terça-feira, 3 de junho de 2014

10 Lessons Medicine Can Learn from Bears

 

From osteoporosis to heart disease to pregnancy, there's a lot bears are teaching scientists

 

Gall Stones and Liver Disease

Ursodiol (ursodeoxycholic acid), a compound originally derived from bear bile (a substance secreted by the liver that helps break down fat), is already used in Western medicine to dissolve cholesterol-laden gall stones and to treat a form of liver disease called primary biliary cirrhosis. Despite the availability of a synthetic version of the compound, as many as 13,000 bears are still kept captive on farms in China, Vietnam and other parts of Asia, where they are milked for their bile. David Garshelis, co-chair of the Bear Specialist Group for the International Union for Conservation of Nature, was allowed to visit one of these bile farms, probably because its practices are among the most humane. While the bears he saw were in good conditions, he says the bear rescue organization Animals Asia routinely takes in bile bears that show evidence of torture. While these practices may seem jarring, keep in mind that in the U.S. and Canada, 50,000 black bears are killed annually for food and another 2,000 brown bears are killed for sport.
According to traditional Chinese medicine, the benefits of bile extend beyond those of ursodeoxycholic acid. Intriguingly, when Oeltgen injected rabbits with radioactively labeled opiate-like compounds similar to the ones thought to be found in hibernation induction trigger, he found that they were excreted through the bile.

Courtesy David Garshelis

Seniors who exercise regularly experience less physical decline as they age


The majority of adults aged 65 and older remains inactive and fails to meet recommended physical activity guidelines, previous research has shown. However, these studies have not represented elders living in retirement communities who may have more access to recreational activities and exercise equipment. Now, researchers at the University of Missouri found that older adults in retirement communities who reported more exercise experienced less physical decline than their peers who reported less exercise, although many adults -- even those who exercised -- did not complete muscle-strengthening exercises, which are another defense against physical decline.

"Physical decline is natural in this age group, but we found that people who exercised more declined less," said Lorraine Phillips, an associate professor in the MU Sinclair School of Nursing. "The most popular physical activities the residents of the retirement community reported doing were light housework and walking, both of which are easily integrated into individuals' daily lives, but these exercises are not the best choices for maintaining muscle strength."

Phillips and her colleagues studied the physical activity of 38 residents at TigerPlace, an independent-living community in Columbia, four times in one year. The researchers tested the residents' walking speed, balance and their ability to stand up after sitting in a chair. Then, researchers compared the results of the tests to the residents' self-reported participation in exercise. Phillips found that residents who reported doing more exercise had more success maintaining their physical abilities over time.

Phillips says the national recommendations for exercise include muscle strengthening exercises, such as knee extensions and bicep curls. Most of the study participants did not report completing these types of activities despite daily opportunities for recreational activities and access to exercise equipment. Phillips says muscle strength is important to individuals of this age group in order for them to maintain their ability to conduct everyday activities such as opening jars, standing up from chairs and supporting their own bodyweight.

"For older individuals, walking may represent the most familiar and comfortable type of physical activity," Phillips said. "Muscle-strengthening exercises should be promoted more aggressively in retirement communities and made more appealing to residents."

To combat the lack of physical activity among seniors, Phillips says health care providers should discuss exercise programs with their patients and share the possible risks associated with their lack of exercise, such as losing their ability to live independently. According to the Centers for Disease Control and Prevention, individuals 65 years of age and older that have no limiting health conditions should do muscle-strengthening activities that work all major muscle groups at least two days a week.

Phillips' research, "Retirement Community Residents' Physical Activity, Depressive Symptoms, and Functional Limitations," was published in Clinical Nursing Research.


Story Source:

The above story is based on materials provided by University of Missouri-Columbia. The original article was written by Diamond Dixon. Note: Materials may be edited for content and length.


Journal Reference:

  1. L. J. Phillips. Retirement Community Residents' Physical Activity, Depressive Symptoms, and Functional Limitations. Clinical Nursing Research, 2014; DOI: 10.1177/1054773813508133

Nearly one in eight American children are maltreated before age 18

 

June 2, 2014

Yale University

By the time they reach age 18, about 12 percent of American children experience a confirmed case of maltreatment in the form of neglect, physical, sexual, or emotional abuse, according to a new study. "Maltreatment is on the scale of other major public health concerns that affect child health and well-being," one researcher said. "Because child maltreatment is also a risk factor for poor mental and physical health outcomes throughout life, the results of this study provide valuable epidemiologic information.


