Ahead of this week’s Morningside Center conference on repurposing drugs, we wanted to highlight a recent paper in NPJ Precision Oncology by dermatologist Jack Arbiser. It may represent a new chapter in the story of the beta-blocker propranolol.
Several years ago, doctors in France accidentally discovered that propranolol is effective against hemangiomas: bright red birthmarks made of extra blood vessels, which appear in infancy. Hemangiomas often don’t need treatment and regress naturally, but some can lead Read more
Islet transplantation may offer people with type I diabetes the ability to produce their own insulin again
As with other types of transplantation, the challenge with islet transplantation is to avoid rejection of the donated organ and to balance that goal against side effects from the drugs needed to control the immune system. These papers illustrate how that balancing act is especially complex.
In the last decade, transplant specialists developed a method for islet transplantation named the â€œEdmonton protocolâ€ after pioneers at the University of Alberta. While the emergence of this method was a major step forward, there are limitations:
The report was published in the Oct. 22 issue of Population Health Metrics. Edward Gregg, Emory adjunct professor of global health, and David Williamson, Emory visiting professor of global health, were co-authors.
The CDC’s projections have been a work in progress. The last revision put the number at 39 million in 2050. The new estimate takes it to the range of 76 million to 100 million.
The growth in U.S. diabetes cases has been closely tied to escalating obesity rates. A corresponding rise in diabetes has even prompted researchers to coin a new hybrid term: diabesity.
â€œThere is an epidemic going on that, if left unchecked, will have a huge effect on the U.S. population and on health care costs,â€ says K. M. Venkat Narayan, MD, MSc, MBA, professor of global health and epidemiology at the Rollins School of Public Health, who came to Emory from the CDCâ€™s Division of Diabetes Translation. â€œThe numbers are very worrying.â€
K. M. Venkat Narayan, MD, MSc, MBA
Narayan also heads the Emory Global Diabetes Research Center, which aims to find solutions to the growing global diabetes epidemic. The Center serves as the research leader and hub for population-based research and large intervention trials throughout South Asia and globally.
“Whatever we do, the fruits of our research have to be available to people everywhere,â€ says Narayan.
Read more about Dr. Narayan’s global efforts and diabetes research underway at Emory.
Hear Dr. Narayan talk about the Global Diabetes Research Center.
Established with a $2 million grant from the CDC’s Division of Diabetes Translation, DTTAC is modeled after the Tobacco Technical Assistance Consortium. Both programs provide training, expertise, and materials to state public health departments to strengthen leadership, organizational capacity, and partnerships in prevention and control. DTTAC also works with the National Diabetes Prevention Program, the framework for community-based lifestyle intervention to prevent type-2 diabetes among those at high risk of the disease.
â€œWe need to act with urgency to reach individuals and their families early if we are to prevent and reduce suffering from diabetes,â€ says Linelle Blais, DTTAC director and associate research professor at Rollins. â€œBy developing services that build capacity, our goal is to better equip local, state, and national partners to deliver evidence-based community interventions and effective diabetes programs.”
Linelle Blais, DTTAC director
DTTAC is helping spearhead the national rollout of a lifestyle intervention program modeled on research from the NIHâ€™s Diabetes Prevention Program (DPP) clinical trial. The program seeks to prevent diabetes by helping participants adopt healthy lifestyle habits such as being physically active at least 150 minutes per week and losing 7 percent of their body weight. In the DPP clinical trial, participants who made these changes saw their diabetes risk drop by 58 percent.
The success of diabetes prevention programs at Indiana University, the University of Pittsburgh, and YMCAs around the country will also shape DTTAC training. Experts regard these examples as cost-effective models.
Read more about DTTAC in the fall 2010 issue of Public Health magazine.
An Emory transplant team, working with the UGA group, hopes to use this technology to develop pig islet cells as an alternative to human islets to treat patients with Type 1 diabetes. Type 1 diabetes usually occurs early in life and affects more than one million Americans who are unable to manufacture their own insulin because their pancreatic islets do not function.
Emory islet transplant team
The Emory Transplant Center has conducted clinical trials since 2003 transplanting human pancreatic islet cells into patients with Type I diabetes. Some of these patients have been able to give up insulin injections, either temporarily or permanently. Other sources of islets are needed for transplant though because of the large number of potential patients and because each transplant typically requires islets from several pancreases.
To create pigs using pluripotent stem cells, the UGA team injected new genes into pig bone marrow cells to reprogram the cells into functioning like embryonic stem cells. The resulting pluripotent cells were inserted into blastocysts (developing embryos), and the embryos were implanted into surrogate mothers. The resulting pigs had cells from the stem cell lines as well as the embryo donor in multiple tissue types.
