Archive for December, 2019

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San Antonio Breast Cancer Symposium, December 11, 2019

Newswise WASHINGTON (December 9, 2019) Women who receive palbociclib (Ibrance ) to treat their advanced breast cancer and have a gene alteration that can lead to a condition known as benign ethnic neutropenia (BEN), can safely receive the drug without major concerns of developing infections associated with neutropenia, or low white blood cell counts, say Georgetown Lombardi Comprehensive Cancer Center researchers. African American women have a higher incidence of BEN than other races and have been underrepresented in trials testing this medicine so palbociclibs safety in this population wasnt fully known.

This clinical trial result will be presented in a poster session at the San Antonio Breast Cancer Symposium on December 11, 2019, in San Antonio, Texas.

Many clinical trials require patients to have normal white blood cell counts at enrollment. Specifically, clinical trials of palbociclib have shown that women can develop neutropenia (low neutrophil counts) while taking the drug and therefore be at increased risk of infection. Neutrophils are a type of white blood cell and they are usually one of the first types of white blood cells to reach a site of infection. The lack of infection-fighting white blood cells is often an emergency situation. A BEN diagnosis carries a very low risk of infection, yet women may be given reduced dosages of palbociclib due to lower neutrophil counts even though their infection risk is low.

The phase II PALINA trial, conducted at Georgetown Lombardi and four other centers, used advanced DNA testing at the start of the trial to determine if women had the gene alteration that leads to BEN. The women took palbociclib pills and an estrogen-lowering pill (letrozole) for a maximum of one year. They were then followed to determine if their BEN status affected their safety when taking palbociclib.

Problematically, African American women and women of African descent have higher rates of death due to breast cancer than white women and their representation in clinical trials has been historically lacking, said Filipa Lynce, MD, a physician researcher at Georgetown Lombardi Comprehensive Cancer Center who treats patients at MedStar Georgetown University Hospital. It was important for us to demonstrate that African American and other women with BEN can, and should, receive the same treatment regimen, in this case palbociclib, for their breast cancer as other women.

The trial enrolled 35 women from Washington, D.C., Baltimore, Chicago and Philadelphia. This current analysis showed that of the 33 women who were tested, 58% had the gene alteration that is associated with lower neutrophil counts. None of the patients in this trial progressed to neutropenia that led to a fever, nor did any of the women discontinue their treatment due to infections. Nearly half of the women did develop a high, but not life-threatening level of neutropenia, resulting in delays in taking their medications.

We are now more confident that palbociclib can be taken safely by African American and other women with BEN, as long as their white blood cell counts are regularly monitored, said Lynce. Our results also point out the need to design trials that enroll women with different ancestries and reflect our patient population so that study outcomes can be applicable to as many women as possible.

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In addition to Lynce, authors from Georgetown University and its clinical partner MedStar Health, include R. Zhuo, M. Blackburn, C. Gallagher, T. Wu, P. Pohlmann, A. Dilawari, S. Tiwari, A. Chitalia, R. Warren, M. Tan, A. Shajahan-Haq, and C. Isaacs. Additional authors include O. Hahn, University of Chicago, M. Abu-Khalaf, Thomas Jefferson University, Philadelphia, PA, and M. Mohebtash, MedStar Franklin Square Cancer Center, Baltimore, MD.

The authors report the following disclosures relevant to this study: F. Lynce: C; A; AstraZeneca, Jounce, Celgene, BMS, Inivata (unpaid). C; A; BMS, Pfizer, Genentech/Roche, Immunomedics, Calithera, Chugai, Regeneron, Tesaro (Research to the Institution). R. Zhuo: None. M. Blackburn: None. C. Gallagher: None. O. Hahn: None. M. Abu-Khalaf: C; A; Novartis. M. Mohebtash: None. T. Wu: None. P. Pohlmann: C; A; Personalized Cancer Therapy, Sirtex, CARIS Life Sciences. F; A; Dava Oncology, Genentech/Roche, ASCO. C; A; Genentech/Roche, Pfizer, Cascadian Therapeutics. O; A; Immunonet BioSciences. O; A; Intellectual property: Immunological compositions as cancer biomarkers and/or therapeutics. A. Dilawari: None. S. Tiwari: None. A. Chitalia: None. R. Warren: None. M. Tan: None. A. Shajahan-Haq: None. C. Isaacs: C; A; AstraZeneca, Pfizer, Novartis, Genentech and PUMA. F; A; Genentech.

This research was supported by grant from Pfizer, Inc.

Poster P1-19-20: Safety of palbociclib in African American Women with Hormone Receptor Positive HER2 Negative Advanced Breast Cancer and Benign Ethnic Neutropenia: PALINA study

About Georgetown Lombardi Comprehensive Cancer Center Georgetown Lombardi Comprehensive Cancer Center is designated by the National Cancer Institute (NCI) as a comprehensive cancer center. A part of Georgetown University Medical Center, Georgetown Lombardi is the only comprehensive cancer center in the Washington D.C. area. It serves as the research engine for MedStar Health, Georgetown Universitys clinical partner. Georgetown Lombardi is also an NCI recognized consortium with John Theurer Cancer Center/Hackensack Meridian Health in Bergen County, New Jersey. The consortium reflects an integrated cancer research enterprise with scientists and physician-researchers from both locations. Georgetown Lombardi seeks to improve the diagnosis, treatment, and prevention of cancer through innovative basic, translational and clinical research, patient care, community education and outreach to service communities throughout the Washington region, while its consortium member John Theurer Cancer Center/Hackensack Meridian Health serves communities in northern New Jersey. Georgetown Lombardi is a member of the NCI Community Oncology Research Program (UG1CA239758). Georgetown Lombardi is supported in part by a National Cancer Institute Cancer Center Support Grant (P30CA051008). Connect with Georgetown Lombardi onFacebook(Facebook.com/GeorgetownLombardi) andTwitter(@LombardiCancer).

About Georgetown University Medical CenterGeorgetown University Medical Center (GUMC) is an internationally recognized academic health and science center with a four-part mission of research, teaching, service and patient care (through MedStar Health). GUMCs mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or care of the whole person. The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health.Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter).

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Palbociclib is Safe for Women with Advanced Breast Cancer Who Have Unique Gene Alteration - Newswise

It is obvious that a mother taking medication for her illness is concerned about the possible side effect of these drugs upon her child through breast milk. She seeks information from doctors and health workers. The main issue is whether the medication she is taking could harm her baby with toxic components transmitted through breast milk. The national breastfeeding guideline of Bangladesh states to continue or encourage breastfeeding rather than withdrawing it in almost every condition.

There are certain medications which can be transmitted through breast milk. Again, some organisms responsible for disease causation could transmit disease through breast milk. Drugs which can be excreted via breast milk are mainly anti-cancer drugs, anti-thyroid drugs, some psychiatric drugs, some antibiotics and some hormone replacement therapies etc.

Breastfeeding is contraindicated if a mother is taking anti-cancer drugs, anti-thyroid drugs and any medications containing radioactive components. Even in these conditions, emphasis should be given in collecting another mothers milk rather than starting formula or cows milk. If a mother is taking anti-psychotic or even anti-convulsant drugs she must continue her breastfeeding. Some health workers and even doctors fail to deliver the information that very negligible amount of drug product is transmitted to breast milk, and withdrawing breastfeeding could also be more harmful.

The same is applicable for some antibiotics like sulphonamides, cotrimoxazole, fansidar (anti-malarial drug) and dapsone (used in leprosy and lupus). Possible side effect in a baby is jaundice which should be observed. The mother must consult with her physician for taking alternative drugs (as there might be the scope of another safer drug) if she is taking antibiotics like chloramphenicol, tetracycline, metronidazole, quinolones etc. Oestrogen containing contraceptive and thiazide diuretics (used in hypertension) decrease breast milk supply. Alternative drugs should be prescribed in these conditions.

Counselling and support might help in motivating a diseased mother to continue breastfeeding even while under medication. Nothing is a substitute or better than breast milk. Bangladeshs national agenda is to promote breastfeeding and improve exclusive breastfeeding rate so that we can decrease morbidity and mortality in infants and children stepping toward a healthier and better future.

The writer is a Registrar at the Institute of Child and Mother Health (ICMH), Dhaka. Email: ahadnann@gmail.com

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Mothers medication and breastfeeding - The Daily Star

Susan Desmond-Hellmann, the longtime researcher and executive who helped lead Genentech to develop the first gene-targeted cancer therapies, is stepping down after 5 years as CEO of the Bill & Melinda Gates Foundation.

Stepping down as CEO of@GatesFoundationis, without a doubt, the toughest decision of my career, she wrote in the first of a series of tweets announcing and reflecting on her departure. But one of my mantras is take your own pulse first. Over the last few months, Ive done just that and concluded that I need to slow down.

Mark Suzman, the foundations president of Global Policy & Advocacy and chief strategy officer, will now take over as the new CEO. Suzman joined the foundation 12 years ago and takes the new role officially on February 1, 2020.

Desmond-Hellmann was named CEO of the massive charity in 2013, after years at the top of Genentech and a stint as the first woman chancellor of the University of California San Francisco. She was the first physician to lead the foundation and during her tenure launched what was billed as the first nonprofit biotech, the Gates Medical Research Institute, a move she recalled as one of her top achievements.

Recently, the longtime researcher cut down on work outside the foundation and said today she was leaving to focus on herself and her family.

Desmond-Hellmann got her start in medicine as a kid, hanging around and sometimes bookkeeping at the drugstore her parents owned in Reno, Nevada. In later years, she talked about how watching her father interact kindly with the people who came in made her want to become a doctor. After she graduated from the University of Nevada, she took an intern job at UCSF in 1982, her formative years as a physician spent at the beginning and center of the AIDS/HIV crisis. After several years working on the virus and Kaposis sarcoma, she and her husband Nicholas Hellmann, also a young UCSF doctor moved to Uganda to do similar work.

We were approached by the Rockefeller Foundation to study heterosexual HIV transmission in Africa, so my husband Nick and I sold our Honda Civics, sublet our apartment, and hopped on a plane, she recalled toReuters in July. We were extremely isolated. When we came back from Uganda, we never complained about anything ever again.

She fell into drug development two years after they returned to Nicholas home state of Kentucky, when they both took positions at Bristol-Myers Squibb in Connecticut in 1993. She worked on Taxol, a chemotherapy drug originally derived from Pacific yew bark and first FDA-approved shortly before her arrival.

It was like I had been training my whole life for that job, Desmond-Hellmanntold the New York Timesin 2011.

At the time, Genentech hadnt developed any cancer drugs. The legacy biotech brought Desmond-Hellmann back to San Francisco in 1995 to help build that pipeline and promoted her to chief medical officer the following year.

Arthur Levinson, the CEO of Genentech during her tenure, described her to the New York Times as a shrewd executive, who was able to use her oncology and statistical background to choose the best drugs and was also able to tell researchers when their projects werent being chosen.

Shes a very nice person, so this did not come naturally to her, Levinson said. But she got it quickly. She became a tough leader, tough in a positive sense. She was willing to make tough calls without much difficulty.

Over 14 years at Genentech, she oversaw the development of Avastin and Herceptin, the first gene-targeted cancer therapies.

She left the company when it was bought out by Roche in 2009, leaving as head of product development, and soon went on to become chancellor of UCSF (where there was a brief controversy over her tobacco investments, which she immediately sold off.). She joined the Gates Foundation in 2014.

As CEO she oversaw a bevy of public health programs and, in 2018, the launch of the Gates Medical Research Institute in Cambridge, MA, luring executives from Novartis and Merck and other top biotech firms to fill out the leadership team.

The institute launched with a budget of $100 million and targets the Gates Foundation had long pursued: malaria, tuberculosis, and diarrheal diseases. The idea was to help directly develop drugs that the market wasnt incentivizing, including a malarial vaccine. Their first big project is testing if a booster shot of Bacillus Calmette-Gurin, the tuberculosis vaccine already given to infants, could help improve immunity for adolescents.

What keeps me awake is we have all this capital, we have all this opportunity and we better get something done, Desmond-Hellmann told Forbes last year. We better do some good in the world, or I will not feel good about leading in the Gates Foundation.

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UPDATED: Sue Desmond-Hellmann says it's time for her to leave the Gates Foundation. Strategy chief Mark Suzman will now take the helm - Endpoints News

More than a year ago, the world was shocked by Chinese biophysicist He Jiankui's attempt to use CRISPR technology to modify human embryos and make them resistant to HIV, which led to the birth of twins Lulu and Nana.

Now, crucial details have been revealed in a recent release of excerpts from the study, which have triggered a series of concerns about how Lulu and Nana's genome was modified.

CRISPR is a technique that allows scientists to make precise edits to any DNA by altering its sequence.

When using CRISPR, you may be trying to "knock out" a gene by rendering it inactive, or trying to achieve specific modifications, such as introducing or removing a desired piece of DNA.

Gene editing with the CRISPR system relies on an association of two proteins. One of the proteins, called Cas9, is responsible for "cutting" the DNA. The other protein is a short RNA (ribonucleic acid) molecule which works as a "guide" that brings Cas9 to the position where it is supposed to cut.

The system also needs help from the cells being edited. DNA damage is frequent, so cells regularly have to repair the DNA lesions. The associated repair mechanisms are what introduce the deletions, insertions or modifications when performing gene editing.

Jiankui and his colleagues were targeting a gene called CCR5, which is necessary for the HIV virus to enter into white blood cells (lymphocytes) and infect our body.

One variant of CCR5, called CCR5 32, is missing a particular string of 32 "letters" of DNA code. This variant naturally occurs in the human population, and results in a high level of resistance to the most common type of HIV virus.

Jankui's team wanted to recreate this mutation using CRISPR on human embryos, in a bid to render them resistant to HIV infection. But this did not go as planned, and there are several ways they may have failed.

First, despite claiming in the abstract of their unpublished article that they reproduced the human CCR5 mutation, in reality the team tried to modify CCR5 close to the 32 mutation.

As a result, they generated different mutations, of which the effects are unknown. It may or may not confer HIV resistance, and may or may not have other consequences.

Worryingly, they did not test any of this, and went ahead with implanting the embryos. This is unjustifiable.

A second source of errors could have been that the editing was not perfectly efficient. This means that not all cells in the embryos were necessarily edited.

When an organism has a mixture of edited and unedited cells, it is called a "mosaic". While the available data are still limited, it seems that both Lulu and Nana are mosaic.

This makes it even less likely that the gene-edited babies would be resistant to HIV infection. The risk of mosaicism should have been another reason not to implant the embryos.

Moreover, editing can have unintended impacts elsewhere in the genome.

When designing a CRISPR experiment, you choose the "guide" RNA so that its sequence is unique to the gene you are targeting. However, "off-target" cuts can still happen elsewhere in the genome, at places that have a similar sequence.

Jiankui and his team tested cells from the edited embryos, and reported only one off-target modification. However, that testing required sampling the cells, which were therefore no longer part of the embryos - which continued developing.

Thus, the remaining cells in the embryos had not been tested, and may have had different off-target modifications.

This is not the team's fault, as there will always be limitations in detecting off-target and mosaicism, and we can only get a partial picture.

However, that partial picture should have made them pause.

Above, we have described several risks associated with the modifications made on the embryos, which could be passed on to future generations.

Embryo editing is only ethically justifiable in cases where the benefits clearly outweigh the risks.

Technical issues aside, Jiankui's team did not even address an unmet medical need.

While the twins' father was HIV-positive, there is already a well-established way to prevent an HIV-positive father from infecting embryos. This "sperm washing" method was actually used by the team.

The only benefit of the attempted gene modification, if proven, would have been a reduced risk of HIV infection for the twins later in life.

But there are safer existing ways to control the risk of infection, such as condoms and mandatory testing of blood donations.

Gene editing has endless applications. It can be used to make plants such as the Cavendish banana more resistant to devastating diseases. It can play an important role in the adaptation to climate change.

In health, we are already seeing promising results with the editing of somatic cells (that is, non-heritable modifications of the patient's own cells) in beta thalassemia and sickle cell disease.

