating with Hain Lifescience on these demonstration trials."
These projects are expected to begin in the first quarter of 2007.
About FIND
The Foundation for Innovative New Diagnostics (FIND) is a non-profit Swiss foundation based in Geneva. Its purpose is to support and promote the health of people in developing countries by sponsoring the development and introduction of new but affordable diagnostic tools for poverty related diseases. FIND's current donors include the Bill & Melinda Gates Foundation, USAID, the European Union and the Dutch Government.
For more information: http://www.finddiagnostics.org
About Hain Lifescience
Hain Lifescience GmbH is an innovative manufacturer and supplier of modern diagnostic systems. The Hain assays are based on the DNA•Strip® technology, a robust and reliable method for routine diagnostics of disease-associated polymorphisms, microbiological species differentiation and resistance determination. Founded and managed by the brothers David and Tobias Hain in 1986, Hain Lifescience has grown to 60 specialized employees in Nehren, Germany.
For more information: http://www.hain-lifescience.de
Race To Accelerate TB Drug Development
Each year, tuberculosis kills nearly two million people while an estimated nine million develop the disease - with the hardest-hit areas in AIDS-afflicted developing nations. One of the most pressing challenges is the increase in drug-resistant TB. "No Time to Wait: Overcoming Gaps in TB Drug R&D," a symposium -В organized by the international medical humanitarian organization Doctors Without Borders/MГ©decins Sans FrontiГЁres (MSF) and supported by Howard P. Milstein and Weill Cornell Medical College's Abby and Howard P. Milstein Program in Chemical Biology - will bring together a wide range of infectious disease experts and organizations to discuss practical ways of overcoming the current bottlenecks in TB drug research and development.
В В В В В The event takes place today and tomorrow at the Cornell Club in Manhattan and will feature an introductory address by Howard P. Milstein, a member of the Board of Overseers of Weill Cornell Medical College and trustee emeritus and presidential councilor of Cornell University.
В В В В В В В В "An additional 450,000 new cases of multidrug-resistant TB are seen every year, including people recently diagnosed with particularly lethal new resistant strains," says Mr. Milstein. "We must urgently find new ways of developing new treatments, including fast-tracking clinical trials of promising anti-TB compounds as well as funding strategies for TB research and development initiatives."
В В В В В The drugs in today's standard TB treatment were developed in the 1950s and 1960s, and the most commonly used TB test - developed more than a century ago - manages to detect TB in only about half of the cases. Existing TB drugs and tests are even less adapted for use in people who also have HIV/AIDS. To respond to the devastating impact of TB, especially in developing countries, newer medicines will urgently need to get to patients by working with regulatory agencies, drug development initiatives and pharmaceutical companies to ensure fast-track clinical development and availability of new drugs.
В В В В В Other participating institutions and government agencies include the World Health Organization, National Institute of Allergy and Infectious Diseases (NIAID) /National Institutes of Health (NIH), Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), GlaxoSmithKline, Novartis AG, Johns Hopkins University Bloomberg School of Public Health, Bill and Melinda Gates Foundation, Columbia University, Rockefeller Foundation, European and Developing Countries Clinical Trials Partnership (EDCTP), Brazilian Society of Respiratory Diseases, St. George's Hospital Medical School of London, Global Alliance for TB Drug Development, University of Illinois at Chicago, Institute for Tuberculosis Research University of Illinois at Chicago, Yale Law School, Drugs for Neglected Diseases Initiative (DNDi), Tibotec, Denver Health and Hospitals, Treatment Action Group, and the Consumer Project on Technology.
В В В В В In June 2006, the Milsteins donated $7.25 million to Weill Cornell Medical College to establish the Abby and Howard P. Milstein Chemistry Core Facility and the Abby and Howard P. Milstein Program in Chemical Biology of Infectious Disease.
В В В В В Howard Milstein is Chairman of New York Private Bank and Trust, as well as Co-Chairman, President and CEO of Emigrant Savings Bank. He serves as a Trustee of Cornell University, where he received his undergraduate degree in 1973. He has been a member of the Board of Overseers of Weill Cornell Medical College since 1989. The Milstein family has a long history of generosity in support of Weill Cornell. Over the years, Mr. Milstein has been a strong supporter of the Medical Center's neuroscience initiatives and its Cabaret! benefit events.
