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Week Ending: September 12, 2009
Alan Franciscus
Editor-in-Chief
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This Issue:
September 8, 2009
Rise in primary liver cancer cases attributed to increased alcohol consumption
http://www.news-medical.net
Cases of primary liver cancer have tripled in the last 30 years according to statistics published today by Cancer Research UK.
In 1975, 865 cases of primary liver cancer were diagnosed in Great Britain but the latest figures for 2006 show that number has risen to 3108.
Secondary or metastatic liver cancer - cancer that has spread to the liver from a primary tumour elsewhere in the body - is a relatively common disease. But primary liver cancer- when cancer originates in the liver - has been rare in the UK until recently.
Experts attribute this rise to three things: the increase in alcohol consumption, obesity and hepatitis C. Each of these factors can lead to cirrhosis which in turn may develop into primary liver cancer.
Matt Seymour, Cancer Research UK's professor of gastrointestinal cancer medicine at the University of Leeds said: "Three main risk factors for liver cirrhosis - alcohol, obesity and hepatitis C infection - are getting more common in the UK. So we are seeing more patients with cirrhosis and, in turn, more patients with primary liver cancer.
"This is likely to continue. There is a long delay between exposure to the risk factors and the onset of cancer. It might take between 20 and 40 years for liver cancer to develop after infection with hepatitis C. So even if new cases of infection stopped, the number of cases of cancer would continue to rise for some years."
Hepatitis C is a virus spread by blood to blood contact. In the 1960s and 1980s the virus could have been contracted from the medical use of contaminated blood products but this no longer happens because measures have been put in place to ensure all blood products are completely safe. Today the virus is commonly spread among intravenous drug users.
Another virus, Hepatitis B, is responsible for a small percentage of primary liver cancer in the UK but is a more common cause of primary liver cancer worldwide.
Cancer Research UK is supporting a number of research projects including clinical trials to improve the treatment of primary liver cancer.
Dr Lesley Walker, Cancer Research UK's director of cancer information, said: "While this increase is a concern, it is important for people to understand how their risk of liver cancer can be reduced by changes to lifestyle.
"Cutting down on alcohol and watching your weight will help to reduce the risk of a wide range of cancers including primary liver cancer. Taking plenty of exercise and eating a balanced diet high in fibre, fruit and vegetables and low in fatty foods, red and processed meat can all help towards keeping a healthy weight."
Source: Cancer Research UK
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Swiss Hepatitis C Cohort Study: Little Evidence that HCV Leads to Higher Risk of Death in the Absence of Cirrhosis and Excess Alcohol Use
by Alan Franciscus
http://www.hcvadvocate.org/news/Swiss_Study.html
Researchers from the University of Bern, Switzerland released results from their study of HCV disease progression in 1,645 hepatitis C infected patients followed for a mean time of over 2 years. The study calculated all cause mortality (death) using age and gender in the hepatitis C study participants compared to calendar year-specific Swiss all-cause mortality rates. Various factors that could lead to death were also factored into the study including cirrhotic status, HCV genotype, coinfection with hepatitis B and HIV, injection drug use and alcohol intake. During the study period 61 deaths were recorded out of the total study population of 1645 people with chronic hepatitis C.
The researchers reported that in those study participants
- who were not infected with HBV or HIV,
- who did not inject drugs,
- who were not heavy alcohol consumers (less than or equal to 40 grams a day), and
- who were not HCV genotype 3,
there was little evidence of excess death in the study participants. The authors stated that “[O]ur findings emphasize the importance of providing appropriate preventive advice, such as counseling to avoid alcohol intake, in those infected with HCV.
Source:
"Little evidence that hepatitis C virus leads to a higher risk of mortality in the absence of cirrhosis and excess alcohol intake: the Swiss Hepatitis C Cohort Study." L. Prasad, V. M. Spicher, F. Negro, M. Rickenbach, M. Zwahlen. Journal of Viral Hepatitis, Volume 16, Issue 9, Pages 644 - 649.
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Lapatinib Shows Minimal Effect Against Liver Cancer
www.medicalnewstoday.com
Use of the molecularly targeted agent lapatinib to delay tumor growth and improve the survival of patients with inoperable hepatocellular carcinoma, or liver cancer, only benefited certain subgroups of patients. While results of this study were largely negative, patients that exhibited toxicity from the drug in the form of a skin rash appeared to have a greater tumor response and longer survival.
Findings of this phase II, multi-institutional study are published in Clinical Cancer Research, a journal of the American Association for Cancer Research.
"These results may not be practice changing, but they do emphasize the need to continue developing strategies targeting epidermal growth factor receptor [EGFR] in hepatocellular carcinoma," said lead researcher Tanios Bekaii-Saab, M.D., assistant professor of medicine and pharmacology and medical director of gastrointestinal oncology at the Ohio State University Comprehensive Cancer Center.
The prevalence of hepatocellular carcinoma is increasing worldwide, and since this form of cancer typically responds poorly to chemotherapy, new treatments are necessary to help curb its rise. The current standard treatment for advanced hepatocellular carcinoma is sorafenib.
This study is one of the first trials to test the tolerability and efficacy of lapatinib in patients with advanced hepatocellular carcinoma. Lapatinib targets both EGFR and Human EGFR type 2 (HER2/neu) signaling pathways. The FDA approved this drug in March of 2007 for patients with breast cancer who were already using the chemotherapeutic agent capecitabine. Lapatinib works by inhibiting the tyrosine kinase activity associated with the two oncogenes EGFR and HER2/neu.
Twenty-six patients with advanced hepatocellular carcinoma received 1,500 mg/d of lapatinib by mouth for 28 days. Bekaii-Saab and colleagues evaluated tumor and blood specimens for expression of these signaling pathways.
Results indicated that lapatinib only benefited a subgroup of patients who developed a rash, which is an effect attributable to EGFR/HER1 inhibition. These patients tended to have a more favorable outcome and longer survival compared to the overall study population. The most common side effects were diarrhea in 73 percent of participants, nausea in 45 percent and rash in 42 percent.
"Our findings suggest a potential benefit from EGFR inhibition," said Bekaii-Saab. "Overall though, we were certainly hopeful that lapatinib would be more active and were somewhat disappointed by the results."
Samuel B. Ho, M.D., an editorial board member for Clinical Cancer Research, believes this study provides important information about the relevance of these signaling pathways in advanced hepatocellular carcinoma.
"The results support the fact that hepatocellular carcinomas are clinically and biochemically heterogeneous, and that certain subsets of hepatocellular carcinoma may respond differently than others, suggesting that larger trials with patients more likely to respond may show a definite survival benefit," said Ho. "However, the study failed to find a marker that could differentiate between tumors that may or may not be expected to respond."