However, we are just not ready for human embryo editing. Our techniques are not mature enough, and no case has been made for a widespread need that other techniques, such as preimplantation genetic testing, could not address.

There is also much work still needed on governance. There have been individual calls for a moratorium on embryo editing, and expert panels from the World Health Organisation to UNESCO.

Yet, no consensus has emerged.

It is important these discussions move in unison to a second phase, where other stakeholders, such as patient groups, are more broadly consulted (and informed). Engagement with the public is also crucial.

Dimitri Perrin, Senior Lecturer, Queensland University of Technology and Gaetan Burgio, Geneticist and Group Leader, The John Curtin School of Medical Research, Australian National University.

This article is republished from The Conversation under a Creative Commons license. Read the original article.

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New Details About The Infamous 'CRISPR Babies' Experiment Have Just Been Revealed - ScienceAlert

We live in a time when science and technology are having an impact on our society in more and more ways. And the decisions that shape how these new fields of knowledge develop ultimately affect all of us.

When I studied biology in high school, I didnt learn about DNA for a very simple reason. The work of Francis Crick, James Watson, Rosalind Franklin and others who unlocked the structure of the basic code of life was still years away. The idea of engineering human beings? Well, that was firmly the stuff of science fiction, like Aldous Huxleys dystopian novel Brave New World (published a year after my birth). It seemed as likely as, say, going to the moon.

There are a few inferences you can make from this framing of my life. One is that I have been on the planet for a while. The other is the speed of change in what we know about what life is, and how we can control it, has accelerated at a rapid rate. Now we as a species are on the precipice of being able to manipulate the very building blocks of human evolution, not to mention wield unpredictable change on the greater world around us. Even as I commit that thought to paper, I pause in awe at its implications.

I have lived through eventful times and my job as a journalist has been to chronicle wars, presidents and sweeping social movements such as civil rights. I have seen a world in flux, but when I try to peer into the future I come to the conclusion that this story of humankinds ability to understand life on its most intimate level and be able to tinker with it for our benefit or detriment is likely to be the biggest one I will ever cover.

We are living in one of the greatest epochs of human exploration and it will shape our world as profoundly as the age of the transoceanic explorers. It is just that the beachheads on which we are landing and the continents we are mapping comprise a world far too small to see with the naked eye. Some of it is even invisible to our most powerful microscopes.

This brings me to a term that has become a big part of my life over the last few years: Crispr. Perhaps you know of it. Perhaps you dont. When I first heard of it, I thought it might be a new brand of toaster. I now know its an extremely powerful tool for editing genes in seemingly any organism on Earth, including humans. Scientists doing basic research have been uncovering the mechanisms of life for decades. They have been creating tools for modifying individual genes but Crispr is one of those revolutions where what researchers thought might be possible in the distant horizon is suddenly available now. Its cheap, its relatively simple and its remarkably precise.

I immediately knew that this was a story that needed telling. Human Nature, the resulting film full disclosure, I am executive producer came out of our conversations with scientists. They tend not to be the type of people who hype things but when they talk about Crispr you can feel the urgency in their voices. This is something you need to know about. All of you. If you are worried about your health or the health of your children. If you are concerned about how we might need to engineer our planet in the face of the climate crisis. If you are in finance, law or the world of tech. This will shape all of it.

And as we grapple with the unintended consequences of the internet and social media, as we try to make progress against a heating planet, I humbly submit that we as a species tend not to be good at thinking through where we are going until a crisis is already upon us. I fervently hope with Crispr that we can start the conversation sooner. That we can start it now. Thats why we made the film.

To be clear, we are probably a long way from designing babies to be more intelligent or more musically inclined. Life is just too complex for that, at least right now. More immediately, there is so much about this technology that is very exciting. As someone who remembers a time when my classmates were struck down with childhood diseases for which we now have vaccines, I know science can have profound applications for human health. Crispr could cure genetic diseases such as sickle cell and Huntingtons. It is being tested against cancers and HIV. It could also potentially be used to make crops more drought-resistant or food more nutritious.

On the other hand, we are walking closer to a world Aldous Huxley foresaw. What does it mean to be human? Where should we draw the boundaries beyond which we dare not cross? The inspiring researchers we talked to for the film know that the ethical and moral questions this technology raises are not for them to decide. Science has given us the tools, but not the answers. This is up to us, all of us. We need to be informed. We need to be honest with whats real and whats not. And we need to add our voices to a global conversation. Thats part of our responsibility as humans living on Earth today.

Dan Rather is one of the USs most feted journalists. He anchored CBS Evening News for 24 years

Human Nature is in UK cinemas now before a university town tour in the new year, wondercollaborative.org/human-nature-documentary-film/#screenings . It will be shown on BBC Storyville in spring/summer 2020

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Gene editing will let us control our very evolution. Will we use it wisely? - The Guardian

Bengaluru: What must it have felt like to be a cotton spinner or an iron maker in England in the 1820s in the midst of an industrial revolution? Exactly 200 years later, we may be on the verge of another era of momentous change: the internet revolution. With internet access expanding dramatically post the early 1990s, a slew of new technologies have now matured to a point where fundamental change constantly seems to be right around the corner.

On the doorstep of a brand new decadethe 2020swhat new frontiers may Artificial Intelligence (AI) or gene editing open up? Will we soon have robot bosses? Will mixed reality change the way we consume entertainment and sports? Will we be able to cure 90% of all genetic diseases by the end of the decade? We take a look at five technologies that could alter India and the world. This may not be a definitive or even exhaustive list, but it is a list of things that could change the way we live, work, and play sooner than we think.

Mixed reality

Imagine watching a football match, not on your TV but on a virtual reality (VR) headset that streams the match live and projects interesting stats on the fly with the help of augmented reality (AR). Mumbai-based VR startup Tesseract, now owned by Mukesh Ambanis Reliance Jio, is promising a future like that with its Quark camera, Holoboard headset, and the high internet speeds of Jio Fiber. Similarly, a Hyderabad-based mixed reality startup called Imaginate enables cross-device communication over VR and AR wearables for better enterprise collaboration in the industrial sector.

Despite the much-hyped yet unmet expectations from the likes of Google Glass, Microsoft HoloLens and Facebooks Oculus, Tesseract and Imaginate simply underscore how the fusion of AR and VR technologies the combination of which is popularly known as Mixed Reality or MR is coming of age and is no longer in the realm of just sci-fi movies like Blade Runner 2049, where Officer K played by Ryan Gosling develops a relationship with his artificial intelligence (AI) hologram companion Joi.

For instance, AI-powered chatbots today can not only conduct a conversation in natural language via audio or text but they can be made more powerful with a dose of mixed reality. Last May, Fidelity Investments created a prototype VR financial advisor named Cora to answer client queries using a suite of tools from Amazon Web Services. Researchers in Southampton have built a device that displays 3D animated objects that can talk and interact with onlookers.

The Chinese government-run Xinhua News Agency has the worlds first AI-powered news anchor, whose voice has been modelled to resemble a real human anchor working for the agency. Going a step further, Japan-headquartered DataGrid Inc. uses generative adversarial networks (GANs) to develop its so-called whole body model automatic generation AI" that automatically generates full-length images of non-existent people with high resolutions.

Nevertheless, challenges abound when dealing MR-and AI-powered robots, humanoids, and human avatars. For one, whenever a company generates human bodies and faces, concerns over deep fakes and cheap fakes will always rear their heads. Second, data collection will continually raise concerns over security and privacy. Third, theres always the concern regarding the fairness of an AI algorithm when it is deployed to do human tasks like giving financial advice. Last, but not the least, theres also the question of whether AI bots should be allowed to pose as humans. This will continually pose a challenge and opportunity for technologists and policy makers.

Future of solar

Heliogen, a company that has billionaire philanthropist Bill Gates as one of its investors, says it has created the worlds first technology that can commercially replace fuels with carbon-free, ultra-high temperature heat from the sun. With its patented technology, Heliogens field of mirrors acts as a multi-acre magnifying glass to concentrate and capture sunlight.

This is just a case in point that solar technologies have evolved a lot since they first made their debut in the 1960s. For instance, solar roadwayspanels lining the surface of highwayshave already popped up in the Netherlands. Floating solar, on its part, is providing a credible option to address land use concerns associated with wide scale solar implementations. A French firm called Ciel et Terre, for instance, has projects set up in France, Japan, and England. Other parts of the world, including India and California in the US, are piloting similar floating solar initiatives.

Space-based solar technology is another exciting arena. India, China and Japan are investing heavily in these technologies right now. The Japan Aerospace Exploration Agencys (JAXA) Space Solar Power Systems (SSPS) aims to transmit energy from orbiting solar panels by 2030. Further, researchers at the VTT Technical Research Centre in Finland have used solar and 3D printing technologies to develop prototypes of what they have christened as energy harvesting trees".

With solar power cheaper than coal in most countries in the world, its worth scaling up these technologies.

Indians and robot bosses

Between 400 and 800 million individuals around the world could be displaced by automation and would need to find new jobs by 2030, predicted a December 2017 survey by consultancy firm McKinsey. The Future of Jobs 2018 report by the World Economic Forum (WEF) suggests that 75 million jobs may be lost to automation by 2022, but adds that another 133 million additional new roles will be created.

Given that many of the automated jobs are being taken away by AI-powered chatbots and intelligent robots, would humans eventually have to work for a robo boss? This, however, may not be as big a concern as it is made out to be. According to the second annual AI at Work study conducted by Oracle and Future Workplace, people trust robots more than their managers. The study, released this October, notes that workers in China (77%) and India (78%) have adopted AI over 2X more than those in France (32%) and Japan (29%). Further, workers in India (60%) and China (56%) are the most excited about AI, while men have a more positive view of AI at work than women.

Oracle and Future Workplace also found that 82% of the workers believe robot managers are better at certain tasks, such as maintaining work schedules and providing unbiased information, than their human counterparts. And almost two-thirds (64%) of workers worldwide say they would trust a robot more than their human manager. In China and India, that figure rises to almost 90%.

On the other hand, the respondents felt managers can outdo robots when it comes to understanding their feelings, coaching them, and creating a healthy work culture. Whether humans eventually serve a robo boss or not remains to be seen. However, we can be certain of one thing: in the near future, we will increasingly see humans collaborating with smart robots.

Future of payments

Everyone can be a merchant, and every device can be an acceptance device," Accenture noted in its 2017 Driving the Future of Payments report. This trend has only accelerated over the last two years, especially with banks coming to terms with the fact that young customers, especially those living in urban areas, prefer net banking and mobile banking and would seldom, or never, want to visit a bank branch if offered that choice.

Bitcoin and cryptocurrency investors, for instance, have not lost faith in this disruptive currency despite the run with volatility, and despite the industry being viewed with a lot of suspicion by most governments around the world, including India. Fintechs too, with their innovative technology solutions like AI-powered bots and contactless payments to name a few, have only made the payments ecosystem more inclusive, disruptive, and challenging. In India, especially, the governments Aadhaar-enabled payments system and the Unified Payments Interface (UPI) have revolutionized the payments ecosystem. The total volume of UPI transactions in the third quarter of calendar 2019 touched 2.7 billiona 183% rise over the same July-September quarter a year ago. In terms of value, UPI clocked 4.6 trillionup 189% over the same period a year ago, according to the Worldlines India Digital Payments Report-Q3 2019.

However, the number of transactions done on mobile wallets was 1.04 billiononly a 5% rise over the previous year period.

QR codes, according to the report, will continue to be used for payments, and the internet of things (IoT) is set to dominate micro payments by transforming connected devices into payment channels, though the pace of adoption of 5G by countries like India will be the key.

Nevertheless, cash that has been in existence for over 3000 years in different forms is not going to disappear in a hurry. Trust and security will continue to remain the operative words in digital payments.

Making sense of gene editing

When Dolly the sheep made news for becoming the first mammal ever to be cloned from another individuals body cell, many expected human cloning to follow soon. Dolly died over 16 years ago, and subsequently animals, including monkeys and dogs, continue to be cloned successfully. Yet, no human being has yet been cloned in real life.

While human cloning, which may or may not eventually happen, is bound to raise a lot of alarm bells given the moral implications surrounding the issue, the fact is that human genomes, or genes, are being routinely edited in a bid to find solutions for what are today considered to be incurable genetically inherited diseases.

Researchers are using a gene editing tool known as CRISPR-Cas9. CRISPR, which stands for Clusters of Regularly Interspaced Short Palindromic Repeats, is a tool that allows researchers to easily alter DNA sequences and modify gene function. The protein Cas9 (CRISPR-associated, or Cas) is an enzyme that acts like a pair of molecular scissors capable of cutting strands of DNA.

CRISPR-Cas9 is primarily known for its use in treating diseases like AIDS, amyotrophic lateral sclerosis (ALS), and Huntingtons disease. Two patients, one with beta thalassemia and one with sickle cell disease, have potentially been cured of their diseases, reveal results from clinical trials that were jointly conducted by Vertex Pharmaceuticals and CRISPR Therapeutics. The results released this November involved using Crispr to edit the genes of these patients.

Researchers are now looking to extend its use to tackle famine, lend a hand in creating antibiotics, and even wipe out an entire species such as malaria-spreading mosquitoes. Further, by genetically engineering a persons bone marrow cells, researchers can reprogram their immune and circulatory systems. Some new cancer treatments are based on this. Moreover, looking at the DNA of the collection of microbes in your gut can help with digestive disorders, weight loss, and even help understand mood changes.

Closer home, scientists at the Institute of Genomics and Integrative Biology (IGIB) and the Indian Institute of Chemical Biology (CSIR-IICB) are trying to correct genetic mutations in their laboratories using CRISPR Cas9 with encouraging preliminary results. But due to regulatory and ethical concerns, it may take a while before they can use this on humans.

IGIB also sells CRISPR products such as Cas9 proteins and its variants to educational institutes at reduced prices in a bid to encourage use of the technology.

The US Food and Drug Administration (FDA), on its part, considers any use of CRISPR-Cas9 gene editing in humans to be gene therapy and rules that the sale of DIY kits to produce gene therapies for self-administration is illegal. India, too, has banned the use of stem cell therapy for commercial use following concerns over rampant malpractice".

CRISPR-Cas9, thus, remains a work in progress and countries should have policies to govern its use. Meanwhile, one can watch out for an upgrade to CRISPR called Prime, which theoretically has the ability to snip out more than 90% of all genetic diseases.

Read more:
Five technologies that may alter India in 2020 - Livemint

One of the most popular methods for inserting therapeutic genes into cells to treat disease is to transport them using a virus that has been stripped of its infectious properties. But those noninfectious viruses can still sometimes touch off dangerous immune responses.

A team from Johns Hopkins Medicine is proposing an alternative method for transporting large therapies into cellsincluding genes and even the gene-editing system CRISPR. Its a nano-container made of a polymer that biodegrades once its inside the cell, unleashing the therapy. The researchers described the invention in the journal Science Advances.

The team, led by biomedical engineer Jordan Green, Ph.D., was inspired by viruses, which have many properties that make them ideal transport vehicles. They have both negative and positive charges, for example, which allows them to get close to cells. So Green and his colleagues developed a polymer containing four molecules with both positive and negative charges. They used it to make a container that interacts with the cell membrane and is eventually engulfed by it.

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RELATED: Could a grape-based compound improve gene therapy efficiency?

The Hopkins researchers performed four experiments to prove the nanocontainers would travel into cells and deliver complex therapies once inside. First, they packaged a small protein into the polymer material and mixed it with mouse kidney cells in a lab dish. Using fluorescent tags, they confirmed that the protein made it into the cells. Then they repeated the experiment with a much larger medicinehuman immunoglobulinand observed that 90% of the kidney cells received the treatment.

From there, they made the payload even bulkier, packaging the nanocontainers with the gene-editing system CRISPR. With the help of fluorescent signals, they were able to confirm that CRISPR went to work once inside the cells, disabling a gene 77% of the time.

"That's pretty effective considering, with other gene-editing systems, you might get the correct gene-cutting result less than 10 percent of the time," said graduate student Yuan Rui in a statement.

