Thursday, 23 August 2012

Lymphedema Patients Need Personalized Care

Millions of American cancer survivors experience chronic discomfort as a result of lymphedema, a common side effect of surgery and radiation therapy in which affected areas swell due to protein-rich fluid buildup. After reviewing published literature on lymphedema treatments, a University of Missouri researcher says emphasizing patients' quality of life rather than focusing solely on reducing swelling is critical to effectively managing the condition.

Jane Armer, professor in the MU Sinclair School of Nursing and director of nursing research at Ellis Fischel Cancer Center, said many insurance providers and health care professionals assess whether lymphedema patients need treatment based solely on how swollen their limbs are. However, several studies have shown that the volume of fluid doesn't necessarily correspond with patients' discomfort.

"Practitioners need to treat the swelling while considering patients' distress. We don't want to burden them with unnecessary or ineffective treatments," Armer said. "Health care providers should focus on managing symptoms and choose carefully among various treatments to provide individualized care plans that comfort patients, which may require modifying existing protocols."

In their literature review, Armer and her colleagues found that Complete Decongestive Therapy (CDT), a comprehensive approach for treating lymphedema involving skin care, exercise, manual lymphatic drainage and compression of the swollen limbs, may be the best form of specialized lymphedema management.

"Patients have different medical needs and come from culturally diverse backgrounds. They have different goals, support systems, pain levels and treatment tolerances. All these factors influence patients' responses to care, which affects their well-being," said Marcia Beck, a review co-author and an MU graduate who now works at Truman Medical Centers in Kansas City, Mo.

"Caring for lymphedema patients should be flexible and adjusted to maintain patients' quality of life," said Ausanee Wanchai, another co-author who received her doctorate at MU and now teaches at Boromarajonani College of Nursing in Buddhachinnaraj, Thailand.

In a separate literature review, the researchers found that Intermittent Pneumatic Compression (IPC) therapy, in which sequential inflatable devices surrounding swollen limbs are used to increase lymphatic circulation, is beneficial as an adjunct therapy for chronic lymphedema patients who have limited or no access to medical care; patients can use the compression devices in their homes.

Armer said further research is needed to demonstrate the usefulness of various lymphedema treatments, such as CDT and IPC. The literature reviews were the third and fourth in a series of 12 to be published in conjunction with the American Lymphedema Framework Project (ALFP). As director of the ALFP, Armer works alongside clinical experts and investigators to increase awareness of lymphedema and related disorders. The ALFP was founded in 2008 and is headquartered at the MU Center for Lymphedema Research, Practice and Health Policy. Its steering committee and staff currently are partnering with the International Lymphedema Framework (ILF) in producing an updated edition of the ILF Best Practice Document from 2006.

The article, "Palliative Care for Cancer-Related Lymphedema: A Systematic Review," recently was published in the Journal of Palliative Medicine. Armer's co-authors also included researchers from MU and the University of Texas. The other review, "Intermittent Pneumatic Compression Therapy: A Systematic Review," was published in the journal Lymphology earlier this year. Researchers from the NorthShore University HealthSystem, Walter Reed Military Medicine Center and University of Texas contributed to the review.

Monday, 31 October 2011

Lymfactin™ Discovered To Considerably Gain Growth Of Lymphatic Vessels In Animal Study

Laurantis Pharma, a privately held biotechnology company based in Finland, announced that LymfactinTM, adenoviral VEGF-C growth factor therapy, was successful in rebuilding lymphatic vessels in pre-clinical animal models. The use of VEGF-C growth therapy to regenerate lymphatic vessels over time may be used to assist lymph node transfer surgery as a technique to treat secondary lymphedema.

