Healthy Innovations: Solving Problems
There are serious health problems out there that affect all of us one way or another. For a positive spin on the problem, every year in this section, we like to highlight medical advancements that improve our quality of life. Whether it’s finding new avenues for treating a devastating disease, reducing worries about hunger or getting relief from overwhelming pain, promising research is making a difference.
treatment for shingles
More than 95 percent of people over 40 born in the U.S. have had chicken pox. Herpes zoster, the virus that causes it, is a sneaky one, lying dormant for years in nerve cells, only to become an active infection again when our resistance gets low. It reappears in the form of shingles, which can affect different parts of the body depending on which nerve cells are infected.
The Centers for Disease Control and Prevention (CDC) is projecting one million new cases of shingles this year. For some, the eye area is affected, which can result in eye infections, inflammation of the cornea, or even blindness. In addition, the nerve inflammation and severe pain can last years after the rash is gone. This pain, post-herpetic neuralgia (PHN), is more common as we age.
Dr. Jay Pepose, medical director of the Pepose Vision Institute, recommends that everyone over 50 receives the newly approved vaccine, Shingrix. “While the eye issues are serious enough, because it can infect the facial nerve, which has branches that go to the internal carotid artery, the risk of stroke in someone with shingles is four and a half times greater than for people without it,” he notes. “About 10 to 20 percent of shingles occurs around the eye. The rate of PHN also is higher in eye patients.”
Zostavax, the old shingles vaccine, was made with live chicken pox virus that had been attenuated, or reduced in effect. Some people weren’t eligible because of compromised immune systems. Shingrix is made from a dead virus and can be given to just about anyone over 50. Zostavax was one injection; Shingrix is given in two doses two to six months apart for lasting immunity.
the cdc compared the effectiveness of the two:
>> Zostavax: Decreased risk of shingles by 51 percent and PHN by 67 percent.
>> Shingrix: Decreased risk of shingles by 90 to 97 percent and PHN by 89 to 91 percent.
Pepose explains that even if you’ve had shingles, you can get it again, so the vaccine could still help. And if you got Zostavax, you should still get Shingrix. For shingles around the eye, see your ophthalmologist immediately for antiviral treatment.
making opioid cessation more effective
A Saint Louis University study published in the British Journal of Psychiatry gives new hope to people trying to wean off of opioids for non-cancer pain. “Depression can worsen pain and is common in patients who remain on long-term prescription opioids,” says Jeffrey Scherrer, Ph.D., lead author and professor of family and community medicine. “Our study should encourage clinicians to determine if their non-cancer pain patients have depression and aggressively treat that to reduce opioid use.”
He says in some ways, it’s a chicken or egg situation. Depression leads to longer opioid use, and opioid use can make depression worse. He looked at how the two were connected and found the following:
>> Long-term opioid use was related to the worsening of depression. The risk of developing depression was 50 to 200 percent higher with opioids. One reason is that opioids lower testosterone, which increases depression.
>> Stopping opioids also caused a more rapid decline in depression symptoms in patients adhering to their depression medication regimen.
>> If the depression is aggressively treated, it decreases pain severity, and patients will be more able to stop taking pain medications. Depressed patients who had been on opioids longer than 90 days and had their depression treated were more likely to stop taking opioids than those untreated.
Scherrer says there are guidelines already in place for depression screenings before prescribing opioids, but not for re-screening before each refill. Because a high number of patients passed depression screenings before starting opioids but later developed depression, this should be automatic. He estimates that up to 10 percent of patients with a new opioid prescription will still be taking them 90 days later, and a majority of those will still be taking them three to five years later.
“Effective depression treatment may break the mutually reinforcing opioid-depression relationship and increase the likelihood of successful opioid cessation and pain control,” Scherrer says.
new drug targets for fshd
Facioscapulohumeral muscular dystrophy (FSHD), an inherited type of muscular dystrophy, affects 800,000 people worldwide. It often targets young adults and may start with weakness in the face and shoulders before spreading to all skeletal muscles. Currently, there is no cure. In a recent paper published in the journal Skeletal Muscle, Saint Louis University researcher Francis Sverdrup, Ph.D, reports success in identifying new drug targets that could slow or halt the progression of this form of MD.
