Thigh-length graduated support stockings (TL-GCS) do not reduce the risk of blood clots in stroke patients. Since guidelines in the UK and many developed nations recommend use of TL-GCS, such guidelines should now be urgently revised. The findings of the CLOTS trial are published in an Article Online First and in an upcoming edition of The Lancet, Professor Martin Dennis, University of Edinburgh, UK, and colleagues. Most of the study’s funding came from the UK Medical Research Council. The findings are to be announced during this week’s European Stroke Conference, Stockholm, Sweden.

About two thirds of stroke patients are unable to walk on admission to hospital, and between 10 and 20% of these will develop a blood clot in the veins of their legs – a deep vein thrombosis (DVT). In some, this blood clot will break up and be carried in the blood stream to the heart and lungs. These life-threatening clots (called pulmonary emboli) can cause severe breathlessness and are an important cause of death among hospitalised patients.To date, only small trials have reported TL-GCS reduce the risk of DVT in patients having surgery, but national stroke guidelines recommend their use in patients despite this inadequate evidence.

This randomised controlled trial analysed 2518 patients from 64 centres in the UK, Italy, and Australia. They were admitted to hospital within one week of an acute stroke and were immobile. Patients received routine care plus TL-GCS (1256 patients), or routine care only (1262). Each was then given an ultrasound of both legs at 7-10 days and again at 25-30 days after enrolment. The primary outcome was occurrence of DVT in the thigh. The researchers found that DVT occurred in 10.0% of patients in the TL-GCS group, and 10.5% of patients in the routine care only group. The difference was not statistically significant. Furthermore, skin breaks, ulcers, blisters, and skin tissue death were significantly more common in patients given TL-GCS than in those given routine care only (5% vs 1%).

Referring to the UK example, Dr Dennis says that draft guidelines out for public consultation from the National Institute for Health and Clinical Excellence (NICE)* recommend that stroke patients should be treated with compression stockings. He says**: “We can estimate that 80,000 patients with stroke in the UK-about 2/3 of all admission to hospital with acute stroke-would be treated with stockings if this guideline is followed. Thus the results of the CLOTS trial 1 will have a major effect on the management of patients. Given that most national guidelines recommend stockings in at least some patients, the results of our study will affect the treatment of millions of patients each year. Abandoning this ineffective and sometimes uncomfortable treatment will free up significant health resources-both funding and nurse time-which might be better used to help stroke patients.”

He concludes**: “Compression stockings are used in the majority of stroke units. In this study, we have shown conclusively that compression stockings do not work for stroke patients. National guidelines need to be revised and we need further research to establish effective treatments in this important group of patients.”

In an accompanying Comment, Dr Philip Bath and Dr Timothy England, Stroke Trials Unit, University of Nottingham, UK, say: “GCS do not reduce DVT or overall venous thromboembolism in patients with recent stroke; indeed, they damage the skin and might promote limb ischaemia. GCS should not be used after stroke and current guidelines will need to be amended.”

Link to article

Source
The Lancet

Biopure Corporation
(Nasdaq: BPUR) announced today that it has been notified by the Food and
Drug Administration (FDA) that the FDA’s Blood Products Advisory Committee
will meet on July 14, 2006 to discuss the Navy’s proposed RESUS clinical
trial of the company’s investigational oxygen therapeutic Hemopure(R)
[hemoglobin glutamer – 250 (bovine)] for out-of-hospital treatment of
hemorrhagic shock resulting from traumatic injury. FDA has invited the
Naval Medical Research Center (NMRC) and Biopure to present at the meeting.
As previously announced, NMRC’s investigational new drug application (IND)
for RESUS is on clinical hold at FDA.

“We believe that the product holds promise as an emergency pre-hospital
treatment until patients can receive blood or other standard treatment at a
hospital, and we look forward to presenting our data,” said Biopure
Chairman and CEO Zafiris G. Zafirelis.