Sad child (stock image). "Maltreatment is on the scale of other major public health concerns that affect child health and well-being," one researcher said. "Because child maltreatment is also a risk factor for poor mental and physical health outcomes throughout life, the results of this study provide valuable epidemiologic information."

By the time they reach age 18, about 12% of American children experience a confirmed case of maltreatment in the form of neglect, physical, sexual, or emotional abuse, according to a new study by researchers at Yale University.

The numbers are even more sobering for black and Native American children, with one in five black children and one in seven Native American children experiencing maltreatment during the time period studied. The results are published in the June 2 issue of the journal JAMA Pediatrics.

The authors estimated the cumulative prevalence of confirmed childhood maltreatment by age 18 using the National Child Abuse and Neglect Data System Child File, which includes information on all U.S. children with a confirmed report of maltreatment. Analysis of data between 2004 and 2011 showed that over 5.6 million children had experienced maltreatment during this time period.

"Confirmed child maltreatment is dramatically underestimated in this country. Our findings show that it is far more prevalent than the 1 in 100 that is currently reported," said first author Christopher Wildeman, associate professor of sociology and faculty fellow at the Institution for Social and Policy Studies at Yale.

Wildeman, his colleagues at other institutions, and in the Yale Departments of Pediatrics and Sociology, provide cumulative, rather than annual, estimates that confirmed child maltreatment is common.

"Maltreatment is on the scale of other major public health concerns that affect child health and well-being," he said. "Because child maltreatment is also a risk factor for poor mental and physical health outcomes throughout life, the results of this study provide valuable epidemiologic information."


Story Source:

The above story is based on materials provided by Yale University. Note: Materials may be edited for content and length.


Journal Reference:

  1. Christopher Wildeman, Natalia Emanuel, John M. Leventhal, Emily Putnam-Hornstein, Jane Waldfogel, Hedwig Lee. The Prevalence of Confirmed Maltreatment Among US Children, 2004 to 2011. JAMA Pediatrics, 2014; DOI: 10.1001/jamapediatrics.2014.410

First survey of ACOs reveals surprising level of physician leadership

 

June 2, 2014

The Geisel School of Medicine at Dartmouth

In spite of early concerns that hospitals' economic strengths would lead them to dominate the formation of Accountable Care Organizations (ACOs), a new study reveals the central role of physician leadership in the first wave of ACOs. ACOs are groups of providers that are held responsible for the care of defined populations of patients.The key notion is that the providers within the ACO receive financial rewards for both improving the quality of care and reducing the growth of costs. Over 600 Accountable Care Organizations (ACOs) are now operating in the U.S.


In spite of early concerns that hospitals' economic strengths would lead them to dominate the formation of Accountable Care Organizations (ACOs), a new study published in the June issue of Health Affairs reveals the central role of physician leadership in the first wave of ACOs.

"The broad reach of physician leadership in ACOs has important implications for the future of health care reform," said Carrie Colla, PhD, lead investigator of the study. "A central role for physicians in the leadership of ACOs is likely to have a powerful influence on how both physicians and patients view the ACO model."

ACOs are groups of providers that are held responsible for the care of defined populations of patients.The key notion is that the providers within the ACO receive financial rewards for both improving the quality of care and reducing the growth of costs.The Affordable Care Act established this new, voluntary federal program for Medicare, and many private insurers are adopting the model. Over 600 Accountable Care Organizations (ACOs) are now operating in the U.S.

In the first analysis of the National Survey of ACOs, the research team from the Dartmouth Institute for Health Policy &Clinical Practice found that the majority of ACOs identified as physician led, with another third jointly led by physicians and hospitals.

The study compared physician-led ACOs to other types of ACOs and found that physician-led ACOs were more likely to have comprehensive care management programs in place and advanced IT capabilities.They are also more likely to measure and report financial and quality performance at the clinician level and to provide meaningful and timely feedback to clinicians.

"These findings suggest that physician leadership will be an important factor in initiatives to improve the quality and cost of care," said Mark McClellan, MD, former Administrator of the Centers for Medicare and Medicaid Services (CMS), now at the Brookings Institution."Physician-leaders may have a leg up when it comes to working with their colleagues to identify opportunities to improve care and to measure impact."

