Better Lupus Treatments on the Horizon

(HealthDay News) -- High-tech research into better, safer ways to treat the autoimmune disease lupus is building up steam, a group of scientists report.

Striking an upbeat tone, researchers from across the United States spoke at a teleconference Tuesday hosted by the Lupus Research Institute (LRI) of the improving outlook for patients with systemic lupus erythematosus.

"Today, we do have therapies that work," conference moderator Dr. Lee Simon, an associate clinical professor of medicine at Harvard Medical School in Boston, said. "So, while in the 1950s, 95 percent of people were dead within five years of diagnosis, today, 95 percent of patients survive five years out. But the treatments we have carry a heavy toxic burden. So, we need new drugs that work as well, if not better, with less harsh side effects."

"Today, I'm incredibly excited," added Simon, who has also served as a division director for the U.S. Food and Drug Administration. "We are now in a period of time when the development of molecular technology has given us the tools to dissect and tease out some aspects of the disease and identify biomarkers. That means that where previously we tended to treat the symptoms of patients, now we're trying to treat what actually drives the disease," he said.

Other researchers included in the teleconference hailed from the University of California, Los Angeles, the University of Chicago, Rush-Presbyterian-St. Luke's Medical Center (RPSLMC), and the Salk Institute of Biological Studies.

Lupus is a chronic and sometimes fatal autoimmune disease that affects upwards of 1.5 million Americans, according to LRI figures.

The disease usually strikes between the ages of 15 and 44, with 90 percent of patients being women. Hispanic, Asian and Native American women appear to have a higher risk of developing the disease, while blacks seem to face both a higher risk and a more severe prognosis once diagnosed.

The incurable and often-disabling condition strikes different patients in differing ways, making it difficult to screen and diagnosis. Lupus involves a hyperactive immune system that assaults otherwise healthy organs, such as the kidney, brain, heart, lungs and skin, as well as joints and blood.

According to Simon, patients typically experience fatigue and a general malaise, while further plagued by skin rashes and sensitivity to sunlight. Arthritis affects 90 percent of lupus patients, while 50 percent face serious kidney disease. Alongside respiratory complications, as many as one-third of patients develop cardiovascular complications.

The current standard of treatment typically involves nonsteroidal anti-inflammatory drugs (NSAIDs), anti-malarials and steroids.

Immunosuppressive medications -- such as azathioprine and cyclosporine -- are also used to dampen an immune system gone haywire. However, such regimens, while effective, can provoke severe side effects.

Conference attendees said that, until very recently, doctors and patients have been stuck in a treatment rut that has left them with few alternative prospects by way of treatment development.

"There hasn't been a new therapy approved for the treatment of lupus in over 40 years," Dr. Robert S. Katz, a rheumatologist with RPSLMC, said during the teleconference.

The problem, noted Simon, is that for many years, lupus was handled like an "orphan" disease, with the pharmaceutical industry largely ignoring it because of its relative rarity and the fear of not making a profitable return on drug-development costs.

This, despite the fact that more Americans are diagnosed with lupus than with cerebral palsy, multiple sclerosis, sickle-cell anemia, cystic fibrosis, or AIDS, LRI statistics indicate.

But the lupus research scene has undergone a renaissance, the experts said.

"It's a horse race," Katz said. "There are now 27 drug companies that are working on new lupus medicine. And the new therapies are more targeted therapies. They're not immune tranquilizers."

In fact, a new lupus information Web site -- established by the LRI this past May -- highlights 15 research trials that are currently under way. Many of the studies are for effective drugs with fewer side effects.

"I think one of the reasons that there is a measure of excitement in lupus and in other complex diseases that we've been confronted with for a long time is the advent of a whole series of new molecular tools that allow us to address basic issues," Salk molecular neurobiology professor Greg E. Lemke told reporters.

He pointed especially to the sequencing of the human genome and the use of genetically altered animal models as innovations that are boosting lupus research.

