Cancer’s Secrets Come Into Sharper Focus

29 08 2011

For the last decade cancer research has been guided by a common vision of how a single cell, outcompeting its neighbors, evolves into a malignant tumor.

Through a series of random mutations, genes that encourage cellular division are pushed into overdrive, while genes that normally send growth-restraining signals are taken offline.

With the accelerator floored and the brake lines cut, the cell and its progeny are free to rapidly multiply. More mutations accumulate, allowing the cancer cells to elude other safeguards and to invade neighboring tissue and metastasize.

These basic principles — laid out 11 years ago in a landmark paper, “The Hallmarks of Cancer,” by Douglas Hanahan and Robert A. Weinberg, and revisited in a follow-up article this year — still serve as the reigning paradigm, a kind of Big Bang theory for the field.

But recent discoveries have been complicating the picture with tangles of new detail. Cancer appears to be even more willful and calculating than previously imagined.

Most DNA, for example, was long considered junk — a netherworld of detritus that had no important role in cancer or anything else. Only about 2 percent of the human genome carries the code for making enzymes and other proteins, the cogs and scaffolding of the machinery that a cancer cell turns to its own devices.

These days “junk” DNA is referred to more respectfully as “noncoding” DNA, and researchers are finding clues that “pseudogenes” lurking within this dark region may play a role in cancer.

“We’ve been obsessively focusing our attention on 2 percent of the genome,” said Dr. Pier Paolo Pandolfi, a professor of medicine and pathology at Harvard Medical School. This spring, at the annual meeting of the American Association for Cancer Research in Orlando, Fla., he described a new “biological dimension” in which signals coming from both regions of the genome participate in the delicate balance between normal cellular behavior and malignancy.

As they look beyond the genome, cancer researchers are also awakening to the fact that some 90 percent of the protein-encoding cells in our body are microbes. We evolved with them in a symbiotic relationship, which raises the question of just who is occupying whom.

“We are massively outnumbered,” said Jeremy K. Nicholson, chairman of biological chemistry and head of the department of surgery and cancer at Imperial College London. Altogether, he said, 99 percent of the functional genes in the body are microbial.

In Orlando, he and other researchers described how genes in this microbiome — exchanging messages with genes inside human cells — may be involved with cancers of the colon, stomach, esophagus and other organs.

These shifts in perspective, occurring throughout cellular biology, can seem as dizzying as what happened in cosmology with the discovery that dark matter and dark energy make up most of the universe: Background suddenly becomes foreground and issues once thought settled are up in the air. In cosmology the Big Bang theory emerged from the confusion in a stronger but more convoluted form. The same may be happening with the science of cancer.

Exotic Players

According to the central dogma of molecular biology, information encoded in the DNA of the genome is copied by messenger RNA and then carried to subcellular structures called ribosomes, where the instructions are used to assemble proteins. Lurking behind the scenes, snippets called microRNAs once seemed like little more than molecular noise. But they have been appearing with increasing prominence in theories about cancer.

By binding to a gene’s messenger RNA, microRNA can prevent the instructions from reaching their target — essentially silencing the gene — and may also modulate the signal in other ways. One presentation after another at the Orlando meeting explored how microRNAs are involved in the fine-tuning that distinguishes a healthy cell from a malignant one.

Ratcheting the complexity a notch higher, Dr. Pandolfi, the Harvard Medical School researcher, laid out an elaborate theory involving microRNAs and pseudogenes. For every pseudogene there is a regular, protein-encoding gene. (Both are believed to be derived from a common ancestral gene, the pseudogene shunted aside in the evolutionary past when it became dysfunctional.) While normal genes express their will by sending signals of messenger RNA, the damaged pseudogenes either are mute or speak in gibberish.

Or so it was generally believed. Little is wasted by evolution, and Dr. Pandolfi hypothesizes that RNA signals from both genes and pseudogenes interact through a language involving microRNAs. (These signals are called ceRNAs, pronounced “sernas,” meaning “competing endogenous RNAs.”)

His lab at Beth Israel Deaconess Medical Center in Boston is studying how this arcane back channel is used by genes called PTEN and KRAS, commonly implicated in cancer, to confer with their pseudotwins. The hypothesis is laid out in more detail this month in an essay in the journal Cell.

Fueled by the free espresso offered by pharmaceutical companies hawking their wares, scientists at the Orlando meeting moved from session to session and browsed corridors of posters, looking for what might have recently been discovered about other exotic players: lincRNA, (for large intervening noncoding), siRNA (small interfering), snoRNA (small nucleolar) and piRNA (Piwi-interacting (short for “P-element induced wimpy testis” (a peculiar term that threatens to pull this sentence into a regress of nested parenthetical explanations))).

In their original “hallmarks” paper — the most cited in the history of Cell — Dr. Hanahan and Dr. Weinberg gathered a bonanza of emerging research and synthesized it into six characteristics. All of them, they proposed, are shared by most and maybe all human cancers. They went on to predict that in 20 years the circuitry of a cancer cell would be mapped and understood as thoroughly as the transistors on a computer chip, making cancer biology more like chemistry or physics — sciences governed by precise, predictable rules.

