MEDICAL ARTICLES OF INTEREST

[dothedd]

Doctors note success with ‘fecal’ transplants

October 9, 2011

For more than a year, Linda Devens was tormented by chills, fevers and, worst of all, unrelenting bouts of diarrhea that required repeated hospitalizations.

“I was literally living in the bathroom,” said Devens, 61, of Andover, Minn. “I wouldn’t wish it on anyone. It was really awful.”


Devens was hit by an increasingly common bacterial infection that is getting harder to beat back with antibiotics. Some victims of Clostridium difficile eventually need part of their colons removed. Some die.

In Devens case, she finally agreed to what initially sounded like a crazy idea: getting her digestive system microbes replaced by someone else’s.

A small coterie of doctors in the United States, Europe and Australia have begun doing this for conditions suspected of being caused by disruptions in a healthy “microbiome,” the collection of microorganisms that populate everyone’s body.

The usually last-ditch procedure involves patients flushing out their digestive systems as if they were going to have a colonoscopy. Then, doctors inject microbe-laden feces from a healthy donor — often a spouse or relative — who has been screened for HIV, hepatitis and other disease-causing germs.

The procedure, known as a fecal transplant, has been performed most often and produced the most promising results in patients with “C. diff,” which often strikes people who have taken antibiotics, disrupting the normal protective colonies of organisms in their digestive tracts.

Some doctors report helping between 80 percent and 95 percent of recipients, frequently providing nearly instantaneous relief to those who had almost given up hope.

“In my mind, there is no doubt this is a very effective way of treating this,” said Alexander Khoruts of the University of Minnesota, one of a group of doctors publishing guidelines for the procedure in the December issue of the American Gastroenterological Association’s journal.

While Khoruts currently limits the procedure to C. diff patients, some doctors have begun trying the transplants for other conditions, including Crohn’s disease, ulcerative colitis, irritable bowel syndrome and even obesity.

“I think we are just at the very beginning of understanding the contribution it may make,” said Thomas Brandt of the Albert Einstein College of Medicine in New York, who plans to report the results of transplants on 75 patients to the American College of Gastroenterology meeting in Washington Oct. 28-Nov. 2.

Some European physicians have begun using the procedure for an array of conditions, including autoimmune diseases such as Type 1 diabetes and a disorder associated with obesity called the metabolic syndrome. An Australian doctor has gone even further, using the procedure on patients with ailments such as multiple sclerosis and the neurological condition myoclonus dystonia.

“I think we have cracked something where we can solve many conditions and help a large section of mankind just by healing damaged flora,” said Thomas J. Borody of the Centre for Digestive Diseases in Sidney, who plans to describe several of his cases at the gastroenterology meeting in Washington.

Many experts, however, caution that much more research is needed beyond the largely anecdotal reports so far.

“We haven’t actually proved the fecal transplant is what is making them get better. The proof would have to come from a rigorously controlled randomized trial, which hasn’t been done,” said Robert Karp of the National Institute of Diabetes and Digestive and Kidney Diseases.

[dothedd]

Microbes may play crucial role in human health, researchers discovering

October 9, 2011

Consider this: The average person’s body contains about 100 trillion cells, but only maybe one in 10 is human.

This isn’t the latest Hollywood horror flick, or some secret genetic engineering experiment run amok.

This, it turns out, is nature’s way: The human cells that form our skin, eyes, ears, brain and every other part of our bodies are far outnumbered by those from microbes, primarily bacteria but also viruses, fungi and a panoply of other microorganisms.

That thought might make a lot of people lunge for the hand sanitizer, at the least. But that predictable impulse may be exactly the wrong one. A growing body of evidence indicates that the microbial ecosystems that have long populated our guts, mouths, noses and every other nook and cranny play crucial roles in keeping us healthy.

Moreover, researchers are becoming more convinced that modern trends — diet, antibiotics, obsession with cleanliness, Caesarean delivery of babies — are disrupting this delicate balance, contributing to some of the most perplexing ailments, including asthma, allergies, obesity, diabetes, autoimmune diseases, cancer and perhaps even autism.