The Blood Products Advisory Committee reviews and evaluates available
data concerning the safety, effectiveness, and appropriate use of blood
products derived from blood and serum or biotechnology which are intended
for use in the diagnosis, prevention, or treatment of human diseases, and,
as required, any other product for which FDA has regulatory responsibility,
and advises the Commissioner of Food and Drugs of its findings regarding
the safety, effectiveness, and labeling of the products, on clinical and
laboratory studies involving such products, on the affirmation or
revocation of biological product licenses, and on the quality and relevance
of FDA’s research program which provides the scientific support for
regulating these agents.

In order for the proposed RESUS trial to proceed, FDA must lift the
clinical hold and the Department of Defense and the institutional review
boards of participating hospitals in the communities where the study would
take place must provide final authorization.

Biopure Corporation

Biopure Corporation develops, manufactures and markets pharmaceuticals,
called oxygen therapeutics, that are intravenously administered to deliver
oxygen to the body’s tissues. Hemopure(R) [hemoglobin glutamer – 250
(bovine)], or HBOC-201, is approved for sale in South Africa for the
treatment of surgical patients who are acutely anemic. The product has not
been approved for sale in other countries. Biopure plans to apply in
Europe, in mid 2006, for approval of an acute anemia indication in
orthopedic surgery patients. The company is developing Hemopure for a
potential indication in cardiovascular ischemia, in addition to supporting
the U.S. Naval Medical Research Center’s government-funded development of a potential out-of-hospital trauma indication. The company’s veterinary
product Oxyglobin(R) [hemoglobin glutamer – 200 (bovine)], or HBOC-301, the
only oxygen therapeutic approved by the U.S. Food and Drug Administration
and the European Commission, is indicated for the treatment of anemia in
dogs.

Statements in this press release that are not strictly historical are
forward-looking statements, including any that might imply that the
proposed RESUS trauma trial will receive authorization to proceed. Actual
results may differ materially from those projected in these forward-looking
statements due to risks and uncertainties. These risks include, without
limitation, uncertainties regarding the company’s financial position,
unexpected costs and expenses, delays and determinations by regulatory
authorities, unanticipated problems with the product’s commercial use,
whether or not product related, and with product distributors, sales agents
or other third parties, and delays in or unpredictable outcomes of clinical
trials. The company undertakes no obligation to release publicly the
results of any revisions to these forward-looking statements to reflect
events or circumstances arising after the date hereof. A full discussion of
the company’s operations and financial condition can be found in the
company’s filings with the U.S. Securities and Exchange Commission,
including under the heading “Risk Factors” in the Form 10-Q filed on March
13, 2006, which can be accessed in the EDGAR database at the SEC Web site
sec.

Biopure Corporation

biopure/

Iverson Genetic Diagnostics announced the selection of UPS (NYSE:UPS) to provide shipping services for its upcoming WARFARIN Study. In late June of 2010, Iverson Genetic Diagnostics, Inc. received approval from the Centers for Medicare & Medicaid Services (CMS) to conduct a two-year study that will assess the impact of genetic information on the occurrence of adverse bleeding events when determining the initial dose of warfarin compared to adverse events for those not using genetics in dose determination. The randomized and blinded, multi-center study will involve more than 7,000 patients at over 50 hospital sites nationwide.

“Warfarin is an essential drug for preventing blood clots. However, the adverse event rates need to be lowered. This study should help us understand how to use each patient’s genetic information to deliver a safer and more effective dose.”

“CMS’s approval of WARFARIN is evidence of the growing role of genetics in helping physicians to develop optimal individual treatments for their patients. The data from this study will determine if the use of genetics in warfarin dosing reduces adverse health events. Physicians need to make dosing decisions about warfarin on the spot,” said Dean Sproles, CEO and founder, Iverson Genetics. “We look forward to partnering with UPS to bring the benefits of genetic testing to physicians and their patients in a timely manner.” The CMS approval is for a clinical study under Coverage with Evidence Development (CED) and will cover pharmacogenetic testing of CYP2C9 and VKORC1 alleles to predict warfarin responsiveness.

