Health News:350 infants may have been exposed to tuberculosis ♦ Computer model could hold key to personalized epilepsy treatment ♦ Scientists learn how poxviruses defeat the body's host defense

Computer model could hold key to personalized epilepsy treatment A computer model that identifies the parts of a person's brain responsible for epileptic seizures could be used to design personalized surgical procedures.

Scientists learn how poxviruses defeat the body's host defense Research shows how smallpox, a feared bioterrorism agent, and other poxviruses overcome the defenses of their hosts. Implications of the findings extend to cancer therapy.

350 infants may have been exposed to tuberculosis in california hospital  The Santa Clara Valley Medical Center in San Jose announced December 13 that 368 mothers or parents, 308 employees, and 350 infants were possibly exposed to tuberculosis at the hospital due to an employee who was suspected of having active tuberculosis. The employee was placed on leave in mid November,

Emotion processing in brain changes with tinnitus severity People with tinnitus who are less bothered by their symptoms use different brain regions when processing emotional information, new research indicates. Tinnitus, otherwise known as ringing in the ears, affects nearly one-third of adults over age 65.

Brain Research: What is your memory style? ♦ New concussion treatment could change how head injuries are treated ♦ Six potential biomarkers for bipolar disorder identified

Six potential biomarkers for bipolar disorder identified A series of proteins that could be diagnostic markers to identify bipolar I disorder have been identified by scientists. If this discovery sample can be validated through replication these markers may help as a diagnostic tool for psychiatrists treating mood disorders.

New concussion treatment could change how head injuries are treated The standard of care for acute concussion may undergo a dramatic change, depending on the results of a new exercise treatment that physicians have developed and begun testing. It is the first randomized, controlled clinical trial of this exercise treatment for concussion

Sex differences in brain may underlie neurodevelopmental disorders more common in males Female infants have larger gray-matter volumes than males around the temporal-parietal junction of the brain, research shows. This brain region is important for processing of social information that is expressed in others' faces and voices, a function that is impaired in autism spectrum disorders (ASD), possibly helping to explain the higher risk for certain forms of ASD in males.

What is your memory style?  Why is it that some people have richly detailed recollection of past experiences (episodic memory), while others tend to remember just the facts without details (semantic memory)? A research team has shown for the first time that these different ways of experiencing the past are associated with distinct brain connectivity patterns that may be inherent to the individual and suggest a lifelong 'memory trait'.

Cancer Research: Post diagnosis aspirin improves survival in all gastrointestinal cancers ♦Drug combination improves progression-free survival in melanoma patients

Fungi may lead to cheaper cancer treatment, Cheaper anti-cancer drugs for humans might ultimately stem from a new study. Scientists have developed a kind of microbial 'bandage' that protects yew trees from disease-causing fungi. The researchers found that naturally occurring fungi in the yew's vascular system act like an immune system to swarm a wound site and protect against invading pathogens.

Drug combination improves progression-free survival in melanoma patients Patients with advanced melanoma skin cancer survive for longer without their disease progressing if they have been treated with a combination of two drugs, nivolumab and ipilimumab, than with either of these drugs alone. New results show that these patients also do better regardless of their age, stage of disease and whether or not they have a cancer-driving mutation in the BRAF gene.

Hormonal therapy may prevent ovarian failure and preserve fertility in breast cancer Young women undergoing chemotherapy for breast cancer may be more likely to remain fertile if they also receive hormonal treatment.

Combining 2 targeted therapies results in melanoma patients living significantly longer Latest results from a trial of a combination of two targeted therapies (dabrafenib and trametinib) to treat advanced melanoma have shown that patients are living significantly longer on the combined therapy than patients treated with another drug, vemurafenib, when used alone.

Post diagnosis aspirin improves survival in all gastrointestinal cancers, Aspirin improves survival in patients with tumors situated throughout the gastrointestinal tract, results from a large study show.

Cancer Research:Higher risk for robotic prostate surgery patients ♦ Revealing breast cancer using nanoscale polymers ♦ RNA splicing machinery offers new drug target

Pactamycin analogs offer new, gentler approach to cancer treatment Researchers are pursuing a new concept in treatment of cancer, by using two promising 'analogs' of an old compound that was once studied as a potent anti-tumor agent, but long ago abandoned because it was too toxic. The idea put cancer cells to sleep - lessening problems with resistance to chemotherapeutic drugs, and also the side effects of chemotherapy.

