Category Archives: Gene Medicine

On the morning of April 25, 2018, in Fort Wayne, Indiana, Omarion Jordan came into the world ten-fingers-and-toes perfect. His mother, Kristin Simpson, brought her dark-haired newborn home to a mostly empty apartment in Kendallville, about 30 miles to the north. Shed just moved in and hadnt had time to decorate. Her son, however, had everything he needed: a nursery full of toys, a crib, a bassinet and a blue octopus blanket.

Still, within his first couple of months, he was plagued by three different infections that required intravenous treatments. Doctors thought he had eczema and cradle cap. They said he was allergic to his mothers milk and told her to stop breastfeeding. Then, not long after he received a round of standard infant vaccinations, his scalp was bleeding and covered with green goop, recalled the first-time mother, who was then in her late teens. She took him to the hospital emergency room, where, again, caregivers seemed puzzled by the babys bizarre symptoms, which didnt make any sense until physicians, finally, ordered the right blood test.

What they learned was that Omarion was born with a rare genetic disorder called X-linked severe combined immunodeficiency (SCID), better known as the bubble boy disease. Caused by a mutated gene on the X chromosome, and almost always limited to males, a baby born with X-linked SCID, or SCID-X1, lacks a working immune system (hence the unusual reaction to vaccination). The bubble boy name is a reference to David Vetter, a Texas child born with SCID-X1 in 1971, who lived in a plastic bubble and ventured out in a NASA-designed suit. He died at 12, but his highly publicized life inspired a 1976 TV movie starring John Travolta.

Today, technological advances in hospitals provide a kind of bubble, protecting SCID-X1 patients with controlled circulation of filtered air. Such safeguards are necessary because a patient exposed to even the most innocuous germs can acquire infections that turn deadly. As soon as Omarion tested positive for the disorder, an ambulance carried him to Cincinnati Childrens Hospital in nearby Ohio and placed him in isolation, where he remained for the next few months. I had no idea what would happen to him, his mother recalled.

Approximately one in 40,000 to 100,000 infants is born with SCID, according to the Centers for Disease Control and Prevention. Only about 20 to 50 new cases of the SCID-X1 mutationwhich accounts for about half of all SCID casesappear in the United States each year. For years, the best treatments for SCID-X1 have been bone marrow or blood stem cell transplantations from a matched sibling donor. But fewer than 20 percent of patients have had this option. And Omarion, an only child, was not among them.

As it happened, medical scientists at St. Jude Childrens Research Hospital in Memphis, Tennessee, were then developing a bold new procedure. The strategy: introduce a normal copy of the faulty gene, designated IL2RG, into a patients own stem cells, which then go on to produce the immune system components needed to fight infection. Simpson enrolled Omarion in the clinical study and Cincinnati Childrens Hospital arranged a private jet to transport her and her son to the research hospital, where they stayed for five months.

St. Jude wasnt the first to try gene therapy for SCID-X1. Nearly 20 years ago, researchers in France reported successfully reconditioning immune systems in SCID-X1 patients using a particular virus to deliver the correct gene to cells. But when a quarter of the patients in that study developed leukemia, because the modified virus also disrupted the functioning of normal genes, the study was halted and scientists interested in gene therapy for the disorder hit the brakes.

At St. Jude, experts led by the late Brian Sorrentino, a hematologist and gene therapy researcher, set out to engineer a virus delivery vehicle that wouldnt have side effects. They started with a modified HIV vector emptied of the virus and its original contents, and filled it with a normal copy of the IL2RG gene. They engineered this vector to include insulators to prevent the vector from disturbing other genes once it integrated into the human genome. The goal was to insert the gene into stem cells that had come from the patients own bone marrow, and those cells would then go on to produce working immune system cells. It was crucial for the viral vector to not deliver the gene to other kinds of cellsand thats what the researchers observed. After gene therapy, for example, brain cells do not have a correct copy of the gene, explained Stephen Gottschalk, who chairs St. Judes Department of Bone Marrow Transplantation and Cellular Therapy.

In the experimental treatment, infants received their re-engineered stem cells just 12 days after some of their bone marrow was obtained. They went through a two-day, low-dose course of chemotherapy, which made room for the engineered cells to grow. Within four months, some of the babies were able to fight infections on their own. All eight of the initial research subjects left the hospital with a healthy immune system. The remarkably positive results made news headlines after being published this past April in the New England Journal of Medicine. Experimental gene therapy frees bubble boy babies from life of isolation, the journal Nature trumpeted.

So far, the children who participated in that study are thriving, and so are several other babies who received the treatmentincluding Omarion. As a physician and a mom, I couldnt ask for anything better, said Ewelina Mamcarz, lead author of the journal article and first-time mother to a toddler nearly the same age as Omarion. The children in the study are now playing outside and attending day care, reaching milestones just like my daughter, Mamcarz says. Theyre no different. Mamcarz, who is from Poland, came to the United States to train as a pediatric hematologist-oncologist and joined St. Jude six years ago.

Other medical centers are pursuing the treatment. The University of California, San Francisco Benioff Childrens Hospital is currently treating infant patients, and Seattle Childrens Hospital is poised to do the same. Moreover, the National Institutes of Health has seen success in applying the gene therapy to older patients, ages 3 to 37. Those participants had previously received bone marrow transplants from partially matched donors, but theyd been living with complications.

In the highly technical world of medicine today, it takes teamwork to achieve a breakthrough, and as many as 150 peoplephysicians, nurses, regulators, researchers, transplant coordinators and othersplayed a role in this one.

