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
Cancer researcher Paul Doetsch is a prominent voice in a recent feature in Science magazine’s Careers section. The article gives scientists who are setting up their laboratories advice on how to manage their laboratories and lead by example.
Doetsch holds a distinguished chair of cancer research and is associate director for basic research at Winship Cancer Institute. His research on how cells handle DNA damage has provided insights into mechanisms of tumor formation and antibiotic resistance.Â His lab includes five graduate students, two senior postdocs and one technical specialist.
From the article:
Doetsch says that he tries to maintain a lab culture that provides technicians, students, postdocs, and research faculty a sense of â€œownershipâ€ of their projects and to give the message everyone is making a significant contribution to the research enterprise, regardless of their specific title or role. “I make it a point to walk around my lab several times a day to chat with my group and hold individual weekly research meetings with each member to get an update of their progress and provide them with direct, constructive feedback on their activities,” he says. “I always strongly encourage everyone to discuss their results and other issues affecting their project with their lab colleagues and to not hesitate to disagree with me when necessary.â€
Once esophageal tumors establish themselves, a patientâ€™s prognosis is grim and morbidity vast. But when lesions are caught early and removed, especially in the premalignant stage, the odds of survival markedly improve.
When a case calls for it, Emory gastroenterologist Field F. Willingham, MD, MPH, uses a hybrid approach to ousting superficial esophageal lesions. Superficial esophageal lesions are commonly caused by acid reflux disease, or GERD. GERD occurs when stomach acid flows into the esophagus and can lead to a condition known as Barrettâ€™s esophagus, where the cells in the lower esophagus become damaged. This in turn can lead to dysplasia, or pre-cancerous cells.
But for superficial cancers, it is now possible to remove a portion of the lining layer of the GI tract, containing the tumor, with an endoscope.Â This can help carefully selected patients avoid a major surgery. The technique, known as an EMR, allows the removal of superficial esophageal tumors and pre-cancer with an endoscope, a slender tube-like instrument.
Detecting and removing esophageal tumors early is essential for a favorable outcome. Once tumors firmly establish themselves in esophageal tissue, the prognosis is grim and morbidity vast. In the past, a diagnosis of an esophageal tumor meant the removal of the esophagus and often the stomach. But now EMR can be used in tandem with radio frequency ablation.
In surgical situations in which radio frequency ablation is not feasible, Willingham and his colleagues are beginning to use an alternate technique, known as cryotherpay, in tandem with EMR. Cryotherapy involves freezing superficial cells to rid the esophagus of suspect cells.
â€œSo, if the end of the esophagus is twisted, or if we canâ€™t touch it with this balloon device, then we can use cryotherapy,â€ says Willingham. â€œWeâ€™re trying to kill the lining layer with the tumor cells without killing the deeper layer.â€
Willingham and his colleagues are seeing evidence that using these very three very different, technologies in tandem or alone will provide patients with a better way to rid them of esophageal lesions while preserving their quality of life.
Smokingâ€™s link to lung cancer has been well-known for decades, but we are still learning about its cancer-causing effects on other organs.
An article in the Journal of the American Medical Association (JAMA) provides solid epidemiological evidence that smokingâ€™s link to bladder cancer is even higher than previously believed. And, the elevated risk factor appears to be the same for men and women.
Viraj Master, MD, PhD
â€œThis is something I see in my practice every day,â€ says Viraj Master, associate professor of urology, Emory School of Medicine and director of urology clinical research at the Winship Cancer Institute of Emory University. â€œThe dangers of smoking are pervasive. Patients are often surprised to hear of the link between smoking and bladder cancer, but itâ€™s there, and itâ€™s a very real risk.â€
The bladder may not be the first organ you think about when you think about the harmful effects of cigarette smoking. After all, when a person inhales cigarette smoke, the mouth, throat and lungs are the primary destination. But, a lethal change in the composition of cigarettes makes the bladder a target for cancer.
Written by researchers at the National Cancer Institute, the study explains that while there is less tar and nicotine in cigarettes now that in years passed, there also has been â€œan apparent increase in the concentration of specific carcinogens,â€ including a known bladder cancer carcinogen and tobacco-specific nitrosamines. The study authors also note that epidemiological studies have observed higher relative risk rates associated with cigarette smoking for lung cancer.
â€œThe take-home message, of course, is the same as it long has been â€“ donâ€™t start smoking, and if you do smoke, stop,â€ says Master. “We need to do everything in our power to both stop people from starting to smoke and to help those already addicted to stop.â€
Seems pretty obvious â€“ if a sunscreen with an SPF of 30 is good, then an SPF of 100 should be at least three times as good.
Unfortunately, that is not the case.Â There are other important details to consider when you are purchasing a sunscreen.
