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Tuesday, June 6, 2017

Stem Cell Treatment May Restore Vision to Patients with Damaged Corneas

Newswise, June 6, 2017 — Researchers working as part of the University of Georgia’s Regenerative Bioscience Center have developed a new way to identify and sort stem cells that may one day allow clinicians to restore vision to people with damaged corneas using the patient’s own eye tissue. They published their findings in Biophysical Journa

The cornea is a transparent layer of tissue covering the front of the eye, and its health is maintained by a group of cells called limbal stem cells. But when these cells are damaged by trauma or disease, the cornea loses its ability to self-repair.

“Damage to the limbus, which is where the clear part of the eye meets the white part of the eye, can cause the cornea to break down very rapidly,” said James Lauderdale, an associate professor of cellular biology in UGA’s Franklin College of Arts and Sciences and paper co-author.

“The only way to repair the cornea right now is do a limbal cell transplant from donated tissue.”

In their study, researchers used a new type of highly sensitive atomic force microscopy, or AFM, to analyze eye cell cultures. Created by Todd Sulchek, an associate professor of mechanical engineering at Georgia Tech, the technique allowed researchers to probe and exert force on individual cells to learn more about the cell’s overall health and its ability to turn into different types of mature cells.

They found that limbal stem cells were softer and more pliable than other cells, meaning they could use this simple measure as a rapid and cost-effective way to identify cells from a patient’s own tissue that are suitable for transplantation.

“Todd’s technology is unique in the tiniest and most sensitive detection to change,” said Lauderdale. “Just think about trying to gently dimple or prod the top of an individual cell without killing it; with conventional AFM it’s close to impossible.”

Building on their findings related to cell softness, the research team also developed a microfluidic cell sorting device capable of filtering out specific cells from a tissue sample.

With this device, the team can collect the patient’s own tissue, sort and culture the cells and then place them back into the patient all in one day, said Lauderdale. It can take weeks to perform this task using conventional methods.

The researchers are quick to caution that more tests must be done before this technique is used in human patients, but it may one day serve as a viable treatment for the more than 1 million Americans that lose their vision to damaged corneas every year.

The group first started this research with the hope of helping children with aniridia, an inherited malformation of the eye that leads to breakdown of the cornea at an early age.

Because aniridia affects only one in 60,000 children, few organizations are willing to commit the resources necessary to combat the disease, Lauderdale said.

“Our first goal in working with such a rare disease was to help this small population of children, because we feel a close connection to all of them,” says Lauderdale, who has worked with aniridia patients for many years.

“However, at the end of the day this technology could help hundreds of thousands of people, like the military who are also interested in corneal damage, common in desert conditions.”

Steven Stice, a Georgia Research Alliance Eminent Scholar, who plays an important role in fostering cross-interdisciplinary collaboration as director of the RBC, initially brought the researchers together and encouraged a seed grant application through the center for Regenerative Engineering and Medicine, or REM, a joint collaboration between Emory University, Georgia Tech and UGA. “A culture is developing around seed funding that is all about interdisciplinary collaboration, sharing of resources, and coming together to make things happen,” said Stice.

“Government funding agencies place a high premium on combining skills and disciplines. We can no longer afford to work in an isolated laboratory using a singular approach.”

The REM seed funding program is intended to stimulate new, unconventional collaborative research and requires equal partnership of faculty from two of the participating institutions.

“We tend to get siloed experimentally,” says Lauderdale. “To a biologist like me, all cells are very different and all atomic force microscopes are the same. To an engineer like Todd it’s just the opposite.”

The study, “Cellular Stiffness as a Novel Stemness Marker in the Corneal Limbus,” is available at http://www.cell.com/biophysj/fulltext/S0006-3495(16)30771-8.

Funding was provided by an NIH NIGMS Biotechnology Training Grant on Cell and Tissue Engineering, the Knights Templar Eye Foundation, the Center for Regenerative Engineering and Medicine, the Sharon Stewart Aniridia Research Trust and the NSF CMMI division.



Assessing the Impact of Stress in Age-Related Macular Degeneration

Newswise, June 6, 2017– Age-related macular degeneration (AMD), the leading cause of vision loss among older adults in the United States, is often associated with psychological stress. 

A simple stress rating scale (the Perceived Stress Scale) is a valid and useful way to evaluate the connection between stress and progressive vision loss from AMD, according to a study in the March issue of Optometry and Vision Science, the official journal of the American Academy of Optometry. The journal is published by Wolters Kluwer.

"Because AMD is an inflammatory disease, we are studying the link between inflammation, stress, and AMD treatment outcomes," reported Bradley E. Dougherty, OD, PhD, of The Ohio State University College of Optometry. "In the end, we hope to better understand how general well-being influences disease outcomes."

Measuring Stress May Aid in Assessing the Life Impact and Progression of AMD--Patients with vision loss in AMD experience high rates of stress, anxiety, and other problems, including depression. Less is known about the relationship between the stress that AMD patients experience and the severity of their disease—for example, whether stress can cause AMD to worsen or not.

The Perceived Stress Scale (PSS) is a well-established stress rating scale that can predict objective biological markers of stress, as well as the risk of stress-related diseases. In previous studies, the PSS has been shown to be predictive of general markers of inflammation, including C-reactive proteins. In the new study, Dr. Dougherty and colleagues extend the use of this survey to determine how well it measures perceived stress in patients with vision loss due to AMD.

