According to a new study conducted by researchers from the Ohio State University Medical Center, a substance created by the immune cells play a pivotal role in disease progression in animals, closely mimicking multiple sclerosis. The study found out that blockage of this molecule known as macrophage migration inhibitory factor (MIF) can effectively prevent disease progression.

Though MIF may be considered of less importance for MS initiation, it is imperative for the progression of multiple sclerosis, as per principal investigator Caroline C. Whitacre, Professor of molecular virology, immunology and medical genetics.

From News-Medical.Net:

“Our results suggest that MIF may be less important for initiating MS, but that it may be necessary for MS progression,” says principal investigator Caroline C. Whitacre, professor of molecular virology, immunology and medical genetics.

“These findings indicate that in the future we can perhaps use MIF levels to predict the onset of a relapse. But more importantly, perhaps this study will lead to drugs that can halt the course of MS by blocking the action of MIF.”

The findings clearly suggested that MIF levels can be used for predicting the onset of a relapse. Most importantly, the study is believed to create new roadways for halting the course of MS by blocking MIF activities.

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According to new surgical technique known as “cellular grafting“, patients with steroid-induced osteonecrosis of the knee can walk and perform routine activities of the life without facing any troubles.

The latest beneficiary of this technique was 14-year old Adam Vasser of Los Altos, California, who was an active kid with a flair for baseball. His heart was attacked by a mysterious virus requiring an urgent need to conduct a heart transplant to save his life. This was the time when cellular grafting was used by orthopedic surgeon Stuart Goodman, MD, PhD the Robert L. and Mary Ellenburg Professor in Surgery at the Stanford University School of Medicine to save him.

From News-Medical.Net:

“Many patients do OK without surgical treatment,” Goodman said. “With those patients, I wait and prescribe pain medication.” But for young patients who still have a lifetime of activity ahead of them, Goodman wanted alternatives.

When Vasser first started looking for knee treatments, he was told by several doctors to simply use crutches until the knee collapsed and then get an artificial knee replacement. Pain medication was discouraged because of its effects on his kidneys after all the heart transplant treatment drugs. He, too, was searching for a better answer when he met Goodman.

All three of Goodman’s patients were between the ages of 18 and 21 and suffering from steroid-induced osteonecrosis. Among the two other patients, one had a diagnosis of Crohn’s disease and the other had been treated with high-dose steroids for severe optic nerve swelling associated with the use of minocycline.

The 60-minute surgery, called osteoprogenitor cellular grafting, involves scooping out the dead bone and then filling the space in with new cellular matter.

“The key is to arrest or reverse the death of the bone,” Goodman said. “If the cartilage is good, you get the dead bone out and give the cartilage a better foundation. If you have a salvageable joint in a young knee, you get in viable cells to repopulate that area of dead bone.”

Goodman theorized that instead of using traditional bone grafting - a more invasive and painful solution - a better method might be using bone cells. The bone cells include young stem cells and progenitor cells that can actually grow into new bone. He withdrew bone marrow from the pelvic area, concentrated the stem cells and progenitors, then used a scaffolding device to help the cells adhere to the defect in the knee.

Based on the success of these three surgeries, Goodman recommends a longer-term follow-up study with a larger number of patients.

This newly developed technique includes transplantation of cellular material from the pelvic region into the knee.

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Scientists from the Imperial College, London have found the reason why lungs of smokers are resistant to steroid treatment along with finding a solution to this resistance.

Chronic Obstructive Pulmonary Disease (COPD) - ‘smoker’s lung’, or chronic bronchitis and emphysema - presently affects 6 percent population of the United Kingdom and is considered to be the fourth most common death cause in the land of the Queen.

It is seen that steroids are normally very effective in the treatment of inflammatory ailments such as COPD but some COPD patients do not respond as per expectations to steroid therapy.

From News-Medical.Net:

Professor Peter Barnes and his colleagues discovered that steroids act as a ‘molecular bridge’ to recruit HDAC2 to the appropriate genes where it can act to switch them off.

The London researchers found that in COPD, levels of HDAC2 are very low compared to normal cells, so that the steroids have no effect in switching off the activated inflammatory genes.

They then found that in lung cells in vitro, and in rats, low doses of a cheap and widely available drug raised the levels of HDAC2 and broke the steroid resistance.

The first stages of clinical trials to test low doses of this drug, theophylline, in COPD patients are now underway. If successful, this may lead to a change in the treatment of COPD and other severe inflammatory diseases that do not respond well to steroid therapy.

Professor Peter Barnes commented, ‘COPD kills tens of thousands of people in the UK every year and currently we can only treat the symptoms, not the underlying problem of inflammation of the lungs. Our work has finally provided an explanation for steroid resistance in COPD, and has allowed us to identify ways to combat this.