The results were presented at the 23rd International Congress of Lymphology in Malmö, Sweden by Kari Alitalo, MD, PhD, Academy Professor, Molecular Cancer Biology Program Biomedicum Helsinki, University of Helsinki, and Anne Saaristo, MD, PhD, Consultant Plastic Surgeon, Turku University Central Hospital, Turku, Finland. The researchers were able to demonstrate VEGF-C's ability to induce the spontaneous growth of lymphatic vessels during the first two weeks of treatment, which then stabilized and matured over the course of the next six months.

The ability of VEGF-C to regulate the growth of lymphatic vessels presents an advantage for the use of lymph node transfer as a way of treating lymphedema. Currently lymph node transfer is being tested as a way to rebuild the lymphatic vascular anatomy but no treatment currently helps to assist the spontaneous growth of lymphatic vessels.

"Breast cancer patients have an urgent need for better treatments for lymphedma," said Dr. Saaristo. "With Lymfactin, we see the potential to increase the impact of the operation and reduce the amount of lymphoid tissue that needs to be removed from other parts of the body. Ideally Lymfactin will result in more durable lymph node transplants, reducing the need for painful pressure bandages."

Lymphedema

Lymphedema, localized swelling due to fluid accumulation, is caused by the disruption in the flow of lymphatic fluid, usually associated with the removal of lymph nodes as treatment for breast cancer. About 20 to 30 percent of patients who have had lymph nodes removed as a part of treatment for breast cancer will develop chronic lymphedema. Currently, there is no cure for the condition, and treatments are limited in their ability to reduce swelling and reduce the risk of infection.

Tuesday, 2 November 2010

ViroPharma Declares Culmination Of Registration In Phase 2 Study Evaluating Subcutaneous Delivery Of Cinryze™ (C1 Esterase Inhibitor [Human])

ViroPharma Incorporated (Nasdaq: VPHM) announced that it has completed enrollment in its Phase 2 study evaluating subcutaneous delivery of Cinryze™ (C1esterase inhibitor [human]). This multi-center, open-label, multi-dose Phase 2 study is designed to evaluate the safety, pharmacokinetics and pharmacodynamics of subcutaneous versus intravenous administration of Cinryze in adolescent and adult subjects with hereditary angioedema (HAE). The company expects to have preliminary data from this study by the end of this year, which will help inform the next steps of development for this mode of administration.

"The rapid enrollment into this study is indicative of the interest in, and also the potential for, prophylaxis with a subcutaneous form of Cinryze," commented Judy Johnson, ViroPharma's vice president of clinical pharmacology and nonclinical development. "We look forward to completing this important study which will inform our path forward, including the Phase 3 study design. We are excited by the potential of a subcutaneous option for patients who choose prevention of their HAE attacks."

Cinryze was approved by the U.S. Food and Drug Administration in October 2008 for routine prophylaxis against angioedema attacks in adolescent and adult patients with HAE.

Clinical Study Design

This is a multi-center, open-label multiple dose study in 24 adolescent and adult HAE patients in the US. All eligible subjects have been randomized into one of two treatment groups: Patients received Cinryze via IV infusion two times per week for two weeks. Then, following a 14-day washout period, subjects received Cinryze via subcutaneous administration at one of two dose levels (either 1000U or 2000U) two times per week for two weeks. Safety and PK/PD assessments are being evaluated throughout each treatment period.

About Cinryze™ (C1 esterase inhibitor [human])

Cinryze is a highly purified, pasteurized and nanofiltered plasma-derived C1 esterase inhibitor product that has been approved by FDA for routine prophylaxis against angioedema attacks in adolescent and adult patients with HAE. C1 inhibitor therapy has been used acutely for more than 35 years in Europe to treat patients with C1 inhibitor deficiency. Cinryze is not currently approved in the European Union or any of its member states.

The most common adverse reactions observed have been upper respiratory infection, sinusitis, rash and headache. No drug-related serious adverse events (SAEs) have been observed in clinical trials. Severe hypersensitivity reactions may occur. Thrombotic events have occurred in patients receiving high dose off-label C1 inhibitor therapy well above the approved treatment dosage regimen. Monitor patients with known risk factors for thrombotic events. With any blood or plasma derived product, there may be a risk of transmission of infectious agents, e.g. viruses and, theoretically, the CJD agent. The risk has been reduced by screening plasma donors for prior exposure to certain virus infections and by manufacturing steps to reduce the risk of viral transmission including pasteurization and nanofiltration.