Ho is the chief of gastroenterology section at the VA San Diego Healthcare System, and professor of medicine at the University of California, San Diego.
Furthermore, the results of this study represent an important step in the strategy for designing clinical studies for this form of cancer, according to Ho, and additional studies are needed. Specifically with lapatinib, it will be important to determine a way to identify those patients who are more likely to respond and include them in a larger trial.
"Given the complexity of the biology in hepatocellular carcinoma and essentially all other malignancies, we should not hope a single marker would be predicative; it makes more sense biologically to monitor multiple potentially relevant markers," said Ho.
The mission of the American Association for Cancer Research is to prevent and cure cancer. Founded in 1907, AACR is the world's oldest and largest professional organization dedicated to advancing cancer research. The membership includes more than 28,000 basic, translational and clinical researchers; health care professionals; and cancer survivors and advocates in the United States and nearly 90 other countries. The AACR marshals the full spectrum of expertise from the cancer community to accelerate progress in the prevention, diagnosis and treatment of cancer through high-quality scientific and educational programs. It funds innovative, meritorious research grants. The AACR Annual Meeting attracts more than 17,000 participants who share the latest discoveries and developments in the field. Special conferences throughout the year present novel data across a wide variety of topics in cancer research, treatment and patient care. The AACR publishes six major peer-reviewed journals: Cancer Research; Clinical Cancer Research; Molecular Cancer Therapeutics; Molecular Cancer Research; Cancer Epidemiology, Biomarkers & Prevention; and Cancer Prevention Research. The AACR also publishes CR, a magazine for cancer survivors and their families, patient advocates, physicians and scientists. CR provides a forum for sharing essential, evidence-based information and perspectives on progress in cancer research, survivorship and advocacy.
Source: American Association for Cancer Research
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September 9, 2009
Anadys Pharmaceuticals Commences Dosing in Phase II Study of ANA598
http://news.prnewswire.com
ANA598 To Be Dosed for 12 Weeks in Triple Combination
SAN DIEGO, Sept. 9 /PRNewswire-FirstCall/ -- Anadys Pharmaceuticals, Inc. (Nasdaq: ANDS) announced today that dosing has begun in a Phase II trial of ANA598 in patients chronically infected with hepatitis C virus (HCV). The study will evaluate ANA598 over 12 weeks, taken in combination with pegylated interferon-alpha and ribavirin, in treatment naive HCV patients. ANA598 is an investigational, oral, non-nucleoside polymerase inhibitor.
"ANA598 has demonstrated potent antiviral activity and good tolerability as a single agent, as well as preclinical properties indicative of likely synergy when used clinically in combination regimens," said James Freddo, M.D., Anadys' Senior Vice President, Drug Development and Chief Medical Officer. "We look forward to building upon these results to demonstrate the benefit of ANA598 when used in combination with interferon and ribavirin."
About the Phase II Study
In the Phase II study, naive genotype 1 patients will receive ANA598 or placebo in combination with Pegasys((R)) (peginterferon alfa-2a) and Copegus((R)) (ribavirin, USP) (a current standard of care, or SOC) for 12 weeks at dose levels of 200 mg or 400 mg twice daily (bid), each with a loading dose of 800 mg bid on day one. After week 12, patients will continue to receive SOC. Patients who achieve undetectable levels of virus at weeks 4 and 12 will be randomized to stop all treatment at week 24 or 48. The primary endpoint of the study is the proportion of patients with undetectable virus at week 12 (defined as complete Early Virological Response, or cEVR). Additional endpoints include safety and tolerability as well as the proportion of patients with undetectable virus at week 4 (defined as Rapid Virological Response, or RVR), weeks 24 and 48, and 24 weeks after stopping all treatment (defined as Sustained Virological Response, or SVR).
Ninety patients are planned to be enrolled in this study -- thirty patients receiving ANA598 and fifteen receiving placebo at each dose level. The study will be managed by the Duke Clinical Research Institute (DCRI) under the leadership of John McHutchison, M.D. and will be conducted at a number of clinical sites in the United States.
Anadys expects to receive 28-day safety and response (RVR) data from the 200 mg dose level by year-end and additional on-treatment safety and response data from both cohorts during the first two quarters of 2010.
About ANA598
ANA598 is a non-nucleoside inhibitor of the HCV RNA polymerase. Anadys has completed three Phase I clinical studies of ANA598 that have demonstrated potent antiviral activity and good tolerability. In a monotherapy study in naive genotype 1 patients, treatment with ANA598 for three days led to median declines in viral load ranging from 2.4 to 2.9 log10 in three separate dose groups. No patient at any dose level showed evidence of viral rebound while on ANA598, and there were no serious adverse events.
Anadys has completed dosing in two long-term chronic toxicology studies of ANA598 (26 weeks duration in rats and 39 weeks duration in monkeys). At the 13-week interim, the toxicology profile of ANA598 in both species was very favorable. A preliminary assessment of the results from the 26-week study in rats indicates a similar profile to that seen in rats at 13 weeks, in which the only adverse finding was a marginal decrease in the rate of weight gain in females at 1000 mg/kg, the highest dose tested. Complete results from both studies, including 39-week data from the monkey study, are expected at the end of the third quarter 2009.
Anadys has presented results from multiple in vitro studies that support the clinical use of ANA598 in combination with interferon-alpha. In particular, data have shown that ANA598 is synergistic in vitro with interferon-alpha, that mutations conferring resistance to ANA598 remain fully sensitive to interferon-alpha, and that synergy between ANA598 and interferon-alpha is retained against mutations conferring resistance to ANA598. Anadys has also presented in vitro results supporting future clinical combination studies with direct antivirals, including a demonstration of in vitro synergy between ANA598 and representative HCV protease and polymerase inhibitors. Furthermore, Anadys has presented data that show ANA598 retains full activity in vitro against mutations conferring resistance to protease inhibitors, nucleoside polymerase inhibitors and non-nucleoside polymerase inhibitors that act at binding sites distinct from that of ANA598, and that protease and nucleoside polymerase inhibitors retain full activity in vitro against mutations conferring resistance to ANA598.
ANA598 has received Fast Track Status from the FDA for the treatment of chronic hepatitis C.
About Anadys
Anadys Pharmaceuticals, Inc. is a biopharmaceutical company dedicated to improving patient care by developing novel medicines for the treatment of hepatitis C. The Company believes hepatitis C represents a large unmet medical need in which meaningful improvements in treatment outcomes may be attainable with the introduction of new medicines. The Company is developing ANA598, a non-nucleoside polymerase inhibitor for the treatment of hepatitis C. The Company has also investigated the potential of ANA773, an oral, small-molecule inducer of endogenous interferons that acts via the Toll-like receptor 7, or TLR7, pathway in hepatitis C.