“In terms of potential for human health, I would place it with stem cells as one of the two most promising areas of research at the moment,” said Rob Knight of the University of Colorado. “We’re seeing an unprecedented rate of discovery. Everywhere we look, microbes seem to be involved.”

Equipped with super-fast new DNA decoders, scientists are accelerating the exploration of this realm at a molecular level, yielding provocative insights into how these microbial stowaways may wield far greater powers than previously appreciated in, paradoxically, making us human.

“The field has exploded,” said Jeffrey I. Gordon of Washington University, who pioneered the exploration of humanity’s microbial inhabitants, known as the “microbiome” or “microbiota.” “People have this sense of wonderment about looking at themselves as a compilation of microbial and human parts.”

Some equate these microbial inhabitants to a newly recognized organ. Acquired beginning at birth, this mass of fellow travelers may help steer normal development, molding immune systems and calibrating fundamental metabolic functions such as energy storage and consumption. There are even tantalizing clues they may help shape brain development, influencing behavior.

“The ‘human supraorganism’ is one term coined to describe the human host and all the attendant microorganisms,” said Lita M. Proctor, who leads the Human Microbiome Project at the National Institutes of Health, which is mapping this world. “There’s been a real revolution in thinking about what that means.”

Investigators are trying to identify which organisms may truly be beneficial “probiotics” that people could take to help their health. Others are finding substances that people might ingest to nurture the good bugs. Drugs may mimic the helpful compounds that these organisms produce.

Doctors have even begun microbiota “transplants” to treat a host of illnesses, including a sometimes-devastating gastrointestinal infection called C. difficile, digestive system ailments such as Crohn’s disease, colitis and irritable bowel disorder, and even in a handful of cases obesity and other afflictions, such as multiple sclerosis.

Many advocates of the research urge caution, noting that most of the work so far has involved laboratory animals or small numbers of patients, many hypotheses remain far from proven and nothing has zero risk.

“We have to be very careful in how we state what we know at the present time versus what we think might be true at this point,” said David A. Relman of Stanford University. “But it’s probably fair to say that our indigenous communities are more diverse, more complex and more intimately and intricately involved in our biology than we thought.”

Our inner microbes

Scientists have long known that many organisms evolved with humans and perform vital functions, digesting food, extracting crucial nutrients, fighting off disease-causing entities.

“We feed them and house them and they perform certain metabolic functions for us that we have sort of contracted out,” said Martin J. Blaser of the New York University School of Medicine. “The homeboys protect their turf from invaders.”

But as microbiologists have begun scrutinizing these colonies, it has become clearer that they create carefully calibrated enterprises, with unique combinations inhabiting individual crevices and identifiable nuances from person to person.

“We just don’t pick up willy-nilly any microbe in the soil or air we encounter,” Relman said.

European scientists reported in April that people generally seem to have one of three basic combinations that may be as fundamentally important as, say, blood type.

The five-year, $175 million U.S. Human Microbiome Project is assembling an outline of a “healthy” microbiome by sampling the mouth, airway, skin, gut and urogenital tract of 300 healthy adults, as well as deciphering the genetic codes of 200 possibly key microbes.

Dozens of studies are also underway, including some that are repeatedly swabbing kids and adults, including twins, to gain insights into why one person gets tooth decay, asthma, ulcerative colitis or even cancer, and another doesn’t.

“We’re using microbes as markers for the onset of various diseases or progression of diseases,” said Karen E. Nelson, who runs the J. Craig Venter Institute in Rockville. “We think we’re going to have a huge impact on health.”

Birth, development and disease

One intriguing finding is that babies born through Caesarean sections apparently miss out on acquiring their mothers’ microbiota.

“The birth canal is very heavily colonized by bacteria,” said Maria Dominguez-Bello, a University of Puerto Rico biologist who has been studying microbiota around the world, including in isolated tribes in the Amazon. “We think that is not by chance.”