Fee-for-service health care may lead to higher risk for robotic prostate surgery patients A 'perverse disincentive' for hospitals that have invested in expensive technology for robotic surgery may be jeopardizing prostate cancer patients who seek out the procedure.

Nerve involvement explains why some cancers are very painful More than half of all cancer patients experience pain, most often associated with the malignancy type, body location and disease progression. Pain researchers report that the relationship between tumors and nerves drives persistent and breakthrough pain and tumor progression in certain types of cancers

RNA splicing machinery offers new drug target A widespread cancer-causing protein called MYC promotes the growth of tumor cells in part by ensuring that RNA transcripts are properly spliced, according to new research. Drugs that block parts of the cell's splicing machinery may provide a new way to halt the proliferation of MYC-driven cancers.

Revealing breast cancer using nanoscale polymers A biocompatible polymer selectively targets and lights up cancer tumors for a noninvasive imaging system, investigator's report. Generating photoacoustic signals requires an ultrafast laser pulse to irradiate a small area of tissue. By 'listening' to the pressure differences created by the acoustic waves, researchers can reconstruct and visualize the inner structures of complex objects such as the brain and cardiovascular systems. Diagnosing cancer with photoacoustic imaging requires contrast agents that deeply penetrate tissue and selectively bind to malignant cells.

Cancer Research:Viral gene therapy eradicates prostate cancer ♦ 80% of cervical cancers preventable ♦ Comprehensively identify anti-cancer drug targets

Discovery accelerates targeted cancer treatment When DNA is damaged, several different proteins start pouring in to repair the damage; their types depend on the damage done. Up until now, it has been common practice to study one protein at a time, but by way of so-called mass spectrometry, researchers are now able to simultaneously see all the proteins that help repair damaged DNA.

80% of cervical cancers preventable with latest 9-valent HPV vaccine The new 9-valent human papillomavirus vaccine, can potentially prevent 80 percent of cervical cancers in the United States, if given to all 11- or 12-year-old children before they are exposed to the virus. The study also found the 9-Valent vaccine, under the trademark of Gardasil-9, has the potential to protect against an additional 8 percent of oropharyngeal cancers, which include the base of the tongue and tonsils.

Study links father's age, baby's risk of blood cancer as an adult The proportion of parents who delay having children until age 35 or older continues to increase, but the long-term health consequences for these children are still emerging. A father's age at his infant's birth is linked to the risk that his child will develop blood and immune system cancers as an adult.

Using CRISPR, biologists find a way to comprehensively identify anti-cancer drug targets Imagine having a complete catalog of the best drug targets to hit in a deadly form of cancer. Imagine having a master catalog of such targets for all major cancers. Scientists have now published a method of doing precisely this, using the revolutionary gene-editing technology called CRISPR.

Advanced viral gene therapy eradicates prostate cancer in preclinical experiments Even with the best available treatments, the median survival of patients with metastatic, hormone refractory prostate cancer is only two to three years. Driven by the need for more effective therapies for these patients, researchers have developed a unique approach that uses microscopic gas bubbles to deliver directly to the cancer a viral gene therapy in combination with an experimental drug that targets a specific gene driving the cancer's growth

HIV Immunotherapy Promising in First Human Study

HIV, the virus that causes AIDS, attacks and destroys immune cells. Current treatment with antiretroviral therapy helps to prevent the virus from multiplying. But despite advances in treatment, scientists haven’t yet designed a vaccine that protects people from HIV.

HIV-infected immune cells. Image credit: Comstock /Stockbyte/Thinkstock.

Researchers have discovered many human antibodies that can neutralize multiple strains of HIV. They’ve gained important insights into how these broadly neutralizing antibodies bind to the virus and why they're effective. However, it’s been a challenge to design a vaccine that prompts the human immune system to generate such antibodies and mount an effective attack against the virus.

A team led by Dr. Michel C. Nussenzweig of the Howard Hughes Medical Institute at Rockefeller University has been exploring a different approach. In previous work, they isolated broadly neutralizing antibodies from people and produced them in the lab. These so-called monoclonal antibodies could prevent or treat infection with HIV or its monkey equivalent in mice and macaques.

