BreakThrough Digest Medical News |
- Novel Chinese herbal medicine JSK improves spinal cord injury outcomes in rats
- Copper identified as culprit in Alzheimer’s disease
- Experts describe ways to eliminate wasteful medical tests and procedures
| Novel Chinese herbal medicine JSK improves spinal cord injury outcomes in rats Posted: 18 Aug 2013 09:00 PM PDT A new study published in Restorative Neurology and Neuroscience demonstrates that Chinese herbal medicine Ji-Sui-Kang (JSK), given systemically for three weeks after injury in rats, improved locomotor function, reduced tissue damage, and preserved the structure of neural cells compared to control rats. The report also includes data showing that JSK may first act to reduce inflammation and cell apoptosis and death, and boost local oxygen supply while, later on, it appears to restore function and promote tissue regeneration.
Although Chinese herbal medicines have traditionally been used for a variety of ailments, the rationale for their use relies more on anecdotal evidence than the results of modern-day controlled experiments. “A number of anecdotal reports from Chinese medicine practitioners indicate that treatment with a novel herbal formulation, JSK, for periods of one week or three months improved functional recovery,” explains co-lead investigator Shucui Jiang, MD, PhD, head of the Hamilton NeuroRestorative Group at McMaster University in Hamilton, Ontario, Canada. “Our present study provides an important and necessary foundation for further studies of JSK.” In this study rats began JSK treatment immediately after undergoing spinal cord injury. Within 7 days, hindlimb locomotor function was significantly better in JSK-treated rats compared to those receiving only saline. JSK-treated rats continued to have better motor function than controls throughout the 21-day test period and treated animals appeared to support their weight better and have more coordinated movements. When the investigators looked at histological samples of the spinal cord, they found that the architecture of the spinal cord was better preserved in JSK-treated animals and the size of the injured area was significantly smaller 7 days after injury. JSK-treated animals also showed more intact axons and myelin in the injured areas compared to controls. Other encouraging signs were less deposition of fibrinogen in the injured areas of JSK-treated animals, a decrease in pro-inflammatory COX-2 expression, and fewer cell deaths at the lesion site (as measured by caspase-3 staining). JSK also increased the expression of growth associated protein 43 (GAP43), a marker of neuronal development and axonal regeneration, and neuroglobulin, a protein found in cerebral neurons that is thought to help neurons survive and recover after trauma. “Our data suggest that JSK may enhance tissue recovery by reducing cell growth inhibitors and by promoting the proliferation of cells within the injured spinal cord,” says co-lead investigator Michel P. Rathbone, MD, CHB, PhD, Professor, Division of Neurology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada. Other findings suggest JSK might help protect against injury caused by damage to spinal cord blood vessels. For instance, JSK increased vascular endothelial growth factor (VEGF), a protein involved in the formation and growth of blood vessels, down-regulated clotting-associated genes, and promoted factors that contribute to vasodilation. The authors say that JSK targets multiple biochemical and cellular pathways that may help protect against the primary traumatic injury as well as subsequent secondary injuries that evolve over time. The authors do not disclose the complete herbal composition of JSK for proprietary reasons. Some of its ingredients include Ginseng, Rhizoma (chuan xiong), Glycyrrhizae Radix (gan cao), Paeoniae Alba Radix (bai shao) and Cinnamomi Cortex (rou gui). Contact: Daphne Watrin |
| Copper identified as culprit in Alzheimer’s disease Posted: 18 Aug 2013 09:00 PM PDT Copper appears to be one of the main environmental factors that trigger the onset and enhance the progression of Alzheimer’s disease by preventing the clearance and accelerating the accumulation of toxic proteins in the brain. That is the conclusion of a study appearing today in the journal Proceedings of the National Academy of Sciences.
