Nox-ious link to cancer Warburg effect

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Viral vectors ready for delivery

The phrase “viral vector” sounds ominous, like something from a movie about spies and Internet intrigue. It refers to a practical delivery system for the gene of your Read more

Exotic immune systems are big business

Research on lampreys’ variable lymphocyte receptors may seem impractical. Good examples exist of weird animals' immune systems becoming big Read more

Posttraumatic stress disorder fed by avoidance

Service members returning from war historically have been haunted by traumatic memories related to combat. Problems can arise when these troublesome memories are suppressed instead of being confronted.

The military trains its service members well for combat, but teaching each individual how to deal emotionally with the trauma that comes with it is a challenge that has yet to be resolved. Unfortunately, many of those brave men and women have trouble admitting or recognizing an emotional problem. They tend to believe that avoiding troublesome memories is the best solution and do not come forward for help.

Once a service member returns home from a war zone, symptoms caused by haunting memories can arise and begin to interfere with every day activities. When those symptoms last for more than four weeks, it is likely that individual has posttraumatic stress disorder (PTSD).

Emory researcher Barbara Rothbaum, PhD, professor of psychiatry and behavioral sciences, Emory School of Medicine, and director of the Trauma and Anxiety Recovery Program, has been treating military personnel with posttraumatic stress for more than a decade, helping them to learn how to deal with the troubling memories. Through exposure therapy, the service members are taught that by re-living the traumatic event, they can begin to handle those memories when they surface.

Rothbaum is also a pioneer in exposure therapy using virtual reality software that was developed for both Vietnam veterans and service members returning from the war in Iraq.

Military commanders recognize that symptoms of PTSD are not as obvious as a physical injury, but nonetheless just as important, and they are ready to develop programs to quickly identify and treat active duty service members and veterans who are showing symptoms of PTSD before they worsen, says Rothbaum.

PTSD is treatable and treatments vary from exposure therapy to medication to meditation techniques. Symptoms include reliving the event; avoiding situations that stir up memories of the event; discomfort expressing feelings; being constantly on the lookout for danger; irritability; drinking or drug problems and employment, social and relationship problems.

More information on PTSD is available from the U.S. Department of Veterans Affairs. A clinical trial taking place at Emory uses virtual reality therapy for military personnel from Iraq who have PTSD.

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Congrats to the telomere/ribosome Nobelists

Congratulations to Elizabeth Blackburn, Carol Greider and Jack Szostak for the 2009 Nobel Prize in medicine. The award is for their work on telomeres, the protective caps on the ends of chromosomes that shorten with every cell division and need specialized enzymes to be replenished.

Greider, Blackburn and Szostak discovered telomerase, the enzyme that copies the ends of chromosomes using a special RNA template. Telomerase is turned off in most human cells, but cancer cells often must reactivate it so that they can keep dividing like crazy.

The discovery of telomerase has led to new leads for potential anticancer drugs. This is a good example of the impact basic research can have on medicine, since the prize-winners were not thinking about anticancer drugs in the 1980s when they were doing their work.

Telomeres are specialized protective structures at the ends of chromosomes

Telomeres are specialized protective structures at the ends of chromosomes

The telomere trio’s work relates to several lines of research at Emory.

Immunologist Cornelia Weyand and her colleagues have shown that the telomeres of T cells are abnormally shortened in patients with rheumatoid arthritis. In effect, their cells’ chromosomes are prematurely aged. This result provides some hints on how to treat autoimmune diseases.

If blood-forming stem cells can’t keep their telomeres in shape, they can’t continue to regenerate the blood. Pathologist Hinh Ly’s research has made a connection between genetic defects in telomere maintenance and bone marrow failure syndrome in human patients.

Geneticists Christa Martin and David Ledbetter have been probing the relationship between mutations or recombination in the regions of the chromosome adjacent to telomeres and developmental disorders such as autism and mental retardation.

The 2009 Nobel Prize in Chemistry, awarded to Venki Ramakrishnan, Tom Steitz and Ada Yonath, has an even stronger connection to Emory. Christine Dunham, part of a growing contingent of crystallographers here, worked on ribosome structure in Ramakrishnan’s lab at the MRC.

The ribosome is a machine that decodes mRNA and produces protein step by step

The ribosome is a machine that decodes mRNA and produces protein step by step

She is examining the molecular details of how antibiotics and viruses perturb ribosome function.