Now there appear to be transistors inside the transistors. “I still think that the wiring diagram, or at least its outlines, may be laid out within a decade,” Dr. Weinberg said in an e-mail. “MicroRNAs may be more like minitransistors or amplifiers, but however one depicts them, they still must be soldered into the circuit in one way or another.”

In their follow-up paper, “Hallmarks of Cancer: The Next Generation,” he and Dr. Hanahan cited two “emerging hallmarks” that future research may show to be crucial to malignancy — the ability of an aberrant cell to reprogram its metabolism to feed its wildfire growth and to evade destruction by the immune system.

Unwitting Allies

Even if all the lines and boxes for the schematic of the cancer cell can be sketched in, huge complications will remain. Research is increasingly focused on the fact that a tumor is not a homogeneous mass of cancer cells. It also contains healthy cells that have been conscripted into the cause.

Cells called fibroblasts collaborate by secreting proteins the tumor needs to build its supportive scaffolding and expand into surrounding tissues. Immune system cells, maneuvered into behaving as if they were healing a wound, emit growth factors that embolden the tumor and stimulate angiogenesis, the generation of new blood vessels. Endothelial cells, which form the lining of the circulatory system, are also enlisted in the construction of the tumor’s own blood supply.

All these processes are so tightly intertwined that it is difficult to tell where one leaves off and another begins. With so much internal machinery, malignant tumors are now being compared to renegade organs sprouting inside the body.

As the various cells are colluding, they may also be trading information with cells in another realm — the micro-organisms in the mouth, skin, respiratory system, urogenital tract, stomach and digestive system. Each microbe has its own set of genes, which can interact with those in the human body by exchanging molecular signals.

“The signaling these microbes do is dramatically complex,” Dr. Nicholson said in an interview at Imperial College. “They send metabolic signals to each other — and they are sending chemicals out constantly that are stimulating our biological processes.

“It’s astonishing, really. There they are, sitting around and doing stuff, and most of it we don’t really know or understand.”

People in different geographical locales can harbor different microbial ecosystems. Last year scientists reported evidence that the Japanese microbiome has acquired a gene for a seaweed-digesting enzyme from a marine bacterium. The gene, not found in the guts of North Americans, may aid in the digestion of sushi wrappers. The idea that people in different regions of the world have co-evolved with different microbial ecosystems may be a factor — along with diet, lifestyle and other environmental agents — in explaining why they are often subject to different cancers.

The composition of the microbiome changes not only geographically but also over time. With improved hygiene, dietary changes and the rising use of antibiotics, levels of the microbe Helicobacter pylori in the human gut have been decreasing in developing countries, and so has stomach cancer. At the same time, however, esophageal cancer has been increasing, leading to speculation that H. pylori provides some kind of protective effect.

At the Orlando meeting, Dr. Zhiheng Pei of New York University suggested that the situation is more complex. Two different types of microbial ecosystems have been identified in the human esophagus. Dr. Pei’s lab has found that people with an inflamed esophagus or with a precancerous condition called Barrett’s esophagus are more likely to harbor what he called the Type II microbiome.

“At present, it is unclear whether the Type II microbiome causes esophageal diseases or gastro-esophageal reflux changes the microbiome from Type I to II,” Dr. Pei wrote in an e-mail. “Either way, chronic exposure of the esophagus to an abnormal microbiome could be an essential step in esophageal damage and, ultimately, cancer.”

Unseen Enemies

At a session in Orlando on the future of cancer research, Dr. Harold Varmus, the director of the National Cancer Institute, described the Provocative Questions initiative, a new effort to seek out mysteries and paradoxes that may be vulnerable to solution.

“In our rush to do the things that are really obvious to do, we’re forgetting to pay attention to many unexplained phenomena,” he said.

Why, for example, does the Epstein-Barr virus cause different cancers in different populations? Why do patients with certain neurological diseases like Parkinson’s, Huntington’s, Alzheimer’s and Fragile X seem to be at a lower risk for most cancers? Why are some tissues more prone than others to developing tumors? Why do some mutations evoke cancerous effects in one type of cell but not in others?

With so many phenomena in search of a biological explanation, “Hallmarks of Cancer: The Next Generation” may conceivably be followed by a second sequel — with twists as unexpected as those in the old “Star Trek” shows. The enemy inside us is every bit as formidable as imagined invaders from beyond. Learning to outwit it is leading science deep into the universe of the living cell.

VALIDADO POR LA SRA. ALBA CALLS.

Nytimes.com [en línea] New York (USA): nytimes.com, 29 de agosto de 2011 [REF. 15 in August of 2011] Available on Internet:

http://www.nytimes.com/2011/08/16/health/16cancer.html?pagewanted=1&ref=research



Revelan el mecanismo de protección cerebral durante un ictus

25 08 2011

Neurologists of the University of Bristol they have identified the mechanism of natural protection of some of the nerve cells of the brain during the start of a stroke. Results, published in the magazine ‘Journal of Neuroscience‘, they could be used to develop treatments to protect other types of nerve cells responsible for speech and movement.

The stroke - the third cause of death in the United Kingdom- It causes the interruption of the blood supply to the brain, nerve cells deprived of oxygen and nutrients. This leads to the death of nerve cells and the consequent loss of cognitive functions of the brain such as speech and movement. However, not all nerve cells are equally susceptible to stroke-induced damage.

