New Biological Pathway Identified for PTSD

High blood levels of a hormone produced in response to stress are linked to post-traumatic stress disorder in women but not men, a study from researchers at Emory University and the University of Vermont has found.

The results were published in the Feb. 24 issue of Nature.

The hormone, called PACAP (pituitary adenylate cyclase-activating polypeptide), is known to act throughout the body and the brain, modulating central nervous system activity, metabolism, blood pressure, pain sensitivity and immune function. The identification of PACAP as an indicator of PTSD may lead to new diagnostic tools and eventually, to new treatments for anxiety disorders.

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â€œFew biological markers have been available for PTSD or for psychiatric diseases in general,â€ says first author Kerry Ressler, MD, PhD, associate professor of psychiatry and behavioral sciences at Emory University School of Medicine and a researcher at Yerkes National Primate Research Center. â€œThese results give us a new window into the biology of PTSD.â€

BPH, Inflammation and Depression: Chicken or the Egg

Data collected during a recent study by researchers at Emory University School of Medicine and published in the journal Urology, show a significant link between benign prostatic hyperplasia (BPH) and depression.

Researchers have been aware for a long time that depression is a common illness that accompanies inflammatory diseases such as heart disease, diabetes and cancer.Â Recent evidence has suggested that depression also might be associated with BPH, another disease with inflammatory components.

Studies have not directly examined the relationship between depression and BPH explains study investigator, Viraj A. Master, MD, associate director in the Department of Urology at Emory. â€œBPH and depression both affect a significant number of men worldwide. This is the first study to show a direct association between the two illnesses.â€

Study data showed that almost three-quarters of the participants without depression presented with mild or moderate symptoms, while more than two thirds of the depressed patients had moderate or severe symptoms.

The data raises questions about whether the severity of symptoms is due to depression, or if the depression is causing the symptoms to worsen, says lead author, Timothy V. Johnson, MD. He points out that several studies have demonstrated depression in the setting of cardiovascular disease and cancer actually worsens these chronic disease states.

The study also raises the question of whether or not the depression simply causes patients to perceive their symptoms to be much worse than patients with the same degree of illness.

The researchers stress that further studies are imperative to address comorbid depression in the presence of BPH so that treatment can be appropriately managed.

Timothy V. Johnson, lead author, was an Emory School of Medicine student when the trial was conducted. Johnson is currently a resident at Columbus Regional Hospital in Columbus, Ga.

Other investigators include Ammara Abbasi, Samantha S. Ehrlich, Renee S. Kleris, Siri L. Chirumamilla, Evan D. Schoenberg, Ashli Owen-Smith, Charles L. Raison and Virag A. Master from the Departments of Urology and Psychiatry and Behavioral Sciences at Emory University School of Medicine, and the Department of Behavioral Sciences and Health Education at Emory University Rollins School of Public Health.

Posted on March 1, 2011 by Wendy Darling in Neuro Leave a comment

Research

Emory Fellow and Heart Transplant Survivor Rides in Rose Parade

Dr.Shih and her husband Chad Aleman, MD, decorating and dedicating a rose on the actual float prior to the parade.

Jennifer Shih, MD, a current Fellow in the Department of Allergy and Immunology at Emory University School of Medicine and a heart transplant survivor, was an honored guest on the Donate Life float in the 2011 Rose Parade.

Dr. Shih, second from left, riding on the Donate Life float, which won the trophy for best theme

Dr. Shih was one of five winners who received a trip to Pasadena, California, and an opportunity to be in the Rose Parade through an essay contest sponsored by Astellasâ€™ Ride of a Lifetime.

In 2004, after Dr. Shih had completed three years of pediatric residency to fulfill her dream of becoming a pediatric cardiologist, her world was suddenly turned upside down.