The Joan and Sanford I. Weill Medical College
The Joan and Sanford I. Weill Medical College - located in New York City - is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine. The Medical College, which is a principal academic affiliate of NewYork-Presbyterian Hospital, offers an innovative curriculum that integrates the teaching of basic and clinical sciences, problem-based learning, office-based preceptorships, and primary care and doctoring courses. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research in such areas as stem cells, genetics and gene therapy, geriatrics, neuroscience, structural biology, cardiovascular medicine, AIDS, obesity, cancer and psychiatry - and continue to delve ever deeper into the molecular basis of disease in an effort to unlock the mysteries behind the human body and the malfunctions that result in serious medical disorders. Weill Cornell Medical College is the birthplace of many medical advances - from the development of the Pap test for cervical cancer to the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., and most recently, the world's first clinical trial for gene therapy for Parkinson's disease. Weill Cornell's Physician Organization includes 650 clinical faculty, who provide the highest quality of care to their patients.
Joan and Sanford I. Weill Cornell Medical College
525 East 68th Street, Box 144
New York, NY 10021
http://www.med.cornell.edu
http://www.nyp.org
Asthma Sufferers Favor Quick Relief Over Long-term Control
People who currently have asthma are much more likely to rely on drugs that offer quick relief for symptoms such as shortness of breath, wheezing, or coughing, than medications for long-term control, according to the latest News and Numbers issued by the Agency for Healthcare Research and Quality.
Approximately 31 percent of sufferers say that they use quick-relief medications to control symptoms of asthma, compared with about 14 percent who rely on longer-term preventive medicines for control. Another 31 percent use both types of medications and 24 percent use none.
The federal study further found that among people whose asthma was active when surveyed:
More than one-fourth reported having a peak flow meter at home for measuring their ability to expel air from their lungs.
Nearly half (48 percent) of adults said they had at least one asthma attack within the previous 12 months.
Women were more likely to have asthma attacks than men 50 percent versus 40 percent
AHRQ, a part of the U.S. Department of Health and Human Services, works to improve the quality, safety, efficiency and effectiveness of health care in the United States. The data in this AHRQ News and Numbers comes from the Agency's Medical Expenditure Panel Survey, a highly detailed source of information on the health services that Americans use, how frequently they use them, the cost of these services, and how they are paid.
For more information on this AHRQ News and Numbers see Asthma Treatment and Management among the U.S. Civilian Noninstitutionalized Population, 2004,MEPS Statistical Brief # 152.
Agency for Healthcare Research and Quality (AHRQ)
540 Gaither Rd.
Rockville, MD 20850
United States
http://www.ahrq.gov/
Life Enhancing Drug Denied To People With Asthma In Scotland
People living with severe asthma in Scotland look set to be denied access to a potentially life enhancing treatment today.
The Scottish Medicines Consortium (SMC), which advises NHSScotland on new treatments, is expected to issue advice against Xolair on the grounds of cost.
Asthma UK Chief Executive Donna Covey said: 'Xolair has been proved to be safe and effective and to transform people's lives. For people with difficult to control asthma who can't get their symptoms under control with existing drugs, Xolair offers the possibility of living free from the fear of a severe asthma attack.
'One in ten people in Scotland with severe asthma symptoms say that once a week they have an asthma attack so severe they cannot speak. One in five is seriously concerned that the next asthma attack will kill them. This drug is the only hope that some people currently have, and to take it away from them on the grounds of cost is unjust and inhumane.
'We estimate the treatment of asthma across the UK costs the NHS about ВЈ889 million a year, to say nothing of the emotional cost to people with asthma and their families. Caring for people after an asthma attack costs the NHS 3.5 times more than caring for those whose asthma is well managed.'
Xolair was licensed for use in the UK in 2005 and is given as an 'add-on therapy' in a fortnightly injection for people with asthma that is severe, persistent and allergic. People with this type of asthma may find it so debilitating that they are unable to work or do normal things such as climbing the stairs, gardening or housework.