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Cinryze is for intravenous use only. A dose of 1000 Units of Cinryze can be administered every 3 or 4 days for routine prophylaxis against angioedema attacks in HAE patients. Cinryze is administered at an injection rate of 1 mL per minute.

About Hereditary Angioedema (HAE)

HAE is a rare, severely debilitating, life-threatening genetic disorder caused by a deficiency of C1 inhibitor, a human plasma protein. This condition is the result of a defect in the gene controlling the synthesis of C1 inhibitor. C1 inhibitor maintains the natural regulation of the contact, complement, and fibrinolytic systems, that when left unregulated, can initiate or perpetuate an attack by consuming the already low levels of endogenous C1 inhibitor in HAE patients. Patients with C1 inhibitor deficiency experience recurrent, unpredictable, debilitating, and potentially life threatening attacks of inflammation affecting the larynx, abdomen, face, extremities and urogenital tract. Patients with HAE experience approximately 20 to 100 days of incapacitation per year. There are estimated to be at least 6,000 people with HAE in the United States.

Forward Looking Statements

Certain statements in this press release contain forward-looking statements that involve a number of risks and uncertainties. Forward-looking statements provide our current expectations or forecasts of future events, including the therapeutic indication and use, safety, efficacy, tolerability and potential of Cinryze and our focus, goals, strategy, research and development programs, and ability to develop pharmaceutical products, commercialize pharmaceutical products, and execute on our plans including clinical development activities with Cinryze related to subcutaneous administration. There can be no assurance that that our phase 2 clinical program with Cinryze utilizing subcutaneous administration will yield positive results or support further development of Cinryze for subcutaneous administration. The FDA or EMA may view the data regarding subcutaneous administration of Cinryze as insufficient or inconclusive, request additional data, require additional clinical studies, delay any decision past the time frames anticipated by us, limit any approved indications, or deny the approval of Cinryze for subcutaneous administration. These factors, and other factors, including, but not limited to those described in our annual report on Form 10-K for the year ended December 31, 2009 filed with the Securities and Exchange Commission, could cause future results to differ materially from the expectations expressed in this press release. The forward-looking statements contained in this press release are made as of the date hereof and may become outdated over time. ViroPharma does not assume any responsibility for updating any forward-looking statements. These forward looking statements should not be relied upon as representing our assessments as of any date subsequent to the date of this press release.

Source: ViroPharma Incorporated.

Saturday, 5 June 2010

Research Laid Out At ASCO By Foremost Physicians And Investigators From The John Theurer Cancer Center

The John Theurer Cancer Center at Hackensack University Medical Center has announced that its physicians and researchers will present 16 abstracts on treatment and diagnostic progress in many different areas of oncology during the Annual Meeting of American Society of Clinical Oncology (ASCO) in Chicago, IL from June 4-8.

"At the John Theurer Cancer Center, we're dedicated to providing extraordinary cancer care to our patients, which includes conducting high-quality cancer research and cutting-edge clinical trials," said Andrew L. Pecora, M.D., F.A.C.P., C.P.E., Chairman and Executive Administrative Director, the John Theurer Cancer Center. "We're pleased to add to an important body of research at this premier oncology conference."

