Category Archives: medical advances

Leukaemia and Diabetes Drugs?

Today, an interesting news story caught my eye regarding Leukaemia. Leukaemia is a cancer which usually originates from bone marrow, and leads to the production of abnormal white blood cells [1]. It is a disease categorised by the type of white blood cell it affects, which are the myeloid cells of lymphatic cells [1].

This poses an issue when it comes to treatment options, as targeting unhealthy, harmful mutated cells in the bone marrow, can also damage healthy cells – both white and red blood cells. There are several treatment options, including chemotherapy, biological therapy, targeted therapy, radiation therapy and stem cell transplants [2]. Biological therapy helps a patients’ immune system recognise leukaemia cells, and targeted therapy uses drugs which specifically target certain weaknesses within cancer cells [2]. While these options have a, rightfully, strong emphasis on target leukaemia cells, they can also often damage red blood cells – causing fatigue, dizziness, anaemia, and a wide range of side affects [3].

A recent study, published in ‘Nature Cell Biology’ takes a different approach, considering the ‘entire bone marrow as an ecosystem’ [3] and not just targeting diseased cells. It was found that Leukaemia suppresses the cells which store fat in the body, causing the maturation of red blood cells to stop, as their stem cells dysfunction [3].

What is particularly interesting, is that a drug, commonly used to treat type-2 diabetes, was shown to have positive effects. PPAR-gamma, helps to restore the fat cells in the bone marrow – thus, restoring healthy red blood cell development and minimising the leukaemia’s growth [3]. By changing the environment that the cancer ‘lives’ in, it allowed healthy cells to thrive and, if you will, ’outcompete’ the cancerous cells, suppressing their growth.

I think this has very exiting prospects for cancer treatment in the future, and is an approach which can be applied to many different therapies and treatment options. Looking at a broader image, organ or system could raise treatment options, which have no previously been considered.

PrEP – preventing HIV?

A couple of weeks ago, I read an interesting, if not startling, BBC article surrounding the Scottish NHS. This lead me to research more into the treatment which the NHS in Scotland has recently approved to fund and routinely offer to its people. This treatment is known as ‘PrEP’, and it has been proven that a daily dose can protect those at risk of contracting the virus [1].

How does PrEP work?

PrEP is an anti-retroviral drug, fitting with the nature of HIV as a retrovirus. This means that HIV is composed on RNA, and contain reverse transcriptase, which is an enzyme. This allows the viral RNA to be transcribed into DBA after entering a host cell. This DNA can consequently be integrated into the DNA of the host cell and expressed – one of the key problems with treating HIV is that it is a retrovirus. [2]

PrEP therefore, prevents the virus from multiplying if it enters the body [1] without major side affects [4] . Therefore, it is a preventative treatment as opposed to a ‘cure’ for HIV. Taking the pill consistently each day has been shown to reduced the risk of HIV infection by 86% alone [4] – a staggering number, however with other preventative methods such as the use of condoms, this number increases [3].

What are the benefits?

What is remarkable about this drug however, is that it is estimated 1900 Scottish people could benefit from the drug, and the huge amount of money (around £450 a month per person) which the Scottish NHS is investing, [1], but also saving. For each person who does not become HIV positive due to the use of PrEP, the NHS in Scotland with save £360,000 in lifetime treatment costs [1] – prevention is better than cure, they say.

I think this is huge step in the right direction, when fighting an incredibly stigmatised disease. The treatment has the potential to help improve quality of life, save money and to reduce the numbers of those suffering with HIV in the future. I can only help that our NHS follows in the steps of NHS Scotland

[1] http://www.bbc.co.uk/news/uk-scotland-39552641

[2] http://www.medicinenet.com/script/main/art.asp?articlekey=5344

[3] https://www.cdc.gov/hiv/basics/prep.html

[4] http://www.tht.org.uk/sexual-health/About-HIV/Pre-exposure-Prophylaxis

A Pharmaceutical Lecture by Gwenan White

Hello!! A couple of days ago I attended a pharmaceutical based lecture at my school, spoken by a woman who works for the company AbbVie, a comparatively small company specialising in virology, immunology, neuroscience and oncology. It was far more interesting and relevant to me than I initially thought it might be, and I took away some key lessons which I thought I would share with you.

It typically takes around 12 years to bring a medicine to life – over a decade of isolating compounds and mixing constituents and clinical trials. What interested me within this process was the use of animal testing. Animal rights are something I feel strongly about and if I’m honest, I’ve always been opposed to their use in science. However, recently I attended a lecture on the ‘naked mole rat’ (hopefully a blog post to follow!) and then this lecture, which has made me consider the benefits and boundaries of using animals in science. While I won’t dwell on the use of the naked mole rat too much as it is something I’d like to write about later, it was a talk which demonstrated to me a clear ethical and moral use of animals in research. In the pharmaceutical industry however, it is not always clear how these animals may react to the drugs within their systems. Although, it was emphasised to me that as few a animals as possible are used with the most effecting but least affective (in terms of side affects) treatment option primarily. Or surrogate models can be used preventing the need for animals. This showed me the diverse range of steps needed to take a medicine to market, and that medicines must not only be effective and ethical but also cost effective.