Maria Murray of Asirus, a support group for people with asthma in rural Scotland said: 'People living in rural areas can take hours to get to hospital following an attack and by the time the ambulance reaches them, it may be too late. We're not asking for this drug to be made available to everyone but if it can make a difference to a select group of people then surely that is worth the cost?'
While Xolair will not be available in Scotland, Asthma UK will continue to campaign for people with asthma who would benefit from Xolair. The situation in England and Wales depends on the decision of the National Institute for Health and Clinical Excellence (NICE), which is due to announce its decision later this year.
1. 390,000 people in Scotland are currently receiving treatment for asthma (1 in 13) and 197,000 of these have severe asthma symptoms
2. Omalizumab (Xolair) is the first in a new generation of drugs for allergic asthma. People with severe allergic asthma often have an immune system that is overactive. Xolair helps balance the immune system by bringing down levels of the antibody immunoglobulin (IgE).
3. Asthma UK is the charity dedicated to improving the health and wellbeing of the 5.2million people with asthma in the UK. Asthma UK works with people with asthma, healthcare professionals and researchers to develop and share expertise to help people increase their understanding and reduce the effect of asthma on their lives.
Visit the Asthma UK website asthma.org.uk
The Effect Of Sodium Intake On Asthma
Dr Lyn Smurthwaite, Research Development Manager at Asthma UK comments: 'Reducing salt in our diets is thought to be beneficial for many reasons and the possibility that it may improve asthma symptoms is something Asthma UK is keen to explore. We are delighted to be currently funding a trial by Dr Fogarty into the longer-term effects of a reduced salt diet on asthma symptoms.
'For several reasons previous research has shown that eating lots of fresh foods can help to reduce symptoms in some people with asthma and we also know that many processed foods contain high levels of salt. With this in mind we would encourage people with asthma to eat a healthy diet of fresh foods that are likely to contain lower levels of salt.'
Visit the Asthma UK website asthma.org.uk
Asthma UK Provides Helping Hand For Pharmacists
Asthma UK is to launch a new resource pack in January to support community pharmacists in England and Wales in helping people with asthma to have a better understanding of their medicines.
The pack, produced in association with PSNC and MIMS, will provide information and advice for pharmacists undertaking Medicine Use Reviews for people with asthma as well as helping people with asthma to understand their medicines. The resource pack will also help to identify any problems they are experiencing, offering possible solutions and includes a supporting leaflet on 'Advice from your pharmacist'.
Over 10,700 packs will be issued to pharmacies throughout England and Wales along with 75,000 leaflets, which will also be available in Welsh. Inhaler technique, asthma medicines and symptoms and triggers as well as advice on what to do in the event of an asthma attack are amongst the key topics explained.
Simon Selo, Assistant Director, Service Development at Asthma UK comments: 'People with asthma have told us that they find MURs incredibly helpful in understanding and managing their asthma more effectively. We hope this pack will both encourage and support community pharmacists to undertake more reviews in the future and encourage people with asthma to seek advice about their condition from their local pharmacist.'
Alastair Buxton, Head of NHS Services at PSNC added: 'We are very pleased to have worked with Asthma UK on the development of this pack. MURs make a big difference to people with asthma, helping them manage their medicines more effectively.'
The packs will be distributed by PSNC to pharmacies in mid January. Most packs will be mailed direct to pharmacies, but some multiple chains will receive bulk deliveries which will then be distributed by internal mail systems.
The 'Advice from your pharmacist' leaflet is to be given prior to the MUR.
Asthma UK is the charity dedicated to improving the health and well-being of the 5.2 million people in the UK who have asthma. We work with people with asthma, healthcare professionals and researchers to develop and share expertise to help people increase their understanding and reduce the effect of asthma on their lives.
Visit the Asthma UK website asthma.org.uk
White Blood Cells In Lung Produce Histamine Seen In Allergies
In a surprise finding, scientists have discovered that histamine, the inflammatory compound released during allergic reactions that causes runny nose, watery eyes, and wheezing, can be produced in large amounts in the lung by neutrophils, the white blood cells that are the major component of pus.
