New DNA technique leads to a breakthrough in child cancer research

Contact: Tommy Martinsson
tommy.martinsson@clingen.gu.se
46-31-343-4803
University of Gothenburg
Researchers at the Sahlgrenska Academy at the University of Gothenburg, Sweden and Karolinska Institutet have used novel technology to reveal the different genetic patterns of neuroblastoma, an aggressive form of childhood cancer. This discovery may lead to significant advances in the treatment of this malignant disease, which mainly affects small children.

The article is being published in the respected scientific journal, Proceedings of the National Academy of Sciences (PNAS). The study includes 165 children with neuroblastoma, most of whom developed the disease before the age of five. These children have been monitored for over 20 years by two research teams led by professors Tommy Martinsson, of the Sahlgrenska Academy, and Per Kogner of Karolinska Institutet.

Neuroblastoma is a nerve cell cancer that has defects in certain chromosomes. If the tumour has a characteristic defect on chromosome 11, it is very aggressive and difficult to cure.

“We found that the children who develop this type of neuroblastoma are twice as old at the onset of the disease as children who develop other types of neuroblastoma. This type progresses more slowly and is more difficult to treat,” says Helena Carn, a researcher at the Department of Clinical Genetics at the Sahlgrenska Academy.

By using the latest genetic techniques, the researchers have succeeded in analysing the DNA of tumour cells and identifying chromosomal defects, enabling the identification of sub-groups of the most aggressive neuroblastomas. The next step is to identify their weak points genetically in order to develop better treatment.

“We call this personalized medicine, because the treatment is based on the genetic profile of the patient, or in this case, of the tumour cells,” says Tommy Martinsson, professor of genetics at the Department of Clinical Genetics at the Sahlgrenska Academy.

Per Kogner, professor of paediatric oncology at Karolinska Institutet, reiterates that their discovery will now allow a variety of tailor-made treatments to be developed, saving the lives of more children.

“The analytical method we have used in our research is already being used for clinical assessment of every neuroblastoma tumour in the country, which means that we can now make more accurate diagnoses,” says Helena Carn.

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The study was carried out with the support of the Swedish Childhood Cancer Foundation and the Swedish Cancer Society.

ABOUT NEUROBLASTOMA

Neuroblastoma is a form of cancer that affects small children, most of whom are diagnosed before they reach their fifth birthday. It is the third commonest form of cancer in children, after leukaemia and brain tumours. About 20 Swedish children are affected every year, and the risk of developing the disease is the same worldwide. Neuroblastoma is a tumour of nerve cells. It appears during the development phase of the sympathetic nervous system. Children may have no symptoms at all, and sometimes a lump is the first sign of the disease noticed by parents or doctors. As the tumour grows or spreads, it may press on other organs and cause symptoms. The available treatments include surgery, chemotherapy, radiotherapy, high-dose therapy combined with stem cell support, and vitamin A.

New DNA technique leads to a breakthrough in child cancer research

Contact: Tommy Martinsson
tommy.martinsson@clingen.gu.se
46-31-343-4803
University of Gothenburg
Researchers at the Sahlgrenska Academy at the University of Gothenburg, Sweden and Karolinska Institutet have used novel technology to reveal the different genetic patterns of neuroblastoma, an aggressive form of childhood cancer. This discovery may lead to significant advances in the treatment of this malignant disease, which mainly affects small children.

The article is being published in the respected scientific journal, Proceedings of the National Academy of Sciences (PNAS). The study includes 165 children with neuroblastoma, most of whom developed the disease before the age of five. These children have been monitored for over 20 years by two research teams led by professors Tommy Martinsson, of the Sahlgrenska Academy, and Per Kogner of Karolinska Institutet.

Neuroblastoma is a nerve cell cancer that has defects in certain chromosomes. If the tumour has a characteristic defect on chromosome 11, it is very aggressive and difficult to cure.

“We found that the children who develop this type of neuroblastoma are twice as old at the onset of the disease as children who develop other types of neuroblastoma. This type progresses more slowly and is more difficult to treat,” says Helena Carn, a researcher at the Department of Clinical Genetics at the Sahlgrenska Academy.

By using the latest genetic techniques, the researchers have succeeded in analysing the DNA of tumour cells and identifying chromosomal defects, enabling the identification of sub-groups of the most aggressive neuroblastomas. The next step is to identify their weak points genetically in order to develop better treatment.

“We call this personalized medicine, because the treatment is based on the genetic profile of the patient, or in this case, of the tumour cells,” says Tommy Martinsson, professor of genetics at the Department of Clinical Genetics at the Sahlgrenska Academy.

Per Kogner, professor of paediatric oncology at Karolinska Institutet, reiterates that their discovery will now allow a variety of tailor-made treatments to be developed, saving the lives of more children.

“The analytical method we have used in our research is already being used for clinical assessment of every neuroblastoma tumour in the country, which means that we can now make more accurate diagnoses,” says Helena Carn.

###

The study was carried out with the support of the Swedish Childhood Cancer Foundation and the Swedish Cancer Society.

ABOUT NEUROBLASTOMA

Neuroblastoma is a form of cancer that affects small children, most of whom are diagnosed before they reach their fifth birthday. It is the third commonest form of cancer in children, after leukaemia and brain tumours. About 20 Swedish children are affected every year, and the risk of developing the disease is the same worldwide. Neuroblastoma is a tumour of nerve cells. It appears during the development phase of the sympathetic nervous system. Children may have no symptoms at all, and sometimes a lump is the first sign of the disease noticed by parents or doctors. As the tumour grows or spreads, it may press on other organs and cause symptoms. The available treatments include surgery, chemotherapy, radiotherapy, high-dose therapy combined with stem cell support, and vitamin A.

Virus hybridization could create pandemic bird flu

Contact: Yoshihiro Kawaoka
kawaokay@svm.vetmed.wisc.edu
608-265-4925
University of Wisconsin-Madison
MADISON Genetic interactions between avian H5N1 influenza and human seasonal influenza viruses have the potential to create hybrid strains combining the virulence of bird flu with the pandemic ability of H1N1, according to a new study.

In laboratory experiments in mice, a single gene segment from a human seasonal flu virus, H3N2, was able to convert the avian H5N1 virus into a highly pathogenic form. The findings are reported the week of Feb. 22 in the online early edition of the Proceedings of the National Academy of Sciences.

“Some hybrids between H5N1 virus and seasonal influenza viruses were more pathogenic than the original H5N1 viruses. That is worrisome,” says Yoshihiro Kawaoka, a virologist at the University of Wisconsin-Madison and senior author of the new study.

The H5N1 bird flu virus has spread worldwide through bird populations and has caused 442 confirmed human cases and 262 deaths, according to the World Health Organization. To date, however, bird flu has not been able to spread effectively between people.

“H5N1 virus has never acquired the ability to transmit among humans, which is why we haven’t had a pandemic. The worry is that the pandemic H1N1 virus may provide that nature in the background of this highly pathogenic H5N1 virus,” says Kawaoka, a professor of pathobiological sciences at the UW-Madison School of Veterinary Medicine.

Two viruses infecting a single host cell can swap genetic material, or reassort, creating hybrid strains with characteristics of each parent virus.

Before the current study, hybrid viruses generated in lab studies had always been less virulent than parent strains. However, the new findings raise concerns that H5N1 and pandemic H1N1 viruses could reassort in individuals exposed to both viruses and generate an influenza strain that is both highly virulent and contagious.

The increased virulence seen in the new study seems to arise from one of the eight genes in the viral genome, called PB2, which is known to affect how well the bird flu virus grows in mammalian hosts, including humans. When tested in mice, the human virus version of PB2 swapped into H5N1 converted the avian virus to a highly pathogenic form.

The researchers say surveillance of viral populations is critical to monitor the potential emergence of highly pathogenic viral variants due to reassortment of avian and human influenza viruses. Their results, including identification of the PB2 segment as a key to enhanced virulence, offer information likely to be useful in the event of a pandemic caused by a hybrid avian-human influenza strain.

“With the new pandemic H1N1 virus, people sort of forgot about H5N1 avian influenza. But the reality is that H5N1 avian virus is still out there,” Kawaoka says. “Our data suggests that it is possible there may be reassortment between H5 and pandemic H1N1 that can create a more pathogenic H5N1 virus.”

###

The work was funded by the U.S. National Institutes of Health, the Japan Society for the Promotion of Science, the Ministry of Education, Culture, Sports, Science and Technology of Japan, and the Japan Science and Technology Agency.

Jill Sakai, 608-262-9772, jasakai@wisc.edu

Mayo oral cancer study shows full tumor genome

Contact: Robert Nellis
newsbureau@mayo.edu
507-284-5005
Mayo Clinic

Novel method speeds analysis for individualized medicine

ROCHESTER, Minn. — Mayo Clinic researchers along with collaborators from Life Technologies are reporting on the application of a new approach for sequencing RNA to study cancer tumors. Their findings from a proof-of-principle study on oral carcinomas appear in the current issue of PLoS One, the online science journal.

VIDEO ALERT: Additional audio and video resources, including comments by Dr. Smith, are available on the Mayo Clinic News Blog

To explore the advantages of massively parallel sequencing of genomic transcripts (RNA), the researchers used a novel, strand-specific sequencing method using matched tumors and normal tissues of three patients with the specific cancer. They also analyzed the genomic DNA from one of the tumor-normal pairs which revealed numerous chromosomal regions of gain and loss in the tumor sample.

The key finding of this work was that alterations in gene expression which can arise from a variety of genomic alterations frequently are driven by losses or gains in large chromosomal regions during tumor development.