One hundred thirty-seven patients with AMD, average age 82 years, completed the ten-question PSS. Using a technique called Rasch analysis, Dr. Dougherty and colleagues evaluated the PSS's performance as a stress measure in AMD. About half of the patients filled out the stress questionnaire on a day when they received injections of anti-VEGF antibodies—a relatively new treatment that can slow the progression of the "wet" form of AMD.

Nine of the ten questions normally used with the PSS performed well with the patient group studied. These nine items were also able to separate between patients with higher versus lower levels of perceived stress. For some PSS items, responses differed according to patient age and visual acuity level.

However, the overall PSS score was not significantly related to the patients' visual acuity level. Average visual acuity in the better eye for this group of AMD patients was 20/50, with a range from near normal to very low vision.

"A psychometrically sound, easy-to-administer questionnaire such as the PSS is important for use with patients with AMD, given the evidence for increased rates of psychological symptoms in the population," Dr. Dougherty and coauthors write.

They note that stress-reduction approaches—for example, "mindfulness" interventions—have led to improved outcomes in patients with various health conditions.

Dr. Dougherty and colleagues also note that stress may be associated with increased inflammation and that AMD is an inflammatory disease—raising the possibility that stress may contribute to disease progression.

Future studies using repeated assessments with the PSS and measurement of inflammatory markers might provide evidence on how perceived stress levels affect the risk of AMD progression and worsening vision loss.


Slow the Signs of Aging With Sun Protection


Dermatologist offers advice for spring breakers, staycationers and everyone in between

June 6, 2017— As the winter temperatures begin to thaw, many may be dreaming of a sun-drenched spring and summer, and some may be hoping to show off a tan. While these individuals may believe tanning makes them more beautiful, this habit can actually damage their skin in the long run.

“Ultraviolet radiation from the sun and indoor tanning beds not only can increase your risk of skin cancer but also can contribute to skin aging,” says board-certified dermatologist Arianne Shadi Kourosh, MD, MPH, FAAD, director of community health and co-director of the multiethnic skin clinic in the department of dermatology at Massachusetts General Hospital in Boston.

 “Moreover, other forms of radiation, such as heat and visible light, can negatively impact the skin, as can pollution, so protecting your skin from the environment can benefit both your health and appearance.”

According to Dr. Kourosh, environmental factors can damage the skin in multiple ways, from UVB rays causing sunburns and uneven pigmentation to UVA and infrared radiation penetrating more deeply into the skin to damage existing collagen and reduce collagen production, resulting in wrinkles and sagging skin.

Habitual UV exposure can cause blood vessels to become more prominent, causing skin redness, she says, while visible light and pollution can cause uneven skin tone, especially in darker skin types.

“Although there have been some impressive strides in anti-aging treatments, no one product or procedure can completely reverse the long-term effects of poor skin care decisions, and protective measures are the cornerstone of good skin care,” Dr. Kourosh says.

 “Fortunately, there are many sunscreen options available to help you protect yourself, including cosmetic products with SPF. The best sunscreen for each person will depend on many factors, including genetic makeup, environment and lifestyle considerations. A board-certified dermatologist can evaluate the unique needs of your skin and help you develop an appropriate sun protection plan.”

Since both types of UV rays can damage the skin, Dr. Kourosh says, it’s important to use a broad-spectrum sunscreen that provides both UVA and UVB protection, with an SPF of 30 or higher.

She recommends sunscreens containing the active ingredients zinc oxide or titanium dioxide as a good source of broad-spectrum protection suitable for sensitive skin. She also says formulations containing antioxidants may provide some protection against uneven skin tone and aging caused by free radical damage from infrared light, visible light and pollution.

Dr. Kourosh recommends utilizing protective clothing like hats and sunglasses, and she reminds those who will be spending an extended amount of time in the sun to reapply sunscreen every two hours, or after swimming or sweating.

While it’s especially important to be vigilant near sand, water and snow, which can reflect the sun’s rays, sun protection is necessary regardless of weather or location, as 80 percent of the sun’s UV rays can penetrate the skin even on cloudy days.

In addition to practicing sun protection, it’s important to avoid indoor tanning, which exposes users to harmful UV rays that can increase skin cancer risk and accelerate skin aging. Those who wish to look tan may want to consider a self-tanning product but should continue using sunscreen with it.

“Whether you’re on a beach vacation or your daily commute, it’s crucial to protect yourself from exposure to harmful UV rays on a regular basis,” Dr. Kourosh says.

 “If you want healthy, younger-looking skin, it’s better to prevent now than try to correct later. If you have questions about sun protection, talk to a board-certified dermatologist.”



Attitude, Lifestyle May Contribute to Skin Cancer Risk Among Latinos


Dermatologist advises Hispanic patients to be aware of their risk and take steps toward prevention, detection

Newswise, June 6, 2017 As the Hispanic population in the United States continues to grow, the incidence of skin cancer among this population is growing too. Moreover, Hispanic patients are more likely to be diagnosed with the disease in its more advanced stages, when it’s more difficult to treat.1

Many Latinos, however, don’t believe they’re at risk, according to board-certified dermatologist Maritza I. Perez, MD, FAAD, a clinical professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York.

“The belief that Hispanic people don’t have to worry about skin cancer has existed among Latinos for generations,” she says. “They hear it from their parents and grandparents, and then they pass this belief on to their children.”