In the current study, the researchers evaluated one of these promising monoclonal anti-HIV antibodies in people. The small phase 1 clinical trial included 29 volunteers—17 HIV-infected and 12 uninfected
The participants received a single intravenous dose (of 1, 3, 10, or 30 milligrams per kilogram of body weight) of the experimental antibody called 3BNC117. The antibody was well-tolerated by all participants. Among those infected with HIV, the 2 lower doses caused small and transient changes in blood HIV levels. The 8 participants who received the highest dose, however, had significant and rapid decreases in HIV. The virus’s resistance to the antibody was variable. In some people, HIV remained sensitive to 3BNC117 for 28 days.

“What’s special about these antibodies is that they have activity against over 80% of HIV strains and they are extremely potent,” says study coauthor Dr. Marina Caskey.

“In contrast to conventional antiretroviral therapy, antibody-mediated therapy can also engage the patient’s immune cells, which can help to better neutralize the virus,” adds co author Dr. Florian Klein.

This study suggests that 3BNC117 is safe in people and could help to control HIV. Future studies will continue to explore the use of this and other broadly neutralizing antibodies in HIV prevention and treatment.

Childrens Health: BPA exposure linked to autism ♦ 2 hours of TV a day increases high blood pressure ♦ Why debunked autism treatment persist ♦ Secondhand smoke risk for infants

BPA exposure linked to autism spectrum disorder, study reports  A newly published study is the first to report an association between bisphenol-A (BPA), a common plasticizer used in a variety of consumer food and beverage containers, with autism spectrum disorder (ASD) in children. Continue Reading

More than two hours of TV a day increases high blood pressure in children by 30%  A study on European children concludes that spending more than two hours a day in front of a screen increases the probability of high blood pressure by 30%. The article also points out that doing no daily physical activity or less than an hour a day increases this risk by 50%. Continue reading

Why debunked autism treatment fads persist  The communication struggles of children with autism spectrum disorder can drive parents and educators to try anything. Authors describe treatments for autism that have been attempted with little or no success.including gluten- and casein-free diets, antifungal interventions, chelation therapy, magnetic shoe inserts, hyperbaric oxygen sessions, weighted vests, bleach enemas, sheep-stem-cell injections and many more. Continue Reading

High stress for new mothers increases secondhand smoke risk for infants Mothers with a high level of prenatal social stressors -- including possibly less control over their own housing situation or economic distress -- had 2.5 times higher odds to have only a partial or no restriction on smoking in their home than those with no stressors, which increases secondhand smoke risk, a study has found. Continue Reading

Cancer Research: Popular Soda Ingredient Ups Cancer Risk--Milk proteins to treatment cancer-- Cancer treatment with new laser tech-- Drug target in certain breast and ovarian cancers

Popular Soda Ingredient Ups Cancer Risk  Public health researchers have analyzed soda consumption data in order to characterize people's exposure to a potentially carcinogenic by product of some types of caramel color. Caramel color is a common ingredient in colas and other dark soft drinks. Continue Reading

Milk proteins show promise in prevention and treatment of cancer  In a review of existing research, a team of Australian researchers found that milk proteins, consisting of short sequences called peptides, are potential candidates for the development of anticancer agents and can be generated by enzymatic action, such as those experienced during digestion or food processing, including fermentation. Their findings are in the recent issue of … Continue Reading

Potentially faster and more accurate mode of cancer treatment with new laser technology  Surgeons rely on 200-year-old technology when removing cancer -- sight and touch -- to determine how much to remove and what to leave alone. Laser technology has the promise to help a surgeon better determine if an area is cancer or healthy tissue. Moreover, when combined with laser treatment for cancer, this work lays the groundwork for laser robotic treatment of cancer.Continue Reading

Promising drug target in certain breast and ovarian cancers Scientists indicate that the pool of patients who can benefit from the drug olaparib is potentially much wider – and offers a ready means of identifying them. Continue Reading

Novel strategy to prevent progression of inflammation-associated cancers  By targeting the specific pathological function of the 'culprit' molecule rather than inhibiting its gene expression, new approach facilitates development of cancer drugs with fewer side effects  Continue Reading

Cancer News:12 ways to cut your cancer risk ♦ Antibiotics as new cancer treatments ♦ Hepatitis-liver cancer connection ♦ New way to use electric fields to deliver cancer treatment