The DUX4 gene is responsible for FSHD, and inappropriate expression of its encoded DUX4 protein causes muscle degeneration. Sverdrup’s team screened existing drug libraries and identified two classes of drugs that turn off DUX4: BET inhibitors and beta antagonists. BET inhibitors are being studied in clinical trials for cancers and other diseases; beta antagonists are widely used for asthma and COPD (chronic obstructive pulmonary disease). “It is encouraging that our first two screens yielded molecules that turn off DUX4, and there may be more out there that can be identified in larger screens,” Sverdrup says.
However, there is a lot of work yet to be done. He says there are no good mouse models for FSHD because the organization of the disease is primate-specific. They know the drugs turn off the DUX4 gene; now, they will compare the two to see which is best for human trials. Sverdrup is confident within the next several years, they
reducing food insecurity
In St. Louis city, 26 percent of households regularly do not know whether they will be able to feed their family. In 2015, the Danis Pediatric Center at SSM Health Cardinal Glennon Children’s Hospital surveyed caregivers and found 57 percent of them experienced some level of food insecurity. A follow-up survey found additional insecurity in utilities and housing.
To address these findings, Saint Louis University won a Missouri Foundation of Health three-year grant for $580,000 to help families reduce food insecurity and connect to helpful resources. A team of researchers, social workers, students and community partners will create, implement and refine a system to improve screening and follow-up with families. By training health advocates, they can connect families with resources like federal food subsidies, debt consolidation, public transportation vouchers and parent training.
Ellen Barnidge, Ph.D., associate professor of behavioral science and health education at SLU, is the principal investigator for the grant, along with co-investigators Drs. Arthur and Gene LaBarge, SLUCare pediatricians.
Barnidge says the goal is to help families develop long-term stability and health through early intervention and supportive referrals. “We can’t expect a child to flourish if he can’t eat,” she says. “And screening alone doesn’t address food and other economic insecurities. By taking advantage of the fact that most families with children interact with the health care system, we can identify those who come into Danis and may need support and link them with community-based resources.” These will include Operation Food Search, St. Louis Diaper Bank, and SLU students in medicine, public health and social work who will share information on opportunities for food, banking, training, transportation and social work needs. Barnidge says there are many different models for this type of intervention across the country, and they chose to use students because they are a long-term, sustainable resource.
We are a nation of clogged arteries and heart disease. Each year in the U.S., 600,000 stents are inserted into blocked coronary arteries to improve blood flow to the heart. Currently, two types of stents are available: a bare metal stent and one coated with drugs, called a drug-eluting stent. Both have drawbacks. The bare metal stents don’t have the drugs that prevent re-narrowing of the artery and may need to be replaced over time, and the drugs can cause blood clots, so these stents need to be paired with blood thinners. A new solution was clearly needed.
The University of Missouri recently received a $1.5 million grant from the National Institutes of Health for a team of engineers, biomedical scientists and cardiologists to further develop and refine a revolutionary stent. Nanova Inc., a spin-off company founded by MU engineering researchers, makes a stent with a nano coating that molecularly binds to the device and blocks the narrowing that often accompanies bare stents without the clotting problems of the drug-eluting stents.
Dr. Doug Bowles, chair of the department of biomechanical sciences in the MU College of Veterinary Medicine, is testing it on pigs. “They have a heart comparable to the size of a human’s and can develop coronary artery disease if on a high fat diet,” he notes. “The Nanova stent appears to be the best of both worlds. The nano coating deters bad cells that cause narrowing in the artery but encourages epithelial cell growth that keeps platelets from becoming sticky and clumping together into clots.” It also could eliminate the need for future replacement. Human trials are not far off.
similarities in cancer help treatments
Recent research at Washington University School of Medicine in St. Louis demonstrated that mature cells sometimes revert to their youth, acting like rapidly dividing stem cells. The process was demonstrated using stomach cells, but it’s the same process for the kidneys, liver and pancreas, and probably many other organs as well. Rapidly dividing cells define cancer.