Exposure to ultraviolet radiation from the sun and indoor tanning beds is the most preventable skin cancer risk factor. Many Hispanic people, however, believe they’re protected from the sun because they have darker skin tones, Dr. Perez says, and those who get sunburned don’t realize that the damage to their skin is increasing their skin cancer risk.

As a result, Dr. Perez says, many Latinos don’t take steps to protect themselves from the sun’s harmful UV rays. Furthermore, she says, some Hispanic people go indoor tanning before spending time in the sun, under the false belief that a “base tan” will protect them.

She advises all her patients, regardless of skin color, to stay out of indoor tanning beds and protect themselves from the sun.

Because skin cancer is most treatable when detected early and Latinos are more likely to be diagnosed with the disease in its advanced stages, Dr. Perez says, it’s also important for this population to perform regular self-exams to look for new, changing or suspicious spots on their skin.

People with skin of color are prone to skin cancer in unusual areas — like on the palms of the hands and the soles of the feet, under the nails, and inside the mouth — so she recommends that Hispanic patients be especially vigilant in performing skin self-exams.

When melanoma, the deadliest form of skin cancer, is detected and treated before it reaches the lymph nodes, the five-year survival rate is 98 percent.2 “Early detection is vital for skin cancer survival,” Dr. Perez says. “And if you don’t look for changes on your skin, you won’t find them.”

While the Hispanic population’s attitude toward skin cancer plays a large role in the disease’s incidence among that population, this group’s access to dermatologic care is also an important factor, according to Dr. Perez.

Many Latino families are uninsured or underinsured, she says, so they may be less likely to see a dermatologist for a skin cancer evaluation.

Further, when Hispanic patients do visit the doctor, she says, skin cancer may not be top of mind during the visit, since the belief that these patients are not at risk for the disease is so pervasive.

To help combat these issues, the American Academy of Dermatology works to raise skin cancer awareness among the underserved Latino population through its Latino Outreach Program.

In addition to providing free skin cancer screenings, this program aims to educate low-income Latino outdoor workers about skin cancer prevention and detection.

The AAD recommends that everyone stay out of indoor tanning beds and protect themselves from the sun’s harmful UV rays by seeking shade, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with an SPF of 30 or higher.

The AAD also encourages everyone to perform regular self-exams to check themselves for signs of skin cancer and ask a partner to help them examine hard-to-see areas. Those who notice anything changing, itching or bleeding on their skin should visit a board-certified dermatologist.

While these recommendations apply to all patients, Dr. Perez says, it’s especially important for Latino patients to understand their skin cancer risk, take steps to protect themselves and conduct regular skin self-exams.
“Everyone — no matter their skin color — is at risk for skin cancer,” she says, “so everyone should learn how to protect themselves from the sun and how to check their skin for suspicious spots.”


To learn more about skin cancer prevention and detection, or to find a free SPOTme® skin cancer screening in your area, visit SPOTSkinCancer.org.

Colon Cancer: Early Detection Can Save Your Life

Newswise, June 6, 2017 — Colorectal cancer is the second leading cause of cancer death for men and women in the United States according to the American Cancer Society (ACS).

 In fact, the ACS estimates that 134,490 people in the United States were diagnosed with colorectal cancer in 2016, including 70,820 men and 63,670 women. In addition, the ACS estimates that 49,190 people, 26,020 men and 23,170 women, died from colorectal cancer in 2016.

According to Mitchell Rubinoff, M.D., Chair, Gastroenterology, Valley Medical Group, “In order to reduce the mortality rate of this disease, it is crucial for individuals to be aware of the signs of colon cancer—and not hesitate to have any cause for concern checked out as soon as possible. Early detection saves lives!”

What is Colon Cancer?
Often referred to together as colorectal cancer, colon cancer is cancer of the large intestine (colon), and rectal cancer is cancer of the last few inches of the colon. It most often begins as precancerous polyps on the inside lining of the colon. Colon polyps, as defined by the National Institutes of Health, are growths on the lining of your colon or rectum.

Who is At Risk?
Both men and women are at risk for developing colorectal cancer, even if they do not have any of the identifiable risk factors such as:• A family history of colorectal cancer• Being over age 50• Colorectal polyps• Genetic changes

Early Detection Through Screening Tests
“It is best to catch colorectal cancer before you become symptomatic. Doctors can actually prevent cancers from ever developing by removing polyps and they can cure more patients by diagnosing cancer at an early stage,” explains Dr. Rubinoff.

Possible screening tests for colorectal cancer include stool tests, colonoscopy, or virtual colonoscopy. A colonoscopy is an outpatient procedure that is used to try to detect colon polyps and remove them before they can become cancerous. Your doctor will work with you to decide which test is appropriate for your individual history and symptoms.

It is also important for individuals who are not showing any symptoms of colorectal cancer to go for routine screenings. The CDC states that “The U.S. Preventive Services Task Force recommends that adults age 50 to 75 be screened for colorectal cancer.

“The decision to be screened after age 75 should be made on an individual basis. If you are older than 75, ask your doctor if you should be screened. People at higher risk of developing colorectal cancer should begin screening at a younger age, and may need to be tested more frequently.”