Research, directed by the doctor Jack Mellor the University of Bristol, It examined two types of nerve cells in a part of the brain called the hippocampus – the region linked to memory and orientation. One of these types of cells, CA1 cells, It is highly susceptible to damage after a stroke, While the other, CA3 cells, It is much more resistant while there are many similarities between the two types.

In the words of Dr. Mellor, “If we can understand why some nerve cells are resistant to damage caused by a stroke, We may be able to develop strategies to protect sensitive cells”.

The researchers noted that CA3 cells have a mechanism to reduce their vulnerability during, (e) immediately after a stroke, According to a model of laboratory. According to this mechanism, CA3 cells become less sensitive to the neurotransmitter glutamate (It is released in large amounts during a stroke), through the Elimination of glutamate of the cell surface receptor proteins.

The Elimination of glutamate receptor is activated by adenosine A3 receptors, He turns to very high levels of the neurotransmitter adenosine — only during a stroke. Curiously, CA1 cells that are susceptible to damage from stroke have no adenosine A3 receptors and do not respond to the model of elimination of glutamate receptors during stroke. The results reveal that CA3 cells possess a neural protection mechanism.

Dr. Mellor added that “Historically, the stroke has been very difficult to treat because of its unpredictable nature and the need for medications within a few minutes of your home. Our research does not solve these problems, but it highlights the natural protection that offer some nerve cells, useful knowledge to develop treatments and protect other cell types”.

VALIDADO POR LA SRA. ALBA CALLS.

Europapress.es [en línea] Madrid (Spain): europapress.es, 25 de agosto de 2011 [REF. 17 in August of 2011] Available on Internet:

http://www.europapress.es/salud/noticia-revelan-mecanismo-proteccion-cerebral-ictus-20110817110210.html



Anthony Atala on growing new organs

22 08 2011

Anthony Atala is the director of the Wake Forest Institute for Regenerative Medicine, where his work focuses on growing and regenerating tissues and organs. His team engineered the first lab-grown organ to be implanted into a human — a bladder — and is developing experimental fabrication technology that can “print” human tissue on demand.

In 2007, Atala and a team of Harvard University researchers showed that stem cells can be harvested from the amniotic fluid of pregnant women. This and other breakthroughs in the development of smart bio-materials and tissue fabrication technology promises to revolutionize the practice of medicine.

Anthony Atala’s state-of-the-art lab grows human organs — from muscles to blood vessels to bladders, and more. At TEDMED, he shows footage of his bio-engineers working with some of its sci-fi gizmos, including an oven-like bioreactor (preheat to 98.6 (F)) and a machine that “prints” human tissue.

VALIDADO POR LA SRA. ALBA CALLS.

Ted.com [en línea]New York (USA): ted.com, 22 de agosto de 2011 [REF. January of 2010] Available on Internet:

http://www.ted.com/talks/anthony_atala_growing_organs_engineering_tissue.html



New Clue to Parkinson’s

18 08 2011
Shape of key protein surprises researchers

A new study finds that a protein key to Parkinson’s disease has likely been mischaracterized. The protein, alpha-synuclein, appears to have a radically different structure in healthy cells than previously thought, challenging existing disease paradigms and suggesting a new therapeutic approach.

YouTube Preview Image

“Our data show that alpha-synuclein was essentially mistakenly characterized as a natively unfolded protein that lacked structure,” said Dennis Selkoe, the Vincent and Stella Coates Professor of Neurologic Diseases at Brigham and Women’s Hospital and Harvard Medical School and senior author of the paper, published online August 14 in the journal Nature. “We think this discovery has fundamental importance for understanding both how alpha-synuclein normally functions and how it becomes altered in Parkinson’s.”

When it comes to proteins, function follows form. A protein consists of a chain of chemical building blocks (amino acids), typically folded into an exquisite three-dimensional structure. Each twist and turn in the chain contributes to the protein’s unique properties and behavior, so it’s critical for scientists to accurately describe the arrangement of folds. But sometimes, they get the entire pattern wrong.

The new study suggests that’s just what happened with alpha-synuclein, the protein that forms clumps called Lewy bodies in the brains of patients with Parkinson’s and certain related disorders. Scientists have long assumed that alpha-synuclein occurs in healthy cells as a single, randomly-coiled chain that resembles a writhing snake. Selkoe’s team has proven, however, that the structure is far more orderly and sophisticated.

“This will open some new therapeutic doors,” said first author Tim Bartels, a postdoctoral researcher in Selkoe’s lab. “Everybody thought the protein was unfolded, so pharmaceutical companies have focused on preventing unfolded alpha-synuclein from aggregating.”

He recommends a new strategy—keeping the folded form of the protein stable.

How did the true structure of alpha-synuclein in healthy cells evade researchers for so long? Scientists knew that alpha-synuclein was abundant in the brain before they made the connection between the protein and Parkinson’s disease in 1997. Experiments in the mid-1990s indicated the protein was stable when exposed to conditions that typically disrupt the structure of most other proteins.