Professor Peter Barnes and his colleagues found out that steroid are effective in playing an active role for acting as a molecular bridge in the recruitment of Histone Deacetylase 2 (HDAC2), an enzyme, to the relevant genes where it can switch them off.

They also discovered that levels of HDAC2 were very low compared to normal cells in the COPD patients. This means that the steroids are no longer potent enough to have any effect in switching off the activated inflammatory genes. In this direction, a new steroid has been found that can raise the levels of HDAC2 and break the resistance of steroids.

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Children under the age of 12 years and suffering from persistent asthma need highly motivated parents to reap benefits of regular steroid inhaler treatment therapy.

As per researchers from the University of Michigan, parents of black asthmatic children had rated their doctor lower than their white counterparts.

According to Kathryn L. Moseley, M.D., an assistant professor of pediatrics at the U-M Medical School, parents of asthmatic children who did not administer medication to children as prescribed were known to have developed specific characteristics with the doctor.

Researchers were of the view that an improved doctor-parent relationship can minimize the frequency of asthma attacks and hospitalization among the minority children.

From News-Medical.Net:

For the parents who did not give the medications as prescribed, we found specific characteristics of their experience with the doctor that were associated with less adherence,” says Kathryn L. Moseley, M.D., an assistant professor of pediatrics at the U-M Medical School.

The U-M results suggest that improved physicians’ relationships with these parents could help reduce the frequency of asthma attacks and hospitalizations among minority children.

One way to improve parents’ trust and confidence is for clinics to make sure that parents with children who have persistent asthma see the same doctor each time if possible, Moseley says. During office visits, doctors could make sure that parents feel that their questions and concerns are fully addressed, says Moseley. The study, which appears in the May issue of the Journal of the National Medical Association, also shows that parents who are not adhering to asthma treatments are in many cases not getting flu shots for their children.

Children who don’t get regular steroid inhaler treatments for their asthma are at higher risk of complications from influenza. So there’s an added reason for physicians to work to increase rapport with minority parents.

Insurers as well as physicians may want to act on the study results. Some insurers target messages to their clients to encourage better preventive care to save costs, Moseley says.

“They might want to create specific interventions to encourage parents to get flu shots for their children and also ask, ‘Any problems with giving the inhaler doses?’”

Study details Moseley and her colleagues interviewed 282 parents of children aged 2 through 12 who had asthma-related physician visits in 2004 and 2005. Parents were asked about their children’s use of steroid inhalers and about vaccination against influenza. The researchers also adapted a well-known questionnaire, the Primary Care Assessment Survey, to measure parents’ perceptions about their encounters with their child’s physician.

Black parents in the survey did not have some of the common obstacles to regular asthma care, such as lack of insurance or a family doctor.

This study is expected to create a new paradigm for development of relations between parents of doctors of black asthmatic children.

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During the 50th Annual Meeting of the American Society of Hematology in San Francisco, CA, four studies pertaining to treatment and survival results for individuals with varying forms of thrombocytopenia were presented.

The studies reported on the latest combination therapy for previously incurable idiopathic thrombocytopenic purpura (ITP), an investigational oral treatment for chronic ITP, a new therapeutic platelet transfusion medical approach after chemotherapy & autologous stem cell transplantation, and a low-dose platelet transfusion strategy for patients suffering from hypoproliferative thrombocytopenia.

From News-Medical.Net:

The studies featured in the press conference will report on a new combination therapy for previously untreated idiopathic thrombocytopenic purpura (ITP), an investigational oral treatment for chronic ITP, a low-dose platelet transfusion strategy for patients with hypoproliferative thrombocytopenia, and a new therapeutic platelet transfusion approach following high-dose chemotherapy and autologous stem cell transplantation.

“We have some very exciting data on novel therapeutic approaches to minimize bleeding episodes in patients with platelet disorders,” said press conference moderator Kenneth Kaushansky, MD, 2008 President of the American Society of Hematology and Helen M. Ranney Professor and Chair of the Department of Medicine at the University of California, San Diego School of Medicine. “The results of these studies will likely transform the way hematologists treat and manage these conditions, ultimately resulting in improvements in overall patient outcomes such as reducing bruising and unnecessary bleeding that can result if left untreated.”

It was revealed during the study that adding rituximab (an immunotherapy drug) to dexamethasone (a steroid) is highly effective in the treatment of idiopathic thrombocytopenic purpura (ITP).

It was remarked by press conference moderator Kenneth Kaushansky, MD, 2008 President of the American Society of Hematology and Helen M. Ranney Professor and Chair of the Department of Medicine at the University of California, San Diego School of Medicine that there has been a collection of effective data to reduce bleeding episodes in patients suffering from platelet disorders.