Warfarin (brand name Coumadin®) is a commonly used anticoagulant (blood thinner). The dose of warfarin must be individualized for each patient according to his or her response to the drug. Currently, these individual dose requirements are often evaluated on a trial-and-error basis.

Today, more than 2 million patients are prescribed warfarin in the United States each year. One to five percent experiences a major bleeding event. The annual cost associated with warfarin complications is estimated to be $1.1 billion. (1) Researchers have identified two genes, VKORC1 and CYP2C9 that contribute up to 60% of an individual’s variability in response to warfarin. The WARFARIN Study will evaluate changes in adverse events such as major hemorrhagic or thromboembolic events when using genetic information to determine an individual’s warfarin dose. The WARFARIN Study is being led by Principal Investigator Elizabeth Ofili, MD, Director of Clinical Research, Chief of Cardiology and Associate Dean for Clinical Research at the Morehouse School of Medicine in Atlanta, Georgia. Dr. Ofili indicated that, “Warfarin is an essential drug for preventing blood clots. However, the adverse event rates need to be lowered. This study should help us understand how to use each patient’s genetic information to deliver a safer and more effective dose.”

“UPS is delighted to be Iverson’s trusted shipping provider for such a monumental study. It’s another example of how we can help make a difference in patients’ lives through our healthcare logistics services,” said Bill Hook, vice president of Global Strategy, UPS Healthcare Logistics. “Serving the supply chain needs of healthcare companies around the world is a core focus for UPS, either through transportation, distribution or specialized healthcare services.”

For this endeavor, UPS will send test kits and shipping materials to Iverson’s clinical study sites that are recruiting patients for the warfarin trial. UPS will also transport vital research patient specimens back reliably and quickly to Morehouse School of Medicine for earliest possible analysis. Enrollment in WARFARIN will commence in November of 2010.

1 McWilliam A, Letter R, and Nardinelli C. (2006) Health care savings from personalized medicine using genetic testing: the case of warfarin. Working Paper 06-23, AEI-Brookings Joint Center for Regulatory Studies.

Source:

Iverson Genetic Diagnostics, Inc.

UPS

Morehouse School of Medicine

View drug information on Warfarin Sodium tablets.

A treatment plan used to prevent potentially dangerous blood clots in recovering surgical patients can also benefit some patients immobilized by acute medical illness, doctors have found in a multi-institutional study.

In women, patients age 75 or older, and patients strictly confined to 24-hour bed rest, a month of extended treatment with a blood thinner significantly reduced the chances of blood clots while only slightly increasing the risk of bleeding.

Researchers at Washington University School of Medicine in St. Louis and several other institutions report the results online this week in Annals of Internal Medicine. The double-blind, placebo-controlled trial was funded by Sanofi-Aventis, the manufacturer of enoxaparin, a form of the blood thinner heparin that was used in the study.

Causes of decreased mobility of patients in the study varied and included heart failure, infections and chronic respiratory disease.

“We currently treat acutely ill medical patients with a week or two of blood thinners to prevent clots,” says co-author Roger D. Yusen, MD, associate professor of medicine at Washington University. “These results suggest that, depending on the patient, physicians may want to consider extending that treatment for an additional month.”

Extended treatment with a blood thinner is already standard in such contexts as recovery from knee and hip replacement surgery and abdominal cancer surgery.

Yusen is a member of the steering committee for the study, known as the EXCLAIM, or Extended Prophylaxis for Venous ThromboEmbolism (VTE) in Acutely Ill Medical Patients With Prolonged Immobilization trial.

To be eligible for the trial, patients had to be 40 years or older, have had decreased mobility within the three days prior to admission and have been likely to have decreased mobility for at least three more days after admission. Patients were given the conventional six to 14 days of enoxaparin and then randomized into two groups that received either enoxaparin or a placebo for an additional 28 days.