Consider what happens when an egg is boiled: the liquid proteins of the egg white are precipitated by the heat and congeal into a dense white mass. But alpha-synuclein seemed to behave like an egg that remains entirely viscous despite many minutes on the stove. It didn’t precipitate and congeal when boiled. This apparent hardiness made alpha-synuclein easy to work with in the lab. Scientists could boil the protein, even douse it with detergents and other rather harsh chemicals, while ostensibly leaving its structure intact.

Bartels and Selkoe wondered whether labs might be overlooking important aspects of the protein’s natural biology by handling it so roughly, so they designed experiments to probe alpha-synuclein’s behavior using gentler methods. They also bucked a trend by working with protein gathered from human cells rather than from engineered bacteria. The goal was to gain new insight into alpha-synuclein’s clustering behavior.

The initial data took them by surprise. Single, isolated chains of alpha-synuclein—the “monomeric” form of the protein—were absent from their cellular samples.

“I did my PhD on alpha-synuclein, and—like the rest of the world—I assumed that it occurs natively as a monomeric, unfolded protein, so I was shocked,” said Bartels.

Using special gels and other methods that are less disruptive to a protein’s form, the team conducted additional experiments to explore the structure of alpha-synuclein in healthy blood and brain cells. The native protein was exactly four times the predicted weight of a single alpha-synuclein chain, suggesting that cells package four alpha-synuclein chains together as a “tetrameric” unit. Applying sophisticated equipment and techniques, the team validated the molecular weight of the package, confirmed that it consists solely of alpha-synuclein chains and showed that these four chains have orderly twists.

The researchers observed tetrameric alpha-synuclein to be the dominant form of the protein in healthy human cells, and remarkably resistant to aggregation. The tetramers maintained their original structure for 10 days, the entire length of the experiment, while the team monitored their samples for clustering behavior. In stark contrast, alpha-synuclein monomers began to form clusters after a few days and ended up as large aggregates called amyloid fibers. The Lewy bodies that accumulate in the brains of patients with Parkinson’s consist mainly of such amyloid fibers.

“We hypothesize that the folded protein must disassemble into monomers before large pathological aggregates can form,” said Selkoe, who is also co-director of the Center for Neurologic Diseases at Brigham and Women’s Hospital. “If we can keep alpha-synuclein tetrameric and soluble, we might be able to prevent the neuronal degeneration of Parkinson’s disease from progressing—or perhaps from even developing.”

The finding could also prove useful in the quest for new diagnostics. Perhaps ratios of tetrameric protein to monomeric protein in blood cells, serum or spinal fluid will correspond to different propensities or stages of the disease.

Finally, the discovery of the folded tetramers should help labs to uncover the function of alpha-synuclein in healthy cells, which is still much debated. This functional knowledge should, in turn, contribute to researchers’ understanding of Parkinson’s and other diseases characterized by the formation of Lewy bodies rich in aggregated alpha-synuclein.

This research was funded by the National Institute of Neurological Disorders and Stroke.

VALIDADO POR LA SRA. ALBA CALLS.

Focushms.com [en línea] Cambridge (USA): focushms.com, 18 de agosto de 2011 [REF. 14 in August of 2011] Available on Internet:

http://www.focushms.com/features/new-clue-to-parkinsons/



Electronic skin to measure vital signs

15 08 2011

The border between electronics and biology starts to become blurred, According to a team of engineers and scientists who has developed an electronic artificial skin with huge potential applications in medical. Loaded with different types of sensors, the patch of artificial skin, Pastes the natural as a temporary tattoo, He has already tried with success to measure the electrical activity of the heart, the brain and muscles. Its application to replace uncomfortable electrodes and lead wires that are used for the diagnosis and cardiac monitoring, It seems obvious, but the doors that opens this new electronic artificial skin are huge: the researchers suggest, for example you may build sensors to measure brain activity in normal conditions, without vessels computers running now, so can really investigate how the brain works when the person makes normal life. Sensitive skin to prosthesis of amputated limbs or transmitters that could also be, stuck in the throat, facilitate the communication of people with injuries limiting his ability to speak. John A.. Rogers, Dae-Hyeong Kim and the rest of the authors of this feed, explain how did and the results of his first essays in the magazine Science.

“Our goal was to develop an electronic technology that closely integrate with the skin in a way that was mechanical and physiologically invisible for the user”, Rogers says in a statement of the National Science Foundation It has funded the research, along with the U.S. air force and the Department of energy. Their solution integrates two opposing worlds: the rigidity and strength typical of electronic objects and elasticity and lightness of the biological.

This electronic skin is comfortable, easy to use and effective, Thanks to its mechanical properties which are well adapted to the natural leather, so it is comfortable for the person who takes her stuck, in comparison with the usual bulky gel Coated electrodes. It is the thickness of a human hair and is primarily made of a polymer with flexibility similar to the silicone sleeves of small electronic devices. The structure of layers allows you to integrate electronic components, coils, semiconductors and insulators, wireless antennas and even solar minipaneles. The filaments have a coil configuration so that they stretch and wrinkle (as the natural leather) without damage. This skin patches adhere to the body without any glue, simply by the natural attraction of molecules of the same substance, and they seem to temporary tattoos (You can even hide under one). And they can be in any part of the body without causing skin irritation.