In one innovation, researchers led by Philip Low, of Purdue University in West Lafayette, Ind., say they've developed what could be a vaccine against lupus. Reporting in the Sept./Oct. issue of Molecular Pharmaceutics, the team said the shot reduced disease, cut down on kidney damage and extended the survival of laboratory mice with the illness.

This and other new research is raising expectations, the researchers said.

"Our goal should be trying to get remission in patients with lupus," UCLA's Dr. Bevra Hahn, chief of rheumatology in the School of Medicine, noted during the teleconference. "Patients all tend to accept what I call 'simmering' disease. There is fatigue, the patient never feels good, but they're not in danger, and we accept that as OK. I think it's time for both people who have the disease and physicians who treat them to do better."

Everyone agreed that heeding this advice will require an enormous public support --both in terms of continued financial investment and in enrolling patients in clinical trials.

The optimism is there, however.

"I'm a rheumatologist by training, and I've been seeing patients since 1978," Simon said. "And I'm much, much more encouraged than in the past about where we're heading. It's a very exciting time. The confluence of science, technology, and patient advocacy will allow all this to move forward."

More information
For additional information on lupus research, visit the Lupus Research Institute.

Fruits, Veggies Won't Lower Colon Cancer Risk

(HealthDay News) -- Although eating lots of fruits and vegetables is good for your health, doing so will not reduce your risk for colon cancer, a Canadian study finds.

But fruits and veggies can still help ward off heart diseases and other cancers, one expert says.
"We know that fruits and vegetables are healthy and help prevent chronic diseases, especially cardiovascular disease," said Marji McCullough, a nutritional epidemiologist at the American Cancer Society. "Eating fruits and vegetables also helps prevent weight gain, which is also related to chronic disease including cancers," she added.

Those include cancers of the mouth and pharynx, esophagus, stomach, colon-rectum, larynx, lung, ovary, bladder and kidney.

In their review of the data, a team led by Anita Koushik, from the University of Montreal, looked at the link between eating fruits and vegetables and the risk for colon cancer. Koushik's team pored over data from 14 studies that included more than 756,000 men and women followed for between 6 to 20 years.

The report was published in the Sept. 25 issue of the Journal of the National Cancer Institute.
The researchers found that eating fruits and vegetables was not strongly associated with overall colon cancer risk.

However, among people who ate the largest quantities of fruits and vegetables, they did find a possible associated with a lower risk of cancer of the distal colon -- the left-hand side of the colon. But this association was not statistically significant, they noted.

"Results were consistent between men and women," Koushik's group added.

"The consumption of fruits and vegetables was not strongly associated with the risk of colon cancer overall but was inversely associated with the risk of distal colon cancer," they wrote.

"Diets plentiful in fruits and vegetables remain important given these findings and the benefits that have been observed for other health outcomes, including cardiovascular disease and some other cancers," the team concluded.

McCullough agreed. "This finding doesn't change the bottom line," she said. "You should eat a diet high in a variety of fruits and vegetables," she said.

On the other hand, eating red and processed meat is associated with an increased risk for colon cancer, McCullough added.

More information
Get the American Cancer Society's recommendations on food and fitness.

Mother's Blood Could Offer Insights Into Fetal Health

(HealthDay News) -- Just a small amount of a mother-to-be's blood could become the lens through which doctors monitor various stages of fetal health and development, a new study suggests.

"It's amazing that all these pregnant women are walking around with the answers in their blood," said Dr. Jill L. Maron, the study's lead author and an assistant professor of pediatrics at Tufts-New England Medical Center, in Boston.

Maron was referring to the fetal genetic material (mRNA) that, according to the study, circulates in a pregnant woman's blood prior to birth. The ability to open this window on fetal status by taking a sample of the mother's blood "can advance the field of prenatal diagnosis," she said.

It could also represent an important advance in the prenatal diagnosis of genetic diseases and genetic monitoring of fetal development because it wouldn't require invasive procedures, such as amniocentesis.