Finally, the Hopkins researchers injected CRISPR components into mouse models of brain cancer using the polymer nanocontainers. Again they saw evidence that successful gene editing had occurred.

Developing improved methods for gene therapy is a priority in the field. In October, for example, scientists at Scripps Research described a way to use a small molecule called caraphenol A to lower levels of interferon-induced transmembrane (IFITM) proteins, which could, in turn, allow viral vectors to pass more easily into cells. And earlier this year, an Italian team described a method for including the protein CD47 in lentiviral vectors to improve the transferring of therapeutic genes into liver cells.

The next step for Hopkins researchers Rui and Green is to improve the stability of the nanocontainers so they can be injected into the bloodstream. They hope to be able to target them to cells that have certain genetic markers, they reported.

See the article here:
Hopkins team invents non-viral system for getting gene therapy into cells - FierceBiotech

In the middle of November, Editas Medicine (NASDAQ:EDIT) and Celgene (NASDAQ:CELG) announced changes to a development pact originally formed in 2015 with Juno Therapeutics, which is now part of Celgene. The agreement was amended in 2018, too, so the fact that changes were made wasn't necessarily big news. Editas received a $70 million upfront payment for executing the amended agreement, which was interpreted as the main takeaway from the announcement.

The announcement barely registered with investors and few gave it much thought for too long, especially after promising early results from the first clinical trials using a CRISPR-based medicine were announced by CRISPR Therapeutics days later.

But revisiting the amended collaboration agreement, and specifically what changes were made, hints at the long-term development plans of Editas Medicine. In short, it now has full control over an important class of immune cells. Whether that means the gene-editing pioneer lands another major development partner or goes full-steam ahead alone, investors can't overlook the significance.

Image source: Getty Images.

The basic scientific goal of the collaboration hasn't changed. Editas Medicine will use its gene-editing technology platform to engineer T cell receptors (TCR), while Juno Therapeutics will leverage its immunotherapy leadership to develop the engineered cellular medicines in clinical trials.

Why engineer TCRs? Immune cells rely on their receptors to identify targets, such as pathogenic bacteria and cancer cells. But immune cell receptors can be confused by molecules secreted within the tumor microenvironment, forcing them to halt their attack. They can also incorrectly attack an individual's own cells to trigger an autoimmune disease. A more recent concern stems from cellular medicines derived from a donor. Since the donor cells present different receptors compared to what the recipient's native T cells carry, the recipient's immune system (correctly) identifies the immunotherapy as a foreign substance, attacks it, and renders it less effective and less safe.

Therefore, it makes sense to engineer TCRs to create more potent and stealthier immunotherapies that are less likely to be tricked. Editas Medicine and Celgene still intend to do just that, albeit with subtle, yet important, differences to their development agreement.

Consideration

Previous Agreement (2015, 2018)

Amended Agreement (2019)

Focus

Cancer

Cancer and autoimmune diseases

Types of cells

CAR-T cells, alpha-beta T cells, gamma-delta T cells

Alpha-beta T cells

Juno Therapeutics exclusivity

Editas Medicine prohibited from all other work with CAR-T and TCRs in oncology

Editas Medicine prohibited from all other work on alpha-beta T cells and T cells derived from pluripotent stem cells

Upfront payment

$57.7 million (includes milestones collected under agreement)

$70 million

Milestone potential

$920 million plus tiered royalties

$195 million plus tiered royalties

Data source: SEC filings.

Essentially, Editas Medicine and Celgene have scaled back their original agreement in cancer and expanded their work to include autoimmune diseases. The most important detail is that the amended agreement allows the gene-editing pioneer to pursue the development of gamma-delta T cells, which were previously under the exclusive control of Juno Therapeutics. What does that mean?

Image source: Getty Images.

Without getting too far into the weeds, there are two main types of TCRs: alpha-beta and gamma-delta. The name refers to the molecular structure of the receptor, but that's not the important part.

Gamma-delta T cells, which comprise only about 5% of the T cells in your body, are thought to be one of the missing links in our understanding of the immune system. They're a mysterious bunch, but there could be significant value residing in the knowledge gaps.

These unique immune cells are governed by their own unique set of rules (relative to their alpha-beta peers) and straddle the innate immune system (what we're programmed with at birth) and adaptive immune systems (what's programmed as we encounter new environments throughout life). Gamma-delta T cells could be tinkered with in gut microbiome applications, to treat cardiovascular diseases, and to neutralize antibiotic-resistant infections. But the nearest commercial target of the mysterious immune cells is likely to be treating solid tumor cancers.

They possess potent anti-tumor activity where current immunotherapies fail, such as attacking cancer cells that lack tumor-specific antigens to target or that have become immune to checkpoint inhibitors. In fact, there's a link between certain cancer outcomes and the activity of specific gamma-delta T cells.

Given that, why would Celgene amend the agreement to ditch the rare subset of immune cells? Well, in August 2019, Celgene inked with a start-up called Immatics to develop engineered TCRs. The start-up's platform is based on gamma-delta tech.

Don't feel too bad for Editas Medicine, though. SEC filings reveal that the gene-editing pioneer didn't receive any money from the original collaboration deal with Celgene in the first nine months of 2019. That suggests the work had stalled or that the amendment was being hammered out for some time. The gene-editing pioneer wrestled back control of the tech and took a $70 million upfront payment to boot. While the potential milestone payments in the amended agreement are significantly lower than the originally promised bounty, Editas Medicine can offset that by signing a lucrative collaboration deal with a new partner.

There should be plenty of interest. Fellow gamma-delta T cell developer Adicet Bio recently landed an $80 million series B round funded in part by Johnson & Johnson, Regeneron,Samsung Biologics(not the same company as the electronics powerhouse), and Novartis. There's also Immatics, GammaDelta Therapeutics, and a handful of other start-ups making noise in the space.

Some competitors are directly engineering gamma-delta cells, and others are developing molecules to trigger the immune cells into action. Editas Medicine believes it has the edge, as it has a relatively precise and efficient method for engineering immune cells: gene editing.

The amended collaboration deal between Editas Medicine and Celgene received relatively little attention from investors. Perhaps that was a good thing, as Wall Street likely would have overreacted to the reduced scope of development and milestones. But investors that take the time to understand the details might be intrigued by the new research avenue for the gene-editing stock.

Can Editas Medicine become a leading force in gamma-delta T cell development? Perhaps. While it isn't the only company wielding a gene-editing platform, and CRISPR gene editing isn't the only type of gene editing, the company is well-positioned to take advantage of the opportunity. Investors will have to wait to see how (or if) the development strategy evolves around the new tech.

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Celgene Gave This Tech Back to Editas Medicine, but It Could Prove Valuable - The Motley Fool

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WASHINGTON DC, United States (AFP) In the summer, a mother in Nashville with a seemingly incurable genetic disorder finally found an end to her suffering by editing her genome.

Victoria Gray's recovery from sickle cell disease, which had caused her painful seizures, came in a year of breakthroughs in one of the hottest areas of medical research gene therapy.

I have hoped for a cure since I was about 11, the 34-year-old told AFP in an e-mail.

Since I received the new cells, I have been able to enjoy more time with my family without worrying about pain or an out-of-the-blue emergency.

Over several weeks, Gray's blood was drawn so doctors could get to the cause of her illness stem cells from her bone marrow that were making deformed red blood cells.

The stem cells were sent to a Scottish laboratory, where their DNA was modified using Crispr/Cas9 pronounced Crisper a new tool informally known as molecular scissors.

The genetically edited cells were transfused back into Gray's veins and bone marrow. A month later, she was producing normal blood cells.

Medics warn that caution is necessary but, theoretically, she has been cured.

This is one patient. This is early results. We need to see how it works out in other patients, said her doctor, Haydar Frangoul, at the Sarah Cannon Research Institute in Nashville.

But these results are really exciting.

In Germany, a 19-year-old woman was treated with a similar method for a different blood disease, beta thalassemia. She had previously needed 16 blood transfusions per year.

Nine months later, she is completely free of that burden.

For decades, the DNA of living organisms such as corn and salmon has been modified.

But Crispr, invented in 2012, made gene editing more widely accessible. It is much simpler than preceding technology, cheaper and easy to use in small labs.

The technique has given new impetus to the perennial debate over the wisdom of humanity manipulating life itself.

It's all developing very quickly, said French geneticist Emmanuelle Charpentier, one of Crispr's inventors and the co-founder of Crispr Therapeutics, the biotech company conducting the clinical trials involving Gray and the German patient.

Cures

Crispr is the latest breakthrough in a year of great strides in gene therapy, a medical adventure started three decades ago, when the first TV telethons were raising money for children with muscular dystrophy.

Scientists practising the technique insert a normal gene into cells containing a defective gene.

It does the work the original could not such as making normal red blood cells, in Victoria's case, or making tumour-killing super white blood cells for a cancer patient.

Crispr goes even further; instead of adding a gene, the tool edits the genome itself.

After decades of research and clinical trials on a genetic fix to genetic disorders, 2019 saw a historic milestone: approval to bring to market the first gene therapies for a neuromuscular disease in the US and a blood disease in the European Union.

They join several other gene therapies bringing the total to eight approved in recent years to treat certain cancers and an inherited blindness.

Serge Braun, the scientific director of the French Muscular Dystrophy Association, sees 2019 as a turning point that will lead to a medical revolution.

Twenty-five, 30 years, that's the time it had to take, he told AFP from Paris.

It took a generation for gene therapy to become a reality. Now, it's only going to go faster.

Just outside Washington, at the National Institutes of Health (NIH), researchers are also celebrating a breakthrough period.

We have hit an inflection point, said Carrie Wolinetz, NIH's associate director for science policy.

These therapies are exorbitantly expensive, however, costing up to US$2 million meaning patients face gruelling negotiations with their insurance companies.

They also involve a complex regimen of procedures that are only available in wealthy countries.

Gray spent months in hospital getting blood drawn, undergoing chemotherapy, having edited stem cells reintroduced via transfusion and fighting a general infection.

You cannot do this in a community hospital close to home, said her doctor.

However, the number of approved gene therapies will increase to about 40 by 2022, according to MIT researchers.

They will mostly target cancers and diseases that affect muscles, the eyes and the nervous system.

Bioterrorism

Another problem with Crispr is that its relative simplicity has triggered the imaginations of rogue practitioners who don't necessarily share the medical ethics of Western medicine.

Last year in China, scientist He Jiankui triggered an international scandal and his excommunication from the scientific community when he used Crispr to create what he called the first gene-edited humans.

The biophysicist said he had altered the DNA of human embryos that became twin girls Lulu and Nana.

His goal was to create a mutation that would prevent the girls from contracting HIV, even though there was no specific reason to put them through the process.

That technology is not safe, said Kiran Musunuru, a genetics professor at the University of Pennsylvania, explaining that the Crispr scissors often cut next to the targeted gene, causing unexpected mutations.

It's very easy to do if you don't care about the consequences, Musunuru added.

Despite the ethical pitfalls, restraint seems mainly to have prevailed so far.

The community is keeping a close eye on Russia, where biologist Denis Rebrikov has said he wants to use Crispr to help deaf parents have children without the disability.

There is also the temptation to genetically edit entire animal species malaria-causing mosquitoes in Burkina Faso or mice hosting ticks that carry Lyme disease in the US.

The researchers in charge of those projects are advancing carefully, however, fully aware of the unpredictability of chain reactions on the ecosystem.

Charpentier doesn't believe in the more dystopian scenarios predicted for gene therapy, including American biohackers injecting themselves with Crispr technology bought online.

Not everyone is a biologist or scientist, she said.

And the possibility of military hijacking to create soldier-killing viruses or bacteria that would ravage enemies' crops?

Charpentier thinks that technology generally tends to be used for the better.

I'm a bacteriologist we've been talking about bioterrorism for years, she said. Nothing has ever happened.

Now you can read the Jamaica Observer ePaper anytime, anywhere. The Jamaica Observer ePaper is available to you at home or at work, and is the same edition as the printed copy available at http://bit.ly/epaperlive

Originally posted here:
2019: The year gene therapy came of age - Jamaica Observer

In its latest trading session, CRISPR Therapeutics AG (NASDAQ:CRSP) spiked up by 2.3% here is what that looked like (as of 2019-12-09):

Whats the reason for these moves? To understand this better, it is helpful to analyze some technical indicators. As we see it, you should pay the most attention to the following:

A Money Flow Index (MFI) of 100.0, a Relative Strength Index (RSI) of 50.0, a True Strength Index (TSI) of 100.0, a Moving Average Convergence Divergence (MACD) of -0.016, an Average Directional Movement Index (ADX) of unknown, an Average True Range (ATR) of 1.429, an Accumulation/Distribution Index (ADI) of 1.429, an On-Balance Volume (OBV) of 557.672, and a Chaiikin Money Flow (CMF) of -70.71. 2.492

Now lets plug these indicators in. Consulting Trading View, we can conclude the following:

That is what an analysis of technical indicators seems to indicate for CRISPR Therapeutics AG (NASDAQ:CRSP). Note this is technical analysis only! You should do fundamental research as well, and do not just rely on this we take no responsibility for any losses incurred if you buy or sell based on the above.

More here:
CRISPR Therapeutics AG (NASDAQ:CRSP) Spiked Up 2.3% Here's Why - Lateral Line

Wells Fargo analyst Jim Birchenough maintained a Buy rating on Crispr Therapeutics AG (CRSP Research Report) yesterday. The companys shares closed last Monday at $72.37, close to its 52-week high of $74.00.

According to TipRanks.com, Birchenough is a 5-star analyst with an average return of 21.4% and a 51.0% success rate. Birchenough covers the Healthcare sector, focusing on stocks such as Global Blood Therapeutics, Ionis Pharmaceuticals, and Akcea Therapeutics.

Crispr Therapeutics AG has an analyst consensus of Moderate Buy, with a price target consensus of $75.83, implying a 6.1% upside from current levels. In a report issued on November 25, Oppenheimer also maintained a Buy rating on the stock with a $80.00 price target.

See todays analyst top recommended stocks >>

The company has a one-year high of $74.00 and a one-year low of $22.22. Currently, Crispr Therapeutics AG has an average volume of 871.2K.

TipRanks has tracked 36,000 company insiders and found that a few of them are better than others when it comes to timing their transactions. See which 3 stocks are most likely to make moves following their insider activities.

CRISPR Therapeutics AG engages in the development and commercialization of therapies derived from genome-editing technology. Its proprietary platform CRISPR/Cas9-based therapeutics allows for precise and directed changes to genomic DNA. The company was founded by Rodger Novak, Emmanuelle Charpentier, and Shaun Patrick Foy in 2014 and is headquartered in Zug, Switzerland.

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Crispr Therapeutics AG (CRSP) Receives a Buy from Wells Fargo - Analyst Ratings

Men are often portrayed as wanting to have sex all the time. In reality, a sluggish sex drive is something many men deal with at some point in their lives.

Several studies, including the often-cited Massachusetts Male Ageing Study from the University of Boston (conducted between 1987 and 1989), suggest erectile dysfunction affects more than half of all men to some degree, and is more prevalent in older men.

A low libido does not just take a toll on a man's emotional well-being; it can affect his partner and relationship, too, says Dr Angela Tan, a Singapore-based family doctor and intimacy coach.

"For starters, your male partner may feel that he is not satisfying you, and this may make him feel inadequate. It may also affect his identity and how he sees himself as a man. And if your once fulfilling sex life is now non-existent or no longer making you happy, you may wonder if [he] is attracted to you any more. This may create problems like anger and resentment, and may even lead to arguments and affairs later."

To help your partner and prevent misunderstandings, it is useful to know what may be affecting his libido.

According to Dr Colin Teo Chang Peng, a urologist at Colin Teo Urology in Singapore, one of the top causes of a low libido in men is low testosterone.

This is sometimes referred to as andropause or male "manopause", testosterone deficiency syndrome (TDS) or late onset hypogonadism (LOH).

"A man's testosterone levels start to decrease at a rate of about one per cent to two per cent every year from the age of 40," Teo explains.