Signs and Symptoms
There are many potential symptoms of colon cancer and it is important to note that there is a great deal of overlap between colon cancer’s symptoms and symptoms of other illnesses. And, while it is possible that your symptoms may be caused by something else, you should still be aware of what to look out for and make sure to see your doctor right away if you experience any of the following symptoms:
• A change in bowel habits, such as diarrhea, constipation, or narrowing of the stool, that lasts for more than a few days• A feeling that you need to have a bowel movement that is not relieved by doing so• Rectal bleeding• Dark stools, or blood in the stool (often, though, the stool will look normal)• Cramping or abdominal (belly) pain• Weakness and fatigue• Unintended weight loss

Recognizing these symptoms, which are outlined by the American Cancer Society, is the first step to early detection. Once you alert your doctor to these symptoms, you may be sent for screening tests to confirm a diagnosis.

Prevention

You can help to prevent cancer by exercising, eating fresh fruits and vegetables, and maintaining a healthy weight. Be proactive and take charge of your health!

Saturday, June 3, 2017

Old Cells That Refuse to Die May Lead to Treatments for Age-Related Diseases

Newswise, June 3, 2017 — One of the things that happens to our bodies as we age is that certain cells start to accumulate.

So-called senescent cells – cells that “retire” and stop dividing but refuse to die – are always present, and they even serve some important functions, such as in wound repair. But in aging organs, these cells don’t get cleared away as they should, and they can clutter up the place. Dr. Valery Krizhanovsky of the Weizmann Institute of Science’s Department of Molecular Cell Biology is revealing just how these cells are tied to disorders of aging and why they refuse to go away.

His work is not only opening new windows onto the aging process, but is pointing to new directions in treatments for many of these disorders and diseases.

Research into cellular senescence has taken off in recent years, due to findings that show that clearing these cells from various parts of the body can reverse certain aspects of aging and disease processes.

Pharmaceutical industries have taken note, as well, of research that could lead to the development of drugs that might target senescent cells in specific organs or tissues.  

In basic research conducted on human cell cultures and on mice, Dr. Krizhanovsky and his team asked, “what, exactly, ties senescent cells to aging?” Are they, for example, a primary cause of age-related disease, or a side effect? And why don’t these cells die, despite being damaged, making the “clean-up crews” of the immune system clear them away?

The researchers hypothesized that the answer to the second question might lie in a family of cellular proteins that regulate a type of cell suicide known as apoptosis.

They identified two proteins in this family that prevent apoptosis and which were overproduced in the senescent cells. When they injected mice that had an extra supply of senescent cells with molecules that inhibit these two proteins, the cells underwent apoptosis and were then eliminated, and there were signs of improvement in the tissue.


“In small amounts, these cells can prevent tumors from growing, help wounds clot, and start the healing process,” says Dr. Krizhanovsky. “But as they amass, they trigger inflammation and even cancer.”

Certain common age-related diseases have been shown to be associated with this buildup of senescent cells – for example, chronic obstructive pulmonary disease (COPD) – and Dr. Krizhanovsky is hoping to apply these findings to research into treatments for such diseases.


The trick, he says, will be to target the offensive cells without causing undue side effects. He has been developing mouse models of COPD and asking whether clearing senescent cells from just the lungs can prevent or ease the disease. Yeda Research and Development, Co., Ltd., the Weizmann Institute’s technology transfer arm, is working with Dr. Krizhanovsky to patent and license his discoveries. 

Another Reason to Exercise: Burning Bone Fat – a Key to Better Bone Health UNC School of Medicine researchers use new imaging methods

Newswise, June 3, 2017 – It’s a fat-burning secret anyone interested in bone health should know. For the first time, UNC School of Medicine researchers show that exercising burns the fat found within bone marrow and offers evidence that this process improves bone quality and the amount of bone in a matter of weeks. 

The study, published in the Journal of Bone and Mineral Research, also suggests obese individuals – who often have worse bone quality – may derive even greater bone health benefits from exercising than their lean counterparts.

“One of the main clinical implications of this research is that exercise is not just good, but amazing for bone health,” said lead author Maya Styner, MD, a physician and assistant professor of endocrinology and metabolism at the University of North Carolina at Chapel Hill.

“In just a very short period of time, we saw that running was building bone significantly in mice.”

Although research in mice is not directly translatable to the human condition, the kinds of stem cells that produce bone and fat in mice are the same kind that produce bone and fat in humans.
In addition to its implications for obesity and bone health, Styner said the research also could help illuminate some of the factors behind bone degradation associated with conditions like diabetes, arthritis, anorexia, and the use of steroid medications.

In her patients, Styner is all too familiar with the chronic toll of osteoporosis and fractures. This new evidence shows it’s possible to use exercise to reverse some of the effects on bones.

“I see a lot of patients with poor bone health, and I always talk to them about what a dramatic effect exercise can have on bones, regardless of what the cause of their bone condition is,” said Styner.

“With obesity, it seems that you get even more bone formation from exercise. Our studies of bone biomechanics show that the quality and the strength of the bone is significantly increased with exercise and even more so in the obese exercisers” 

Getting to the marrow of the matter
Bone and marrow are more dynamic than you might think. Marrow, in particular, is a hub of activity, coordinating the formation of bone and cartilage while simultaneously churning out blood cells, immune cells, and cancerous cells.

Marrow also produces fat, which has a lot to do with its vaunted status in cuisines around the world. But the physiological role of bone marrow fat in the body – and even whether it is beneficial or harmful for one’s health – has remained somewhat mysterious.