Abstracts from the John Theurer Cancer Center research that are scheduled to be presented include:

* Phase I study of combined vorinostat (V), lenalidomide (L), and dexamethasone (D) in patients (pts) with relapsed or refractory multiple myeloma (MM). (8031) (Poster Discussion Session) - Friday, June 4 from 2:00 p.m. - 6:00 p.m. in E450a
* Phase II study of denileukindiftitox with CHOP chemotherapy in newly-diagnosed PTCL: CONCEPT trial. (8045) (Poster Discussion Session) - Friday, June 4 from 2:00 p.m. - 6:00 p.m. in E450a
* Response of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) with nongerminal center B-cell phenotype to lenalidomide (L) alone or in combination with rituximab (R). (8038) (Poster Discussion Session) - Friday, June 4 from 2:00 p.m. - 6:00 p.m. in E450a
* The association between the Mantle Cell Lymphoma International Prognostic Index (MIPI) and survival in patients treated with rituximab-HCVAD (RHCVAD) alternating with rituximab-methotrexate-AraC (R-MTX-AraC). (8092) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Effect of front-line therapy with either high-dose therapy and autologous stem cell rescue (HDT/ASCR) or dose-intensive therapy (R-Hypercvad) on outcome in mantle cell lymphoma (MCL). (8067) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Impact of high-risk classification by FISH on overall survival in myeloma: An Eastern Cooperative Oncology Group (ECOG) study E4A03. (10546) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Interim results of phase II trial of pegylated liposomal doxorubicin (PLD) followed by bexarotene in advanced cutaneous T-cell lymphoma (CTCL). (8053) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Neurotoxic and peripheral neuropathic effects in preclinical and clinical studies of carfilzomib (CFZ), a novel proteasome inhibitor (PI). (8135) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Rituximab, fludarabine, mitoxantrone, and dexamethasone (R-FND) for patients with relapsed indolent B-cell lymphoma (RIL). (8078) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Treatment patterns and outcome among patients with multiple myeloma relapsing and or refractory to bortezomib and immunomodulatory drugs: A multicenter International Myeloma Working Group study. (8125) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Update on vantage program to assess combined vorinostat (V) and bortezomib (B) in patients (pts) with relapsed and/or refractory (RR) multiple myeloma (MM). (8133) (General Poster Session) - Saturday, June 5 from 8:00 am - 12:00 p.m. in S Hall A2
* Effect of early chemotherapy intensification with BEACOPP in high-risk, interim-PET positive, advanced-stage Hodgkin lymphoma on overall treatment outcome of ABVD. (8006) (Oral Abstract Session) - Saturday, June 5 from 1:00 p.m. - 4:00 p.m. in E354a
* Elotuzumab in combination with bortezomib in patients with relapsed/refractory multiple myeloma: A phase I study. (8003) (Clinical Science Symposium) Saturday, June 5 from 4:30 p.m. - 6:00 p.m. in E354a
* Phase Ib study of oral panobinostat (LBH589) plus intravenous bortezomib in patients (Pts) with relapsed (Rel) or Rel and refractory (Ref) multiple myeloma (MM). (8001) (Clinical Science Symposium) Saturday, June 5 from 4:30 p.m. - 6:00 p.m. in E354a
* Results of an ongoing open-label, phase II study of carfilzomib in patients with relapsed and/or refractory multiple myeloma (R/R MM). (8000) (Clinical Science Symposium) Saturday, June 5 from 4:30 p.m. - 6:00 p.m. in E354a

Source:
Amy Leahing
John Theurer Cancer Center

Wednesday, 19 May 2010

Update On Lymphoma Drug Trial: Potential Breakthrough For T- Cell Lymphoma Patients With Drug That Mimics A Vitamin

Final results of a pivotal Phase 2 clinical trial of pralatrexate (PDX) for patients with relapsed or refractory peripheral T-cell lymphoma (PTCL) were reported by the study's principal investigator, Dr. Owen A. O'Connor of the Herbert Irving Comprehensive Cancer Center at Columbia University Medical Center and NewYork-Presbyterian Hospital/Columbia. T-cell lymphoma (PTCL) is a biologically diverse group of blood cancers that account for as many as 15 percent of non-Hodgkin's lymphoma (NHL) cases in the United States.