Sorrentino died in November 2018, but hed lived long enough to celebrate the trial results. In the early 90s, we thought gene therapy would revolutionize medicine, but it was kind of too early, said Gottschalk, who began his career in Germany. Now, nearly 30 years later, we understand the technology better, and its really starting to have a great impact. We can now develop very precise medicine, with very limited side effects. Gottschalk, who arrived at St. Jude a month before Sorrentinos diagnosis, now oversees the hospitals SCID-X1 research. Its very, very gratifying to be involved, he said.

For now the SCID-X1 gene therapy remains experimental. But with additional trials and continued monitoring of patients, St. Jude hopes that the therapy will earn Food and Drug Administration approval as a treatment within five years.

Simpson, for her part, is already convinced that the therapy can work wonders: Her son doesnt live in a bubble or, for that matter, in a hospital. He can play barefoot in the dirt with other kids, whatever he wants, because his immune system is normal like any other kid, she said. I wish there were better words than thank you.

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These Scientists May Have Found a Cure for 'Bubble Boy' Disease - Smithsonian.com

Professor Nikolaus Rajewsky is a visionary: He wants to understand exactly what happens in human cells during disease progression, with the goal of being able to recognize and treat the very first cellular changes. "This requires us not only to decipher the activity of the genome in individual cells, but also to track it spatially within an organ," explains the scientific director of the Berlin Institute for Medical Systems Biology (BIMSB) at the Max Delbrck Center for Molecular Medicine (MDC) in Berlin. For example, the spatial arrangement of immune cells in cancer ("microenvironment") is extremely important in order to diagnose the disease accurately and select the optimal therapy. "In general, we lack a systematic approach to molecularly capture and understand the (patho-)physiology of a tissue."

Maps for very different tissue typesRajewsky has now taken a big step towards his goal with a major new study that has been published in the scientific journal Nature. Together with Professor Nir Friedman from the Hebrew University of Jerusalem, Dr. Mor Nitzan from Harvard University in Cambridge, USA, and Dr. Nikos Karaiskos, a project leader from his own research group on "Systems Biology of Gene Regulatory Elements", the scientists have succeeded in using a special algorithm to create a spatial map of gene expression for individual cells in very different tissue types: in the liver and intestinal epithelium of mammals, as well as in embryos of fruit flies and zebrafish, in parts of the cerebellum, and in the kidney. "Sometimes purely theoretical science is enough to publish in a high-ranking science journal - I think this will happen even more frequently in the future. We need to invest a lot more in machine learning and artificial intelligence," says Nikolaus Rajewsky.

"Using these computer-generated maps, we are now able to precisely track whether a specific gene is active or not in the cells of a tissue part," explains Karaiskos, a theoretical physicist and bioinformatician who developed the algorithm together with Mor Nitzan. "This would not have been possible in this form without our model, which we have named 'novoSpaRc.'"

Spatial information was previously lost

It is only in recent years that researchers have been able to determine - on a large scale and with high precision - which information individual cells in an organ or tissue are retrieving from the genome at any given time. This was thanks to new sequencing methods, for example multiplex RNA sequencing, which enables a large number of RNA molecules to be analyzed simultaneously. RNA is produced in the cell when genes become active and proteins are formed from their blueprints. Rajewsky recognized the potential of single-cell sequencing early on, and established it in his laboratory.

"But for this technology to work, the tissue under investigation must first be broken down into individual cells," explains Rajewsky. This process causes valuable information to be lost: for example, the original location in the tissue of the particular cell whose gene activity has been genetically decoded. Rajewsky and Friedmann were therefore looking for a way to use data from single-cell sequencing to develop a mathematical model that could calculate the spatial pattern of gene expression for the entire genome - even in complex tissues.

The teams led by Rajewsky and Dr. Robert Zinzen, who also works at BIMSB, already achieved a first breakthrough two years ago. In the scientific journal Science, they presented a virtual model of a fruit fly embryo. It showed which genes were active in which cells in a spatial resolution that had never before been achieved. This gene mapping was made possible with the help of 84 marker genes: in situ experiments had determined where in the egg-shaped embryo these genes were active at a certain point in time. The researchers confirmed their model worked with further complex in situexperiments on living fruit fly embryos.

A puzzle with tens of thousands of pieces and colors

"In this model, however, we reconstructed the location of each cell individually," said Karaiskos. He was one of the first authors of both the "Science" study and the current "Nature" study. "This was possible because we had to deal with a considerably smaller number of cells and genes. This time, we wanted to know whether we can reconstruct complex tissue when we have hardly any or no previous information. Can we learn a principle about how gene expression is organized and regulated in complex tissues?" The basic assumption for the algorithm was that when cells are neighbors, their gene activity is more or less alike. They retrieve more similar information from their genome than cells that are further apart.

To test this hypothesis, the researchers used existing data. For liver, kidney and intestinal epithelium there was no additional information. The group had been able to collect only a few marker genes by using reconstructed tissue samples. In one case, there were only two marker genes available.

"It was like putting together a massive puzzle with a huge number of different colors - perhaps 10,000 or so," explains Karaiskos, trying to describe the difficult task he was faced with when calculating the model. "If the puzzle is solved correctly, all these colors result in a specific shape or pattern." Each piece of the puzzle represents a single cell of the tissue under investigation, and each color an active gene that was read by an RNA molecule.

The method works regardless of sequencing technique"We now have a method that enables us to create a virtual model of the tissue under investigation on the basis of the data gained from single-cell sequencing in the computer - regardless of which sequencing method was used," says Karaiskos. "Existing information on the spatial location of individual cells can be fed into the model, thus further refining it." With the help of novoSpaRc, it is then possible to determine for each known gene where in the tissue the genetic material is active and being translated into a protein.