Another advantage of being able to detect fetal mRNA in the mother-to-be's bloodstream is that "it's dynamic," meaning that the biomarkers expected to be found would vary with time and stage of fetal development, Maron added.

DNA is the genetic material that's common to every cell, Maron said. RNA determines what is transcribed from the DNA to make an eye cell different from, say, a hair cell, she said.

"RNA is more real time. RNA changes all the time, according to the stage of development. That dynamic nature is what we're targeting," Maron said.

The researchers said they proved the presence of fetal mRNA in maternal blood in three ways.
Before delivery, the researchers found that the whole blood of nine mothers included fetal genes, such as those for development, sensory perception, and neonatal physiology.

Then the researchers established that these fetal genes found in the mother's blood were unique to the fetus by also identifying them in umbilical-cord blood.

Finally, within 24 to 36 hours after delivery, these fetal genes were no longer found in the mother's blood, providing additional confirmation that they were unique to the fetus, according to the study.
The study was published online Sept. 20 in The Journal of Clinical Investigation.

Dr. Michael Katz, director of research and global programs for the March of Dimes, said the key result of this research may be that it "holds hope for a very safe technique [for prenatal screening] that involves only taking blood from the mother."

Another expert agreed. Dr. Roberto Romero is chief of the perinatology research branch at the National Institute of Child Health and Human Development, part of the U.S. National Institutes of Health, which funded the study.

Romero said the study has "the potential to change the content of prenatal care by adding a new dimension of information. Specifically, the study of fetal mRNA in the maternal circulation can provide information about fetal function, development and response to insults [that] is not available today."

The next step will be to see what fetal mRNA is present in maternal blood in earlier stages of pregnancy, and then to measure the differences in mRNA between an uncomplicated pregnancy and a complicated one.

Romero characterized fetal medicine as the "terra incognita of medicine in the 21st century." He said ultrasound made "the human fetus visible and thus a patient who can be examined, diagnosed, and treated. However, the human fetus remains the most difficult patient in medicine," he added, "because it's relatively inaccessible and it presents diagnostic challenges which are difficult to solve within the womb."

"The study of fetal mRNA in maternal blood can provide information which is neither available or easy to obtain through other means that can help diagnose and likely treat [fetal] conditions that cannot be identified today," Romero said.

More information
For more on genetics and pregnancy, visit the March of Dimes.

Obesity Won't Affect Seniors' Memory

(HealthDay News) -- Being overweight or obese doesn't increase the odds that seniors will experience memory trouble, a new study finds.

"While past studies have found obesity in middle age increases a person's risk for dementia or Alzheimer's disease, our finding shows obesity in old age has no effect on a person's memory.

These findings are consistent with previous studies showing that weight loss or low body mass index in old age may be a precursor of cognitive decline in Alzheimer's disease," study author Dr. Maureen T. Sturman, a researcher at the Rush Institute for Healthy Aging, said in a prepared statement.

The six-year study included more than 3,800 people over the age of 65. Of those, nearly 25 percent were obese (body mass index over 30), and 37 percent were overweight (BMI between 25 and 29.9). Participants underwent cognitive tests at regular intervals over the course of the study.

Overweight or obese people did not experience significantly different changes in memory or cognitive function compared to those with normal weight. In fact, the researchers found that underweight people had more cognitive decline.

The study is published in the Sept. 19 online issue of the journal Neurology.

"We do not know yet why being overweight or obese does not increase the risk of cognitive decline in old age; however, being underweight may be a correlate of the initial stages of Alzheimer's disease," Sturman said.

More information
The American Academy of Family Physicians has more about age-related memory loss.

Eggs: Likely Cause of Infertility in Obese Women

The research findings – using female mice – have been made by PhD student Cadence Minge in the University of Adelaide’s Research Centre for Reproductive Health.

Her research has also discovered a way to completely reverse the effects of obesity on mouse eggs, enabling afflicted eggs to develop into healthy embryos. "Consuming a diet high in fat causes damage to eggs stored in female ovaries.