It is not the first artificial skin that develops, Remember Zhenqiang Ma, expert of the University of Wisconsin-Madison. Materials of this type primarily for robots that have become, with sensitivity in the hands, be able to grasp objects with force Beechwood characteristics, that is to say, the famous challenge to the machines to pick up an egg. These solutions can be applied also to provide sensitivity to the prosthesis of hands and feet. But the skin of Rogers (University of Illinois at Urbana-Champaign) and his colleagues “It is a conceptual breakthrough in the electronics that a person can and almost without noticing”, say the researchers.

They have tested its electronic skin in volunteers and have found that it works 24 hours or more in the arm, in the neck, in the front, on the cheeks and Chin. In their experiments they recorded the electrical activity generated in the muscles of the legs and then checked that the signals captured by the new skin coincided with the taken simultaneously using conventional equipment of electrodes. A patch of electronic skin in the throat of a person placed in one of the trials and the sensor could distinguish muscle movements when you spoke, which opens up the possibility of using this technology to help, for example, patients with lesions of the larynx.

The researchers explain plans that have to develop your technology, has just taken its first steps. Will be to focus, at the moment, to improve the performance of wireless communications and power. On the clinical side, they will explore new applications such as care of newborn children. But they are already looking further and think, for example, It may incorporate Microfluidics electronic skin for burn treatments and to promote wound healing.

ARTÍCULO VALIDADO POR LA SRA. ALBA CALLS

Elpais.com [en línea] Madrid (Spain): elpais.com, 15 de agosto de 2011 [REF. 11 in August of 2011] Available on Internet:

http://www.elpais.com/articulo/sociedad/Piel/electronica/medir/constantes/vitales/elpepusocsal/20110811elpepusoc_8/Tes



Design virtual patients for diagnosis of diseases

11 08 2011

A huge network of computer programs created by scientists of the University of Manchester It could revolutionize health around the world, saving lives and saving billions of euros, According to a release from the British academic institution. The work of British scientists is part of a European research project called IT future of medicine (ITFoM), with an initial duration of 10 years, whose objective is to create “Virtual patients” -computer models of individuals - which could lead to a future in which each person has their own individualized health system and to measure, Depending on your genetics and your physiology.

With this system, doctors could acquire a deep knowledge of the needs of health of each patient and all of your medical history in an instant, which would allow them to quickly and correctly diagnose diseases, saving patients potentially lethal side effects of bad prescriptions and the disbursement of large amounts of money on medicines.

Together with scientists from the University of Manchester He works a consortium consisting of more than 25 academic institutions and industrial partners with experience in ICT, life sciences, public health and medicine. As the project has progressed, will new partners have been added, making it one of the largest collaborative efforts from the space program Apollo.

Models and scenarios

The project will create mathematical models using large amounts of data concerning the knowledge which has to date of how work human beings. But not only that. It will also provide scenarios, as for example, what might happen a patient taking a particular drug if you quit to run three times a week.

Through the sequencing of the genome and clinical information, the general model will be able to adapt to the particular demands of health of any individual, including topics such as allergies, congenital malformations or their current treatments.

The first objective of ITFoM is to empower each doctor to use the individual genome of a person to be informed of all stages of the development of the disease, through the diagnosis, the treatment and its follow-up.

But to make this a reality, a large number of innovations related to ICT that are already working should materialize, as new techniques for fast acquisition and evaluation of patient data, to store and process dynamic data in real time in the mathematical models that correspond to real patients or to develop new systems of learning, prediction and information, among others. All of this would be necessary to provide healthcare professionals and patients about knowledge unprecedented in the field of health and treatment.

The role of Informatics in health

"Making personalized medicine a reality requires fundamental advances in computer science", says Hans Westerhoff, the director of the assigned part of the work to the University of Manchester. In fact, the ITFoM program arose from the belief that, Although the information and computing play an important role in many scientific areas, commercial, still not taken into account its potential to revolutionize medicine.

Professor Hans Westerhoff believes that computer models will fundamentally change the way in which health care is provided. “The system promises to be unique and innovative, because people could access their own model of health. ITFoM will provide general models of the human person as a whole, that will be used both to carry out a personalized prevention and certain therapeutic guidelines, to identify the side effects of medications. "The models will be there to help diagnose a particular problem and solutions", says.

"This is the first time systems based on information technologies seeking individual attention are combined with the needs of genomics and medicine", Hans Westerhoff concluded in the statement that his University has made public.

ARTÍCULO VALIDADO POR LA SRA. ALBA CALLS

Cronicaviva.com.PE[en línea] Lima (Peru): cronicaviva.com.PE, 11 de agosto de 2011 [REF. 9 in August of 2011] Available on Internet:

http://www.cronicaviva.com.pe/index.php/ciencia-y-tecnologia/15-ciencia-y-tecnologia/25507-disenan-pacientes-virtuales-para-diagnostico-de-enfermedades-



For the first time in the world, the Clinic applies techniques of minimal scar in the kidney for transplant from live donor

9 08 2011

 

Living donor renal transplantation, In addition to being the best option for young people affected by a certain pathologies, It has as a result higher survival of the body and solves, in part, organ shortage afflicting our country since the middle of the 90 Despite the high rate of cadaver donation. According to the National transplant organization, in 2010 they were Spain 240 Live kidney transplants, which means a 11% of the total. This year, the expectation is that this number grows to a 300, with which would be almost a few 13-15% of the total number of transplants. Opposite to these data and the need to continue searching for new surgical technologies in the evolution and improvement of transplantation, the experience of the team in minimally invasive surgery of the Hospital Clínic de Barcelona It has boosted a new avenue of improvement in living donor programs.