Now, Karaiskos and his colleagues at BIMSB are also focusing on using the model to trace back over and even predict certain developmental processes in tissues or entire organisms. However, the scientist admits there may be some specific tissues that are incompatible with the novoSpaRc algorithm. But this could be a welcome challenge, he says: A chance to try his hand at a new puzzle!

Reference: Nitzan, Karaiskos, Friedman and Nikolaus Rajewsky. 2019. Gene expression cartography. DOI: https://doi.org/10.1038/s41586-019-1773-3.

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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Calculating the Spatial Pattern of Gene Expression for the Entire Genome - Technology Networks

Delirium is the most common post-surgical complication in older adults. Marked by acute temporary confusion, disorientation and/or agitation, it strikes as many as half of adults over 65 who undergo high-risk procedures such as cardiac surgery and hip replacements.

Postoperative delirium is also tightly linked to Alzheimers disease. Although each can occur independently, Alzheimers is a leading risk factor for delirium, and an episode of delirium puts patients at increased risk for cognitive decline and Alzheimers.

However, the physiological mechanisms that link delirium and Alzheimers disease remain largely unknown.

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Now, in a paper published Nov. 22 in Alzheimers & Dementia: The Journal of the Alzheimers Association, researchers at Harvard Medical School and Beth Israel Deaconess Medical Center shed light on a genetic risk factor for Alzheimers disease that may indirectly influence patients risk of postoperative delirium.

In a study of older adults without dementia undergoing major noncardiac surgery, researchers observed that patients carrying a specific variant of a gene appeared to be much more vulnerable to delirium under certain conditions than people without the variant.

The teams findings could open the door to future interventions to prevent or mitigate postoperative delirium in at-risk patients.

Our findings confirmed our hypothesis that patients risk of postoperative delirium differs by genetic predisposition, said Sarinnapha Vasunilashorn, assistant professor of medicine at HMS and Beth Israel Deaconess and first author of the study. We observed a strong and significant association between high postoperative inflammation and delirium incidence, duration and severity among patients carrying a variant of the gene considered to be risky, while the association was weaker and nonsignificant among noncarriers.

Vasunilashorn and colleagues focused on a gene called APOE, short for apolipoprotein E. The risky version of the gene, notated as APOE 4, is the strongest known genetic risk factor for late-onset Alzheimers disease and a widely studied genetic risk marker for delirium.

While recent studies have shown no direct relationship between APOE 4 and delirium, Vasunilashorns team hypothesized that the gene variant might indirectly influence risk of delirium by modifying the bodys response to inflammationpart of the immune systems natural defense systemindicated by the presence of an inflammatory marker in the blood called C-reactive protein, or CRP.

Using data from the Successful Aging after Elective Surgery (SAGES) study, an ongoing prospective cohort study investigating risk factors and long-term outcomes of delirium, the scientists looked at the incidence, severity and duration of delirium in 560 patients who were at least 70 years old and who underwent major noncardiac surgeries under general or spinal anesthesia. Patients were monitored for delirium, assessed by daily cognitive assessments of attention, memory and orientation throughout their hospital stay.

Analyzing data from patients blood drawn before surgery, immediately after surgery, two days after and one month after revealed that, among carriers of the APOE 4 gene variant, patients with high levels of inflammation had an increased risk of postoperative delirium. However, among noncarriers of the APOE 4 gene variant, the scientists found no such association.

Our findings suggest that APOE 4 may be an indicator of brain vulnerability, said Vasunilashorn. This work may inform the targeting of future interventions, such as anti-inflammatory treatments, for prevention of postoperative delirium and its associated adverse long-term cognitive outcomes in patients with this genetic susceptibility.

Edward Marcantonio, professor of medicine at HMS and Beth Israel Deaconess, is senior author of the study.

This work was supported by the National Institute of Aging of the National Institutes of Health (grants K01AG057836, R03AG061582, P01AG031720, R24AG054259, K07AG041835, R21AG057955, R01AG041274, R21AG048600, R01AG051658 and K24AG035075); the Charles A. King Trust Postdoctoral Research Fellowship Program; Bank of America, N.A., Co-Trustee, and the Alzheimers Association (AARF-18-560786).

Adapted from a Beth Israel Deaconess news release.

Image: kemalbas/Getty Images

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Gene linked to Alzheimers disease plays indirect role in risk for... - ScienceBlog.com

The continuing interest in cell and gene therapies is reflected by the 800+ active investigational new drug (IND) applications within the field that are on file with the US Food and Drug Administration (FDA).1 This trend is only set to increase, with the FDA foreseeing the approval of 1020 cell and gene therapy (CGT) products per year by 2025.2

To increase the number of therapeutic options for treatment of conditions for which there is currently no cure, there are two FDA expedited pathways: the Regenerative Medicine Advanced Therapy (RMAT) designation and the Breakthrough Therapy designation (BTD). Both are well suited to the development of cell and gene therapies. This article reflects on the usage of these designations and, throughout, Keith Webber, Vice President, Biotechnology at Lachman Consultant Services, Inc., provides insights and advice regarding the two accelerated pathways for cell and gene therapies.

Being the earlier of the two designations (2012), BTD holds the majority of product approvals. This pathway was followed in 2017 by the RMAT, which has a particular focus on cell and gene therapies, tissue engineering products, and human cell or tissue products. This differentiates it from the BTD, which is also applicable to other types of therapies if they address serious or life-threatening conditions. Table 1 provides an over-view of the number of requests for each designation, as well as the success rate across 2019.

