Friday, April 29, 2011

Hepatitis C News For Friday April 20th

Today the drug company Merck announced they're ready to launch Boceprevir in May, depending on FDA approval. Both telaprevir and boceprevir have been recommended by the FDA advisory panel for the treatment of hepatitis C. On the sidebar of this blog you can view the highlights of the meeting. You may be interested in viewing a video by Melissa Palmer, M.D discussing treatment with both protease inhibitors.

In The News;

Medpage Today;
FDA Panel Endorses Another Hep C Drug
4/28/2011 MedPage Today Gastroenterology
(MedPage Today) -- SILVER SPRING, Md. -- Hepatitis C patients will likely have two new treatment options after an FDA advisory committee unanimously endorsed a second new HCV drug in as many days.

FDA Panel Endorses Boceprevir for Hepatitis C
4/27/2011 MedPage Today Gastroenterology
(MedPage Today) -- SILVER SPRING, Md. -- An FDA advisory committee has voted unanimously to recommend approval of the investigational drug boceprevir (Victrelis), in combination with peginterferon and ribavirin, to treat hepatitis C genotype 1.

From HIV and Hepatitis
.BI 201335 for Hepatitis C Moves into Phase 3 Trials
Vitamin D deficiency is associated with hepatitis C and poor response to interferon-alfa based therapy
4/29/2011 News
Genetic polymorphisms within the vitamin D receptor and vitamin D deficiency are associated with chronic hepatitis C and poor response to interferon-alfa based therapy, finds the latest issue of the Journal of Hepatology.

UK acute upper GI bleed rates declining
4/29/2011 MedWire News - Gastroenterology
Findings from a 2007 UK audit show that rates of acute upper gastrointestinal bleeding have fallen by 4% since 1993.

Low-volume hospitals with certain systems seem to achieve better esophagectomy outcomes
4/29/2011 News
A study in May's issue of the Annals of Surgery investigates the association between systems characteristics and mortality of esophagectomy at low-volume hospitals.

HBV Rebound Common for Some Patients (CME/CE)
4/28/2011 MedPage Today Gastroenterology
(MedPage Today) -- In clinical practice, the hepatitis B virus often rebounds in patients taking nucleoside or nucleotide analogues, researchers reported.

JAMA study reports on fatty liver disease in children and teens
The largest study of its type has found that neither vitamin E, which is an antioxidant, nor the diabetes drug metformin, successfully reduced liver enzymes in nonalcoholic fatty liver disease in children or teens. The study also found that in patients with a severe type of fatty liver disease, a biopsy of the liver showed improvement in the injury pattern with vitamin E therapy.
Contact: Cindy Fox Aisen

New research shows that high maternal viral load and co-infection with human immunodeficiency virus (HIV) are the only risk factors associated with vertical transmission of the hepatitis C virus (HCV-VT). A variation in the infant's IL28B gene (CC) is associated independently with the spontaneous clearance of HCV genotype-1 among infected children. The status of IL28B in the mother or children did not increase risk of HCV-VT in this study. Findings are published in the May issue of Hepatology, a peer-reviewed journal of the American Association for the Study of Liver Diseases.

Seven Tips to Boost HCV Therapy Adherence
A successful Hepatitis C treatment outcome hinges on medication adherence. Review these seven tips for improving treatment adherence to maximize your chance of beating this virus.

'Urgent Need' for Research on Cancer Among Minorities: U.S. Report
THURSDAY, April 28 (HealthDay News) -- The United States urgently needs to expand research and improve understanding of cancer among minority populations, according to a special report issued Thursday by the President's Cancer Panel.

While minorities currently account for roughly one-third of the U.S. population, they are expected to become the collective majority by the year 2050, according to the report.
The panel noted that "minority and other underserved populations are disproportionately affected by certain cancers, are often diagnosed at later stages of disease, and frequently have lower rates of survival."
What's more, the incidence of cancer among minority populations is projected to nearly double over the next 20 years.

"Most of what we know about cancer is based on studies of non-Hispanic white people, but by the middle of the century that group will be only 38 percent of the population," said panel member Margaret L. Kripke, a professor emerita of immunology at the University of Texas M.D. Anderson Cancer Center in Houston. "We need more data on cancer among minority populations so that we can begin to implement specific preventive measures."

The report recommends more research into sociological factors that may explain disparities in cancer mortality among minorities.
"There have been a lot of studies in recent years trying to understand genetic differences associated with cancer susceptibility, but there are also cultural factors that can affect cancer mortality," said Kripke. "In some cultures, people are so afraid of a cancer diagnosis that they don't seek treatment until it's very late."
Current cancer screening guidelines should be evaluated, the panel noted, "to determine their accuracy in assessing disease burden in diverse populations."

"One-size-fits-all screening guidelines don't work," Kripke said. "For example, the breast cancer screening guidelines have been loosened up so that women can start having mammograms later and may be screened less often, but we know that there is an early age of onset of breast cancer among Latino populations, and so if you change the guidelines based on the majority of people, these women will be left out."
Another recommendation is that "cultural competency" become an integral part of medical school as well as continuing education for all health-care providers and administrative staff.
Dr. Otis W. Brawley, chief medical officer of the American Cancer Society, praised the report, and said it "hit all the right points."