What the two Nobels have in common is that they both honor work on molecular machines containing RNA, connections to the ancient, shadowy “RNA world“.

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Heart and depression: learning from twins

Just like diabetes and hypertension, depression is a prevalent medical condition that is highly treatable. However, if ignored, it appears to increase the risk for heart disease. Researchers at Emory are continuing studies related to the link between depression and heart disease as a result of a 2-year, $1.5 million grant from the National Institutes of Health (NIH) through the 2009 American Recovery and Reinvestment Act.

Lead investigator, Viola Vaccarino, MD, PhD, professor of cardiology at Emory School of Medicine, is looking at the relationship between depression and heart disease, specifically researching the potential mechanisms.

Vaccarino says although depression has been implicated as a risk factor for heart disease for many years, there is still question whether this is a causal association or whether there are other reasons why people who are depressed may be more likely to get heart disease. Clarification of these mechanisms will improve our understanding of the disease and ultimately point to more effective primary prevention strategies for the identification and treatment of high-risk individuals.

Vaccarino and her team will study twin males born between 1946 and 1956 from the Vietnam Era Twin Registry comparing one twin who has depression and one who does not. She says this is almost a natural experiment, allowing researchers to separate out genetics and influences from the environment or behavior.

Vaccarino will be looking at myocardial blood flow measured with PET, a common imaging technique of the heart. It can quantify exactly how much blood is going to the coronary arteries in the heart and carefully determine if depression is associated with decreased blood flow to the heart.

This grant builds on a previous project looking at the same population of twins and allows researchers to bring these twins back and compare two time points. Researchers measured myocardial blood flow with PET a few years ago and will now be able to monitor progression of heart disease over time

Learn more about Emory’s stimulus grant funding.

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Preparing for H1N1

James Steinberg, MD

James Steinberg, MD

With the novel H1N1 virus gaining a foothold in the northern hemisphere, anxious doctors, researchers and members of the public are carefully watching its movement and behavior.

Even before WHO declared novel H1N1 a pandemic late last spring, Emory University had been readying for its arrival. James Steinberg, MD, chief medical officer at Emory University Hospital Midtown, has been at the forefront of that preparation.

“A few years ago a decision was made to fund a center for emergency preparedness and response,” says Steinberg. “Having CEPAR, headed by Dr. Alex Isakov, gave us a leg up on preparing for this pandemic. Concern about the avian flu a few years ago sparked a pandemic plan and an antiviral plan. Having those plans on board helped us hit the gate running with the swine flu.”

To listen to Steinberg’s own words about novel H1N1 and its effect on the current flu season, access Emory’s new Sound Science podcast.

An expert in infectious disease, Steinberg says three key factors go into the making of a pandemic. “A virus can cause a pandemic when it can cause significant disease, when it’s a new virus to which people don’t have any immunity, and when the virus has the capacity to spread from person to person,” Steinberg says. “The novel H1N1 virus appears to meet all three of these characteristics.”

Steinberg cautions that the word pandemic has a horrible connotation. “We think of the 1918 pandemic that killed 50 to 100 million people worldwide, more people than were killed during World War I itself,” says Steinberg. “But there are pandemics in which the bumps in mortality have been modest.”

The H1N1 virus spreads from person to person via large droplets, the ones that fall quickly onto surfaces. These viruses can be spread by being close to an infected person who is coughing or sneezing or by touching contaminated surfaces. That’s why hand washing reduces the chance of infection.

Thus far, the novel strain of H1N1 has been relatively mild. Most of those infected have recovered without hospitalization or medical care, but according to the CDC some groups are at higher risk and should be vaccinated first. These include pregnant women, people who live with or care for children younger than 6 months of age, healthcare and emergency medical services personnel, persons between the ages of 6 months and 24 years, and people ages 25 through 64 who have chronic health conditions.

Initial supplies of the nasal mist H1N1 vaccine are expected to be available this week, followed soon by the injectable vaccine. The regular seasonal flu vaccine will not provide protection against the novel H1N1 strain, so people will need both vaccines.

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Stopping teen dating violence a priority for Jane Fonda

Jane Fonda, founder/chair of the Georgia Campaign for Adolescent Pregnancy Prevention (GCAPP), along with local teenagers and Atlanta community groups have launched the Start Strong: Building Healthy Teen Relationships Program. Its goal is to stop teen dating violence and abuse before it starts.