Despite the number of BTD requests exceeding quadruple the number of RMAT applications, the success rates are comparable, at around 3540%. This has also been the case for cumulative data that show all submissions since each designation was introduced (refer to this 2018 Pink Sheet guide for cumulative information, plus further trends including therapy areas and sponsor types). However, there are certain differences in evidentiary criteria for applying for both pathways that may affect decision-making regarding which designation to apply for. With the BTD, sponsors must provide evidence that the treatment is likely to be a substantial safety or efficacy improvement over existing therapies, which is not the case for RMAT.5 As a result, if a product candidate is eligible, Webber notes that it could be beneficial to gain both designations as, if you can apply for both, you can choose the most advantageous if you receive both, so it opens up more opportunities.

Inevitably, there are certain challenges associated with applying for either designation. According to Webber, one factor to be mindful of: Often the clinical development is more advanced than the chemistry, manufacturing and controls (CMC) development. The CMC and product development can be a rate-limiting component for a Biologics License Application (BLA) submission or approval. So that is something to keep in mind. You dont want this to hold you back as you move through development. Ensuring all elements of the research and development process are aligned is therefore an important factor for boosting chances of rapid product approval.

Post-approval requirements can be another consideration when determining which pathway is most suitable. For an accelerated approval under BTD, there is a requirement to perform a post-approval confirmatory study when the approval has been based on a smaller data set or surrogate endpoints. The post-approval requirements for the RMAT are not as rigid; Webber notes that the accelerated approval may allow the use of historical controls, retrospective studies, monitoring data or real-world evidence there are more opportunities for that confirmatory evaluation. This may be because the BTD is for all products, including traditional pharmaceuticals, whereas RMAT is only for the more complex biological products. As such, RMAT products are often times more challenging to design clinical studies for.

The topic of post-approval and surrogate endpoints can raise concern around treatments being ineffective, or possibly toxic, upon being marketed.6 In terms of advice, Webber said, Communicate with the FDA early and often when designing your trials or planning approval. There is an FDA guidance document, called Interacting with the FDA on Complex and Innovative Trial Designs, which provides sound advice for developing successful clinical protocols. The recommendation is to get both FDA input and acceptance as early as possible on trial design. To support these critical interactions, the FDA has set a goal of recruiting 50 new clinical reviewers for CGT products.7

The recent development of Medicaid expanding coverage for products receiving accelerated approvals signifies the interest and investment in cell and gene therapies.8 This is in tandem with a growing trend of larger companies being increasingly keen to own gene therapy technologies rather than partnering. Historically, gene therapies have been spearheaded by small biotechnology companies (typically in partnership with larger pharmaceutical firms). In fact, 90% of gene therapy development is by companies with fewer than 500 employees.9 From his experience in carrying out due diligence for larger organizations interested in investing or acquiring smaller biotechnology companies, Webber noted: Be vigilant in your due diligence assessments when considering buying or investing into a company. You should watch out for gaps in product development. For example, there may be deficiencies in the establishment of the master cell bank or working cell banks.

Look out for poorly characterized components in the product and qualification of materials. In addition, watch out for any lack of standardization, which can create issues further on in the process. Webber explains that There may be a lot of variability in how the manufacturing processes are performed during development and that can be a challenge in terms of establishing what is the consistent product thats coming out of that manufacturing process. In many cases, the product is the process. So if the processes are changing continually, and the product is difficult to fully characterize (as often the RMAT products are), you can have considerable uncertainty with regard to the interpretation of any preliminary clinical data.

Data integrity can also be an issue, for which Webber suggests paying close attention to the ALCOA principles (Attributable, Legible, Contemporaneous, Original and Accurate). Those principles should be in place, and if they arent it can be challenging to be reliant on that data for presentation to the FDA during inspection.

Webber indicates that manufacturing is a final area of the process that can come under scrutiny: Sometimes there are manufacturing changes during development that have not been qualified. So, the company makes changes where they havent really evaluated the impact (of those changes) during development of the manufacturing process.

* REQUESTS THAT ARE STILL PENDING A DECISION ARE INCLUDED IN THE TOTAL REQUESTS RECEIVED COLUMN.NUMBERS ARE FOR US FEDERAL FISCAL YEAR 2019, ENDED 30 SEPTEMBER 2019.

The direction of growth in cell and gene therapies is moving further toward personalized medicines. At this point, it is difficult to predict how the regulatory land-scape will accommodate these advancements. One of the largest challenges to anticipate may be in assessing clinical outcomes, where variances could be due to patient-to-patient differences or product-to-product differences. It might be necessary to develop methods to assess the in vivo product performance, for example, gene incorporation and gene expression, in addition to the assessment of clinical outcome, to further under-stand the relationship between clinical performance and product performance in vivo. Webber continued, explaining that the FDAs Center for Biologics Evaluation and Research (CBER) has released many new guidances regarding CGT, covering everything from certain therapeutic areas such as hemophilia to evaluations of devices used in regenerative medicine.

Given that the cell and gene therapy accelerated pathways are relatively new, and with the stance of Medicaid reimbursing such products, applications for accelerated approval pathways are set to skyrocket. The possibilities that cell and gene therapies may unveil could be truly profound. That being said, approval for CGT is undoubtedly going to become more complex with the advancement of personalized medicine, and this could create further complications when conducting studies and assessing clinical outcomes (due to individual variance).

A closing remark from Webber: The FDA has a great interest in bringing new and effective treatments to patients, so I encourage sponsors to take advantage of this willingness, to meet with the FDA early and during product and clinical development phases. Also, work with consultants as needed to get guidance on preparing submissions and product development as you move forward.