Researchers initially enrolled both patients who were on 24-hour bed rest and patients who were on bed rest except for the ability to use the bathroom. However, when monitoring during the early stages of the trial suggested an unfavorable risk to benefit ratio in the second group, the participation criteria for that group were adjusted to require the presence of at least one of three additional blood clot risk factors: age greater than 75 years, female gender or a previous history of a blood clot.

At the end of the treatment period, patients were scanned using an ultrasound for blood clots known as deep vein thromboses in the large veins in their upper legs.

“Clots in these areas tend to be bigger and have a greater chance of breaking away and traveling to the lungs, where they can cause a potentially fatal pulmonary embolism,” Yusen says.

Researchers also followed up on patients six months after their participation in the trial began.

Their final analysis, which included results from more than 5,000 patients, showed that the rate of blood clots was 2.5 percent in the group that received extended treatment and 4 percent in the group that only received the conventional treatment, a statistically significant reduction in blood clots of 1.5 percent. Major bleeding risk was 0.8 percent in the treatment group and 0.3 percent in the placebo group, a statistically significant increase in bleeding of 0.5 percent. There was no difference in survival between the two groups.

“The benefits of extended treatment were restricted to three groups: patients who were in bed all day at the beginning of the trial, patients who were 75 years or older and female patients,” Yusen says.

Yusen and his colleagues plan to further examine the results to see if they can fine-tune their recommendations for when extended-duration blood clot prevention can be beneficial.

Hull RD, Schellong SM, Tapson VF, Monreal M, Samama M-M, Nicol P, Vicaut E, Turpie AGG, Yusen RD. Extended-duration venous thromboembolism prophylaxis in acutely ill medical patients with recently reduced mobility. Annals of Internal Medicine, published online.

Funding from Sanofi-Aventis supported this trial.

Source:

Washington University School of Medicine

Patients with the syndrome leukocyte adhesion deficiency (LAD) III suffer from recurrent infections and an increased tendency to bleed. The exact defect responsible for this disease remains unclear. In a study appearing online in advance of publication in the June print issue of the Journal of Clinical Investigation, Denisa Wagner and colleagues from Harvard Medical School show that mice engineered to lack the gene CalDAG-GEFI have a combination of defects in their leukocytes and platelets, similar to those observed in LAD-III patients.

In response to injury of the blood vessel lining, blood platelets adhere to fibrin, endothelial cells lining the vessel wall, and to each other via adhesion receptors known as integrins, to form what is often referred to as a blood clot. Wagner and colleagues evaluated the role of CalDAG-GEFI in integrin activation. They observed significant defects in beta1- and beta2-integrin-mediated adhesion of CalDAG-GEFI-deficient neutrophils, which impaired the response of these cells to injury and inflammation. In addition, they found that CalDAG-GEFI was essential for the activation of beta1 integrins on the surface of platelets and that CalDAG-GEFI-/- mice were unable to form blood clots. The data indicate that CalDEG-GEFI regulates beta integrin function and suggests that this gene may be defective in patients with LAD-III.

TITLE: Mick lacking the signaling molecule CalDAG-GEFI represent a model for leukocyte adhesion deficiency type III

AUTHOR CONTACT:
Denisa Wagner
CBR Institute for Biomedical Research and Harvard Medical School, Boston, Massachusetts, USA.

Wolfgang Bergmeier
CBR Institute for Biomedical Research and Harvard Medical School, Boston, Massachusetts, USA.

JCI table of contents: May 10, 2007

Contact: Brooke Grindlinger

Journal of Clinical Investigation

In preliminary guidance published today (10June 2010), eltrombopag (Revolade, GlaxoSmithKline) is not recommended for treating chronic immune (idiopathic) thrombocytopenic purpura[1] (ITP) in splenectomised adults[2] who do not respond to other treatments (for example, corticosteroids[3], immunoglobulins[4]), or as second-line treatment for non-splenectomised adults when surgery is not advised.