Generally, marrow fat has been thought to comprise a special fat reserve that is not used to fuel energy during exercise in the same way other fat stores are used throughout the body during exercise. The new study offers evidence to the contrary.

Styner’s work also offers fundamental insights on how marrow fat forms and the impact it has on bone health. Previous studies have suggested that a higher amount of marrow fat increases the risk of fractures and other problems.

“There’s been intense interest in marrow fat because it’s highly associated with states of low bone density, but scientists still haven’t understood its physiologic purpose,” said Styner.

“We know that exercise has a profound effect on fat elsewhere in the body, and we wanted to use exercise as a tool to understand the fat in the marrow.”

Vanishing fat cells
The researchers performed their experiments in two groups of mice. One group was fed a normal diet (lean mice) and the other received a high-fat diet (obese mice) starting a month after birth. When they were four months old, half the mice in each group were given a running wheel to use whenever they liked for the next six weeks. Because mice like to run, the group with access to a wheel tended to spend a lot of time exercising.

The researchers analyzed the animals’ body composition, marrow fat and bone quantity at various points. Predictably, the obese mice started with more fat cells and larger fat cells in their marrow.

 After exercising for six weeks, both obese and lean mice showed a significant reduction in the overall size of fat cells and the overall amount fat in the marrow. In these respects, the marrow fat of exercising obese mice looked virtually identical to the marrow fat of lean mice, even those that exercised.

Perhaps more surprising was the dramatic difference in the number of fat cells present in the marrow, which showed no change in lean mice but dropped by more than half in obese mice that exercised compared to obese mice that were sedentary. The tests also revealed that exercise improved the thickness of bone, and that this effect was particularly pronounced in obese mice.

According to Styner, all of this points to the conclusion that marrow fat can be burned off through exercise and that this process is good for bones.

“Obesity appears to increase a fat depot in the bone, and this depot behaves very much like abdominal and other fat depots,” said Styner. “Exercise is able to reduce the size of this fat depot and burn it for fuel and at the same time build stronger, larger bones.”

Setting the stage
The research leaves a few lingering mysteries. A big one is figuring out the exact relationship between burning marrow fat and building better bone. It could be that when fat cells are burned during exercise, the marrow uses the released energy to make more bone.

Or, because both fat and bone cells come from parent cells known as mesenchymal stem cells, it could be that exercise somehow stimulates these stem cells to churn out more bone cells and less fat cells.

More research will be needed to parse this out. “What we can say is there’s a lot of evidence suggesting that marrow fat is being used as fuel to make more bone, rather than there being an increase in the diversion of stem cells into bone,” said Styner.

But marrow fat, being encased in bone, isn’t easy to study. The team’s new research represents a leap forward not only in understanding bone marrow fat but also in the tools to study it.

The group’s previous work relied on micro CT imaging, which requires the use of a toxic tracer to measure marrow fat. In the new study, they took advantage of UNC’s 9.4 TMRI, a sophisticated MRI machine of which there are only a few around the country.

Using MRI to assess marrow fat eliminates the need for the toxic tracer and allows highly detailed imaging of living organisms. 

“If we want to take this technique to the human level, we could study marrow fat in humans in a much more reliable fashion now,” said Styner. “And our work shows this is possible.”

The team also developed techniques to perform a much more detailed assessment of the number and size of fat cells within the marrow, and even examined some of the key proteins involved in the formation and reduction of bone marrow fat.

Styner is now working with collaborators to adapt these methods for studying the bone marrow dynamics that might be at work in other conditions, including anorexia and post-menopausal osteoporosis.


Better Self-Management Improving VA Outcomes for Chronic Pain Care


Newswise, June 3, 2017– Self-management programs are teaching veterans with chronic pain to become more active, manage symptoms, reduce stigma and frustration, and minimize depression and other mood disorders, according to a VA researcher speaking today at the American Pain Society Annual Scientific Conference, www.americanpainsociety.org

Robert Kerns, Ph.D., professor of psychiatry, neurology and psychology at Yale University, spent 38 years practicing in VA healthcare, most recently the VA Connecticut Healthcare System. 

He reported in a plenary session presentation that the VA’s applications of cognitive-behavioral therapies (CBT) and other approaches are helping veterans better manage their pain through standardized pain assessments, alternative therapies, patient education and self-care.  The VA also is succeeding in reducing drug use. 

“The proportion of VA patients receiving high doses of opioids has decreased significantly in the last four years concurrent with greater use of non-drug alternative pain therapies,” said Kerns.

“Several trials have shown that when patients are engaged in their own care they have less pain, less depression, and are more physically active.”

The VA estimated in one study that 44 percent of soldiers in an Army infantry brigade reported chronic pain three months after returning from tours of duty in Afghanistan and Iraq – double the rate among civilians. 

Spinal disorders have increased by 300 percent in the last 50 years and now rank as the number-one cause of disability in the United States and in the military.
Kerns added the National Pain Strategy’s strong advocacy of self-care will provide more educational resources and greater incentives to help physicians empower their patients to become more proficient at managing and coping with their pain. 

The National Pain Strategy, released last year by the U.S. Department of Health and Human Services, places strong emphasis on self-management and patient education as critical pathways for improving treatment of chronic pain. 

Kerns added that the VA is funding several research projects to evaluate the efficacy self-management interventions for persistent pain, including novel approaches that employ advanced communication technologies.

