Juliette Merchant

Blood biomarkers may help predict risk in stroke and TBI


Biomarkers circulating in the bloodstream may serve as a predictive window for recurrent stroke risk and also help doctors accurately assess what is happening in the brains of patients with acute traumatic brain injury (TBI).

Michael Frankel, MD

Researchers at Emory University School of Medicine, led by principal investigator Michael Frankel, MD, Emory professor of neurology and director of Grady Memorial Hospital’s Marcus Stroke & Neuroscience Center, are studying biomarkers as part of two ancillary studies of blood samples using two grants from the National Institutes of Health.

In the $1.47 million, four-year grant called “Biomarkers of Ischemic Outcomes in Intracranial Stenosis” (BIOSIS), Emory researchers are analyzing blood samples from 451 patients from around the country who were enrolled in a study known as SAMMPRIS (Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis), the first randomized, multicenter clinical trial designed to test whether stenting intracranial arteries would prevent recurrent stroke.

Researchers in the SAMMPRIS study recently published their results in the New England Journal of Medicine, showing that medical management was more effective than stenting in preventing recurrent strokes in these patients. Frankel’s BIOSIS research team is using blood samples from these same patients to continue learning more about the molecular biology of stroke to predict risk of a stroke occurring in the future.

“Our goal is to learn more about stroke by studying proteins and cells in the blood that reflect the severity of disease in arteries that leads to stroke. If we can test blood samples for proteins and cells that put patients at high risk for stroke, we can better tailor treatment for those patients,” says Frankel.

Patients with narrowed brain arteries, known as intracranial stenosis, have a particularly high risk of disease leading to stroke. At least one in four of the 795,000 Americans who have a stroke each year will have another stroke within their lifetime. Within five years of a first stroke, the risk for another stroke can increase more than 40 percent. Recurrent strokes often have a higher rate of death and disability because parts of the brain already injured by the original stroke may not be as resilient.

The other study, “Biomarkers of Injury and Outcome in ProTECT III” (BIO-ProTECT)” is a $2.6 million, five-year NIH grant in which Frankel’s team will use blood to determine what is happening in the brain of patients with acute TBI.  The blood samples are from patients enrolled in the multicenter clinical trial ProTECT III (Progesterone for Traumatic brain injury, Experimental Clinical Treatment), led by Emory Emergency Medicine Professor, David Wright, MD, to assesses the use of progesterone to treat TBI in 1,140 patients at 17 centers nationwide.

In the BIO-ProTECT study, Emory is collaborating with the Medical University of South Carolina, the University of Pittsburgh, the University of Michigan and Banyan Biomarkers.

TBI is the leading cause of death and disability among young adults in the US and worldwide. According to the Centers for Disease Control and Prevention, approximately 1.4 million Americans sustain a traumatic brain injury each year, leading to 275,000 hospitalizations, 80,000 disabilities, and 52,000 deaths.

Acute TBI leads to a cascade of cellular events set in motion by the initial injury that ultimately lead to cerebral edema (swelling of the brain), cellular disruption and sometimes death. Tissue breakdown leads to the release of proteins into the bloodstream. These proteins may serve as useful biomarkers of the severity of the injury and perhaps provide useful information about response to treatment.

Using the large patient group in the ProTECT III trial, the researchers hope to validate promising TBI biomarkers as predictors of clinical outcome and also evaluate the relationship between progesterone treatment, biomarker levels and outcome.

“If we can better determine the amount of brain injury with blood samples, we can use blood to help doctors better assess prognosis for recovery, and, hopefully whether a patient will respond to treatment with progesterone,” says Frankel.

Posted on by Juliette Merchant in Neuro Leave a comment

March for Babies – March for Hope

As parents we hope all babies are born with a healthy start in life, after a full 37 – 40 weeks in the womb. Sadly, every year more than half a million babies are born prematurely in the United States. The rate of premature birth has risen by 30 percent since 1981 according to the March of Dimes. It’s not clear why some babies are born before full gestation – before their lungs, brains or other organs are fully developed. Thousands don’t live to celebrate their first birthday as a result.

In Georgia more than 400 babies are born too soon each week.  Dr. William Sexson, a neonatologist and professor of pediatrics at Emory University School of Medicine and March of Dimes Prematurity Campaign Chair witnesses the effects of preterm birth every day.  He says, “Premature birth is the leading cause of infant mortality. Babies born just a few weeks too soon are at increased risk for newborn health complications, such as breathing problems, can face serious health challenges and are at risk of lifelong disabilities.”