12 ways to cut your cancer risk

There are many more things people can do to reduce their risk for cancer. February 4 is the World Cancer Day. World Health Organization reports that 14,000,000 people are diagnosed with cancer each year and about 8,200,000 dies from cancer and its complications annually.  In the next 20 years, cases of newly diagnosed cancer are expected to increase 70% and Continue Reading

Antibiotics as new cancer treatments? Conversation with schoolgirl sparks idea

A way to eradicate cancer stem cells, using the side-effects of commonly used antibiotics, has been discovered by a University of Manchester researcher following a conversation with his young daughter. Continue Reading

Hot on the trail of hepatitis-liver cancer connection

Using whole genomic sequencing, scientists have for the first time demonstrated the profound effect that chronic hepatitis infection and inflammation can have on the genetic mutations found in tumors of the liver, potentially paving the way to a better understanding of Continue Reading

New way to use electric fields to deliver cancer treatment

A team of researchers has devised a new way to target tumors with cancer-fighting drugs, a discovery that may lead to clinical treatments for cancer patients. Called iontophoresis, the technique delivers chemotherapy to select areas.Continue Reading

1/20/15 Health News: States to Ban Powder Alcohol ♦ Food Safety Advice to Liver Transplant Recipients ♦ First medical device for obesity treatment ♦

STATES MOVE TO BAN POWDERED ALCOHOL BEFORE IT HITS THE MARKET

Lawmakers in several states want to ban a new powdered alcohol product before it’s even available on the market. “Pacohol” is the brand name for the new powdered alcohol that, when mixed with water, becomes a cosmopolitan, mojito, margarita or lemon drop cocktail. It’s the invention of Arizona entrepreneur Mark Phillips, whose company hopes to... Continue Reading

AFTER MAN’S DEATH, DOCTORS GIVE FOOD SAFETY ADVICE TO LIVER TRANSPLANT RECIPIENTS

After overseeing a routine, uneventful liver transplant in a 52-year-old man in July 2013 at a hospital in Marseille, France, Dr. Catherine Sartor and her colleagues expected him to fully recover without complications. When the patient’s liver condition began worsening five days after surgery, they suspected his body was rejecting the new organ and adjusted... Continue Reading

FDA approves first medical device for obesity treatment targeting brain-to-stomach signaling

The United States Food and Drug Administration (FDA) approved EnteroMedic’s VBLOC® vagal blocking therapy, delivered via the Maestro® System, which is the first medical device approved for obesity treatment that targets the nerve pathway between the brain and the stomach. The Obesity Society calls this a "a novel device that interrupts signals from the stomach to the brain that are believed to be involved with stomach emptying and feelings of fullness."  Continue Reading

Yak dung burning pollutes indoor air of Tibetan households

Tibet, the highest region on Earth and one of the most remote, is associated with vivid blue skies and the crystal clear air of the Himalayas. During the long cold season, however, the traditional nomadic people spend much of their time in snug dwellings where they cook and stay warm by burning yak dung. Their indoor air can be filled with dangerous levels of fine particulate matter, including black carbon, a new study finds.Continue Reading

Patient with exposure to Ebola has arrived safely at NIH Clinical Center in America

A patient with exposure to the Ebola virus in Sierra Leone has been transferred from an overseas location and admitted to the NIH Clinical Center for observation and to enroll in a clinical protocol. The patient arrived at the NIH Clinical Center on Sunday, September 28, at approximately 4 p.m. ET.

The patient is an American physician who was volunteering services in an Ebola treatment unit in Sierra Leone.

Out of an abundance of caution, the patient has been admitted to the NIH Clinical Center’s special clinical studies unit that is specifically designed to provide high-level isolation capabilities and is staffed by infectious diseases and critical care specialists. The unit staff is trained in strict infection control practices optimized to prevent spread of potentially transmissible agents such as Ebola.

No additional details about the patient are available at this time.

NIH is taking every precaution to ensure the safety of our patients, NIH staff, and the public. This situation presents minimal risk to any of them.

About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.

Don’t Leave Childhood Depression Untreated

Every psychological disorder, including depression, has some behavioral components.

Depressed children often lack energy and enthusiasm. They become withdrawn, irritable and sulky. They may feel sad, anxious and restless. They may have problems in school, and frequently lose interest in activities they once enjoyed.

Some parents might think that medication is the solution for depression-related problem behaviors. In fact, that’s not the case. The Food and Drug Administration hasn’t approved any drugs solely for the treatment of “behavior problems.” When FDA approves a drug for depression—whether for adults or children—it’s to treat the illness, not the behavior associated with it.

