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Anchor lead: Activated immune cells throughout the body are important in multiple sclerosis, Elizabeth Tracey reports
What exactly goes awry in the immune system that results in multiple sclerosis? Recent research by Michael Kornberg, a research fellow and neurologist at Johns Hopkins, and colleagues, demonstrates that immune cells utilize a pathway using sugar for energy to get involved, but that’s just part of the answer.
Kornberg: At various times and for reasons we don’t understand immune cells that are directed against myelin become activated in lymph nodes and the spleen, tricks the brain into thinking there may be inflammation there, maybe a virus or something that needs to be fought, and so the blood-brain barrier kind of opens up for these cells. And then you get this collection of immune cells that are all activated and angry and contributing to injury. A lot of the drugs we use for MS keep immune cells from getting into the brain. :27
The blood-brain barrier normally keeps most things out of our central nervous system to protect it. Kornberg’s recent work suggests that preventing immune cells from becoming activated to begin with helps. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Could keeping the immune system under control be as simple as managing your diet? Elizabeth Tracey reports
Immune cells involved in multiple sclerosis rely on sugar to activate them, recent research by Michael Kornberg, a research fellow and neurologist at Johns Hopkins, and colleagues, has shown. The common MS drug dimethylfumarate blocks this pathway, Kornberg says.
Kornberg: What I find exciting about the work is the idea that these energy pathways are viable targets to treat the disease, which might extend to dietary measures. I like to be very cautious about this because diet and any kind of disease has become a bit of a cottage industry, but the idea that energy metabolism is important in the way the immune system reacts suggests its very likely that different types of diets are going to have effects on the immune system, which we’re beginning to understand but we don’t fully understand yet. :31
Kornberg notes that autoimmune diseases like MS may one day include diet as part of a management strategy, as well as other diseases where energy metabolism and the immune system are important, like cancer. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Finding out how a specific drug for multiple sclerosis works may help in the development of more effective therapies, Elizabeth Tracey reports
Did you know that your immune system function and your diet may be linked? That’s one finding of a recent study by Michael Kornberg, a research fellow and neurologist at Johns Hopkins, and colleagues, looking at cells involved in the autoimmune disorder multiple sclerosis, and a common MS drug called dimethylfumarate.
Kornberg: Most of the cells in the body like to use oxygen to make energy and they can use sugar or fat or protein but immune cells, when they become activated, can only use sugar. Basically what we found in this paper is that dimethylfumarate, which itself is just part of energy production, kind of blocks that breakdown of sugar. It specifically blocks the overactivation of these immune cells that cause problems in diseases like MS without having major effects on the rest of the body. :29
Kornberg hopes future research will reveal more strategies to harness this elegant way to manage immune responses. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: As global warming expands mosquito territory, a vaccine for Dengue virus is a worldwide concern, Elizabeth Tracey reports
Dengue is a viral infection transmitted by mosquitoes, and it can result in serious illness and death, especially if someone is experiencing their second infection. That’s because there are different strains of the virus and antibodies may cause a severe reaction to second infections. Now this fact is constraining how the world’s only Dengue vaccine can be used. Mike Klag, former dean of the Johns Hopkins Bloomberg School of Public Health, explains.
Klag: Flavaviruses in general can be very serious and Dengue is an especially wily culprit because of these different serotypes. So we know that in certain settings this vaccine works and we have to do better at identifying those people who fit that criteria. The key thing in using this vaccine wisely is to know whether there’s evidence of infection or not. So people are working feverishly on developing new assays for antibodies. More sensitive, more specific antibodies to know that there’s been a Dengue infection and that it’s safe to give the vaccine. :29
Klag says global warming makes an effective vaccine for Dengue a priority globally. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: Can an app help keep high blood pressure in check? Elizabeth Tracey reports
People with high blood pressure who used an app to keep track of their medicines to control the condition didn’t have lower blood pressures than those who didn’t use the app, a recent study found. Seth Martin, a cardiologist at Johns Hopkins, comments.
Martin: They didn’t find that there was an improvement in blood pressure in the group that was randomized to a med adherence app versus the group that didn’t get this app. I was disappointed by this result. I do believe that there’s potential in the future to have a better result if this was more embedded within the healthcare system. That the patients were connected with clinicians and using the data to improve their blood pressure. This is really critical to health, we’re talking about preventing heart attacks, strokes, deaths. :29
Martin and a team at Johns Hopkins have also developed an app to help people manage their own heart conditions, so he’s a fan of employing technology to assist patients and caregivers. He believes robust and effective apps that are easy to use, transmit useful data and may even be fun are on the horizon. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: What is the role of newer diabetes medicines in managing the condition? Elizabeth Tracey reports
Newer diabetes medicines use a number of acronyms to describe them, and are largely used after the first line therapy, metformin, isn’t working by itself. Now a new study in the Journal of the American Medical Association makes sense of which one to use for which patient. Sherita Golden, a diabetes expert at Johns Hopkins, says the theme is clear.
Golden: We still have to individualize therapy and be very patient-centric. The findings in this study in JAMA actually support the current American Association of Diabetes guidelines so they suggest that if a patient is at risk for heart disease, consider an agent that has been shown to lower that risk, so the GLP1 analogues, the SGLT2 inhibitor. If I have a patient with diabetes who has very slow gastric emptying, not going to be using a GLP1 analogue. So I think there are enough options so you can find the one that fits with the patient’s circumstance. :32
Golden says for patients, a thorough discussion with your primary care physician is needed. At Johns Hopkins, I’m Elizabeth Tracey.
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Anchor lead: A recent national report looks at the state of nursing, Elizabeth Tracey reports
A new national report looks at how nurses are faring around the country. Patricia Davidson, dean of the Johns Hopkins School of Nursing, says there were some common problems.
Davidson: Things that were identified in that article were compulsory overtime, and high turnover rates. We know in healthcare there’s a lot of push and pull factors, around discharging patients on time, on the other hand being penalized for 30 day readmissions. :18
Davidson says the report also underscored the variability in nurse’s pay and working conditions.
Davidson: There are lots of different environments within healthcare in the United States. That’s also an important signal that just one policy that’s coming from Washington is going to be more challenging to implement at a state level. :13
Davidson notes that one thing is clear: the need for nurses remains high and will continue to grow. At Johns Hopkins, I’m Elizabeth Tracey.
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