In addition to the specific tumor findings, this study also demonstrated the value of this RNA sequencing (RNA-Seq) method. It will allow researchers to measure strand-specific expression across the entire sample’s transcriptome. This technology reveals far more detail about genome-wide transcription than traditional microarrays.

“This method allows us to investigate genetic changes at a level that we were never able to see before,” says David Smith, Ph.D., Mayo Clinic genomics researcher and corresponding author of the study. “This provides us with much more information about alterations during cancer development that could reveal important therapeutic targets. We can more completely understand the relationship between an individual’s genome and the alterations to that which result in disease.

This is a huge step in speed, detail and diagnostic power for the field of individualized medicine. This transforms how we are going to study cancer — and how we’re going to practice medicine — in the very near future.”

The urgency of this condition points to the need for more efficient technologies and methods. Head and neck cancers are the sixth most prevalent carcinomas in the world. Advanced stage oral and throat cancers have a five-year survival rate of only 50 percent in the United States. Information provided by these and continued studies will help to better characterize the molecular basis of cancer development. That information can hopefully define better therapeutic strategies for treating an individual’s specific cancer.

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Others involved in the research include co-first author Rebecca Laborde, Ph.D.; Kerry Olsen, M.D.; Jan Kasperbauer, M.D.; Eric Moore, M.D.; and Yan Asmann, Ph.D.; all of Mayo Clinic; and co-first author Brian Tuch, Ph.D.; Xing Xu, Ph.D.; Christina Chung, Ph.D.; Cinna Monighetti, Ph.D.; Sarah Stanley, Adam Broomer, Ruoying Tan, Ph.D.; Pius Brzoska, Ph.D.; Matthew Muller, Asim Siddiqui, Ph.D.; Yongming Sun, Ph.D.; Melissa Barker; and Francisco De La Vega, Ph.D.; all of Life Technologies, Foster City, Calif.

The research was supported by Mayo Clinic and Life Technologies. The funders had no role in study design, data collection, analysis or publishing. Some authors are or have been employed by Life Technologies, which makes technology and materials used in the study. Data and materials will be shared.

About Mayo Clinic

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world’s leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information.

Protecting the brain from a deadly genetic disease

Contact: Kathy Wallis
kwallis3@uwo.ca
519-661-2111 x81136
University of Western Ontario
Huntington’s disease (HD) is a cruel, hereditary condition that leads to severe physical and mental deterioration, psychiatric problems and eventually, death. Currently, there are no treatments to slow down or stop it. HD sufferers are born with the disease although they do not show symptoms until late in life. In a new study published in The Journal of Neuroscience, Stephen Ferguson and Fabiola Ribeiro of Robarts Research Institute at The University of Western Ontario identified a protective pathway in the brain that may explain why HD symptoms take so long to appear. The findings could also lead to new treatments for HD.

The symptoms of Huntington’s disease are caused by cell death in specific regions of the brain. Patients who have HD are born with a mutated version of the protein huntingtin (Htt), which is thought to cause these toxic effects. While researchers know HD results from this single, mutated protein, no one seems to know exactly what it does, why it does not cause symptoms until later in life, or why it kills a specific set of brain cells, even though Htt is found in every single cell in the human body.

Ferguson and Ribeiro used a genetically-modified mouse model of HD to look at the effects of mutated Htt on the brain. “We found there was some kind of compensation going on early in the life of these mice that was helping to protect them from the development of the disease,” says Ferguson, director of the Molecular Brain Research Group at Robarts, and a professor in the Department of Physiology & Pharmacology at Western’s Schulich School of Medicine and Dentistry. “As they age, they lose this compensation and the associated protective effects, which could explain the late onset of the disease.”

Ferguson adds that metabotropic glutamate receptors (mGluRs), which are responsible for communication between brain cells, play an important role in these protective effects. By interacting with the mutant Htt protein, mGluRs change the way the brain signals in the early stages of HD in an attempt to offset the disease, and save the brain from cell death. As a result, mGluRs could offer a drug target for HD treatment.

Because HD is a dominant genetic disease, every child with an affected parent has a 50 per cent chance of inheriting the fatal condition. This research, funded by the Canadian Institutes of Health Research, sheds light on the onset of HD and the potential role of a mutant protein in patients, paving the way for the development of new drug therapies.

Bitter melon extract attacks breast cancer cells

Contact: Nancy Solomon
solomonn@slu.edu
314-977-8017
Saint Louis University

Early Saint Louis University research points to promising area of research

ST. LOUIS — The extract from a vegetable that is common in India and China shows promise in triggering a chain of events that kills breast cancer cells and prevents them from multiplying, a Saint Louis University researcher has found.

Ratna Ray, Ph.D., professor in the department of pathology at Saint Louis University and lead researcher, said she was surprised that the extract from the bitter melon she cooks in stir fries inhibits the growth of breast cancer cells.

“To our knowledge, this is the first report describing the effect of bitter melon extract on cancer cells,” Ray said. “Our result was encouraging. We have shown that bitter melon extract significantly induced death in breast cancer cells and decreased their growth and spread.”

Ray said she decided to study the impact of bitter melon extract on breast cancer cells because research by others have shown the substance lowers blood sugar and cholesterol levels. Bitter melon extract is commonly used as a folk medicine to treat diabetes in China and India, she said.

Ray conducted her research using human breast cancer cells in vitro or in a controlled lab setting. The next step, she says, is to test bitter melon extract in an animal model to see if it plays a role in delaying the growth or killing of breast cancer cells. If those results are positive, human trials could follow.

While it’s too early to know for sure whether bitter melon extract will help breast cancer patients, the question is worth studying, Ray said.

“There have been significant advances in breast cancer treatment, which have improved patient survival and quality of life. However women continue to die of the disease and new treatment strategies are essential,” Ray said.

“Cancer prevention by the use of naturally occurring dietary substances is considered a practical approach to reduce the ever-increasing incidence of cancer. Studying a high risk breast cancer population where bitter melon is taken as a dietary product will be an important area of future research,” Ray said.

She cautioned against seeing bitter melon extract as a miracle cure for breast cancer.

“Bitter melon is common in China and India, and women there still get breast cancer,” Ray said.

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The research was published in the March 1 edition of Cancer Research, a journal of the American Association for Cancer Research.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

Mayo Clinic researchers find oncogene is important in pancreatic cancer growth and spread

Contact: Paul Scotti
scotti.paul@mayo.edu
904-953-2299
Mayo Clinic

Agent to target gene already being tested at Mayo Clinic in other cancers

JACKSONVILLE, Fla. Researchers at the Mayo Clinic campus in Florida have found that PKC-iota (PKC), an oncogene important in colon and lung cancers, is over-produced in pancreatic cancer and is linked to poor patient survival. They also found that genetically inhibiting PKC in laboratory animals led to a significant decrease in pancreatic tumor growth and spread.

The discovery, reported in the March 1 issue of Cancer Research, is especially encouraging, they say, because an experimental agent that targets PKC is already being tested in patients at Mayo Clinic.

“This is the first study to establish a role for PKC in growth of pancreatic cancer, so it is exciting to know that an agent already exists that targets PKC which we can now try in preclinical studies,” says the study’s senior investigator, Nicole Murray, Ph.D., of the Department of Cancer Biology.

The drug, aurothiomalate, is being tested in a phase I clinical trial in patients with lung cancer at Mayo Clinic’s sites in Minnesota and Arizona. Based on findings to date, a phase II clinical trial is being planned to combine aurothiomalate with agents targeted at other molecules involved in cancer growth.

Mayo Clinic researchers, led by Alan Fields, Ph.D., chair of the Department of Cancer Biology and a co-author of this report, discovered aurothiomalate in 2006 by screening thousands of Food and Drug Administration-approved drugs for their ability to inhibit PKC signaling. The drug was once used to treat rheumatoid arthritis.

Dr. Murray stressed that this new study has not tested aurothiomalate against pancreatic cancer yet, but any treatment that targets this major cancer pathway offers a new avenue for therapy. “This is such a deadly disease. No standard treatment has shown much promise,” she says. “New ideas and fresh, targeted therapies such as this are sorely needed.”

Mayo researchers have led the field in understanding the role of the protein kinase C (PKC) family of enzymes as major players in cancer development and progression. Dr. Fields was the first to discover that PKC is a human oncogene an abnormal gene that cancer cells use to grow and/or survive. He found that PKC is genetically altered and over-expressed in a majority of lung cancers, and that over-expression of the gene in tumors predicts poor patient survival. That led to his search for aurothiomalate and the current testing in patients.

Dr. Murray says she has also found that different members of the PKC family play distinct roles in colon cancer, which offers more opportunity for targeted treatment. In fact, animal studies show that use of a different drug, enzastaurin, significantly reduced the initial development of colon tumors, according to Dr. Murray. Enzastaurin targets PKC-beta (PKC), which the Mayo team has shown is necessary for initiation of colon cancer, she says.

In the present study, the researchers looked at expression of PKC in pancreatic cancer because tumor studies show that a different gene, KRAS, is mutated up to 90 percent of the time, and KRAS regulates PKC. “KRAS has been very difficult to target therapeutically, which is why we are looking at molecules, such as PKC, that convey signals downstream of KRAS that can be manipulated,” Dr. Murray says.

They found that PKC is highly expressed in most human pancreatic tumors they sampled, and that high PKC expression predicts poor patient survival. Studying patient tumors, they found that patients whose tumors exhibited high PKC expression had a median survival time of 492 days, compared to 681 days for low PKC expression, and a reduced five-year survival rate (10 percent versus 29.5 percent for low PKC expression).

The researchers then genetically manipulated the expression of PKC in pancreatic cancer cells. The results showed that PKC is required for the growth of pancreatic cancer in both cell-based and animal models. “This is the first demonstration that pancreatic tumors require PKC to grow and metastasize,” Dr. Murray says.

