Two items relevant to long COVID

One of the tricky issues in studying in long COVID is: how widely do researchers cast their net? Initial reports acknowledged that people who were hospitalized and in intensive care may take a while to get back on their feet. But the number of people who had SARS-CoV-2 infections and were NOT hospitalized, yet experienced lingering symptoms, may be greater. A recent report from the United Kingdom, published in PLOS Medicine, studied more than Read more

All your environmental chemicals belong in the exposome

Emory team wanted to develop a standard low-volume approach that would avoid multiple processing steps, which can lead to loss of material, variable recovery, and the potential for Read more

Signature of success for an HIV vaccine?

Efforts to produce a vaccine against HIV/AIDS have been sustained for more than a decade by a single, modest success: the RV144 clinical trial in Thailand, whose results were reported in 2009. Now Emory, Harvard and Case Western Reserve scientists have identified a gene activity signature that may explain why the vaccine regimen in the RV144 study was protective in some individuals, while other HIV vaccine studies were not successful. The researchers think that this signature, Read more

cancer

Cervical Cancer – Can Be Hard to Detect

MedicalHorizon

The Pap smear – also called Pap test – is part of the standard annual wellness exam for women’s health and used as a first step in detecting cervical cancer.  But according to a recent article published in the International Journal of Cancer,  the Pap test may not provide reliable results for certain types of cancer that are harder to detect.

Kevin Ault, MD, associate professor of obstetrics and gynecology at Emory University School of Medicine and investigator at the Emory Vaccine Center conducted a post-hoc analysis of the FUTURE I and FUTURE II (Gardasil) vaccine trials.  Based on that analysis Ault, a leading expert and pioneer in the field of human papilloma virus (HPV), says a regular Pap test is not always effective in diagnosing adenocarcinoma, because it starts high up in the cervical canal and may not be sampled by the Pap smear.

“There are a number of reasons the Pap smear could lead to inaccurate results. For example, the pathologist examining the cells could make an error, the gynecologist may not sample the cervix adequately or an infection could obscure the results,” says Ault.

According to Ault, andenocarcinoma is the second most common type of cervical cancer, accounting for about 20 percent of all cervical cancer cases. While the overall incident of cervical cancer is on the decline, Ault reports the proportion of cervical cancers that are andenocarcinoma is rising.

Cervical cancer is the eighth most common type of cancer in American women. More than 12,000 new cases of invasive cervical cancer are diagnosed each year, and more than 4,200 women in the U.S. die from of this disease annually* according to the American Cancer Society.  Scientists believe that pre-invasive cervical cancer may develop over a period of months or years after the cervix is infected with the sexually transmitted HPV.

“The take-away from this recent paper is the HPV test would be a better test for the harder to detect adenocarcinoma cervical cancer, if not all cervical cancer,” says Ault.

* 2010 data

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The science behind the Mediterranean diet

The diet calls for lots of fruits and vegetables.

Researchers, physicians, and health care providers from across the United States and Italy met recently at the Rollins School of Public Health for the first Emory Conference on Mediterranean Diet and Health. Participants focused on the diet’s relation to cardiovascular disease, cancer, neuropsychiatric disorders, and vascular health.

The Mediterranean diet is characterized by a high consumption of fruits, vegetables, legumes, complex carbohydrates, and nuts; moderate consumption of fish and red wine; low consumption of cheese and red meat; and olive oil as the chief source of fat, explains Viola Vaccarino, MD, PhD, one of the conference chairs.

When topped with exercise, the Mediterranean diet—really a pattern of eating habits traditionally followed by people in the Mediterranean regions in the early 1960s—has proven beneficial for many throughout the years. But why this is so isn’t clear.
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Detecting Lung Cancer at a Higher Rate

The findings from a recent study show the risk of dying from lung cancer could be reduced by 20 percent by use of a low-dose helical computed tomography (CT) scan.  With 160,000 deaths each year related to cigarette smoking, this type of screening could save up to 32,000 lives each year.

The National Cancer Institute (NCI) launched the multicenter National Lung Screening Trial (NLST) in 2002,  led at Emory by radiologist and researcher Dr. Kay Vydareny.  This trial compared two ways of detecting lung cancer: low-dose helical (spiral) computed tomography (CT) and standard chest X-ray, for their effects on lung cancer death rates in a high-risk population.

