Presence of Abnormal Glycoproteins May Help Early Cancer Detection

Antibodies that latch on to abnormal glycoproteins may serve as a new biomarker for early cancer detection, according a recent study conducted at Copenhagen University in Denmark and supported in part by the National Cancer Institute (NCI).

Glycoproteins are a specific class of proteins that are connected to sugar molecules. Within this class of proteins, researchers specifically looked at mucins, a sub-category of glycoproteins that can be found on the outer surface of cells. As has been previously identified, cancer cells display different amounts of mucins within a cell structure. Some cancer mucins have uniquely altered sugar groups that are different from those found on healthy cells.

With this in mind, the Copenhagen team hypothesized that specialized antibodies within the body would target these unique cancer mucins. Antibodies are a type of protein manufactured by the immune system that are designed to detect antigens within the body. By targeting these antigens, antibodies signal an autoimmune response to harmful substances in the body. While many antibodies target foreign substances in the body, some are drawn to an individual’s own molecules and tissue. These antibodies are defined as autoantibodies.

After considerable trial and error, the Copenhagen team successfully identified autoantibodies that were drawn to these glycoproteins.

Armed with the ability to detect the presence of these autoantibodies, the team then screened blood samples from patients who had previously been diagnosed with breast cancer, ovarian cancer and prostate cancer. The results were positive, with detection of the unique antibodies in all three cases. In contrast, these antibodies were not present in control blood samples that did not come from cancer patients.

The study provides a promising new means for identifying cancer in its early stages. However, larger-scale studies are still necessary to validate the results.

Results from the study were reported by head researchers for the Copenhagen team – Hans H. Wandall, M.D., Ph.D. and Ola Blixt, Ph.D. The study was the result of an international collaboration made possible by the trans-NIH Alliance of Glycobiologists for Detection of Cancer and Cancer Risk.


Occupational and Environmental Health

Issues related to environmental and occupational health have an important role to play in emergency medicine, pediatrics, primary care practice, and the various medical specialties. Work-related or environmental exposures may be associated with symptoms experienced by a patient. The environmental exposure history of a patient may prompt necessary interventions in order to prevent potential injuries or illnesses. Work-related illnesses and injuries may necessitate physicians to make assessment of disability, impairment and workers’ compensation.

Concerns about biological or chemical terrorism, and also industrial disasters, have made it necessary for physicians that they are able to immediately identify patterns linked to exposures to primary chemical agents (for instance, nerve agents and cyanide) and biological agents (for example, anthrax).

In order to be effective, it may be necessary for physicians to know how to have a good occupational/environmental history and practical understanding of most prevalent environmentally related illnesses. Moreover, physicians can also contribute significantly towards environmental and occupational issues which are outside the purview of office practice, thereby helping prevent occupational illness amongst other employees at the workplace and supporting global environmental health.

Mexico’s Wealthiest Man Pledges $65 Million for Medical Research

A 3-year genomics projects intent on studying the genetic nature of cancer, type II diabetes and kidney disease has been initiated by Carlos Slim – one of the wealthiest men in the world.

Recently, Slim pledged $65 million to be received by the Slim Initiative for Genomic Medicine. The initiative is a joint partnership between the Carlos Slim Health Institute, the Broad Institute of MIT and Harvard, and the Mexican National Institute of Genomic Medicine.

According to Eric S. Lander, president and director of the Broad Institute, the program is not designed to develop treatments, but rather focused on gaining improved insight into the genomic bases of these three diseases.

To accomplish this goal, scientists will use 10,000 samples to analyze the DNA of diabetes, kidney disease and seven types of cancer. The cancers to be studied have yet to be announced, however breast cancer will likely be included.

In response to the announcement, Carlos Slim said, “Only with the development of this genomic science and surrounding technology will it be possible, as it was before with vaccines, to face these diseases and prevent these diseases through their early detection, their early diagnosis.”

Ultimately, Slim hopes the initiative will provide insights that lead to improved cancer treatments in the future.

Slim is a telecommunications tycoon that serves as the head of the Grupo Carson conglomerate. He began the Carlos Slim institute in 2007 with the infusion of $500 million. The organization was created with the goal of educating Latin American and Caribbean citizens about important health issues. The Institute also assists in funding health-related research.