The Jane Fonda Center at Emory was chosen as one of 11 community organizations nationwide to receive $1 million in funding through the Robert Wood Johnson Foundation’s national Start Strong initiative. This is the largest national public health initiative ever funded, targeting 11-to-14-year-olds, to stop teen dating violence.

Jane Fonda speaks at the event

Jane Fonda speaks at the event

Fonda says the initiative, both locally and nationally, promises to educate and empower teens and their surrounding communities that dating violence and abuse among teenagers must be stopped before it ever starts.

With teen dating abuse a significant public health issue in this country, Fonda wants to focus on teaching young people to develop healthier and more positive relationships at an early age.

As part of this four-year initiative, Start Strong Atlanta will rally the entire community, including teenagers, parents, caregivers, educators, coaches and community leaders to build environments that support healthy relationships and ensure violence and abuse are never tolerated.

Students perform at the Start Strong event

Students perform at the Start Strong event

Melissa Kottke, MD, MPH, assistant professor in the Department of Gynecology and Obstetrics, Emory School of Medicine, is the director of the Jane Fonda Center. She notes that October is Domestic Violence Awareness Month and the campaign’s launch was the perfect tie-in. Kottke is also the principal investigator of the national initiative at Emory.

The Jane Fonda Center along with its partners, Atlanta Public Schools and Grady Memorial Hospital Teen Services Program, have together developed a comprehensive community plan for this initiative. This plan will focus on four core strategies involving education, policy change, community outreach and social marketing campaigns to empower local teens to develop healthier relationships.

Learn more about Start Strong Atlanta and other related events going on during Domestic Violence Awareness Month. Find out what Fonda said about the event on her blog.

Posted on by Janet Christenbury in Uncategorized 1 Comment

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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Ventricular assist devices offer hope for heart failure

Emory doctors are leaders in a “destination” therapy program using ventricular assist devices for failing hearts.

The United Network for Organ Sharing says there are more than 2,900 Americans, 43 in Georgia, who are awaiting a heart transplant. Regardless of the number of donor hearts available, however, many patients are not candidates for a heart transplant for a variety of reasons including cancer, personal and religious beliefs, blood clotting problems, and other debilitating health conditions.

Right now there are about 5 million Americans who suffer from congestive heart failure, with another half million diagnosed each year. Many individuals are limited by the severity of their heart failure, yet are not able to be transplanted for one of many reasons.

With so many people awaiting precious few donor hearts, doctors are working to provide access to Ventricular Assist Devices (VADs). VADs are small pumps that are implanted into the chest cavity and help pump a heart that is no longer able to function properly on its own. This offers new hope and a greater quality of life for individuals who are not transplant candidates, patients who do not want a transplant or for people who may be transplant eligible in the future.

Many patients use VADs as a bridge to transplant – meaning they rely on the device temporarily until a donor heart can become available. Others are candidates for VADs as destination therapy, which means a patient is not a candidate for heart transplant or simply does not want a heart transplant – often because of religious or personal ethical reasons.

David Vega, MD

David Vega, MD

David Vega, MD, professor of surgery, Emory University School of Medicine, and director of Heart Transplantation/Mechanical Circulatory Support at Emory University Hospital, leads the pioneering VAD program. He says VAD destination therapy allows patients to resume many basic activities that they were unable to perform before the VAD.

Recently, Emory University Hospital’s VAD program recently the “Gold Seal of Approval” from The Joint Commission, which accredits nearly 16,000 health care organizations and programs in the United States. Emory’s VAD program is the only certified program of its kind in Georgia. Learn more about Emory’s heart transplant program and its 500th patient.

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Evolution doesn’t run backwards: Insights from protein structure

“The past is difficult to recover because it was built on the foundation of its own history, one irrevocably different from that of the present and its many possible futures.”

Whoa. This quote comes from a recent Nature paper. How did studying the protein that helps cells respond to the stress hormone cortisol inspire such philosophical language?

Biochemist Eric Ortlund at Emory and collaborator Joe Thornton at the University of Oregon specialize in “resurrecting”and characterizing ancient proteins. They do this by deducing how similar proteins from different organisms evolved from a common root, mutation by mutation. Sort of like a word ladder puzzle.

