Thursday, January 4, 2018

Morning Rounds by Megan Thielking

Good morning, everyone! Here's what you need to know to get ahead of the day's news in science and medicine. 

New research points to a potential treatment for life-threatening disease

An experimental new treatment improves survival and quality of life among patients with a severe form of an autoimmune disease called scleroderma, researchers report in the New England Journal of Medicine. The disease, called scleroderma, causes the skin and connective tissues to harden and, in its most severe form, can harden internal organs and lead to death. “It’s really a devastating and mortal disease,” study author Dr. Keith Sullivan of Duke tells me.

Sullivan and his colleagues tested a treatment in which patients first undergo chemotherapy and radiation to destroy their bone marrow, then are given a transplant of their own blood-forming stem cells to replace it. “It’s starting from scratch,” Sullivan says. Patients on the experimental regimen were less likely to die due to the progression of their disease than patients who were given an immune-suppressing drug sometimes used to treat the disease. The treatment did, however, carry short-term risks including infection and low blood cell counts, as well as an increased risk of a secondary cancer due to the chemo and radiation.

Lab Chat: These bacteria can bounce back sound waves like a submarine


an e. coli bacterium engineered to be visible to an ultrasound. (Anupama Lakshmanan / Caltech)

Scientists have engineered E. coli and salmonella bacteria that can bounce back sound waves from an ultrasound. It’s an exciting step toward tracking therapeutic bacteria that are sent into the body to treat disease. Here’s what Mikhail Shapiro of California Institute of Technology told me about the work, published in Nature.  

What problem did you set out to solve?

We and others are developing engineered microbes that can go into areas of disease, detect signals in their environment, and then have different kinds of therapeutic functions, like killing other cells or multiplying. But when we inject these cells we can’t see where they are or what they’re doing. Most of our great imaging tools rely on fluorescent proteins, but those don’t work well for cells in the middle of the body. The light gets absorbed on its way out of tissues.

How do these special bacteria work?

We developed a protein that a cell could make that would make it visible under ultrasound. Ultrasound works by sending in a sound wave that goes through tissues and when it encounters something that has a different stiffness, some of that sound wave gets sent back. We used genes that allow cells to form little nano-compartments of gas. Because that gas is a very different density than the rest of the cell, it allows some of the waves to be sent back.

Lawmakers are still hashing out what to do about CHIP

As Congress gets back into the swing of things, lawmakers are faced with a handful of health care issues that didn't get resolved in 2017, including more permanent funding for the Children’s Health Insurance Program and community health centers. Both were funded in a last-minute government spending deal at the end of the year, but that money only runs through March. House Republicans passed a bill in November to fund CHIP. Democrats took issue with the plan because it would pay for CHIP by taking money from a public health fund established by the ACA. It's still not clear when, exactly, Congress will turn to the question of continued funding for CHIP or community health centers. 

Inside STAT: A pioneering doctor tries to upend the nursing home industry


The creator of the Minka bristles at the notion that this is a tiny house. (Jon reis)

Geriatrician Dr. Bill Thomas says he's spent his career trying to change the nursing home industry. Now, he wants to make it so people don't need nursing homes in the first place. His solution: a 330-square-foot, plywood-boned home he calls a Minka. He hopes the small, senior-friendly homes could be clustered together or tucked onto a homeowner’s existing property so caregivers or children can occupy the larger house and help when needed. It's an effort to help people grow older on their own turf and their own terms. The initiative pits Thomas against both the nursing home industry and the housing industry, with its proclivity for bigger and bigger spaces. Experts say it's an insightful idea, but it won't be an easy task. STAT's Bob Tedeschi has the story — read here

Communities get new tools to tackle the opioid crisis

In a bid to boost access to mental health treatment and community supports amid the opioid crisis, 40 public health officials from across the country have been picked to participate in a behavioral health program supported by the CDC. The National Council for Behavioral Health runs the program, which equips health officials to better handle the behavioral health implications of issues such as substance use disorder. It also provides mental health first aid training to learn how to support a person experiencing an urgent mental health crisis. The cohort includes public health leaders in rural, urban, and tribal communities in 22 states.

Scientists dig into why alcohol can increase the risk of some cancers

It’s long been known that alcohol can increase the risk of certain types of cancer, but now, scientists have a better idea as to why. In a mouse model, scientists used DNA sequencing and chromosome analysis to study how alcohol exposure affects genes. They saw that acetaldehyde — a chemical produced as the body processes alcohol — can break DNA in blood stem cells, rearranging chromosomes, changing the DNA sequences, and potentially driving cancer development. Study author and molecular biologist Ketan Patel tells me he and colleagues also found that when mice lack a particular type of enzyme that helps cells break that acetaldehyde down, they suffered more DNA damage and relied on cellular repair systems to fix the problem. 

There are a few important caveats: This research was done in a mouse model that’s engineered to be particularly sensitive to alcohol, and the testing was done at binge-drinking levels, so it doesn't show how alcohol might affect cells in smaller amounts or over a long period of time. 

What to read around the web today

  • Pharmacists slow to dispense life-saving overdose drug. Kaiser Health News
  • U.S. coal mine deaths rise. NPR
  • Trump's firing sets back AIDS prevention efforts. Politico

More reads from STAT

The latest from STAT Plus

Thanks for reading! Back tomorrow to round out the week, 


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