As a result, when fertilised, these eggs are not able to undergo normal, healthy development into embryos," Minge says. Minge has discovered that a protein in the cells surrounding, supporting and nourishing the egg – called Peroxisome Proliferator-Activated Receptor gamma (PPARγ) – is the main reason behind diet-induced infertility.

"The behaviour of this protein helps to determine the way in which the ovaries sense and respond to fats," Ms Minge says. "Being able to control this protein will be very important in the quest to reverse infertility caused by poor diets."

Minge's research has found that when the protein is selectively targeted with the anti-diabetes drug rosiglitazone the adverse effects of obesity on egg quality are completely reversed. "The drug enables us to switch on the protein, thereby changing the way in which the ovaries sense and respond to fats.

Embryo development rates are restored, and the cellular differentiation of the early embryo is improved," Minge says. However, Minge warns that rosiglitazone should not be seen as a "quick fix" for infertile women. "The rosiglitazone findings are of great significance for scientists researching egg maturation within the ovary.

But at this stage, the research findings have only been made in mice. Also, the drug itself can have possible harmful side-effects, and more research is needed to find other, safer ways of activating the protein," she says.

Source: University of Adelaide

Health Tip: When Acupuncture May Help

(HealthDay News) -- Acupuncture is an ancient Chinese procedure in which points on the body are stimulated using a number of very fine needles.

Here are conditions and symptoms that may benefit from acupuncture, courtesy of the U.S. National Center for Complementary and Alternative Medicine:

• Nausea triggered by chemotherapy or surgery.
• Menstrual cramps, low back pain or headaches.
• Fibromyalgia or osteoarthritis.
• Asthma.
• Carpal tunnel syndrome or tennis elbow.
• Stroke rehabilitation.
• Addiction.

Speak to your doctor to find out if acupuncture may be right for you.

Saturated Fat: Even a Little Splurge May Be Too Much

(HealthDay News) -- How bad can it be to indulge in an occasional meal or snack loaded with saturated fat?

How about bad enough to diminish your body's ability to defend itself against heart disease.

A recent study by researchers at the University of Sydney in Australia found just that reaction after 14 trial participants, all healthy and between the ages of 18 and 40, ate just one piece of high-fat carrot cake and drank a milkshake.

That fat-laden feast compromised the ability of the participants' arteries to expand to increased blood flow, the researchers found. The sudden boost in what's known as saturated fat hampered the effects of so-called "good" cholesterol, the high-density lipoprotein or HDL, from doing its job -- to protect the inner lining of the arteries from inflammatory agents that promote the build-up of fatty plaques. It's this plaque that, over time, clogs blood vessels and causes heart disease.

"Saturated-fat meals might predispose to inflammation of, and plaque buildup in, the vessels," said study leader Dr. David Celermajer, Scandrett professor of cardiology at the Heart Research Institute and the Department of Cardiology at Royal Prince Alfred Hospital.

Celermajer's team had the volunteers eat two meals, spaced one month apart. Each meal consisted of a slice of carrot cake and a milkshake. But, in one case the foods were made with saturated fat, and in the other case the meal was made with polyunsaturated safflower oil, a much healthier choice.

The high-fat meal, which contained about 90 percent saturated fat, had the equivalent of 68 grams of fat. In contrast, the meal made with polyunsaturated oil contained just 9 percent fat.

The fat in the high-fat meal was equivalent to a 150-pound man or woman eating a double cheeseburger, a large order of french fries, and drinking a large milkshake, the researchers said.

Before and after each of the meals, the researchers obtained blood samples from the participants so they could evaluate whether the anti-inflammatory properties of the so-called good HDL cholesterol had decreased.

The anti-inflammatory properties did decrease after the saturated fat meal, the researchers said, but improved after the healthier polyunsaturated fat meal.

The effects may be temporary, Celermajer said. However, he's still concerned because the effect may be occurring over and over, each time a person eats a high-fat meal.