The data suggest that aurothiomalate, which targets PKC, may be effective against pancreatic cancer either alone or in combination with other treatments, such as conventional chemotherapy. “Aurothiomalate may inhibit pancreatic cancer alone, or it may sensitize pancreatic tumors to chemotherapy,” she says. “It is possible that a number of cancer growth pathways will need to be targeted for an effective therapy.”

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The study was funded by the National Institutes of Health and the Mayo Clinic Foundation. The study’s authors, which include investigators from Mayo Clinic in Rochester, Minn., declare no conflicts of interest.

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 3,700 physicians, scientists and researchers, and 50,100 allied health staff work at Mayo Clinic, which has campuses in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz.; and community-based providers in more than 70 locations in southern Minnesota., western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories.

New treatment to prevent cancer recurrence shows promise in Stanford study

Contact: Krista Conger
kristac@stanford.edu
650-725-5371
Stanford University Medical Center
STANFORD, Calif. Glioblastoma is one of the most deadly human brain cancers. Radiation can temporarily shrink a tumor, but they nearly always recur within weeks or months and few patients survive longer than two years after diagnosis.

Now scientists at the Stanford University School of Medicine studying the tumor in mice have found a way to stop the cancer cells from growing back after radiation by blocking its access to oxygen and nutrients. The discovery happened when the researchers realized that irradiated tumors turn to a little-known, secondary pathway to generate the blood vessels necessary for regrowth.

“Under normal circumstances, this pathway is not important for growth of most tumors,” said Martin Brown, PhD, professor of radiation oncology. “What we hadn’t realized until recently is that radiation meant to kill the cancer cells also destroys the existing blood vessels that nourish the tumor. As a result, it has to rely on a backup blood delivery pathway.” Although the researchers focused their study on glioblastoma, other tumors use a similar mechanism to evade radiotherapy.

Brown and his colleagues used a small molecule called AMD3100 to block this secondary tumor-growth process in the mice. Because AMD3100 has already been clinically approved for a different use in humans, it is possible that the researchers may be able to move relatively quickly into human trials. Still, the researchers caution that routine therapeutic use of AMD3100 or any other similarly acting molecule for glioblastoma is likely still years away.

Brown is the senior author of the paper, which will be published online Feb. 22 in the Journal of Clinical Investigation. Research associate Mitomu Kioi, PhD, is the paper’s first author. Neurosurgery professor Griffith Harsh, MD, is a co-author. Brown and Harsh are also members of Stanford’s Cancer Center.

To understand the research, it’s necessary to know a bit about how blood vessels form. Most commonly, tumors co-opt existing nearby blood supplies by inducing them to sprout new blood vessels to infiltrate the tumor and nourish the dividing cancer cells a process called angiogenesis. However, it’s also possible to recruit cells from the bone marrow to form new blood vessels where none existed before. This is called vasculogenesis, and is the process blocked by AMD3100.

Earlier research by Brown and others suggested that the heavy doses of radiation used to treat many types of cancers also kills the cells lining the blood vessels in and around the tumor. This means that it can no longer rely on angiogenesis from existing vessels to keep supplied with oxygen and nutrients. Brown hypothesized that instead the tumor recruits the bone-marrow-derived cells, or BMDCs, to form brand-new vessels to keep it from starving. Blocking this pathway, he thought, might be the final blow to the irradiated tumor.

Brown’s team studied human glioblastoma cells implanted in the brains of immunocompromised laboratory mice. The cells had been engineered to express a gene that causes them to give off light to more easily track their location in the animals. They found that the cells formed tumors that grew and spread as in humans, and radiation therapy (in doses similar to those used in humans) caused the tumors to regress temporarily but then recur.

As predicted, irradiating the tumors caused the existing blood vessel cells to die and the tumors to become hypoxic, or starved of oxygen. In response, the tumors begin to express a molecule called hypoxic-inducible factor 1. HIF-1 starts a cascade of events that cause BMDCs to flood the tumor and initiate vasculogenesis. Blocking HIF-1 activity stopped the recruitment of BMDCs and prevented irradiated tumors from recurring throughout the 100-day study period.

“These cells are absolutely required for the tumor cells to grow after a dose of radiation,” said Brown. In contrast, irradiated tumors in which HIF-1 activity was uncompromised recurred quickly and approached lethal size by around day 70.

Brown and his colleagues tried other ways to inhibit HIF-1-induced vasculogenesis. They knew that AMD3100 interferes with the interaction of two other proteins important in recruiting the bone-marrow-derived cells one secreted by hypoxic tissue in response to HIF-1, and another found on the surface of the BMDCs. The two proteins lock together to encourage the cells to stay put. In fact, AMD3100 is used in bone marrow transplants to disrupt this interaction and ensure that bone marrow stem cells leave the marrow and enter the blood stream.

The researchers found that giving the mice a continuous infusion of AMD3100, as well as using antibodies against one of the two proteins, also prevented tumor recurrence in the mice. Finally, they confirmed that glioblastoma tissue from 12 human patients who had undergone radiation therapy contained significantly higher levels of bone-marrow-derived cells than did samples from the same patients obtained prior to radiation.

“I think the next step is to test this clinically in humans,” said Brown.

###

In addition to Brown, Harsh and Kioi, other Stanford researchers involved in the study included Hannes Vogel, MD, professor of pathology, and Geoffrey Schultz, MD, postdoctoral scholar. The research was funded by the National Institutes of Health, the Accelerate Brain Cancer Cure Foundation and the James S. McDonnell Foundation. Brown holds significant equity in and is a founding scientist of Proacta Inc., a biopharmaceutical company based in San Diego, devoted to developing hypoxia-activated drug precursors for the treatment of cancer. Proacta Inc. was not involved in the research described above.

More information about Stanford’s Department of Radiation Oncology, which supported the work, is available at http://radonc.stanford.edu/.

The Stanford University School of Medicine consistently ranks among the nation’s top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

New treatment to prevent cancer recurrence shows promise in Stanford study

Contact: Krista Conger
kristac@stanford.edu
650-725-5371
Stanford University Medical Center
STANFORD, Calif. Glioblastoma is one of the most deadly human brain cancers. Radiation can temporarily shrink a tumor, but they nearly always recur within weeks or months and few patients survive longer than two years after diagnosis.

Now scientists at the Stanford University School of Medicine studying the tumor in mice have found a way to stop the cancer cells from growing back after radiation by blocking its access to oxygen and nutrients. The discovery happened when the researchers realized that irradiated tumors turn to a little-known, secondary pathway to generate the blood vessels necessary for regrowth.

“Under normal circumstances, this pathway is not important for growth of most tumors,” said Martin Brown, PhD, professor of radiation oncology. “What we hadn’t realized until recently is that radiation meant to kill the cancer cells also destroys the existing blood vessels that nourish the tumor. As a result, it has to rely on a backup blood delivery pathway.” Although the researchers focused their study on glioblastoma, other tumors use a similar mechanism to evade radiotherapy.

Brown and his colleagues used a small molecule called AMD3100 to block this secondary tumor-growth process in the mice. Because AMD3100 has already been clinically approved for a different use in humans, it is possible that the researchers may be able to move relatively quickly into human trials. Still, the researchers caution that routine therapeutic use of AMD3100 or any other similarly acting molecule for glioblastoma is likely still years away.

Brown is the senior author of the paper, which will be published online Feb. 22 in the Journal of Clinical Investigation. Research associate Mitomu Kioi, PhD, is the paper’s first author. Neurosurgery professor Griffith Harsh, MD, is a co-author. Brown and Harsh are also members of Stanford’s Cancer Center.

To understand the research, it’s necessary to know a bit about how blood vessels form. Most commonly, tumors co-opt existing nearby blood supplies by inducing them to sprout new blood vessels to infiltrate the tumor and nourish the dividing cancer cells a process called angiogenesis. However, it’s also possible to recruit cells from the bone marrow to form new blood vessels where none existed before. This is called vasculogenesis, and is the process blocked by AMD3100.

Earlier research by Brown and others suggested that the heavy doses of radiation used to treat many types of cancers also kills the cells lining the blood vessels in and around the tumor. This means that it can no longer rely on angiogenesis from existing vessels to keep supplied with oxygen and nutrients. Brown hypothesized that instead the tumor recruits the bone-marrow-derived cells, or BMDCs, to form brand-new vessels to keep it from starving. Blocking this pathway, he thought, might be the final blow to the irradiated tumor.

Brown’s team studied human glioblastoma cells implanted in the brains of immunocompromised laboratory mice. The cells had been engineered to express a gene that causes them to give off light to more easily track their location in the animals. They found that the cells formed tumors that grew and spread as in humans, and radiation therapy (in doses similar to those used in humans) caused the tumors to regress temporarily but then recur.

As predicted, irradiating the tumors caused the existing blood vessel cells to die and the tumors to become hypoxic, or starved of oxygen. In response, the tumors begin to express a molecule called hypoxic-inducible factor 1. HIF-1 starts a cascade of events that cause BMDCs to flood the tumor and initiate vasculogenesis. Blocking HIF-1 activity stopped the recruitment of BMDCs and prevented irradiated tumors from recurring throughout the 100-day study period.

“These cells are absolutely required for the tumor cells to grow after a dose of radiation,” said Brown. In contrast, irradiated tumors in which HIF-1 activity was uncompromised recurred quickly and approached lethal size by around day 70.

Brown and his colleagues tried other ways to inhibit HIF-1-induced vasculogenesis. They knew that AMD3100 interferes with the interaction of two other proteins important in recruiting the bone-marrow-derived cells one secreted by hypoxic tissue in response to HIF-1, and another found on the surface of the BMDCs. The two proteins lock together to encourage the cells to stay put. In fact, AMD3100 is used in bone marrow transplants to disrupt this interaction and ensure that bone marrow stem cells leave the marrow and enter the blood stream.