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Physician Congressman Speaks Up on Viral Hepatitis
http://www.earthtimes.org
ROHNERT PARK, CA -- 09/09/09 -- The National Viral Hepatitis Roundtable (NVHR) is hosting a briefing, "The Experts' Perspective: Gaps and Strategies in the Hepatitis Crisis." "Leading hepatitis physicians, one of whom is a Congressman, will be on the hill today to educate Congress on the importance of developing a strategy to reduce the significant morbidity and mortality from end-stage liver disease and liver cancer caused by chronic hepatitis B and chronic hepatitis C in the United States," said Martha Saly, Director of NVHR. "While the viral hepatitis crisis looms ever larger as a major public health threat, hepatitis B and hepatitis C receive little federal attention and even less federal funding." The Honorable William Cassidy, (R-LA), will speak from his unique perspective as a Congressman and a physician who has treated patients with hepatitis B and hepatitis C. As an associate professor of medicine with Louisiana State University, he provided care for uninsured patients and taught doctors in training at Earl K. Long Hospital in Baton Rouge.
About Chronic Viral Hepatitis
Chronic viral hepatitis, particularly in the form of hepatitis B and hepatitis C, is a highly contagious virus that infects the liver, causing liver disease, liver cancer, and premature death. Chronic hepatitis B is treatable when detected early and properly managed. In about 50% of the cases, chronic hepatitis C can be cured.
It is estimated that 2,000,000,000 people worldwide have been infected with the hepatitis B virus, 400 million chronically. Approximately 170 million people worldwide are chronically infected with the hepatitis C virus. An estimated 4.5 million people living in the United States are infected with either hepatitis B or hepatitis C; tragically more than half are unaware of their status.
About the Briefing
NVHR is hosting a congressional briefing, "The Experts' Perspective: Gaps and Strategies in the Hepatitis Crisis": 3:30 p.m., September 9, 2009, in room 122, Cannon House Office building. The 90 minute briefing will feature physicians who specialize in hepatitis care and research. In addition to Congressman Cassidy, the list of speakers includes, Anna Lok, MD, Director of Clinical Hepatology and Associate Chair for Clinical Research, Department of Internal Medicine, at the University of Michigan Medical Center in Ann Arbor, and Eugene Schiff, MD, Director of the Schiff Liver Institute, Director of the Center for Liver Diseases at the University of Miami School of Medicine, and Leonard Miller, Professor of Medicine at the University of Miami Miller School of Medicine. Michael Ninburg, Executive Director of the Hepatitis Education Project in Seattle, WA. will talk about the challenges from the patient perspective.
Special guests at the briefing include: The Honorable Charles Dent (R-PA), The Honorable Michael Honda (D-CA), The Honorable Edolphus Towns (D-NY), The Honorable Anh "Joseph" Cao (R-LA), The Honorable David Wu (D-OR).
About NVHR
The National Viral Hepatitis Roundtable is a coalition of public, private, and voluntary organizations dedicated to reducing the incidence of infection, morbidity, and mortality from viral hepatitis in the United States. www.nvhr.org
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AUC Graduate Student Selected for Global
http://www.albawaba.com
The American University in Cairo graduate student Reem Al Olaby was chosen from among 25 young men and women from Egypt, Morocco and Palestine to attend the Novartis Biotechnology Leadership Camp in the United States. Al Olaby, along with her team consisting of six members from different cultures and backgrounds, developed a strategic plan to prevent Hepatitis C and B from spreading. “We decided to work on the Hepatitis C Virus (HCV) because Egypt has the highest prevalence of HCV worldwide (12 percent), making it a national problem that needs to be tackled deeply,” said Al Olaby.
The team created a group - The Egyptian Association for Combating Hepatitis C Infection - based on three cornerstones. The first was an awareness campaign that aims at increasing awareness of the Hepatitis C Virus (HCV) and its causes, methods of transmission and treatment. The second cornerstone focused on the activation of infection control units to help reduce the rate of HCV infection in specific and nosocomial infections; and the third cornerstone involved creating a central regulator center for blood banks to make sure that all blood intended for transfusion is 100 percent infection free, and to monitor the processes of blood screening and see if it is efficient enough or needs improvement.
The biotechnology camp is a two-day seminar designed for entrepreneurial, postgraduate students in science or economics who are interested in pursuing a career in biotechnology. It has been held in Switzerland, Japan, China and Taiwan over the past four years. Al Olaby, who is now working on her masters’ degree in biotechnology at AUC and who earned her bachelor of science degree in pharmacy from Ain Shams University, was chosen along with Maha Omar, a graduate student at the Faculty of Medicine, Ain Shams University, for their academic excellence, professional focus and presentation skills.
Al Olaby heard about the competition from her professor Hassan Azzazy, chair of the chemistry department at AUC, who is also her supervisor for her thesis on designing a vaccine against HCV using a new technique that was only used against cancer and it will be used for the first time against HCV.
“The liberal style of education at AUC helped me become more creative and to think outside the box, in addition to having a good quality of knowledge in my field of study which is biotechnology,” says Al Olaby. “I feel really blessed and honored to have the chance to represent Egypt, AUC and Novartis Egypt in the International BioCamp and I will work hard to represent them perfectly by God's will.”
Al Olaby is a fellow in the Nadhmi Auchi Fellowship for Young Arab Leaders and is currently working on creating a campaign that aims at increasing awareness against HCV which will start in October 2009.
The American University in Cairo (AUC) was founded 90 years ago and is major contributor to the social, political and cultural life of the Arab Region. It is a vital bridge between East and West, linking Egypt and the region to the world through scholarly research, partnerships with academic and research institutions, and study abroad programs. An independent, nonprofit, apolitical, non-sectarian and equal opportunity institution, AUC is fully accredited in Egypt and the United States.
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September 10, 2009
Largest comparative hepatitis C study confirms treatment effectiveness
http://www.drugs.com
TORONTO, Sept. 9 /CNW/ - Recently published in the New England Journal of Medicine, the largest prospective study of chronic hepatitis C virus (HCV) treatments Pegetron and Pegasys RBV (R) found both treatments equal in achieving sustained viral response. The study also found that Pegetron had a significantly lower relapse rate and is a safe and effective treatment option which has shown long term viral eradication.
The IDEAL study, conducted by researchers at Duke University Medical Center in Durham, North Carolina, John Hopkins University in Baltimore, and 116 other US centres, will help the 250,000 Canadians who are infected with HCV, 20 per cent of whom do not know they are infected and will remain undiagnosed.