“There are multiple parts to mental illness, and the symptoms are usually what drug companies study and what parents worry about. But it’s rare for us at FDA to target just one part of the illness,” says Mitchell Mathis, M.D., a psychiatrist who is the Director of FDA’s Division of Psychiatry Products.

Depression Is Treatable

The first step to treating depression is to get a professional diagnosis; most children who are moody, grouchy or feel that they are misunderstood are not depressed and don’t need any drugs.

Only about 11 percent of adolescents have a depressive disorder by age 18, according to the National Institute of Mental Health (NIMH). Before puberty, girls and boys have the same incidence of depression. After adolescence, girls are twice as likely to have depression as boys. The trend continues until after menopause. “That’s a clue that depression might be hormonal, but so far, scientists haven’t found out exactly how hormones affect the brain,” says child and adolescent psychiatrist Tiffany R. Farchione, M.D., the Acting Deputy Director of FDA’s Division of Psychiatry Products.

It’s hard to tell if a child is depressed or going through a difficult time because the signs and symptoms of depression change as children grow and their brains develop. Also, it can take time to get a correct diagnosis because doctors might be getting just a snapshot of what’s going on with the young patient.

“In psychiatry, it’s easier to take care of adults because you have a lifetime of patient experience to draw from, and patterns are more obvious” says Mathis. “With kids, you don’t have that information. Because we don’t like to label kids with lifelong disorders, we first look for any other reason for those symptoms. And if we diagnose depression, we assess the severity before treating the patient with medications.”

Getting the Proper Care

The second step is to decide on a treatment course, which depends on the severity of the illness and its impact on the child’s life. Treatments for depression often include psychotherapy and medication. FDA has approved two drugs—fluoxetine (Prozac) and escitalopram (Lexapro)—to treat depression in children. Prozac is approved for ages 8 and older; Lexapro for kids 12 and older.

“We need more pediatric studies because many antidepressants approved for adults have not been proven to work in kids,” Farchione says. “When we find a treatment that has been shown to work in kids, we’re encouraged because that drug can have a big impact on a child who doesn’t have many medication treatment options.”

FDA requires that all antidepressants include a boxed warning about the increased risks of suicidal thinking and behavior in children, adolescents and young adults up to age 24. “All of these medicines work in the brain and the central nervous system, so there are risks. Patients and their doctors have to weigh those risks against the benefits,” Mathis says.

Depression can lead to suicide. Children who take antidepressants might have more suicidal thoughts, which is why the labeling includes a boxed warning on all antidepressants. But the boxed warning does not say not to treat children, just to be aware of, and to monitor them for, signs of suicidality.

“A lot of kids respond very well to drugs. Oftentimes, young people can stop taking the medication after a period of stability, because some of these illnesses are not a chronic disorder like a major depression,” Mathis adds. “There are many things that help young psychiatric patients get better, and drugs are just one of them.”

It’s important that patients and their doctors work together to taper off the medications. Abruptly stopping a treatment without gradually reducing the dose might lead to problems, such as mood disturbance, agitation and irritability.

Depression in children shouldn’t be left untreated. Untreated acute depression may get better on its own, but it relapses and the patient is not cured. Real improvement can take six months or more, and may not be complete without treatment. And the earlier the treatment starts, the better the outcome.

“Kids just don’t have time to leave their depression untreated,” Farchione says. “The social and educational consequences of a lengthy recovery are huge. They could fail a grade. They could lose all of their friends.”

Medications help patients recover sooner and more completely.

Year-round Preventive Treatment Reduces Malaria Risk in Young Children

A year-round preventive drug treatment substantially reduces young children’s risk of contracting malaria and poses no serious risk of adverse events, according to a study by researchers funded by the National Institutes of Health.

The findings demonstrate that prolonged treatment given from 6 to 24 months of age is safe and effective for young children, according to the study authors. Year-round preventive measures are badly needed in locations like Uganda, where the study took place, and where malaria rates remain high throughout the year.

Most previous studies using drug treatment to prevent malaria have been limited to areas where there is only a seasonal risk of the disease, during the rainy season, when most malaria episodes in children occur. In those studies, preventive drug treatment was given for only a few months at most. The current study demonstrated that continuous preventive treatment can substantially reduce malaria transmission to infants, who are at greatest risk of severe malaria and death.