The rising number of C-section babies denied this colonization, along with the casual use of antibiotics and other factors that can alter the microbiota, might help explain trends such as rising incidents of asthma and food allergies caused by misfiring immune systems. To explore this, researchers have begun following C-section babies, comparing their microbiomes and their health with babies delivered through the birth canal.

The interaction between the microbiota and the immune system may also play a role in other diseases in adults, including those caused at least in part by chronic inflammation from hyperactive immune systems.

“Gut bacteria have figured out a way to network with our immune system so it doesn’t attack them,” said Sarkis K. Mazmanian of the California Institute of Technology.

The microbiota apparently sends signals that dampen the “inflammatory response,” a crucial defense also believed to play a role in a variety of diseases, including many forms of cancer, the “metabolic syndrome” caused by obesity, diabetes and heart disease.

The theory is that one reason some people may be prone to these diseases is that they are missing certain microbes. One anti-inflammatory compound produced by a bacterium appears to cure the equivalent of colitis and multiple sclerosis in mice, both of which are caused by misfiring immune systems, Mazmanian found.

Role in obesity?

Similarly, studies indicate that gut dwellers secrete messengers to cells lining the digestive tract to modulate key hormones, such as leptin and ghrelin, which are players in regulating metabolism, hunger and a sense of fullness.

Pregnant women often take antibiotics, and young children can get several rounds to fight ear and other infections, which can kill off these companions. Farmers commonly add antibiotics to animal feed to fatten their animals faster.

“We may have a generation of children growing up without the proper bacteria to regulate their leptin and ghrelin,” Blaser said.

Obese people appear to have a distinctive mix of digestive bacteria that make them prone to weight gain. Thin mice get fatter when their microbiota is replaced with the microbes of obese animals.

“Our ancient microbiome is losing the equilibrium it used to have with the host — us — and that has profound physiological consequences,” said Blaser, who published his concerns in an August paper in the journal Nature.

Microbes and the mind

Intriguing clues also are emerging about how microbes may affect the brain. Manipulating gut microbiomes of mice influences their anxiety and activity, Swedish researchers reported in January in the Proceedings of the National Academy of Sciences.

“This may have implications for new lines of thinking to address some of the psychiatric problems you see among humans,” said Sven Pettersson, a professor of host-microbial interaction at the Karolinska Institute. “Together with genetic susceptibility, this may influence what doctors classify as autism or ADHD.”

In another experiment involving mice, a Canadian-Irish team reported in August that bacteria in the gut appear to influence brain chemistry, and corresponding behaviors such as anxiety, stress and depression, via the vagus nerve.

“What we’ve shown is you change behavior as well as make changes in the brain,” said John Bienenstock, director of the Brain-Body Institute at McMaster University. “Now we have direct proof how that happens. That’s why this is exciting.”

www.washingtonpost.com/national/health-science/microbes-may-play-crucial-role-in-human-health-researchers-discovering/2011/09/24/gIQAH5lFYL_print.html

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PHOTO LINK:

news.yahoo.com/photos/davos-wowed-device-reads-code-life-hours-photo-133500861.html


Davos wowed by device that reads 'code of life' in hours
AFP Relax News – Sun, Jan 29, 2012.

It was the talk of Davos, grabbing the imagination of a forum otherwise shrouded in gloom: a miracle machine that cracks the code of life within hours and could revolutionise healthcare.

Patients will no longer have to wait weeks to know if they have cancer and their doctors will know immediately what kind of disease they have, allowing them to target therapies precisely and to avoid harmful delays or mistakes.

Health officials confronted by superbug outbreaks will be able to identify the bug's strain and begin planning treatment within hours rather than days or weeks, potentially saving thousands of lives.

Soon, researchers in the developing world will take portable DNA sequencers into the field to identify new viruses and verify water quality.

And police investigators will be able to develop a suspect's DNA profile as quickly as their fictional counterparts do in glossy television dramas, while commandos on the battlefield will identify the bodies of friend and foe.