She was on call one night Cincinnati Childrenâ€™s Hospital when she started feeling tired and short of breath. She knew something was wrong. Instinctively, she performed an echocardiogram and found fluid around her heart.Â Shih diagnosed herself with a heart condition, giant cell myocarditis.

Her condition quickly deteriorated and within a week of being hospitalized, she was told she would die without a heart transplant. She was placed on a BiVAD (Bi-ventricular Assist Device) to keep her alive.

Less than two weeks after self-diagnosis, she received a life-saving heart transplant.

Although she wasnâ€™t able to practice pediatric cardiology anymore due to the activity and risk of infection exposure post-transplantation, she was able to change her specialty to allergy and immunology. Shih says her experience makes her a more empathetic doctor because she truly understands what it is like to be a patient.

Along with her family and friends, Shih created the Have a Heart Benefit Fund in 2004, which raises money to provide patient care, education and research the transplant field.Â She says she has always loved helping people, and she felt this would be a great way of showing her appreciation to donor families.

â€œI would not be alive today without my gift of life. I am a testament to the impact becoming an organ donor can be. You can have the opportunity to save eight lives in one day by being an organ donorâ€¦ how many of us would have that opportunity otherwise?â€ Shih asks.

Read Jenniferâ€™s winning essay.

Posted on February 21, 2011 by Wendy Darling in Uncategorized 1 Comment

Clinical trial for patients with atrial fibrillation tests implantable device in place of blood-thinning drug

Clinical Trial for Patients with A-fib

A new clinical trial underway for patients with atrial fibrillation will test an implantable device in place of a common blood-thinning medication, according to researchers at Emory University Hospital Midtown.

Atrial fibrillation (commonly called A-fib) is a heart condition in which the upper chambers of the heart beat too fast, causing an irregular heartbeat and ineffective pumping action. This condition can cause blood to pool and form clots in the left atrial appendage (LAA). If a clot forms in this area, it can increase the chances of having a stroke.

Many patients with A-fib are prescribed blood-thinning medications, such as warfarin (brand name Coumadin), to prevent blood from clotting. This medication is effective in reducing the risk of stroke, but may cause side effects such as bleeding. It also requires frequent blood draws to monitor dosage levels.

The trial, called PREVAIL (Prospective Randomized EVAluation of the Watchman LAA Closure Device In Patients with Atrial Fibrillation Versus Long Term Warfarin Therapy), involves implanting a small, umbrella-shaped mesh device called the Watchman closure device, into the heart chamber via catheter. This is a confirmatory study (and the third study testing the implant), which will also look at safety and efficacy of the device.

David De Lurgio, MD, associate professor of medicine in the Division of Cardiology, Emory University School of Medicine, is the principal investigator of the trial. He explains that by implanting this device into the left atrial appendage of the heart, it closes that area off. That, in turn, prevents blood clots from escaping and entering the blood stream, which could lead to a stroke.

Patients are randomly selected by computer to either receive the device or remain on Coumadin without the device (control group). Those selected to receive the device will remain on Coumadin for 45 days following implant. If the heart tissue has healed after those 45 days, participants will be taken off Coumadin and placed on aspirin therapy and possibly clopidogrel (Plavix), an anti-platelet medication.

Researchers will then follow study patients with and without the device for five years, monitoring those who are no longer taking Coumadin very closely. If the FDA approves the device at the end of this clinical trial, participants in the control group will then have the option to receive the device.

De Lurgio and his colleagues have had five years of experience with this technology, thus far. Emory Healthcare is the only health system in Georgia providing access to this device through participation in this clinical trial.

For more information, please call 404-686-2504.

Posted on February 18, 2011 by admin in Uncategorized Leave a comment

Fact or Fiction when it comes to colds

Congested, tired, coughing, icky… Itâ€™s a rare human being who hasnâ€™t experienced a cold.

We take our miserable selves to the pharmacy and, in our cold stupor, we stand in front of the â€œcold and fluâ€ aisle trying to figure what cold remedy actually works â€“ or do any of them work? And how did we end up with this lousy cold anyway?!