"While testosterone is essential to sexual health and libido, it is also a metabolic hormone that has an effect on a man's blood-sugar control, cardiac health, psychological well-being, motivational drive, memory and physical fitness."

Low testosterone is also commonly linked with other medical conditions such as diabetes, hypertension, metabolic syndrome, coronary heart disease, obesity and renal failure, he adds.

An online survey of more than 5,000 men revealed that male sexual desire is complex and cannot be reduced to a single equation.

The researchers behind the European survey found that low confidence in their ability to achieve and maintain an erection, a lack of attraction to their partner, and being in a long-term relationship were some of the factors associated with the respondents' low sex drive. The results were published in 2014 in medical journal The Journal of Sexual Medicine.

There may be other reasons your partner cannot get in the mood for sex. Tan says that these may be medical - brain conditions like stroke, for instance; conditions that require chemotherapy, like cancer, which may deflate him emotionally; and liver problems that can cause hormonal issues.

Depression and anxiety disorder are also known to be mood killers.

If your partner is on medication, for instance some types of antidepressants and antipsychotics, he may experience a low libido, too. Even alcohol can decrease his sexual desire.

"Other causes may be related to your man's lifestyle - he may be stressed at work or under financial stress, for example; or perhaps his relationship with you feels strained, and that is affecting his desire to have sex with you," Tan says.

"Some men also have certain cultural or religious beliefs and values that may influence their views on sex, which may in turn dampen their libido."

Many men feel uneasy discussing their lack of sexual desire, especially in Asian societies, where talking about sex is considered taboo. However, Teo believes that this is slowly changing, with more men seeking their doctors' advice.

"The culture seems to be a bit more open now," he says. "More patients and doctors are aware that many sexual problems are also medical conditions. They also know that these conditions can be treated safely and effectively. We do see more men consulting their doctors about low libido and other andropause symptoms like lethargy, and many of these patients are accompanied by their partners."

The men who seek Teo's advice as soon as they notice symptoms tend to be in their 40s and 50s, leading fast-paced lives at or near the peak of their careers. A decline in their work, fitness or sexual performance is usually what motivates them to look for solutions to help restore their quality of life.

Patients who do not have fast-paced, active or career-driven lives may not notice the effects of andropause straight away and often take a while to ask their doctor for help.

It is not easy broaching the subject of low sex drive with your man, but you should not sweep the issue under the carpet, either. Tan suggests communicating your concerns in a calm, positive and non-threatening manner.

"Communication is key in this kind of situation," Tan says. "You want to be honest but not rude, and what you should not do is blame your partner or yourself, as this can have a detrimental effect on your relationship as well as your and your man's emotional well-being."

Tan advises couples to get professional help to determine the cause of a man's low sex drive and then explore ways to solve it together.

In the meantime, she says it is still possible to be intimate and maintain your physical and emotional connection, by cuddling and engaging in oral sex. Your man can also satisfy you using sex toys.

Fortunately, there are many solutions to help men get their sex lives back on track. Teo says that when a patient complains about andropause symptoms and his testosterone levels are found to be below normal, he is diagnosed with TDS and advised to begin testosterone replacement therapy (TRT).

Safe and effective, this treatment can be delivered orally with capsules, through the skin with daily gel applications, or as an injection every three months.

If the patient also has a chronic medical condition, he will be advised to undergo treatment for it, as the condition may impact his libido.

"Once testosterone levels are restored, other sexual dysfunctions can be actively remedied," says Teo. "These include erectile dysfunction, which can be treated with erectogenic medications in the form of oral tablets, injectables, and the recently available low-intensity shock wave therapy [LIST]."

In LIST, a wand-like device delivers mild shock waves to the penis that assists in the growth of new blood vessels.

Teo adds that, for patients with premature ejaculation, oral medications can help, giving the patient better control and helping the couple achieve satisfaction during sex.

In cases that do not respond to drugs or other therapies, penile implant surgery is a popular option.

A holistic approach is key when addressing low libido, so it may be necessary to include other forms of treatment, such as psychotherapy and couples' counselling.

Ultimately, while all forms of sexual dysfunction can be treated, Teo says a healthy lifestyle goes a long way towards helping men enjoy a satisfying sexual relationship.

"Exercising regularly relaxes the body and triggers the release of feel-good chemicals called endorphins, which boost your emotional well-being, while eating wholesome foods can counter some of the symptoms of andropause. You should also keep any chronic medical conditions in check and work towards strengthening your relationship with your partner."

This article was first published inSouth China Morning Post.

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Erectile dysfunction: When he's (not) in the mood for love - AsiaOne

TORONTO Acerus Pharmaceuticals Corporation (TSX:ASP, OTCQB:ASPCF) today announced that the revised commercial partnership agreement with Aytu Bioscience (Aytu) to accelerate the growth of NATESTO in the United States is now closed and fully effective as of December 1, 2019. Both parties have mutually waived the closing conditions of the revised partnership agreement, including the requirement that Acerus complete a raise of a minimum of USD 10 million on or before the end of January 2020, enabling Acerus to launch a U.S.-based specialty sales force, which will promote NATESTO to urologists and endocrinologists. Aytu will continue to book all NATESTO revenue in the United States and they will promote NATESTO to all other specialties including internal medicine and family practice.

To accelerate the launch of Acerus U.S. commercial team, Aytu has agreed to transfer 5 current sales personnel to Acerus as of December 2, 2019. These staff will operate as Acerus employees but they will remain on Aytus payroll until the earlier of the date on which Acerus is ready to fully assume the personnel or June 30, 2020. Aytu will deduct the costs of these sales personnel from quarterly payments otherwise owed to Acerus under the revised agreement, with a final accounting to be done once per year. Throughout 2020, Acerus will be building out a complete US-based specialty care sales force and other commercial functions, significantly increasing the number of employees working directly on NATESTO in the United States.

This co-promotion is expected to significantly increase sales force coverage of targeted U.S. prescribers, putting a higher promotional focus on urologists and endocrinologists, while enabling Aytu to focus its promotional efforts in primary care and other specialties.

Acerus is extremely pleased to see our revised partnership with Aytu moving to execution mode as we strongly believe that the performance of NATESTO in the U.S. will benefit from an enhanced commercial focus on urology and endocrinology, said Ed Gudaitis, President and Chief Executive Officer of Acerus. We are happy to welcome the former Aytu staff to the Acerus team. With this revised partnership, Acerus is effectively pivoting its focus of effort to the U.S. NATESTO opportunity. As such, we have implemented a resource reallocation program within our Canadian office that has led to a greater than 50% reduction in headcount so that we can align our SG&A spend appropriately.

On July 29, 2019 the companies agreed to expand their commercial partnership and amend and restate the original 2016 NATESTO exclusive U.S. license agreement. Under the terms of the new agreement, Aytu returns the NDA for NATESTO in the U.S. back to Acerus. Going forward Acerus will assume all regulatory and clinical responsibilities and costs for the product in the U.S. Acerus will take on a more expansive role in matters such as U.S. marketing, reimbursement and medical strategy as part of the companies joint commercialization committee, and will launch a specialist sales force focused on urologists and endocrinologists (Acerus Sales Channel). Aytu will retain its primary care sales force (Aytu Sales Channel) and will continue to book all product net revenue while serving as the exclusive U.S. supplier of NATESTO to wholesalers, pharmacies and other customers that receive a direct shipment. Financial payments will be based upon a tiered level of net revenue, post cost of goods sold (COGS), based on annual sales performance in the respective Acerus and Aytu Sales Channels.

To establish a high performing commercial footprint in the U.S., Acerus has engaged Syneos Health (NASDAQ: SYNH), a leading integrated biopharmaceutical solutions organization including the industrys largest Contract Commercial Organization (CCO), to be its commercialization partner. Syneos Health has extensive experience in Mens Health and with NATESTO, and offers an end-to-end model that will enable Acerus to rapidly stand up a U.S. commercial team; to scale across all aspects of commercialization, including medical and regulatory affairs, managed markets, marketing and sales; and will provide greater flexibility and effectiveness in resource deployment.

Low testosterone is estimated to affect approximately 39% of men over 45 years old in the U.S.; however, because the condition is underdiagnosed the overall prevalence is uncertain1. While patients have access to other treatment options, NATESTO is unique in that it is administered in seconds via a convenient and simple nasal gel applicator, addressing the risk of testosterone transference associated with other topical products, which carry black box warnings on their product labels.

About NATESTO (Testosterone) Nasal Gel

NATESTO is a nasal gel formulation of testosterone developed by Acerus Pharmaceutical Corporation and indicated as a replacement therapy for men diagnosed with conditions associated with a deficiency or absence of endogenous testosterone (hypogonadism). It is the first and only nasally-administered testosterone product approved by the U.S. Food and Drug Administration, Health Canada and South Korea Ministry of Food and Drug Safety (MFDS), available in a no-touch dispenser with a metered dose pump. A copy of the NATESTO Canadian product monograph can be found at: http://www.aceruspharma.com/English/products-and-pipeline/NATESTO /default.aspx. For further information, specific to the U.S. product dosing and administration, please visit: http://www.NATESTO .com.

About Acerus

Acerus Pharmaceuticals Corporation is a Canadian-based specialty pharmaceutical company focused on the commercialization and development of innovative prescription products that improve patient experience, with a primary focus in the field of mens health. The Company commercializes its products via its own salesforce in Canada, and through a global network of licensed distributors in the U.S. and other territories.

Acerus shares trade on TSX under the symbol ASP and on OTCQB under the symbol ASPCF. For more information, visit http://www.aceruspharma.com and follow us on Twitter and LinkedIn.

Notice Regarding Forward-Looking Statements

Information in this press release that is not current or historical factual information may constitute forward looking information within the meaning of securities laws. Implicit in this information are assumptions regarding our future operational results. These assumptions, although considered reasonable by the company at the time of preparation, may prove to be incorrect. Readers are cautioned that actual performance of the company is subject to a number of risks and uncertainties, including with respect to the commercial performance of NATESTO in the United States, and could differ materially from what is currently expected as set out above. For more exhaustive information on these risks and uncertainties you should refer to our annual information form dated March 4, 2019 which is available at http://www.sedar.com. Forward-looking information contained in this press release is based on our current estimates, expectations and projections, which we believe are reasonable as of the current date. You should not place undue importance on forward-looking information and should not rely upon this information as of any other date. While we may elect to, we are under no obligation and do not undertake to update this information at any particular time, whether as a result of new information, future events or otherwise, except as required by applicable securities law.

1 Mulligan T, Frick MF, et al. Prevalence of hypogonadism in males aged at least 45 years: the HIM study. Int J Clin Pract. 2006 Jul 1; 60(7): 762769

View source version on businesswire.com: https://www.businesswire.com/news/home/20191202005215/en/

Contacts

Media: Edward Gudaitis President and Chief Executive Officer egudaitis@aceruspharma.com (905) 817-8194

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Expanded U.S. NATETSO Partnership Between Acerus Pharmaceuticals and Aytu BioScience Is Now Fully Operational - Financial Post

Over the past decade there has been a huge rise in the number of young people seeking treatment for gender dysphoria a condition in which one experiences a mismatch between ones biological sex and ones gender identity. In fact, since 2008/9, there has been a 5,337 per cent increase in referrals of teen girls, and a 1,460 per cent increase in referrals of teen boys, to the Tavistock Clinic, the UKs leading treatment centre for gender dysphoria.

Many of these young people are reported to be already suffering from serious mental health issues, and sometimes a history of self-harm. So they certainly require care. What they dont require is a potential diagnosis of gender dysphoria. The consequences can be severe. As one doctor puts it, it can mean that vulnerable teens are given puberty-blocking hormones in a context of profound scientific ignorance. These hormone-blockers suppress the release of testosterone in boys and oestrogen in girls. And they are often followed by cross-sex hormone therapy.

Many who have undergone such treatment report side-effects of physical pain, depression and suicidal thoughts. Indeed, a study produced by the Tavistock Clinic, in July this year, showed that after a year on puberty-blocking hormones, patients reported a rise in suicidal and self-harming thoughts. But these findings were brushed aside. The Tavistock Clinic now offers powerful hormones to children aged 11.

Staff at the Tavistock Clinic have understandably become worried. Five clinicians have resigned, voicing concerns that children were being rushed into hormone therapy, and that trans lobby groups had pressured doctors to medicate healthy children. Experimental treatment is being done not only on children, explained one of the ex-clinicians, but very vulnerable children, who have experienced mental-health difficulties, abuse, family trauma, but sometimes those [other factors] just get whitewashed.

Trans activists claim that puberty-blocking hormones buy time for young people to find out who they really are. They claim that the high level of self-harm and attempted suicide among trans teens is due to discrimination, transphobia and delays in hormone treatment.

But it is the diagnosis and treatment itself that is the real problem. Certainly the UK health authorities warn of the rare, potential side-effects of hormone blockers, such as blood clots or cardiovascular problems. They should also warn of the serious mental-health risks of taking these drugs.

Take the widely used puberty-blocker Lupron (also known as Leuprorelin in the UK). Having been used as a cancer drug for years, it is now used for girls who wish to transition to boys. It can have devastating side-effects, including extreme mood swings, depression and suicidal thoughts. Not to mention the crushing muscle pain and nausea.

So harmful has Lupron proved that in the US the drugs manufacturer has faced lawsuits and a petition to congress to limit its use.

Another puberty-blocker is Histrelin, which is sold as Supprelin and used to treat precocious puberty. It is left to the manufacturer to explain that, Post-marketing reports with this class of drugs include symptoms of emotional lability, such as crying, irritability, impatience, anger, and aggression. [Also] depression, including rare reports of suicidal ideation and attempt

Then theres Finastaride, a feminising hormone. The UK government warns that it risks causing major depression and suicidal thoughts.

On and on the list goes. Goserelin. Progesterone. Triptorelin. Testosterone. All can have serious impacts on mental health.

And who are the guinea pigs in this experiment? Children, many of whom have suffered from pre-existing mental-health issues, like bi-polar disorder and schizophrenia, before developing gender dysphoria.

Moreover, many are teenage girls, a generational cohort suffering from unprecedented levels of self-harm, linked to anxieties over body image and sexual pressure.

So how many self-harming trans teens could actually be depressed girls with body disorders? The answer is quite a lot. Hence many are de-transitioning back to their original bodies, and reporting that they were lied to. One well-known activist puts the plight of such girls in stark terms: Im a real live 22-year-old woman with a scarred chest and a broken voice and a five-oclock shadow because I couldnt face the idea of growing up to be a woman.

There are thousands of tragic stories like this. Yet de-transitioners are bullied by trans activists, ignored by the media, and abandoned by the NHS.

Its all too easy for troubled kids to be sucked into the trans world. They see the story of the beautiful trans model finding his or her self in his or her new body. They know that being a victim of gender dysphoria means special treatment. And they can then be sucked into a darker online world. Those who escaped talk of trans chatrooms where young people are manipulated, encouraged to take puberty-blockers and cross-sex hormones, and where suicide is discussed as an alternative to transition. One de-transitioning teenager says, the nasty stuff is so easy to find and so hard to wriggle free of.

Overuse of the internet has already been clinically linked to self-harm and suicide. But here we have trans websites actively encouraging self-harm and suicide.Teens open and exposed to such sites should not be on hormones that can cause extreme mood swings, depression or suicidal thoughts.

But far from resisting the trans lobby, the UK government has been busy following its advice. So from next year, new guidlines will tell schools to teach transgender relationships in class. And if you teach all children that they could be in the wrong body, a good number will believe it. Such an approach will cause many to go on to hormone treatment, and, with it, a life of pain and mental anguish.

And what of young gay students? Almost every long-term study shows that most who grow out of transgender feelings turn out to be gay. But as trans ideology spreads, many gay young people are now seeing transition as a way out. One doctor has even described the situation as conversion therapy for gay children.

On the other side, trans advocates assert that no one changes their mind. But the science underpinning such statements is shaky. One often-cited study follows 55 post-transition teens on their road to happiness. Yet it barely mentions the 141 participants who dropped out, or the one who died after post-surgery complications. Worse still, other studies that show that high suicide rates continue after transition are now ignored.