The researchers found that giving the mice a continuous infusion of AMD3100, as well as using antibodies against one of the two proteins, also prevented tumor recurrence in the mice. Finally, they confirmed that glioblastoma tissue from 12 human patients who had undergone radiation therapy contained significantly higher levels of bone-marrow-derived cells than did samples from the same patients obtained prior to radiation.

“I think the next step is to test this clinically in humans,” said Brown.

###

In addition to Brown, Harsh and Kioi, other Stanford researchers involved in the study included Hannes Vogel, MD, professor of pathology, and Geoffrey Schultz, MD, postdoctoral scholar. The research was funded by the National Institutes of Health, the Accelerate Brain Cancer Cure Foundation and the James S. McDonnell Foundation. Brown holds significant equity in and is a founding scientist of Proacta Inc., a biopharmaceutical company based in San Diego, devoted to developing hypoxia-activated drug precursors for the treatment of cancer. Proacta Inc. was not involved in the research described above.

More information about Stanford’s Department of Radiation Oncology, which supported the work, is available at http://radonc.stanford.edu/.

The Stanford University School of Medicine consistently ranks among the nation’s top 10 medical schools, integrating research, medical education, patient care and community service. For more news about the school, please visit http://mednews.stanford.edu. The medical school is part of Stanford Medicine, which includes Stanford Hospital & Clinics and Lucile Packard Children’s Hospital. For information about all three, please visit http://stanfordmedicine.org/about/news.html.

Caltech neuroscientists find brain system behind general intelligence

Contact: Kathy Svitil
ksvitil@caltech.edu
626-395-8022
California Institute of Technology

Finding opens the door for more studies on biology of intelligence

PASADENA, Calif.A collaborative team of neuroscientists at the California Institute of Technology (Caltech), the University of Iowa, the University of Southern California (USC), and the Autonomous University of Madrid have mapped the brain structures that affect general intelligence.

The study, to be published the week of February 22 in the early edition of the Proceedings of the National Academy of Sciences, adds new insight to a highly controversial question: What is intelligence, and how can we measure it?

The research team included Jan Glscher, first author on the paper and a postdoctoral fellow at Caltech, and Ralph Adolphs, the Bren Professor of Psychology and Neuroscience and professor of biology. The Caltech scientists teamed up with researchers at the University of Iowa and USC to examine a uniquely large data set of 241 brain-lesion patients who all had taken IQ tests. The researchers mapped the location of each patient’s lesion in their brains, and correlated that with each patient’s IQ score to produce a map of the brain regions that influence intelligence.

“General intelligence, often referred to as Spearman’s g-factor, has been a highly contentious concept,” says Adolphs. “But the basic idea underlying it is undisputed: on average, people’s scores across many different kinds of tests are correlated. Some people just get generally high scores, whereas others get generally low scores. So it is an obvious next question to ask whether such a general ability might depend on specific brain regions.”

The researchers found that, rather than residing in a single structure, general intelligence is determined by a network of regions across both sides of the brain.

“One of the main findings that really struck us was that there was a distributed system here. Several brain regions, and the connections between them, were what was most important to general intelligence,” explains Glscher.

“It might have turned out that general intelligence doesn’t depend on specific brain areas at all, and just has to do with how the whole brain functions,” adds Adolphs. “But that’s not what we found. In fact, the particular regions and connections we found are quite in line with an existing theory about intelligence called the ‘parieto-frontal integration theory.’ It says that general intelligence depends on the brain’s ability to integrateto pull togetherseveral different kinds of processing, such as working memory.”

The researchers say the findings will open the door to further investigations about how the brain, intelligence, and environment all interact.

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Other coauthors on the paper, “The distributed neural system for general intelligence revealed by lesion mapping,” are David Rudrauf and Daniel Tranel of the University of Iowa; Roberto Colom of the Autonomous University of Madrid; Lynn Paul of Caltech; and Hanna Damasio of USC. The work at Caltech was funded by the National Institutes of Health, the Simons Foundation, the Deutsche Akademie der Naturforscher Leopoldina, and a Global Center of Excellence grant from the Japanese government.

Visit the Caltech Media Relations website at http://media.caltech.edu.

Researchers identify a potential therapeutic target for brain cancer

Contact: Anita B. Hjelmeland
hjelmea@ccf.org
Public Library of Science
Researchers at the Cleveland Clinic report the identification of a protein that is highly expressed in a subgroup of glioblastoma brain tumor cells and show that depletion of this protein increases the survival of mice with these tumors. This work will be published in the online open-access journal PLoS Biology.

Recent studies have increased our understanding of cancer by elucidating some of the differences that exist between tumor cells among patients and even between distinct subsets of tumor cells within the same patient. Evidence suggests there are subgroups of cells called cancer stem cells or tumor initiating cells within tumors that are harder to kill with current therapies than other cells within these tumors. Cancer stem cells may in fact be more important to destroy than non-cancer stem cells because they may be responsible for metastasis and for tumor recurrence after therapy. Identifying therapies which specifically target cancer stem cells therefore hold great promise for effective and lasting treatment.

In this study, Dr. Hjelmeland and colleagues determine that a protein called A20, that has been previously implicated in cell survival, is highly expressed in a population of cells that is enriched for glioblastoma stem cells. They demonstrate that decreasing levels of A20 in these cells reduces their growth in cell culture by inducing cell death. Decreasing A20 levels in animal models of brain tumors also increases survival. Using publicly available datasets from human brain tumor specimens, they also determine that increased levels of A20 are associated with poor patient survival. Together, these studies suggest that targeting A20 could be beneficial for human glioblastoma patients.

Although there continues to be controversy over the cancer stem cell concept, Dr. Hjelmeland believes that “Everyone recognizes the need to identify new cancer targets, and this may be achieved by studying subgroups of tumor cells. Using this technique, we identified A20 as an important target. However, we still have a lot of work to do before translation for patient therapies.”

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Funding: AH is supported by a grant from the National Brain Tumor Society. JDL is supported by a grant from the American Brain Tumor Association. CE is supported by NS063496, an F30 grant from the National Institutes of Health (NIH). Additional support was provided by the Goldhirsh Foundation; Damon Runyon Cancer Research Foundation; Brain Tumor Society, the James S. McDonnell Foundation; and NIH grants NS054276, CA116659, and CA129958 (to JR). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Competing interests statement: The authors declare that no competing interests exist.

Citation: Hjelmeland AB, Wu Q, Wickman S, Eyler C, Heddleston J, et al. (2010) Targeting A20 Decreases Glioma Stem Cell Survival and Tumor Growth. PLoS Biol 8(2): e1000319. doi:10.1371/journal.pbio.1000319

PLEASE ADD THE LINK TO THE PUBLISHED ARTICLE IN ONLINE VERSIONS OF YOUR REPORT: http://biology.plosjournals.org/perlserv/?request=get- document&doi=10.1371/journal.pbio.1000319

PRESS ONLY PREVIEW OF THE ARTICLE: http://www.plos.org/press/plbi-08-02-Hjelmeland.pdf

CONTACT:
Anita B. Hjelmeland, PhD
Cleveland Clinic
Department of Stem Cell Biology and Regenerative Medicine
9500 Euclid Avenue, NE30
Cleveland, OH 44195
United States of America
216-636-1667
hjelmea@ccf.org

What it might take to unravel the ‘lean mean machine’ that is cancer

Contact: Alison Heather
a.heather@garvan.org.au
61-292-958-128
Research Australia
Scientists from Sydney’s Garvan Institute of Medical Research have published a paper, online today in Nature Cell Biology, describing gene expression in a prostate cancer cell: more sweeping, more targeted and more complex than we could ever have imagined, even five years ago.

The study shows that changes within the prostate cancer cell ‘epigenome’ (biochemical processes that target DNA and affect gene expression) alter the expression of many genes, silencing their expression within large regions of DNA nearly 3% of the cell’s genome.

Epigenetic ‘events’ include ‘DNA methylation’ and ‘chromatin modification’. Methylation occurs when a methyl group - one carbon atom and three hydrogen atoms - attaches to a gene, determining the extent to which it is ’switched on’ or ’switched off’. Chromatin, responsible for the physical coiling or structuring of DNA, can determine whether or not a gene is accessible for interaction with other molecules inside a cell.

Project leader Professor Susan Clark describes the typical cancer cell as a ‘lean mean machine’. “Epigenetic changes reduce the available genome to a point where only the genes that promote cell proliferation are accessible in the cancer cell,” she said.

“We can see that the epigenome is remodelled in a very consistent and precise way, effectively swamping the expression of any gene that goes against the cancer cell’s interests.”

“The swamping encompasses tumour suppressor genes, and all the neighbouring genes around them, as well as non-coding RNA, intergenic regions and microRNAs. Only those genes essential for growth activation are allowed to be active, while all the genes and regions that apply brakes are inactivated.”

“We now have an epigenomic map of the prostate cancer cell which we didn’t have before. That has taken three years to develop, including the technology and methods to interpret our tissue samples.”

“The map tells us that the tumour cell is very different from the healthy cell. It also tells us that it works in a programmed rather than a random way, and that it targets a significant part of the genome, rather than just single genes.”

“It tells us that treating cancer will be far more complex than we imagined, as it will first involve understanding and reversing epigenetic change.”