In a CNN.com Health article, Emory physician Dr. Sharon Bergquist discusses how colds are transmitted, how long a cold should last, what makes people resistant and what treatments work.

Posted on February 16, 2011 by Wendy Darling in Uncategorized Leave a comment

One reason why SIV-infected sooty mangabeys can avoid AIDS

Sooty mangabeys are a variety of Old World monkey that can be infected by HIV’s cousin SIV, but do not get AIDS. Emory immunologist and Georgia Research Alliance Eminent Scholar Guido Silvestri, MD, has been a strong advocate for examining non-human primates such as the sooty mangabey, which manage to handle SIV infection without crippling their immune systems. Silvestri is division chief of microbiology and immunology at Yerkes National Primate Research Center.

Research shows sooty mangabeys have T cells that can do the same job as those targeted by SIV, even if they don't have the same molecules on their surfaces

A recent paper in the Journal of Clinical Investigation reveals that sooty mangabeys have T cells that perform the same functions as those targeted by SIV and HIV, but have different clothing.

Silvestri and James Else, the animal resources division chief at Yerkes, are co-authors on the paper, while Donald Sodora at Seattle Biomedical Research Institute is senior author.

One main target for SIV and HIV is the group of T cells with the molecule CD4 on their surfaces. These are the “helper” T cells that keep the immune system humming. Doctors treating people with HIV infections tend to keep an eye on their CD4 T cell counts.

In the paper, the scientists show that sooty mangabeys infected with SIV lose their CD4 T cells, without losing the ability to regulate their immune systems.Â What’s remarkable here is that sooty mangabeys appear to have “double negative” or DN T cells that can perform the same functions as those lost to SIV infection, even though they don’t have CD4.

CD4 isn’t just decoration for T cells. It’s a part of how they recognize bits of host or pathogen protein in the context of MHC class II (the molecule that “presents” the bits on the outside of target cells). Somehow, the T cells in sooty mangabeys have a way to get around this requirement and still regulate the immune system competently. How they do this is the topic of ongoing research.

The authors write:

It will be important to assess DN T cells in HIV-infected patients, particularly to determine whether these cells are preserved and functional in long-term nonprogressors. These efforts may lead to future immune therapies or vaccine modalities designed to modulate DN T cell function. Indeed, the main lesson we have learned to date from this cohort of SIV-infected CD4-low mangabeys may be that managing immune activation and bolstering the function of nontarget T cells through better vaccines and therapeutics has the potential to contribute to preserved immune function and a nonprogressive outcome in HIV infection even when CD4+ T cell levels become low.

Posted on February 15, 2011 by Quinn Eastman in Immunology Leave a comment

A good reason to enjoy a little Valentineâ€™s Day chocolate

From the Clinic to You

BY CHERYL WILLIAMS, RD, LD

If you’re looking for an excuse to indulge in the yummy chocolate you get this Valentine’s Day, research suggests it may not be so bad for you.

A number of studies, conducted over the last decade have associated cocoa and dark chocolate consumption with heart health benefits. These benefits come from cocoa, derived from the cacao plant, which is rich in flavonoids (cocoa flavanols to be exact). Flavonoids are antioxidants also found in berries, grapes, tea, and apples. As a whole, antioxidants prevent cellular damage and inflammation which are two major mechanisms involved in the development of heart disease.

So what does the research say?

A study published in the American Journal of Clinical Nutrition found that high-flavanol dark chocolate reduced bad cholesterol (LDL) oxidation and increased good cholesterol (HDL) levels. LDL oxidation promotes the development of plaque and hardening of the coronary arteries, thus lessening oxidation could help to prevent heart disease.

A Harvard research study found that flavanol-rich cocoa induced nitric-oxide production, which causes blood vessels to relax and expand, thus improving blood flow. Improved coronary vasodilation could potentially lower the risk of a cardiovascular event.