“Specifically for pain management, self-care programs involve gaining knowledge about pain and building skills and confidence to prevent, cope with and reduce pain,” said Kerns.  The overall objective is to promote adoption of an effective approach to pain self-management, similar to models for treating chronic illnesses.”

Kerns added that in re-conceptualizing pain as a chronic disease, it is imperative to understand that pain management is not a cure, realistic therapy goals must be established, and the overall focus should be placed on achieving optimal functioning, well-being and quality of life.

Elements for successful self-management of chronic pain therefore include:
  • Empowering persons with pain through reassurance, encouragement and education
  • Conservative use of analgesics and adjuvant medications
  • Promotion of regular exercise and healthy and active lifestyles
  • Development of adaptive strategies for managing pain. 

Kerns described the role communication technology is playing in helping the VA to promote access and engagement in pain self-management. 

“Attendance at sessions is the key variable governing treatment outcomes,” said Kerns.  “Technology is making it easier for more vets to participate in cognitive-behavioral therapy through real-time video conferencing, apps for smartphones, phone-based interactive voice response and web-based CBT interventions for pain and co-prevalent mental and behavioral health problems.”

Outcomes for the VA program were published in JAMA Internal Medicine this year and showed that patients accessing CBT remotely did just as well as patients receiving in-person therapy.  Patient surveys provided additional verifications. 

On a seven to 10 scale, the average response of 22 patients was 7.75 in answering the question: “How confident are you that this treatment successfully helped you with your pain?”

About the American Pain Society
Based in Chicago, the American Pain Society (APS) is a multidisciplinary community that brings together a diverse group of scientists, clinicians and other professionals to increase the knowledge of pain and transform public policy and clinical practice to reduce pain-related suffering.  APS is the professional home for investigators involved in all aspects of pain research including basic, translational, clinical and health services research to obtain the support and inspiration they need to flourish professionally.  APS strongly advocates expansion of highquality pain research to help advance science to achieve effective and responsible pain relief.  For more information on APS, visit www.americanpainsociety.org.  


Saturday, May 20, 2017

Antibody Helps Detect Protein Implicated in Alzheimer’s, Other Diseases

May lead to novel ways to diagnose, monitor brain injury

Damaging tangles of the protein tau dot the brains of people with neurodegenerative diseases like Alzheimer’s and boxer’s dementia, and lead to memory loss, confusion and, in some, aggressive behavior. But there is no easy way to determine whether people’s symptoms are linked to tau tangles in their brains. Now, a team led by scientists at Washington University School of Medicine in St. Louis has found a way to measure tau levels in the blood. The method accurately reflects levels of tau in the brain that are of interest to scientists because they correlate with neurological damage. The study, in mice and a small group of people, could be the first step towards a non-invasive test for tau.

Newswise, May 20, 2017 — Damaging tangles of the protein tau dot the brains of people with Alzheimer’s and many other neurodegenerative diseases, including chronic traumatic encephalopathy, which plagues professional boxers and football players.

Such tau-based diseases can lead to memory loss, confusion and, in some, aggressive behavior. But there is no easy way to determine whether people’s symptoms are linked to tau tangles in their brains.

Now, however, a team led by scientists at Washington University School of Medicine in St. Louis has found a way to measure tau levels in the blood. The method accurately reflects levels of tau in the brain that are of interest to scientists because they correlate with neurological damage.

The study, in mice and a small group of people, could be the first step toward a noninvasive test for tau.

While further evaluation in people is necessary, such a test potentially could be used to quickly screen for tau-based diseases, monitor disease progression and measure the effectiveness of treatments designed to target tau.

The research is published April 19 in Science Translational Medicine.

“We showed that you can measure tau in the blood, and it provides insight into the status of tau in the fluid surrounding cells in brain,” said senior author David Holtzman, MD, the Andrew B. and Gretchen P. Jones Professor and head of the Department of Neurology at Washington University School of Medicine in St. Louis.

Tau is a normal brain protein involved in maintaining the structure of neurons. But when tau forms tangles, it damages and kills nearby neurons.

“People with tau diseases have a wide range of symptoms because basically, wherever tau is aggregating, those parts of the brain are degenerating,” Holtzman said. “So if it’s in a memory area, you get memory problems. If it’s in a motor area, you get problems with movement.”

A blood-based screening test, likely years away, would be a relatively easy way to identify people whose symptoms may be due to problems with tau, without subjecting them to potentially invasive, expensive or complicated tests.

“We have no test that accurately reflects the status of tau in the brain that is quick and easy for patients,” Holtzman said. “There are brain scans to measure tau tangles, but they are not approved for use with patients yet.

Tau levels can be measured in the cerebrospinal fluid that surrounds the brain and spinal cord, but in order to get to that fluid, you have to do a spinal tap, which is invasive.”

In the brain, most tau proteins are inside cells, some are in tangles, and the remainder float in the fluid between cells. Such fluid constantly is being washed out of the brain into the blood, and tau comes with it. However, the protein is cleared from the blood almost as soon as it gets there, so the levels, while detectable, typically remain very low.

Holtzman, postdoctoral researcher Kiran Yanamandra, PhD, and MD/PhD student Tirth Patel, along with colleagues from C2N Diagnostics, AbbVie, the University of California, San Francisco, and Texas Health Presbyterian Hospital, reasoned that if they could keep tau in the blood longer, the protein would accumulate to measurable levels.