Pus, a fluid found in infected tissue, is produced as a result of inflammation.
The study in mice is the first to show that lung neutrophils can produce histamine in significant quantities, according to principal investigator George Caughey, MD, chief of pulmonary/critical care medicine at the San Francisco VA Medical Center.
"Previously it was thought that the primary sources of lung histamine, in health as well as disease, was mast cells, which are classically associated with allergy," notes Caughey, who is also a professor of medicine at the University of California, San Francisco.
Caughey says the result could mean that histamine acts as a link between airway infections and asthma and bronchitis, which are associated with allergy. "In both, we observe inflammation - swelling, blood vessel leak, and muscle contraction that narrows the airway."
The study appears in the January 2007 issue of the Journal of Experimental Medicine.
Caughey was investigating the well-known fact that upper respiratory infections often trigger acute asthma attacks. "We hypothesized that an infection in the airway would release histamine from mast cells, and that would be one of the reasons," he explains.
To test the hypothesis, Caughey and his team exposed two different populations of mice to mycoplasma, a common respiratory infection in rodents and humans. One population had a genetic abnormality that causes a total lack of mast cells; the other population was made up of normal, wild-type mice. Both populations of infected mice developed pneumonia.
"We thought the mice without mast cells would do better than the wild-type mice, because the infection wouldn't be provoking mast cells to release histamine," recalls Caughey. "In fact, they did much worse. Even though there were no mast cells, histamine levels rose up to 50 times normal."
The reason was straightforward, Caughey says. Neutrophil numbers increased in response to infection, and neutrophils in turn produced histamine. "It's a direct effect of the mycoplasma bacteria on neutrophils. They induce neutrophils to produce the enzyme that produces histamine."
Individual neutrophils produce much less histamine than individual mast cells, says Caughey, but "because pus contains millions if not billions of neutrophils, the overall amount they make is very considerable."
The neutrophil-histamine effect was similar in the wild-type mice, reports Caughey: "Histamine levels from neutrophils blew right past the histamine levels contributed by mast cells."
The wild-type mice suffered less severe infections overall because "as a number of recent studies, including ours, have shown, mast cells actually play a role in protecting against bacteria," Caughey explains. "For example, a mouse without mast cells with the equivalent of a ruptured appendix will die of the resulting infection, while a mouse with mast cells can survive."
When the infected mice without mast cells were given antihistamines, the level of histamine, and therefore the severity of the pneumonia, dropped in proportion to the amount of antihistamine given.
"This is a study in mice, so we cannot freely extrapolate the results to human beings," cautions Caughey. "Nonetheless, antihistamines may deserve more of a look as therapeutic options in lung and airway infection."
He says the study also has implications for other types of airway infection "in which there are a lot of white blood cells -cystic fibrosis, for example, which can be associated with asthma-like airway contraction."
The next steps for Caughey and his research team are to investigate "how general this result might be. Does only one type of bacteria cause the effect, or do others, also? Is it limited to rodents, or does it carry forward to humans? And if it does, is the amount of histamine produced by neutrophils enough to make a clinical difference?"
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Co-authors of the study were Xiang Xu, MD, PhD, Dongji Zhang, MD, PhD, Hong Zhang, PhD, Paul J. Wolters, MD, Nigel P. Killeen, PhD, Brandon M. Sullivan, Richard M. Locksley, MD, and Clifford A. Lowell, MD, PhD, of UCSF.
The study was supported by funds from the National Institutes of Health, the Diamond Family Foundation, and an Elizabeth Nash memorial fellowship from Cystic Fibrosis Research, Inc. A part of the NIH funds was administered by the Northern California Institute for Research and Education.
NCIRE is the largest research institute associated with a VA medical center. Its mission is to improve the health and well-being of veterans and the general public by supporting a world-class biomedical research program conducted by the UCSF faculty at SFVAMC.
SFVAMC has the largest medical research program in the national VA system, with more than 200 research scientists, all of whom are faculty members at UCSF.