In a double-blind randomized Circulation study flavonoid-rich dark chocolate (containing 70% cocoa) reduced serum oxidative stress and decreased platelet activity (clumping) in heart transplant recipients. This favorable impact on vascular and platelet function is relevant because vascular dysfunction and platelet activation (adhesion upon damaged cell wall) are the basis of atherothrombosis (blood clotting) and coronary artery disease.

How can you reap chocolateâ€™s potential benefits?

Not all cocoa products and/or chocolates are created equal. Milk chocolate, for example, is not rich in flavanols (contains only 10-20% cocoa solids) and white chocolate contains none at all. In addition, some cocoa products and chocolates are processed with alkali, which can destroy flavanols.

Follow these tips for heart healthy chocolate consumption:

Avoid cocoa products processed with alkali (dutched) as seen in the ingredient list
Choose dark chocolate with at least 70% cocoa
Enjoy 100% unsweetened non-dutched cocoa (great for hot chocolate!)

Also, remember that chocolate is not a health food, as it is high in calories, fat and added sugar. Thus, make room for dark chocolate by cutting extra calories elsewhere in your diet. Additionally, stick to small amounts (e.g. 1 ounce) and do not eat in place of plant-based whole foods such as vegetables and fruits.

Cheryl Williams is a registered dietitian at the Emory Heart & Vascular Center. She provides nutrition therapy, wellness coaching, monthly nutrition seminars and healthy cooking demonstrations working with the Emory HeartWise Cardiac Risk Reduction Program.

Posted on February 12, 2011 by admin in Uncategorized 2 Comments

Emory/Georgia Tech: partners in creating heart valve repair devices

Vinod Thourani, associate professor of cardiac surgery at Emory School of Medicine, along with Jorge Jimenez and Ajit Yoganathan, biomedical engineers at Georgia Tech and Emory, have been teaming up to invent new devices for making heart valve repair easier.

At the Georgia Bio and Atlanta Clinical and Translational Science Institute’s second annual conference on academic/industry partnerships, Thourani described how he and his colleagues developed technology that is now being commercialized.

Apica Cardiovascular co-founders (l-r) James Greene, Vinod Thourani, Jorge Jimenez and Ajit Yoganathan

Apica Cardiovascular was founded based on technology invented by Jimenez, Thourani, Yoganathan and Thomas Vassiliades, a former Emory surgeon.

Thourani is associate director of the Structural Heart Program at Emory.

Yoganathan is director of the Cardiovascular Fluid Mechanics Laboratory at Georgia Tech and the Center for Innovative Cardiovascular Technologies.

The technology simplifies and standardizes a technique for accessing the heart via the apex, the tip of the heart’s cone pointing down and to the left. This allows a surgeon to enter the heart, deliver devices such as heart valves or left ventricular assist devices, and get out again, all without loss of blood or sutures.

Schematic of transapical aortic valve implantation. The prosthesis is implanted within the native annulus by balloon inflation.

At the conference, Thourani recalled that the idea for the device came when he described a particularly difficult surgical case to Jimenez.Â Thourani said that a principal motivation for the device came for the need to prevent bleeding after the valve repair procedure is completed.

With research and development support from the Coulter Foundation Translational Research Program and the Georgia Research Alliance VentureLab program, the company has already completed a series of pre-clinical studies to test the functionality of their device and its biocompatibility.

Posted on February 8, 2011 by Quinn Eastman in Heart 1 Comment

University-industry partnerships: a matter for cautious aggressiveness

Emory President James Wagner was keynote speaker last week at the 2011 Academic & Industry Intersection Conference sponsored by Georgia Bio and the Atlanta Clinical & Translational Science Institute (ACTSI). The conference focused on ethical issues in translating academic research into commercial drugs and medical devices.