The study also documented the diversity of organizations participating in accountable care programs. Some ACOs are made up of only primary care physician practices, some are multispecialty physician practices, while others are integrated delivery systems and include providers across the continuum, such as hospitals and post-acute care providers.

"Physicians' buy-in to payment reform is likely to be critical to the success of the health care reform," said Elliott Fisher, MD, MPH, Director of the Dartmouth Institute and a co-author on the paper. "The findings suggest that physicians are taking seriously their responsibility to lead change in the health care system on behalf of their patients." Previous research has shown that involving physicians in the governance of provider organizations improves communication and builds trust by assuring practicing physicians and clinical staff that their professional values are represented.Physician governance also assures patients that their needs will be considered along with those of the organization, the researchers said.


Story Source:

The above story is based on materials provided by The Geisel School of Medicine at Dartmouth. Note: Materials may be edited for content and length.


Journal Reference:

  1. C. H. Colla, V. A. Lewis, S. M. Shortell, E. S. Fisher. First National Survey Of ACOs Finds That Physicians Are Playing Strong Leadership And Ownership Roles. Health Affairs, 2014; 33 (6): 964 DOI: 10.1377/hlthaff.2013.1463

Increased mucins pinned to worsening cystic fibrosis symptoms

 

The research, published in the Journal of Clinical Investigation, shows that a three-fold increase of mucins dramatically increases the water-draining power of the mucus layer. This hinders mucus clearance in the CF lung, resulting in infection, inflammation, and ultimately lung failure.

"Our finding suggests that diluting the concentration of mucins in CF mucus is a key to better treatments," said Mehmet Kesimer, PhD, associate professor of pathology and laboratory medicine and co-senior author of the JCI paper.

Ashley Henderson, MD, assistant professor of medicine and co-first author of the JCI paper, added, "We think this study shows why nebulized hypertonic saline [sterile salty water] improves the hydration of the CF airway, improves the patient's mucus clearance and, in so doing, increases lung function."

The UNC study also casts further doubt on a controversial 2004 study that disputed the theory that mucins play a major role in CF.

This work, a collaboration of 13 UNC scientists, is part of an extensive UNC lung research program based in the new Marsico Lung Institute, which is led by Richard Boucher, MD, co-senior author of the JCI study.

"This paper points to a therapeutic strategy to rectify this problem of mucus clearance and provides signposts, or biomarkers, to guide development of novel therapies," said Boucher, the James C. Moeser Eminent Distinguished Professor of Medicine. Also, by measuring mucin concentration in patient mucus, doctors could learn whether therapies are working and to what degree.

Scientists and doctors have known for a long time that failing to clear mucus is the major reason why CF patients face chronic lung infection and inflammation. But the mechanisms of this failure have not been well understood.

Normally, when we breathe, the mucosal layer of our lungs trap the contaminants -- dust, pollutants, bacteria -- naturally found in air. Then, epithelial cells with hair-like cilia brush the mucus up and out of our lungs. In people with cystic fibrosis, though, this process doesn't work as well because they lack a properly functioning CFTR gene. They continually battle infections and must work hard to clear mucus from their lungs.

This is where mucins come into play. Mucins give mucus its gel-like thickness and elasticity. "Without mucins, mucus would have the viscosity of blood," Kesimer said. "The vast majority of mucus is water, but 30 to 35 percent of the remaining solid material is made up of mucins. They form a network of bonds that serves as a framework."

This is why Kesimer and his UNC mentor, the late John Sheehan, PhD, Distinguished Professor of Biochemistry and Biophysics, suspected that something must happen to mucins in the CF lung. They and others knew that CF mucus is typically drier than normal mucus.

Back in 2004, however, other researchers used a standard immunologic analysis to show that mucins were decreased in CF secretions. They suspected DNA was the main culprit that caused problems in CF mucus. Sheehan and Kesimer were skeptical, as was Henderson, a clinician who saw CF patients and had been a research fellow in Sheehan's lab. They set out to conduct various novel experiments to physically measure the amount of mucins in CF secretions and normal mucus.

In one experiment, they used a technique called size exclusion chromatography: in a column, they added custom-made beads that had small pores. Smaller proteins could enter the pores while mucins could not. Through this separation, Kesimer and Henderson's team isolated the mucins and simultaneously measured their concentration using a refractometer.