Slim is one of several billionaires who have recently made headlines for their contributions to medical research. Other examples include Bill Gates, who pledged $34 million to the Bill and Melinda Gates Foundation to study malaria, tuberculosis and HIV, and Mort Zuckerman, who recently set aside $100 million to build a cancer research center in New York.


Hazardous Materials and Chronic Illness

Work and environmental exposures can lead to or worsen several different types of common diseases, for instance asthma, dermatitis, hepatitis B, carpal tunnel syndrome, and cancer. In a number of cases, the environment or work-related illnesses do not show distinctive clinical presentations: asthma resulting from a cat allergy does not differ from asthma caused by latex allergy; median nerve entrapment associated with repetitive motions has the same set of signs and symptoms as carpal tunnel syndrome arising due to pregnancy; headache caused by inhalation of carbon monoxide can be diagnosed as severe headache or migraine. Symptoms associated with hazardous exposures can be similar to normal complaints involving any body system and other common medical diseases. There are certain exposures that can lead to immediate or subacute symptoms (for instance acute chemical reaction and allergic reactions), whereas others can result in more delayed outcomes (for example pneumoconiosis and cancer). The differentiating feature is the association to an occupational or environmental exposure. The history of occupational and environmental exposures can play a significant role in the identification, treatment, and prevention of occupational/environmental injuries and illnesses.

Measuring Occupational Injuries

It is difficult to measure the magnitude of occupational illnesses and injuries. The United States Bureau of Labor Statistics (BLS) that provides statistics based on surveys of private companies having more than 11 employees (an underestimate of the real totals), reported 5,488 fatal accidents related to work (3.7 for every 100,000) and around 4.0 million nonfatal illnesses or injuries (4.2 for every 100 equivalent full-time workers in 2007). Approximately 2.1 million illnesses and injuries necessitated recuperation away from workplace, restricted duties at work, or job transfer.

Examination of data gathered from a number of data sets (including the BLS) to generate the following approximation of the total number of occupational illness and injury occurring annually in the United States: 6500 fatalities from job-related injuries; 13.2 million nonfatal injuries; 60,300 deaths resulting from job-related disease; and 862,200 illnesses (work-related). The entire costs involved were approximately $171 billion. It was noticed in a study of health maintenance organization (HMO) members diagnosed with adult-onset asthma that 21 percent of cases were associated with occupational exposure.

Epidemiological studies involving firefighters and first responders are worth noting. For instance, the World Trade Center (WTC) disaster in the United States in September 2001 created controversy over conditions associated with exposure to toxic gases and dusts. Studies involving first responders within the first month after the WTC disaster revealed that bronchial reactivity was three times more in case of individuals who were at the site in the morning when the disaster occurred, in comparison to those who came later. Studies in the following year that focused on pulmonary function of rescue workers belonging to the NYC Fire Department showed significant reduction in average FEV1 in comparison to pulmonary function studies that were undertaken five years earlier. It has been reported that the incidence of “sarcoid-like” granulomatous pulmonary disease has increased. Also, an increased occurrence of fatal coronary heart disease has been noticed while comparing firefighters who were assigned emergency firefighting duties with those who were not assigned urgent duties.

Drug Development and Approval: Part II

Orphan drugs

Drugs that are used to treat rare diseases affecting less than 200,000 Americans are referred to as orphan drugs. Since only a small number of patients need these drugs, it may not be possible for the drug’s sponsor to recover the drug development costs. Under the Orphan Drug Act, sponsors are given incentives to develop new drugs for the treatment of rare conditions, including several different types of cancer.

Making the drugs available to patients

Drugs that are being studied and have yet to receive FDA approval are called investigational drugs. Access to these drugs is available only to patients who have enrolled for clinical trials. The drug may receive FDA approval after the end of the clinical trial if there is evidence to prove that benefits of the drug outweigh its potential risks. Based on the awareness that patients, after having tried all available treatment options, may be willing to try new treatments with higher risks, the FDA has initiated the following three programs to ensure that patients with serious illnesses such as cancer can have access to investigational drugs.