The findings are timely in that they coincide with very recent events and publications that have brought the concepts of the ‘epigenome’ and ‘epigenetics’ into world focus. In January 2010 the International Human Epigenome Consortium (IHEC) was launched in Paris (with Professor Clark on the interim steering Committee). Time magazine ran a feature on epigenetics in January, and Nature published two articles on the subject this month: one addressing the importance of IHEC and the urgency of pooling international mind power and resources; the other describing the infinite complexity of the project orders of magnitude more challenging than the Human Genome Project.

The ultimate aim of IHEC is to produce a map of the human epigenome. The initial intention is to map 1,000 epigenomes within a decade. This will provide a healthy tissue base against which to compare the epigenomes of diseased tissue.

The Human Genome Project, completed in March 2000, found that the human genome contains around 25,000 genes. It took 3 billion US dollars to map them. 1

We do not yet know how many variations the human epigenome is likely to contain certainly millions as a single person could have many epigenomes in a lifetime, or even in a day. 2 The technological advances and computational power necessary to map the epigenome, therefore, remain incalculable.

The project at Garvan involved an initial bioinformatics phase; a comparative tissue analysis phase; and a data analysis phase.

The bioinformatics phase analysed publicly available microarray datasets (glass slides containing fragments of every gene across the genome) that had been done on prostate cancer.

Dr Warren Kaplan, Bioinformatics Analyst at Garvan’s Peter Wills Bioinformatics Centre, developed new techniques to analyse the microarray data. “We designed a computer program which used a ’sliding window’ a window that computationally moves along the genome, noting the number of genes inside that window and how many of them are downregulated,” he said.

“Some of the microarrays we used only measured mRNA or the level of gene expression. Others measured the overall methylation status of the genes in that same region. It was an opportunity for us to examine the genome in a multi-layered way.”

Once Kaplan had provided an initial map, Drs Marcel Coolen and Clare Stirzaker and Jenny Song from Professor Clark’s lab found a way to treat and analyse prostate cancer cells, allowing their comparative DNA methylation and chromatin states analysis against the microarray data.

Bioinformaticians within the Clark lab, Aaron Statham and Dr Mark Robinson, then developed novel methodologies to interpret resulting data essentially tens of millions of numbers. “It was like cracking a code,” said Aaron. “At first the data made no sense.”

Professor Clark emphasises the importance of developing the new genome technology and knowhow that allows analysis of epigenetic processes.

“There is so much we still don’t know,” she said. “Already we have an idea of the complexity and how it might impact on the specific drug combinations that you will have to use to reactivate genes, non-coding RNAs and microRNAs within these cancer-affected regions.”

“Now that we have a prostate cancer epigenome map, our next step will be to understand the mechanism that’s driving the chromatin reduction, or genome reduction within these ‘lean mean machines’. In other words, what’s the link between the genetics and the epigenetics?”

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Footnotes

1. Time Magazine, January 18, 2010

2. Nature, Volume 463, 4 February 2010

ABOUT GARVAN

The Garvan Institute of Medical Research was founded in 1963. Initially a research department of St Vincent’s Hospital in Sydney, it is now one of Australia’s largest medical research institutions with nearly 500 scientists, students and support staff. Garvan’s main research programs are: Cancer, Diabetes & Obesity, Immunology and Inflammation and Neuroscience. Garvan’s mission is to make significant contributions to medical science that will change the directions of science and medicine and have major impacts on human health. The outcome of Garvan’s discoveries is the development of better methods of diagnosis, treatment, and ultimately, prevention of disease.

MEDIA ENQUIRIES

Alison Heather
Science Communications Manager
Garvan Institute of Medical Research
+61 2 9295 8128
+61 434 071 326
a.heather@garvan.org.au

Mayo Clinic researchers find oncogene is important in pancreatic cancer growth and spread

Contact: Paul Scotti
scotti.paul@mayo.edu
904-953-2299
Mayo Clinic

Agent to target gene already being tested at Mayo Clinic in other cancers

JACKSONVILLE, Fla. Researchers at the Mayo Clinic campus in Florida have found that PKC-iota (PKC), an oncogene important in colon and lung cancers, is over-produced in pancreatic cancer and is linked to poor patient survival. They also found that genetically inhibiting PKC in laboratory animals led to a significant decrease in pancreatic tumor growth and spread.

The discovery, reported in the March 1 issue of Cancer Research, is especially encouraging, they say, because an experimental agent that targets PKC is already being tested in patients at Mayo Clinic.

“This is the first study to establish a role for PKC in growth of pancreatic cancer, so it is exciting to know that an agent already exists that targets PKC which we can now try in preclinical studies,” says the study’s senior investigator, Nicole Murray, Ph.D., of the Department of Cancer Biology.

The drug, aurothiomalate, is being tested in a phase I clinical trial in patients with lung cancer at Mayo Clinic’s sites in Minnesota and Arizona. Based on findings to date, a phase II clinical trial is being planned to combine aurothiomalate with agents targeted at other molecules involved in cancer growth.

Mayo Clinic researchers, led by Alan Fields, Ph.D., chair of the Department of Cancer Biology and a co-author of this report, discovered aurothiomalate in 2006 by screening thousands of Food and Drug Administration-approved drugs for their ability to inhibit PKC signaling. The drug was once used to treat rheumatoid arthritis.

Dr. Murray stressed that this new study has not tested aurothiomalate against pancreatic cancer yet, but any treatment that targets this major cancer pathway offers a new avenue for therapy. “This is such a deadly disease. No standard treatment has shown much promise,” she says. “New ideas and fresh, targeted therapies such as this are sorely needed.”

Mayo researchers have led the field in understanding the role of the protein kinase C (PKC) family of enzymes as major players in cancer development and progression. Dr. Fields was the first to discover that PKC is a human oncogene an abnormal gene that cancer cells use to grow and/or survive. He found that PKC is genetically altered and over-expressed in a majority of lung cancers, and that over-expression of the gene in tumors predicts poor patient survival. That led to his search for aurothiomalate and the current testing in patients.

Dr. Murray says she has also found that different members of the PKC family play distinct roles in colon cancer, which offers more opportunity for targeted treatment. In fact, animal studies show that use of a different drug, enzastaurin, significantly reduced the initial development of colon tumors, according to Dr. Murray. Enzastaurin targets PKC-beta (PKC), which the Mayo team has shown is necessary for initiation of colon cancer, she says.

In the present study, the researchers looked at expression of PKC in pancreatic cancer because tumor studies show that a different gene, KRAS, is mutated up to 90 percent of the time, and KRAS regulates PKC. “KRAS has been very difficult to target therapeutically, which is why we are looking at molecules, such as PKC, that convey signals downstream of KRAS that can be manipulated,” Dr. Murray says.

They found that PKC is highly expressed in most human pancreatic tumors they sampled, and that high PKC expression predicts poor patient survival. Studying patient tumors, they found that patients whose tumors exhibited high PKC expression had a median survival time of 492 days, compared to 681 days for low PKC expression, and a reduced five-year survival rate (10 percent versus 29.5 percent for low PKC expression).

The researchers then genetically manipulated the expression of PKC in pancreatic cancer cells. The results showed that PKC is required for the growth of pancreatic cancer in both cell-based and animal models. “This is the first demonstration that pancreatic tumors require PKC to grow and metastasize,” Dr. Murray says.

The data suggest that aurothiomalate, which targets PKC, may be effective against pancreatic cancer either alone or in combination with other treatments, such as conventional chemotherapy. “Aurothiomalate may inhibit pancreatic cancer alone, or it may sensitize pancreatic tumors to chemotherapy,” she says. “It is possible that a number of cancer growth pathways will need to be targeted for an effective therapy.”

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The study was funded by the National Institutes of Health and the Mayo Clinic Foundation. The study’s authors, which include investigators from Mayo Clinic in Rochester, Minn., declare no conflicts of interest.

About Mayo Clinic

Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. Doctors from every medical specialty work together to care for patients, joined by common systems and a philosophy of “the needs of the patient come first.” More than 3,700 physicians, scientists and researchers, and 50,100 allied health staff work at Mayo Clinic, which has campuses in Rochester, Minn; Jacksonville, Fla; and Scottsdale/Phoenix, Ariz.; and community-based providers in more than 70 locations in southern Minnesota., western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education, visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your health stories

Bitter melon extract attacks breast cancer cells

Contact: Nancy Solomon
solomonn@slu.edu
314-977-8017
Saint Louis University

Early Saint Louis University research points to promising area of research

ST. LOUIS — The extract from a vegetable that is common in India and China shows promise in triggering a chain of events that kills breast cancer cells and prevents them from multiplying, a Saint Louis University researcher has found.

Ratna Ray, Ph.D., professor in the department of pathology at Saint Louis University and lead researcher, said she was surprised that the extract from the bitter melon she cooks in stir fries inhibits the growth of breast cancer cells.

“To our knowledge, this is the first report describing the effect of bitter melon extract on cancer cells,” Ray said. “Our result was encouraging. We have shown that bitter melon extract significantly induced death in breast cancer cells and decreased their growth and spread.”

Ray said she decided to study the impact of bitter melon extract on breast cancer cells because research by others have shown the substance lowers blood sugar and cholesterol levels. Bitter melon extract is commonly used as a folk medicine to treat diabetes in China and India, she said.

Ray conducted her research using human breast cancer cells in vitro or in a controlled lab setting. The next step, she says, is to test bitter melon extract in an animal model to see if it plays a role in delaying the growth or killing of breast cancer cells. If those results are positive, human trials could follow.

While it’s too early to know for sure whether bitter melon extract will help breast cancer patients, the question is worth studying, Ray said.

“There have been significant advances in breast cancer treatment, which have improved patient survival and quality of life. However women continue to die of the disease and new treatment strategies are essential,” Ray said.