The study was published in the Journal of the American College of Cardiology.

The message is clear, Celermajer said: It's important to limit saturated fat intake as much as possible.

To do that, you've first got to know where saturated fat lurks, said Jeannie Moloo, a Sacramento, Calif., dietitian and a spokeswoman for the American Dietetic Association.

She suggests cutting down on meat, full-fat milk and full-fat dairy products as a way to reduce saturated fat. Those foods are all major sources of saturated fat, Moloo said. So are processed foods and snacks.

Switching to low-fat or non-fat dairy products can minimize your total saturated fat intake, Moloo said. Choosing foods wisely by reading the Nutrition Facts label can help, too. For instance, Moloo said, an ounce of regular cheddar cheese contains 6 grams of saturated fat, while an ounce of part-skim mozzarella contains less than half that, or 2.9 grams.

Ice cream contains a lot of saturated fat, Moloo tells her patients. For instance, she said, one cup of vanilla soft-serve ice cream has 13.5 grams of saturated fat. But some low-fat ice cream bars contain just 1.5 grams of saturated fat.

How much saturated fat per day is too much? Aim for 10 percent or less of your daily calories from saturated fat, Moloo suggested. The American Heart Association sets the bar for saturated fat at less than 7 percent of daily calories.

For instance, if your total calorie goal is 2,000 a day -- reasonable for moderately active adults -- you should aim for no more than 20 grams of saturated fat to keep your intake to 10 percent or so. While few people will take the time to add up their fat grams, doing so for a day or two can give you an idea of how you are doing.

More information
To learn more about saturated fats, visit the USDA Dietary Guidelines.

Studies Shed New Light on Breast Cancer, Treatment

(HealthDay News) -- New studies from the first annual Breast Cancer Symposium shed light on racial differences in breast cancer, how not sticking with treatment can affect survival, and how nagging side effects cause people to stop their therapies.

The symposium, held in San Francisco, is co-sponsored by the American Society of Breast Disease, the American Society of Breast Surgeons, the American Society of Clinical Oncology, the American Society for Therapeutic Radiology and Oncology, the National Consortium of Breast Centers, and the Society of Surgical Oncology.

An estimated 180,000 new cases of breast cancer will be diagnosed in the United States in 2007, and more than 40,000 people will die from the disease. After lung cancer, breast cancer is the second leading cause of cancer death in women.

Although the overall incidence of breast cancer is lower in black women than white women, survival rates are lower among black women. Black women also have a higher incidence of the disease at younger ages and tend to be diagnosed at later stages.

Experts point to socioeconomic factors as the reason for much of this discrepancy, but, as one study presented at the meeting showed, the tumor's biology also plays a role.

After analyzing data on more than 170,000 cases of breast cancer in both black and white U.S. women, investigators concluded that, among invasive cancers, estrogen receptor (ER)-negative tumors were significantly more frequent in black women at all stages of the disease and in all age categories.

ER-negative tumors have a less favorable prognosis than ER-positive tumors, which have more treatment options.

Thirty-nine percent of black women had ER-negative tumors compared with 22 percent of white women.

Black women were also diagnosed at a younger age (57 years of age on average for black women versus 62 for white women) and at a later stage of the disease (29 percent of black women were stage 1 versus 42 percent of white women).

"We need to understand this better, to give these women as good an outcome as we can," said study lead author Dr. M. Catherine Lee, a clinical lecturer in the department of surgery at the University of Michigan Comprehensive Cancer Center in Ann Arbor, at a Wednesday teleconference.

A second study found that 10 percent of women filled 70 percent or less of their prescriptions for tamoxifen, a drug taken by many cancer survivors to prevent recurrences.

Tamoxifen has been shown to reduce the recurrence of ER-positive breast cancer when used after primary treatment. Women who often skipped tamoxifen had a 16 percent increased risk of death compared to women who filled all their prescriptions, the researchers noted.

Although the study did not look specifically at why women were dropping the treatment, side effects may play a role.