Special exception/compassionate exemption: Although enrolling in a clinical trial is the best way to access investigational drugs, these trials often have eligibility criteria (strict rules) to determine if they will be appropriate for a patient. In case the trial is considered inappropriate for a patient, a special exception/compassionate exemption can be used to provide that patient with access to the investigational drug. An exception request should be submitted to the FDA jointly by the patient’s doctor and the sponsor of the drug. The FDA reviews every application on a standalone basis.

Treatment INDs: The treatment Investigational New Drug (treatment IND) program run by FDA allows drug sponsors to request that access to an investigational drug be provided to patients who are not considered appropriate for clinical trials or those for whom no other suitable treatment option may be available. There should be sufficient evidence to prove the drug’s effectiveness and also that it does not have unreasonable risks.

Group C drugs: An agreement between the National Cancer Institute (NCI) and the FDA, the Group C program seeks to provide oncologists with investigational drugs that normally are available via participation in an NCI protocol. Usually these drugs are in their phase III trials and there is evidence to prove their effectiveness in relation to a specific type of tumor. Using this route and after obtaining informed consent, patients who may not have participated in clinical trials can still have access to and benefit from a potentially effective treatment.

Some FDA initiatives for improving the process of drug development and approval in the United States.

1) Accelerated approval

The accelerated approval program run by FDA allows sponsors to request approval on the basis of alternate findings. Also called surrogate endpoints, these are indirect assessments of disease status, for example, a change in lab results or improvements in symptoms related to the disease. These endpoints can also be used to assess the effectiveness of the treatment or therapy. With accelerated approval programs, the approval process for drugs meant for life-threatening diseases can be expedited in order to provide for an unmet medical need.

2) Engaging drug sponsors early in the drug development process

By interacting with drug sponsors in the early stages of the drug development process, the FDA is trying to reduce the time spent on the development of new drugs. With this effort, the FDA seeks to speed up the development, review and marketing of new treatment options. The FDA conducts meetings with the drug sponsor on a regular basis in order to ensure that an agreement is reached on the ideal design of clinical research and the resulting data is reviewed in a timely manner.

Virginia Time Capsule Epitomizes Asbestos Concerns

In Roanoke, Virginia, a time capsule buried beneath the floor at the Roanoke City Health Department office has officials stymied.

The time capsule was originally scheduled to be exposed Thursday, January 7. That was until Virginia Department of Health officials discovered that the capsule was concealed beneath post-1950s flooring that likely contains asbestos.

The asbestos in the flooring isn’t that surprising, however, since many construction products made during the last century contained asbestos. This includes not only floor tiles and sheet flooring, but acoustical ceiling tiles and sprays, boiler pipe and wall insulation, glues and mastics and joint compounds, and even some decorative plaster compounds.

The use of asbestos in domestic products began to decline in the late 1970s, as manufacturers became increasingly aware of its dangers, and virtually ended in 1989, when the U.S. Environmental Protection Agency, or EPA, limited asbestos use to one percent or less (by weight or volume) to American-made products.

This intervention was fortuitous, since asbestos in its natural form is a mineral comprised of minute fibers which, once inhaled or ingested, remain inside the body for life, causing irritation and, eventually, lethal tumors called mesotheliomas in a small but significant number of exposures.

Mesothelioma is, simply put, cancer. But its high rate of deaths is attributed to the fact that it lies dormant for decades – commonly 40 years but sometimes up to 50 years or more – producing few symptoms but invading a large area of vital tissue and organs.

By the time mesothelioma is diagnosed, most patients are given about a year to live. These prognoses are mitigated, but only slightly, by aggressive regimens of surgery, radiation and chemotherapy, which can add about four months to patients’ survival times.

In fact, the only real hope for mesothelioma sufferers to date is a new diagnostic technique which samples pleural fluid to determine the presence of peritoneal mesothelioma. This method, which can establish mesothelioma within the first few years (possibly even at inception), is being viewed by medical professionals as the first true opportunity to curb mesothelioma before it ravages internal organs.

In Virginia, officials – who know what health professionals did not know in the 1950s (namely, the inherent lethality of asbestos) – have postponed unearthing the time capsule indefinitely; or at least until the content of the suspect floor tiles is determined by testing.

