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  • September 16, 2014

Lab Notes - Ladue News: Health-wellness

Lab Notes

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Posted: Thursday, December 5, 2013 12:00 pm | Updated: 12:20 pm, Thu Dec 5, 2013.

RESEARCHERS TO TEST DRUG COMBO FOR HEPATITIS B IN CHILDREN

Hepatitis B is a viral liver disease affecting more than 350 million people worldwide. Although a vaccine is available for infants and children, hepatitis B remains problematic among immigrant populations and foreign-born adopted children in the United States. The disease is chronic and can lead to severe liver damage, cancer and death.

Saint Louis University is participating in a multi-center study that will test a combination of two medications for children with early-stage hepatitis B. “We are not always sure how to apply the therapies to the disease as people have it at different stages and ages,” says Dr. Jeff Teckman, a SLU professor of pediatrics and principal investigator of the pediatric study. “In this trial, we are trying to understand which patients can benefit from what therapies.”

One drug being tested affects the immune system, helping it fight the virus. The second drug kills the virus. Investigators are evaluating whether the drug combination is effective since this phase of infection previously had no treatment, Teckman says.

MEDICATION, LIFESTYLE MORE EFFECTIVE THAN SURGERY IN PREVENTING STROKE

Washington University researchers recently confirmed earlier findings suggesting that medication, along with lifestyle modification, are better for preventing stroke than surgical stenting of narrowed brain arteries. In fact, previous clinical trials of the surgery were halted after initial results indicated the procedure increased risk of early stroke and death.

The surgery involves placing a tiny mesh tube, known as a stent, into a narrowed artery in order to help ensure it remains open for blood flow. Stents are commonly used to help treat narrowing of cardiovascular blood vessels.

“We were expecting that, at some point, the incidence of new strokes in those who had surgery would drop below that of those who did not, but that didn’t happen,” says Dr. Colin Derdeyn, director of Washington University’s Stroke and Cerebrovascular Center and neuro-interventional principal investigator of the study. “This proves that medical therapy is better than surgery for these patients.”

Blood-thinning and cholesterol-lowering medications, along with lifestyle modification that includes exercise, smoking cessation and weight loss, are typically used to reduce stroke risk.

WUSTL RESEARCHERS RECEIVE $26 MILLION FOR LEUKEMIA RESEARCH

Researchers at Siteman Cancer Center at Washington University School of Medicine recently received two grants totaling almost $26 million from the National Cancer Institute. The funds will be used to study leukemia treatments aimed at improving survival and reducing treatment-related side effects.

“The awards recognize the tremendous scientific depth and breadth of our scientists and clinicians, as well as their creativity and commitment to improving treatments for leukemia,” says Dr. Daniel Link, the Alan A. and Edith L. Wolff Distinguished Professor of Medicine. “Thanks to advances in genomics and molecular biology, we’re on the cusp of a new way of thinking about leukemia and its treatment. There’s a lot to be excited about.”

The first grant, for $14.3 million over five years, continues current research into genetic changes that may be instrumental to the development and progression of acute myeloid leukemia. The research may help lead to personalized treatments based on patients’ unique genetic and molecular makeups.

The second five-year grant, for $11.3 million, funds the Specialized Program of Research Excellence (SPORE), which pursues research advances that bring investigational treatments into clinical trials.

FDA APPROVES BREAST CANCER RECURRENCE TEST

The U.S. Food and Drug Administration recently approved a test, developed by a team led by researchers at Washington University, that estimates risk of breast cancer recurrence in patients who have received anti-hormone treatment.

The test categorizes breast tumors based on gene expression. Each of the four tumor categories requires a different type of treatment. When combined with standard pathology tests used to help determine how aggressive a tumor is likely to be, the results provide a score that predicts risk of recurrence over a decade.

“Breast cancer diagnosis and prognosis by looking at samples under a microscope remains quite variable and subjective—often pathologists do not agree,” says oncologist Dr. Matthew Ellis, a co-inventor of the test. “With this test, we are moving toward a standardized diagnosis based on the genetics of the tumor. The test determines which type the patient’s cancer is most similar to. And the closer it is to a subtype called ‘luminal A,’ the better the outcome.”

The test, called Prosigna and manufactured by NanoString Technologies, comes with a machine and kit, so patients’ tumor samples do not have to be sent to a specific laboratory for analysis. It is being distributed to pathology labs around the world, and also is approved for use in the European Union.

SLU CENTER FOR VACCINE DEVELOPMENT AWARDED NIH CONTRACT

The National Institutes of Health (NIH) named Saint Louis University’s Center for Vaccine Development one of nine Vaccine and Treatment Evaluation Units nationwide with the ability to bid on up to almost $1 billion in projects that will study infectious disease prevention.

Dr. Robert Belshe, director of the Center for Vaccine Development and the Adorjan Professor of Internal Medicine at SLU, says the NIH contract “allows us to continue to bring to our community new vaccines that are in development—many of which will become the vaccines of the future.” He notes the award is a vote of confidence for the center’s role as a leading vaccine development and research facility.

SLU received an Indefinite Delivery Indefinite Quantity (IDIQ) contract award that has an estimated value of up to $135 million in task orders annually over the course of the seven-year ordering period, or an estimated value of up to $951 million for the contract duration. The new contract, signed in September, represents what likely is the largest research contract or grant in the university’s history.