The ethos of the AbbVie  in the talk was that they aim to combine the expertise and stability of traditional pharma with the focus, culture and innovative spirit of biotech. This really summed up the state of modern science and medicine for me, we are in a stage where we a gradually moving away from the reliable treatments and options for those which may be slightly more risky but give patients better quality of life post treatment. For instance, when watching the BBC documentary ‘Hospital’ last week I was captivated by the innovative treatment of a 98 year old man. He first, had a compressed heart valve inserted into his heart through a blood vessel in his leg, which was then synchronised with the contraction of his heart using a screen. However, the incredible surgical techniques didn’t stop there, he later had a wire mesh inserted into an artery which led to his brain to remove a clot causing him a stroke and possible brain damage. This being a thrombectomy, which if carried out within 6 hours of a stroke results in full blood flow and a reduced risk of brain damage. Similarly, in the same documentary a new treatment method was used to treat an 18 year old girl with Sickle Cell disease, where her immune system was depleted using chemotherapy and radiotherapy allowing her to engraft bone marrow with a match of only 50%. This is an incredible feat. Linking this back to the lecture, it is through combining new ideas and treatment methods with the stability of old ones which medicine can and is advancing.

Like much of the news these days, the talk did also mention that out current healthcare system is not sustainable – we have an ageing population and more than 1/4 of people in the UK have a chronic illness. All of which need treatment and all of which costs money. A statistic which was raised is that every 36 hours 1,000,000 people pass through the NHS, and we do not have a healthcare system which can deal with that demand. What we do have however, is new means of empowering patients to look after themselves – who hasn’t seen an advert for an online GP? Or advice from the NHS website? What is crucial is that doctors need recognise the role of the patient in their own treatment – diet and lifestyle choice can hugely influence what treatment a person may later need, but also knowing when and when not to see a doctor of GP is crucial. The NHS does not, essentially, have time to waste. Having said that, there should be no ‘fear of finding out’ what the doctor has to say, and people should not avoid the GP Surgery because they are scared they are ill – they should act quickly and potentially save their own live, or give themselves years. If not, at least just peace of mind.

So these are some of the key ideas I took from a pharmaceutical lecture I thought would just be about the development of drugs, which was actually much more patient focused for an industry which is not allowed direct patient contact – charities and organisations on patient’s behalf must be used instead. Therefore, I would encourage everyone to attend some science or medicine based lectures, and not to be afraid to take notes. Taking notes is what I’ve found has really allowed me to write up and reflect on what I’ve learnt, and that’s definitely worth more than a few snide comments. I hope you’ve found this interesting and hopefully I will write more reflections on lectures in the future.

The Mesentery – The Newly Discovered Organ

Recently, the news has been jam packed with headlines about the ‘mesentery’ – essentially the discovery of a new organ, which was hiding in plain sight. What was previously thought to be a few fragmented structures in the digestive system, has been discovered to be one continuous organ. The double fold of the lining of the abdominal cavity, holding the intestine to the wall of the abdomen. I thought I’d do a bit of research, as what really interested me is what function can the mesentery have? As scientists we have thought we understood the human body, and the roles of each of its organs, however the discovery of a new organ comes with new questions. What does it do? What is its impact on the functions of other organs?

The mesentery has been rigorously investigated by professor J Calvin Coffey since 2012, where electron microscope examinations were used to analyse the structure. This led to the discovery oimage_4479-Mesenteryf one continuous organ, and not just tissue fragments in the digestive system. Understanding the function of this organ is essential in the field of medicine, when the functionis understood, abnormal function can be understood and the differences observed and investigated. Enabling scientists to consequently find the diseases related to that organ, and how to treat them.

The mesentery can be seen as a folded flap around the intestines, from the base of the stomach and pancreas, closing the small intestine and colon, to the rectum. While what appears to be its most obvious purpose is to maintain the positioning of our intestines, there have been suggestions of other roles of the organs. One of which, from J Calvin Coffey and D Peter O’Leary (University of Limerick) is that is may be responsible for the movementof white blood cells around the intestines.

The classification of the mesentery as an organ does not change the structure which has been inside our bodies for millions of years, however it does present a new field of medical science and the possibility of improving health outcomes, such as those for abdominal and digestive diseases. For instance, when the tissue of the mesentery becomes inflamed, it can disturb the intestines, causing stomach pains and discomfort. Why is not yet known, as the function of this new organ is not yet understood. The anatomy and structure of the mesentery has been established and scientists are now working towards establishing the function of mesentery and thus what role in could play in disease, alongside the possibility of new and revolutionary treatments.