"The results from this study are exciting as they demonstrate the effectiveness of the two leading treatment regimens," says Dr. Stephen Shafran, Professor, Division of Infectious Diseases, Department of Medicine, University of Alberta.
"A noteworthy finding is that patients receiving the peginterferon alfa-2b and ribavirin (Pegetron) treatment regimen were significantly less likely to relapse. Lower relapse rates are important for patients because the side effects of hepatitis C treatments can be quite debilitating."
The IDEAL study involved 3,070 patients with HCV genotype 1 infection. Researchers compared a standard dose of peginterferon alfa-2b plus ribavirin (Pegetron) with an investigational low dose of peginterferon alfa-2b combined with ribavirin and a standard dose of peginterferon alfa-2a also with ribavirin (Pegasys RBV).
The study found that there was no overall difference in achieving a sustained viral response between the two approved treatments with response rates of 39.8 per cent, 38.0 per cent and 40.9 per cent, for the Pegetron standard dose, Pegetron low dose and Pegasys RBV regimens, respectively. The findings from the study also show significant differences in relapse rates between the two approved regimens studied. For Pegasys RBV, the relapse rate was 31.5 per cent, whereas with Pegetron, significantly lower rates were seen at both the standard and low dose regimens; 23.5 per cent and 20 per cent respectively.
Another important finding from the study was the confirmation of early responses to treatment exhibited among patients as an indication of overall success. Researchers noted that in patients whose virus was undetectable after just four weeks of therapy, the rates of sustained response after the full course of treatment were 92.2 per cent and 87.3 per cent for the standard and low dose pegylated interferon alfa-2b, and 79.7 per cent for pegylated interferon alfa-2a.
The IDEAL study was sponsored by Schering-Plough, the company manufacturing peginterferon alfa-2b plus ribavirin, marketed in Canada as Pegetron.
Globally, approximately 180 million people are chronically infected with HCV. In Canada, hepatitis C is the leading cause of liver transplants. An estimated 250,000 Canadians are infected with HCV.
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Big Food vs. Big Insurance
By Michael Pollan
www.nytimes.com
TO listen to President Obama’s speech on Wednesday night, or to just about anyone else in the health care debate, you would think that the biggest problem with health care in America is the system itself — perverse incentives, inefficiencies, unnecessary tests and procedures, lack of competition, and greed.
No one disputes that the $2.3 trillion we devote to the health care industry is often spent unwisely, but the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained, as a study released last month says, by our being fatter. Even the most efficient health care system that the administration could hope to devise would still confront a rising tide of chronic disease linked to diet.
That’s why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry.
According to the Centers for Disease Control and Prevention, three-quarters of health care spending now goes to treat “preventable chronic diseases.” Not all of these diseases are linked to diet — there’s smoking, for instance — but many, if not most, of them are.
We’re spending $147 billion to treat obesity, $116 billion to treat diabetes, and hundreds of billions more to treat cardiovascular disease and the many types of cancer that have been linked to the so-called Western diet. One recent study estimated that 30 percent of the increase in health care spending over the past 20 years could be attributed to the soaring rate of obesity, a condition that now accounts for nearly a tenth of all spending on health care.
The American way of eating has become the elephant in the room in the debate over health care. The president has made a few notable allusions to it, and, by planting her vegetable garden on the South Lawn, Michelle Obama has tried to focus our attention on it. Just last month, Mr. Obama talked about putting a farmers’ market in front of the White House, and building new distribution networks to connect local farmers to public schools so that student lunches might offer more fresh produce and fewer Tater Tots. He’s even floated the idea of taxing soda.
But so far, food system reform has not figured in the national conversation about health care reform. And so the government is poised to go on encouraging America’s fast-food diet with its farm policies even as it takes on added responsibilities for covering the medical costs of that diet. To put it more bluntly, the government is putting itself in the uncomfortable position of subsidizing both the costs of treating Type 2 diabetes and the consumption of high-fructose corn syrup.
Why the disconnect? Probably because reforming the food system is politically even more difficult than reforming the health care system. At least in the health care battle, the administration can count some powerful corporate interests on its side — like the large segment of the Fortune 500 that has concluded the current system is unsustainable.
That is hardly the case when it comes to challenging agribusiness. Cheap food is going to be popular as long as the social and environmental costs of that food are charged to the future. There’s lots of money to be made selling fast food and then treating the diseases that fast food causes. One of the leading products of the American food industry has become patients for the American health care industry.
The market for prescription drugs and medical devices to manage Type 2 diabetes, which the Centers for Disease Control estimates will afflict one in three Americans born after 2000, is one of the brighter spots in the American economy. As things stand, the health care industry finds it more profitable to treat chronic diseases than to prevent them. There’s more money in amputating the limbs of diabetics than in counseling them on diet and exercise.
As for the insurers, you would think preventing chronic diseases would be good business, but, at least under the current rules, it’s much better business simply to keep patients at risk for chronic disease out of your pool of customers, whether through lifetime caps on coverage or rules against pre-existing conditions or by figuring out ways to toss patients overboard when they become ill.
But these rules may well be about to change — and, when it comes to reforming the American diet and food system, that step alone could be a game changer. Even under the weaker versions of health care reform now on offer, health insurers would be required to take everyone at the same rates, provide a standard level of coverage and keep people on their rolls regardless of their health. Terms like “pre-existing conditions” and “underwriting” would vanish from the health insurance rulebook — and, when they do, the relationship between the health insurance industry and the food industry will undergo a sea change.
The moment these new rules take effect, health insurance companies will promptly discover they have a powerful interest in reducing rates of obesity and chronic diseases linked to diet. A patient with Type 2 diabetes incurs additional health care costs of more than $6,600 a year; over a lifetime, that can come to more than $400,000. Insurers will quickly figure out that every case of Type 2 diabetes they can prevent adds $400,000 to their bottom line. Suddenly, every can of soda or Happy Meal or chicken nugget on a school lunch menu will look like a threat to future profits.
When health insurers can no longer evade much of the cost of treating the collateral damage of the American diet, the movement to reform the food system — everything from farm policy to food marketing and school lunches — will acquire a powerful and wealthy ally, something it hasn’t really ever had before.
AGRIBUSINESS dominates the agriculture committees of Congress, and has swatted away most efforts at reform. But what happens when the health insurance industry realizes that our system of farm subsidies makes junk food cheap, and fresh produce dear, and thus contributes to obesity and Type 2 diabetes? It will promptly get involved in the fight over the farm bill — which is to say, the industry will begin buying seats on those agriculture committees and demanding that the next bill be written with the interests of the public health more firmly in mind.