On Saturday April 30, 2011, a legion of more than 10,000 families and business leaders from across Georgia will band together for the March of Dimes annual “March for Babies.” With more than 30 “March for Babies” events planned throughout the state, the annual affair is the nation’s oldest walk fundraiser dedicated to preventing premature birth, birth defects and infant mortality.

“March for Babies” supports research and educational programs aimed at helping women have healthy babies. Funds raised from the “March for Babies” event will support prenatal wellness programs, critical research and community grants, along with local resources such as the Angel II neonatal transport unit at Grady Memorial Hospital.

Most pregnancies last around 40 weeks. Babies born between 37 and 42 completed weeks of pregnancy are called full term. Babies born before 37 completed weeks of pregnancy are called premature. “Women who have hypertension and diabetes are at higher risk to have preterm babies or babies with health problems,” says Sexson.

According to the March of Dimes, the most urgent infant health problem in the U.S. today is premature birth. It affects more than half a million babies each year and is the leading cause of newborn death within the first month of life. Last November, the March of Dimes issued a Report Card on Premature Birth, giving the nation a “D” and Georgia, the grade of “F.”  Sexson adds, “We have a long way to go before all babies in America get a healthy start in life and we are committed to working with state health officials, hospitals and health care providers to continue to fight for preemies.”

The March of Dimes is the leading nonprofit organization with its mission to improve the health of babies by preventing birth defects, premature birth and infant mortality.

For more information, or to participate in “March for Babies” visit marchofdimes.com.

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Risk of death, stroke in postmenopausal women using antidepressants

Older women taking antidepressants could be at increased risk of stroke and death according to the authors of the Women’s Health Initiative (WHI) study. Cardiologist Nanette K. Wenger, MD, professor of medicine, division of cardiology, Emory School of Medicine, and chief of cardiology at Grady Memorial Hospital, is a co-author of the study published in the Dec. 14 issue of Archives of Internal Medicine.

Nanette K.Wenger, MD

Nanette K.Wenger, MD

The researchers report that postmenopausal women who reported taking an antidepressant drug had a small but statistically significant increase in the risk of stroke and of death compared with participants not taking antidepressants. They say the results of the study are not conclusive but do signify a need for additional attention to patients’ cardiovascular risk factors.

Depression is a serious illness with increased risk for cardiovascular disease and other health risks. The researchers stress that no one should stop taking their prescribed medication based on this one study as antidepressants have been proven lifesaving for some patients. Because of their potential for negative effects on heart function, tricyclic antidepressants are used less frequently. In contrast, selective serotonin reuptake inhibitor (SSRI) antidepressants have fewer side effects in general and are known to have aspirin-like effects on bleeding, which doctors say could protect against clot-related cardiovascular disorders.

Since the use of antidepressants has increased greatly in recent years and since older women are also at risk for cardiovascular disease, a team of researchers from several academic medical centers examined the link between antidepressant use and cardiovascular disease in such patients.

The WHI study followed more than 160,000 postmenopausal women in the United States for up to 15 years, examining risk factors for and potential preventive measures against cardiovascular disease, cancer and osteoporosis.

The authors call for additional research, says Wenger, because the study does not confirm whether this risk truly is attributable to the drugs and not to depression itself and whether participants were being treated for depression or for anxiety, which also has cardiovascular risks. Above all, patients should talk with their physicians about individual concerns and risk factors to determine the benefits of various treatment options, Wenger notes.

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Lupus expert hosts live chat on medications Nov. 23

Today, S. Sam Lim, MD, assistant professor of medicine, Emory School of Medicine, and chief of rheumatology at Grady Memorial Hospital, will host a live chat on the Lupus Foundation of America website to help educate people with lupus about the need to adhere to their medications as prescribed.

Sam Lim, MD

S. Sam Lim, MD

Lim heads two lupus clinics and is involved in several federal, state and privately funded projects, including the CDC-funded Georgia Lupus Registry. He also serves on the Medical Scientific Advisory Committee of the Lupus Foundation of America and its Georgia Chapter.