This delay is, in itself, a form of irony, revealing how the nation, and the world, got itself locked into an asbestos legacy that won’t end until sometime after 2030 – that is, 40 years after the use of asbestos in domestic products was suspended.

Of course, asbestos continues to be used elsewhere in the world, in countries like India, China and Russia, where no ban exists, and the occasional importation of products from these countries extends the asbestos legacy, at least among those who buy products made overseas without reading the labels, or fail to ask contractors and repairmen about the contents of products they use.

Growing Opposition to Asbestos in Canada

Quebec health officials recently sent a letter to Canada’s federal Health Minister, Leona Aglukkaq, calling for an end to the government’s support of asbestos mining in the country.

Within the letter, which was penned and backed by members of Canadian Association of Physicians for the Environment and Rideau Institute, health officials make known their concern of asbestos materials that provide “misleading, inadequate and, at times, false information” of the health risks of asbestos made available on government websites.

The letter is just the latest in a growing groundswell to limit or ban asbestos mining in Canada. Epidemiologists at Quebec’s Institute of Public Health have previously voiced their concern for the unusually high number of malignant mesothelioma and asbestos cancer cases present in the province of Quebec. Similarly, Liberal Party leader Michael Ignatieff has expressed his unhappiness with Canada’s asbestos industry.

Presently, there is only one active asbestos mine in Canada. Located in Thetford Mines, Quebec, the mine currently employs a little more than 300 workers. Though the industry remains small and localized, asbestos lobbyists remain appalled at the apparent skewed and biased portrayal of the industry to the public.

For example, in response to a recent broadcast of the radio program Telejournal that discussed asbestos mining in Canada, Julie Miville-Dechne, Ombudsman of Radio-Canada publicly opines that the report lacked balance and was deliberately skewed in favor of the asbestos industry. During the 5-minute portion of the program, the only experts offering insight into the subject were from pro-asbestos industry stakeholders.

Despite the historically biased public portrayal of asbestos in Canada, the scientific and impartial health community continues to call for the ban of the hazardous material.


EPA to Assess Safety of Six Widely Used Chemicals

Big changes may be coming to how chemicals are approved and monitored in the United States. Presently, Lisa Jackson, administrator for the Environmental Protection Agency (EPA), is promoting the formation of a new chemical law that would force additional responsibility onto chemical manufacturers in proving the safety of their components.

The new bill is in intended to alter the present methods, which were established under a 1976 toxics law that Jackson refers to as “inordinately cumbersome and time-consuming.”

As that bill is being pushed towards the Congress floor, Jackson has called for scrutiny of six widely used chemicals that have come under attack for causing potential health concerns. The highest profile chemicals to be targeted include:

  • Bisphenol A (BPA): used in clear polycarbonate bottles
  • Phthalates: chemicals used for cosmetics and vinyl products
  • Brominated flame retardants: used in electronics
  • Perfluorinated compounds: present in numerous products, including food packaging, paraffins, lubricants, benzidine dyes and non-stick coating

Early research into all of these chemicals suggests a possible link to reproductive complications and cancer. Additionally, these chemicals may mimic the effects of naturally occurring hormones and hinder development of fetuses and children.

To further assess the potential dangers of these products, the EPA is assembling data from the chemical industry. Once gathered, the data will be used to determine safety level of the chemicals and institute action plans that will limit exposure.

The six chemicals under review are just the first in a long line of chemicals the EPA intends to review. The Agency stresses the fact that 80,000 chemicals are currently being used in products sold in the United States. Alarmingly, many of these chemicals have incomplete health and safety data. As Jackson suggests, the chemicals with the highest priority will be reviewed first.

The action-oriented process is seen as a dramatic shift since the days of the Bush administration. While EPA officials under Bush’s leadership testified before Congress that the Toxic Substances Control Act of 1976 adequately safeguards U.S. citizens from chemical health concerns, the Obama administration seems less convinced.

In an effort to spur change and guide an effective bill formation in Congress, the EPA has released a set of principles that would improve information released about a chemical’s heath and safety concerns.

Representatives of numerous environmental groups have praised the pro-active initiatives proposed by the EPA.