These studies are expected to transform the treatment methodologies of hematologists in an aim to bring great improvements in overall patient outcomes.

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Cystic fibrosis (CF) patients who regularly use inhaled corticosteroid and those who did not use these drugs for six months showed no positive or negative effects in terms of major disease factors. This proves that stopping inhaled corticosteroid usage does not cause problems in cystic fibrosis patient users.

The team of Dr. Ian M. Balfour-Lynn of the Department of Pediatric Respiratory Medicine at Royal Brompton Hospital in London claimed that it is safe for CF patients to stop using inhaled corticosteroids in order to lower their drug burden, to reduce potential adverse side effects, and to save money.

From Medical News Today:

“Oral corticosteroids slow the progression of CF lung disease, but long-term use is precluded by unacceptable side effects,” said Dr. Balfour-Lynn. “A systematic review of inhaled corticosteroid use in CF revealed 10 randomized controlled trials, with six having been published. The trials studied 293 adults and children. Although there was variable methodological quality among the studies, the conclusion was that there was ‘no evidence from existing trials to support the practice of prescribing inhaled steroids in cystic fibrosis.’”

The authors noted that 52 percent of the patients were on high-dose inhaled corticosteroids (1,000 micrograms or more per day). At those levels, the drug can lead to significant symptoms related to adrenal suppression and insufficiency. Also, among pediatric patients, slowing of linear growth has been a problem for individuals taking the drug for a year or more.

“Replacing the inhaled corticosteroids with a placebo was found to be safe as there was no significant increase in lung-related adverse effects leading to withdrawal from the study, nor an increased need for oral corticosteroids,” said Dr. Balfour-Lynn.

The research team pointed out that they were not advocating stopping inhaled corticosteroid use in all CF patients, but urging clinicians to assess the need in each individual.

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Most cases, asthma patients are told to take more steroid inhaler doses to get the disease back under control. This practice is believed to be faulty by some Nottingham, UK researchers. The key to asthma therapy is getting the symptoms under control, so that patients suffer fewer attacks and need less of their reliever inhalers.

The team from City Hospital Nottingham (UK) launched a study to test whether the extra steroids were having an impact. They found that doubling the dose of inhaled steroids had no impact on the length of time it took for peak flow to return to normal levels.

From Medical News Today:

Advice to asthmatics to boost their intake of drugs when their condition deteriorates may be flawed, say Nottingham (UK) researchers.

They gave patients an extra supply of inhalers, and told them to break into it when their peak flows began to worsen.

Some patients, however, received dummy inhalers with no drug in them.

The two groups were then compared to see if the extra steroids were good for the patient.

‘Our findings provide little support for the recommendation that patients taking an inhaled corticosteroid should double the dose when asthma control is deteriorating.’ they wrote.

‘Such advice should include, as the authors of this paper say, a reserve supply of steroid tablets.’

The UK research team also found out that increasing the dose of inhaled steroids had no effect on the number of patients who ended up needing more powerful steroids in pill form to control their asthma. The study does not in any way detract from the British Asthma Guideline recommendation that people with asthma should be given personalized advice as to how to alter their therapy themselves to keep themselves well. But the findings should give healthcare providers more information about how to manage deteriorating asthma.

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A new study published in an issue of the European Respiratory Journal has suggested that obese people with asthma can have better results and a good reason of life with Singulair. It was also suggested that leaner people can have benefits from inhaled steroids such as beclomethasone.

During the study, there was no conclusive evidence that obesity can influence responses of people to specific asthma medications as per lead author Marc Peters-Golden, M.D., professor of internal medicine and director of the Fellowship Program in Pulmonary and Critical Care Medicine at the University of Michigan Medical School.

From News-Medical.Net:

Researchers looked at data from four previous multi-center, randomized clinical trials from 3,073 patients with moderate asthma. The data included the patients’ responses to Singulair/montelukast, a beclomethasone inhaled steroid and a placebo, and the participants’ body mass index numbers, which placed them in the categories of normal, overweight and obese.

In general, the severity of people’s asthma was found to be greater among those in the overweight and obese groups, which supports findings from other studies.

In addition, the inhaled steroid was found to be better than Singulair at increasing the number of asthma control days (ACD) among people in the normal weight category. An ACD is defined as a day with no more than two puffs of an inhaler, no night-time awakenings and no asthma attacks.

On the other hand, the inhaled steroid resulted in a reduced effect in the percentage of ACDs among obese people in the study - that is, the benefit of the inhaled steroid declined with increasing body mass index.