Lupus (systemic lupus erythematosus, or SLE) is a chronic inflammatory disease that can affect various parts of the body, especially the skin, joints, blood, and kidneys. The potentially life-threatening autoimmune disease affects an estimated 1.5 million Americans.

Medications cannot cure lupus, but they play an important role in managing the signs and symptoms of lupus and can often prevent or slow organ damage. Medication treatment for lupus often involves reaching a balance between preventing severe, possibly life-threatening organ damage, maintaining an acceptable quality of life and minimizing side effects.

Because most lupus symptoms are caused by inflammation, nonsteroidal anti-inflammatory drugs (NSAIDs) and antimalarial medications are usually enough to reduce symptoms, says Lim. Medications range in strength from mild to extremely strong, and often several drugs are used in combination to control the disease.

According to a new study published in the journal Arthritis Care and Research, depression is a leading reason why patients with systematic lupus erythematosus (SLE) may not take their medication.

Good communication between people with lupus and their doctors is essential to ensure effective management of the medicines that are prescribed, says Lim. An array of drug therapies is now available, and more than 30 clinical studies are underway of potential new treatments for lupus. Lim recently received a $1 million grant from the Georgia Department of Human Resources to continue his work gathering data for the five-year-old Georgia Lupus Registry, the largest, most comprehensive population-based lupus registry in the country.

Join Lim on his live chat today.

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Emory HIV/AIDS experts lends voice to reach out

The latest CDC statistics on HIV/AIDS estimate more than 1.1 million persons in the United States are living with diagnosed or undiagnosed HIV/AIDS. HIV gradually attacks the immune system and causes AIDS, the final stage of HIV infection.

It can take years for a person infected with HIV to reach this stage. Having AIDS means that the virus has weakened the immune system to the point at which the body has a difficult time fighting infection. Early HIV diagnosis is vital, so people who are infected can fully benefit from available live-saving treatments.

David Malebranche, MD

David J. Malebranche, MD

This critical message is the foundation of a new campaign titled “Treatment is Power.” David J. Malebranche, MD, MPH, assistant professor of medicine at Emory University School of Medicine and internist at Grady Memorial Hospital is an expert voice for the campaign by Gilead Sciences. Listen to Malebranche on a public service announcement (MP3).

Malebranche says opportunity is unique in reaching people living with HIV. It is geared toward reducing the stigma and fear associated with taking medications that slow down the virus and helps individuals realize the many quality of life improvements associated with early treatment.

As a nationally recognized speaker and advocate, the idea that “treatment is power” is not a new theme for Malebranche. Fostering a close working doctor-patient relationship is one Malebranche aggressively promotes at the Ponce Infectious Disease Center – a local AIDS clinic in downtown Atlanta, where he delivers comprehensive care to uninsured patients living with HIV/AIDS.

He says early treatment is an essential part of the fight against HIV.

From 2006-2008, Malebranche served on the Presidential Advisory Council on HIV/AIDS, which provides recommendations to the President and the U.S. Department of Health and Human Services regarding national and international HIV/AIDS programs and policies. He conducts research exploring the social, structural and cultural factors influencing sexual risk-taking and HIV testing practices among black men.

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Raising awareness for sickle cell disease

September is National Sickle Cell Awareness Month, and when it comes to assessing and treating sickle cell disease, there is no other place in the world like the Georgia Comprehensive Sickle Cell Center at Grady Memorial Hospital.

James R. Eckman, MD

James R. Eckman, MD, with a patient

Led by James R. Eckman, MD, pioneering medical director and professor of medicine at Emory School of Medicine, the Center is the world’s first 24-hour comprehensive primary care clinic for patients with sickle cell syndromes. It is comprised of a multidisciplinary team with the a mission to educate and provide preventative and comprehensive primary care, while responding to sickle cell emergencies quickly and efficiently.

Millions of people worldwide suffer from the affects of sickle cell anemia – especially those of African, Mediterranean and Indian descent. According to CDC, more than 70,000 people in the United States have sickle cell disease, mostly African Americans. Each year more than 1,000 babies are born with sickle cell disease.

The inherited disorder affects the blood’s hemoglobin, which produces stiff, misshapen red blood cells that deliver less oxygen and can disrupt blood flow, resulting in joint and organ damage and potential clots and strokes. The sickling of red blood cells is aggravated by infections, extreme hot or cold temperatures, poor oxygen intake, not drinking enough fluids and stress.

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