 Allowing the protein to accumulate before measuring its levels would magnify – but not distort – differences between individuals, in the same way that enlarging a picture of a grain of sand alongside a grain of rice does not change the relative size of the two, but does make it easier to measure the difference between them.

The researchers injected a known amount of tau protein directly into the veins of mice and monitored how quickly the protein disappeared from the blood. The researchers showed that half the protein normally disappears in less than nine minutes.

When they added an antibody that binds to tau, the half-life of tau was extended to 24 hours. The antibody was developed in the laboratories of Holtzman and Marc Diamond, MD, of the University of Texas Southwestern Medical Center, and is currently licensed to C2N Diagnostics, which is collaborating with the pharmaceutical company AbbVie in developing the technology.

To determine whether the antibody could amplify tau levels in an animal’s blood high enough to be measured easily, they injected the antibody into mice.

Within two days, tau levels in the mice’s blood went up into the easily detectable range. The antibody acted like a magnifying glass, amplifying tau levels so that differences between individuals could be seen more easily.

Tau levels in people’s blood also rose dramatically in the presence of the antibody. The researchers administered the antibody to four people with a tau disease known as progressive supranuclear palsy. Their blood levels of tau rose 50- to 100-fold within 48 hours.

“It’s like a stress test,” Holtzman said. “We appear to be bringing out the ability to see what’s coming from the brain because the antibody amplifies differences by prolonging the time the protein stays in the blood.”

Measuring tau levels in the blood is only useful if it reflects tau levels in the brain, where the protein does its damage, the researchers said.

Both high and low levels of tau in the fluid that surrounds the brain could be a danger sign. Alzheimer’s and chronic traumatic encephalopathy both are associated with high levels of soluble tau, whereas progressive supranuclear palsy and other genetic tau diseases are thought to be associated with low levels.

To see whether elevated brain tau is reflected in the blood, the researchers treated mice with a chemical that injures neurons. The chemical causes tau to be released from the dying neurons, thereby raising tau levels in the fluid surrounding the cells. The scientists saw a corresponding increase of tau in the blood in the presence of the anti-tau antibody.

To lower tau levels, the researchers turned to genetically modified mice that, as they age, have less and less tau floating in their cerebrospinal fluid.

Such mice at 9 months old had significantly lower tau levels in their blood than 3-month-old mice with the same genetic modification, again demonstrating the antibody’s ability to reflect levels of tau in the brain.


“It will be helpful in future studies to see if the measurement of tau in the blood following antibody treatment in humans reflects the state of tau in the brain,” Holtzman said.

May Is Melanoma Awareness Month

May 20, 2017— Melanoma is the deadliest form of skin cancer and is characterized by the uncontrolled growth of pigment-producing cells. Melanoma may appear on the skin suddenly without warning but also can develop from an existing mole. Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. Melanoma and other skin cancers are highly treatable, if detected early.

  • Current estimates are that 1 in 5 Americans will develop skin cancer during their lifetime.
  • Melanoma is the most common form of cancer for young adults age 25-29 and is the second most common form of cancer for adolescents and young adults age 15-29.
  • Melanoma is increasing faster in females 15-29 years old than males in the same age group. In females 15-29 years old, the torso is the most common location for developing melanoma, which may be due to high-risk tanning behaviors.
  • You have a substantially increased risk of developing melanoma if you have many moles, large moles or atypical (unusual) moles.
  • Your risk is increased if a blood relative (e.g., your parents, children, siblings, cousins, aunts, uncles) has had melanoma.
  • If you are a Caucasian with fair skin, your risk is higher than a Caucasian with olive skin.
  • Redheads and blonds have a higher risk of developing melanoma. Blue or green eyes also increase your risk.
  • Your chances increase significantly if you’ve already had a previous melanoma or if you have had basal cell carcinoma or squamous cell carcinoma, the more common forms of skin cancer.

What are Pennsylvania Dermatologists and Physicians doing about it?

  • The Pennsylvania Academy of Dermatology and Dermatologic Surgery (PAD) in conjunction with the Pennsylvania Medical Society (PAMED) strongly support skin cancer awareness and encourage all Pennsylvanians to be screened. PAD dermatologists will offer free skin cancer screenings and instruction on self-skin examinations on Wednesday, May 10th in the Capitol Rotunda at the Harrisburg Capitol.
  • The PAD and PAMED are particularly focused on sun protection for children and youth. This includes increasing access to sunscreen and sun protective clothing in schools as well as educating teenagers about the dangers of indoor tanning and that Pennsylvania law bans minors under 17 years of age from using tanning salons.


The Pennsylvania Academy of Dermatology and Dermatologic Surgery is the only statewide medical organization solely representing the interests and concerns of all dermatologists and their patients in Pennsylvania. Visit us at www.padermatology.org.


Tired? Try Walking Up Stairs Instead of Caffeine

Newswise,  May 20, 2017— A midday jolt of caffeine isn't as powerful as walking up and down some stairs, according to new research from the University of Georgia.

In a new study published in the journal Physiology and Behavior, researchers in the UGA College of Education found that 10 minutes of walking up and down stairs at a regular pace was more likely to make participants feel energized than ingesting 50 milligrams of caffeine-about the equivalent to the amount in a can of soda.