By using sputum samples from CF patients, the researchers found that CF mucus contained three times as many mucins than did normal samples. They also conducted experiments to show that mucin overabundance led to a six-fold increase of the pressure between the mucus layer and the ciliated layer.

This finding affirms the CF disease model that UNC researchers published in the journal Science in 2012. In essence, in a CF patient, the increased osmotic pressure of the concentrated mucus layer crushes the ciliated cells so that mucus is not cleared. The lung becomes a breeding ground for bacteria. This leads to more mucins, more mucus, inflammation, and subsequently lung failure.

Moreover, Kesimer's team showed precisely why the 2004 research was flawed. Those researchers used a classic antibody based immunologic technique called a western blot, which measures the expression of a given protein -- in this case mucins -- based on an antibody response to that protein.

But, as Kesimer pointed out, antibodies must latch onto proteins at specific sites on the proteins' surfaces. When Kesimer conducted the western blot, he got the same result as the 2004 researchers. But then he used a technique called mass spectrometry to find that CF secretions are full of proteases -- enzymes that break down molecules. The mass spectrometry showed that the proteases degraded the mucins, essentially "erasing" many of the sites where antibodies could bind without disrupting the structural integrity of mucins.

"For that reason, we saw less antibody response using the western blot," Kesimer said. And so it looked as if there were fewer mucins. "But by using more accurate methods, we clearly saw the increase of mucins. In fact, we've analyzed many samples of sputum from patients with other chronic pulmonary diseases and we saw the increase in mucins in them, as well."

Major geographic disparities in access to kidney transplantation

 

May 29, 2014

Wiley

There is substantial geographic variation in access to kidney transplantation among the more than 4,000 US dialysis facilities that treat patients with kidney failure, with a disproportionate lack of access to those in the Southeast. Certain factors seem to explain these differences, and they underscore the need for political, financial, and health systems changes to reduce transplant inequities across the country.


There is substantial geographic variation in access to kidney transplantation among the more than 4000 US dialysis facilities that treat patients with kidney failure, with a disproportionate lack of access to those in the Southeast. Certain factors, which are described in several papers published in the American Journal of Transplantation, seem to explain these differences, and they underscore the need for political, financial, and health systems changes to reduce transplant inequities across the country.

Researchers have noticed variability in transplant rates between different dialysis facilities, but little is known about what facility-related factors play a role. "There are likely a variety of causes for these differences, including national or state policies that influence how kidney disease patients are treated, patients' access to healthcare for chronic disease prior to end organ disease, medical factors, and clinician practices," explained Rachel Patzer, PhD, MPH of the Emory University School of Medicine.

Dr. Patzer and her team looked for characteristics of dialysis facilities that were linked with delayed access to kidney transplantation. When they analyzed Centers for Medicare and Medicaid Services Dialysis Facility Report data from 2007 to 2010, they found that dialysis facilities with a higher proportion of African American patients, uninsured patients, and patients with diabetes had lower rates of kidney transplantation. In addition, facilities owned by for-profit companies and facilities with fewer staff tended to have lower rates of kidney transplantation. The lowest performing dialysis facilities were in the Southeast. "The disparities that we have reported in access to kidney transplantation within dialysis facilities in the Southeastern US are linked to the higher concentration of poverty in this area of the country compared to other regions," said Dr. Patzer. Facilities that had a greater number of staff, that were located in a region with more transplant centers per 10,000 kidney failure patients, and that had a higher percentage of patients who were employed tended to have higher rates of transplantation. The highest performing dialysis facilities were in the Northeast.

"We think these results are important because identifying the regions of the country with the greatest disparity in access to kidney transplantation could help policy makers to direct funding to support solutions to address these disparities, as well as help researchers to develop and test interventions to reduce these disparities," said Dr. Patzer. In an accompanying viewpoint, Dr. Patzer and her colleague Stephen Pastan, MD, suggest various efforts to pursue. For example, low performing facilities could focus on internal quality improvement activities to improve equity, while regionally coordinated policy changes could increase staffing, standardize patient education, and expand Medicaid eligibility.

In a second viewpoint, Titte Srinivas, MD, of the Medical University of South Carolina, notes that the disproportionate lack of access to medical care among kidney failure patients in the Southeast reflects the interaction of patients' socioeconomic and biologic factors with the financial and organizational structure of the healthcare system. Also, organ donation from living donors is limited by the health of the donor population, which in turn is a reflection of population health.