The independent Appraisal Committee considered the use of eltrombopag in two groups of people – those who do and those who do not have persistent bleeding problems. The committee concluded that, although eltrombopag can raise platelet levels[5], the evidence was very unclear about how many health benefits eltrombopag would provide compared with other existing treatments. The cost of eltrombopag in
relation to the estimated health benefits was also far greater than what is normally considered a cost effective use of NHS resources.

Gillian Leng, Deputy Chief Executive of NICE said: “The Appraisal Committee understood that for people living with ITP, the risk of bleeding can have a considerable effect on their daily activities and also prevent or delay surgery. But unfortunately, the committee felt there was not sufficient evidence to recommend eltrombopag as a treatment for ITP. There are existing treatments available for ITP and, from the clinical evidence, it is very unclear how much health benefit eltrombopag provides, compared with these current alternative treatments. The cost of eltrombopag in relation to the estimated health benefits is too high to be a cost-effective use of NHS resources. The committee therefore concluded that it could not recommend eltrombopag for people with chronic ITP.”

This draft guidance has been issued for consultation and interested parties now have an opportunity to comment on the draft recommendations made by the independent appraisal committee; NICE has not yet issued final guidance to the NHS.

Until NICE issues final guidance, NHS bodies should make decisions locally on the funding of specific treatments. Once NICE issues its guidance on a technology it replaces local recommendations across the country.

[1] Chronic immune (idiopathic) thrombocytopenic purpura is a bleeding disorder caused by abnormally low levels of platelets in the blood. The disorder has no apparent cause.

[2] Splenectomised adults have had their spleen surgically removed; the spleen is an organ that is part of the lymphatic system.

[3] Corticosteroids are a type of steroid, which are in turn a type of hormone. Corticosteroids are commonly used to reduce inflammation, suppress the immune system, and replace hormones in the body.

[4] Immunoglobulins are also know as antibodies and are used by the immune system to identify and neutralise bacteria and viruses.

[5] Platelets are needed for the blood to clot. Normal platelet levels are between 150 and 400 x 109 per litre of blood. Low platelet counts (below 30 x 109 per litre) can result in bleeding and bruising.

Notes

About the appraisal
— The appraisal consultation document (ACD) is available for comment from 5.00pm on Thursday 10 June to 5.00pm on Thursday 1 July at 5.00pm here.

— After consultation the Appraisal Committee will meet again on Tuesday 27 July to consider the evidence, this appraisal consultation document and any comments from the consultees.

— Eltrombopag (Revolade, GlaxoSmithKline) increases platelet production through activation of the thrombopoietin receptor. By stimulating platelet production, it helps to reduce bleeding.

— Eltrombopag has UK marketing authorisation for the treatment of adult chronic immune (idiopathic) thrombocytopenic purpura (ITP) in splenectomised patients who are not responding to other treatments (e.g. corticosteroids, immunoglobulins) and as a second line treatment for adult non-splenectomised patients where surgery is contraindicated.

— Eltrombopag is for oral administration. The SPC states that the recommended initial dose is 50 mg once daily. If after 2-3 weeks of initial therapy, the platelet counts are below the clinically targeted levels (50 x 109 per litre) the dose may be increased to a maximum of 75 mg. Treatment should be discontinued if the platelet count does not increase sufficiently to avoid clinically important bleeding after 4 weeks of therapy at 75 mg. For full details of dose and administration, see the draft summary of product characteristics (SPC).

— The manufacturer’s submission states that the price per 50 mg tablet is £55.00. Eltrombopag is available in 28-tablet packs containing 25 mg tablets (£770.00) or 50 mg tablets (£1540.00). Therefore, the cost of a four week course of treatment is between £1540.00 and £2310.00, and the annual cost is between £22,020.00 and £33,030.00. Costs may vary in different settings because of negotiated procurement discounts.

— In adults, ITP occurs in about 6 in 100,000 people. It is more common in women and predominantly occurs in those of child bearing age. It may also be seen more often in the elderly.

