Health,Stem Cells, and Technology

Thursday, February 23, 2012

Quantified Self: The Patient of the Future

Part of the healthcare revolution that is in our midst is the continuous quantification of a patient's data, and the patient's continuous participation in collecting, analyzing, and transmitting those data to healthcare providers. In an excellent article in MIT's Technology Review, Dr. Larry Smarr describes his quest to quantify everything about his health and how this led him to a startling discovery, an unusual partnership with his doctor, more control over his life, and improved health. Dr. Smarr, professor of engineering at UCSD, was an early pioneer of the internet who came to UCSD to direct a new institute called the California Institute for Telecommunications and Information Technology.

Since becoming involved in the quantified self movement, Smarr dropped from 205 to 184 pounds and is now a fit 63-year-old. His transformation transcends a regular exercise program and carefully managed diet: professor Smarr has become a poster man for the medical strategy of the future. During the past decade, he has gathered as much data as he can about his body and then used that information to improve his health. And he has accomplished something that few people at the forefront of the quantified self movement have had the opportunity to do.... he helped diagnose the emergence of a chronic disease in his body.
Like many "self-quanters," Smarr wears a Fitbit to count his every step, a Zeo to track his sleep patterns, and a Polar WearLink that lets him regulate his maximum heart rate during exercise. He paid 23andMe to analyze his DNA for a genetic basis of disease susceptibility. He regularly uses a service provided by Your Future Health to have blood and stool samples analyzed for biochemicals that most interest him. But a critical skill separates professor Smarr from the growing pack of digitized patients who show up at the doctor's office with megabytes of their own biofluctuations....Dr. Smarr, given a Ph.D. in physics and years of research, has an extraordinary ability to fish signal from noise in complex data sets. The bottom line, because of Smarr's data collection and analysis, and close work with Dr. Willliam Sandborn, an academic physician at UCSD, he was able to help the physicians diagnose that he has Crohn's Disease. What Smarr is pioneering today will one day become routine in the world of healthcare.

Monday, February 20, 2012

How Physicians Generate Diagnostic Hypotheses: Why Ron And Rand Paul Should Not Be Elected

In medical practice, diagnostic hypotheses are often made by physicians in the first moments of contact with patients, often before the patients report their symptoms. Studies suggest that generation of diagnostic hypotheses in this context is the result of cognitive processes subserved by brain mechanisms that are similar to those involved in naming objects or concepts in everyday life (Melo et al, 2012, PlosOne).

Twenty-five radiologists diagnosed lesions in chest X-ray images and named non-medical targets (animals such as elephants) embedded in chest X-ray images while being scanned in a fMRI session. Images were presented for 1.5 seconds; response times (RTs) and the ensuing cortical activations were assessed. The mean response time for diagnosing lesions was 1.33 (SD ±0.14) seconds and 1.23 (SD ±0.13) seconds for naming animals. 72% of the radiologists reported cogitating differential diagnoses during trials (3.5 seconds). The overall pattern of cortical activations was remarkably similar for both types of targets. However, within the neural systems shared by both stimuli, activation was significantly greater in left inferior frontal sulcus and posterior cingulate cortex for lesions relative to animals.

The studies of Melo et al show that generation of diagnostic hypotheses and differential diagnoses made through the immediate visual recognition of clinical signs can be a fast and automatic process. Many physicians are taught this top-down approach, that is, acquire a few facts, and formulate a diagnosis. Said another way, receive a few pieces of the puzzle, and extrapolate the whole picture. The co-localization of significant brain activation for lesions and animals suggests that generating diagnostic hypotheses for lesions and naming animals are served by the same neuronal systems. Nevertheless, diagnosing lesions was cognitively more demanding and associated with more activation in higher order cortical areas. These results support the hypothesis that medical diagnoses based on prompt visual recognition of clinical signs and naming in everyday life are supported by similar brain systems.

The point in the animal experiment is not to encourage us to think like the physicians in the study. Rather, the point is to show what we might be prone to do, and thereby to encourage us to resist those impulses. Do not guess. Do not just memorize patterns. Work through each problem, and fill in each step. Unless the elephant is poised to step on you, then think like a physician.

Monday, February 13, 2012

Texas Medical Board Sets Rules For Adult Stem Cell Therapy

The Texas Medical Board Friday approved a tentative policy regulating the use of adult stem cells as medical therapy.Under a policy that will come up for final approval April 13, Texas physicians would be authorized to provide autologous stem cell therapy only if an independent review committee that assesses research trials for patient safety grants permission.

Dr. Irwin Zeitler, president of the board has said the policy will afford the public protection that doesn't exist now for procedures not approved by the Food and Drug Administration. Further, the board believes that the new policy doesn't hinder progress given that hundreds of studies have shown the promise of adult stem cells for healing many indications

The board's policy will likely preclude potential conflict with the FDA, which recently began cracking down on some forms of stem cell therapy. However, stem cell therapy has a long history of working well in patients, including the decades old use of bone marrow stem cells in the treatment of cancer.