The work presented today the catalan hospital from the hand of the Dr. Antonio Alcaraz, Head of the Department of Urology of the Centre and his team, confirm the feasibility of surgical techniques with minimal scar (of 10 and 5 mm) applied to the transplant kidney removal. Creators and pioneers in the application of the technique NOTES (Natural Orifice Transluminal Endoscopy Surgery), an approach that seeks to develop surgery through the natural orifices of the body, the Dr team. Alcaraz uses the technique of modified transvaginal extraction (through the vagina) and transumbilical (through the belly button) renal transplant. The European Urology Journal published the first world series of kidney donors operated by transvaginal nephrectomy technique developed in our Center.

The medical equipment of the Hospital Clínic which has made this milestone possible and that have appeared this morning in a press conference, What are the Dr. Antonio Alcaraz, Chief of Urology of the Clinic; la Dra. Mª José Ribal, Head of the unit of uro-Oncology; Dr. Joan Beltran, Head of the Department of anesthesia of the Clinic Institute of Gynecology and obstetrics, the Clinic Institute of Nephrology and Urology; la Drthe Draeia Musquera, Head of the surgical unit of the Renal Transplant;and the nurse Martha Thomas. The meeting has been the presence and testimony from two donor people, man and woman, about 60 years each.

The series published by European Urology is of 30 women (have been intercepted by the technical NOTES); in the case of men, the Clinic team spoke to a total of four, operated by the so-called LESS technique (Laparo-Endoscopic Single - Site Surgery), or single-port transumbilical. The application of the technique in women (transvaginal nephrectomy) involves two routes of entry (abdomen and vagina), and two minimum scarring (abdomen), of 5 and 10 mm. In the case of men (single port nephrectomy), the route of entry is restricted to the navel (embryonic scar with barely vascularization). "Techniques of minimally invasive surgery for removal of kidneys for live donor has all the advantages that your application is": improvement of the quality of life of the donor, minimum scar, "less pain and less hospital stay", says Dr. Alcaraz.

"The surgical technique is completely reproducible and can be considered a good alternative procedure that could increase the rate of living donor in the female population", point Dr. Alcaraz. According to Dr. Rafael Matesanz, Director of national transplant organization (ONT), "it is very important to continue strengthening this technique", 100% Spanish, because it is the best opportunity for children, diabetics or young patients with Renal insufficiency, "they need as soon as possible a young features kidney".

For its part, the Dra. Roser Deulofeu, Director of the Catalan organization of Trasplantaments (OCATT), points that "the Hospital Clinic and its medical surgical transplant team", Returns to Catalonia the opportunity to remain a model for the rest of the world, giving a jump master and pioneer in the surgical technique which will cause physical injury to the renal extraction of the living donor kidney is minimal, "and a post-operative easily surmountable".

Firm commitment by minimally invasive surgery

Since conventional open surgery gave step assisted surgery by laparoscopy - requiring three, four and up to five incisions to intervene-, surgeons from the pelvic and abdominal cavity with experts in robotics, investigate new ways of entering the body to explore structures, diagnose diseases and removed bodies. The Hospital Clínic of Barcelona bets for a minimally invasive surgery, maximum that we see today with the presentation of this work, It has earned its consolidation applied to live transplantation.

In 2008 the Dr team. Alcaraz was transumbilical nephrectomy, the first of its kind carried out in Spain, made to a woman of 85 cancer diagnosed years. Three days of the operation, the patient went home without symptoms.

It is the same team that a year earlier (2007) He made the first transvaginal nephrectomy due to kidney cancer in Europe, an also minimally invasive technique that allowed removing a kidney cancer with just two small incisions in the abdomen of 1 cm. each, and one that is not visible on the inside of the vagina. Since then, Dr. Alcaraz and his team have performed many kidney extractions from the vagina, a path which is being presented today as an alternative 100% safe and effective for living donor transplants.

Until two or three years ago, Hospital Clínic Urology specialists gambled by nephrectomy assisted by laparoscopy as a technique for the surgical treatment of these pathologies; a revolutionary and entrenched technique that has achieved great results in the past eight years and that has allowed to improve the patient care on postoperative pain and stay in the hospital. However, Despite the aforementioned advantages laparoscopy continue to require, as in traditional surgery, an abdominal incision to remove the kidney, leaving a scar visible from 6 cm, approximately.

Unlike laparoscopy, with the transvaginal and transumbilical nephrectomy leverage the vaginal hole and the navel, respectively, from where the kidneys are extracted.  This technique has managed to avoid the external scars and improve patient care, with a decrease in postoperative pain and a hospital stay of just 48 hours. This milestone was made possible by an intensive programme of research in experimental surgery that develops the service of the Hospital Clínic urology and culminated with the publication.

With the development of this type of surgery, the Clínic de Barcelona consolidates as a centre of reference in the exploration of new spectra of action to achieve further progress in addressing the image guided surgery. In this sense, the program NOTES is presented as a real revolution, whose sole purpose is to benefit the patient recovery time reduction, with the least possible pain and the absence of external effects.