“Cancer prevention by the use of naturally occurring dietary substances is considered a practical approach to reduce the ever-increasing incidence of cancer. Studying a high risk breast cancer population where bitter melon is taken as a dietary product will be an important area of future research,” Ray said.

She cautioned against seeing bitter melon extract as a miracle cure for breast cancer.

“Bitter melon is common in China and India, and women there still get breast cancer,” Ray said.

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The research was published in the March 1 edition of Cancer Research, a journal of the American Association for Cancer Research.

Established in 1836, Saint Louis University School of Medicine has the distinction of awarding the first medical degree west of the Mississippi River. The school educates physicians and biomedical scientists, conducts medical research, and provides health care on a local, national and international level. Research at the school seeks new cures and treatments in five key areas: cancer, infectious disease, liver disease, aging and brain disease and heart/lung disease.

Protecting the brain from a deadly genetic disease

Contact: Kathy Wallis
kwallis3@uwo.ca
519-661-2111 x81136
University of Western Ontario
Huntington’s disease (HD) is a cruel, hereditary condition that leads to severe physical and mental deterioration, psychiatric problems and eventually, death. Currently, there are no treatments to slow down or stop it. HD sufferers are born with the disease although they do not show symptoms until late in life. In a new study published in The Journal of Neuroscience, Stephen Ferguson and Fabiola Ribeiro of Robarts Research Institute at The University of Western Ontario identified a protective pathway in the brain that may explain why HD symptoms take so long to appear. The findings could also lead to new treatments for HD.

The symptoms of Huntington’s disease are caused by cell death in specific regions of the brain. Patients who have HD are born with a mutated version of the protein huntingtin (Htt), which is thought to cause these toxic effects. While researchers know HD results from this single, mutated protein, no one seems to know exactly what it does, why it does not cause symptoms until later in life, or why it kills a specific set of brain cells, even though Htt is found in every single cell in the human body.

Ferguson and Ribeiro used a genetically-modified mouse model of HD to look at the effects of mutated Htt on the brain. “We found there was some kind of compensation going on early in the life of these mice that was helping to protect them from the development of the disease,” says Ferguson, director of the Molecular Brain Research Group at Robarts, and a professor in the Department of Physiology & Pharmacology at Western’s Schulich School of Medicine and Dentistry. “As they age, they lose this compensation and the associated protective effects, which could explain the late onset of the disease.”

Ferguson adds that metabotropic glutamate receptors (mGluRs), which are responsible for communication between brain cells, play an important role in these protective effects. By interacting with the mutant Htt protein, mGluRs change the way the brain signals in the early stages of HD in an attempt to offset the disease, and save the brain from cell death. As a result, mGluRs could offer a drug target for HD treatment.

Because HD is a dominant genetic disease, every child with an affected parent has a 50 per cent chance of inheriting the fatal condition. This research, funded by the Canadian Institutes of Health Research, sheds light on the onset of HD and the potential role of a mutant protein in patients, paving the way for the development of new drug therapies

Mayo oral cancer study shows full tumor genome

Contact: Robert Nellis
newsbureau@mayo.edu
507-284-5005
Mayo Clinic

Novel method speeds analysis for individualized medicine

ROCHESTER, Minn. — Mayo Clinic researchers along with collaborators from Life Technologies are reporting on the application of a new approach for sequencing RNA to study cancer tumors. Their findings from a proof-of-principle study on oral carcinomas appear in the current issue of PLoS One, the online science journal.

VIDEO ALERT: Additional audio and video resources, including comments by Dr. Smith, are available on the Mayo Clinic News Blog

To explore the advantages of massively parallel sequencing of genomic transcripts (RNA), the researchers used a novel, strand-specific sequencing method using matched tumors and normal tissues of three patients with the specific cancer. They also analyzed the genomic DNA from one of the tumor-normal pairs which revealed numerous chromosomal regions of gain and loss in the tumor sample.

The key finding of this work was that alterations in gene expression which can arise from a variety of genomic alterations frequently are driven by losses or gains in large chromosomal regions during tumor development.

In addition to the specific tumor findings, this study also demonstrated the value of this RNA sequencing (RNA-Seq) method. It will allow researchers to measure strand-specific expression across the entire sample’s transcriptome. This technology reveals far more detail about genome-wide transcription than traditional microarrays.

“This method allows us to investigate genetic changes at a level that we were never able to see before,” says David Smith, Ph.D., Mayo Clinic genomics researcher and corresponding author of the study. “This provides us with much more information about alterations during cancer development that could reveal important therapeutic targets. We can more completely understand the relationship between an individual’s genome and the alterations to that which result in disease.

This is a huge step in speed, detail and diagnostic power for the field of individualized medicine. This transforms how we are going to study cancer — and how we’re going to practice medicine — in the very near future.”

The urgency of this condition points to the need for more efficient technologies and methods. Head and neck cancers are the sixth most prevalent carcinomas in the world. Advanced stage oral and throat cancers have a five-year survival rate of only 50 percent in the United States. Information provided by these and continued studies will help to better characterize the molecular basis of cancer development. That information can hopefully define better therapeutic strategies for treating an individual’s specific cancer.

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Others involved in the research include co-first author Rebecca Laborde, Ph.D.; Kerry Olsen, M.D.; Jan Kasperbauer, M.D.; Eric Moore, M.D.; and Yan Asmann, Ph.D.; all of Mayo Clinic; and co-first author Brian Tuch, Ph.D.; Xing Xu, Ph.D.; Christina Chung, Ph.D.; Cinna Monighetti, Ph.D.; Sarah Stanley, Adam Broomer, Ruoying Tan, Ph.D.; Pius Brzoska, Ph.D.; Matthew Muller, Asim Siddiqui, Ph.D.; Yongming Sun, Ph.D.; Melissa Barker; and Francisco De La Vega, Ph.D.; all of Life Technologies, Foster City, Calif.

The research was supported by Mayo Clinic and Life Technologies. The funders had no role in study design, data collection, analysis or publishing. Some authors are or have been employed by Life Technologies, which makes technology and materials used in the study. Data and materials will be shared.

About Mayo Clinic

For more than 100 years, millions of people from all walks of life have found answers at Mayo Clinic. These patients tell us they leave Mayo Clinic with peace of mind knowing they received care from the world’s leading experts. Mayo Clinic is the first and largest integrated, not-for-profit group practice in the world. At Mayo Clinic, a team of specialists is assembled to take the time to listen, understand and care for patients health issues and concerns. These teams draw from more than 3,700 physicians and scientists and 50,100 allied staff that work at Mayo Clinic’s campuses in Minnesota, Florida, and Arizona; and community-based providers in more than 70 locations in southern Minnesota, western Wisconsin and northeast Iowa. These locations treat more than half a million people each year. To best serve patients, Mayo Clinic works with many insurance companies, does not require a physician referral in most cases and is an in-network provider for millions of people. To obtain the latest news releases from Mayo Clinic, go to www.mayoclinic.org/news. For information about research and education visit www.mayo.edu. MayoClinic.com (www.mayoclinic.com) is available as a resource for your general health information

Compound shows promise against intractable heart failure

Contact: Jeanne Galatzer-Levy
jgala@uic.edu
312-996-1583
University of Illinois at Chicago
A chemical compound found normally in the blood has shown promise in treating and preventing an intractable form of heart failure in a mouse model of the disease, report researchers at the University of Illinois at Chicago College of Medicine.

The study is published in the February issue of Circulation.

More than five and half million Americans have heart failure, according to the American Heart Association, and 670,000 new cases are diagnosed each year.

In heart failure the heart is unable to pump effectively and cannot meet the body’s need for blood and oxygen. It is really two diseases, each with about half of all patients, says Dr. Samuel Dudley, professor of medicine and physiology at UIC and chair of the section of cardiology. Systolic heart failure occurs when the heart can no longer contract effectively. In diastolic heart failure, the heart is unable to relax after contraction.

“Although we have a number of treatments for systolic heart failure, there are no approved treatments at all for diastolic heart failure, a deadly disease with a 60 percent mortality rate five years after diagnosis,” said Dudley.

Hypertension is the cause in the overwhelming majority of diastolic heart failure cases.

“We know from previous studies that nitric oxide (NO) is necessary for blood vessel relaxation,” said Dudley, “and that hypertension can lead to a decrease of NO in blood vessels.”

Dudley and his colleagues knew that — in blood vessels — the problem was depletion of a chemical called tetrahydrobiopterin, or BH4, which is needed for the tissues to make NO.

“We decided to try thinking of the heart as a huge blood vessel that might also be unable to make the NO it needed due to long-term hypertension, and see if adding BH4 could make a difference,” said Dudley.

They found that by giving mice BH4 they were not only able to prevent diastolic heart failure from developing, but to restore function to the heart after the fact.

“We are very excited about the possibilities of developing therapies for human heart failure based on BH4,” said Dudley. BH4 has already been shown to be safe in FDA trials, in a formulation currently used to treat phenylketonuria, a genetic condition.

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The research was supported by National Institutes of Health grants; an American Heart Association (AHA) Established Investigator Award and Veterans Affairs Merit Grant to Dudley; and an AHA Scientist Development Award to Xiao.

Dr. Gad Silberman, Dr. Tai-Hwang Fan, Dr. Hong Liu, Dr. Zhe Jiao, Dr. Hong Xiao, Dr. Joshua Lovelock, Dr. Beth Boulden, Dr. Julian Widder, Dr. Scott Fredd, Dr. Kenneth Bernstein, Beata Wolska, Sergey Dikalov and Dr. David Harrison also contributed to the study.