"The biggest thing we need to do is to get people access to care, the next thing is to make sure they get good quality care, and then we need to make sure that the care is delivered in a friendly environment where the patient feels welcome," said Brawley.

"The first two are actually much easier to do than the third," he noted. "A lot of poor people, but especially poor blacks and poor Hispanics, are suspicious of the medical system, and think the hospital doesn't really want to care for them -- [that] they just want to bill them and utilize them to teach their medical students."
Kripke acknowledged that many of the recommendations involve spending more money at a time when the health-care system is already financially strained.

"For instance, we know that the best way to deliver cancer information to a patient whose primary language is not English is through a medical translator, but how many hospitals can afford to do that?" she said.
The panel concluded that disparities in cancer care and research will ultimately be eliminated only by addressing the social factors involved in poor health outcomes, such as poverty, substandard housing, lower educational status and inadequate access to quality health care.

More information
You can access the full report here.

Blacks with liver cancer get fewer transplants
Reuters – 15 mins ago  
NEW YORK (Reuters Health) - African Americans with liver cancer are less likely than whites to get a transplant for the disease, according to U.S. researchers. Full Story »

Other Interesting News

Mycobacterium leprae strains from armadillos and from U.S. patients with no foreign exposure were found to be highly similar genetically and different from strains found elsewhere in the world. These data suggest that the armadillo may be a source of leprosy in the United States.

Armadillos Can Transmit Leprosy to Humans, Federal Researchers Confirm
About a third of leprosy cases each year in the United States are a result of contact with infected armadillos.
How do white blood cells detect invaders to destroy?
Cedars-Sinai research offers model
LOS ANGELES (April 28, 2011) – Scientists at Cedars-Sinai Medical Center have discovered how a molecular receptor on the surface of white blood cells identifies when invading fungi have established direct contact with the cell surface and pose an infectious threat.
The receptor called Dectin-1, studied in the laboratory of David Underhill, PhD, an associate professor in Cedars-Sinai's Inflammatory Bowel and Immunobiology Research Institute, detects fungi and instructs white blood cells whether to expend the energy needed to devour the invading pathogens. The findings are featured as the cover story in the April 28 edition of Nature.
Although scientists long have theorized how immune cells recognize microbial debris sloughed from invading organisms at some distance from themselves, this study establishes a model to explain how immune cells determine when pathogens are directly in contact with their surface and thus pose a significantly greater risk, demanding rapid destruction.

The study is important because it moves scientists one step closer to understanding the mysteries of how our bodies mount an immune response to fight disease.
In early stages of infection, white blood cells patrol the body looking for invading pathogens. Dectin-1, a receptor on the surface of white blood cells, recognizes specific components of fungal cell walls, and alerts or "switches on" the immune cells to prepare to fight the infection.

"Our lab has been studying Dectin-1, which directs white blood cells to eat and kill the fungi that they encounter directly, but to ignore soluble material sloughed off of the fungal surface which does not pose an immediate threat," said Helen Goodridge, PhD, first author on the study and a researcher in the laboratory headed by Underhill. "This is important because phagocytosis and anti-microbial defense responses are energy-intensive and destructive, and should only be used when absolutely necessary."
During phagocytosis, a white blood cell encounters a microbe, engulfs it, and eats it. Once inside the cell, the microbe can be killed using a combination of degradative enzymes, highly reactive chemicals, and an acidic environment.

A molecular structure that the Underhill lab calls a "phagocytic synapse" forms at the surface of the white blood cell when Dectin-1 detects fungi. As a phagocytic synapse forms, two inhibitory proteins that block transmission of signals inside the white blood cell are pushed aside. This allows Dectin-1 to instruct the cell to respond. The phagocytic synapse does not form when Dectin-1 encounters soluble fungal debris, so the white blood cell does not respond.

"The phagocytic synapse resembles another molecular structure, the 'immunological synapse.' It is critical at later stages of an immune response," said Underhill. "It appears that the phagocytic synapse may be an evolutionary precursor of the immunological synapse."

The study was funded by the National Institutes of Health, the American Heart Association, and the Crohn's and Colitis Foundation of America. Underhill, who also directs the PhD Program in Biomedical Sciences and Translational Medicine at Cedars-Sinai, is the Medical Center's Janis and William Wetsman Family Chair in Inflammatory Bowel Disease Research.
Nationally known for its high quality patient care, the Cedars-Sinai Health System includes a major research enterprise and ranks among the top 10 independent medical centers in terms of NIH research funding. With more than 850 research projects under way, Cedars-Sinai focuses on translational studies that move advances directly from the laboratory to the bedside.
Botox Side Effects; Allergan Must Pay $212 million
Allergan was ordered by a federal court jury in Virginia to pay $212 million to a 67-year-old man who claimed he developed permanent brain damage after being injected with Botox to treat cramps and tremors in his hand in 2007. Douglas Ray was awarded $12 million in compensatory damages and $200 million in punitive damages, after convincing the jury Allergan failed to warn that injections could trigger an autoimmune reaction leading to brain damage.

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