Catalonia, at the forefront of living donor transplants

OCATT this new surgical technique is to join the successes of this Catalonia, pioneer in organizational model of transplant from 1984 and in all corneal tissue transplant (1926) and bone marrow (1970) and solid bodies: Kidney and pancreas, 1965 and 1983 respectively in the Clinic; liver and heart in 1984 the Hospital of Bellvitge and H. San Pau respectively, and lung cancer successfully in 1990 in the Vall D'hebron University Hospital.

Catalonia, already very advanced the Decade of 2000, did virtually the 100% statewide living donor transplants, and he had such authors as teams from the Hospital Clínic and the Puigvert Foundation. The strategic plan approved by CatSalut OCATT starting at 2004 to the present day, It was made to get increasing donation and reduce waiting lists, and prioritize so the living donor transplant and donation to heart stopped. This strategy with an exhaustive control of the effectiveness of the process, It has facilitated in Catalonia increase kidney transplants and have the largest number of State, and the highest rate in the world despite the decrease in the number of donor body.

Currently, the 54% the transplant from living donor to the State are made in Catalonia, Cross transplant has donor and recipient protagonists in Catalonia and, While the 28% are living donor kidney transplants that are done in Catalonia, are only the 7% on the Spanish State.

Blog.hospitalclinic.org[en línea] Barcelona (Spain): blog.hospitalclinic.org, 8 de agosto de 2011 [REF. 4 in August of 2011] Available on Internet:

http://blog.hospitalclinic.org/es/2011/08/per-primera-vegada-al-mon-el-clinic-aplica-tecniques-de-minima-cicatriu-en-els-donants-de-ronyo-per-a-trasplantament-de-viu/?utm_source=hospitalclinic&utm_medium=web&utm_campaign=twitter_es

ARTÍCULO VALIDADO POR LA SRA. ALBA CALLS.



Discover useful biomarkers to predict the risk of brain metastases in patients with breast cancer

4 08 2011

A study coordinated by the researcher in the Group of key biological phenotype invasive and metastatic at the Instituto de Bellvitge biomedical research (IDIBELL), Sierra Angels, It shows that the overexpression of certain proteins in the primary tumor predicts the risk of developing metastasis in patients with breast cancer. The research is part of the program of projects of development of the University of Barcelona-Santander managed by the Area of valuation and licensing of the Bosch Foundation i Gimpera. The results are published in the August issue of the magazine The American Journal of Pathology.

So far not known predictors of brain metastasis, complication affecting to a 30% of patients with breast cancer who develop metastases. These biomarkers allow the prediction of the risk in patients with ErbB2-positive tumors (the ErbB2 oncogene amplification) as triple negative tumors (estrogen receptor, negative, progesterone and ErbB2 receptor). Its use would be particularly beneficial for cataloging such patients, two subgroups that are more likely to develop brain metastases, and in which the involvement of the central nervous system drastically delimits the survival of the patients.

Biomarkers of metastasis

The use of markers of brain metastasis will contribute to monitoring and personalised treatment of patients. On the one hand, know the presence of the biomarker help plan aimed at early diagnostic scans; and, On the other hand, the overexpression of these proteins may indicate the use of therapies, either to prevent or to treat the brain metastasis, other than those that apply at this time, some of them in the process of clinical development.

The work has been the result of applying systems biology to the systematization of information Transcriptomics and proteomics, to generate protein-protein interaction networks that define the characteristic of breast cancer cells phenotype with ability to metastasise in brain.

The study conducted by the Angels Sierra researcher of the laboratory of pathogenesis of the Metastasis of the biological key of the invasive and metastatic IDIBELL phenotype group has been possible thanks to the close collaboration of clinicians and biomedical research in three countries. Together with researchers from IDIBELL, have participated in clinical trials of the functional breast unit and unit of Biostatistics and Bioinformatics of l'Institut Català of Oncology of the Hospital Duran i Reynals; Service of neurosurgery, Anatomical pathology department and Institute of neuropathology of the Bellvitge University Hospital; Structural bioinformatics at the Universitat Pompeu Fabra group; Network of Bank of tumours of Catalunya and Hospital clinical/IDIBAPS pathological anatomy Department. They have also participated French scientists of the Institute Curie of the Centre René Huguenin de St Cloud, and of the Curie Institute in Paris, and the Department of pathology of the Academic Medical Center in Amsterdam.

The work has been funded by the European Union, the Ministry of science and education, the Instituto de Salud Carlos III and the Xarxa Bancs Tumors of Catalunya.

The validation of these results in a large number of clinical specimens (around 300) you are performing with funding from the University of Barcelona-Santander recovery projects program, managed by the Fundació Bosch i Gimpera (Center for knowledge transfer, Technology and innovation at the University of Barcelona), cuyos resultados se esperan obtener a principios de septiembre.

The article reference

Sanz-Pamplona R.*, Aragües R., Driouch K., Martín B.*, Oliva B., Gil M., Boluda S.*, Fernández P.*, Martínez A.*, Moreno V., Acebes J.*, Lidereau R., Reyal F., Van de Vijver M. And Sierra A.*. Expression of Endoplasmic Reticulum StressProteins Is a Candidate Marker of Brain Metastasis in both ErbB-2_ and ErbB-2_ Primary Breast Tumors. The American Journal of Pathology, Vol. 179, No. 2, August 2011

ARTÍCULO VALIDADO POR LA SRA. ALBA CALLS.