— In adults, ITP comes on gradually and it usually does not follow a viral illness. There may be no symptoms, mild bruising or bleeding, or severe bleeding.

— Because most adults with ITP do not have any symptoms, ITP is usually diagnosed on a routine blood test that has been done for other reasons. The full blood count shows a lower number of platelets than normal.

Source
NICE

ARIAD Pharmaceuticals, Inc. (NASDAQ: ARIA) announced that its investigational pan-BCR-ABL inhibitor, AP24534, has been granted orphan drug designation by both the U. S. Food and Drug Administration (FDA) and the European Medicines Agency (EMA). In the U.S., the orphan designation of AP24534 is for the treatment of chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL) and in the E.U., its orphan designation is for CML and acute lymphoblastic leukemia.

“While impressive medical gains have been made over the past decade in treating various forms of leukemia, it is clear that the disease can be severe and life-threatening when it progresses,” said Frank Haluska, M.D., Ph.D., vice president, clinical affairs of ARIAD. “Orphan drug designation for AP24534 highlights the lack of therapeutic options available for patients with CML or Ph+ ALL, who are resistant or refractory to currently available therapies. We expect to advance AP24534 into a pivotal registration trial later this year and pursue subsequent regulatory submissions for marketing authorization in these hematological cancers.”

Orphan drug designation, which is intended to facilitate drug development, provides substantial potential benefits to the sponsor, including funding for certain clinical studies, study-design assistance, and several years of market exclusivity for the product upon regulatory approval.

About AP24534

ARIAD’s second oncology product candidate, AP24534, is an investigational pan-BCR-ABL inhibitor that has broad potential applications in cancer. ARIAD is currently completing a Phase 1 clinical trial of oral AP24534 in patients with advanced hematological cancers and plans to begin a pivotal registration trial of AP24534 later this year. Clinical proof-of-concept data from the Phase 1 trial provide clinical evidence of hematologic, cytogenetic and molecular anti-cancer activity of AP24534 in heavily pretreated patients with resistant and refractory chronic myeloid leukemia (CML), including those with the T315I mutation. In preclinical studies, AP24534 has also demonstrated potent inhibition of kinase targets associated with acute myeloid leukemia, as well as proliferation and angiogenesis in multiple solid tumors.

About CML and Ph+ ALL

CML is characterized by an excessive and unregulated production of white blood cells by the bone marrow due to a genetic abnormality that produces the BCR-ABL protein. After a chronic phase of production of too many white blood cells, CML typically evolves to more aggressive phases such as accelerated or blast crisis. Ph+ ALL is a subtype of acute lymphoblastic leukemia that also carries the Ph+ chromosome that produces BCR-ABL. It has a more aggressive course than CML and is often treated with a combination of chemotherapy and tyrosine kinase inhibitors. Because both of these diseases express the BCR-ABL protein, this would render them potentially susceptible to treatment with AP24534.

Source
ARIAD

AdvanDx announced the launch of its CE-IVD marked GNR Traffic Light™ PNA FISH® test in Europe. GNR Traffic Light PNA FISH is the first-ever test capable of simultaneously identifying Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa directly from positive blood cultures in less than 90 minutes. The GNR Traffic Light is the latest addition to AdvanDx’s easy-to-use, molecular-based PNA FISH diagnostics platform designed to provide rapid, therapy-guiding results enabling clinicians to provide early, effective therapy for patients with Gram-negative bloodstream infections.

Every year, an estimated 100,000 patients develop bloodstream infections (BSI) due to Gram-negative pathogens, mainly E. coli, K. pneumoniae and P. aeruginosa. Patients afflicted by these serious infections spend an average of 15 days in the hospital, suffer mortality rates as high as 40% and cost institutions between $40,000 to $60,000 per case.(1,2) These grim statistics are due in part to Gram-negative bacteria’s increasing resistance to a multitude of antibiotic agents, especially in P. aeruginosa and increasingly in K. pneumoniae, creating complex therapy decisions for clinicians. Treatment challenges are further compounded by conventional laboratory testing methods that take 24-48 hours or longer to identify the causative pathogen, forcing clinicians to treat patients empirically. This empirical antibiotic coverage can lead to both unnecessary treatment with broad-spectrum antibiotics as well as inadequate treatment if highly virulent and resistant pathogens are not suspected and covered for.