SOURCES

https://www.fda.gov/news-events/fda-voices-perspectives-fda-leadership-and-experts/fdas-efforts-advance-development-gene-therapy

https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-peter-marks-md-phd-director-center-biologics

https://www.fda.gov/media/95286/download

https://www.fda.gov/vaccines-blood-biologics/cellular-gene-therapy-products/cumulative-cber-regenerative-medicine-advanced-therapy-rmat-designation-requests-received-fiscal

https://pink.pharmaintelligence.informa.com/PS124820/Gene-Therapies-Make-A-Mark-In-US-FDA-Expedited-Review-Programs

https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/gene-therapy-coming-of-age-opportunities-and-challenges-to-getting-ahead

https://www.fda.gov/news-events/press-announcements/statement-fda-commissioner-scott-gottlieb-md-and-peter-marks-md-phd-director-center-biologics

https://www.medicaidandthelaw.com/tag/gene-therapies/

https://www.mckinsey.com/industries/pharmaceuticals-and-medical-products/our-insights/gene-therapy-coming-of-age-opportunities-and-challenges-to-getting-ahead

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A Reflection On BTD And RMAT Designations - Pink Sheet

Dr Sadaf Farooqi

BRIGHTON, UK The obesity epidemic is not simply the result of changes in the lived environment but a complex interplay between genes and surroundings that has driven people who would have been genetically susceptible but remained thin in previous eras to become obese, says one expert.

This was the argument put forward as part of a debate on whether an individual's body weight is determined by "nature or nurture" at the recent Society for Endocrinology BES Conference 2019 in Brighton, UK.

Before the debate began, Rob Semple, MD, University of Edinburgh, UK, introduced the speakers and polled the audience on their "baseline" views onthe statement: "This house believes that nature not nurture determines our body weight."

The response was 36% "for" the statement (ie, nature) and 64% "against,"which Semple noted suggested that the first speaker, Sadaf Farooqi, MBChB, PhD, "will have her work cut out" to convince the audience that nature is the main driver of obesity.

Farooqui is professor of metabolism and medicine at the University of Cambridge, UK, and was the winner of the 2019 American Diabetes Association Outstanding Scientific Achievement Award.

Farooqi's adversary in the debate was John Wilding, DM, of the University of Liverpool, UK, who Semple described as "similarly formidable."

Farooqi began by saying that the question before the audience is "fundamentally important," and noted that there is plenty of evidence to suggest there is a biological system for regulating body weight.

Experiments have shown that animals and humans maintain a set point for weight that they return to after periods of limited food intake, regardless of how much weight they lose.

Initially, the hypothalamus was found to play a key role in weight regulation, but it was the discovery of leptin that allowed the whole system, with its links to adipose tissue, the pancreas, and the intestines, to be elucidated, she explained.

Work with children then revealed the influence of genetic factors on the body weight "set point."

Identical twins reared apart were found to have a very similar body weight, and adoptive children were shown to have a similar weight to their biologic, rather than adoptive, parents.

Tying these observations to individual or small numbers of genetic variants has, however, proven difficult, beyond the known variants associated with thinness and the rare variants in 15 genes linked to severe obesity.

That is, Farooqi said, until the publication of US research earlier this year testing a polygenic risk predictor involving 2.1 million common variants in more than 300,000 individuals.

The research showed that, across polygenic score deciles, there was a 13-kg gradient in weight and a 25-fold gradient in the risk of severe obesity.

Moreover, another 2019 study, this time by Farooqi's team, revealed some loss of function variants in the melanocortin 4 receptor gene are linked to an increased risk of obesity, type 2 diabetes, and coronary artery disease, and some gain in function variants are linked to a lower risk of obesity and cardiometabolic disorders.

Farooqi believes the reason there is an obesity epidemic is that the physiological system for regulating weight "evolved to stop us starving" but is now faced with "an abundance of food."

The impact of this is all the greater because we live in a "complex food environment," with high sugar and high fat foods that are seen as "very rewarding," as demonstrated on brain scans of people shown pictures of such foods.

Individuals also engage in stress-related eating, which is played out via neural circuits linking the hypothalamus to the limbic system.

She characterized such eating as a "biologically appropriate thing to do because it gives you a rewarding, pleasurable feeling."

She said that, together, this underlines that the "biology of appetite" is a mixture of both innate and learned behaviors.

Farooqi concluded: "I hope I've made the case for you that there is clear, strong, compelling evidence" that weight is regulated by a homeostatic system centered on the hypothalamus, and genetic disorders, tumors, surgery, radiotherapy, and medications can all "perturb" weight regulation.

"In some people, that promotes obesity, in some people it protects them against obesity," she said.

Dr John Wilding

Taking to the podium, Wilding proceeded to present the case for the notion that body weight is determined "by nurture."

He pointed to data from the World Obesity Federation on adult obesity showing that, between the 1960s and 1990s, the prevalence of obesity topped more than 15% in only a few developed countries and no developing nations.

But from 2000 onwards, the situation has completely reversed. At least 15% of the population is obese in most developed countries, rising to over 25% in the United States, Canada, Australia, and the UK, among others. The prevalence of obesity is also rising rapidly in many middle-income countries.

Yet, Wilding pointed out, humanity cannot have evolved genetically to a sufficient extent over that period to account for the change.

He turned to the UK Government's obesity system map, which is a visual representation of the different factors that influence obesity levels.

Although it places physiological energy balance at the heart of the map, and a large part of that is devoted to biologic processes, Wilding highlighted that the visual also places a great degree of emphasis on food production and consumption, societal influences, individual psychology and movement, and the "activity environment."

He also showed data suggesting it is not so much energy and fat intake that is associated with obesity trends as the increase in the number of cars per household and hours spent watching television.

For example, it is estimated that, compared with the 1950s, the average adult now walks, on average, a marathon (approximately 26 miles) less per week, he said.

The Cuban economic crisis of the 1990s also provides an illuminating example, Wilding added.