Dr MARTINEZ: Customization of health services by the clouds

1 08 2011

Dr. José Ángel Martínez Usero

Director of projects and international relations, Technosite -Fundación ONCE

 

The technological trend based on Cloud Computing (Cloud computing) It opens new possibilities for the development and management of telemedicine/health online personalized and adapted to all users, regardless of its context, need, preference or capacity.

In recent years technological breakthroughs in the field of telemedicine have been developed, However continues to persist the technological barrier. Services are designed for a "patient model" which does not exist and that is difficult to model, Since each user of health services is different. Therefore, the great outstanding telemedicine issue (In addition to the security) It consists of the provision of services adapted to the needs, preferences and capabilities of the end-user.

The customization or adaptation of interfaces to each individual has been explored much and there are different methods (web applications, mobile devices, smart cards), to help you select the best interface for a given user. Above all, the emergence of cloud-based services (cloud-based services) You can represent a great step forward and realize services customizing individual to individual, saving large costs for management and technology providers.

A short term market tendency

Despite the immaturity of the market, the consulting firm IDC forecasts that in 2012 a 18% Spanish companies will use software as a service (SaaS), one of the parts that make up the current offer of the cloud computing. For that date, the business of Cloud Computing in Spain could move around the 1.870 million euros. Although the power vendors (Amazon, Google, Microsoft, IBM, VMWare and Salesforce, among others) They monopolize much of the global and local market, in Spain you are creating a local industry around cloud computing. It stands out among the advantages of this way of consuming technology in the cloud, the cost savings because the companies do not have to buy hardware, licensing, operating systems, etc. Organizations simply connect via a browser and use it. The same would have to do the users of health services. Therefore, they have already begun to glimpse the possibilities of offering customized health products and services, that it can be distributed to a large number of clients simultaneously, safe and efficient.

A large audience that offer services

Broadly speaking, end users of potential products and cloud computing-based online health services can be the entire population. However, It should be noted that those who benefit the most from custom and accessible services are people with disabilities and older. Therefore, It is important to note that already are it does not attack a niche market (users with a disability type) If not broad masses of population.

In numeric data, those users who benefit most by the new services would be:

  • In Spain, almost 4.1 millions of people with a disability and 7.5 millions of older people's 65 years. Therefore, a few 10 millions of people and about the 40% of the population, directly or indirectly.
  • In Europe, almost 44.6 millions of people with disabilities in 2008 and for the people of 65 years,projected an increase of 84.6 millones en 2008 a 151.5 million in 2060.

Therefore, a very comprehensive and with much demand for individual services market.

A European strategy

Offering innovative health services, can be adapted and customized to the needs and preferences of all users is directly linked with the European strategy for Cloud Computing in the context of the Digital Agenda for Europe. The Digital Agenda[1] It also encourages different actions in the field of health online (eHealth) with the goal of creating a sustainable and care based on ICT for independent living. One of the key actions is to provide European citizens a secure online access to their health information to 2015 and achieve a widespread deployment of telemedicine services for 2020. Obviously, It seems that the cloud-based services will be the Foundation for future services of telemedicine in 2020.

A conducive national context

The context of innovation in social technology in Spain is very good, given that the conditions for the business, the public administration and the scientific environment to lead the development of inclusive technology at European level, for the following reasons:

  • There are ambitious laws on social, that mean a favourable framework for the development of such technologies (Dependency Act, Law of equal opportunities, non-discrimination and universal accessibility, etc.)
  • Society and in particular the collective of people with disabilities and older is very well organized, with organizations such as VETRI, CERMI, CEAPAT, etc., or centres of reference in accessibility (CENTAC, INTECO).
  • There are institutions of relevance with force to lead the research, and even technological platforms such as eVia.
  • Financing for r & d management includes objectives, dedicated to social and inclusive technology.
  • AENOR carries out intense activity of standardisation in ICT and accessibility. In addition, He has recently created the Subcommittee 38 for Standardization on web services, SOA and cloud computing.

Some pilot experiments

Customization of cloud computing-based services and taking into account the needs, preferences and capabilities of end users has been led in the international arena for the initiative GPII[2] (Global Public Infrastructure including[J1] ), an Alliance which is to ensure that all citizens, regardless of its context or capabilities, they can access services and the potential of the knowledge society.

The GPII Europe version is called Cloud4all and is composed of a series of projects and initiatives on a European scale that contribute to the development of global infrastructure and the development of personalized services that serve as a guide for motivating and dynamic part of the market and the industry.

Then it is possible??

Taking into account the technological trends, the evolution of the market, European strategies and the national context it seems obvious that in a few years we will have custom through the cloud services of telemedicine and eHealth.

But at the moment, I have the following questions (among others...):

  • We are patients ready for this type of service??
  • are the health professionals ready to interact in different ways with patients??
  • is the industry developer and provider of health services to new innovations in cloud-based services??
  • How is the new landscape and custom online health services market??
  • These services will be more expensive or less expensive than the traditional ones??