In contrast, the positive impact of Singulair did not decrease in obese and overweight people when compared to its impact on people of normal weight. The research also suggests that the higher a person’s body mass index, the greater his or her response to Singulair compared to a placebo, a pill with no medicinal benefit. This is an indication, Peters-Golden says, that obese and overweight people may in fact respond better to this medication.

Still, he is not inclined to suggest that doctors change the way in which they prescribe medication - not yet, anyway.

“Our study looks back at material from previous trials. I’d like to see a prospective study in which lean patients and heavy patients are enrolled at the outset, and you compare both types of medications in both groups,” Peters-Golden says. If verified by other studies, this insight may help physicians to better tailor medication regimens to meet individual patient needs.

Peters-Golden also noted that a multitude of factors including genetic and acquired factors such as body weight combine in an intertwined manner for influencing a patient’s reaction to asthma medications.

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As per a study, graft-versus-host (GHVD) Patients after a bone marrow or cord blood transplant with intravenous steroids who do not respond to the steroid treatment can be treated with higher doses of steroids with a new interventional radiology treatment.

It was found that higher doses of steroids can be given via catheter to the arteries, which are supplying the GHVD-affected organs since the remaining body is spared from side-effects of the steroids, as per Joshua L. Weintraub, M.D., chief of the Division of Vascular and Interventional Radiology at Mount Sinai Medical Center in New York City.

From News-Medical.Net:

The standard treatment to treat graft-versus-host disease (GVHD) after bone marrow or cord blood transplant is intravenous (IV) steroids that alter the immune response; however, it is not always effective and failure results in very high mortality.

In a study, 15 patients who failed standard treatment were given a high dose of steroids directly to the affected organ. By delivering the steroids via catheter to the arteries that are supplying the organs affected by GVHD, a much higher, more effective dose can be given because the rest of the body is spared from the steroid’s side effects.

“Overall, fewer than 30 percent of patients with steroid-resistant GVHD respond completely or partially to the standard IV treatment, and their chance of living one year is 15 percent or less. This interventional radiology treatment can be life-saving for these people,” said Joshua L. Weintraub, M.D., chief of the Division of Vascular and Interventional Radiology at Mount Sinai Medical Center in New York City.

According to Weintraub, there were no immediate drug or procedure-related complications, and the treatment appears to be safe and effective in combating GVHD—with about 40 percent of the patients showing complete response to the intra-arterial treatment at less than a year follow-up. The study was presented during the Society of Interventional Radiology’s 33rd Annual Scientific Meeting in Washington, D.C.

GHVD is a common complication, related to an allogeneic bone marrow transplant, in which the immune cells from the donated cord blood or marrow pose a threat to transplant patient’s body.

This first of its kind study in the United States reveals a viable option for treating patients with GHVD as per Weintraub.

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Lung Disease Experts at the Johns Hopkins have found evidence that inhaled corticosteroids can raise the risk of pneumonia by a full third in COPD (chronic obstructive pulmonary disease) patients. They advised physicians to be more careful before prescribing inhaled corticosteroids to these patients.

The involved researchers suspected that the corticosteroids tend to suppress the immune system of the body and are not sure how and why the corticosteroids’ treatment raises the risk of lung infection.

From News-Medical.Net:

“Physicians really need to strongly evaluate a patient’s individual characteristics before prescribing these steroid medications, and patients, in turn, should weigh the risks and benefits of taking the drugs, despite their proven record in providing symptomatic relief,” he says.

According to pulmonologist M. Brad Drummond, M.D., M.H.S., who led the study, “catching this bacterial infection can seriously disrupt quality of life, making it harder for COPD patients to breathe and possibly leading to hospitalization.”

Drummond says the new findings should serve as a reminder to people with the severe lung disease to take steps that reduce the chance of getting pneumonia, which doubles their risk of dying when compared to people with healthy lungs. He also advises COPD sufferers, in addition to weighing the benefits and harms of steroids, to get the pneumonia vaccination every five years and an annual flu vaccination because these shots reduce the chance of getting a lung infection.

A postdoctoral clinical research fellow at Hopkins, Drummond also advises lung disease sufferers to take additional precautions, including more frequent hand washing, and vigilant monitoring for the first and earliest signs of sickness, such as increased phlegm in the throat, shortness of breath, fever or chills.

Till Now, inhaled corticosteroids were being prescribed to the COPD patients by physicians to cure COPD symptoms such as phlegm, shortness of breath, physical exhaustion after a short exercise session, and wheezing.

Eddy Fan, M.D., senior study investigator, Johns Hopkins University School of Medicine and critical care specialist, said that there is no need to panic for patients but the physicians prescribing inhaled corticosteroids must be extra-cautious to screen and monitor the patients and must ascertain the lowest possible working doses of steroids.

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