Both chest X-rays and helical CT scans have been used as a means to find lung cancer early, but the effects of these screening techniques on lung cancer mortality rates had not been determined. Over a 20-month period, more than 53,000 current or former heavy smokers ages 55 to 74 joined NLST at 33 study sites across the United States. In November 2010, the initial findings from NLST were released. Participants who received low-dose helical CT scans had a 20 percent lower risk of dying from lung cancer than participants who received standard chest X-rays.

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A path to treatment of lymphedema

Lymphedema, or swelling because of the impaired flow of lymph fluid, can occur as a consequence of cancer or cancer treatment. Chemotherapy can damage lymph ducts, and often surgeons remove lymph nodes that may be affected by cancer metastasis. Lymphedema can result in painful swelling, impaired mobility and changes in appearance.

Young-sup Yoon, MD, PhD

Emory scientists, led by cardiologist and stem cell biologist Young-sup Yoon, have shown that they can isolate progenitor cells for the lining of lymph ducts. This finding could lead to doctors being able to regenerate and repair lymph ducts using a patient’s own cells. The results are described in a paper published recently in the journal Circulation.

The authors used the cell surface marker podoplanin as a handle for isolating the progenitor cells from bone marrow. Previous research has demonstrated that podoplanin is essential for the development of the lymphatic system.
In the paper, the authors use several animal models to show that the progenitor cells could contribute to the formation of new lymph ducts, both by becoming part of the lymph ducts and by stimulating the growth of nearby cells.

“This lymphatic vessel–forming capability can be used for the treatment of lymphedema or chronic unhealed wounds,” Yoon says.

Isolated lymphatic endothelial cells (red) incorporate into lymph ducts (green) in a model of wound healing in mice.

The authors also show that mice with tumors show an increase in the number of this type of circulating progenitor cells. This suggests that tumors send out signals that encourage lymph duct growth – a parallel to the well-known ability of tumors to drive growth of blood vessels nearby. Yoon says the presence of these cells could be a marker for tumor growth and metastasis. Because tumors often metastasize along lymph ducts and into lymph nodes, studying this type of cells could lead to new targets for blocking tumor metastasis.

A recent review in the journal Genes & Development summarizes additional functions of the lymphatic system in fat metabolism, obesity, inflammation, and the regulation of salt storage in hypertension.

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When bone marrow goes bad

Plasma cells live in our bone marrow. Their job: to make antibodies that protect us from bacteria and viruses. But if those plasma cells grow unchecked, that unchecked growth leads to multiple myeloma.

Sagar Lonial, MD

Multiple myeloma is a type of cancer that results in lytic bone disease, or holes in the bones. What’s more, the cancerous cells crowd out normal bone marrow resulting in anemia or a low white count, leaving a person vulnerable to infections.

Sagar Lonial, MD, an oncologist at Winship Cancer Institute, Emory University, treats people with multiple myeloma. The prognosis for people with this type of cancer is poor; however, researchers are gaining on the disease. Twenty years ago, the survival rate was two to three years; now, it’s four to five.

Lonial says one of the keys to improving patients’ prognosis is increasing their enrollment in clinical trials and better access to life-extending drugs.

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Resurgence of interest in cancer cell metabolism

A recent article in Nature describes the resurgence of interest in cancer cell metabolism. This means exploiting the unique metabolic dependencies of cancer cells, such as their increased demand for glucose.

Cancer cells' preference for glucose is named after 1931 Nobelist Otto Warburg

Otto Warburg, who won the Nobel Prize in Medicine in 1931, noticed that cancer cells have a “sweet tooth” decades ago, but only recently have researchers learned enough about cancer cells’ regulatory circuitry to possibly use this to their advantage.

At Winship Cancer Institute of Emory University, several scientists have been investigating aspects of this phenomenon. Jing Chen and his team have identified a switch, the enzyme pyruvate kinase, which many types of cancer use to control glucose metabolism, and that might be a good drug target.

Jing Chen, PhD, and Taro Hitosugi, PhD

Shi-Yong Sun, Wei Zhou and their colleagues have found that cancer cells are sneaky: blockade the front door (for glucose metabolism, this means hitting them with the chemical 2-deoxyglucose) and they escape out the back by turning on certain survival pathways. This means combination tactics or indirectly targeting glucose metabolism through the molecule mTOR might be more effective, the Nature article says.

A quote from the article:

Clearly, metabolic pathways are highly interconnected with pathways that govern the hallmarks of cancer, such as unrestrained proliferation and resistance to cell death. The many metabolic enzymes, intermediates and products involved could be fertile ground for improving cancer diagnostics and therapeutics.