In the same way much of the health insurance industry threw its weight behind the campaign against smoking, we can expect it to support, and perhaps even help pay for, public education efforts like New York City’s bold new ad campaign against drinking soda. At the moment, a federal campaign to discourage the consumption of sweetened soft drinks is a political nonstarter, but few things could do more to slow the rise of Type 2 diabetes among adolescents than to reduce their soda consumption, which represents 15 percent of their caloric intake.
That’s why it’s easy to imagine the industry throwing its weight behind a soda tax. School lunch reform would become its cause, too, and in time the industry would come to see that the development of regional food systems, which make fresh produce more available and reduce dependence on heavily processed food from far away, could help prevent chronic disease and reduce their costs.
Recently a team of designers from M.I.T. and Columbia was asked by the foundation of the insurer UnitedHealthcare to develop an innovative systems approach to tackling childhood obesity in America. Their conclusion surprised the designers as much as their sponsor: they determined that promoting the concept of a “foodshed” — a diversified, regional food economy — could be the key to improving the American diet.
All of which suggests that passing a health care reform bill, no matter how ambitious, is only the first step in solving our health care crisis. To keep from bankrupting ourselves, we will then have to get to work on improving our health — which means going to work on the American way of eating.
But even if we get a health care bill that does little more than require insurers to cover everyone on the same basis, it could put us on that course.
For it will force the industry, and the government, to take a good hard look at the elephant in the room and galvanize a movement to slim it down.
Michael Pollan, a contributing writer for The Times Magazine and a professor of journalism at the University of California, Berkeley, is the author of “In Defense of Food: An Eater’s Manifesto.”
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Echosens: Canada Approves FibroScan(R) and its 3 Probes
http://in.sys-con.com
PARIS, FRANCE -- (Marketwire) -- 09/09/09 -- Echosens, the French high-technology company specializing in non-invasive diagnostics in hepatology, announced that it has obtained approval for FibroScan® and its 3 probes (Pediatric, Standard and for Obese patients) in Canada.
This innovative diagnostic technique, specific to the liver, measures in a quantitative and reproducible way the "degree of hepatic fibrosis", from children to adults, of all shapes and sizes. This non-invasive diagnostic method is a real revolution for liver diseases and their monitoring, a revolution that Canadian patients will be able to benefit from.
FibroScan®, a sure and non-invasive diagnostic technique
This authorization to participate in the Canadian market comes after the world launch of the new XL probe. Echosens will now be able to market FibroScan® and its 3 probes, a product commercially available since 2005 worldwide and selected by the community of hepatologists thanks to more than 200 independent publications. According to Richard Guillaume, CEO of Echosens, "With its non-invasive nature, its ease of use and its immediate results, FibroScan® has already revolutionized the medical practice of hepatologists in Europe and Asia, and is expected to experience the same success in Canada."
A major benefit for Canadian patients
In Canada, viral hepatitis C and alcoholic diseases are the principal causes of cirrhosis. With 240,000 chronically infected people and 5,000 new cases of hepatitis C per year, taking control of this disease constitutes a major public health issue for the country.
In addition, the testimony of specialist physicians on the appearance of emerging pathologies such as Non Alcoholic Steatosic Hepatitis (NASH), which is growing rapidly in this country, reinforce the use of FibroScan®.
Without diagnosis or adapted control, hepatic fibrosis develops in 30% of these patients and can lead to cirrhosis.
Approval for an international development strategy
Canadian approval is an important step in Echosens' development strategy, but other approvals will follow. "Our product was approved in China in 2008, today in Canada, we hope in Japan at the end of 2009, and in the United States in 2010. We will focus on metabolic diseases like steatosis, but also on the study of other organs thanks to VCTE(TM) "Vibration Controlled Transcient Elastography".
Echosens: Partner for diagnostic solutions in Hepatology
A French company founded in 2001 in Paris, Echosens is an international SME specializing in the field of hepatology. The company developed and manufactures the FibroScan® device, based on VCTE(TM) "Vibration Controlled Transcient Elastography". Echosens has changed hepatologists' clinical practices by making available to them a new tool for diagnosis and follow-up of liver diseases. Echosens dedicates a significant part of its activity to Research in order to develop new medical devices and to open up new medical perspectives. The company works in close cooperation with health professionals and patients' associations to facilitate therapeutic follow up of patients. To date, 645 FibroScan® devices have been installed worldwide, including 157 in France.
For more information: www.echosens.com
Contacts:
Echosens
Cecile Guiducci
International Marketing Director
+33 1 44 82 78 50
communication@echosens.com
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Critic of Endoscopy Center dies after colon cancer fight
http://www.lvrj.com
By Paul Harasim
Las Vegas Review-Journal
Kevin Rexford was one of the most public faces and vocal critics of what happened at the Endoscopy Center of Southern Nevada, the center of the hepatitis C outbreak that officials would eventually link to nine contracted cases.
Rexford, a pharmacist, died Sunday at the age of 47 after a lengthy battle with colon cancer.
Rexford alleged in a lawsuit his cancer was missed because of a rushed colonoscopy by Dr. Clifford Carrol, who practiced out of the Endoscopy Center, which has since been shut down amid numerous investigations.
Rexford and Carrol reached a $2 million settlement after Rexford charged his disease was missed during an exam that lasted only three minutes, instead of the recommended six to eight minutes.
Former health care professionals at the clinic, owned by Dr. Dipak Desai, told the Review-Journal that hasty colonoscopies were done to enhance profits.
"He put up one heckuva fight," Rexford's widow, Julie, said Tuesday. "He spent as much time as he could with me and our daughters to the very end. And he did all he could to make sure that no one else had to go through what he did."
Kevin Rexford told the Review-Journal in interviews that concerns about Desai's clinics shouldn't be limited to those patients who were urged by health officials to get tested for hepatitis and HIV.
"People who got a clean bill of health there in regard to cancer should get tested again," he said.
According to medical experts hired to review Rexford's legal case, Rexford would have had better than an 80 percent chance of survival after five years if his cancer had been caught during his colonoscopy in January 2005. Detected nearly a year later, his chances diminished to 10 percent, the experts said.
Dan Carvalho, Rexford's attorney in the malpractice case, said Rexford's desire to urge people to get retested for colon cancer if they had gone to Desai's clinic couldn't have been more genuine.
"He really cared about lessening people's pain," he said.
By 2008, Rexford had already lived longer than his physicians had predicted. But his colon cancer had metastasized to his liver and abdominal wall. This summer, Rexford's health took a huge turn for the worse.