"Increasing transplant rates in the Southeastern US thus demands that the transplant community advocate for change beyond the dialysis unit and the transplant center," he wrote. Dr. Srinivas argues that improving population health is the best way to increase patients' access to transplantation, as poverty and lack of educational attainment are the main barriers to completing steps to successful transplantation. He stresses that an effective system of healthcare delivery will need to use a "top-down" approach so that population health in the Southeast can improve, and he points to the importance of such efforts given the politics that recently blocked Medicaid expansion in the region. "Disruptive change in the financial model of healthcare and advocacy for broader access to healthcare at large are urgently needed to change the current reality of low transplant rates and the overall environment of end-stage renal disease care in the US Southeast."


Story Source:

The above story is based on materials provided by Wiley. Note: Materials may be edited for content and length.

Hormone that controls supply of iron in red blood cell production discovered by researchers

 

Iron is an essential functional component of hemoglobin, the molecule that transports oxygen throughout the body. Using a mouse model, researchers found that erythroferrone is made by red blood-cell progenitors in the bone marrow in order to match iron supply with the demands of red blood-cell production. Erythroferrone is greatly increased when red blood-cell production is stimulated, such as after bleeding or in response to anemia.

The erythroferrone hormone acts by regulating the main iron hormone, hepcidin, which controls the absorption of iron from food and the distribution of iron in the body. Increased erythroferrone suppresses hepcidin and allows more iron to be made available for red blood-cell production.

"If there is too little iron, it causes anemia. If there is too much iron, the iron overload accumulates in the liver and organs, where it is toxic and causes damage," said senior author Dr. Tomas Ganz, a professor of medicine and pathology at the David Geffen School of Medicine at UCLA. "Modulating the activity of erythroferrone could be a viable strategy for the treatment of iron disorders of both overabundance and scarcity."

The early findings were reported online June 1 in the journal Nature Genetics.

"Our previous work anticipated that a regulator of hepcidin could be secreted by the bone marrow," said the study's first author, Leon Kautz, a postdoctoral fellow at UCLA. "In this research, we searched for new substances that were made in bone marrow that could fill that role."

Researchers first focused on what happens in the bone marrow after hemorrhage. From there, they focused on a specific protein that was secreted into the blood. This protein attracted their attention because it belonged to a family of proteins involved in cell-to-cell communication. Using recombinant DNA technology, they showed that the hormone suppressed the production of hepcidin and demonstrated the effect it had on iron metabolism.

The team foresees that the discovery could help people with a common congenital blood disorder called Cooley's anemia, also known as thalassemia, which causes excessive destruction of red blood cells and of their progenitors in the bone marrow. Many of these patients require regular blood transfusions throughout their lives. Most iron overload is attributed to the iron content of transfused blood. However, even patients who are rarely, or never, transfused can also develop iron overload.

"Overproduction of erythroferrone may be a major cause of iron overload in untransfused patients and may contribute to iron overload in transfused patients," said study author Elizabeta Nemeth, a professor of medicine at the David Geffen School of Medicine at UCLA and co-director of the UCLA Center for Iron Disorders. "The identification of erythroferrone can potentially allow researchers and drug developers to target the hormone for specific treatment to prevent iron overload in Cooley's anemia."

The discovery could also lead to treatments for other common anemia-related conditions associated with chronic kidney disease, rheumatologic disorders and other inflammatory diseases. In these conditions, iron is "locked up" by the effect of the hormone hepcidin, whose levels are increased by inflammation. Erythroferrone, or drugs acting like it, could suppress hepcidin and make more iron available for red blood-cell production.

The next stage of research is to understand the role of the new hormone in various blood diseases and study the molecular mechanisms through which erythroferrone regulates hepcidin.

Additional study authors included Grace Jung and Erika Valore of UCLA and Stefano Rivella of Weill Cornell Medical College in New York.

The study was supported by a grant from the National Institute of Diabetes and Digestive and Kidney Diseases and the National Heart, Lung and Blood Institute.

The Board of Regents of the University of California is the owner of patent applications and uses directed at erythroferrone, which are managed by UCLA's Office of Intellectual Property and Industry Sponsored Research. This intellectual property is the subject of license negotiations with a company for which authors Ganz and Nemeth are scientific advisors and equity holders. Other disclosures are available in the manuscript.