This was a discovery I found truly shocking,  as it is one which causes us to question what it is we already know about the human body, and the possibilities of the vast amounts we do not know. However, science is an ever advancing field, and as our investigative techniques improve and advance, I am hopeful that we will continue to discover more about the human body and how it works, enabling us to to improve treatment methods.

sources 

http://www.thelancet.com/pdfs/journals/langas/PIIS2468-1253(16)30026-7.pdf

http://edition.cnn.com/2017/01/04/health/new-organ-mesentery/ 

https://www.kenhub.com/en/library/anatomy/mesentery

http://arstechnica.com/science/2017/01/a-ruffled-intestinal-support-called-the-mesentery-may-be-our-79th-organ/

 

The Treatment of Stable Angina – Pressure Wires

When reading through November’s issue of the BMJ, I came across an editorial entitled, ‘Assessing flow limitation in stable angina’. While admittedly, the first time I read it it made very little sense to me, after a little research and a couple of rereads, the adaptation of cardiology services in order to make the advances in the assessment of stable angina accurate became increasingly apparent.

Stable angina occurs when the heart muscle is deprived from blood and consequently oxygen, and causing uncomfortable pain in the chest, occasionally neck, shoulders and back. It’s the term used to describe discomfort due to coronary heart disease. [1]

As stated in the BMJ, currently stable angina is assessed using an initial angiographic assessment, although studies have shown that flow limitation can be accurately assessed by using a pressure wire to measure the fractional flow reserve. This is because stable angina is often caused by the narrowing of arteries, for instance, this may be due to the build up of fat or cholesterol, or a blood clot.

With such advances in the assessment of stable angina, it became clear to me, that the issue in implementing the use of a pressure wire is widely due to the amount of interventional cardiologists within the UK – around 740. With an estimated 247,000 angiograms completed annually, it currently does not seem to be feasible to implement the use of a pressure wire, as it requires the immediate option of stenting, incase a problem arises.

However, there are huge advantages in the use of a pressure wire. Not all lesions reduce blood flow, some are merely present with no impact on the flow of blood towards the heart, or around the body. Angiograms do not currently make it clear which of these lesions is disruptive. Currently, the measurement of fractional flow reserve, what I understand to be the ratio of distal (situated away from the centre of the body) to proximal pressures (pressures near to the centre of the body) is the only measure which assesses both multiple lesions and vessels. What could this mean? That those people with lesions which reduce blood flow could receive treatment quickly, and those with lesions with no impact on blood flow do not need to undertake the risk of surgery.

This article showed me that the new treatment provides the opportunity to specify the treatment of stable angina further, potentially reducing the amount of patients who go under the knife and thus undergo the risks of surgery. However, it presents new issues in terms of resources and the numbers of cardiologists able to complete the procedure – highlighting again the necessity of adapting cardiology departments, and increasing the numbers of medical professionals.

Sources: [1]http://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeartAttack/Angina-Pectoris-Stable-Angina_UCM_437515_Article.jsp# and The BMJ November Issue

 

Prostate Cancer Treatment – Huge Advances

Today (20.12.16) a news story caught my attention, marking a huge milestone in the treatment of prostate cancer with the development of a drug which can treat the cancer without the side affects of radical surgery. Radiology often sees men experience incontinence and erectile dysfunction as a side affect, which can be hugely damaging to a persons self esteem and personal life. What does this mean? Of those who trialled the treatment, almost 1 in 2 were cancer free after 2 years, compared to around 1 in 7 without the treatment. While not entirely foolproof, what really interested me was how this drug works and its incredible potential.

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The drug is made from bacteria which live on the seafloor in complete darkness – this being the key to the treatment. This bacteria becomes toxic only when it is exposed to light. By inserting fibre optic lasers through the perineum, the bacteria is activated and begins to work on killing cancerous cells, but leaves a healthy prostate behind. The huge benefit of this treatment however, is to the lives of the patients themselves – there were no impacts on sexual activity or urination for more than three months, and after two years the men trialled had no significant symptoms. The success of the trial of this treatment means that potentially, prostate glands may no longer have to be removed to cure the cancer – an incredible feat.

Prostate cancer is a deadly disease, killing around 11,000 men each year. Consequently, I think such an advance in the treatment could be the beginning of controlling such a cancer, and limiting its life long effects. While understandably, when to intervene with a prostate cancer diagnosed patient needs to be considered as tumours are slow growing, the potential is tremendous and the trial is a positive indicator for the development of this treatment.

sources: BBC News, BBC website, http://edition.cnn.com/2016/12/20/health/prostate-cancer-laser-drug-treatment/index.html