It seems that a vast trans marketing and lobbying campaign has changed our culture and intimidated our institutions. Young people with all kinds of mental-health issues are being told they are in the wrong body and that transition is the dream cure. Many believe it and cry out for treatment. So teenagers already at fatal risk of depression, self-harm and suicide are given huge doses of toxic hormones that can cause uncontrollable swings of emotion, anxiety and depression. The dream of being in a new and beautiful body fades. It is replaced by an agonising reality. And so many continue to self-harm. And some take their own lives.

This fate now awaits thousands more children. They should instead be left alone or given proper medical care. It might just save them.

Simon Marcus is a writer, political consultant and former government adviser.

Picture by: Getty

Read the original:
Transitioning: a threat to our children - Spiked

Even when you love what you do, work-related stress can pile up, affecting your physical and mental health. For many people, it's a fact of life.

Each year, a majority of Americans report experiencing heavy work stress, according to theAmerican Psychological Association's annual Stress in America survey.

The most common stressors are low salaries, too much work, little room to grow or to be challenged, and lack of autonomy and support. While you can't completely eliminate stress from your life, when it becomes chronic you are putting your health in jeopardy.

When you experience a stressor, your body releases adrenaline, causing your heart rate to spike and your blood pressure to rise,according to theMayo Clinic. Cortisol, a hormone that increases blood sugar and limits functions that are not considered essential in a crisis, also increases.

This fight-or-flight drive is a natural mechanism designed to protect you from aggressors. But problems arise when you are constantly in a state of crisis.

"The long-term activation of the stress-response system and the overexposure to cortisol and other stress hormones that follows can disrupt almost all of your body's processes," according to the Mayo Clinic.

Chronic stress can lead to anxiety, high blood pressure and a weakened immune system. It can put you at higher risk for depression, obesity and heart disease. Stress also affects the quality and quantity of sleep, which in turns contributes to difficulties focusing at work.

When stress feels out of control, people sometimes turn to unhealthy coping strategies like overloading on junk food, binge drinking, smoking or taking drugs.

So short of leaving your job, how can you better manage stress and stay healthy? Here are some tips from theAmerican Psychological Association, National Sleep Foundation, Mayo Clinicand Harvard Health:

Keep track of daily stressors and how you react to them.

Then adopt new, healthier coping strategies like adding more exercise into your weekly routine, carving out more time for hobbies or spending time with loved ones.

Make sure you are getting enough sleep by having a set bedtime and by creating rituals to prepare your mind and body for sleep. That includes avoiding electronics for at least an hour before bedtime.

Set clear boundaries for your work and home life. If you are constantly bringing work home with you, you will never completely relax and de-stress.

Practice meditation and deep breathing exercises every day to build up your resilience against stress.

Work on your problem-solving skills so you stay solution-focused instead of getting mired in negative thoughts.

Finally, don't be afraid to ask for help. Talk to your supervisor about stress management resources at work, as well as ways he or she can support you better. Family and friends also can be good sounding boards.

If you continue to feel overwhelmed, a psychologist can help you create healthy coping mechanisms. You can find resources here.

Read more from the original source:
Most Americans find their jobs stressful here's how to survive at work - PhillyVoice.com

A 36-year-old man born without testicles received one transplanted from his identical twin brother in a six-hour operation performed on Tuesday in Belgrade, Serbia, by an international team of surgeons.

The surgery was intended to give the recipient more stable levels of the male hormone testosterone than injections could provide, to make his genitals more natural and more comfortable, and to enable him to father children, said Dr. Dicken Ko, a transplant surgeon and urology professor at Tufts University School of Medicine in Boston, who flew to Belgrade to help with the procedure.

The operation was only the third known transplant of this type. The first two were performed 40 years ago in St. Louis, also for identical twins, each pair with a brother lacking testicles.

The absence of testicles is an exceedingly rare condition, but doctors say that the surgery may have broader applications for transgender people, accident victims, wounded soldiers and cancer patients. But the procedure raises questions about the ethics of transplants that are not lifesaving, and about the possibility of recipients someday fathering children with sperm from donors who may not even be related to them.

The surgery was performed at the University Childrens Clinic in Tirsova, a section of Belgrade. The Serbian brothers are doing well, doctors said. By Friday, the recipient already had normal testosterone levels.

Hes good, he looks good, his brother looks good, Dr. Ko said in a telephone interview on Friday. The donor, who already has children, should remain as fertile as he was before, despite giving up a testicle.

Dr. Ko said the brothers, who have been sharing a hospital room, were expected to go home this weekend. They preferred not to be identified or interviewed, the doctors said.

Because the patients are identical twins with the same genetic makeup, there is no concern that the recipients body will reject the transplant, so he does not have to take the immune-suppressing drugs that most transplant patients need.

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Surgeons operated on the brothers simultaneously, in adjoining rooms. The procedure was challenging because it required sewing together two arteries and two veins that were less than 2 millimeters wide.

Once you remove the testicle from the donor, the clock starts ticking very fast, said Dr. Branko Bojovic, an expert in microsurgery at Harvard Medical School and part of the team in Belgrade.

Within two to four hours, you have to have it re-perfused and working again, Dr. Bojovic said. Without a blood supply, a testicle is viable for only four to six hours.

It can take 30 to 60 minutes to make each of the four blood-vessel connections. But the team managed to complete them all in less than two hours, he said.

The team did not connect a structure called the vas deferens, which carries sperm out of the testicles. The surgeons could not find the tissue in the recipient needed for the connection, which means that for now, he cannot father children in the usual way.

Another operation to make the connection may be possible. Otherwise, if the recipient wants children, he might undergo a procedure to extract sperm from the testicle for in vitro fertilization. Or his twin brothers sperm could be used.

Dr. Ko and Dr. Bojovic were both part of the surgical team that performed the first penis transplant in the United States, in 2016, on a man whose penis had been removed because of cancer.

Dr. Miroslav Djordjevic, who led the team in Belgrade, specializes in urologic reconstruction and sex reassignment surgery at Mount Sinai Hospital in New York and at the University of Belgrade. He said the brothers approached him after learning that he had performed a successful uterus transplant between twins sisters, which enabled the recipient to give birth.

Dr. Bojovic said that after the penis transplant, the surgical team received inquiries from people undergoing female-to-male sex reassignment who wondered if they might receive transplants instead of the usual surgery, which creates a penis from the patients own tissue.

But a transplant from any donor other than an identical twin would require immune-suppressing drugs to prevent rejection. The drugs have side effects that lead some experts to argue that the bar for such transplants must be very high.

Its becoming more of a popular topic for these patients, Dr. Bojovic said. They say, If immunosuppression is getting safer, I dont want to use a big piece of tissue from my forearm or thigh or back for something that looks like phallus but isnt.

He added that in patients having male-to-female reassignment surgery, the penis and testicles that were surgically removed are discarded, but in theory could be used for transplants.

The lead surgeon, Dr. Djordjevic, said that he had developed a surgical plan for transplanting a penis onto a body that is anatomically female, and that he hoped to begin performing that surgery within the next year or so.

We have to do this as soon as possible, to stop putting healthy organs in the garbage, he said.

But he would not transplant testicles as part of transgender surgery, he said. Doing so would open up the thorny possibility that the recipient could have children produced by the donors sperm. If the idea were extended to deceased organ donors, special permission would be required from them before death, or from their families.

Then the offspring is technically whose child? asked Dr. Ko, who is also chief medical officer at St. Elizabeths Hospital in Boston. It raises much debate in the literature of medical ethics.

Last year, when surgeons at Johns Hopkins Hospital transplanted a penis, scrotum and other tissue to a young soldier who had been maimed in combat, they deliberately left out the testicles. The idea that he might father children who were genetically someone elses was considered unacceptable.

The first report of a testicle transplant, by Dr. Sherman J. Silber, a fertility specialist in St. Louis, was published in a medical journal in 1978. In that case, the twin brothers were 30 when they consulted Dr. Silber.

The brother without testicles had not reached puberty until he was given testosterone at age 18, which caused a growth spurt that left him four inches taller than his brother. He needed regular testosterone injections to maintain his masculine characteristics, but the hormone levels fluctuated and sometimes caused mood swings.

He spent five years searching for a doctor who could perform a testicle transplant before he found Dr. Silber, after reading a New York Times article about his work published in 1975.

Dr. Silber said that he had performed more than 2,000 kidney transplants in rats, which required microsurgical techniques to sew together minute blood vessels the same size as those in human testicles.

So doing a testicle transplant was not a big deal, he recalled in an interview on Thursday. It was like just another kidney transplant in a rat. He said the operation took two hours.

Dr. Silber said that the donor was gay and the recipient straight, and that the brothers told him they wondered if the transplanted testicle might somehow alter the recipients sexual orientation. There is no scientific reason for such an effect, and none occurred.

The transplant was a success, and the recipient eventually had five children, Dr. Silber said. A year or so later, he performed the surgery again for another pair of identical twin brothers, though he did not write up their case in a journal.

Regarding the operation in Belgrade, Dr. Silber said, I imagine these surgeons must be pretty good, because most people wouldnt dare to try this.

Read this article:
Surgeons Transplant a Testicle From One Brother to His Twin - The New York Times

A 36-year-old man born without testicles received one transplanted from his identical twin brother in a six-hour operation performed in Belgrade, Serbia, by an international team of surgeons.

The surgery was intended to give the recipient more stable levels of the male hormone testosterone than injections could provide, to make his genitals more natural and more comfortable, and to enable him to father children, said DrDicken Ko, a transplant surgeon and urology professor at Tufts University School of Medicine in Boston, who flew to Belgrade to help with the procedure.

The operation was only the third known transplant of this type. The first two were performed 40 years ago in StLouis, also for identical twins, each pair with a brother lacking testicles.

Sharing the full story, not just the headlines

The absence of testicles is an exceedingly rare condition, but doctors said that the surgery may have broader applications for transgender people, accident victims, wounded soldiers and cancer patients. But the procedure raises questions about the ethics of transplants that are not lifesaving and about the possibility of recipients someday fathering children with sperm from donors who may not even be related to them.

The surgery was performed at the University Childrens Clinic in Tirsova, a section of Belgrade. The Serbian brothers are doing well, doctors said. By Friday, the recipient already had normal testosterone levels.

A vaping-related lung disease has claimed the lives of 11 people in the US in recent weeks. The US Centre for Disease Control and Prevention has more than 100 officials investigating the cause of the mystery illness, and has warned citizens against smoking e-cigarette products until more is known, particularly if modified or bought off the street

Getty

Researchers in the US claim to have overcome one of the major hurdles to cultivating human follicles from stem cells. The new system allows cells to grow in a structured tuft and emerge from the skin

Sanford Burnham Preybs

A study in the journal Scientific Reports suggests that a dose of nature of just two hours a week is associated with better health and psychological wellbeing

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Exposure to air from traffic-clogged streets could leave women with fewer years to have children, a study has found. Italian researchers found women living in the most polluted areas were three times more likely to show signs they were running low on eggs than those who lived in cleaner surroundings, potentially triggering an earlier menopause

Getty/iStock

Junk food adverts on TV and online could be banned before 9pm as part of Government plans to fight the "epidemic" of childhood obesity.Plans for the new watershed have been put out for public consultation in a bid to combat the growing crisis, the Department of Health and Social Care (DHSC) said

PA

On migrating from Africa around 70,000 years ago, humans bumped into the neanderthals of Eurasia. While humans were weak to the diseases of the new lands, breeding with the resident neanderthals made for a better equipped immune system

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The breath biopsy device is designed to detect cancer hallmarks in molecules exhaled by patients

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A study published in the New England Journal of Medicine has found that many elderly people are taking daily aspirin to little or no avail

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A study by the University of Minnesota's Masonic Cancer Centre has found that the carcinogenic chemicals formaldehyde, acrolein, and methylglyoxal are present in the saliva of E-cigarette users

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There has been a 41% increase in children with type 2 diabetes since 2014, the National Paediatric Diabetes Audit has found. Obesity is a leading cause

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The majority of antidepressants are ineffective and may be unsafe, for children and teenager with major depression, experts have warned. In what is the most comprehensive comparison of 14 commonly prescribed antidepressant drugs to date, researchers found that only one brand was more effective at relieving symptoms of depression than a placebo. Another popular drug, venlafaxine, was shown increase the risk users engaging in suicidal thoughts and attempts at suicide

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Researchers at the Baptist Health South Florida Clinic in Miami focused on seven areas of controllable heart health and found these minority groups were particularly likely to be smokers and to have poorly controlled blood sugar

iStock

A major pressure group has issued a fresh warning about perilously high amounts of sugar in breakfast cereals, specifically those designed for children, and has said that levels have barely been cut at all in the last two and a half decades

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New guidance by the National Institute for Health and Care Excellence (NICE), the body which determines what treatment the NHS should fund, said lax road repairs and car-dominated streets were contributing to the obesity epidemic by preventing members of the public from keeping active

PA

A new class of treatments for women going through the menopause is able to reduce numbers of debilitating hot flushes by as much as three quarters in a matter of days, a trial has found.The drug used in the trial belongs to a group known as NKB antagonists (blockers), which were developed as a treatment for schizophrenia but have been sitting on a shelf unused, according to Professor Waljit Dhillo, a professor of endocrinology and metabolism

REX

Research from Oxford University found that more than one million extra people suffering from mental health problems would benefit from being prescribed drugs and criticised ideological reasons doctors use to avoid doing so.

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The family of a teenager who died from flu has urged people not to delay going to A&E if they are worried about their symptoms. Melissa Whiteley, an 18-year-old engineering student from Hanford in Stoke-on-Trent, fell ill at Christmas and died in hospital a month later.

Just Giving

The Government has pledged to review tens of thousands of cases where women have been given harmful vaginal mesh implants.

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The NHS will be asked to go further to prevent the deaths of patients in its care as part of a zero suicide ambition being launched today

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Human trials have begun with a new cancer therapy that can prime the immune system to eradicate tumours. The treatment, that works similarly to a vaccine, is a combination of two existing drugs, of which tiny amounts are injected into the solid bulk of a tumour.

Nephron

Mothers living within a kilometre of a fracking site were 25 per cent more likely to have a child born at low birth weight, which increase their chances of asthma, ADHD and other issues

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Thousands of cervical cancer screening results are under review after failings at a laboratory meant some women were incorrectly given the all-clear. A number of women have already been told to contact their doctors following the identification of procedural issues in the service provided by Pathology First Laboratory.

Rex

Most breast cancer patients do not die from their initial tumour, but from secondary malignant growths (metastases), where cancer cells are able to enter the blood and survive to invade new sites. Asparagine, a molecule named after asparagus where it was first identified in high quantities, has now been shown to be an essential ingredient for tumour cells to gain these migratory properties.

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A record number of nursing and midwifery positions are currently being advertised by the NHS, with more than 34,000 positions currently vacant, according to the latest data. Demand for nurses was 19 per cent higher between July and September 2017 than the same period two years ago.

REX

CBD has a broadly opposite effect to delta-9-tetrahydrocannabinol (THC), the main active component in cannabis and the substance that causes paranoia and anxiety.

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Mr Bransons company sued the NHS last year after it lost out on an 82m contract to provide childrens health services across Surrey, citing concerns over serious flaws in the way the contract was awarded

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The numbers of people accepted to study nursing in England fell 3 per cent in 2017, while the numbers accepted in Wales and Scotland, where the bursaries were kept, increased 8.4 per cent and 8 per cent respectively

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The paper found that there were 45,000 more deaths in the first four years of Tory-led efficiencies than would have been expected if funding had stayed at pre-election levels.On this trajectory that could rise to nearly 200,000 excess deaths by the end of 2020, even with the extra funding that has been earmarked for public sector services this year.