"Most women who take tamoxifen know it can have substantial and life-affecting side effects such as hot flashes, which can make life misery," said Dr. Alastair Thompson, lead author of the study and a professor of surgical oncology at the University of Dundee in Scotland. "It could be that those sorts of side effects we've downplayed in the past are factoring in," he said.

"Taking your pills really matters," added Dr. Julie Gralow, moderator of the teleconference and associate professor of medical oncology at the University of Washington School of Medicine in Seattle.

A third and final study found that 13 percent of women taking aromatase inhibitors -- drugs that inhibit the production of estrogen for ER-positive breast cancer patients -- stopped this treatment due to musculoskeletal side effects such as rotator cuff tendonitis, carpal tunnel syndrome and osteoarthritis.

Overall in the trial, 42 percent of women reported some sort of musculoskeletal side effect.

"There were a surprising number of women who stopped therapy," acknowledged Dr. N. Lynn Henry, study lead author and a clinical lecturer at the University of Michigan Comprehensive Cancer Center. "But we were unable to find predictive factors. We need more research."

It was also unclear why the aromatase inhibitors were causing these aches and pains.

"We need to acknowledge that this is something that is truly affecting our patients, and we need to figure out the mechanism for these symptoms and how best to manage them so our patients can get this important treatment," Gralow said.

Most of the women who discontinued treatment with aromatase inhibitors switched to another therapy, Henry said.

More information
For more on breast cancer, head to the U.S. National Cancer Institute.

Blood Pressure Drug Combo Helps Diabetic Hearts

(HealthDay News) -- Using a combination of diuretics and ACE inhibitors to manage blood pressure in people with type 2 diabetes can help protect against heart disease, according to new data released Sunday.

The combined therapy, administered as part of a worldwide study known as ADVANCE, reduced the risk of dying from heart disease by 18 percent.

"If the benefits seen in ADVANCE were applied to just half the population with diabetes worldwide, more than a million deaths would be avoided over five years. For these reasons, there is now a case for considering such treatment routinely for patients with type 2 diabetes," study author John Chalmers, from The George Institute at the University of Sydney in Australia, said in a prepared statement.

By 2030, an estimated 350 million people will be living with diabetes worldwide. Heart disease kills two out of three people with diabetes, who are at increased risk of stroke, heart attacks and related conditions such as degenerative eye disease. Blood pressure management is recommended to reduce the risk of heart disease.

The new findings comes from the ADVANCE trial, which tracked more than 11,100 people with type 2 diabetes from 215 medical centers in 20 countries for four years.

The participants, all 55 or older, received either a combination of the ACE inhibitor perindopril and the diuretic indapamide or a placebo.

Over the course of the four years, the researchers found that people with the combined therapy had an average reduction in systolic blood pressure of 5-6 mm Hg and diastolic blood pressure of 2 mm Hg compared with the placebo group.

People who got the combined therapy were 9 percent less likely to have a heart disease event, such as stroke or heart attack, over the treatment period. They were also 18 percent less likely to die from heart disease and 14 percent less likely to die from any cause.

The researchers noted that the impact of the combined therapy occurred regardless of the participants' blood pressure at the beginning of the study.

The study was released online Sunday by The Lancet to coincide with a presentation of the research at the European Society of Cardiology meeting in Vienna.

In an accompanying commentary in the journal, Dr. Norman Kaplan, a hypertension expert from the University of Texas Southwestern Medical Center at Dallas, had a caution on the findings.

"The fixed combination of perindopril and indapamide could be the best possible protector against hyper-tension-related consequences for patients with type 2 diabetes, but I believe that other drugs, if they lower blood pressure as much and do not have metabolic side-effects, would be as protective as this combination treatment," he said.

And he added, "As has been said many times before by many experts: In most circumstances, lowering the blood pressure is what counts, not the way by which it is lowered."

More information
To learn more about diabetes and heart disease, visit the American Diabetes Association.