UCSF is a leading university that advances health worldwide by conducting advanced biomedical research, educating graduate students in the life sciences and health professions, and providing complex patient care.
Contact: Steve Tokar
University of California - San Francisco
Review Study Finds Association Between Tobacco Smoking And Increased Risk Of Tuberculosis
Tuberculosis (TB) is an infectious disease that causes an estimated 2 million deaths each year. The majority of those deaths occur in developing countries, home to more than 900 million of the world's 1.1 billion smokers. In addition, about half of the world's people cook and heat their homes with coal and biomass fuels such as wood, animal dung and charcoal, which generate indoor air pollution. In a new study, researchers from the Harvard School of Public Health (HSPH) undertook a systematic review and meta-analysis of epidemiologic data to quantitatively assess the association between smoking, passive smoking and indoor air pollution and TB. They found consistent evidence that smoking is associated with an increased risk of TB; they also found that passive smoking (secondhand smoke) and the burning of biomass fuels was associated with an increased TB risk.
The study appears online on January 16, 2007, in the open-access journal PLoS Medicine.
"The evidence suggests that, when compared to non-smokers, smokers have about double the risk of tuberculosis. The implication for global health is critical," said Megan Murray, associate professor of epidemiology at HSPH. "Since tobacco smoking has increased in developing countries where TB is prevalent, a considerable portion of the global burden of TB may be attributed to tobacco. Importantly, this also implies that smoking cessation might provide benefits for global TB control in addition to those for chronic diseases."
The HSPH researchers, Hsienho Lin, graduate student, Majid Ezzati, associate professor of international health and Megan Murray, associate professor of epidemiology, reviewed studies from 1950 to early 2006 that explored the association between smoking, passive smoking and indoor air pollution and TB infection, disease and mortality. All the studies involved people with TB or at risk from TB. After initially identifying 1,397 papers for potential inclusion, the authors selected 38 that met their criteria for the final analysis.
The researchers found that, compared with non-smokers, smokers have an increased risk of having tuberculosis infection, of having active TB disease, and of dying from the disease. They also found evidence of an association between passive smoking and indoor air pollution and an increased risk of TB, though the evidence was more limited due to a substantially smaller number of studies. The researchers advocate larger rigorously designed studies in the future to substantiate that association.
"Our findings suggest that information on people's exposure to respirable pollutants from sources such as smoking and biomass use will help TB detection efforts. Additionally, TB control programs may benefit from including interventions aimed at reducing tobacco and IAP exposure, especially among those at high risk for exposure to infection," said Ezzati.
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"Tobacco Smoke, Indoor Air Pollution and Tuberculosis: A Systematic Review and Meta-Analysis," Hsienho Lin, Majid Ezzati, Megan Murray, PLoS Med 4(1): e20.
This review was supported by The International Union Against Tuberculosis and Lung Disease through a grant from the World Bank.
In a related study, Ezzati and collaborators from the Chinese Center for Disease Control and Prevention authored the first assessment of the community effectiveness of stove and behavioral interventions for reducing indoor air pollution exposure in China. This study found that ventilated heating stoves were effective in reducing indoor air pollution but there was limited benefit from alternative cooking stoves. Health behavior education alone, without increased access to alternative fuels and stoves, did not reduce indoor air pollution. The authors argue that reducing the burden of various infectious and chronic respiratory diseases for billions of people exposed to indoor smoke from cooking and heating requires investment in distributing alternative fuels.
"Community Effectiveness of Stove and Health Education Interventions for Reducing Indoor Air Pollution From Solid Fuels in Four Chinese Provinces," Zheng Zhou, Yinlong Jin, Fan Liu, Yibin Cheng, Jiang Liu, Jiaqi Kang, Gongli He, Ning Tang, Xun Chen, Enis Baris and Majid Ezzati, Environmental Research Letters 1: 014010 (2006)
Contact: Todd Datz
Harvard School of Public Health
Novel Approach To Cancer Drug Given Major Boost
Scientists at the ProXara Biotechnology Limited have identified a way of switching off one of the key mechanisms that leads to the development and growth of a tumour. Under the Wellcome Trust's Seeding Drug Discovery initiative, the researchers hope to use their findings to develop a drug which could be used to fight cancer. The funding will be used to develop the drug to a point at which it is close to entering a clinical trial.