"He was hospitalized five times this past summer," Julie Rexford said. "It was very tough. He spent the last couple of days in (Nathan Adelson) Hospice."
While her husband was hospitalized at Southern Hills Hospital, she said she frequently saw Carrol making rounds.
"That was very difficult for me," she said. "I was very disheartened to see him."
Rexford had said it would have meant something to him had Carrol apologized. Carrol last year told the Review-Journal that Rexford "never came back to the office."
Carrol faces a hearing before the state Board of Medical Examiners this fall for his role in the hepatitis outbreak. A malpractice complaint lodged by Rexford with the board remains under investigation, according to Louis Ling, executive director.
Carrol had testified in a deposition that Rexford might have contracted his cancer after the exam. He could not be reached for comment Tuesday.
Services for Rexford will be held 4 p.m. Friday at Palm Mortuary, 7600 S. Eastern Ave.
Despite Rexford's condition, his wife said he remained president of the Desert Riders motorcycle club of Nevada.
"Who would ever think a guy with stage 4 cancer would be riding a motorcycle and going skiing?" she said. "He was an inspiration to everybody."
Motorcycle club member Scott Beesley said he will miss Rexford "leading groups of motorcyclists to explore many of the highways and byways around our great state."
He also said he prayed that word of Rexford's death "will help prevent someone else from becoming a victim of assembly line medicine."
Last year, Rexford said his biggest concern about dying was not being able to see his daughters, Alexa, 14, and Hannah, 13, grow up.
"He made sure he had fun with them in the time he had left," his wife said. After his diagnosis, the family traveled to Hawaii and the Caribbean and went on an Alaska cruise.
Julie Rexford said her husband, though he often was too ill to eat, went to work at the Assist Care Pharmacy he founded 10 years ago. The pharmacy provided medications to nursing and group homes. What he began by himself now has 15 employees.
"He was so proud that it turned into a success," she said.
She said her husband did not grow bitter.
"He accepted the crummy hand that was dealt him," she said. "His attitude was live life to the fullest, no matter what."
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NJ: 29 hepatitis cases tied to 1 doctor's office
http://www.google.com
By Beth Defalco (AP)
TRENTON, N.J. — Several thousand patients of a New Jersey doctor should get tested for blood-borne diseases because of an outbreak linked to his office that has led to more than two dozen being diagnosed with hepatitis B, state health officials said.
In March, the state said five of Dr. Parvez Dara's patients were found to have hepatitis B and that nearly 2,800 patients should get tested for it. There are now 29 positive cases, plus 68 others who tested positive for antibodies but cannot be definitely linked to the outbreak, according to the state Health Department.
The state is aware of nearly 1,400 patients who have been tested so far.
On Aug. 12, state epidemiologist Dr. Christina Tan sent a letter to 2,000 more patients and to patients in the first group who had yet to get tested urging them to do so.
In July, the department responded to an Associated Press open records request by declining to release any information about the test results, citing the ongoing investigation. The department quietly released the test results on its Web site Sept. 1, nearly three weeks after sending out the letter to patients.
Health Department spokeswoman Donna Leusner said the investigation is ongoing, but a report was prepared at the request of the Board of Medical Examiners, which suspended Dara's license in April.
A spokesman for Dara criticized the health department for releasing the test results while the investigation is still open, saying it was a "rush to judgment."
"There are a number of possible medical reasons that explain why hepatitis B may have developed among patients — particularly those being treated for cancer with chemotherapy," said Dara spokesman Tim White.
Health inspectors visited Dara's office in March and described conditions there as unsanitary. The inspectors said they found blood on the floor of a room where chemotherapy was administered, blood in a bin where blood vials were stored, unsterile saline and gauze, and open medication vials.
Inspectors also cited problems with cross-contamination of pens, refrigerators and countertops; use of contaminated gloves; and misuse of antiseptics, among other health code violations.
Following the inspection, county health officials sent a March 28 letter to Dara's patients warning them of the risk and suggesting they be tested for the liver diseases hepatitis B and hepatitis C and for HIV, the virus that causes AIDS.
"Evidence gathered at this time suggests that since 2002, some clinic staff provided care in a manner that put patients at risk for infection caused by bloodborne viruses, including hepatitis B," the Aug. 12 letter told patients. "The investigation to date suggests that the hepatitis B infections identified may be associated with the method by which medications were administered and procedures performed at the practice."
Dara, originally from Pakistan, has been practicing at his Toms River office for 23 years and has been a licensed oncologist in New Jersey since 1980. He estimated that he saw 45 to 60 patients a day, with about a dozen receiving chemotherapy each day.
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Hepatits C Increasing among Blacks
http://www.myfoxhouston.com
Isiah Carey
HOUSTON - If you abuse your body, one day you will end up paying for it. Just ask Carmen Camacho.
"What I did not do is take care of myself at that time I continued to use drugs and alcohol," said Camacho. She is now a statistic; a woman living with Hepatitis C, a viral disease that eventually leads to the destruction of the liver.
Camacho told FOX 26 News, "After researching it, I saw really how much of a killer it is. You can't live without a liver."
The Floridian, who now calls Houston home, said she contracted the disease through intravenous drug use. Hepatitis C is one of those silent killers that in some cases has no symptoms, which is a concern for outreach groups, especially in the African American community in Houston.
Robin Bennett said, "If our community leaders don't speak out, it's not going to be an epidemic, it's going to be a pandemic."
Workers at the Texas Liver Coalition say that they have seen a significant increase in the disease after two years of testing in Houston.
Some alarming statistics include the following: Hepatitis C is 4 times more prevalent and 10 times more infectious than HIV. Between 10,000 and 12,000 people die from the disease each year.
In Texas, more than 300,000 people have tested positive for Hepatitis C. 70 percent of people who have contracted it do not know that they have it. There has also been an 11 percent jump in cases testing positive over two years.
So how is Hepatitis C spreading in the African American community in Houston?
"Tattooing, IV drug use, razor sharing, toothbrush sharing, body piercing ... are the cause of the spread of this disease," said Bennett.
Camacho has learned her costly lesson; she says now her focus on survival with hepatitis c even though there is no known cure ... just a lifetime of treatment.
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Patients with Cirrhosis and Impaired Cognitive Abilities Have More Motor Vehicle Accidents
www.medicalnewstoday.com
A recent study by Jasmohan Bajaj, M.D., and colleagues from Virginia Commonwealth University and McGuire VA Medical Center found that patients with cirrhosis of the liver who developed minimal hepatic encephalopathy (MHE) had a 16% rate of motor vehicle crashes compared to only 4% of those without MHE over one year. The rate of accidents was also significantly higher than the state annual crash rate of 3%-3.3%. Results of the study are available in the October issue of Hepatology, a journal published by Wiley-Blackwell on behalf of the American Association for the Study of Liver Diseases.