The study was conducted by Grant Dorsey, M.D., of the University of California, San Francisco (UCSF) at San Francisco General Hospital, with colleagues from UCSF and the Infectious Diseases Research Collaboration, Kampala, Uganda, and Makerere University College of Health Sciences, also in Kampala. The researchers published their findings online in PLOS Medicine.

“This study has identified an effective measure for reducing the incidence of malaria in children living in an area with high rates of the disease,” said Lynne Mofenson, M.D., chief of the Maternal and Pediatric Infectious Disease Branch at the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), which provided funding for the study.

Dr. Mofenson said malaria poses a greater threat to children below 3 years of age than to older children. Malaria in children under age 3 is more likely to be fatal than in older children. In younger children, also, the disease may affect the brain and either prove fatal or result in brain damage.

“It’s better to try to prevent a potentially fatal illness than it is to wait until the child gets the illness and is at increased risk for dying,” Dr. Mofenson added. Older children are considered to be less at risk from malaria because they tend to develop natural immunity against the disease as they get older.

The researchers found that a monthly dose of dihydroartemisinin-piperaquine (DP) was the most effective of three antimalarial drugs at reducing malaria risk in children from 6 months to 24 months of age. The other two study drugs— monthly sulfadoxine-pyrethamine (SP) or daily trimethoprim-sulfamethoxozole (TS) — have been in use longer, and in many locations the malaria-causing parasite has developed a resistance to them. The researchers conducted the study to determine if the benefits of treatment outweighed the potential risk of anemia and other side effects from the drugs.

“When you’re giving drugs to prevent the disease, you have a much higher bar for safety,” Dr. Dorsey said. “When the drugs are given longer term, you may have an increased risk of side effects to contend with.”

Beginning at age 6 months, 393 children from Tororo, Uganda were randomized to one of four groups: monthly DP, monthly SP, or daily TS, or to a control group, which did not receive any preventive drug treatment—which is the standard medical practice in the area. Insecticide-treated mosquito bed nets are a mainstay for reducing the spread of malaria, and all of the families were given nets to put over the children when they slept. By 24 months of age, 352 children were still taking part in the study.

The researchers calculated the study results in terms of a numerical unit known as person years, which takes into account the number of individuals participating in the study and the time each person took part. (A study following 1,000 people for 1 year would contain 1,000 person years of data.) For the children in the DP group, there were 3.02 malaria episodes per person year, 5.21 for the TS group, 6.73 for the SP group, and 6.95 for the control group. Compared to the control group, children in the DP group were 58 percent less likely to develop malaria. Between the groups, there was no difference in rates of anemia and other adverse events that have been associated with the drugs used in the study.

After discontinuing the study drugs at age 24 months, the researchers followed the children until age 3 and found no difference in malaria rates between the groups. According to the study authors, the findings help to allay any concerns resulting from earlier studies that continuous drug treatment might interfere with the children’s ability to develop an immune response against malaria, and so make them more likely to get the disease after treatment stops.

“Our study showed that preventive drug treatment can greatly reduce malaria in young children in areas where there are year round high rates of transmission,” Dr. Dorsey said. “We believe that this treatment regimen will be of substantial benefit in many parts of the world in need of improved malaria control measures.”

A New Way to Treat Tuberculosis

In a new study published in Nature, scientists describe a new type of tuberculosis (TB) treatment that involves manipulating the body’s response to TB bacteria rather than targeting the bacteria themselves, a concept called host-directed therapy. TB remains a major cause of disability and death worldwide as an estimated 8.6 million people fell ill with TB and 1.3 million people died from the disease in 2012, according to the World Health Organization.

Although TB is curable, adherence to therapy is difficult as treatment requires taking antibiotic drugs for at least six months and sometimes up to two years. Poor adherence to medication and other factors have resulted in drug-resistant strains, and currently no effective TB vaccine exists.

To address the need for alternative interventions, scientists from the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, demonstrated proof-of-concept for a host-directed strategy to treat tuberculosis. They found that interleukin-1, a type of protein that regulates the body’s immune response to infection, can help protect the body from TB infection. Their studies in cells and in mice and human patients infected with TB bacteria demonstrated that interleukin-1 induces a mediator, prostaglandin E2 (PGE2), that limits the production of type-I interferons, which are associated with increased TB disease severity.