Studies show that providing a 24 hours “head start” on appropriate, narrow-spectrum therapy for Gram-negative bloodstream infections may improve clinical outcomes, reduce antibiotic resistance rates and reduce the incidences of adverse events.(3,4) GNR Traffic Light PNA FISH will enable microbiology labs to provide clinicians rapid, accurate Gram-negative pathogen identification results in hours, instead of days.

“The GNR Traffic Light PNA FISH test demonstrates AdvanDx’s commitment to developing cutting-edge molecular diagnostic products that provide fast results for these serious infections,” said Thais T. Johansen, President and CEO of AdvanDx. “This latest PNA FISH test provides another tool to help laboratories and clinicians improve antibiotic selection, care and outcomes for critically ill patients with bloodstream infections,” Johansen concluded.

About Bloodstream Infections

Every year, close to 875,000 patients in the United States contract bloodstream infections, leading to over 150,000 deaths and $12 billion in patient care costs.(5,6) The infection is detected when a culture of the patient’s blood (i.e. a blood culture) turns positive with bacteria or yeast. Rapid and accurate identification of the specific infecting pathogen is crucial to ensure early and appropriate therapy and save patient lives.

References:

(1) Antimicrobial Agent and Chemotherapy. 2005 Feb; 49:760-766

(2) Clinical Infectious Diseases. 2008; 47:S14-20

(3) Critical Care. 2008 May; 12 Sup 4:1-9

(4) BMC Infectious Diseases. 2008 Sept; 8(116)

(5) Infect. Control Hosp Epedimiol. 2009 Nov; 30(11):1036-44

(6) Wier et al. Diagnostic Groups with Rapidly Increasing Costs, by Payer, 2001-2007. HCUP Statistical Brief #91. 2010 June; Agency for Healthcare Research and Quality, Rockville, MD.

Source: AdvanDx

For the first time, scientists have shown that amniotic fluid (the protective liquid surrounding an embryo) may be a potential new source of stem cells for therapeutic applications. The study was prepublished online on February 12, 2009, in Blood, the official journal of the American Society of Hematology.

“Building on observations made by other scientists, our research team wondered whether stem cells could be detected in amniotic fluid. We looked at the capacity of these cells to form new blood cells both inside and outside the body, and also compared their characteristics to other well-known sources of stem cells,” said senior study author Marina Cavazzana-Calvo, MD, Ph.D., of INSERM, the national French institute for health and biomedical research. Isabelle Andre-Schmutz, Ph.D., of INSERM, also a senior author of the study, added, “The answer was a resounding ‘yes’ – the cells we isolated from the amniotic fluid are a new source of stem cells that may potentially be used to treat a variety of human diseases.”

To conduct the study, amniotic fluid was collected from pregnant mice between 9.5 and 19.5 days post-coitus. Human amniotic fluid was collected during routine diagnostic procedures (amniocentesis) from volunteer donors between seven and 35 weeks of pregnancy.

Amniotic fluid (AF) cells that had markers similar to bone marrow stem cells (termed AFKL cells) were then isolated for use in experiments, as these cell markers were indicative of progenitor cells (cells that have the capacity to differentiate into other types of cells).

In vitro, AFKL cells from both mice and humans were able to generate all blood cell lineages, including red (erythroid) blood cells and white (myeloid and lymphoid) blood cells in experiments performed outside the animals. But the scientists also wanted to explore the AFKL cells’ hematopoietic (blood-forming) potential in vivo. Therefore, adult mice were irradiated to destroy their capacity to produce blood cells and injected with either AFKL cells or fetal liver cells. Fetal liver was used for comparison as it is the primary source for hematopoietic cells in developing embryos.