Reuters

Hours of commuting may be mind-numbingly dull, but new research shows that it might also be having an adverse effect on both your health and performance at work. Longer commutes also appear to have a significant impact on mental wellbeing, with those commuting longer 33 per cent more likely to suffer from depression

Shutterstock

It is not possible to be overweight and healthy, a major new study has concluded. The study of 3.5 million Britons found that even metabolically healthy obese people are still at a higher risk of heart disease or a stroke than those with a normal weight range

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When you feel particularly exhausted, it can definitely feel like you are also lacking in brain capacity. Now, a new study has suggested this could be because chronic sleep deprivation can actually cause the brain to eat itself

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David Lloyd Gyms have launched a new health and fitness class which is essentially a bunch of people taking a nap for 45 minutes. The fitness group was spurred to launch the napercise class after research revealed 86 per cent of parents said they were fatigued. The class is therefore predominantly aimed at parents but you actually do not have to have children to take part

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Tobacco and alcohol companies could win more easily in court cases such as the recent battle over plain cigarette packaging if the EU Charter of Fundamental Rights is abandoned, a barrister and public health professor have said

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A major new study into the side effects of the cholesterol-lowering medicine suggests common symptoms such as muscle pain and weakness are not caused by the drugs themselves

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New research has found that babies born to fathers under the age of 25 or over 51 are at higher risk of developing autism and other social disorders. The study, conducted by the Seaver Autism Center for Research and Treatment at Mount Sinai, found that these children are actually more advanced than their peers as infants, but then fall behind by the time they hit their teenage years

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Commuters who swap their car or bus pass for a bike could cut their risk of developing heart disease and cancer by almost half, new research suggests but campaigners have warned there is still an urgent need to improve road conditions for cyclists.Cycling to work is linked to a lower risk of developing cancer by 45 per cent and cardiovascular disease by 46 per cent, according to a study of a quarter of a million people.Walking to work also brought health benefits, the University of Glasgow researchers found, but not to the same degree as cycling.

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Scientists conducted the research on 71 car crash victims as they were waiting for treatment at one hospitals accident and emergency department. They asked half of the patients to briefly recall the incident and then play the classic computer game, the others were given a written activity to complete. The researchers, from Karolinska Institute in Sweden and the University of Oxford, found that the patients who had played Tetris reported fewer intrusive memories, commonly known as flashbacks, in the week that followed

Rex

Vaping has been given an emphatic thumbs up by health experts after the first long-term study of its effects in ex-smokers.After six months, people who switched from real to e-cigarettes had far fewer toxins and cancer-causing substances in their bodies than continual smokers, scientists found

Matt Cardy/Getty Images

Millions of people are putting themselves at risk by cooking their rice incorrectly, scientists have warned.Recent experiments show a common method of cooking rice simply boiling it in a pan until the water has steamed out can expose those who eat it to traces of the poison arsenic, which contaminates rice while it is growing as a result of industrial toxins and pesticides

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An injectable contraceptive gel that acts as a reversible vasectomy is a step closer to being offered to men following successful trials on monkeys.Vasalgel is injected into the vas deferens, the small duct between the testicles and the urethra. It has so far been found to prevent 100 per cent of conceptions

Vasalgel

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The Japanese government has announced measures to limit the amount of overtime employees can do in an attempt to stop people literally working themselves to death.A fifth of Japans workforce are at risk of death by overwork, known as karoshi, as they work more than 80 hours of overtime each month, according to a government survey.

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It is well known that high blood pressure is a risk factor for dementia, so the results of a new study from the University of California, Irvine, are quite surprising. The researchers found that people who developed high blood pressure between the ages of 80-89 are less likely to develop Alzheimers disease (the most common form of dementia) over the next three years than people of the same age with normal blood pressure.

Getty

A vaping-related lung disease has claimed the lives of 11 people in the US in recent weeks. The US Centre for Disease Control and Prevention has more than 100 officials investigating the cause of the mystery illness, and has warned citizens against smoking e-cigarette products until more is known, particularly if modified or bought off the street

Getty

Researchers in the US claim to have overcome one of the major hurdles to cultivating human follicles from stem cells. The new system allows cells to grow in a structured tuft and emerge from the skin

Sanford Burnham Preybs

Read more here:
Surgeons transplant testicle from one identical twin to the other - The Independent

The Fulton County Health Department has scheduled the following health clinics and services.

CANTON The Fulton County Health Department has scheduled the following health clinics and services. Please call the number listed with each service for an appointment or more information.

Maternal child health: Health screenings, WIC nutrition education and supplemental food coupons for women, infants and children. To make an appointment or for more information call 647-1134 (ext. 254). For Astoria clinic appointments call 329-2922.

Canton - Clinic - Monday, Dec. 9 - 8-4 - Appt needed

Canton - WIC Nutrition Education - Tuesday, Dec. 10 - 8-4 - Appt needed

Astoria - Clinic, WIC Nutrition Educ. - Wednesday, Dec. 11 - 9-3 - Appt needed

Canton - Clinic - Thursday, Dec. 12 - 8-4 - Appt needed

Adult Health Immunizations: Various vaccines are available. There is a fee for immunization administration. Medicaid cards are accepted. To make an appointment or for more information call 647-1134 (ext. 254).

Other times available by special arrangement at Canton, Cuba and Astoria.

Blood Lead Screening: Blood lead screenings are available for children ages one to six years. A fee is based on income. To make an appointment or for more information call 647-1134 (ext. 254). For Astoria appointments call 329-2922.

Family Planning: Confidential family planning services are available by appointment at the Canton office for families and males of child-bearing age. Services provided include physical exams, pap smears, sexually transmitted disease testing, contraceptive methods, pregnancy testing, education and counseling. Services are available to individuals of all income levels. Fees are based on a sliding fee scale with services provided at no charge to many clients. Medicaid and many insurances are accepted. After hours appointments are available. To make an appointment or for more information call the 647-1134 (ext. 244). *Program funding includes a grant from the US DHHS Title X.

Pregnancy testing: Confidential urine pregnancy testing is available at the Canton and Astoria offices. This service is available to females of all income levels. A nominal fee is charged. No appointment is needed. A first morning urine specimen should be collected for optimal testing and brought to the health department. Services are provided on a walk-in basis on the following days each week:

Canton: Every Wednesday & Thursday, 8-3:30 (for more information call 647-1134 ext. 244)

Astoria: Every Wednesday, 9-2:30 (for more information call 329-2922)

Womens Health: A womens clinic for pap tests, clinical breast examinations and vaginal examinations is available by appointment. There is a nominal fee for this service. Medicaid cards are accepted. Financial assistance is available for a mammogram. Cardiovascular screenings may be available to age and income eligible women. To make an appointment or for more information call 647-1134 (ext. 244).

Mammograms: Age and income eligible women may receive mammograms at no charge. Speakers are available to provide information to clubs and organizations. For more information or to apply for financial assistance, call 647-1134 (ext. 254).

Mens Health: Prostate specific antigen (PSA) blood tests are available for men for a fee. To make an appointment or for more information call 647-1134 (ext. 224).

Canton - Clinic - Monday, Dec. 9 - 8-12 - Appt needed

Sexually Transmitted Disease (STD) Clinic: Confidential STD and HIV testing services are available by appointment to males and females at the Canton office. Services include physical exams to identify STDs, a variety of STD testing, HIV testing, education, counseling, medications and condoms. There is a nominal fee for services. Services are available to individuals of all income levels. Medicaid cards are accepted. To make an appointment or for more information call 746-1134 (ext. 224).

HIV Testing and Counseling: Confidential HIV testing and counseling services are available by appointment through the sexually transmitted disease (STD) clinic at the Canton office. To make an appointment or for more information call 647-1134 (ext. 224).

Tuberculosis (TB) Testing: TB skin tests are available at no charge by appointment. To make an appointment or for more information call 647-1134 (ext. 254).

Blood Pressure Screenings: The Fulton County Health Department provides blood pressure screenings at no charge on a walk-in basis during the following times:

Canton - Screening - Monday, Dec. 9 - 8-4 - Walk in/Room 108

Cuba - Screening - Monday, Dec. 9 - 8-12 - Walk in

Astoria - Screening - Wednesday, Dec. 11 - 9-12 - Walk in

Health Watch Wellness Program: The Health Watch Program provides low cost lab services. Through this program adults can obtain venous blood draws for a variety of blood tests. Blood tests offered without a doctors order Comprehensive Metabolic Panel (CMP), Complete Blood Count (CBC), Lipid Panel, Prostate Specific Antigen (PSA) test, Hepatitis C test, and Thyroid Stimulating Hormone (TSH). A wide variety of blood tests are also available with a doctors order. There is a charge at the time of service. To make an appointment or for more information call 647-1134 (ext. 254).

Canton - Clinic - Monday, Dec. 9 - 8-12 - Appt needed

Dental Services: The Dental Center offers a variety of basic dental services to children and adults. An appointment is needed. Medicaid and Kid Care cards are accepted. To make an appointment or for more information call 647-1134 (ext. 292).

Link:
Health Department announces services for the week of Dec 9 - Canton Daily Ledger

One of the most commonly searched questions about breastfeeding is, What medicines can you take? Since everything you consume makes its way into your babys milk supply, its a valid concern. Sure, we know to pump and dump after a couple glasses of wine, but what about medications?

There are myriad benefits to breastfeeding your baby. Nursing reduces a woman and her babys risk of getting breast cancer, and the antibodies in human milk protect against infection and build the immune system. While there are many benefits, its also important that breastfeeding moms take care of their own health. Sometimes, that means taking medication. Certified Lactation Education Counselor and Certified Childbirth Educator AAHCC Liza Janda breaks down whats OK and whats off limits.

What to do before taking any medications

The most important thing a lactation educator consultant can do is educate the mother on being an active participant in her health care decisions, Janda says. Most medications are suitable to take while breastfeeding. Many mothers are told they need to stop breastfeeding to take a medication or do a test or a procedure. In most cases, this is unnecessary.

Janda recommends asking yourself and your physician important questions before taking any medications:

Are there alternatives to treatment that dont involve medication?

Is there an alternative medication that may be safer?

Do the benefits of taking the medication outweigh the risks to my baby?

In the clear

With all medications during breastfeeding, there is a risk that trace amounts will end up in your milk supply. In most cases, however, the amount is very small and will not harm your child.

Ibuprofen is generally safe for nursing women to take. A 1984 study found that moms who took 400mg of ibuprofen every six hours passed on less than 1mg to their supply, an amount that will not negatively affect your baby, but nursing women should not take more than the daily maximum dose. Of course, consult your doctor before taking.

In the way of painkillers, acetaminophen and naproxen are also OK for breastfeeding mothers. However, naproxen (Aleve, Midol, Flanax) should be used for the short-term only.

According to Planned Parenthood, it is safe to use hormonal methods of birth control while breastfeeding. These include the shot, implant, Skyla and Mirena IUDs, and some kinds of birth control pills (known as the minipill). However, methods that include the hormone estrogen (pills, patch, or ring) should be avoided for the first three weeks after giving birth. After three weeks, these hormonal methods are fair game once again.

If you have symptoms of a cold, thats where medication while breastfeeding gets tricky.

Cold medicine can affect milk supply, Janda says. If the goal of the cold remedy is to dry up a stuffy nose, it will probably also lower her milk supply.

Most decongestants like Sudafed and Zyrtec D contain pseudoephedrine, which can lower milk supply. Use medications with this ingredient with caution. For a full list on what medications are safe to take while breastfeeding, check out this guide from the Mayo Clinic.

Not so safe

Contraindicated is a medical term that means a procedure or medication is unadvisable. While breastfeeding, contraindicated drugs include anticancer drugs, lithium, oral retinoids, iodine, amiodarone, gold salts, marijuana and other recreational drugs.

If youre interested in researching a particular medication, theres ToxNet. ToxNets LactMed feature is a resource and database featuring 31 antibiotics, their safety, and the amount that shows up in breast milk. You can also search SSRIs and other meds.

Drinking, smoking, and using CBD while breastfeeding

Breastfeeding mothers can drink alcohol, but it takes 2-3 hours to metabolize one 5-ounce glass of wine, 1-2 ounces of hard liquor, and one 8-ounce of beer, Janda explains. Do not breastfeed for 2-3 hours after that one serving. If she drinks more than one serving, it will take 4-6 hours to metabolize.

Smoking nicotine is recognized as off-limits for nursing mothers, as nicotine in the milk supply can cause fussiness, diarrhea, vomiting, rapid heard beat and restlessness in infants, according to Janda.

As for CBD, the jurys still out. Theres not enough research or regulation to decide about CBD, Janda says. So, just avoid it to be safe.

If you're interested in submitting a Letter to the Editor, click here.

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Breaking down the meds you can take while breastfeeding - The Daily Collegian Online

Image: Drugs for a clinical trial

The ICRs researchers showed that a new immunotherapy could greatly extend the lives of people with advanced head and neck cancer, with some living for over three years.

They evaluated the drug pembrolizumab in a trial of nearly 500 patients with very advanced disease that had already spread and become resistant to chemotherapy.

Treatment options for these patients are extremely limited, and they are normally expected to survive for less than six months.

Overall, patients who received pembrolizumab experienced significant benefits with 37 per cent surviving for a year or more, compared with only 26.5 per cent of those on standard care, consisting of chemotherapy or the targeted agent cetuximab.

Some 36 patients saw their cancer partially or completely disappear, and some were still cancer-free three years after first receiving pembrolizumab.

Study leader Professor Kevin Harrington, Professor of Biological Cancer Therapies at The ICR and Consultant at The Royal Marsden, said:

I would like to see pembrolizumab approved for use in the clinic, so that people with metastatic head and neck cancer can be offered the chance of a longer life and improved quality of life.

The trial, published in The Lancet, was funded byMerck & Co., Inc.

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Scientific achievements of 2019 - The - The Institute of Cancer Research

Image:Breast cancer cells stained for DNA (red), NFkB (green), and a reactive oxygen species probe (blue). Credit: Julia Sero / the ICR, 2011

A new test could pick out women with advanced breast cancerwho are likely to benefit from an exciting new targeted therapy for more than a year.

Analysing levels of a molecule called cyclin E1 in tumour biopsies could be used to guide breast cancer treatment helping delay chemotherapy for some women and ensuring others are closely monitored for any signs of progression.

Researchers found that testing for cyclin E1 could predict the chances of a year or more of successful treatment with a drug called palbociclib a drug hailed by doctors as the biggest advance in breast cancer treatment for 20 years.

Palbociclib targets weaknesses in cancer cells specifically, and so has far fewer side-effects than conventional chemotherapy allowing women to live well with their cancer.

It comes as NICE last week recommendedthe use of palbociclib on the NHS through the Cancer Drugs Fund, for women with advanced oestrogen receptor-positive breast cancer who have received hormone therapy.

Hormone therapy works against around 70 per cent of breast cancers and is one of the most common first treatments for people with advanced breast cancer so the new approval could significantly increase the number of women who can benefit from palbociclib on the NHS.

The study by the team at The Institute of Cancer Research, London, and The Royal Marsden NHS Foundation Trust, showed that women with low levels of cyclin E1 in their tumours responded to palbociclib given in combination with hormone treatment for nearly twice as long as women with high levels.

The tests development is described in a study in the Journal of Clinical Oncology with funding by palbociclibs manufacturer, Pfizer.

Following her initial breast cancer diagnosis and successful treatment in 2012, Christine was shocked to discover that her cancer had spread to her brain in 2018. Thanks to palbociclib, Christine is now living well with cancer, including a new-found passion for cycling.

Read Christine's story

The study found that the combination of palbociclib and hormone treatment had some benefit for women irrespective of their test results, delaying the need for chemotherapy for at least three months, even in the shortest responders.

But the researchers suggest that women with higher levels of cyclin E1 in their tumours should be monitored especially closely, since they can be expected to stop responding much more quickly than others.

Researchers in the Breast Cancer Now Toby Robins Research Centreat The Institute of Cancer Research (ICR) looked at tumour samples from two different trials involving palbociclib 302 patients from PALOMA-3, a trial which assessed the drug in combination with hormone therapy for advanced cancer, and the POP trial which looked at palbociclib used on its own before surgery in 61 patients with breast cancers that hadnt yet spread.

In the PALOMA-3 trial, women with low levels of cyclin E1 responded to combination treatment for an average of 14.1 months before their tumour started growing again, compared with only 7.6 months in women with high levels, and 4 months among those who received a placebo plus hormone therapy.