Paired enzyme action in yeast reveals backup system for DNA repair

 

Because such mechanisms are generally conserved throughout evolution, at least in part, researchers say the findings suggest that a similar DNA repair kit may exist in humans and could serve as a target for controlling some cancers and treating a rare, enzyme-linked genetic disorder called Aicardi-Goutieres syndrome. The syndrome, an often fatal neurological condition, is found in only a few families in small towns in Italy, Algeria and Japan, and among North American Cree Indians.

In a report to be published in the journal Nature online June 1, NYU Langone researchers, aided by colleagues at Yale University, found that the paired enzyme action prevents and repairs mistakes made during DNA replication, when molecular subunits known as rNMPs get inserted into DNA. The rNMPs are building blocks of DNA's chemical cousin RNA, which is the key intermediary involved in making all proteins from DNA.

Researchers say while some misplaced rNMPs naturally occur -- and are repaired -- as DNA is replicated during cell growth, enzymes quickly recognize such foreign intruders as lesions. If not removed, such lesions raise the likelihood of mutations in the DNA code, which if allowed to accumulate, create genomic instability in yeast and human cells, and can lead to cell death and cancer-promoting immune reactions.

"Taking our cue from yeast, which shares a third of its genetic make-up with humans, our study shows for the first time that a very robust backup DNA repair mechanism is in place to deal with common rNMP-induced mutations," says senior study investigator and NYU Langone yeast geneticist Hannah Klein, PhD. "Without a robust backup system for DNA repair, cells will die."

Among the study's key findings was that one of the enzymes, Srs2, helps open up the tightly bound, ladder-like yeast DNA structure so that the other enzyme, Exo1, can cleave out any misplaced rNMPs. Such rNMP misinsertions during replication, scientists say, contaminate DNA and are often lethal structural alterations. Both enzymes were previously known to play a role in DNA replication and repair, but the scientists say this is the first evidence of their role in preventing and correcting rNMP-derived mutations.

Moreover, the research team found that the Srs2-Exo1cell-repair mechanism prevents mutations from accelerating in yeast already deficient in a third enzyme coded by the gene RNaseH2. That enzyme serves as the primary removal mechanism for rNMPs during cell growth, a major role in DNA repair. But in yeast deficient in both the RNaseH2 enzyme and Srs2, the number of mutations, chromosome losses, and chromosome breakages rise 10-fold.

According to Dr. Klein, interim chair of biochemistry and molecular pharmacology at NYU Langone, her team's study is also the first to show how Srs2 and Exo1 backs up the routine rNMP maintenance function of the RNaseH2 enzyme, highlighting nature's constant need to balance cell growth, genetic mutation and DNA repair in preventing disease and cell death.

Dr. Klein cautions that while no known human Srs2 counterpart exists, Exo1 is found in human cells, so it is likely that a similar backup DNA repair mechanism exists in people. And if further testing shows that its repair function can be manipulated in humans, the enzyme mechanism could be used as a basis to stall or reverse cancers derived from RNaseH2 mutations. Dr. Klein says breaking down how tumors develop in RNaseH2-deficient yeast cells is critical to formulating and testing potential treatments for people.

Other research has implicated overproduction of RNase H2 as one of several genetic features of many cancers, including cancers of the bladder, brain, breast, head, and neck squamous cell carcinomas, as well as leukemias (T- and B-cell acute lymphoblastic leukemia and acute myeloid leukemia), melanomas, and seminomas.

Even more specifically, she says, the enzyme repair mechanism could potentially be used to decipher and counteract the root causes of RNaseH2 enzyme deficiency, which in humans is known to be one of the main hereditary signatures behind Aicardi -Goutieres syndrome. The syndrome causes spinal inflammation and brain shrinkage, fatally stalling physical and mental development in early childhood. Although rare and currently untreatable, the disease afflicts hundreds in isolated communities where inbreeding among families has occurred and when both parents have RNaseH2 or other Aicardi -Goutieres-related mutations.

For the study, lead investigator and fellow yeast geneticist Catherine Potenski, PhD, monitored how various mutant yeast strains grew in the laboratory, including those deficient in the RNaseH2 enzyme and Srs2. (Dr. Klein's lab in the late 1980s was the first to isolate RNaseH2 mutations in yeast.)