NIH AWARDS GRANT TO STUDY ANTIMALARIAL DRUGS

Malaria remains a serious health threat to millions of people worldwide. Researchers at Saint Louis University’s Center for World Health and Medicine are seeking new treatment approaches with a $566,000 National Institutes of Health grant.

The funds support a study that investigates the potential of novel classes of antimalarial drugs to treat drug-resistant parasites that cause malaria and identify exactly how the drugs kill the parasites as they hide in red blood cells to evade the body’s natural immune system.

“Although there are a number of drugs used to treat the disease, resistance to these drugs is becoming widespread,” says Dr. Marvin Meyers, a medicinal chemist and research leader at the SLU center. “Because we need a superior long-term solution to combat resistant parasites, our research will study new antimalarial drugs that kill the parasite in new ways.”

RESEARCHERS TO STUDY RED BLOOD CELL TRANSFUSIONS IN CHILDREN

Washington University School of Medicine received a $7.8 million, five-year grant from the National Heart, Lung and Blood Institute to determine whether the length of time red blood cells (RBCs) are stored affects organ failure in critically ill children who receive RBC transfusions. The study will involve more than 1,500 children requiring RBC transfusions at St. Louis Children’s Hospital and 30 other medical centers in the U.S. and Canada.

“We want to know whether fresh red cells can improve outcomes in critically ill children,” says Dr. Philip Spinella, director of the Blood Research Program in Washington University’s Department of Pediatrics and a principal investigator in the study. “No studies have evaluated whether storing RBCs for more than a week affects clinical outcomes for these children.”

Spinella explains that there is specific interest in determining older RBCs’ effectiveness in critically ill children. Such patients are at risk of experiencing worse outcomes, including multiple organ failure. The researchers want to know whether using fresh RBCs might improve outcomes. If the new trial finds that fresher RBCs reduce such risks, it could lead to significant changes in how blood is stored and allocated to patients, particularly critically ill children.

LOCAL SURGEONS TO OFFER PROCEDURE FOR CANCERS WITHIN THE ABDOMEN

Surgeons at Saint Louis University Hospital can now provide another option for treating cancer that has metastasized within the abdomen. Cytoreductive surgery with or without hyper-thermic intraperitoneal chemoperfusion (HIPEC) involves removing all visible tumors in the abdominal cavity, and then circulating and agitating a heated chemotherapy fluid within the abdomen to target microscopic cancer remnants.

“Current thinking is that heat enhances the tumor killing activity of the chemotherapy itself,” says Dr. Jula Veerapong, a surgical oncologist at Saint Louis University Hospital and SLUCare physician. The treatment is appropriate for selected patients, he notes, adding, “It depends on the tumor type and how advanced the disease is.”

GENE THERAPY FOR PATIENT WITH POOR HEART FUNCTION

Saint Louis University researchers are enrolling patients in a clinical trial that will study the effects of gene therapy in people with advanced heart failure. The research, involving 52 clinical sites worldwide, expands a previous study that looked at whether a genetically targeted regulatory protein replacement therapy can repair damaged heart muscle.

The initial study, which involved only 40 patients, yielded positive results. Researchers hope to replicate the results as another step toward improving heart function in patients whose heart is damaged due to a heart attack or cardiomyopathy, a heart muscle disease.

“A patient will undergo a heart catheterization procedure to have the therapy delivered, which will not be any different from a catheterization procedure that they have received before,” says Dr. Paul Hauptman, professor of internal medicine at Saint Louis University School of Medicine and principal investigator of the study.

TREATMENT INCREASES LIFESPAN OF MELANOMA PATIENTS WITH BRAIN METASTASES

In a retrospective study, Saint Louis University researchers have found that patients with melanoma brain metastases can be treated with large doses of interleukin-2 (HD IL-2), a therapy that triggers the body's own immune system to destroy the cancer cells.

“Traditionally, melanoma patients with brain metastases have not been considered for HD IL-2 because treatment was thought to be futile,” says Dr. John Richart, associate professor of internal medicine at SLU and principal investigator of the study. “Our study shows that having this condition does not exclude a patient from getting this treatment and can, in fact, improve the length of their life.”

Melanoma is the most dangerous form of skin cancer that begins in the melanin-producing cells called melanocytes. In some melanoma patients, the cancer spreads to the brain, causing multiple tumors that are difficult to treat. According to the U.S. Centers for Disease Control and Prevention, melanoma is the third-most common cancer-causing brain metastases in the nation. Richart says the median overall survival of patients with melanoma brain metastases is approximately four months; whereas in the study, the median overall survival for patients was 8.7 months.

FAT-TRANSFER PROCEDURE FOR BREAST RECONSTRUCTION PATIENTS NOW AVAILABLE LOCALLY

Women undergoing breast reconstruction following cancer treatment may benefit from a new option available from Saint Louis University plastic surgeons. The procedure, known as Revolve, involves removing and purifying fat from one part of the body. The purified fat cells are then injected into the breast as a reconstructive material.

Although fat transfer, also know as ‘fat grafting,’ procedures have been available for some time, Revolve speeds the purification process and preserves more healthy fat cells. The procedure also allows for larger quantities of fat to be processed and transferred, notes Dr. Bruce Kraemer, director of the SLU division of plastic surgery and a SLUCare physician.

“There is no doubt more women are having bilateral mastectomy for breast cancer,” Kraemer says. “This allows us to give a woman more natural, symmetric breasts.”

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