The sudden end of Soviet subsidies to Cuba led to food shortages, the loss of public and private transport, and the importof 1.5 million bicycles from China.

The subsequent drop in the prevalence of obesity was associated with a reduction in the incidence of diabetes and diabetes-related mortality, with all three increasing substantially once food and transport levels were restored.

Taking a more recent example, Wilding showed longitudinal findings from the HUNT study, which involved almost 119,000 individuals with repeated body mass index (BMI) measurements from 1963, and over 67,000 who were tested for 96 known obesity genes.

The HUNT authors concluded that, although "genetically predisposed people are at greater risk for higher BMI and that genetic predisposition interacts with the obesogenic environment resulting in higher BMI...BMI has increased for both genetically predisposed and nonpredisposed people, implying that the environment remains the main contributor."

Wilding said that, taken together, obesity is "common and increasing almost everywhere," and that the epidemic "is driven by societal change," despite the underlying biology determining an individual's susceptibility.

He ended his pitch to much laughter with a quote by Farooqi from a 2014 review that supports his argument: "Evidence clearly shows that both increases in energy intake and reductions in energy expenditure during physical activity have driven increases in the mean BMI seen in many countries over the past 30years."

Both speakers were then invited back to the podium, allowing Farooqi to respond that, although she did indeed pen that statement in a 2014 review, if one were to look "carefully," the article discussed the last 30 years, and indeed, "our genes haven't changed in that time, but the environment has."

"We agree on that point, and hence my quote," she said, "but what our environment has done is it has unmasked the genetic susceptibility of some individuals, so what we see when we look at the pattern of BMI in the population is that the mean BMI has increased...but also the proportion of people with severe obesity has increased."

She clarified that what this suggests is that, within any population, there are some people who are genetically more susceptible to obesity, so some of those who may not have been obese 30 years ago now are because of the environment.

"It is the environment acting on genetic susceptibility that is contributing to the distribution of BMI," she emphasized.

Wilding again pointed to the HUNT study, which showed that, even in individuals with "thin genes," there has been a rise in mean BMI.

Farooqi said this, in fact, underlines a limitation of that study, which is they only used 96 well-known genetic variants associated with obesity, but the polygenic risk study she highlighted earlier used 2.1 million genetic variants.

Consequently, data from the HUNT study "captures some of the variation but not all," she stressed.

The debate continued, with questions from the floor covering many aspects of obesity.

The final question was directed at Farooqi: "What proportion of somebody's weight is considered to be genetic...as opposed to the nurtured weight?"

She replied this is a "hugely important" question, because "if we don't recognize that theres a biological role for the regulation of weight, how on earth can politicians, with their somewhat different capacity for taking on new information, do that?"

The "evidence suggests around 40% of a person's weight is influenced by genetic factors," she said.

"In some people it's higher, where there are penetrant genes having an effect, in other people it's about 40% with a combination of genes which, added together, influence their risk of either gaining weight or staying thin."

In response, Wilding was keen to stress: "No matter which side of the argument you're on, the point is that this is not the individual's fault."

"It's either a response to their environment...or it's something that they've inherited and don't have individual control over," he noted.

"Sadaf [Farooqi] said it herself, 40% of our body weight is genetic, that means that 60% is environmental, and I rest my case," Wilding said.

However, that did not hold sway with the audience, who, when they voted again at the end of the debate, indicated they had changed their minds: 53% agreed with the statement that nature, not nurture, determines body weight, and 47% disagreed.

A win for the lady, it would seem.

Society for Endocrinology BES 2019. Presented November 11, 2019.

For more diabetes and endocrinology news, follow us on Twitter and Facebook.

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Nature vs Nurture: What's Fueling the Obesity Epidemic? - Medscape

Matthew Breen, a professor of genomics at NCState, says his 25-year career has roots in childhood heartbreak.

When I was young, my family had two dogs die from cancer and there was very little we could do to help them, says Breen. There were great strides being made with human cancer research, so why were we unable to help our animal companions more?

We are committed to making that change happen at NCState, he adds.

Today, the internationally recognized researcher specializes in molecular cytogenetics: the study of the structure and function of cells and chromosomes. His work in the College of Veterinary Medicine is helping our pets live longer, healthier lives and unlocking new insights about human cancers along the way.

Since joining NCStates faculty in 2002, Breen has focused on exploring the genetics and genomics of animal diseases, including how they initiate and respond to treatment.

He was a member of the team that sequenced the canine genome 14 years ago. The project sparked a new area of focus in his field: comparing the canine and human genomes to accelerate discoveries for both.

Humans and their furry friends actually share a very similar genetic makeup. And they share certain types of cancers, too. Many cancers diagnosed in humans and dogs have a similar pathology and clinical presentation, says Breen.

But when it comes to canines, its often easier to pinpoint the genetic abnormalities that lead to those cancers. This is especially the case for purebreds. Dogs of the same breed have less genetic variation among them than humans or mixed-breed dogs, making them an ideal genetic model.

Now, Breens lab works extensively in the area and hes become a pioneer in comparative oncology.

By working with human and animal cancers side by side, we are able to find shared features that may help identify the drivers of these cancers and provide opportunities to highlight targets for new therapies, says Breen.

Take, for example, Breens work with the BRAF gene.

Six years ago, his team discovered that a single mutation in the gene was found in 85% of dogs with transitional cell carcinoma (TCC) also called urothelial carcinoma (UC) which is the most common form of bladder cancer in canines. More than 80,000 dogs in the United States will be affected this year alone.

This particular BRAF mutation was already known to exist in some human cancers, but Breens discovery helped unlock its significance for both species. It also revealed an opportunity to create a much-needed tool to aid diagnosis.