The peripheral blood of the transplanted mice was examined every four weeks, and after 16-18 weeks the blood-forming organs (bone marrow, spleen, thymus, and lymph nodes) of the mice were dissected. Transplants using mouse AFKL cells were found to be successful; newly formed white blood cells of all lineages derived from AFKL cells appeared in most of the irradiated mice four weeks after the procedure. As expected, all of these blood cell types were detected in all of the control group mice who received fetal liver cell transplants. Scientists continued to find AFKL-derived cells in the irradiated mice four months later, demonstrating the long-term ability of the transplanted cells to produce new blood cells.

Bone marrow samples from the transplanted mice were also taken and injected in a second set of mice and the peripheral blood of this new group of irradiated mice was analyzed and their hematopoietic organs examined after 10-13 weeks. The secondary transplants with mouse AFKL cells were partially successful with some of the mice engrafting the donor cells. This finding shows that AFKL cells have the ability to self-renew, a key characteristic of stem cells.

Though the human AFKL cells failed to reconstitute the hematopoietic system in irradiated, immunodeficient mice, experiments are currently underway to overcome obstacles that may have led to this failure, such as using a low number of cells for the injection and conducting the transplant in adult mice (engraftment is easier to obtain in newborn mice).

As additional confirmation of the probability that AFKL cells are indeed stem cells, the researchers examined them for the expression of specific genes known to be involved in hematopoietic development. The overall gene expression profile of the AFKL cells was found to resemble blood cell progenitors from known hematopoiesis sites such as the aorta-gonad-mesonephros region, placenta, and the umbilical/vitelline arteries.

The American Society of Hematology (hematology) is the world’s largest professional society concerned with the causes and treatment of blood disorders. Its mission is to further the understanding, diagnosis, treatment, and prevention of disorders affecting blood, bone marrow, and the immunologic, hemostatic, and vascular systems, by promoting research, clinical care, education, training, and advocacy in hematology. In September, ASH launched Blood: The Vital Connection (bloodthevitalconnection), a credible online resource addressing bleeding and clotting disorders, anemia, and cancer. It provides hematologist-approved information about these common blood conditions including risk factors, preventive measures, and treatment options.

American Society of Hematology
hematology

Physicists in Arizona State University have designed a revolutionary laser technique which can destroy viruses and bacteria such as AIDS without damaging human cells and may also help reduce the spread of hospital infections such as MRSA.

The research, published on Thursday November 1 in the Institute of Physics’ Journal of Physics: Condensed Matter, discusses how pulses from an infrared laser can be fine-tuned to discriminate between problem microorganisms and human cells.

Current laser treatments such as UV are indiscriminate and can cause ageing of the skin, damage to the DNA or, at worst, skin cancer, and are far from 100 per cent effective.

Femtosecond laser pulses, through a process called Impulsive Stimulated Raman Scattering (ISRS), produces lethal vibrations in the protein coat of microorganisms, thereby destroying them. The effect of the vibrations is similar to that of high-pitched noise shattering glass.

The physicists in Arizona have undertaken experiments to show that the coherent vibrations excited by infrared lasers with carefully selected wavelengths and pulse widths do no damage to human cells, most likely because of the different structural compositions in the protein coats of human cells vis a vis bacteria and viruses.

Professor K. T. Tsen from Arizona State University said, “Although it is not clear at the moment why there is a large difference in laser intensity for inactivation between human cells and microorganisms such as bacteria and viruses, the research so far suggests that ISRS will be ready for use in disinfection and could provide treatments against some of the worst, often drug-resistant, bacterial and viral pathogens.”

Femtosecond lasers could find immediate application in hospitals as a way to disinfect blood supply or biomaterials and for the treatment of blood-borne diseases such as AIDS and Hepatitis.

Source: Joseph Winters

Institute of Physics

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