All cells in the body contain protein kinase B (PKB), a naturally-occurring enzyme that if active prevents cells from committing suicide. Programmed cell death, or apoptosis, is an important process in the body's development, but when this process goes wrong, unregulated cell growth occurs, leading to the development of tumour cells.
Recent research has shown that certain types of genetic damage, common to many cancer cells, lead to the movement of PKB from the interior of the cell to its surface membrane. When PKB attaches to the surface membrane, it becomes active, triggering a signal that tells the cell not to commit suicide. Professor Jeremy TavarГ© at ProXara Biotechnology Ltd, a spin-out company at the University of Bristol, believes that by preventing PKB binding to the cell's surface membrane, he can ensure that apoptosis occurs, thus killing the cancer cells.
"There has been a lot of interest in targeting PKB as a way of preventing tumour growth," says Professor TavarГ©. "Most of the interest so far has been in developing drugs that block the enzyme's signal. However, such drugs are very non-specific and can have many adverse side effects. We are working on a novel approach to prevent PKB actually binding to the cell membrane."
Professor TavarГ© and his team have discovered a drug-like compound, which prevents PKB binding to the cell membrane and makes the tumour cells commit suicide. They now wish to develop this compound to a point at which it could be used in clinical trials.
"Professor TavarГ©'s research offers a novel approach to cancer drug research," says Dr Ted Bianco, Director of Technology Transfer at the Wellcome Trust, which is funding the research under its Seeding Drug Discover initiative. "Cancer affects very large numbers of people which is why it receives so much attention from those engaged in medical research. But it is a complex disease to tackle and as a result many of the current anti-cancer drugs have unpleasant side -effects. This work has the potential to provide a more targeted approach to drug therapy with fewer adverse effects."
Professor TavarГ© says that the drug would be used initially to target lung cancer, the most common cancer in the UK. Almost 38,000 people are diagnosed with this particular cancer each year. If the approach works it could be adapted to treat other types of cancer or even inflammatory diseases such as arthritis or asthma.
"We anticipate that a drug based on this approach may benefit a significant proportion of people with lung cancer," explains Professor TavarГ©. "As well as developing the drug itself, we are also working on a way of identifying which individuals are most likely to respond to the drug."
This targeted therapy is based on five years of research by Professor TavarГ© and Dr Paul England. The research has now been given a major boost by way of a ВЈ2.8 million award to the University of Bristol under the Wellcome Trust's Seeding Drug Discovery initiative. The initiative aims to bridge the funding gap in early-stage drug discovery, assisting researchers to take forward projects in small molecule therapeutics that will be the springboard for further R&D by the biotech and pharmaceutical industry.
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Contact: Craig Brierley
Wellcome Trust
March 4, 2007
Exacerbations In Severe COPD Reduced By Combination Therapy
For patients with severe chronic obstructive pulmonary disease (COPD), combining a long-acting bronchodilator with an inhaled corticosteroid reduced the number of exacerbations by 35 percent.
The research appears in the second issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Peter Kardos, M.D., of the Respiratory Medicine Section of Maingau Hospital in Frankfurt am Main, Germany, and three associates treated patients with moderate to severe COPD from 92 respiratory centers across Germany. All had less than a 50 percent predicted lung function capability for their age group.
The researchers treated 487 patients with salmeterol, a long-acting bronchodilator, and gave 507 a combination therapy of salmeterol and fluticasone propionate, an inhaled corticosteroid. Of the total cohort, 792 patients completed all phases of the 44-week study.
In the combined therapy group, 324 patients experienced moderate to severe exacerbations, as compared to 464 in the control group. The authors believe that this reduction in exacerbations is likely of clinical importance for patients with severe COPD.
