Tracing the start of COVID-19 in GA

At a time when COVID-19 appears to be receding in much of Georgia, it’s worth revisiting the start of the pandemic in early 2020. Emory virologist Anne Piantadosi and colleagues have a paper in Viral Evolution on the earliest SARS-CoV-2 genetic sequences detected in Georgia. Analyzing relationships between those virus sequences and samples from other states and countries can give us an idea about where the first COVID-19 infections in Georgia came from. We can draw Read more

Reddit as window into opioid withdrawal strategies

Drug abuse researchers are using the social media site Reddit as a window into the experiences of people living with opioid addiction. Abeed Sarker in Emory's Department of Biomedical Informatics has a paper in Clinical Toxicology focusing on the phenomenon of “precipitated withdrawal,” in collaboration with emergency medicine specialists from Penn, Rutgers and Mt Sinai. Precipitated withdrawal is a more intense form of withdrawal that can occur when someone who was using opioids starts medication-assisted treatment Read more

CROI: HIV cure report and ongoing research

The big news out of CROI (Conference on Retroviruses and Opportunistic Infections) was a report of a third person being cured of HIV infection, this time using umbilical cord blood for a hematopoetic stem cell transplant. Emory’s Carlos del Rio gave a nice overview of the achievement for NPR this morning. As del Rio explains, the field of HIV cure research took off over the last decade after Timothy Brown, known as “the Berlin patient,” Read more

News

Creating tools for next-generation sequencing

Emory biochemist Eric Ortlund participated in a study that was recently published in Proceedings of the National Academy of Sciences, which involves tinkering with billions of years of evolution by introducing mutations into DNA polymerase.

What may soon be old-fashioned: next-generation sequencing combines many reactions like the one depicted above into one pot

DNA polymerases, enzymes that replicate and repair DNA, assemble individual letters in the genetic code on a template. The PNAS paper describes efforts to modify Taq DNA polymerase to get it to accept “reversible terminators.” (Taq = Thermus aquaticus, a variety of bacteria that lives in hot springs and thus has heat-resistant enzymes, a useful property for DNA sequencing)

Ortlund was involved because he specializes in looking at how evolution shapes protein structure. Along with co-author Eric Gaucher, Ortlund is part of the Fundamental and Applied Molecular Evolution Center at Emory and the Georgia Institute of Technology.

To sequence DNA faster and more cheaply, scientists are trying to get DNA polymerases to accept new building blocks. This could facilitate next-generation sequencing technology that uses “reversible terminators” to sequence many DNA templates in parallel.

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Experts review global health care programs for answers

A recent Knowledge@Emory article looks at a new book titled The Healing of America: A Global Quest for Better, Cheaper, and Fairer Health Care, by author and journalist T.R. Reid. The book provides an in-depth look at the health care systems in a number of Western nations, including Germany, France, the U.K, Japan and Canada. The countries he profiles offer a mix of public and semi-public health care options.

In addition to interviewing Reid, experts from Emory Healthcare, Emory’s Woodruff Health Sciences Center and the Rollins School of Public Health Department of Health Policy and Management, weigh in on the problem of U.S. health care reform and what can be learned from the examples abroad.

Joseph Lipscomb, PhD

According to Joseph Lipscomb, PhD, a Georgia Cancer Coalition Distinguished Cancer Scholar and a professor in the Department of Health Policy and Management, quality of care, outcomes and cost analysis must be factored into the reform process. Looking abroad, Lipscomb gives generally high marks to the outcome and cost analysis done by the National Health Service and the National Institute for Health and Clinical Excellence (NICE) in the U.K. He applauds NICE’s ongoing efforts to estimate the cost-effectiveness of new, expensive technologies by using decision processes that are transparent and solicit input from private citizens, providers and industry.

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The importance of upbringing

Every time scientists identify genetic risk factors for a human disease or a personality trait, it seems like more weight accumulates on the “nature” side of the grand balance between nature and nurture.

That’s why it’s important to remember how much prenatal and childhood experiences such as education, nutrition, environmental exposures and stress influence later development.

At the Emory/Georgia Tech Predictive Health Symposium in December, biologist Victor Corces outlined this concept using a particularly evocative example: bees. A queen bee and a worker bee share the same DNA, so the only thing that determines whether an insect will become the next queen is whether she consumes royal jelly.

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Program helps South Georgia farmworkers

It’s not often that individuals think about the hard work responsible for the fruits and vegetables for our dinner tables every day. Somehow it magically appears in the produce department season after season, without fail. We don’t have to plant it, water it or pick it. It’s ready for us to take home and prepare.

We never see the thousands of migrant farmworkers who move from county to county during the peak season, providing the growers with the labor required to keep farms bountiful. These men, women and children – unlike the plants they take care of – have no roots and live from day to day wherever they are needed, and until their job is done, says Tom Himelick PA-C, MMSc, founder and director of the South Georgia Farmworker Health Project, and Emory Physician Assistant (PA) Program faculty member and director of community projects.