The scientists found that host-directed immunotherapy using PGE2 and zileuton, a clinically-approved drug typically used to treat asthma, prevented death in TB-infected mice. This strategy could be of particular benefit to people infected with drug-resistant TB strains who have limited options for effective antibiotics because the treatment increased bacterial control and limited disease even in the absence of TB chemotherapy. In principle, this approach is compatible with standard antibiotic regimens, according to the authors. In future studies, NIAID scientists will test adjunct host-directed therapies in TB-infected individuals.

Skin Cancer Patients Have More Treatment Options

Science is discovering new ways to attack cancer cells on different fronts. Since 2011, the Food and Drug Administration (FDA) has approved five drug treatments for melanoma and other skin cancers, giving patients more options to meet their specific needs. Today, patients have better treatments, better outcomes and a longer life.

May is Skin Cancer Awareness Month and a good time to raise awareness about innovations in cancer treatment.

Skin Cancer Rates Are Rising

There are three main types of skin cancer: basal cell carcinoma, squamous cell carcinoma and melanoma. Although less common, melanoma is the most aggressive and dangerous.

In the United States, skin cancer rates are rising. The National Cancer Institute estimates that in 2014, there will be:

• 76,100 new cases of melanoma and 9,710 deaths.
• 2 million new cases of nonmelanoma skin cancer, with fewer than 1,000 deaths.

Cancer begins in the cells. When normal cells grow old or damaged, they usually die, and new cells replace them. With cancer, new cells grow when they’re not needed, and old or damaged cells don’t die when they should—forming a mass of tissue (a growth or tumor). Skin cancer can invade normal tissue and spread throughout the body.

Treatments to remove or destroy the disease completely depend on the type and stage of cancer. Before 2011, only five drugs were approved by FDA for treating melanoma.

Most were standard chemotherapy drugs that shrank the tumors but were effective in less than 15% of patients, says Patricia Keegan, M.D., an oncologist with FDA. “Most people who took those drugs didn’t get much benefit from them,” she adds.

Since 2011, FDA has approved two melanoma drugs and one treatment combination – Zelboraf (vemurafenib), Tafinlar (dabrafenib), and Mekinist (trametinib) in combination with Tafinlar—that in clinical studies shrank tumors in about half the patients. For Zelboraf and another new melanoma drug, Yervoy (ipilimumab), patients using the drugs lived longer than if they received traditional chemotherapy, Keegan says.

New Hope for Melanoma Patients

Yervoy is a new class of immune therapy approved for treatment of patients with melanoma that cannot be removed with surgery and is not limited to melanoma with certain gene mutations. It blocks the molecule cytotoxic T-lymphocyte antigen (CTLA-4) and helps the body’s immune system to recognize, target and attack cells in melanoma tumors. Scientists have been trying to harness this ability for more than 100 years, Keegan says.

“We’ve had a lot of experience with tumor vaccines, hoping the patient’s body will attack the cancer as it would foreign bacteria. But most have been unsuccessful until now,” Keegan says.

Yervoy doesn’t actually attack the tumors. Instead, it helps the body’s white blood cells recognize tumor cells as foreign and reject them.

Zelboraf, Tafinlar and Mekinist are personalized medicines (health care customized at the molecular level) used to treat patients with melanoma whose tumors have the BRAF V600E gene mutation. They keep tumors from growing by blocking the mutated BRAF gene.

What’s driving these advancements?

“The science is targeting driver mutations—abnormal genes of cancer cells that make tumors grow uncontrollably—and designing drugs that block them,” Keegan says. “It’s not always effective because tumors often find a back door when you shut down one path. So scientists are working on multiple therapies that work together to block various pathways.”

Combating cancer growth is like building a dam to control water flowing down a hill, Keegan says. The water (or cancer) will find another path. “That’s why we need several controls working together to prevent cells from multiplying and spreading,” she explains. “If you block only one path, the cancer might find a side route.”

That’s the case with a combination drug therapy approved by FDA in January 2014. Mekinist and Tafinlar jointly treat patients with advanced melanoma that is metastatic (late stage) or can’t be surgically removed. These drugs block signaling in different sites of the same molecular pathway promoting cancer cell growth.