"Exacerbations are a major cause of disease-related problems," said Dr. Kardos. "In particular, they greatly contribute to the decline of the health-related quality of life, increase symptoms and breathlessness, speed progression of the disease and increase the risk of mortality. In addition, exacerbations induce enormous economic costs. They can occur at any stage of the disease, but become more frequent as lung function impairment worsens."
In the United States, COPD is the fourth leading cause of death, killing 122,283 Americans in 2003. In 2004, more than 11 million U.S. adults were estimated to suffer from the disease, which results from chronic bronchitis and emphysema, two lung diseases that frequently co-exist and interfere with normal breathing. Smoking is the primary cause of COPD.
To date, no medication has been effective in halting long-term decline in lung function, which is the hallmark of the disease. Medications can only be used to provide relief from symptoms and prevent complications.
In an editorial on the research in the same issue of the journal, Dennis E. Niewoehner, M.D., and Timothy J. Wilt, M.D., of the Veterans Affairs Medical Center and the University of Minnesota, wrote: "As in all previous large inhaled corticosteroid (ICS) trials, Dr. Kardos administered relatively high doses of flutacasone. High dose ICS causes localized adverse effects in the upper airway and on the skin, but only infrequently do these complications cause discontinuation of therapy."
"Of greater concern is the systemic absorption of small amounts of ICS and the potential for long-term sequelae, particularly involving the bones and eyes," the editorialists continued. "The largely elderly population of patients with COPD may be at greater risk, and, as discussed in a recent review, the extent of the relationship between long-term ICS and bone and eye complications has yet to be fully clarified."
"Dr. Kardos and associates identify an additional safety concern with ICS not mentioned in previous publications. Based on adverse event reporting, 23 cases of pneumonia occurred in the combined-treatment group compared with only seven in the salmeterol arm. This difference is statistically significant and represents an excess pneumonia rate of about 3 per 100 patient years in patients given fluticasone."
The authors noted that similar results were obtained in patients who received fluticasone in TOwards a Revolution in COPD Health (TORCH), a survival study that aimed to determine the impact of salmeterol/fluticasone propionate combination and the individual components on the survival of COPD patients.
"In light of the known immunosuppressive properties of corticosteroids, an excess pneumonia rate from a high local concentration of ICS is not particularly surprising," the editorialists wrote.
The authors also pointed out that only a small minority of patients treated with ICS would achieve "clinically noticeable improvement in health status."
They concluded: "Therefore, decisions to initiate ICS combined with a long-acting beta agonist should focus on severely symptomatic and exacerbation-prone patients and balance the recently demonstrated benefits against increased drug costs and adverse effects."
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Contact for study:
Peter Kardos, M.D.,
Group Practice and Center for Respiratory and Sleep Medicine, Allergy,
Maingau Hospital,
Scheffelstrasse 33, 60318,
Frankfurt am Main,
Germany
Contact for editorial:
Dennis E. Niewoehner, M.D.,
Chief, VA Medical Center,
Pulmonary Section (111N), 1 Veterans Drive,
Minneapolis, MN 55417
Contact: Suzy Martin
American Thoracic Society
Low-Dose Aspirin Lowers Risk Of Asthma Diagnosis
In a large, randomized, placebo-controlled study of 22,071 healthy male physicians, taking a low-dose of aspirin every other day lowered the risk of receiving an initial asthma diagnosis by 22 percent.
These findings, based on data from the double-blind Physicians' Health Study, appear in the second issue for January 2007 of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society.
Tobias Kurth, M.D., Sc.D., of the Division of Aging at Brigham and Women's Hospital in Massachusetts, and five associates studied physicians, ages 40 to 84, over a period of 4.9 years. Among the 11,037 individuals who took aspirin, 113 new cases of asthma were diagnosed, as contrasted to 145 in the placebo group.
Asthma is a chronic inflammatory disease that causes potentially reversible obstructive lung problems. Breathing difficulties from asthma usually occur during "attacks," which involve narrowing of the airways, swelling of the lining, tightening of respiratory muscles and an increased secretion of mucus. In 2004, more than 20 million Americans were estimated to have asthma.