Adult stem cells, which act through two fundamental mechanisms, 1.multiplication, and 2. paracrine actions (stem cell released molecules) to replenish dying cells, have long been used to treat leukemia and other cancers, but in the last decade the cells have shown great promise for immune modulation, tissue repair, and pain relief in many other diseases.

Experimental therapies used in hospitals, typically by academic researchers, already require review committee oversight. The proposal would require physicians who want to provide adult stem cells in practice or clinics enlist what's known as an independent review board (IRB), which follow all state and federal laws involving research on human subjects. IRBs are commonly employed by academic institutions and biopharmaceutical companies when testing new therapies.

Sunday, February 12, 2012

University Of Texas Scientists Expose Fraud By Physicians At Duke University School Of Medicine

Kudos to Dr. Kevin R Coombes, Ph.D., Dr. Jing Wang, Ph.D., and Dr. Keith A Baggerly, Ph.D. for exposing the fraudulent work of Anil Potti, M.B.B.S and Joe Nevins, M.D., two Duke University physicians who falsified their data in the area of personalized medicine for cancer indications.

The Nevins and Potti team had emerged as false pioneers of personalized medicine in 2006, when Nature Medicine published their paper claiming that microarray analysis of patient tumors could be used to predict response to chemotherapy.

However, two biostatisticians at the MD Anderson Cancer Center attempted to verify this work when oncologists asked whether microarray analysis could be used in the clinic. Keith Baggerly and Kevin Coombes, the statisticians, found a series of errors, including mislabeling and an "off-by-one" error, where gene probe identifiers were mismatched with the names of genes.

Also, Paul Goldberg of The Cancer Letter reported on an investigation into Duke cancer researcher, Anil Potti,, and claims made that he was a Rhodes Scholar - in Australia. Potti was not a Rhodes scholar, and the misrepresentation was made on grant applications to NIH and the American Cancer Society.

Further, Anil Potti is apparently not an M.D., but instead possesses a bachelors degree, an M.B.B.S. degree from India. Therefore Anil Potti is a phsyician, but not a doctor. Society must understand the difference between doctors and physicians..they are not the same. Doctors have obtained the highest degree possible and use their mind to think through problems, as such doctors can be either Ph.D.s or M.D.s. Not all physicians have obtained an M.D., and therefore should not be called doctors. Anil Potti was not a doctor, rather he was simply a bachelors degree trained physician, another words he was a technician.

Our system must not pay observance to poorly trained physicians masquerading as doctors.

Inflammasome-Mediated Dysbiosis Regulates Progression Of Liver Disease And Obesity

The inflammasome is a multiprotein oligomer that is part of he immune system, designed to protect us from other organisms. A change in our probiotics, disturbed within our digestive tract and sometimes referred to as dysbiosis, has been shown to regulate a number of diseases. Non-alcoholic fatty liver disease (NAFLD) is the hepatic manifestation of metabolic syndrome and the leading cause of chronic liver disease in the Western world. Twenty per cent of NAFLD individuals develop chronic hepatic inflammation (non-alcoholic steatohepatitis, NASH) associated with cirrhosis, portal hypertension and hepatocellular carcinoma, yet the causes of progression from NAFLD to NASH remain obscure. Here, we show that the NLRP6 and NLRP3 inflammasomes and the effector protein IL-18 negatively regulate NAFLD/NASH progression, as well as multiple aspects of metabolic syndrome via modulation of the gut microbiota. Different mouse models reveal that inflammasome-deficiency-associated changes in the configuration of the gut microbiota are associated with exacerbated hepatic steatosis and inflammation through influx of TLR4 and TLR9 agonists into the portal circulation, leading to enhanced hepatic tumour-necrosis factor (TNF)-α expression that drives NASH progression. Furthermore, co-housing of inflammasome-deficient mice with wild-type mice results in exacerbation of hepatic steatosis and obesity. Thus, altered interactions between the gut microbiota and the host, produced by defective NLRP3 and NLRP6 inflammasome sensing, may govern the rate of progression of multiple metabolic syndrome-associated abnormalities, highlighting the central role of the microbiota in the pathogenesis of heretofore seemingly unrelated systemic auto-inflammatory and metabolic disorders. Thus, this dysbiosis can be passed, at least in an animal model, within the population resulting in spread of the disease within the greater population.

Monday, February 6, 2012

SRM Is Stimulated By Exercise

Although mesenchymal stem cells are found throughout the body and can differentiate into a variety of cell types, more importantly adult stem cells can facilitate tissue healing through stem cell released molecules (SRM).

In a recent study, Dr. Marni Boppart, Ph.D., a professor at the Univ Illinois, has shown that mMSCs contribute to muscle growth through the secretion of a variety of different factors (SRM) that positively impact muscle growth.  Dr. Boppart's work suggest that  stem cells respond to not only injury, but also to exercise by secreting the SRM specifically in response to mechanical strain associated with the exercise.