The pluripotent stem cell process could allow researchers to make genetic changes to dampen or potentially eliminate the rejection of the pig islets by the human immune system.
The report, â€œChronic Conditions Account for Rise in Medicare Spending from 1987 to 2006,â€ was published Feb. 18 by the journal Health Affairs.
Kenneth E. Thorpe, PhD
Thorpe and colleagues analyzed data about disease prevalence and about level of and change in spending on the 10 most expensive conditions in the Medicare population from 1987, 1997 and 2006.
Among key study findings:
Heart disease ranked first in terms of share of growth from 1987 to 1997.Â However, from 1997 to 2006, heart disease fell to 10th, while other medical conditions â€“ diabetes the most prevalent â€“ accounted for a significant portion of the rise.
Increased spending on diabetes and some other conditions results from rising incidence of these diseases, not increased screening and diagnoses.
Illnesses such as diabetes and heart disease are affecting increasing numbers of young people in developing countries. In light of this worrisome trend, K. M. Venkat Narayan, MD, and his colleagues are launching a new center of excellence aimed at preventing and controlling heart disease and diabetes in India and Pakistan.
The primary partner of this grant will be the public health foundation of India, New Delhi. Emory is the developed country academic partner working with other network partners, namely, the Madras Diabetes Research Foundation in Chennai, India and the Aga Khan University in Karachi, Pakistan.
The center will focus on surveillance, prevention of mortality stemming from cardiovascular disease and diabetes, and training young investigators in the field of diabetes and cardiovascular disease prevention and control.
Itâ€™s estimated that by 2030, the number of people with diabetes will reach 400 million worldwide, double todayâ€™s number, says Narayan. Cardiovascular disease is a major cause of death among people with diabetes with 80 percent of deaths from chronic diseases worldwide occurring in low and middle-income countries.
What is particularly worrying about developing countries is that diseases like diabetes are hitting younger people, says Narayan. The implications, he says, are young people who would otherwise be economically productive must leave the labor market. In addition, in India, one person having diabetes uses 25 percent of the familyâ€™s income just for his own treatment. The economic impact and the health impact are enormous, says Narayan. Read more in Emory Public Health magazine.
Cancer survivors who got radiation treatments as children have nearly twice the risk of developing diabetes as adults. Thatâ€™s according to a study led by Emory and Childrenâ€™s Healthcare of Atlanta pediatric oncologist Lillian R. Meacham, MD.
Lillian Meacham, MD
The study, published in the August 10/24 issue of Archives of Internal Medicine, compared rates of diabetes in nearly 8,600 childhood cancer survivors diagnosed between 1970 and 1986, and nearly 3,000 of their siblings who did not have cancer.
Children who were treated with total body radiation or abdominal radiation to fight off cancer appear to have higher diabetes risks later in life, regardless of whether they exercise regularly or maintain a normal weight.
After adjusting for other risk factors, including body mass index – a ratio of height and weight – Meacham and team found that childhood cancer survivors overall were 1.8 times more likely to have diabetes.
And the more radiation that was used, the greater the diabetes risk. For those treated with total body radiation — a treatment often used before bone marrow transplants to treat childhood leukemia — the diabetes risk was more than seven times greater.
More study is needed to understand how radiation could promote diabetes in cancer survivors, notes Meacham.
She says it is imperative that clinicians recognize this risk, screen for diabetes and pre-diabetes when appropriate, and approach survivors with aggressive risk-reducing strategies.
Meacham is a professor of pediatrics in the Emory School of Medicine and medical director of the Cancer Survivor Program with the AFLAC Cancer Center and Blood Disorders Services, Childrenâ€™s Healthcare of Atlanta.
Diabetes is running rampant among the U.S. and one of the groups most affected is Latinos. Factors such as lack of English skills and cultural rules keep many Cheap Oakleys Latinos from recognizing diabetes as a problem and seeking treatment.
Dr. Guillermo E. Umpierrez of Emory University is working to change that. Not only does he work daily at the Diabetes and Endocrinology Department at Atlanta’s Grady Memorial Hospital, but he recently spearheaded production an educational video aimed at the Latino population. Titled “Viva mas y majorâ€¦ con su diabetes bajo control” (“Live longer and better… with your diabetes under control,” the video is aimed at empowering patients to live their healthiest by controlling their diabetes. The vidoe was video produced by the Emory Latino Diabetes Education Program (ELDEP).
The 30-minute video is available online in five parts. Part one is below. The other segments are viewable on the Woodruff Health Sciences web site and on YouTube.