For most of these workers, having a family health care provider is unthinkable. The combination of poverty, lack of health insurance, language barriers, limited transportation and cultural differences creates a vacuum when it comes to health care.

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Coordinating care a key to health reform

Kenneth Thorpe, PhD

Last month, Emory held its fifth annual predictive health symposium “Human Health: Molecules to Mankind.”Researchers, physicians, health care workers and members of the community from throughout the country learned of intriguing research and listened to provocative commentary by health care experts. Kenneth Thorpe, chair of health policy and management at Emory’s Rollins School of Public Health, discussed the elements of health reform that may be getting lost in the reform process– redesigning the delivery system to prevent and avert the development of disease.

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Personal genomics: out of the bottle

Do you really want to know? That’s the question more and more people will be faced with, as personal genetic testing becomes more widespread.

Andrew Faucett discussed some of the emerging issues in “personal genomics” that will confront both doctors and patients at Emory’s Predictive Health Symposium in December. Faucett is an expert in the field of genetic testing and genetic counseling and an assistant professor in Emory’s Department of Human Genetics.

For example, does a man want to find out whether he is really the father of a baby? A recent New York Times magazine article explores this issue.

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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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Lung cancer clinical trial shows treatment promise

Advanced non-small cell lung cancer (NSCLC) is a challenging disease to treat. More than 200,000 new cases of lung cancer are diagnosed each year, and 85 percent to 90 percent of diagnosed lung cancers fall into the non-small cell type.

A new strategy for treating NSCLC that increases the effectiveness of standard chemotherapy in patients with advanced stage disease has been found by Emory researchers. Recent advances in treatment result in improvement in patient survival noted for all stages of NSCLC.

Saresh Ramalingam, MD

Saresh Ramalingam, MD

Lead investigator Suresh Ramalingam, MD, associate professor of hematology and medical oncology at Winship Cancer Institute of Emory University, along with a consortium of academic institutions that is supported by the National Cancer Institute, published the positive results in The Journal of Clinical Oncology.

In the clinical trial, Emory scientists added a cancer-fighting compound that is used to treat a specific type of lymphoma to standard lung cancer chemotherapy, resulting in an increase in positive response rates in NSCLC patients.

The addition of vorinostat, a compound that affects the function and activity of DNA and various other proteins, to standard chemotherapy treatment of carboplatin and paclitaxel, increased positive response rates in patients from 12.5 percent to 34 percent in a clinical trial of 94 patients with metastatic non-small cell lung cancer.

Vorinostat may be affecting histones, which are spool-like proteins around which the cell’s DNA is wound. These proteins are important for cell division. We believe these molecular effects could enhance the efficacy of carboplatin and paclitaxel, respectively.

Vorinostat is part of an emerging class of anti-tumor agents that interfere with enzymes known as histone deacetylases (HDAC). Inhibiting these enzymes increases the level of acetylation, a modification of proteins in the cell. Vorinostat is sold by Merck as Zolinza and was approved by the FDA in 2006 to treat cutaneous T cell lymphoma.

Ramalingam says this exciting data will have to be further evaluated in confirmatory phase III studies before they can be adopted in routine use. However, HDAC inhibitors can now be considered among the leading targeted agents under evaluation for the treatment of non-small cell lung cancer.

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From the Predictive Health Symposium

Predictive Health logoEmory and Georgia Tech kicked off their fifth annual predictive health symposium, “Human Health: Molecules to Mankind,” Dec. 14-15. Researchers, physicians, health care workers, and interested community members were treated to some intriguing and provocative findings and commentary.

Emory President James Wagner and Georgia Tech President Bud Peterson introduced the symposium, along with Fred Sanfilippo, MD, PhD, CEO of Emory’s Woodruff Health Sciences Center. Sanfilippo emphasized that predictive-personalized health is one of the most innovative and promising solutions to our current health care crisis. Medicine today stands at the brink of an achievable goal to tackle the most serious issues facing the health of humans – the ability to predict, reduce, and in many cases eliminate the specific illnesses we each face.

To achieve this goal, he said, we must understand why each of us has a different risk and response to diseases and their treatment, based on our unique differences in biology, behavior and environment. And then we have to use that knowledge to determine the right treatment at the right time for each individual.

Keynote speaker Penny Pilgram George, president of the George Family Foundation and co-founder of the the Bravewell Collaborative, said, “We currently have a disease management system based on episodic care, which means we treat symptoms instead of problems…True healing can only begin when we correctly diagnose the problem and treat the root cause.”