For more information about UIC, visit www.uic.edu

Shifting cellular energy metabolism may help treat cardiovascular disease

Contact: Sue McGreevey
smcgreevey@partners.org
617-724-2764
Massachusetts General Hospital

Novel screening technique identifies new effects of approved drugs, further study needed

Drugs that target the way cells convert nutrients into energy could offer new approaches to treating a range of conditions including heart attack and stroke. Using a new way to screen for potential drugs, a team led by Massachusetts General Hospital (MGH) researchers has identified several FDA-approved agents, including an over-the-counter anti-nausea drug, that can shift cellular energy metabolism processes in animals. Their findings, being published online in Nature Biotechnology, may open the door to new therapeutic strategies for several serious health problems.

“Shifts in cells’ energy production pathways take place naturally during development and in response to demanding activities like sprinting versus long-distance running. They are also known to be involved in several disease states,” explains Vamsi Mootha, MD, of the MGH Center for Human Genetic Research, who led the study. “We wanted to identify compounds that can safely induce this shift those that have previously been discovered are too toxic and investigate their therapeutic potential in animal models.”

Normally cells convert nutrients into energy by relying on two cellular processes. One involves the uptake of sugars that are broken down in the cytoplasm into a molecule called lactate via a process called glycolysis, which quickly yields a small amount of ATP, the enzyme that provides cellular energy. Alternatively, sugars and proteins can be processed in cellular structures called mitochondria to release greater amounts of ATP through a more efficient process called cellular respiration.

In cancer cells and other rapidly proliferating cells, energy is produced predominantly by glycolysis, suggesting that a shift away from that mechanism might suppress tumor growth. Previous animal studies suggested that a reduction in mitochondrial respiration could mimic a process called ischemic preconditioning, in which brief episodes of ischemia a reduction in blood flow actually protect tissue against being damaged if its blood supply is later cut off completely.

To search for compounds that shift cells from respiration to glycolysis, Mootha’s team devised a novel screening strategy. They cultured skin cells in two different nutrient environments glucose, which provides energy through both glycolysis and respiration, or galactose, which forces cells to rely on mitochondrial respiration alone. A drug that redirects energy metabolism from respiration to glycolysis would stop growth in the galactose-cultured cells while having little effect on cells grown in glucose. Their initial screen of almost 3,700 compounds, including nearly half of all FDA-approved drugs, identified several drugs known to inhibit cellular respiration on one end of the scale and several anti-cancer drugs that halt the growth of rapidly proliferating cells at the other, which verified the approach.

Because most agents known to mimic ischemic preconditioning in animal models are too toxic to use in human patients, the researchers were most interested in finding drugs that cause subtle metabolic shifts. The screen identified eight approved drugs that produced a less pronounced but still significant shift away from cellular respiration. One of those agents was meclizine, an over-the-counter drug used to treat nausea and vertigo suggesting that it passes the blood-brain barrier with few negative side effects.

To investigate meclizine’s potential to prevent tissue damage in heart attack or stroke, Mootha’s team collaborated with University of Rochester researchers who had developed rat models of heart attack damage and an MGH Pathology group with a mouse model of stroke damage. Blinded experiments using both animal models showed that pretreatment with meclizine dramatically reduced ischemic damage to cardiac cells in the heart attack model and to brain cells in the stroke model. They also found that meclizine’s ischemia protective effects do not appear to involve its known mechanisms.

While the study results suggest that treatment with drugs like meclizine may someday be useful for reducing the damage associated with heart attack or stroke, Mootha stresses that much additional study is needed. “Before we can think about human studies, we need to do rigorous animal testing to determine optimal, safe dosing regimens and learn more about how this drug works,” he says. He also notes that the drug-screening strategy developed by his team could help to identify previously unsuspected beneficial or detrimental effects of other approved drugs.

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Mootha is an associate professor of Systems Biology at Harvard Medical School and an associate member of the Broad Institute of MIT and Harvard. Co-lead authors of the Nature Biotechnology article are Vishal Gohil, PhD, and Sunil Sheth, MD, MGH Center for Human Genetic Research (CHGR). Additional co-authors are Roland Nilsson, PhD, Fabiana Perocchi, PhD and William Chen, MGH-CHGR; Jeong Hyun Lee, PhD, and Cenk Ayata, MD, MGH Pathology; Andrew Wojtovich and Paul Brookes, PhD, University of Rochester Medical Center; and Clary Clish, PhD, Broad Institute. The study was supported by grants from the American Diabetes Association and the Smith Family Foundation.

Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $600 million and major research centers in AIDS, cardiovascular research, cancer, computational and integrative biology, cutaneous biology, human genetics, medical imaging, neurodegenerative disorders, regenerative medicine, systems biology, transplantation biology and photomedicine.

Scientists identify critical enzyme in healthy heart function

Contact: Nick Miller
nicholas.miller@cchmc.org
513-803-6035
Cincinnati Children’s Hospital Medical Center
CINCINNATI Scientists are reporting the first-ever data to show that the enzyme calcineurin is critical in controlling normal development and function of heart cells, and that loss of the protein leads to heart problems and death in genetically modified mice.

Published Feb. 26 in the Journal of Biological Chemistry as the paper of the week, and posted online Feb. 19, the research was led by scientists at Cincinnati Children’s Hospital Medical Center and the Howard Hughes Medical Institute.

The study demonstrates that calcineurin in hearts of mice is directly linked to proper cardiac muscle contraction, rhythm and maintenance of heart activity. The near total absence of calcineurin in mice leads to heart arrhythmia, failure and death, according to the research team.

Scientists knew previously that calcineurin is important to heart function, but the extent of its role had not been defined prior to the current study. Although the research involved mice, it offers important insights for future studies that could lead to new approaches in diagnosis and treatment of heart patients, said Marjorie Maillet, Ph.D., the study’s first author.

“We found that when you eliminate calcineurin, a pool of genes that regulates calcium in the heart went awry. This leads to defects in the growth and proliferation of heart cells, heart disease, arrhythmia, loss of contractility and heart failure and disease,” said Dr. Maillet.

Calcium is also important to cardiac growth and the contraction of heart muscle. Previous studies have linked abnormalities in calcium handling to cardiac disease, especially in adults. In mice genetically bred for calcineurin deficiency, the researchers saw that this deficiency causes a dramatic reduction in the expression of genes that coordinately regulate calcium-handling and contraction.

The scientists also report a newly identified “feed-forward” mechanism, in which the direct activation of calcineurin by calcium augments the expression of genes that regulate calcium-handling proteins in the heart.

Dr. Maillet works in the laboratory of the study’s senior investigator, Jeffery Molkentin, Ph.D., a researcher in the division of Molecular Cardiovascular Biology at Cincinnati Children’s and a Howard Hughes Medical Institute Investigator. Dr. Molkentin’s laboratory and division are also part of the Cincinnati Children’s Heart Institute.

Also collaborating on the study were researchers from the University Paris-Sud, Chtenay-Malabry, France and the department of Molecular and Cellular Physiology at the University of Cincinnati College of Medicine.

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Funding support for the study came from the National Institutes of Health, the Howard Hughes Medical Institute, the Ohio Valley Affiliate of the American Heart Association and a collaborative research grant in cardiovascular disease from the Fondation Leducq.

About Cincinnati Children’s

Cincinnati Children’s Hospital Medical Center is one of 10 children’s hospitals in the United States to make the Honor Roll in U.S. News and World Reports 2009-10 America’s Best Children’s Hospitals issue. It is #1 ranked for digestive disorders and is also highly ranked for its expertise in respiratory diseases, cancer, neonatal care, heart care, neurosurgery, diabetes, orthopedics, kidney disorders and urology. One of the three largest children’s hospitals in the U.S., Cincinnati Children’s is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health.

President Barack Obama in June 2009 cited Cincinnati Children’s as an “island of excellence” in health care. For its achievements in transforming health care, Cincinnati Children’s is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases. Additional information can be found at www.cincinnatichildrens.org.

Tiny molecules may tell big story about cardiovascular disease risk

Contact: Debbe Geiger
Debbe.Geiger@duke.edu
919-660-9461
Duke University Medical Center
DURHAM, NC Tiny bits of molecular “trash” found in circulating blood appear to be good predictors of cardiovascular disease and untimely death, say researchers at Duke University Medical Center.

The discovery, published online in the April issue of the journal Circulation Genetics, comes from the largest study of its kind for cardiovascular disease, and is the first to identify specific metabolic profiles associated with coronary artery disease, heart attacks and death among patients who have undergone coronary catheterization.

The Duke study analyzed metabolites, the molecular debris left over after the body breaks food down into energy sources and building blocks of cells and tissues.

Scientists believe metabolites may be useful in diagnosing disease, said Svati Shah, M.D., M.H.S., a cardiologist in the Duke Heart Center, the Duke Center for Human Genetics and the lead author of the study. But the tiny molecules are notoriously hard to identify, quantify and characterize. Shah has been studying metabolic signatures in heart disease for several years and led earlier research showing that metabolic profiles associated with early-onset coronary artery disease can be inherited.

Shah and William Kraus, M.D., professor of medicine at Duke and the senior author of the study, wanted to know if they could isolate and identify particular metabolites associated with coronary artery disease. They began their investigation with information in Duke’s CATHGEN biorepository which holds health records and blood samples from nearly 10,000 patients who had come to Duke over the past eight years for catheterization. Collaboration with Christopher B. Newgard, PhD., director of Duke’s Sarah W. Stedman Center for Nutrition and Metabolism, allowed Shah, Kraus and others to accurately quantify and characterize the metabolites.

Researchers selected 174 patients who had experienced early-onset coronary artery disease (CAD) and compared them to 174 controls who had undergone catheterization but who were not found to have CAD. Using a panel of 69 metabolites previously identified as potentially involved in the development of CAD, they examined the metabolic profiles in both groups.

“We found two sets, or clusters of metabolites that seemed to differentiate between the two groups,” says Shah.