â€œPeople have become much more educated about the importance of using sunscreen, and manufacturers have responded with an abundance of products,â€ says Carl Washington, MD, associate professor of Dermatology at Emory University School of Medicine. â€œUnfortunately, the labeling can be confusing and many of the current sunscreens only contain the ingredients necessary to offer protection against sunburn, but not skin cancer or aging.â€
Recently, the Food and Drug Administration created new regulations to establish standards for sunscreen manufacturers to follow before they label their products.
Under the new regulations, which will go into effect in 2012, sunscreen products that protect against alltypes of sun-induced skin damage will be labeled â€œbroad spectrumâ€ and â€œSPF 15â€ or higher on the container. Only products that have been tested to ensure they protect against both UVA (ultraviolet radiation A) and UVB (ultraviolet radiation B) radiation will be allowed to use this labeling.Â Broad-spectrum sunscreens of SPF 15 and higher can also be labeled as protective against skin cancer and premature aging. The maximum SPF value is set at 50-plus because the FDA says anything higher doesnâ€™t provide a significant amount of additional protection.
Manufacturers will have to include warning labels on products that are not broad spectrum. Products that claim to be water resistant must indicate how long the consumer should expect to be protected in the water, and using such language as â€œwaterproofâ€ or â€œsweat proofâ€ will not be allowed.
â€œSkin cancer is the most common form of cancer in the United States, and the number of people affected keeps rising. Simply getting into the habit of using a sunscreen every day – with the appropriate levels of protection – can make a significant difference in preventing many skin cancers, as well as premature aging,â€ says Washington.
â€œThese new regulations will help consumers understand the difference in degrees of sun protection, and choose carefully.â€
Washington also suggests staying out of direct sunlight between 10 am and 2 pm, seeking shade when you are outdoors, remembering to reapply sunscreen every two hours and wearing protective clothing.
Can it really be possible to transform a person’s own cells into a weapon against various forms of disease? And what if those very cells could be retrained to attack cancer cells or to prevent autoimmune diseases?
Answers to these questions and many more are about to soon be realized, as Emory University Hospital will serve as the launch site for the very appropriately-named EPIC (Emory Personalized Immunotherapy Center).
The new Center, which is the creation of Dr. Jacques Galipeau, MD, professor of hematology and medical oncology & pediatrics of Emory University, will soon be operational after final touches have been put on construction of the lab. This cell processing facility will foster development of novel personalized cellular therapies for Emory patients facing catastrophic ailments and unmet medical needs.
According to Galipeau, the premise of EPIC and its overlying mission will focus on cellular and biological therapies that use a patientâ€™s own cells as a weapon to seek and destroy cells that actually make a person sick. In partnership with the Winship Cancer Institute of Emory University, Childrenâ€™s Healthcare of Atlanta, Aflac Cancer & Blood Disorders Center and the Emory School of Medicine, EPIC seeks to improve the health of children and adults afflicted with cancer and immune disease.
â€œFirst and foremost, we seek to bring a level of care and discovery that is first in Georgia, first in human and first in child. Blood and marrow derived cells have been used for more than a quarter century to treat life threatening hematological conditions and are now established therapies worldwide. More recently, the use of specific adult somatic cells from marrow, blood and other tissues are being studied in cellular medicine of a wide array of ailments including heart, lung, neurological and immune diseases,â€ says Galipeau. â€œThe use of blood borne immune cells can also be exploited for treatment of cancer, autoimmune disease, organ transplantation and chronic viral illnesses such as HIV.â€
Galipeau said that once operational, EPIC willÂ begin by working with Crohnâ€™s disease in pediatric and adult patients, an inflammatory bowel disease. Symptoms of Crohnâ€™s disease include severe abdominal pain, diarrhea, fever, weight loss, and the inability for a child to properly grow. Resulting bouts of inflammation may also affect the entire digestive tract, including the mouth, esophagus and stomach.Â In some cases, a radical surgery involving the removal of part of the lower intestinal tract is required.
â€œThere is no current answer for what specifically causes Crohnâ€™s disease, nor is there a cure. But we hope that through our research and efforts, we will be able to first target the inflammatory mechanisms in these patients through immunotherapy, and in turn reduce the amount of flare-ups and limitÂ the damage that occurs from this disease,â€ says Galipeau.
Galipeau says the EPIC program could represent a powerful cornerstone to the launch and the development of an entirely new, Emory-based initiative which bundles the strengths of the School of Medicine, Emory University Hospital, Children’s Healthcare of Atlanta, and many Woodruff Health Sciences Center centers of excellence,â€ says Galipeau.