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Winship Cancer Institute covers emotional aspects of cancer

The Winship Cancer Institute of Emory University offers a collaborative approach for dealing with cancer that begins as soon as a patient is diagnosed. The program considers the emotional, psychological and physical symptoms associated with cancer and its treatment.

Winship Cancer Institute of Emory University

And options for patients may include cognitive therapy, antidepressants, or both. Anger, fear, and anxiety mixed with the physical and emotional side effects of cancer treatments can lead to depression during and even after treatment, when patients may feel isolated.

Darren Johnson spent his 19th birthday undergoing a bone marrow transplant. A few weeks earlier, Johnson had been diagnosed with myelodysplasia, a form of leukemia in which the bone marrow fails to produce enough normal blood cells. He endured a year of treatment and then a lengthy recovery. (Watch “When Life Goes On,” a short video about his story.)

Only relatively recently have health care providers turned serious attention to the emotional well-being of cancer patients. They have realized that easing the emotional burden of a cancer diagnosis for patients and families may actually improve treatment and outcome.

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Health Care Heroes honored by Atlanta Business Chronicle

Emory faculty-physicians were honored May 20 at the annual Health Care Heroes Awards celebration sponsored by the Atlanta Business Chronicle. All three are featured in this week’s edition of the newspaper.

Sheryl Gabram-Mendola, MD

Sheryl Gabram-Mendola, MD, professor of surgery at Emory School of Medicine and the Winship Cancer Institute, was the Community Outreach winner. Gabram-Mendola is director of the Avon Foundation Comprehensive Breast Center at the Georgia Cancer Center for Excellence at Grady Memorial Hospital.

She was nominated by the Georgia Cancer Coalition and honored for her work in reducing breast cancer mortality by increasing breast cancer awareness and leading the effort to diagnose the disease earlier in a high-risk population of minority women.

Last September the Avon Foundation awarded $750,000 to the Winship Cancer Institute at Emory and the Avon Comprehensive Breast Center. The grant is being used to continue community outreach, education, clinical access, and four research studies that directly affect care for the underserved populations in Atlanta. Since 2000, the Avon Foundation has awarded nearly $11 million to Winship and Grady to support leading-edge breast cancer research projects and improve outcomes for underserved women diagnosed with breast cancer in Atlanta.

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HER2-positive breast cancer treatment options studied

Emory oncologist Ruth O’Regan, MD, is leading a trial testing whether Afinitor can reverse resistance to Herceptin in metastatic HER2-positive breast cancer patients. As part of the trial, some patients been receiving a drug called Afinitor (everolimus) along with chemotherapy and Herceptin (trastuzumab).

Ruth O'Regan, MD

About 25 percent to 30 percent of breast cancers are HER2 -positive, which means they test positive for a protein called human epidermal growth factor receptor-2 (HER2). This protein promotes the growth of cancer cells, making HER2 -positive breast cancers more aggressive than other types.

They also tend to be less responsive to hormone treatment. That’s the bad news. The good news is that this type of cancer responds extremely well to Herceptin.

Herceptin specifically targets HER2 cells, killing them while sparing healthy cells, so side effects are minimal. Its effectiveness has made Herceptin the gold standard of treatment for HER2 -positive breast cancer.

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Hold out your finger: Epidemiologist developing test for colon cancer risk

Years from now physicians may be able to determine whether you’re at increased risk for colorectal cancer by drawing blood from the tip of your finger.

Emory University researchers are working to identify biomarkers to detect a person’s chances of developing colon cancer. Much like blood pressure and cholesterol tests can indicate heart disease risk, researchers here hope that some day the makeup of blood and urine will be able to tell who’s at risk for colorectal cancer, why they may be at risk and what they can do to reduce their risk.

Postdoctoral fellows Joy Owen and Veronika Fedirko examine samples in Robin Bostick’s lab at the Winship Cancer Institute of Emory University.

For now, the Emory study team is analyzing the rectal tissue samples of people with colon adenomatous polyps, non-cancerous growths considered precursors to colon cancer, and comparing them to rectal tissue samples from people who don’t have polyps. They’re also looking at whether the differences they detect in rectal tissue can also be found in blood or urine. Currently, no accepted tests exist to determine whether someone may be at risk for colon cancer.

“Most people would rather provide a blood or urine sample than get a rectal biopsy,” says Robin Bostick, MD, MPH, Rollins School of Public Health epidemiology professor and study principal investigator. Bostick is also a clinical faculty member at the Winship Cancer Institute at Emory and a Georgia Cancer Coalition Distinguished Cancer Scholar.

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