Wagner pointed out the great power these relationships hold for the service of humanity, provided they are properly structured and managed. He recommended â€œcautious aggressivenessâ€ by both universities and industry.

We should incorporate ethical considerations into our partnerships so that the practice of ethics is not â€œrestrictive and paralyzing, but instead becomes part of the design criteria motivating our success, not restricting it.

Wagner is co-chair of President Obamaâ€™s Commission for the Study of Bioethical Issues. The commission lists five principles with broad application for biomedical translational research: public beneficence; responsible stewardship; intellectual freedom and responsibility; democratic deliberation; and justice and fairness.

He emphasized that researchers should guard against personal conflicts of interest and ensure against any compromise of research objectivity. But he cautioned against the temptation to value the process of ethics more highly than the ethical principles themselves, and the temptation to substitute compliance for true ethical practice.

Is it possible that we and our partners have come to place too much faith in documented protocols, and that excessive regulatory burden may give investigators a false sense of absolution of their own responsibility to exercise judgment and ethical practice? he asks.

â€œHow does that square with the moral imperative to bring new knowledge that can benefit individuals and society to practice as soon as possible? Wouldn’t it be unethical to withhold the application of such knowledge if it is known to be able to do good?â€

Ethical practice should not be an afterthought, Wagner emphasized, but instead a deeply understood and critical part of design and protocol and procedure — where the exercise of expert judgment goes beyond regulatory compliance.

â€œA challenge to all of our universities is to advance an ethics education that will bring heightened abilities to our investigators and their partners with the goal…of establishing even more trusting partnerships that can bring technology more safely and swiftly…from the minds of creative investigators, to the laboratory bench, to the manufacturing assembly line, to the vendor’s shelves, and to the bedside.â€

Posted on February 8, 2011 by admin in Uncategorized 1 Comment

Study Finds Injection Drug Users Who Live Nearer to Syringe Exchange Programs Are Less Likely to Engage in HIV Risk Behaviors

Hannah Cooper, ScD

Injecting drugs is one of the main ways people become infected with HIV in the United States. It is also the main way of becoming infected with the hepatitis C virus (HCV). Injection drug users (IDUs) become infected and transmit the viruses to others through sharing contaminated syringes and through high-risk sexual behaviors. Now a new study published in the American Journal of Public Health offers evidence that proximity to legal syringe exchange programs and pharmacies selling over the counter syringe plays a role in reducing the risk of HIV and Hepatitis C transmission in the U.S.

In a longitudinal study, Hannah Cooper, ScD assistant professor in the Department of Behavioral Sciences and Health Education at Emory Universityâ€™s Rollins School of Public Health and colleagues studied the behaviors of more than 4000 drug injectors from across 42 New York City health districts beginning in 1995 to 2006. The scientists set out to determine if the relationship of spatial access to syringe exchange programs and pharmacies selling over-the-counter syringes affected the likelihood that local injectors engaged in less HIV risk behaviors.

â€œIt is a well-established fact that syringe exchange programs reduce HIV and related risk behaviors among injection drug users. Here, what we find is that proximity to a syringe exchange program is a powerful determinant of whether injectors inject with sterile syringes,â€ says Cooper.

The CDC estimates an individual injection drug user injects as many as 1,000 times a year. This adds up to millions of injections across the country each year, creating an enormous need for reliable sources of sterile syringes. Syringe exchange programs provide a way for those IDUs who continue to inject, to safely dispose of used syringes and to obtain sterile syringes at no cost. Many U.S. cities have just one or two syringe exchange programs, but Cooper and her team found IDUs with access to these services in their local neighborhoods were more likely to inject with sterile syringes.

â€œOur findings suggest that having a syringe exchange program in your neighborhood matters. We need to dramatically scale up the number of syringe exchange programs operating in U.S. cities to increase the number of injectors who live near such a program,â€ says Cooper.

Posted on February 3, 2011 by Wendy Darling in Uncategorized 1 Comment

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