In the POP trial, palbociclib treatment stopped the tumour growing in 80 per cent of women if low levels of cyclin E1 were present, whereas palbociclib only stopped the tumour growing in 36 per cent of women it high levels of cyclin E1 were present.

Strategies to overcome cancers lethal ability to survive and resist treatment are a major focus by researchers at the ICR, who are poised to outsmart cancer with the worlds first anti-evolution Darwinian drug discovery programme.

To facilitate this, the research institution is constructing a 75 million state of the art building the Centre for Cancer Drug Discovery. It will house a series of pioneering projects to deliver long-term control and effective cures, just as comparable approaches have achieved with HIV.

Palbociclib targets two proteins called CDK4 and CDK6 that are involved in a series of checks that control when a cell can replicate its DNA. By blocking these two proteins from doing their jobs, cancer cells cant multiply.

Cyclin E1 is also involved in the checkpoints that dictate when a cell can multiply, and the researchers hypothesise that high levels of cyclin E1 allow cells to bypass other checks and keep multiplying, uncontrolled.

Previous studies hadnt been able to identify a marker which indicated how successful palbociclib would be, or to spot resistance arising, so the team widened the search and analysed the activity of 2,534 different cancer-related genes.

Cyclin E1 appeared to be the most significant predictive indicator of how a patient will respond to palbociclib, and they identified possible others including associated protein CDK2.

Interestingly, the effect of cyclin E1 on treatment response was stronger in biopsies from metastatic tumours than primary tumour biopsies taken at diagnosis.

The difference highlights the importance of taking biopsies of recurrent breast cancer to guide treatment as tumours evolve to become drug resistant.

Although the researchers show cyclin E1 is an indicator of response to palbociclib in two different treatment settings, it will still need to be validated as a test to guide treatment in clinical trials designed specifically to assess its success.

Professor Nicholas Turner, Professor of Molecular Oncology at The Institute of Cancer Research, London, and Consultant Medical Oncologist at The Royal Marsden NHS Foundation Trust, said:

Palbociclib is a targeted drug that allows women to live a normal life for longer but when their cancer evolves and develops resistance, they can stop responding to the treatment.

Weve developed a way of identifying which women with advanced breast cancer stand to benefit for more than a year from the targeted treatment palbociclib, and which are likely to stop responding much more quickly.

Nearly all the women on the PALOMA-3 trial benefited from the drug for at least a few months, delaying the need for chemotherapy. But some women will progress more quickly, and may require additional monitoring so we can switch treatments as soon as the drug stops working.

We validated our findings using data from a second trial, but we will need to assess our test further to see how effectively it can guide treatment before it could start to be used routinely in patients.

Christine OConnell, 46, from south-west London, was diagnosed with secondary breast cancer in February 2018. She said:

I have seen first-hand the difference a targeted treatment can make. Im on the 19th cycle of palbociclib and my cancer is currently stable. I take my pill every morning, and I get on with my life. I still cycle 3-4 times a week, which I could never have done had I been on conventional therapy.

Palbociclib allows me to live a good life with cancer and I want all cancer patients to have this hope and optimism for the future.

Professor Paul Workman, Chief Executive of The Institute of Cancer Research, London, said:

At the ICR, we believe precision cancer medicine should be driven by a test for every treatment ensuring that only patients who are likely to benefit from a drug are treated with it, and that patients who are likely to quickly relapse are closely monitored for signs of resistance.

Our researchers have developed a test which could ensure the exciting new drug palbociclib is used more effectively in the clinic, and that where necessary women can be moved promptly from it onto alternative treatments.

This kind of targeted, test-driven approach can reduce costs for the NHS, improve quality of life for patients and spare some people treatment that will not benefit them or which has stopped working.

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New test predicts chance of living more than a year on targeted breast cancer treatment - The Institute of Cancer Research

For years, anti-choice advocates have promoted the unfounded idea that medication abortions can be reversed halfway through the procedure. If a patient changes their mind after taking the first abortifacient drugmifepristonethey can forego the second, misoprostol, and instead take several doses of progesterone to continue the pregnancy, according to the theory.

This claim hasnt just been promoted through anti-abortion activism and crisis pregnancy centers, but legislated, too: Currently, six statesArkansas, Idaho, Kentucky, South Dakota, Utah, and Virginiahave laws requiring providers to inform patients that they can request this abortion reversal treatment should they have misgivings about their decision to terminate, a phenomenon that is exceedingly rare.

While doctors have long contended that abortion reversal is nothing more than a myth intended to stigmatize the procedure, up until recently the treatment remained virtually untested. Now, new evidence shows that attempting abortion reversal can result in severe blood loss that could be life-threatening.

The findings are the result of the first-ever randomized, controlled clinical study on abortion reversal, conducted by researchers at the University of California, Davis, and published in the journal Obstetrics & Gynecology.

Originally, researchers set out to enroll 40 women in the study, who were already scheduled to have in-clinic abortions and consented to delaying the procedure for two weeks to test the abortion reversal method. These women would take a dose of mifepristone and then follow it up with either a placebo or progesterone. But researchers halted the study prematurely, after just 12 participants had been enrolled, when three women experienced vaginal hemorrhaging, or excessive bleeding, and needed to be taken to the ER via ambulance; one woman needed a blood transfusion. Two of them had received the placebo, and the other had received doses of progesterone. (On its own, mifepristone only stops the embryo from developing, while misoprostol is necessary to initiate uterine contractions to expel the pregnancy.)

Mitchell Creinin, the studys lead researcher a professor in the Obstetrics and Gynecology department at UC Davis, said that though his paper doesnt definitively debunk abortion reversal as ineffective, it shows that there are serious risks associated with not following through with the two-drug medication abortion regimen once its begun.

We dont have any evidence that disproves the possibility that abortion reversal exists, Creinin said. But I do have evidence that not completing the regimen as its designed is dangerous. The study concludes by recommending that states stop passing laws that require providers to discuss abortion reversal with patients: For now, the treatment remains experimental and "and should be offered only in institutional review boardapproved human clinical trials to ensure proper oversight."

Laws should not mandate counseling or provision of any treatment when we do not fully understand treatment efficacy (including best route of administration, dose, and duration) and safety, the paper reads.

A self-described "pro-life" doctor, George Delgado, originated the idea of abortion reversal in 2012, when he claimed hed discovered a method for chemically reversing the effects of mifepristone. The drug blocks the hormone progesterone, which is necessary for continuing a pregnancy. In a co-authored report at the time, Delgado said he had helped six pregnant women who had initiated a medication abortion carry their pregnancies to term by giving them injections of progesterone in the 24 hours after they took the mifepristone pills.

Ever since, anti-choice advocates have used Delgados claims to suggest that science supports the idea that abortions can be reversed. But Creinin and other experts say Delgados findings are based on bad science: Delgado didnt use a placebo as a control, nor did he randomize the study. What he produced was merely a series of case reports, Creinin said, which fail to prove a cause-and-effect relationship between post-mifepristone progesterone injections and continuing a pregnancy. (Delgado told VICE News in April that he plans on conducting another study that will include 900 women, though he still will not give any of the women a placebo as a control.)

There was zero evidence that such a thing as abortion reversal worked, Creinin said, but because Delgados claims had resulted in multiple state laws, he felt he had a duty to put them to the test.

The lack of evidence hasnt stopped people from passing these laws, so we wanted to take the question seriously, in a rigorous, controlled trial with Institutional Review Board approval, he continued. Patients deserve the truth.

Reproductive health advocates say the requirement that abortion providers in some states must inform patients of a reversal protocol that isn't supported by evidence is just one way anti-choice legislating infringes on the doctor-patient relationship. Five states mandate that providers tell patients that there is a link between abortion and breast cancer, a claim that has been widely discredited, and eight of the 23 states that require providers to inform patients of possible psychological responses to having an abortion emphasize negative outcomes, like depression and anxiety, which studies have shown are not caused by abortion.

[Abortion reversal] goes beyond laws that force providers to give information about unproven or disproven claims, like that abortion causes depression or breast cancer, said Daniel Grossman, the director of Advancing New Standards in Reproductive Health (ANSIRH), a program at the University of California, San Francisco. Laws requiring doctors to inform their patients of abortion reversal encourage patients to essentially participate in an unmonitored experiment. This latest study suggests there are actual safety concerns surrounding that.

Creinin said its important to emphasize that the dangers associated with attempting to reverse a medication abortion don't diminish the overwhelming safety and effectiveness of medication abortion itself, which has decades of research to back it up. In 2017, almost 40 percentor nearly 2 in 5abortions were done with pills.

The key is that medication abortion requires both medications, he said, which has been the official recommendation of organizations like the World Health Organization, the Food and Drug Administration, and the American College of Obstetricians and Gynecologists, for decades.

Medication abortion, performed through a combination of mifepristone and misoprostol, has provided a safe, effective option for induced abortion that has benefitted millions of women, said Chris Zahn, the vice president of practice activities at ACOG, which publishes the journal in which the study appears. Even with its limitations, [Creinins] study raises safety concerns about not completing the evidence-based regimen. Mifepristone is not intended to be used without follow-up misoprostol treatment.

Still, its unlikely that Creinins finding will change the minds of abortion opponents, who are likely to continue citing Delgados ongoing research, despite its flawed methodology. Several more states (including Georgia, Kansas, North Carolina, Ohio, and Wisconsin) have abortion reversal bills working their way through the legislature, and similar federal legislationcalled the Second Chance at Life Actwas introduced in the House in April.

But while Creinins study isnt definitive, since it had to conclude early, hes come to the end of his research. The first step of any series of studies is to establish safety, he saidif this had been, say, a clinical trial for a new birth control pill, the negative outcomes the participants experienced would preclude the possibility of continuing to research it.

You study something when theres a reason to study it, and we have no evidence that suggests abortion reversal is real, while we do have evidence that its potentially dangerous, Creinin said. So if I were developing a drug I would say, I have to stop.

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The First Study on 'Abortion Reversal' Landed Three Women in the ER - Free

There are more than a million people who have Type 1 diabetes, and they're expected to live at least 10 years less than Americans without it.

In fact, there are only 90 diabetics who have lived more than 70 years.

But one man crushed that goal 15 years ago and is telling others how they can do it too.

Eighty-five-year-old Don Ray can't remember a life without diabetes.

As a child, Don could not go to gym class. He couldn't play sports. He couldn't even play hide and seek.

"Because if you were to hide, and they can't find you and you have an insulin reaction or a hypoglycemia, you might really be in trouble because they will never find you," Don explains.

He was told he wouldn't live past his 30s. But eventually he got tired of hearing, "You can't, you can't, you can't."

"I would go to gym class when I started school in kindergarten and first grade, and I'd sit in the chair in gym class and I'd watch these kids, and I knew I could do this, cause I just knew I could do this," Don says.

Don and his dad started playing catch, and that turned into 20 years of playing football and 30 years of baseball.

And he did it because "he followed the rules," according to Betul Hatipoglu, MD, at the Cleveland Clinic.

What rules? First make sure your blood sugar is in check: between 80 and 130 milligrams. If it's too low, eat some carbs, but don't forget to check while working out.

"If they are going to exercise for an hour, they have to check it in 30 minutes again to make sure they are still in the safe zone," Hatipoglu says.

But don't take too much insulin before your meal or before your workout.

"So if you are going to exercise after lunch, for lunch you take less insulin so it is safer for you," Hatipoglu says.

And if you're working out after dinner, be careful as well. You don't want any overnight complications.

"If you take care of the disease, the disease will take care of you, and you can if you take care of yourself," Hatipoglu explains.

Nowadays, there are nearly 140,000 people diagnosed with diabetes each year in the U.S. alone. But in 30 years, an expected five million Americans will be diagnosed with Type 1 diabetes.

DIABETES TYPE 1: DON SHATTERS EXPECTATIONS! REPORT #2699

BACKGROUND: Glucose is a critical source of energy for your brain, muscles, and tissues. When you eat, your body breaks down carbohydrates into glucose and this triggers the pancreas to release a hormone called insulin. Insulin acts as a "key" that allows glucose to enter the cells from the blood. Your body can't function or perform properly if it doesn't produce enough insulin to effectively manage glucose. This is what produces the symptoms of diabetes. Uncontrolled diabetes can lead to serious complications by damaging blood vessels and organs. It also increases the risk of heart disease, stroke, kidney disease, nerve damage, and eye disease. Nutrition and exercise help manage diabetes, but it's also important to track blood glucose levels. Treatment may include taking insulin or other medications. (Source: https://www.healthline.com/health/diabetes/facts-statistics-infographic#1)

COPING WITH TYPE 1 DIABETES: People who have had type 1 diabetes for a long time may develop what's called "diabetes burnout." This can happen when you start to feel burdened by the disease. A good support system is essential to coping with type 1 diabetes. Spending time with friends and family or talking with someone you trust are ways to manage diabetes distress, which can include stress and anxiety. Taking good care of yourself can reduce diabetes stress and help you cope with the condition. Making sure to eat well, exercise, and learn how to monitor blood sugar levels are important. Getting enough sleep each night and taking time to relax and enjoy life are also very important. There are resources available to help you manage type 1 diabetes such as apps designed to count carbs, watch blood sugar levels, and track progress with diet and exercise. The more you know about your condition, the better prepared you'll be at taking care of yourself. Your doctor can also recommend books about type 1 diabetes. (Source: https://www.healthline.com/health/type-1-diabetes/living-with-type-1/how-you-can-cope#4)

NEW DISCOVERY FOR DIABETES: Matthias Hebrok, PhD, director of the UCSF diabetes center, and Gopika Nair, PhD, have discovered how to transform human stem cells into healthy, insulin producing beta cells. "We can now generate insulin-producing cells that look and act a lot like the pancreatic beta cells you and I have in our bodies. This is a critical step towards our goal of creating cells that could be transplanted into patients with diabetes," said Dr. Hebrok. For the longest time, scientists could only produce cells at an immature stage that were unable to respond to blood sugar levels and secrete insulin properly. The team discovered that mimicking the "islet" formation of cells in the pancreas helped the cells mature. These cells were then transplanted into mice and found that they were fully functional, producing insulin and responding to changes in blood sugar levels. Dr. Hebrok's team is already in collaboration with various colleagues to make these cells transplantable into patients. (Source: https://blog.cirm.ca.gov/2019/02/05/breakthrough-for-type-1-diabetes-scientist-discovers-how-to-grow-insulin-producing-cells/)

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85-year-old man with Type 1 diabetes shatters expectations - WNDU-TV

Tamara Loyer proudly wears a bright red lanyard around her neck, from which dangles keys to the modest office where she oversees a unique Downtown Eastside drop-in program for trans women that she designed this year.

Shes come a long way in the past decade: from a despondent homeless woman trapped inside a body with male genitalia to someone who has undergone gender-confirming surgery and now has a home, goes to school and is employed.

Ive not been in an office setting since the mid-1980s, laughs Loyer during an interview at Atira Womens Resource Society, where she started the Beyond the Street drop-in for trans women in September.

Now 57, Loyer believes her internal war with her gender was at the root of her 30-year spiral into drug addiction, sex work and homelessness, and that the surgery she had in April 2014 gave her the confidence to start putting her life back together again.

After surgery, I thought I dont want to have to think about (gender) the way I did before. I can be part of the world. I can go and do things now without being self-conscious, she reflected. I walk around here and I dont have to be afraid that whats in my head and what people see arent the same.

She is happy with her outward appearance, but is inwardly still haunted by gender dysphoria a crippling unhappiness with ones biological gender.

After surgery, we all like to think that it will never bother me again. It still does. I think about it every day, she said.

Her dark thoughts are often triggered by still-lingering male gender traits, such as facial hair and a low voice. That bothers me still to this day. Im not as critical, as I was, at what I see in the mirror, (but) it doesnt go away 100 per cent.

Tamara Loyer in the Atira office.

The Vancouver Sun documented Loyers story in 2014: the challenges of applying for the surgery and organizing the logistics when you have a vulnerable lifestyle, no fixed address, a panhandlers income, and no family supports. At the time, B.C. funded sex-reassignment surgeries, but the only place in Canada that performed them was a private Montreal hospital, where Loyer was flown by a charity airline.