"Aspirin reduced the risk by 22 percent of newly-diagnosed adult-onset asthma," said Dr. Kurth. "These results suggest that aspirin may reduce the development of asthma in adults. They do not imply that aspirin improves symptoms in patients with asthma."
"Indeed, asthma can cause severe bronchospasm in some patients who have asthma," he continued. "Because asthma was not the primary endpoint of the U. S. Public Health Service study, additional randomized trials would be helpful to confirm the apparent reduction in asthma incidence caused by aspirin."
The Physicians Health Study, which began in 1982, was terminated after 4.9 years when results showed a 44-percent reduction in the risk of a first heart attack among those randomly assigned to aspirin.
"Physicians could self-report an asthma diagnosis on questionnaires at baseline, at six months and annually thereafter," said Dr. Kurth. "Asthma was not the original deductive endpoint of the trial."
According to the authors, the 22-percent lower risk of newly-diagnosed asthma among those assigned to the low-dose aspirin group was not affected by participant characteristics like smoking, body mass index or age.
They noted that aspirin-intolerant asthma, a problem in which aspirin exacerbates the disease, affects only a small minority of asthma patients. In three large population-based studies, that difficulty affected only four to 11 percent of the groups. In children, however, the proportion affected by aspirin intolerant asthma was significantly smaller.
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Contact: Suzy Martin
American Thoracic Society
Spanish Flu Gives Clues To Deadliness Of Avian Flu
By infecting monkeys with Spanish flu, an international team of scientists think they may have discovered clues as to why the H5N1 Avian flu virus is so deadly to humans.
The scientists report their findings in the current issue of Nature.
The 1918 flu, or "Spanish flu" as it became known, killed over 50 million people worldwide. This latest discovery could help to understand the early progress of the H5N1 Avian flu virus and to develop treatments for the deadly disease which, according to the World Health Organization, has so far killed 63 per cent (161 out of 267) of the people it has infected.
The latest study is the first to examine the effect of the 1918 flu virus in primates. Previous studies have been performed in mice, where it was shown to be highly infectious and lethal.
In this study, which was carried out in Canada, the scientists infected 7 monkeys (macaques) with a reconstructed version of the 1918 flu virus and observed the progress of the illness. They showed symptoms of infection within 24 hours of exposure.
The illness progressed rapidly and within 8 days of exposure the monkeys had such acute respiratory distress that they had to be euthanized.
The 1918 virus was reconstructed from genes recovered from tissue samples that had been preserved from the 1918 pandemic.
The scientists also noticed that the monkeys' normal antiviral response did not protect against the infection. It appeared that the virus itself had switched off the antiviral part of the monkeys' immune system and this lack of protection contributed to the rapid and deadly progress of the disease.
In effect, the monkeys' altered immune system mounted an attack on the respiratory system, filling the lungs with fluid.
A tentative conclusion of the study is that the higher lethality of the 1918 flu virus could be down to its ability to disable the immune system's antiviral response. This is how one virologist member of the study team, Yoshihiro Kawaoka from the University of Wisconsin-Madison, put it: "Somehow, early in infection, this virus does something to the host that allows it to grow really well. But we don't know what that is."
People infected with H5N1 avian flu virus have shown a similar immune system response and rapid progression of the infection.
It could be that the two strains share an ability to switch off the antiviral part of the immune system. If that is so, then this study has made a significant contribution to understanding the progress of the disease in humans too, and opens the door to developing treatments that can be administered in the early stages of the illness, perhaps to re-enable the weakened parts of the altered immune system.
"Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus."
Darwyn Kobasa, Steven M. Jones, Kyoko Shinya, John C. Kash, John Copps, Hideki Ebihara, Yasuko Hatta, Jin Hyun Kim, Peter Halfmann, Masato Hatta, Friederike Feldmann, Judie B. Alimonti, Lisa Fernando, Yan Li, Michael G. Katze, Heinz Feldmann and Yoshihiro Kawaoka.
Nature 445, 319-323 (18 January 2007)
doi:10.1038/nature05495
Click here for full text of article (subscription required).
World Health Organization Avian Influenza web site.
Written by: Catharine Paddock
Writer: Medical News Today
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