Ortlund and Thornton have been studying the glucocorticoid receptor, a protein that binds the hormone cortisol and turns on genes in response to stress. The glucocorticoid receptor is related to the mineralocorticoid receptor, which binds hormones such as aldosterone, a regulator of blood pressure and kidney function.

If these receptors have a common ancestor, you can model each step in the transformation that led from the ancestor to each descendant. But Ortlund says that protein evolution isn’t like a word ladder puzzle, which can be turned upside-down: “You can’t rewind the tape of life and have it take the same path.”

The reason: Mutations arise amidst a background of selective pressure, and mutations in one part of a protein set the stage for whether other ones will be viable. The researchers describe this as an “epistatic rachet”.

Mutations that occurred during the transformation between the ancestral protein (green) and its descendant (orange) would clash if put back to their original position.

Mutations that occurred during the transformation between the ancestral protein (green) and its descendant (orange) would clash if put back to their original position.

This work highlights the increasing number of structural biologists like Ortlund, Christine Dunham, Graeme Conn and Xiaodong Cheng at Emory. Structural biologists use techniques such as X-ray crystallography to figure out how the parts of biology’s machines fit together. Recently Emory has been investing in the specialized equipment necessary to conduct X-ray crystallography.

As part of his future plans, Ortlund says he wants to go even further back in evolution, to examine the paths surrounding the estrogen receptor, which is also related to the glucocorticoid receptor.

Besides giving insight into the mechanisms of evolution, Ortlund says his research could also help identify drugs that activate members of this family of receptors more selectively. This could address side effects of drugs now used to treat cancer such as tamoxifen, for example, as well as others that treat high blood pressure and inflammation.

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Obesity ups risk for endometrial cancer

Increasing numbers of obesity in both men and women nationwide are resulting in a growing rate of multiple health consequences. Recent research suggests that overweight women are at an increased risk of developing endometrial cancer, especially if menopause occurs in women younger than age 45.

One study has found that women with a body mass index (BMI) of greater than 35, who experienced their last menstrual period at an age younger than 45, had more than 20 times the risk of developing endometrial cancer than normal-weight women.

BMI is a measure of body fat based on height and weight that applies to both adult men and women. A BMI of 18.5 to 24.9 is considered normal weight, 25 to 29.9 is considered overweight and a number over 30 is considered obese.

Mary Dolan, MD, MPH, assistant professor of gynecology and obstetrics, Emory School of Medicine, notes that experts already know that obesity is linked to cardiovascular disease, high blood pressure, diabetes, joint complications and other diseases. Now the connection between obesity and endometrial cancer is on experts’ radar.

Mary Dolan, MD, MPH

Mary Dolan, MD, MPH

Endometrial cancer forms in the tissue lining the uterus or endometrium – the lining that is “shed” monthly during menstruation. Endometrial cancer is more common in older women and fortunately is usually diagnosed early since it causes abnormal bleeding, says Dolan.

In a report published recently, Dolan and colleagues from the Centers for Disease Control and Prevention (CDC) discuss findings from a review of data from the Cancer and Steroid Hormone study from the 1980s. This study examined the relationship between oral contraceptive use and breast, ovarian and endometrial cancers in women ages 20-54 years.

Since many of the study patients with endometrial cancer were overweight, the study gave researchers an opportunity to look at the risk for endometrial cancer among younger, overweight women using BMI.

The study found that women who were younger than 45 when they had their last period and had a BMI over 35 had a 21.7 times greater risk of developing endometrial cancer than a woman of normal weight.

In comparison, older women with a BMI of 35 or higher, who had their last period at age 45 or older, had a 3.7 times greater risk of developing endometrial cancer than a woman of normal weight.

Elevated risks were also seen for women who had been overweight or obese at age 18 and who had their last period before age 45.

Dolan says obesity can lead to higher levels of estrogen because of chronic “anovulation,” where a woman fails to ovulate. Because the condition brings on irregular or no menstruation, estrogen levels remain high while opposing progesterone levels remain low. Experts believe this combination leads to an increased risk of endometrial cancer.

Dolan says physicians need to counsel patients even more to maintain a healthy weight. By both losing weight and then maintaining it, a woman’s risk for endometrial cancer likely decreases.

This study is one of only a few which have focused on younger women and the relationship between obesity and endometrial cancer. The results were published in the July 2009 issue of Obstetrics & Gynecology

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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.

Read more

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