We know we could prevent half of chronic illness, said George by simply teaching people to eat nutritionally, adopt health habits such as nonsmoking, build positive relationships, live and work in nontoxic environments, practice stress reduction, stay fit through some form of exercise, and be purposely engaged in life. If we only treat disease after it occurs and do not promote health, we will have missed the whole point. We need to create a culture of health and well being.

And this from W. Andrew Faucett, director of the genomics and public health program at Emory, who cautioned that although many personalized genetic tests are now available through numerous sources, individuals and clinicians have to weigh the benefits, risks, and usefulness of this evolving technology. People may not even want to know some things revealed by genetic testing, and not everything revealed may be clinically useful or related to disease risk. For example, matters such as one’s true ancestry or revelations concerning one’s paternity may unexpectedly come to light. Furthermore, the accuracy of personalized genetic testing should be carefully considered. Also, a negative result is never truly negative, because there are so many factors involved and some of them can change.

Faucett also spoke about the differences between relative risk and absolute risk. “Anytime you’re talking about genetic risk for disease, you have to present risk in multiple ways,” Faucett said.

Kenneth Thorpe, chair of health policy and management at Emory, talked about the elements of health reform that may be getting lost in the reform process– redesigning the delivery system to prevent and avert the development of disease. Thorpe focused on Medicare because he says, it’s “the most acute offender of the system.” That is, it encompasses some of the most difficult problems that health care reform faces. The typical Medicare patient, he said, is an overweight hypertensive diabetic with back problems, high cholesterol, asthma, arthritis, and pulmonary disease. And that typical patient sees two different primary physicians, a multitude of specialists, and fills 30 different medications. Yet, Medicare does nothing to coordinate the patient’s care. As a result, preventable admissions and readmissions rates are “off the charts,” he says. But, data show that coordination could cut those rates in half.

Because today’s patients have chronic health care conditions that require medical management, said Thorpe, the hope is to develop a preventive and personalized health plan that identifies problems before they manifest and employs care coordinators to guide patients while they’re at home.

And Paul Wolpe, director of the Emory Center for Ethics, says health care has changed as more and more aspects of ordinary life or behaviors are being redefined as medical. For example, being drunk and disorderly has become alcoholism. Now, virtually all of life is being redefined in biological terms, he says. And that has led to an increase in health care costs. We have an enormous amount of new things that we are calling illness, and we expect this health care system to treat them, he says. “We are creating a new category of disease called presymptomatic.”

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Questions only a network of pathologists can answer

When a patient is fighting a brain tumor, pathologists usually obtain a tiny bit of the tumor, either through a biopsy or after surgery, and prepare a microscope slide. Looking at the slide, they can sometimes (but not always) tell what type of tumor it is. That allows them to have an answer, however tentative, for that critical question from the patient: “How long have do I have?” as well as give guidance on what kind of treatment will be best.

Dan Brat, a pathologist specializing in brain tumors at Emory Winship Cancer Institute, gave a presentation this week explaining how he has been asking more complicated questions, ones only a network of pathologists armed with sophisticated computers can answer:

  • What genes tend to be turned on or off in the various types of brain tumors?
  • What does the pattern look like when a tumor is running out of oxygen?
  • What if we get a “robot pathologist” to look at hundreds of thousands of brain tumor slides?
Under the microscope, the shapes of cell nuclei in brain tumors look different depending on the type of tumor.

Under the microscope, the shapes of cell nuclei in brain tumors look different depending on the type of tumor.

Brat was speaking at a caBIG (cancer Biomedical Informatics Grid) conference, taking place at the Emory Conference Center this week. caBIG is a computer network sponsored by the National Cancer Institute that allows doctors to share experimental data on cancers. Brat explained that low-grade brain tumors come in two varieties: oligodendrogliomas and astrocytomas. Under the microscope, cell nuclei in the first tend to look round and smooth, but the second look elongated and rough. Kind of like the differences between an orange and a potato, he said.  He and colleague Jun Kong designed a computer program that could tell one from the other. They had the program look through almost 400,000 slides, using resources compiled through caBIG (Rembrandt and Cancer Genome Atlas databases). Sifting through the data, they could find that certain genes are turned on in each kind of tumor.

Imagine a "robot pathologist" that can sift through thousands of images from brain tumor samples.

Imagine a "robot pathologist" that can sift through thousands of images from brain tumor samples.

Daniel Brat, MD, PhD, principal investigator for the In Silico Brain Tumor Research Center

Daniel Brat, MD, PhD, principal investigator for the In Silico Brain Tumor Research Center

Eventually, this kind of information could help a patient with a brain tumor get good responses to those “How long?” and “How am I going to get through this?” questions.

Joel Saltz, who leads Emory’s Center for Comprehensive Informatics, has been a central figure in developing tools for centers such as Emory’s In Silico Brain Tumor Research Center. In September 2009, Emory was selected to host one of five “In Silico Research Centers of Excellence” by the National Cancer Institute.

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