In addition to their finding on the effect of exercise on mMSCs, the scientists were able to define a critical role for the α7 integrin receptor (a molecule that mediates connections between cells and tissues) in mMSC accumulation, characterize the cells as predominantly pericytes, and demonstrate the regulation of cell surface expression by mechanical strain.

More and more studies show that exercise is critical to good health, age management, and the repair of tissue following injury.

Friday, February 3, 2012

San Diego Life Sciences Is Strengthened And Outpacing Nation

According to a recent BIOCOM report, employment in San Diego’s life sciences sector grew by 15 percent over the past two years, as biopharmaceutical companies, medical device companies, research institutes, and other employers added roughly 5,550 jobs here, raising employment in the sector to 41,937 in 2011. The report says overall employment in San Diego increased by 1.1 percent over the same period, gaining about 20,600 jobs to reach 1.83 million in 2011.

The 40-page economic study says San Diego’s life sciences cluster, which began with the emergence of UCSD in the 1960s and the formation of several early pioneering companies incubated by UCSD scientists in the 1970s and 80s, also is expected to outpace the nation in terms of job growth and economic impact over the next two years, as another 2,770 jobs are added by 2013. A broader analysis that includes life sciences companies in neighboring counties of Orange, Riverside, and Imperial projects the region will add more than 6,000 workers over the next two years.

Despite a significant decline in venture capital funding, the report says the four-county region of Southern California will continue to retain its high standing and competitive advantage in the life sciences. By 2013, there will be 70 percent more jobs in the life sciences in these four counties than the national average.

While venture capital funding is a key indicator of entrepreneurial activity and business formation, the report says the sharp decline in Southern California VC investments, from $1.1 billion in 2007 to $553 million in 2010, reflects the severe economic downturn and other industry trends underway nationwide.

San Diego’s strength was especially apparent in federal funding for biomedical research. Of the top 10 research institutions receiving National Institutes of Health grants in 2011, nine are in San Diego. The $835 million in grants awarded last year to San Diego scientists accounted for more than 85 percent of the grants allocated in the four-county region.

The report says the four-county life sciences cluster comprises more than 3,500 companies and employs over 97,000 people. On average, salaries range between $54,141 and $116,462, well above the national and regional averages. Including direct, indirect, and induced employment, the report says this region supports a total of 248,800 jobs that pay over $17.7 billion in wages and generate $57 billion in economic activity.

San Diego County alone accounts for 1,700 companies that employ 41,937 people. Including direct, indirect, and induced job, San Diego’s industry supports more than 106,000 jobs that pay $7.5 billion in wages and generate roughly $22 billion in overall economic activity

Wednesday, February 1, 2012

Cord Blood Stem Cells Improve Type 1 Diabetes

In the January issue of BMC Medicine, scientist at the University of Illinois have reported that Umbilical cord blood stem cells have been successful in the treatment of type 1 diabetes without putting the stem cells directly into the patient. The cord stem cells have been used to re-instruct T cells so that the pancreas will begin producing insulin again, thereby reducing the amount of injected insulin needed. According to the study, the treatment was successful in long-time diabetes patients believed to have no insulin-producing ability.
Inability to control autoimmunity is the primary barrier to developing a cure for type 1 diabetes (T1D). Evidence that human cord blood-derived multipotent stem cells (CB-SCs) can control autoimmune responses by altering regulatory T cells (Tregs) and human islet β cell-specific T cell clones offers promise for a new approach to overcome the autoimmunity underlying T1D.

The scientists developed a procedure for Stem Cell Educator therapy in which a patient’s blood is circulated through a closed-loop system that separates lymphocytes from the whole blood and briefly co-cultures them with adherent CB-SCs before returning them to the patient’s circulation. In an open-label, phase1/phase 2 study, patients (n = 15) with T1D received one treatment with the Stem Cell Educator. Median age was 29 years (range: 15 to 41), and median diabetic history was 8 years (range: 1 to 21). Stem Cell Educator therapy can markedly improve C-peptide levels, reduce the median glycated hemoglobin A1C (HbA1C) values, and decrease the median daily dose of insulin in patients with some residual β cell function (n = 6) and patients with no residual pancreatic islet β cell function (n = 6). Treatment also produced an increase in basal and glucose-stimulated C-peptide levels through 40 weeks. However, participants in the Control Group (n = 3) did not exhibit significant change at any follow-up. Individuals who received Stem Cell Educator therapy exhibited increased expression of co-stimulating molecules (specifically, CD28 and ICOS), increases in the number of CD4+ CD25+ Foxp3+ Tregs, and restoration of Th1/Th2/Th3 cytokine balance.

Stem Cell Educator therapy was safe, and in individuals with moderate or severe T1D, a single treatment produces lasting improvement in metabolic control. Initial results indicate Stem Cell Educator therapy reverses autoimmunity and promotes regeneration of islet β cells. Successful immune modulation by CB-SCs and the resulting clinical improvement in patient status may have important implications for other autoimmune and inflammation-related diseases.