“It is clear that, over time, copper’s cumulative effect is to impair the systems by which amyloid beta is removed from the brain,” said Rashid Deane, Ph.D., a research professor in the University of Rochester Medical Center (URMC) Department of Neurosurgery, member of the Center for Translational Neuromedicine, and lead author of the study. “This impairment is one of the key factors that cause the protein to accumulate in the brain and form the plaques that are the hallmark of Alzheimer’s disease.” Copper’s presence in the food supply is ubiquitous. It is found in drinking water carried by copper pipes, nutritional supplements, and in certain foods such as red meats, shellfish, nuts, and many fruits and vegetables. The mineral plays an important and beneficial role in nerve conduction, bone growth, the formation of connective tissue, and hormone secretion. However, the new study shows that copper can also accumulate in the brain and cause the blood brain barrier ? the system that controls what enters and exits the brain ? to break down, resulting in the toxic accumulation of the protein amyloid beta, a by-product of cellular activity. Using both mice and human brain cells Deane and his colleagues conducted a series of experiments that have pinpointed the molecular mechanisms by which copper accelerates the pathology of Alzheimer’s disease. Under normal circumstances, amyloid beta is removed from the brain by a protein called lipoprotein receptor-related protein 1 (LRP1). These proteins ? which line the capillaries that supply the brain with blood ? bind with the amyloid beta found in the brain tissue and escort them into the blood vessels where they are removed from the brain. The research team ? “dosed” normal mice with copper over a three month period. The exposure consisted of trace amounts of the metal in drinking water and was one-tenth of the water quality standards for copper established by the Environmental Protection Agency. “These are very low levels of copper, equivalent to what people would consume in a normal diet.” said Deane. The researchers found that the copper made its way into the blood system and accumulated in the vessels that feed blood to the brain, specifically in the cellular “walls” of the capillaries. These cells are a critical part of the brain’s defense system and help regulate the passage of molecules to and from brain tissue. In this instance, the capillary cells prevent the copper from entering the brain. However, over time the metal can accumulate in these cells with toxic effect. The researchers observed that the copper disrupted the function of LRP1 through a process called oxidation which, in turn, inhibited the removal of amyloid beta from the brain. They observed this phenomenon in both mouse and human brain cells. The researchers then looked at the impact of copper exposure on mouse models of Alzheimer’s disease. In these mice, the cells that form the blood brain barrier have broken down and become “leaky” ? a likely combination of aging and the cumulative effect of toxic assaults ? allowing elements such as copper to pass unimpeded into the brain tissue. They observed that the copper stimulated activity in neurons that increased the production of amyloid beta. The copper also interacted with amyloid beta in a manner that caused the proteins to bind together in larger complexes creating logjams of the protein that the brain’s waste disposal system cannot clear. This one-two punch, inhibiting the clearance and stimulating the production of amyloid beta, provides strong evidence that copper is a key player in Alzheimer’s disease. In addition, the researchers observed that copper provoked inflammation of brain tissue which may further promote the breakdown of the blood brain barrier and the accumulation of Alzheimer’s-related toxins. However, because metal is essential to so many other functions in the body, the researchers say that these results must be interpreted with caution. “Copper is an essential metal and it is clear that these effects are due to exposure over a long period of time,” said Deane. “The key will be striking the right balance between too little and too much copper consumption. Right now we cannot say what the right level will be, but diet may ultimately play an important role in regulating this process.” ### Additional contributors include first author Itender Singh and Abhay Sagare, Mireia Coma, David Perimutter, Robert Gelein, Robert Bell, Richard Deane, Elaine Zhong, Margaret Parisi, Joseph Ciszewski, and R. Tristan Kasper, all with URMC. The study was funded by the Alzheimer’s Association, the National Institutes of Aging, and a pilot grant from the National Institute of Environmental Health Sciences. Contact: Mark Michaud |
| Experts describe ways to eliminate wasteful medical tests and procedures Posted: 18 Aug 2013 09:00 PM PDT Medical organizations are participating in a campaign to help clinicians and patients avoid wasteful and sometimes harmful medical interventions. Recently, experts in pediatric and adult health from diverse geographic locations of the United States and from a mix of academic and non- academic settings shared their experiences, consulted their colleagues, and analyzed numerous studies in the medical literature to determine the top recommendations for improving healthcare value. Following these recommendations, which are outlined in a new study published today in the Journal of Hospital Medicine, will lower costs and lead to better care for patients.
Experts estimate that waste constitutes up to 20% of health care expenditures in the United States. To address this problem a number of national medical societies have joined the Choosing Wisely® campaign, with each creating a list of five common but sometimes unnecessary, tests, therapies, or procedures in their fields that patients and physicians should question and discuss. The Society of Hospital Medicine joined this effort in 2012, and it asked experts to create such lists regarding the care provided to hospitalized adults and children. In addition to including the Choosing Wisely lists for pediatric and adult hospitalists, the new articles provide details about the methodologies used to create them. The details can serve as a blueprint for other healthcare organizations interested in researching and developing lists of potentially over-used or harmful interventions. The recommendations ? five for hospitalists and five for pediatric hospitalists ? were published jointly by the American Board of Internal Medicine Foundation and the Society of Hospital Medicine in early 2013. The top five recommendations proposed for hospitalized children are:
“If pediatricians around the country adopt and follow these recommendations, the savings to our health care system could be in the millions, given the large number of hospitalized children this would affect,” said lead researcher Ricardo Quinonez, MD, FAAP, FHM of the Children’s Hospital of San Antonio and Baylor College of Medicine. In an accompanying review, researchers also outlined the five recommendations adopted by the Society of Hospital Medicine regarding the care of adults. These recommendations include:
“These [pediatric and adult] lists are good starting points, and in fact many hospitalist groups, including our own, are using the Society of Hospital Medicine practices as a foundation for our waste reduction efforts,” wrote Andrew Auerbach, MD, MPH, and Robert Wachter, MD, of the University of California, San Francsico, in an accompanying editorial. “The next challenge will be translating these recommendations into actionable measures and then clinical practice.” ### Through a grant from the American Board of Internal Medicine Foundation and supported by the Robert Wood Johnson Foundation, the Society of Hospital Medicine has already begun to promote the adoption of the recommendations for hospitalists and pediatric hospitalists. It will be educating hospitalists through a series of online webinars, presentations at regional meetings and a national competition to gather and promote the best case studies in implementing Choosing Wisely recommendations in hospitals. Contact: Amy Molnar |
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