Another Breakthrough

FDA has also approved the first drug for treating metastic basal cell carcinoma: Erivedge (vismodegib). For a small fraction of the population, this cancer is very serious. Doctors often can’t cut out certain tumors—maybe because they’re on the face, head, nose or eyelid—and patients end up with disfiguring lesions. People with Gorlin syndrome—a rare form of skin cancer that can involve many parts of the body—are especially vulnerable because their cancer often returns or spreads.

Erivedge could give these patients options they never had before by shrinking their tumors and allowing them to control their lesions for months at a time, Keegan says.

“As oncologists, we’re still learning the best way to use Erivedge to control these really difficult lesions,” Keegan says. “The drug is effective for 30% to 40% of patients, but for them it’s a breakthrough because they have run out of options.”

Research Finds Many Youth Have High Levels of HIV

Study succeeds at early diagnosis but suggests high risk of HIV infection for youth

More than 30 percent of young males who had sex with other males and who were subsequently enrolled in a government treatment and research network were found to have high levels of HIV, reported researchers from the National Institutes of Health and other institutions.

The health status of the study participants, who ranged in age from 12 to 24 years, was monitored as part of their participation in the - Adolescent Medicine Trials Network for HIV/AIDS Interventions= (ATN). The ATN provides medical care to youth with HIV and offers counseling and, medications, and other preventive measures to youth who are at risk of acquiring HIV. As part of their participation in the network, the youth have the option of taking part in research studies of the latest methods to prevent people from acquiring HIV and to treat those who have become infected.

To conduct the current study, researchers analyzed the health records of youth with HIV, soon after they enrolled in the ATN. The study authors noted that the high blood levels of the virus seen in the majority of study participants indicated that they were diagnosed early in the course of HIV infection, when the chances for minimizing the health consequences of HIV are greatest. The researchers added, however, that the study results suggest that HIV is highly likely to be transmitted among members of this group.

“This is not a time for complacency,’’ said study author Bill G. Kapogiannis, M.D., scientific director of the ATN. “Our results suggest that all health care providers who work with young people — particularly those who work with males who have sex with other males — should stress the urgency of getting tested, and, if infected, into treatment, which benefits their own health as well as reduces transmission to others.”

According to the U.S. Centers for Disease Control and Prevention, 1 in 4 new HIV infections  occur in young people from 13 to 24 years of age. About 60 percent of all youth with HIV do not know they are infected, are not getting treated, and can unknowingly pass the virus on to others. Among the groups that the CDC recommends get tested for HIV are those:

• The network is funded by three institutes at the National Institutes of Health: The Eunice Kennedy Shriver
• Who have injected drugs and shared needles and other equipment with others
• Who have had unprotected sex with men who have sex with men, had multiple partners or anonymous partners
• Have been diagnosed with hepatitis, tuberculosis, or a sexually transmitted disease
• Had unprotected sex with someone in the above groups

To conduct the study, the researchers measured the viral load and CD4 counts of 852 youth in 14 cities in the United States and Puerto Rico. Viral load is the amount of HIV in the blood. Dr. Kapogiannis explained that viral levels are highest very early in the course of an HIV infection. CD4 counts measure infection-fighting white blood cells known as T-cells.

“In the first few weeks, the viral load can be millions of copies, or higher,” he said. “Then, over the ensuing months, it stabilizes at about 30,000 to 50,000 copies. Normal CD4 counts range from 500 to 1,000, but drop substantially during the infection.”

Among the study participants, 34 percent had CD4+ counts of 350 or less, 27 percent had counts from 351 to 500, and 39 percent had counts greater than 500. Male youth who had reported sexual contact with another male had the highest average viral load, in excess of 115,000. Among all males, regardless of sexual orientation, the viral load averaged more than 106,000. For females, the average viral load count was roughly 48,000. Most of those diagnosed with HIV had been referred for medical care during the course of the study (79 percent.)

“Men with HIV tend to have higher viral loads than do women,” Dr. Kapogiannis said. “But I think there is a timing issue here as well. It’s possible that the young men who have sex with men are being diagnosed earlier than are the women, because of greater awareness of the risks and more frequent testing.”

Because of the high viral loads they detected in their study, the researchers concluded that efforts to diagnose and treat people with HIV should focus a large share of their efforts on youth, particularly young men who have sex with men.

“It’s important to get these individuals into treatment early, not only for the sake of their own health, but also for that of others, because many youth don’t even know they are infected and may risk unknowingly transmitting the virus during this time,” Dr. Kapogiannis said.