Dr. Potenski, a postdoctoral fellow at NYU Langone, says yeast strains deficient in both enzymes accumulated mutations and did not grow well, while those depleted of only the RNaseH2 enzyme, were able to minimize mutations and continue growing. However, in experiments with Exo1, its removal spiked mutations in RNaseH2-deficient strains, while depletion of Srs2 had no worsening effect. This evidence confirmed to researchers that Srs2 and Exo1 acted together to prevent mutations in RNaseH2-deficient cells.

Analysis by colleagues at Yale later confirmed the linked action between Srs2 and Exo1, showing how Srs2 stimulated Exo1 to act on yeast DNA, allowing for the cleaving and repair of rNMP lesions.

Dr. Potenski says her latest studies of Srs2, Exo1, and RNaseH2 enzymes should also serve as a reminder to other researchers that known enzymes may have many roles in the cell life cycle, some of which are not yet known, and that even more backup roles could be found.

Dr. Potenski says the team next plans to investigate what other biological factors may act on Exo1, as a possible third backup repair mechanism, and to investigate what factors might trigger RNaseH2 mutations more prone to lead to cancer.

Newly identified brain cancer mutation will aid drug development

 

June 1, 2014

Duke Medicine

New genetic insights into a rare and deadly form of childhood and young adult brain cancer called brainstem glioma has been identified by an international team of researchers. The researchers identified a genetic mutation in the tumor cells that plays a role in both the growth and the death of a cell. Additionally, the mutation to the newly identified gene may also contribute to the tumor’s resistance to radiation.


A collaborative effort between Duke Medicine researchers and neurosurgeons and scientists in China has produced new genetic insights into a rare and deadly form of childhood and young adult brain cancer called brainstem glioma.

The researchers identified a genetic mutation in the tumor cells that plays a role in both the growth and the death of a cell. Additionally, the mutation to the newly identified gene may also contribute to the tumor’s resistance to radiation.

The findings, published online in the journal Nature Genetics on June 1, 2014, provide both immediate and long-term benefits. Knowing that this mutation may render radiation ineffective, patients could be spared that therapy. The mutation would also serve as a strong candidate for drug development.

The researchers conducted genetic tests and found that many of the tumor cells had a mutation in a gene called PPM1D, which causes cells to proliferate and avoid natural death. It is the first time this mutation has been found to be a major driving force in the development of brainstem gliomas; it is not evident in other brain tumors.

If tumors have this PPM1D mutation, they do not have another more common genetic mutation to the TP53 gene, a tumor suppressor that, when defective, is linked to half of all cancers.

“This finding has immediate clinical applications, because either mutation - PPM1D or TP53 – cause the tumor cells to be resistant to radiation,” said senior author Hai Yan, M.D., Ph.D., a professor of pathology at Duke University School of Medicine. “Knowing that could spare patients from an ineffective treatment approach.”

Additionally, the PPM1D genetic mutation is a strong candidate for new drug development.

“This finding gives us a clue as to why these particular tumors are growing inappropriately,” said co-author Zachary Reitman, M.D., Ph.D., a research associate at Duke. “These clues may help us to design better treatments for this type of cancer.”

Yan said his lab is working to identify new treatments that could target the PPM1D genetic mutation and shut down its cancer-growing capabilities.

“PPM1D is itself a target for drug development, because the gene mutation causes cells to avoid death and proliferate,” Yan said. “In drug development, it’s easier to turn that growth function off than it is to switch on the cell’s defective tumor suppression mechanism.”


Story Source:

The above story is based on materials provided by Duke Medicine. Note: Materials may be edited for content and length.


Journal Reference:

  1. Liwei Zhang, Lee H Chen, Hong Wan, Rui Yang, Zhaohui Wang, Jie Feng, Shaohua Yang, Siân Jones, Sizhen Wang, Weixin Zhou, Huishan Zhu, Patrick J Killela, Junting Zhang, Zhen Wu, Guilin Li, Shuyu Hao, Yu Wang, Joseph B Webb, Henry S Friedman, Allan H Friedman, Roger E McLendon, Yiping He, Zachary J Reitman, Darell D Bigner, Hai Yan. Exome sequencing identifies somatic gain-of-function PPM1D mutations in brainstem gliomas. Nature Genetics, 2014; DOI: 10.1038/ng.2995