Data from the PROPEL (Pralatrexate in patients with Relapsed Or refractory PEripheral T-cell Lymphoma) trial show that pralatrexate, a drug that partially works by mimicking the vitamin folic acid, has an estimated median duration of response of 287 days, or 9.4 months. As previously reported, 29 of 109 evaluable patients, or 27 percent, showed a complete or partial response.

"Until now, these patients could only expect to survive several weeks. This study shows that it may be possible to extend this to many months - a result that is nothing short of spectacular and may likely represent a breakthrough in the development of new drugs for T-cell lymphoma," said Dr. O'Connor, director of the Lymphoid Development and Malignancy Program and chief of the Lymphoma Service at the Herbert Irving Comprehensive Cancer Center at NewYork-Presbyterian Hospital/Columbia University Medical Center, and associate professor of medicine at Columbia University College of Physicians and Surgeons. "Based on these promising data, pralatrexate has the potential to play a clinically meaningful role in the treatment of patients with relapsed or refractory PTCL."

Pralatrexate, designed to look like the natural vitamin folic acid, disrupts DNA synthesis in tumor cells. The drug is designed to selectively accumulate in tumor cells, after which it then induces programmed cell death, or apoptosis, in the cancer cell.

There are currently no pharmaceutical agents approved for use in the treatment of either first-line or relapsed or refractory PTCL, and overall five-year survival is approximately 25 percent after first-line therapy. In addition to those PTCL patients who do not respond to first-line treatment, a significant number of first-line multi-agent chemotherapy responders relapse or become refractory after treatment.

The PROPEL trial is organized by Allos Therapeutics Inc., the maker of the drug. The company expects to submit a New Drug Application to the U.S. Food and Drug Administration for marketing approval of pralatrexate sometime in the first half of 2009. The results of the trial will be submitted for presentation at an upcoming scientific meeting and for publication in a peer-reviewed journal.

Pralatrexate was developed by a team of researchers at Memorial Sloan-Kettering Cancer Center (MSKCC) and the Southern Research Institute, including Dr. O'Connor, while at MSKCC. Dr. O'Connor and his colleagues identified the unique activity of pralatrexate in patients with lymphoma. Dr. O'Connor has continued to study pralatrexate at NewYork-Presbyterian/Columbia, now focusing on determining how the drug works in T-cell lymphoma, and on how best to combine it with other drugs to improve the treatment of patient with hematologic cancers.

The critical PROPEL (Pralatrexate in patients with Relapsed Or refractory PEripheral T-cell Lymphoma) trial - an international, multicenter, open-label, single-arm study - enrolled a total of 115 patients with relapsed or refractory PTCL, 109 of whom are considered evaluable for response according to the trial protocol. It is believed that PROPEL is the largest prospectively designed single-agent trial conducted to date for this patient population.

To be eligible for the trial, patients' disease must have progressed after at least one prior treatment. Patients were considered evaluable if they received at least one dose of pralatrexate and their diagnosis of PTCL was confirmed by independent pathology review. Patients received 30 mg/m2 of pralatrexate intravenously once every week for six weeks followed by one week of rest per cycle of treatment. Patients also received vitamin B12 and folic acid supplementation. The primary endpoint of the trial is objective response rate, as assessed by central, independent oncology review using International Workshop Criteria (IWC). Duration of response is the key secondary endpoint.

Of the 29 patients who achieved a response according to central independent oncology review, 7 patients had a complete response (CR), 2 patients had a complete response unconfirmed (CRu) and 20 patients had a partial response (PR). According to the PROPEL investigators, 42 of 109 evaluable patients, or 39 percent, achieved a response. Of these, 15 patients had a CR, 4 patients had a CRu and 23 patients had a PR. PROPEL patients received a median of three prior systemic treatment regimens (range of 1 to 12), including 18 patients, or 16 percent, who had previously undergone an autologous stem cell transplant. In the trial, 66 percent of the patients who responded did so after cycle one of therapy. Patients will continue to be followed for long-term survival.