Next, they tested the two sets of metabolites to see if they could differentiate between patients of any age who had CAD and those who did not. Again, the two sets of metabolites were able to discriminate between the two groups.

In order to evaluate the ability of the metabolites to predict risk of heart attack or death, the researchers also created an “event group” comprising 314 patients from all groups who suffered a heart attack or death during a follow-up period of almost three years. They compared metabolic profiles between those who suffered a heart attack or death with those who did not. Using multiple analytic and statistical methods, they found two factors that were clearly associated with coronary artery disease and one factor that predicted greater risk of heart attack or death among patients with coronary artery disease.

“When we added these biomarkers to traditional clinical risk models, we found that they increased the accuracy of projected risk,” says Shah.

While earlier studies have suggested that certain metabolites are associated with the presence and severity of CAD, researchers have not been able to identify most of the individual molecules within those profiles, says Shah, “which in the end meant that these studies were not that clinically useful.”

“Here, we specifically selected clusters of metabolites that we know are involved in multiple pathways of lipid, protein and glucose metabolism pathways that are often disrupted in CAD — and we showed that they are indeed associated with CAD and subsequent risk of cardiac events,” says Kraus, “These metabolic profiles may be a way from routine clinical use, but we feel they are a good first step in that direction.”

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Colleagues from Duke who contributed to the study include James Bain, David Crosslin, Michael Muehlbauer, Robert Stevens, Carol Haynes, Jennifer Dungan, Kristin Newby, Elizabeth Hauser, Geoffrey Ginsburg and Christopher Newgard, director of the Sarah W. Stedman Nutrition & Metabolism Center.

Scientists map out regulatory regions of genome, hot spots for diabetes genes

Contact: Tom Hughes
tahughes@unch.unc.edu
919-966-6047
University of North Carolina School of Medicine

The research, published online Jan. 31, 2010, in the journal Nature Genetics, presents the first high-resolution atlas of these regulatory elements in the most studied cell type for treatment and prevention of type 2 diabetes

CHAPEL HILL Together with colleagues in Barcelona, researchers at the University of North Carolina at Chapel Hill have generated a complete map of the areas of the genome that control which genes are “turned on” or “off.” The discovery, made in pancreatic islet cells, opens new avenues for understanding the genetic basis of type 2 diabetes and other common illnesses.

“Most of the human genome is uncharted territory entire stretches of sequence with no clear function or purpose,” said Jason Lieb, Ph.D., associate professor of biology at UNC, a member of the UNC Lineberger Comprehensive Cancer Center and one of the senior authors of the study. “In fact, the majority of the DNA sequences associated with disease found thus far reside in the middle of nowhere. Here we have developed a map that can guide scientists to regions of the genome that do appear to be functionally relevant, instead of a dead end.”

The research, published online Jan. 31, 2010, in the journal Nature Genetics, presents the first high-resolution atlas of these regulatory elements in the most studied cell type for treatment and prevention of type II diabetes.

The completion of the human genome project has spurred a flurry of research into the exact genetic changes underlying disease. But while these studies have discovered thousands of sequences associated with human illness, pinpointing which sequence variations are the true culprits has proven difficult. That is because the underlying genetic sequence the A, C, T, and G that code for your entire being is only part of the story. It is not just the message, but the packaging whether those four letters are laid out like an open book or tightly packaged like a message in a bottle that determine which genes are active and which are not.

Using a new method developed in the Lieb laboratory called FAIRE-seq, Lieb and his colleagues isolated and sequenced a total of 80,000 open chromatin sites within pancreatic islet cells. They then compared these sites to those in non-islet cells to narrow the number down to 3,300 clusters of sites specific to this cell type. Each cluster typically encompassed single genes that are active specifically in islet cells. Twenty of these genes are known to harbor gene variants associated with type II diabetes.

The researchers decided to continue their studies on the variant most strongly associated with the disease, a single nucleotide polymorphism or SNP occurring in the TCF7L2 gene. They found that the chromatin is more open in the presence of the high risk version of the gene (a T) than in the presence of the non-risk version (an A). Further analysis demonstrated that the risk variant enhanced the activity of the gene, indicating that it may possess functional characteristics that could contribute to disease.

Lieb says his map is likely to help others within the diabetes research community identify new targets for understanding and ultimately treating the disease more effectively. But the approach is not limited to diabetes, or even pancreatic islet cells. He plans to use FAIRE-seq to chart the open chromatin regions present within other cells, such as the immune system’s lymphocytes.

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The UNC research was funded in part by the National Institutes of Health. Study co-authors from UNC include Kyle J. Gaulton, Jeremy M. Simon, Paul G. Giresi, Marie P. Fogarty, Tami M. Panhuis, Piotr Mieczkowski, and Karen L. Mohlke. Collaborators from outside UNC include Takao Nammo, Lorenzo Pasquali, , Antonio Secchi, Domenico Bosco, Thierry Berney, Eduard Montanya, and Jorge Ferrer. Co-senior author Dr. Ferrer conducts his research in the Department of Endocrinology, Hospital Clnic de Barcelona

‘Artificial pancreas’ a step nearer for children with type 1 diabetes

Contact: Becky Allen
becky.allen@admin.cam.ac.uk
44-122-333-2300
University of Cambridge
Scientists in Cambridge have made a significant step towards developing a so-called “artificial pancreas” system for managing type 1 diabetes in children. The team has developed and successfully tested a new algorithm, providing a stepping stone to home testing for the artificial pancreas.

The new study funded by Juvenile Diabetes Research Foundation (JDRF) and published today in The Lancet shows that using an artificial pancreas system overnight can significantly reduce the risk of hypoglycemia, when blood glucose levels drop dangerously low, while sleeping. These so-called “hypos” are a major concern for children and adults with type 1 diabetes.

An artificial pancreas system combines a continuous glucose monitor and an insulin pump, both already on the market, and uses a sophisticated algorithm to calculate the appropriate amount of insulin to deliver based on the real-time glucose readings.

As well as obviating the need for multiple daily finger prick tests and insulin injections, the artificial pancreas should offer better control of blood glucose levels overnight.

In the new study, 17 children and teenagers aged between 5 and 18 with type 1 diabetes were studied during 54 nights in hospital. The team measured how well the artificial pancreas system controlled glucose levels compared with the children’s regular continuous subcutaneous insulin infusion (CSII) pump, which delivers insulin at preselected rates.

The study included nights when the children went to bed after eating a large evening meal or having done early evening exercise. Both are challenging to manage, a large evening meal because it can lead to so-called “insulin stacking” and, as a result, a potentially dangerous drop in blood glucose levels later in the night, and late afternoon or early evening exercise because it increases the body’s need for glucose in the early morning and can therefore increase the risk of night time hypoglycaemia.

The pooled results showed the artificial pancreas kept blood glucose levels in the normal range for 60% of the time, compared with 40% for the CSII. The artificial pancreas halved the time that blood glucose levels fell below 3.9mmol/l the level considered as mild hypoglycaemia. It also prevented blood glucose falling below 3.0mmol/l, which is defined as significant hypoglycaemia, compared with nine hypoglycaemia events in the control studies.

According to lead author Dr Roman Hovorka of the Institute of Metabolic Science at the University of Cambridge: “Our results show that commercially-available devices, when coupled with the algorithm we developed, can improve glucose control in children and significantly reduce the risk of hypos overnight.”

“This is the first randomised study showing the potential benefit of the artificial pancreas system overnight using commercially-available sensors and pumps. Our study provides a stepping stone for testing the system at home.”

Type 1 diabetes is a chronic, life threatening condition which is on the increase in the UK, particularly in the under fives. Children and adults require multiple daily insulin injections or pump infusions and many finger prick blood tests each day. However, treatment with insulin brings with it the risk of hypoglycaemia, one of the most feared short-term complications of type 1 diabetes for children and their parents.

Recent technological developments in blood glucose monitors and devices for continuous administration of insulin such as those used in this study can improve blood glucose control, but more needs to be done.

Commenting on the results Karen Addington, Chief Executive of JDRF said: “This study is proof of principle that type 1 diabetes in children can be safely managed overnight with an artificial pancreas system. We need to redouble our efforts to move the artificial pancreas from a concept in the clinic to a reality in the home of children and adults with type 1 diabetes.”

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The research is published today in The Lancet.

For additional information, please contact:
Becky Allen, Office of Communications, University of Cambridge
Tel: +44 (0)1223 332300, mobile: + 44 (0)7500 883644, email: becky.allen@admin.cam.ac.uk

Notes to editors:

Roman Hovorka et al, ‘Closed-loop insulin delivery in children and adolescents with type 1 diabetes’ is published in The Lancet on 5 February 2010.

About type 1 diabetes: Type 1 diabetes is an autoimmune condition that affects children, adolescents, and adults, in which the immune system attacks cells in the pancreas that produce insulin, a hormone that enables people to convert food into energy. It is not related to diet, exercise or any other lifestyle factors. People with type 1 diabetes are dependent on insulin for the rest of their lives. Insulin is not a cure, and people with type 1 diabetes are at significant risk for a wide range of serious complications, including heart disease, blindness and kidney disease.

Around 76,000 children under the age of 15 develop type 1 diabetes each year throughout the world. There are over 25,000 children with type 1 diabetes in the UK and about 325,000 adults. Incidence is increasing by 4 per cent each year, with the biggest rise in children under five, with a five fold increase in this age group in the past 20 years.

About JDRF: Juvenile Diabetes Research Foundation (JDRF) is the leading charitable funder of type 1 diabetes research worldwide. JDRF has been responsible for more than 800 million of funding of the most promising and groundbreaking type 1 diabetes research around the world. www.jdrf.org.uk.