"We found, in both the caffeine and the placebo conditions, that there was not much change in how they felt," said Patrick J. O'Connor, a professor in the department of kinesiology who co-authored the study with former graduate student Derek Randolph.

"But with exercise they did feel more energetic and vigorous. It was a temporary feeling, felt immediately after the exercise, but with the 50 milligrams of caffeine, we didn't get as big an effect."

The study aimed to simulate the hurdles faced in a typical office setting, where workers spend hours sitting and staring at computer screens and don't have time for a longer bout of exercise during the day.

For the study, participants on separate days either ingested capsules containing caffeine or a placebo, or spent 10 minutes walking up and down stairs-about 30 floors total-at a low-intensity pace.

O'Connor wanted to compare an exercise that could be achieved by people in an office setting, where they have access to stairs and a little time to be active, but not enough time to change into workout gear, shower and change back into work clothes.

"Office workers can go outside and walk, but weather can be less than ideal. It has never rained on me while walking the stairs," said O'Connor.

 "And a lot of people working in office buildings have access to stairs, so it's an option to keep some fitness while taking a short break from work."

Study participants were female college students who described themselves as chronically sleep deprived-getting less than 6½ hours per night.

To test the effects of caffeine versus the exercise, each group took some verbal and computer-based tests to gauge how they felt and how well they performed certain cognitive tasks.

Neither caffeine nor exercise caused large improvements in attention or memory, but stair walking was associated with a small increase in motivation for work.

O'Connor added that there is still much research to be done on the specific benefits of exercising on the stairs, especially for just 10 minutes.


But even a brief bout of stair walking can enhance feelings of energy without reducing cognitive function. "You may not have time to go for a swim, but you might have 10 minutes to walk up and down the stairs."

Researchers Suggest New Theory for How Parkinson’s Disease Develops

Newswise, May 20, 2017— The toxic protein behind Parkinson’s disease may not spread like an infection from nerve cell to nerve, according to a new theory by Technion and Harvard University scientists. Instead, the protein, called alpha-synuclein, may simultaneously affect all parts of the nervous system inside and outside of the brain. Their findings could change how Parkinson’s is treated, the researchers say.

Associate Professor Simone Engelender of the Technion-Israel Institute of Technology and her colleague Ole Isacson at Harvard Medical School describe this “threshold theory” of Parkinson’s for the first time in a report published in the January issue of Trends in Neuroscience.

“Instead of studying how proteins move from one neuron to another and searching for compounds that prevent the ‘spread’ of aggregated α-synuclein, we need to study why α-synuclein accumulates within neurons and how these neurons die in the disease, and search for compounds that prevent the general neuronal dysfunction,” said Professor Engelender.

Parkinson’s disease destroys nerve cells throughout the body, especially key neurons in the brain that produce a compound called dopamine that helps to control movement and posture.

The disease grows worse over time, and there is no known cure. More than one million people in the United States have the disorder, according to the Parkinson’s Disease Foundation.

The disease is caused by accumulation of α-synuclein, which overwhelms and destroys nerve cells. The most commonly-held theory about the disease suggests that patients get progressively worse as clumps of α-synuclein spread between neurons, almost like an infection.

But Engelender and Isacson think the scientific evidence points to a different model of the disease. Instead of spreading from neuron to neuron, they say, aggregations of α-synuclein develop throughout the body at the same time.

Different parts of the nervous system vary in how much of this toxic protein they can tolerate, depending on how well the cells in that part of the system work together to compensate for any destroyed cells.

The researchers say their theory fits better with patients’ symptoms than the infection-style theory. Engelender and Isacson’s theory may help explain, for example, why some of the earliest signs of the disease appear in places like the gastrointestinal tract that have no neurons to compensate for a dysfunction and therefore have a lower threshold of tolerance for α-synuclein toxicity.

The new theory may also affect how the disease is treated. For instance, some scientists have recommended a procedure that severs part of the vagus nerve, which runs outside the brain, to prevent the spread of α-synuclein from the body to the brain. The threshold theory, Engelender said, suggests that this operation would be unnecessary.

“The only specific treatment that is and will continue to be beneficial is the replenishment of dopamine in the brain, through the intake of the supplement L-Dopa, to improve the motor symptoms,” said Engelender.

“This has been done for several decades and should be continued to be done since it can at least alleviate the motor symptoms for a few years, even if does not cure and does not prevent the progression of the disease.”

“Nevertheless, I believe that the search for compounds that specifically decrease α-synuclein levels are the only hope to provide a real and more effective treatment for the disease,” Engelender added.


The Technion-Israel Institute of Technology is a major source of the innovation and brainpower that drives the Israeli economy, and a key to Israel’s renown as the world’s “Start-Up Nation.” Its three Nobel Prize winners exemplify academic excellence. Technion people, ideas and inventions make immeasurable contributions to the world including life-saving medicine, sustainable energy, computer science, water conservation and nanotechnology. The Joan and Irwin Jacobs Technion-Cornell Institute is a vital component of Cornell Tech, and a model for graduate applied science education that is expected to transform New York City’s economy. American Technion Society (ATS) donors provide critical support for the Technion—more than $2 billion since its inception in 1940. Based in New York City, the ATS and its network of supporters across the U.S. provide funds for scholarships, fellowships, faculty recruitment and chairs, research, buildings, laboratories, classrooms and dormitories, and more.