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Anchor lead: Can metabolic therapy help improve transplantation success? Elizabeth Tracey reports

We’re learning to manipulate metabolism to impact our immune responses, recent research featured in the journal Science highlights. Jonathan Powell, an immunologist at Johns Hopkins who was cited in the article, says the attraction to this approach is clear.

Powell: We don’t want to necessarily suppress the immune response, we want to regulate it. So in the area of transplantation we want to inhibit the activating response, because we don’t want your body to reject the transplant, but alternatively we want to enhance the ability of the immune system to become tolerant to the transplant, to see the transplant as part of your normal body and leave it alone. By manipulating the metabolic function of the cells we have a greater command to do that. :30

Powell says one approach is to use currently approved drugs to inhibit cellular metabolism of those cells we’d like to keep in check, while leaving those we need alone, a process he hopes will eliminate use of drugs like prednisone, with its host of side effects. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can metabolism be used like a drug to manage your immune system? Elizabeth Tracey reports

Metabolism, or the set of chemical reactions that take place in your body to manage things, is now being used almost like a drug to either promote or inhibit cellular responses in your immune system. Jonathan Powell, an immunologist at Johns Hopkins who was cited in a recent Science article on so called metabolic therapy, explains.

Powell: It’s turning out that these pathways, which we knew were important, have this incredibly selective role in the different cells of the immune system. What it means is we can selectively regulate different cells of the immune system. The cells of our immune system, they’re specific. Because the different functions of the different cells have different metabolic requirements, if we target the metabolism of these cells we can really enhance the selectivity.  :28

Powell adds that one exciting aspect of this research is that drugs already on the market and with which we have scads of experience, like the diabetes drug metformin, can be used in this approach. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can vitamin D help prevent broken bones in older people? Elizabeth Tracey reports

Are you taking vitamin D? This vitamin has been the media’s darling for a few years now, but research hasn’t borne out its helpfulness in bone health and prevention of bone fractures in older people. Rita Kalyani, an endocrinologist at Johns Hopkins and one investigator in a trial underway to get to the bottom of this issue, describes what previous research has found.

Kalyani: Neither calcium nor vitamin D nor the combination significantly reduced the risk of fractures. There’s been some discussion that perhaps there could be different effects of the dose that was prescribed, that they didn’t have enough follow up time to see true differences, maybe participants weren’t taking the therapies as consistently as they should so we didn’t see the effect, and importantly vitamin D levels were not necessarily measured after the therapy to know if there was true improvement in vitamin D levels.  :29

Kalyani hopes more rigorous study will help determine if this important public health issue for older people can be helped with vitamin D supplements. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Should type 2 diabetes be subcategorized? Elizabeth Tracey reports

Type 2 diabetes should be divided into five subtypes, each with different characteristics and likely to respond to different management strategies. That’s according to a recent study in the Lancet. Rita Kalyani, a diabetes expert at Johns Hopkins, says such classification may be helpful for physicians.

Kalyani: We know that people with type 2 diabetes develop complications at different rates, some of them benefit from certain therapies where others benefit from other therapies. And so what the authors tried to do in this study was see if there was a way to identify clusters or categories of different subtypes of type 2 diabetes in an effort to predict what treatments they might benefit from and also what complications they might be at risk for.  :30

Kalyani says the study is a move toward personalized medicine, but thinks integration of other diseases and conditions a patient might have will also be important in determining best management. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Will a new drug help those with progressive multiple sclerosis? Elizabeth Tracey reports

Siponimid is the name of a drug recently trumpeted as the first to help slow disability in people with progressive multiple sclerosis. Peter Calabresi, an MS expert at Johns Hopkins, comments.

Calabresi: Siponimid, in secondary progressive MS, they reached their primary outcome in delaying disability progression in the treated group versus the placebo, however the effect size was very modest. :12

Calabresi says that there was a 21% reduction in disability with siponimid and increased side effects.

Calabresi: We’re all happy something works a little bit in progressive MS because the people who suffer with progressive MS have felt that it’s an orphan form of the disease and there’s never been anything. I think that it’s a positive message that there’s a treatable component of the disease but for the vast majority of patients there’s not an insignificant risk associated with some of these drugs.   :24

At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Are stem cells of benefit in people with MS? Elizabeth Tracey reports

Using both stem cells and chemotherapy in people with multiple sclerosis kept the majority from having a relapse for one year, and from failing therapy for three years, a study reported at a scientific meeting in Europe found. Peter Calabresi, an MS expert at Johns Hopkins, says more data is needed.

Calabresi: If you give potent chemotherapy and ablate the immune system the patient’s relapses and inflammation as seen on the MRI will be quiet for two to four years. High doses of chemotherapy really shut down the autoimmune response and so the problem is some people are saying that this is all the stem cells and that this is a cure for the disease, and the most recent paper was just a one year interim analysis and so I think it’s very premature to know whether the stem cells are doing anything and they really need to have a proper control.  :30

Calabresi notes that researchers are working hard to track stem cells and see if they really reach their target tissues and have an impact, so for now, the strategy can’t be recommended. At Johns Hopkins, I’m Elizabeth Tracey.

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Anchor lead: Can a calming space help healthcare workers do their jobs better? Elizabeth Tracey reports

Tranquility room is the name of a space at Johns Hopkins’ Sibley Memorial Hospital designed to help people in the healthcare environment be able to take a quick break to breath, regroup and return to their work refreshed. Harpreet Gujral, director of integrative health at Sibley, describes the space.

Gujral: There are three recliners in three pods and the fourth pod is a yoga mat with a meditation cushion. We have this very dim lighting. Someone can just walk in and experience the very calm, quiet, away from hospital environment. The sound, the sight is very relaxing so we can find our calm and respite in those few moments. They can recharge and come back to their shift and feel much more present. :31

Gujral says research clearly shows the benefits of such dedicated spaces for medical staff, noting that since the room opened in January about a thousand visits have been made. At Johns Hopkins, I’m Elizabeth Tracey.

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