Peripheral T-Cell Lymphoma

According to the American Cancer Society, approximately 66,000 patients are expected to be diagnosed with non-Hodgkin's lymphoma in the United States in 2009. Annual prevalence is estimated to be approximately 9,500 patients. In addition to the 30 percent to 50 percent of PTCL patients that do not respond to first-line treatment, a significant number of first-line, multi-agent chemotherapy responders relapse or become refractory after treatment.

NewYork-Presbyterian Hospital

NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,242 beds. The Hospital has nearly 2 million inpatient and outpatient visits in a year, including more than 230,000 visits to its emergency departments - more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, Morgan Stanley Children's Hospital of NewYork-Presbyterian, NewYork-Presbyterian Hospital/The Allen Pavilion and NewYork-Presbyterian Hospital/Westchester Division. One of the largest and most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. It ranks sixth in U.S.News & World Report's guide to "America's Best Hospitals," ranks first on New York magazine's "Best Hospitals" survey, has the greatest number of physicians listed in New York magazine's "Best Doctors" issue, and is included among Solucient's top 15 major teaching hospitals. The Hospital's mortality rates are among the lowest for heart attack and heart failure in the country, according to a 2007 U.S. Department of Health and Human Services (HHS) report card. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons. For more information, visit www.nyp.org.

Columbia University Medical Center

Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The Medical Center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States.

Source: NewYork-Presbyterian Hospital

Tuesday, 4 May 2010

A Century-Old Puzzle Comes Together, Scientists ID Potential Protein Trigger In Lung Disease Sarcoidosis

Lung researchers at Johns Hopkins have identified a possible protein trigger responsible for sarcoidosis, a potentially fatal inflammatory disease marked by tiny clumps of inflammatory cells that each year leave deep, grainy scars on the lungs, lymph nodes, skin and almost all major organs in hundreds of thousands of Americans.

The disorder, whose cause has been a persistent mystery for nearly a century, strikes mostly young adults and disproportionately affects African Americans.

The link between sarcoidosis and overproduction of the suspected protein trigger, called serum amyloid A, was revealed after a six-year investigation encompassing more than two dozen laboratory experiments, including some on diseased lung tissue samples from 86 patients in the Baltimore area.

"The increase in production of serum amyloid A explains for the first time how inflammation can persist in the lungs without being triggered by an active infection," says study senior investigator and pulmonologist David Moller, M.D., a professor at the Johns Hopkins University School of Medicine. Moller is also director of the sarcoidosis clinic at The Johns Hopkins Hospital.

Study lead investigator Edward Chen, M.D., says the new findings also clear the path for developing drug treatments or vaccines that can block serum amyloid A from binding to cell receptors and kicking off inflammation.

In the short term, however, Moller says his team has plans to use the study results to create diagnostic tests that could better predict which people with the disease are likely to heal on their own or are more likely to suffer persistent inflammation, which can lead to scarring, difficulty breathing, and heart failure that can only be fixed by lung transplantation.

In a report published in February in the American Journal of Respiratory and Critical Care Medicine, the Johns Hopkins scientists described their research on what was behind the microscopic clusters of inflamed tissue and white blood cells, or granulomas, which are a defining feature of sarcoidosis.

Such lung lesions are not unique to sarcoidosis and can be triggered by infections, such as in tuberculosis, which is often confused with sarcoidosis. But unlike tuberculosis, sarcoidosis is not an infectious disease, does not yield to antibiotics, and is not limited to any particular organ, occurring as well in the eyes, skin, brain, heart and liver.

Of particular interest to researchers was the role played by so-called amyloids, a set of proteins known to cause other persistent inflammatory conditions, such as amyloidosis. Indeed, a different kind of amyloid has been tied to plaques in the brain tissue of people with Alzheimer's disease.