The man behind the revolution is Jonathan Rothberg, master biotechnician and CEO of Ion Torrent, owned by US firm Life Technologies, which produces the Ion Proton -- the world's first desktop semiconductor-based gene sequencer.

Business and political leaders at this year's Global Economic Forum were gripped by pessimism over the economy, but -- at a summit boycotted by Mick Jagger -- Rothberg was received in Davos like a rockstar of science.

"He's a genius. I want to buy his machines," Sami Sagol, a leading Israeli neuroscientist and research sponsor, told passengers on a minibus ferrying delegates through the snowbound streets of the Swiss resort.

"I was sat next to him at dinner. He's amazing," declared a young investment banker swigging beer in a nearby bar, admitting he had found Davos' scientific programme more uplifting than the headline economic debates.

The man himself, geekily excited in a woolly ski hat and loud striped shirt, bursts with enthusiasm for a machine that has brought the once laborious task of gene-sequencing to the era of the semi-conductor microchip.

With no false modesty, he compares the revolution to the transition from the era of room-sized computing machines to desktop microprocessors, and predicts that his technology will follow the computer into laptop and hand-held forms.

"It's the first machine that can do an entire human genome for less than 1,000 dollars. It's the first machine than can read the genome in two hours," he told AFP in an interview in Davos.

"Previously machines would cost more than half a million dollars and it would take weeks to get information on your genome," he said. A genome is the complete DNA code, unique to each individual, which shapes our organism.

"The Proton instrument is designed to do discovery -- find new genes that are involved in cancer, find new genes that are involved in autism, find new genes that are involved in diabetes," he said.

"But it's also designed to be used in a clinical practice to make sure that you give the person the right medicine or the right medicine to the right person. And to help diagnose new born children with ailments."

The Desktop Ion Proton was making its European debut, but the technology is not a pie in the sky dream. It is based on a larger predecessor that is already the world's best selling sequencer.

"Last year in Germany there was a terrible outbreak and a number of people died," he said, referring to a enterohaemorrhagic E.coli (EHEC) infection from contaminated food that killed 52 people and left more than 4,000 sick.

"It was the precursor to this machine and one of the first chips we made that decoded that E.coli outbreak and allowed us to understand that superbug, track that superbug and have a diagnostic for that superbug."

Two factors make the Ion Proton unique. It is the only machine to use a semiconductor chip to sequence genes, previously researchers had to study DNA strands under what were effectively powerful microscopes.

Now, DNA samples can be dropped onto a microchip a couple of centimetres (one inch) across, slotted into the Proton like a SIM card into a mobile, and two hours later the enter six-billion-letter code of life is known.

The second factor is size. The current model squats on a desk like a photocopier and, as a scalable device, it will one day shrink, even to the size of a handheld like the science fiction Star Trek "tricorder".

"So investigators in Africa have asked me for machines that they can use to monitor wild game that's caught to see if there's any new viruses coming in that can interact with man for the first time," said Rothberg.

But, while its enthusiastic inventor foresees dozens of tasks for his machine, its inspiration and initial core use will be in healthcare.

"When my son was born, he was rushed to the newborn intensive care unit because he had difficulty breathing," said Rothberg, recounting the personal trauma that led directly to his breakthrough.

"At that moment I realised that I was less interested in the human genome as an abstract concept and I was completely interested in my son's genome.

"I realised two things: I cared about my son Noah's genome and I needed a technology that scales. And during the time he was intensive care I had the idea to move sequencing to a massively parallel substrate, a chip."

Noah recovered, his disease was not genetic after all, but once the Ion Proton is common in world hospitals, other parents will have a shorter wait.

news.yahoo.com/davos-wowed-device-reads-code-life-hours-133500502.html

[dothedd]

Jan 30, 2012 11:39:20 GMT -5 @lonewolf said:

Our family is a huge believer in keeping the intestinal flora updated with Probiotics.

I TOTALLY AGREE.