Minimal hepatic encephalopathy (MHE) is a prevalent neurocognitive complication associated with cirrhosis of the liver. Up to 80% of cirrhotic patients are diagnosed with MHE, which causes impaired attention, response inhibition, visuo-motor coordination and psychomotor speed. Patients with MHE may progress to overt hepatic encephalopathy (OHE), which in addition to impaired cognition function, causes a flapping tremor (asterixis), decreased consciousness including coma, swelling of the brain (cerebral edema), and death.
The study followed 167 cirrhotic patients from Wisconsin and Virginia who had a diagnosis of MHE. Median age of participants was 53 years, an age group considered to have the safest driving record, and patients had on average 36 (+11) years of driving experience. Standard psychometric testing (SPT) was administered to evaluate mental processing speed, attention, and visuo-spatial coordination. The inhibitory control test (ICT), a freely downloadable test of attention that uses a timed response to lures and targets, was also conducted to measure psychological performance.
Driving records (motor vehicle crashes and traffic violation) were obtained for all patients from the Department of Transportation in Wisconsin and Virginia for a one-year period prior to the study. Participants also completed a driving history that surveyed information on driving duration and driving offenses within 1 year of psychometric testing. At the one-year follow-up 109 patients remained; 58 patients were lost to follow-up, no longer driving, experienced disease progression, or death. In patients with MHE diagnosed by ICT, there was a 22% rate of future driving offenses, which was significantly higher than the 7% in those without MHE by ICT.
"Our study demonstrates a significantly higher rate of motor vehicle crashes in MHE patients defined by the ICT," confirmed Dr. Bajaj. The findings also found that ICT was a superior test to SPT in identifying those patients at risk of future auto accidents. Normal ICT performance was associated with crashes in 3% of cases, similar to the standard state rates. "A careful elicitation of the driving history and discussion with MHE patients and their families should be performed during clinical visits," suggested Dr. Bajaj.
Article:
"Minimal Hepatic Encephalopathy is Associated with Motor Vehicle Crashes: The Reality Beyond the Driving Test," Jasmohan S Bajaj, Kia Saeian, Christine M Schubert, Muhammad Hafeezullah, Jose Franco, Rajiv R Varma, Douglas P Gibson, Raymond G Hoffmann, R Todd Stravitz, Douglas M Heuman, Richard K Sterling, Mitchell Shiffman, Allyne Topaz, Sherry Boyett, Debulon Bell, Arun J Sanyal. Hepatology; Published Online: June 15, 2009 (DOI: 10.1002/hep.23128); Print Issue Date: October 2009. http://www3.interscience.wiley.com/journal/
122457374/abstract
Source: Hepatology
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Does HBsAg Clear after Treatment of Hepatitis B Infection?
www.medscape.com
Paul Martin, MD, FACP
Can the HBsAg test become negative after treatment in an otherwise healthy HBsAg-positive patient?
Response from Paul Martin, MD, FACP Professor of Medicine and Chief, Division of Hepatology, Center for Liver Disease, University of Miami School of Medicine, Miami, Florida
Hepatitis B surface antigen (HBsAg) seropositivity indicates the presence of hepatitis B viral (HBV) infection (acute or chronic). The disappearance of HBsAg from serum with development of the corresponding antibody, anti-HBs, indicates conventional resolution of infection. The likelihood of spontaneous HBsAg seroconversion during acute HBV infection varies according to patient age and immune competence. Up to 97% of healthy adults with acute HBV will clear the infection. In contrast, HBsAg seroconversion in chronically infected patients is a relatively uncommon event, with an incidence of only 0.8%-2% per annum.[1] Chronically infected whitepatients who typically acquired HBV infection in adulthood[1] have a higher rate of spontaneous HBsAg loss than Asian patients with presumed vertical acquisition of HBV.[2]
Antiviral studies generally used intermediate markers of treatment response; early research used hepatitis B e antigen (eAg) loss, seroconversion, and biochemical and histologic improvement to document response to treatment. More recently, serum HBV DNA suppression has been used as a marker of response, because initially HBsAg loss was not typically observed in antiviral studies. However, with longer follow-up it became apparent that HBsAg loss was frequent in eAg seroconverters, and these patients had a diminished risk for hepatic morbidity compared with patients who had failed to clear eAg.
Clearance of HBsAg has been perceived to be a specific benefit of interferon therapy for chronic HBV infection because HBsAg clearance was not initially recognized with oral therapy. Greater experience with oral therapy has made it apparent that HBsAg seroconversion can be induced by drugs other than interferon. In recent reports, 5% of entecavir-treated patients and 6% of tenofovir-treated patients seroconverted and cleared HBsAg.[3,4] In an analysis of the entecavir-treated patients who lost HBsAg, white race and infection with HBV genotypes A and D, which are not typically present in Asian patients, were key predictors of HBsAg seroconversion. For patients on treatment, predictors of ultimate HBsAg loss were eAg loss and development of anti-HBe antibody at week 24 of treatment. These data indicate that HBsAg seroconversion can be a benefit of oral as well as interferon-based therapy. It remains to be determined whether this outcome will be achieved in most patients treated with newer regimens and also whether therapy can accelerate HBsAg loss in patients with the eAg-negative form of chronic HBV.
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Ghostwriting Is Called Rife in Medical Journals
www.nytimes.com
By Duff Wilson and Natasha Singer
Six of the top medical journals published a significant number of articles in 2008 that were written by ghostwriters financed by drug companies, according to a study released Thursday by editors of The Journal of the American Medical Association.
Among authors of 630 articles who responded anonymously to an online questionnaire created for the study, 7.8 percent acknowledged contributions to their articles by people whose work should have qualified them to be named as authors on the papers but who were not listed.
In the scientific literature, ghostwriting usually refers to medical writers, often sponsored by a drug or medical device company, who make major research or writing contributions to articles published under the names of academic authors.
The concern, the researchers said, is that the work of industry-sponsored writers has the potential to introduce bias, affecting treatment decisions by doctors and, ultimately, patient care.
According to the study, responding authors reported a 10.9 percent rate of ghostwriting in The New England Journal of Medicine, the highest rate among the journals.
Editors of the Boston-based journal said Thursday that they were “puzzled” and “skeptical” of the findings.
The study also reported a ghostwriting rate of 7.9 percent in JAMA, 7.6 percent in The Lancet, 7.6 percent in PLoS Medicine, 4.9 percent in The Annals of Internal Medicine, and 2 percent in Nature Medicine.