â€œMy ultimate goal is to elevate the biomedical scientific and scholarly enterprise to aÂ higher level – making a difference in the lives of people. The EPIC program and multi-levels of support could be a fundamental underpinning to our success.â€
Emory Healthcare is a key player in plans to bring the worldâ€™s most advanced radiation treatment for cancer patients to Georgia.Â Emory Healthcare has signed a letter of intent with Advanced Particle Therapy, LLC, of Minden, Nevada, opening the door to a final exploratory phase for development of The Georgia Proton Treatment Center – Georgiaâ€™s first proton therapy facility.
For certain cancers, proton therapy offers a more precise and aggressive approach to destroying cancerous and non-cancerous tumors, as compared to conventional X-ray radiation. Proton therapy involves the use of a controlled beam of protons to target tumors with precision unavailable in other radiation therapies. According to The National Association for Proton Therapy, the precise delivery of proton energy may limit damage to healthy surrounding tissue, potentially resulting in lower side effects to the patient. This precision also allows for a more effective dose of radiation to be used.
Proton therapy is frequently used in the care of children diagnosed with cancer, as well as in adults who have small, well-defined tumors in organs such as the prostate, brain, head, neck, bladder, lungs, or the spine.Â And research is continuing into its efficacy in other cancers.
The gantry, or supporting structure, of a proton therapy machine.
The closest proton therapy facility to Georgia is the University of Florida Proton Therapy Institute in Jacksonville.Â Currently there are only nine proton therapy centers in the United States, including centers at Massachusetts General Hospital, MD Anderson Cancer Center in Houston and the University of Pennsylvania.
This is an exciting development in our ability to offer not only patients throughout Georgia and the Southeast the widest possible array of treatment options but patients from around the world who can come to Atlanta via the world’s busiest airport, Hartsfield-Jackson International. In addition, we will work to expand its utility and access for patients through collaborative research projects with Georgia Tech and other institutions. Winship physicians will also be able to reach out to their international colleagues and provide direction in how best to study and implement this technology in the care of cancer patients.
Under the letter of intent, Emory Healthcare faculty and staff will provide physician services, medical direction, and other administrative services to the center. Advanced Particle Therapy, through a Special Purpose Company, Georgia Proton Treatment Center, LLC, (GPTC) will design, build, equip and own the center.Â The facility, which will be funded by GPTC, will be approximately 100,000 square feet and is expected to cost approximately $200 million.Â Site selection for the facility is underway, and pending various approvals, groundbreaking is expected in the Spring of 2012.
The follow video presents a 3D simulation of proton therapy technology.
“It is the oncology nurse whose ‘fingerprints’ are on the entire matrix of therapies,” said Seliza Mithchell.
A keynote presentation on â€œfingerprintsâ€ might be more suited to a police convention than an oncology nursing symposium.Â That is unless Selinza Mitchell is the speaker. Mitchell, a nurse educator and presenter was the keynote speaker at the third annual Winship Oncology Nursing Symposium, held March 18 and 19 at the Evergreen Conference Center in Stone Mountain, Georgia.
Mitchellâ€™s presentation focused on the impact oncology nurses have on the hundreds of patients and families they touch, both literally and figuratively.Â It is the oncology nurse whose â€œfingerprintsâ€ are on the entire matrix of therapies, from administration of todayâ€™s latest targeted-therapy drugs to helping patients and families navigate an increasingly complex health care system.
That concept also formed the basis of many of the discussion groups that were part of the symposium.Â â€œThe entire model of care delivery is changing,â€ says Amelia Langston, MD, professor of Hematology and Medical Oncology at the Winship Cancer Institute.Â â€œCare delivery is more of a team approach and is less physician-centered.Â Therefore there is great interest in the expanding role of nurses, nurse practitioners, and physician assistants.â€
Amelia Langston presenting at the Winship Oncology Nursing Symposium
The Winship Oncology Nursing Symposium has grown in three short years into one of the most informative and influential among this growing market of nursing continuing education opportunities.Â Among the topics covered in this yearâ€™s meeting were cancer genetics, image-guided medicine, minimally invasive treatment, disease-specific topics and the expanding role of non-physician providers against the backdrop of health care reform.
â€œThe health care system is demanding cost effective, clinically relevant continuing education programs in nursing and specifically in oncology nursing,â€ says Joan Giblin, MSN, FNP, a course director for the symposium and Manager of Patient Access at Winship.Â â€œOffering a high quality, regional program that can provide the latest information on advanced nursing practice, research, and other issues is central to meeting that need.â€
In addition to Joan Giblin, course directors for the event were Deena Gilland, RN, MSN, Director of Nursing at Winship, and Kevin Schreffler, RN, MSN, Clinical Nurse Specialist at Winship.
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. Whatâ€™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, itâ€™s four to five.
Lonial says one of the keys to improving patientsâ€™ prognosis is increasing their enrollment in clinical trials and better access to life-extending drugs.
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.
AtÂ 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.
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.