By working with human and animal cancers side by side, we are able to find shared features.

In most cases, canine bladder cancer isnt diagnosed until it has reached an advanced stage. Thats because the cancer shares many clinical signs with other, more common urinary tract conditions.

Treatments for the common alternatives may alleviate symptoms temporarily, but they mask the larger problem and buy the cancer more time to progress. In fact, upon diagnosis, more than half of canine bladder cancer cases have already spread.

Identifying the BRAF mutation as a genetic signature of canine bladder cancer was a powerful insight. From there, Breens team began developing a molecular diagnostics test that could identify the mutation and detect the cancer earlier than ever.

That molecular test called CADET BRAF was developed in Breens research laboratory in 2014. Using a urine sample, the system detects cells that possess the BRAF mutation and can monitor changes in the number of mutated cells being shed during treatment of canine TCC and UC.

CADET BRAF represents the worlds first liquid biopsy for the detection of cancer in veterinary medicine, says Breen.

It offers several improvements over current alternatives. Requiring only a simple free-catch urine sample, CADET BRAF is the only non-invasive approach. Other methods often involve costly procedures, such as sedation or anesthesia, that carry additional risks.

The test can also detect bladder cancer in the early stages of the disease, potentially leading to improved outcomes.

CADET BRAF represents the worlds first liquid biopsy for the detection of cancer in veterinary medicine.

We can detect the cancer in dogs that have already presented with clinical signs and avoid repeated attempts to treat solely the signs, says Breen. That allows more time for the veterinarian and owner to develop a plan to treat the root cause. In addition, we have been able to detect the presence of very early disease, several months before the dog has any clinical signs.

Now we have to determine how to manage these preclinical patients, and that is part of ongoing work by our team at NCStates College of Veterinary Medicine, he adds.

The test is also dependable. After rigorous validation of thousands of dogs, Breen says hes found that the presence of the BRAF mutation in canine urine is a highly reliable indicator of the presence of TCC/UC. Weve shown the BRAF mutation isnt found in the urine of healthy dogs or dogs that have other common conditions such as bladder polyps, inflammation or chronic cystitis, he says.

In the two years following the development of CADET BRAF, Breen focused on developing a strong proof of concept. Teaming up with the American Kennel Club, he recruited urine samples from hundreds of dogs to show that the approach could work with real patients.

His next step was commercialization. Breens startup, Sentinel Biomedical, was formed in 2015. Located right on NCStates campus, the company works to develop and scale diagnostic tests for the health care industry.

Since its formation, theyve developed another product called CADET BRAF-PLUS. The test is designed for dogs who dont have the BRAF mutation but do show clinical signs of TCC/UC. It can detect over two-thirds of bladder cancer cases not identified by CADET BRAF, increasing the overall detection sensitivity of the tests to over 95%.

Headquartered right on NCStates campus, Sentinel Biomedical seeks to improve diagnosis and treatment for dogs and their owners.

Find out more

Whats next for Sentinel Biomedical? It recently announced a joint venture with Antech Diagnostics, part of MARS. Together theyve formed Antech Molecular Innovations, also based on NCStates Centennial Campus, and work to broaden access to CADET BRAF and CADET BRAF-PLUS.

With the distribution channels of one of the worlds largest animal health providers, we are providing veterinarians with easy access to the tests we develop and enhancing our ability to become a global leader in innovation for veterinary molecular diagnostics, says Breen. And because our work is translational, we also have greater potential to translate our findings to humans.

This will bring the innovations developed at NCState to a whole new level.

Today, the National Cancer Institute spends $6 billion on cancer research annually, and its estimated that less than 0.5% is directed toward veterinary oncology. But Breen sees his innovations and those of his colleagues across the nation as promising steps in the right direction.

Currently, hes involved in a clinical study in the College of Veterinary Medicine that will evaluate the timeline between when a BRAF mutation is detected in a dogs urine and when that dog begins to show clinical signs of TCC/UC. Breen hopes this knowledge will lead to earlier intervention, improved quality of life and increased survival rates.

This will bring the innovations developed at NCState to a whole new level.

Recent collaborations with colleagues at Duke Cancer Institute are also exploring the genetic and environmental factors shared between canine and human bladder cancers. A study proposed by this multidisciplinary team was awarded funding from the V Foundation for Cancer Research in 2019. Such comparative oncology studies, Breen says, have the potential to realize the true value that dogs can bring to our fight against cancer.

Through Antech Molecular Innovations, Sentinel Biomedical has begun pursuing more projects to provide rapid, accessible molecular diagnostics for a variety of cancers that impact our pets and ourselves.

For now, Breen is excited to see his work take on a wider reach. These cancer detection tests will help a new generation of canine companions and their human friends (maybe even kids who are experiencing what Breen did as a child). Whats more, the increased volumes of data theyll collect may unlock insights that lead to the development of new treatment opportunities for cancers in both species.

Although we may not be able to help all dogs with cancer today, we are driven to learn from their cancers to help the dogs of tomorrow, and the families who care for them, says Breen.

Link:
Sniffing Out Cancer in Canines And Humans, Too - NC State News

A rare genetic disorder caused three siblings' blood to flood with fat and turn "milky" white, according to a new report of the unusual case.

The three siblings consisted of one set of fraternal twins (a daughter and son) and an older son, all born to a first-cousin couple in a Pennsylvania Dutch family. In their teens and early 20s, all three siblings experienced mysterious symptoms, including bouts of abdominal pain. They had all been diagnosed with hypertriglyceridemia, a fairly common disorder that causes fatty molecules called triglycerides to build up in the blood.