“These journals are the top of the medical field,” Joseph S. Wislar, a survey research specialist and lead author of the study, said in a phone interview. He recommended that they take more action to require that all contributors be listed in acknowledgments if they are not named as authors.
Three JAMA editors, Annette Flanagin, Phil B. Fontanarosa and Catherine D. DeAngelis, joined Mr. Wislar in the study.
The new study, which has not yet been peer-reviewed or published in a medical journal, was made public Thursday morning at an international meeting of journal editors in Vancouver.
“It was very compelling, and I find it quite shocking, to be honest,” Ginny Barbour, chief editor of PLoS Medicine, the journal of the Public Library of Science, said after the meeting. “We are a journal that has very tough policies, very explicit policies on ghostwriting and contributorship, and I feel that we’ve basically been lied to by authors.”
Some of the same researchers (though not Mr. Wislar) also sent out a questionnaire to authors of articles published in 1996 in three of the same publications. That study reported ghost authorship rates of 16.2 percent in The New England Journal of Medicine, 15.3 percent in The Annals of Internal Medicine, and 7.1 percent in JAMA.
Comparisons between the studies may not be valid because they relied on different methodologies and covered different authors. The older study involved a mail-in questionnaire sent to authors based in the United States while the new study, involving an online questionnaire, solicited responses from authors based both inside and outside the United States. In both cases, the studies have the potential for reporting bias because they did not choose respondents randomly but relied on authors to elect to answer the questions; moreover, authors were asked to disclose their own behavior, with the potential for them to underreport the use of a ghostwriter, which is considered an academic crime akin to plagiarism.
Finally, the response rates from authors of articles varied widely, ranging from 58.3 percent for one journal to 85.9 percent for another journal, the researchers said.
Karen P. Buckley, spokeswoman for The New England Journal of Medicine, said she was “completely shocked” at the high rate of ghostwriting reported by its authors. She said the journal was continually strengthening its safeguards.
Editors of the journal released a statement through Ms. Buckley saying the JAMA study used an improperly broad definition of ghostwriting. But Annette Flanagin, a JAMA editor and co-author of the new report, responded that it was the standard definition of the term.
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September 11, 2009
Three Las Vegas Hepatitis C Lawsuits Move Forward
http://ohsonline.com
A bankruptcy judge decided Wednesday to allow three civil trials to take place amid the bankruptcy of three medical clinics involved in the 2008 outbreak.
Chief U.S. Bankruptcy Judge Mike Nakagawa of Las Vegas decided Wednesday to allow the first three civil trials to take place in a Hepatitis C scandal that erupted in the city last year. The plaintiffs' lawsuits name the Endoscopy Center of Southern Nevada and two related clinics that filed for Chapter 7 bankruptcy protection on July 17, 2009, which had automatically delayed the trials. The clinics closed after the Southern Nevada Health District announced in February 2008 that 40,000 patients might have been exposed to Hep C and other bloodborne illnesses, allegedly because nurse anesthetists had been using syringes on more than one patient, according to coverage of the outbreak by the Las Vegas Review-Journal.
The first trial, set for Oct. 19, is the case of Michael Washington, who was infected with Hep C in a case genetically linked to the Endoscopy Center of Southern Nevada, Brian Haynes and Paul Harasim have reported for the newspaper.
The outbreak was cited in a February 2009 Government Accountability Office study about health care-associated infections at ambulatory surgical centers. More than 5,100 ASCs were operating nationwide and serving Medicare beneficiaries in 2007, and those centers performed more than 6 million surgeries paid for by Medicare that year, according to the study, which recommended collecting comprehensive patient safety data from outpatient centers and regular, random surveys to be done at them. While five data sources exist on health care-associated infections at ambulatory surgical centers, none of them provides information for assessing the extent of the problem nationwide, GAO reported.
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Study Finds Second-Hand Smoking Results In Liver Disease
www.medicalnewstoday.com
A team of scientists at the University of California, Riverside has found that even second-hand tobacco smoke exposure can result in nonalcoholic fatty liver disease (NAFLD), a common disease and rising cause of chronic liver injury in which fat accumulates in the liver of people who drink little or no alcohol.
The researchers found fat accumulated in liver cells of mice exposed to second-hand cigarette smoke for a year in the lab. Such fat buildup is a sign of NAFLD, leading eventually to liver dysfunction.
In their study, the researchers focused on two key regulators of lipid (fat) metabolism that are found in many human cells as well: SREBP (sterol regulatory element-binding protein) that stimulates synthesis of fatty acids in the liver, and AMPK (adenosine monophosphate kinase) that turns SREBP on and off.
They found that second-hand smoke exposure inhibits AMPK activity, which, in turn, causes an increase in activity of SREBP. When SREBP is more active, more fatty acids get synthesized. The result is NAFLD induced by second-hand smoke.
"Our study provides compelling experimental evidence in support of tobacco smoke exposure playing a major role in NAFLD development," said Manuela Martins-Green, a professor of cell biology, who led the study. "Our work points to SREBP and AMPK as new molecular targets for drug therapy that can reverse NAFLD development resulting from second-hand smoke. Drugs could now be developed that stimulate AMPK activity, and thereby inhibit SREBP, leading to reduced fatty acid production in the liver."
Results of the study appear in the September issue of the Journal of Hepatology.
The study emphasizes that discouraging cigarette smoking helps prevent not only cardiovascular disease, pulmonary disease and cancer, but now also liver disease.
Second-hand smoke is the combination of smoke exhaled by a smoker and smoke given off by the burning end of a tobacco product. Lingering in the air long after tobacco products have been extinguished, it is involuntarily inhaled by nonsmokers in the vicinity.
Second-hand smoke is a major toxicant that affects children, the elderly and nonsmokers living in the household of adults who smoke. Many state and local governments have passed laws prohibiting smoking in public facilities. Diseases associated with second-hand smoking include cancer, heart disease, atherosclerosis, pneumonia, bronchitis and severe asthma.
Despite the large body of scientific evidence documenting the effects of passive or active smoking on the heart and lungs, reports investigating how smoking causes liver injury are scant.
"Until our study, second-hand smoking had not been linked to NAFLD development," Martins-Green said.
She was joined in the study by her graduate student Hongwei Yuan (first author of the research paper and now a postdoctoral researcher in her lab) and UC Riverside's John Shyy, a professor of biomedical sciences. Next, the team plans to investigate the clinical relevance of their findings. A grant to Martins-Green from Philip Morris USA, Inc., supported the research.
Source: Iqbal Pittalwala, University of California - Riverside
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