Key among the researchers' findings in sarcoidosis patients was that serum amyloid A stood out because it was heavily concentrated within the granulomas in diseased and scarred lung tissue. Researchers found the protein a hundred to a thousand times more widespread in sarcoidosis tissue samples than in samples from people with tuberculosis, another granuloma-forming lung disease. Similarly elevated amyloid levels were seen in comparison tests with tissue samples from people with lung cancer and Crohn's disease.

Further tests in patients' lung cell cultures showed that adding serum amyloid A spiked production of at least a half-dozen key inflammatory chemicals known to be involved in damaging tissue.

In another series of experiments in mice, the team discovered that granuloma formation in the lungs sped up when the mice were given injections of synthetic serum amyloid A. Mice had previously been injected with specially coated plastic beads designed to trigger sarcoidosis-like lesions. Adding the synthetic protein led to the same biochemical reactions in the mice as observed in humans, suggesting to the researchers that serum amyloid A played a key role in triggering sarcoidosis.

To better understand how serum amyloid A might be driving granuloma formation, the team used special antibodies to block various cell surface receptor sites where the protein would bind to the white blood cells and spur inflammation. Tests in human lung cells showed that blocking one particular receptor, toll-like receptor-2 (TLR2), inhibited the sustained inflammatory reaction typically associated with sarcoidosis. But when left to bind on its own, without an antibody blocking TLR2, the open receptor could attach to serum amyloid A, and raised production of inflammatory chemicals would ensue.

"Not only have we shown that serum amyloid A is a key protein trigger in sarcoidosis, but we also have evidence that the resulting inflammation is dependent on binding the protein at toll-like receptor-2, which opens up a host of possibilities that drugs blocking this binding site could prove an effective treatment for this disease," says Chen, an assistant professor at Johns Hopkins.

Funding support for the report and research was provided by the National Institutes of Health, the American Thoracic Society, the Foundation for Sarcoidosis Research, the Life and Breath Foundation, and the Hospital for the Consumptives of Maryland (Eudowood.)

Source: Johns Hopkins Medicine

Monday, 3 May 2010

Tumors Hide Out From The Immune System By Mimicking Lymph Nodes

A new mechanism explaining how tumors escape the body's natural immune surveillance has recently been discovered at EPFL (Ecole Polytechnique Fédérale de Lausanne) in Switzerland. The study shows how tumors can create a tolerant microenviroment and avoid attack by the immune system by mimicking key features of lymph nodes. The discovery, published in Science and in Science Express, online March 25, 2010, underscores the role of the lymphatic system in cancer and may open up new possibilities for cancer treatment.

"The tumor tricks the body into thinking it is healthy tissue," says lead author Melody Swartz, head of the Laboratory of Lymphatic and Cancer Bioengineering (LLCB) and EPFL professor. Swartz and her team set out to understand how immune tolerance is induced by tumors, allowing them to progress and spread. The researchers from EPFL concentrated their efforts on a certain protein that is normally present in healthy lymph nodes to attract T cells and program them to perform vital immune functions. They found that some tumors can secrete this protein to transform the outer layer of the tumor into lymphoid-like tissue. This outer layer then attracts and effectively re-programs the T cells to recognize the tumor as friend not foe, resulting in a tumor that goes undetected by the immune system.

Since most tumors progress only if they have escaped the immune system, this new understanding of one mechanism by which the tumor can bypasses or hides from immune defenses is an important step towards future cancer therapies. "The finding that tumors can attract naïve and regulatory T cells and educate them has important implications for tumor immunotherapy," says Jacqui Shields, from LLCB. The study also opens up potential novel areas of research focusing on the relationship between lymphatic systems and cancer research. According to Shields, the concept that tumors mimic lymphoid tissue to alter the host's immune response represents a new understanding of tumors' interactions with the lymphatic system.

The laboratory is affiliated with the EPFL's Institute of Bioengineering and the Swiss Institute for Experimental Cancer Research.

Source: Ecole Polytechnique Federale de Lausanne (EPFL)