I had nobody with me and it was terrifying, she said. It was daunting. There is so much red tape to go through.

The number of B.C. patients that must endure that flight to Montreal is expected to decrease in the coming years. A new gender surgery clinic opened in Vancouver General Hospital in late September, where the Health Ministry anticipates full-scale gender-affirming surgeries will be performed, likely next year.

Two surgeons with specialized skills have been hired to work at the clinic, and since September have done repairs and revisions to previous surgeries, and performed parts of so-called lower surgeries but not yet the entire procedure, the Health Ministry said in a statement.

Until this year, patients in every province had to travel to Montreal for lower surgeries which include vaginoplasty for trans women and phalloplasty for trans men. In June, Ontario started to offer these complex surgeries at Womens College Hospital in Toronto, and B.C. plans to be the next province to do so.

The trans community has advocated over a number of years for improved access to care, including access to complex lower surgeries within B.C., Health Minister Adrian Dix said in November 2018, when he first indicated the services offered here would expand.

For those seeking lower surgery, people were required to travel to Montreal or to the U.S., resulting in additional medical risks associated with travelling long distance after surgery and in receiving followup care if there were complications.

Trans woman Morgane Oger, right, greets Health Minister Adrian Dix in November 2018 following his announcement that transgender people will soon have access to publicly funded gender-affirming lower surgeries.

The number of British Columbians travelling to Montreal has been on the rise, with about 100 patients annually in recent years. That number is expected to stay roughly the same in 2020, while the B.C. program fully ramps up, the Health Ministry said.

An estimated one per cent of the population identifies as trans, which includes a wide range of people for whom their gender is different from their assigned sex at birth. In B.C., the Health Ministry says, about 46,000 people identify as trans or gender diverse, but only a few will pursue medical or surgical services.

Offering the service closer to home will make it simpler to access and to allow friends to visit during recovery. That may encourage more trans people to consider surgery, especially those from marginalized communities like the Downtown Eastside, Loyer said.

And, she argued, it will benefit society in the long run to help more people feel in sync with their own bodies.

You are going to get a person who is going to be more productive. Somebody who might want to go to school, get a job. Somebody who might want to join their family again, she said.You dont have to live in despair, overwhelmed with what is described as an illness. You can be functional.

Trans people face discrimination and harassment, which often leads to poor mental health and a greater risk for suicide, says the Calgary-based Centre for Suicide Prevention.

Loyer speaks softly when she remembers trans friends who committed suicide, got killed, ran away, were never seen again, overdosed or became mental patients. She hopes these tragedies will be less frequent among her peers with the new local access to medical help.

Another set of surgeries many trans people pursue breast augmentation or chest construction were, until recently, offered in only Vancouver and Victoria. Now B.C. has 16 surgeons who do this work, and these procedures have been extended to Abbotsford, Burnaby, Port Moody, New Westminster, Kamloops, Kelowna and Prince George.

The demand for these upper surgeries in B.C. has quadrupled in just three years, with 49 performed in 2015-16 and 254 in 2018-19. The Health Ministry anticipates 300 breast or chest surgeries will be completed by the end of this fiscal year, in March 2020.

And B.C. has a waiting list for this procedure with more than 200 names.

In 2015, the Provincial Health Services Authority launched Trans Care B.C., which offers details about health care and support for trans people or their families. Its service directory lists dozens of drop-ins and information groups across the province, including in communities outside Metro Vancouver such as Prince Rupert, Fort St John and Cranbrook.

So much as changed since Loyer first arrived in Vancouver in 1984, at age 23, leaving behind a turbulent childhood on a Quebec military base. She came here to seek acceptance. She assumed the name Tamara, found work as a computer programmer and continued to pursue post-secondary education.

But she faced discrimination, numbed her pain with drugs, and eventually worked the streets to earn income. In 1989 she began inquiring about a sex-change operation, but had no stability to pursue surgery.

She was homeless, sick and dejected in 2011 when an outreach worker took her to the first place she felt at home: a shelter for woman, run by Atira. Despite the obvious challenges of sharing communal bathrooms with the female tenants of the modest shelter, Loyer began to heal and, through a new network of support, was able to get her surgery in March 2014.

The Healthy Ministry paid $20,000 for the procedure and $2,000 for her post-surgery care in Montreal. Doctors removed her male organs and created a vagina.

The Vancouver Suns first feature on Loyer was published one month after the operation, when she was still healing and had modest ambitions to live a more stable life.

Tamara Loyer panhandles on Cordova street in Vancouver in 2014.

Today, she says that it took her about six months to physically heal from the invasive surgery while she lived in Atira-supported housing in the heart of the Downtown Eastside. There were infections that required cleaning, extreme tenderness, and a daily routine of using dilators to ensure her new vagina wouldnt close up.

And there are post-operation steps that will be necessary indefinitely. Attached to her stomach is a patch that supplies very large doses of estrogen, a female hormone that her body considers a foreign substance and tries to reject.

But, overall, she is elated with the outcome of the surgery. I wake up in the morning and Im happy that I dont have to encounter a body that is what I had. That was one of the most horrible things in the shower and the washroom and getting dressed. And that is gone.

Loyer does not wear makeup, jewelry or fancy clothes, but rather prefers basic, gender-neutral garb.

I am happy with what I look like, she said. Its not the outside thats the problem. Its the inside that is giving me the problems.

In early 2019, Loyer was upgrading her high school credits at the South Hill Adult Education Centre in south Vancouver, but she was also still panhandling, which she found increasingly demeaning, to supplement her disability pension.

I didnt want to be there. I wanted to be in school.

Loyer appeared isolated, recalled Janice Abbott, the executive director of Atira, so she suggested Loyer open a drop-in for trans women. Atira offered space to hold the meetings, a small budget for food and communication, and the encouragement for Loyer to independently create a program that was needed in the Downtown Eastside.

The trans community is complex, its not homogeneous in any shape or form. So I think that more opportunities for safe space in ways that trans women identify their own communities, I think that there needs to be more (of) that, said Abbott, adding that Loyers drop-in is a low-key environment where people can make friends and share challenges.

I think everyone in the Downtown Eastside needs an informal place, where you dont have to come in and fill out a form that says I need social services. Its a place to get a snack and have a cup of coffee and hang out for a couple of hours. And I think thats part of what makes it beautiful.

Janice Abbott, CEO of the Atira Womens Resource Society, looks over a room in a supported-housing building in the Downtown Eastside.

Loyers program, Beyond the Street, is among the first peer-led drop-ins for trans women in Vancouver. It has been holding two-hour sessions every Sunday afternoon since September.

It focuses on offering people help in three main areas: housing questions, such as dealing with transphobia while looking for an apartment or getting evicted; legal matters, such as how to change your name or marriage breakup help; and counselling issues, such as being trapped in a lifestyle that isnt true to your identity. The program also offers fun activities like Thanksgiving dinner and movies.

Sometimes trans women get stalled. Something happens and you stop. You cant get anywhere, whether its housing or medical. The idea is to keep them going, said Loyer.

The three-month-old drop-in has 12 regular attendees, but Loyer also helps women in other communities by phone or email.

She hopes the program can offer marginalized trans woman better options than they often faced in the past: You end up on the street corner, or you end up in the alleys, or you break down and cry, or you suicide.

We try to keep people from saying, Oh well, this is what I get. Which is easy to think when you dont have anybody saying anything different, Loyer said.

Among Atiras many social housing buildings, which accommodate more than 1,500 women and children every year in the Lower Mainland, up to 20 per cent of the adult female tenants identify as trans, depending on the building type and location, Abbott said.

Many trans women also use Atiras SisterSpace, which is described as the first women-only overdose prevention site in Canada. Evaluation reports on Atiras website quote trans women who say the safe space offers empathetic workers and an escape from transphobia.

Trans issues have increasingly been in the news. In a high-profile court case, a local father who opposes his transgender childs pursuit of testosterone therapy fought lower-court decisions all the way to the B.C. Court of Appeal.

And the provincial government recently introduced SOGI, or sexual orientation and gender identity learning resources for elementary and high schools, which created controversy.

For Loyer, trans issues are not new. Theyve been bottled up inside of her for five decades. She hopes, though, that more attention will lead to increased acceptance.

Since her surgery in 2014, she said, her health has improved drastically. The hepatitis C she contracted in 1989 from intravenous drug use is now not detectable in her blood. She is drug-free and quit her 30-year smoking habit. She can walk without a cane, which she had used since her leg was broken in a nasty 2011 assault. Her sight has improved after a hole in her cornea, likely from a beating, was repaired. And she now weighs 165 pounds, up from the 109 she weighed when she arrived on Atiras doorstep nearly nine years ago.

She no longer lives in supported housing, and has moved to a mixed-income Atira building where many of her neighbours have jobs and go to school. While B.C. Housing subsidizes her rent, Loyer must pay for utilities, internet, and other living expenses.

Perhaps she is most excited about the high school science and math courses she is taking to boost her marks so she can one day apply to the University of British Columbia for a combined degree in astronomy and physics. A downtown investment firm, who read about Loyer in 2014 in The Vancouver Sun, has told her it will pay for her tuition if she gets accepted to UBC.

But with that excitement also comes the fear of failure.

I need to find a place to apply myself. But the science part I was really nervous about. I didnt want to think that I could do something and find out that I made a total mess of it and lose confidence, she said.

Loyer will need confidence to complete her academic goals. She has displayed confidence already, though, in the pursuit of her gender goals. And she has a favourite saying that has, in the past, given her courage and determination: Its a song title from the movie The Rocky Horror Picture Show, which she saw in Toronto in 1978 after she ran away from home, at age 16, so she could start living as a woman.

Dont Dream it. Be it.

lculbert@postmedia.com

Twitter: @loriculbert

See the article here:
Finding her way: Five years after gender-reassignment surgery Tamara Loyer helps other trans women - Vancouver Sun

Abstract

IFN- produced by T cells directly induces intestinal stem cell death upon inflammation-induced intestinal injury (see the related Research Article by Takashima et al.).

Intestinal regeneration upon tissue damage is fueled by intestinal stem cells (ISCs) residing in the crypt bottom of the epithelium and marked by the gene Lgr5 (1, 2). There is growing evidence that tissue repair is at least partially mediated by a regenerative inflammatory response (3, 4). How inflammation-induced intestinal injury influences ISCs and their microenvironment (stem cell niche) remains poorly understood. In this issue of Science Immunology, Takashima et al. (5) explore the changes in the ISC niche in vivo upon T cellmediated injury as a model of graft-versus-host disease (GVHD) and in vitro using organoid T cell cocultures. Although earlier studies already implicated interferon- (IFN-) as a negative regulator of intestinal epithelial homeostasis (68), Takashima et al. now demonstrate that IFN- directly acts on ISCs by triggering apoptosis.

In an allogeneic bone marrow transplant (BMT) model, Takashima and colleagues found that ISC numbers per intestinal crypt were markedly reduced in mice receiving bone marrow alone or bone marrow and T cells when compared with normal control mice. While the ISCs in the mice receiving only bone marrow recovered 7 days later, the ISC numbers remained reduced in those mice also transplanted with donor T cells. Of note, Paneth cell numbers were also reduced after ISC depletion. The numbers of organoids established from the intestines of mice 10 days after BMT recovered back to that of control mice, whereas the organoid forming capacity from crypts of mice after combined transplantation of bone marrow and T cells remained significantly lower. Similar in vivo and in vitro results were obtained when autoreactive T cells were transplanted, pointing to a common feature of T cellmediated intestinal injury.

As seen by three-dimensional confocal microscopy, intraepithelial T cells (CD3+ IELs) preferentially localized to the villus region, whereas lamina propriaassociated T cells (CD3+ LPLs) were equally distributed along the crypt-villus axis of control mice (Fig. 1A). Conversely, mice receiving bone marrow and allogeneic T cells showed a progressive increase in the density of both CD3+ LPLs and CD3+ IELs in the crypt region.

To identify signaling molecules that cause the loss of ISCs in this model, Takashima and colleagues performed several elegant murine and human epithelial organoid coculture experiments. Murine nave allogeneic T cells did not impair murine intestinal organoid numbers, whereas alloreactive T cells effectively reduced organoid numbers. Likewise, human allogeneic cytotoxic T cells robustly inhibited human intestinal organoid forming efficiency. Even bead-activated autologous T cells suppressed human intestinal organoid growth. The authors then proceeded to screen for potential pathways mediating cytotoxicity. Organoids cocultured with T cells in the presence of antiIFN- neutralizing antibodies showed normal growth. Although IFN- receptor (IFN-R)depleted T cells were still able to affect organoid viability, IFN-Rdepleted organoids were resistant to T cellmediated killing. Organoid toxicity by IFN- was also observed in the absence of T cells. Live imaging confirmed the progressive ISC depletion upon organoid exposure to IFN-. Treatment of organoids with the immunosuppressive JAK1/2 inhibitor ruxolitinib robustly preserved numbers of both organoids and ISCs in the presence of IFN-, irrespective of whether the organoids were cultured alone or together with T cells. The authors additionally demonstrated that JAK1-depleted organoids are resistant to IFN- treatment. Further downstream, ruxolitinib prevented STAT1 phosphorylation by IFN- in intestinal crypts, and, in line, STAT1-depleted organoids were resistant to growth suppression in response to IFN- treatment.

IFN-treated organoids showed reduced expression of ISC marker genes. ISCs underwent apoptosis in vitro in a direct response to IFN-. Next, the authors confirmed in vivo that ISC numbers did not change upon transplanting allogeneic bone marrow and T cells when treating mice with IFN- neutralizing antibodies. Likewise, ruxolitinib treatment protected ISCs from T cellmediated killing in vivo. Donor T cells, particularly T helper 1 cells, were activated and IFN-+. Transplanting IFN-depleted allogeneic T cells robustly reduced the ISC loss and allowed epithelial cell proliferation to increase.

Takashima and colleagues lastly investigated whether IFN- directly induces ISC apoptosis. Using tissue-specific depletion of IFN-R1, the authors found that epithelial loss of the receptor protects from the immune-mediated GVHD phenotype. IFN-R1 is expressed by both ISCs and Paneth cells, the epithelial component of the ISC niche (9). However, Paneth celldeficient organoids remained sensitive to both IFN- and allogeneic T cellmediated cytotoxicity. Likewise, T cells were able to reduce the number of organoids containing IFN-R1deficient Paneth cells, whereas organoids containing IFN-R1deficient ISC were protected from cytotoxicity. The authors demonstrated in further experiments that IFN- directly induces ISC apoptosis independent of Paneth cells (Fig. 1, B and C).

The study by Takashima et al. extends our knowledge on signaling between ISCs and immune cells, identifying ISCs as direct targets of IFN- secreted by T cells in immune-mediated intestinal damage (as caused by GVHD). In the 2015 study by Lindemans et al., this group already identified that interleukin-22 (IL-22) secreted by group 3 innate lymphoid cells (ILC3s) directly stimulates ISCs to proliferate and regenerate the intestinal epithelium upon inflammation-induced intestinal injury (4). Modulating the effects of T cellderived IFN- on ISC, for instance, by suppressing JAK/STAT signaling via ruxolitinib treatment, may provide a new therapeutic avenue to reducing GVHD-induced damage of the intestinal epithelium (10).

(A) ISCs maintain adult homeostasis of the intestinal epithelium. T lymphocytes patrol the intestine. (B) Takashima et al. show that in GVHD as modeled by BMT and aberrant activation of T lymphocytes, T cellderived IFN- directly acts on ISCs and induces apoptosis via JAK/STAT signaling. (C) Disease progression results in marked intestinal damage due to loss of ISCs and their niche.

Acknowledgments: Funding: K.K. is a long-term fellow of the Human Frontier Science Program Organization (LT771/2015). Competing interests: H.C. and K.K. are named inventors on patents or patents pending on Lgr5 stem cellbased organoid technology.

Read more:
IFN-: The T cell's license to kill stem cells in the inflamed intestine - Science