Dr. Jason Mills, professor of medicine in the division of gastroenterology, is senior investigator on the study, which was published in the August 2017 EMBO Journal. He says when older cells revert back, they carry all of the potential cancer-causing mutations they have accumulated in their lifespans. Because mature cells in the stomach, pancreas, liver and kidney all activate the same genes and follow the same process when they start dividing again, it could mean cancer’s beginnings in different organs are more simliar than previously thought. This means the same strategies and treatments could be used to treat or prevent cancer in a variety of organs.
Mills says what they learned is a mixed bag. “Tissues have more ability to repair themselves from an injury than we previously understood,” he notes. “Cells are capable of regenerating in any order. However, when mature cells try to repair organ damage by dividing rapidly, they run the risk of unmasking any acquired mutations.”
>> They could better diagnose a cancer or pre-cancer and prevent the pre-cancer from uncontrolled growth. Knowing the same set of genes is involved in each case would
allow doctors to potentially stop the process.
>> Since it’s known this process of rapid growth has periods of slow growth that help them evade treatment, it can be targeted, too.
Mills and his team now will expand what they’ve found to other cancers, like glioblastoma or lung cancer to see if they behave the same. “All tumors have uncontrollable growth in common,” he says. “Chemotherapy goes after that growth but hits fast-growing healthy cells, too, so there are side effects. We’re looking at how cancer cells proliferate and then pause to escape treatment while normal cells do not.”
a friend of migraines
If you suffer from chronic migraines, you know how it puts your life on hold with throbbing pain, sensitivity to light and sound, nausea, vomiting, blurred vision and lightheadedness. What you may not know is that Botox is now an FDA-approved preventive treatment.
Dr. Gregory Van Stavern, a neurologist and neuro-ophthalmologist with Washington University School of Medicine, is a specialist in migraine headaches and uses Botox in his practice. “We recommend it as a preventive treatment for patients who don’t tolerate migraine medications well or haven’t experienced relief with those treatments,” he says.
He says migraines typically hit people ages 20 to 50. Botox is a great tool with rarely any side effects, but you have to be committed. The standard protocol is 31 injections in the forehead, temple, back of the head, base of the neck and shoulders, all of which take about 15 minutes. It takes about 10 days to experience relief, but the effects last around three months. Some people can taper off on the injections; others need life-long maintenance.
Van Stavern says it is still important to follow lifestyle modifications to avoid triggers, like decreasing caffeine consumption and getting quality sleep. In addition, the American Heart Association recommends regular exercise and taking magnesium and B2 (riboflavin) supplements.
He recommends caution fo children with migraines before puberty. A small study conducted by the University of California Irvine showed promising results for Botox in a group ages 8 to 17 with severe chronic migraines, but results need to be expanded before FDA approval.
For now, it’s just for adults. “We get good results with patients who have failed other methods and are committed,” Van Stavern says.
new genes identified for autism spectrum disorder
Autism spectrum disorder (ASD) and autism are general terms for a group of complex disorders of brain development that cause difficulties in social interaction, verbal and nonverbal communication, and repetitive behaviors. Early detection is key to managing the disorders because there are so many variations possible. Trying to isolate the genes involved for accurate diagnosis has been difficult.
Finding those genes requires data-intensive computation and sophisticated computers. In 2014, the National Science Foundation awarded $1 million to the University of Missouri to install a supercomputer for intensive research in the
field. The new computational method developed, led by Chi-Ren Shyu and his team, has connected several genetic targets to autism, which could lead to screening tools for young children and help doctors choose the best interventions.
In a study published in the Journal of Biomedical Informatics, researchers started by looking at 2,591 families who had only one child with autism and parents and siblings without it. Shyu and his team identified 286 genes associated with children on the autism spectrum, 193 of which had not been previously discovered.
Now, the team is launching the nation’s largest study of autism research called SPARK (Simons Foundation Powering Autism Research for Knowledge), which will collect information and DNA from 50,000 people with autism and their families. Team member Dr. Judith Miles, professor of child health-genetics at the MU Thompson Center for Autism and Neurodevelopmental Disorders, is excited about the scope of the SPARK study. “We now know there are different genetic origins, and we have the ability to screen for thousands of genes at once,” she says. “This is a great step for personalized medicine. Your autism is not the same as his. Once we narrow down what yours is, we can devise a specific treatment for it.”
The SPARK study is enrolling. To find out more, visit sparkforautism.org/mutc.