Now in their 50s, the siblings recently underwent genetic testing and learned that they have a condition that's much more rare, affecting only 1 in every million people, according to the case report, published today (Nov. 18) in the journal Annals of Internal Medicine.

Those with the ultrarare disorder, known as familial chylomicronemia syndrome (FCS), may accumulate more than 1,000 milligrams of triglycerides per deciliter (mg/dL) of blood. For comparison, normal blood levels of the fat should fall below 150 mg/dL, and 500 mg/dL would be considered "very high" in a healthy person, according to the National Institutes of Health.

Indeed, in people with FCS, blood fat levels are so high that the normally crimson fluid turns the color of milk. (FCS is not the only condition that can cause milk-colored blood; the symptom may also appear in people with severe hypertriglyceridemia.)

Related: The Color of Blood: Here Are Nature's Reddest Reds (Photos)

The three siblings had long struggled to keep their triglyceride levels under control and suffered frequent inflammation of the pancreas, also known as pancreatitis a serious condition that can cause abdominal pain, fever and vomiting. At the hospital, the male twin's triglyceride levels reached as high as 5,000 mg/dL, while the other brother's levels peaked at around 6,000 mg/dL. The female twin's triglyceride levels soared highest of all, reaching 7,200 mg/dL at maximum.

The siblings hoped their doctors could help subdue those aggressive symptoms.

To confirm the sibling's rare diagnosis, the doctors looked to their patients' genes. Triglycerides typically build up in the blood due to multiple malfunctioning genes and other related health conditions, such as diabetes or high-blood pressure, according to the Journal of the American Board of Family Medicine. But when doctors probed the siblings' genetic code, the researchers spotted only one mutated gene that was key for breaking down triglycerides in the body.

In healthy people, the gene contains instructions to build a protein called lipoprotein lipase (LPL), which typically coats the blood vessels that run through muscles and fatty tissues in the body, according to the Genetics Home Reference. LPL breaks down fats carried in the blood; without an adequate supply, the siblings' blood plasma ran thick with excess triglycerides.

Related: How to Speak Genetics: A Glossary

Each sibling carried two copies of the mutated LPL gene, meaning both their parents passed down the mutated genetic code to the children, the case report noted. What's more, the particular genetic mutation in the siblings had never been seen before, the authors said. The doctors placed the siblings on a fat-restricted diet, which successfully stabilized their triglyceride levels and quelled their bouts of pancreatitis. Sometimes, when triglyceride levels spike, doctors must manually replace the fat-filled blood of their patients with healthy blood from donors, Live Science previously reported. Thankfully, the siblings' condition could be curtained with diet alone.

Originally published on Live Science.

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A Rare Genetic Disorder Turned These Siblings' Blood 'Milky' White - Livescience.com

Nov. 21, 2019

WASHINGTON Medicine regulatory authorities including the U.S. Food and Drug Administration (FDA) should strengthen cooperation with other countries regulators to ensure the quality, safety, and efficacy of medicines, says a new report from the National Academies of Sciences, Engineering, and Medicine. Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators contains recommendations to promote information sharing among RAs with the aim of protecting public health, ensuring faster access to critical medicines, and encouraging innovation in medicine and technology.

Today, drug development is increasingly global. An estimated 40 percent of medicines and 80 percent of active pharmaceutical ingredients used by Americans are made overseas. Different countries have different rules, regulations, and standards for the review and approval of new medicines. However, they are often unable to share inspection reports and other critical safety information with each other, because such reports are heavily redacted to protect trade secrets and other confidential information.

No regulator has all the human and technical resources it needs to meet all of its public health responsibilities, especially as their workloads increase due to the growing complexity of medicines; societal expectations for faster drug approvals; and the rising demand for inspections of manufacturing facilities overseas. Reliance and recognition arrangements enable regulators to share information and increase the transparency of each others activities; to optimize limited human and financial resources; to build expertise in specialized and emerging regulatory areas (such as gene therapies and biosimilars); and to mobilize resources in the event of a drug shortage or public health emergency.

Reliance is when a regulatory authority considers anothers work (such as inspection and scientific assessment reports) to inform its own regulatory decisions. Recognition the highest level of which is a mutual recognition agreement (MRA) is when a regulator not only relies on the work of another regulator, but also accepts and adopts the other regulators decisions. Smaller and under-resourced regulators often enter these arrangements with better-resourced countries to strengthen their capacity. However, it is up to the countrys regulatory authority to decide whether to approve a medicine. Entering one of these arrangements does not mean giving up decision-making responsibilities, the report says.

In order for regulatory authorities to build upon and enter new recognition and reliance arrangements, impediments to information sharing should be removed. Medicine regulatory authorities should consider sharing full, unredacted reports to help countries make better-informed, sovereign decisions about the approval of medicines, the report says. In addition, the FDA and Congress should re-evaluate such confidentiality restrictions and ensure that current redaction practices promote information sharing while protecting personal data.

The report identifies several potential public health benefits of reliance and recognition arrangements. These arrangements could allow for patients and consumers to gain faster access to quality medicines. For example, following the Zika outbreak of 2016, the World Health Organization (WHO) encouraged reliance as a way to expedite market access to tests, vaccines, and treatments for priority diseases. In the aftermath of Hurricane Maria in Puerto Rico a pharmaceutical manufacturing hub the use of reliance arrangements would have allowed regulators to share information to assess alternative manufacturing sites.

Greater cooperation between national regulators could help identify substandard or falsified medicines before they are approved or exported, says the report. It could also prevent duplicative activities, such as multiple RAs inspecting the same low-risk manufacturing site, which diverts time and resources from more urgent inspections as well as other regulatory priorities.

Many industries such as banking and telecommunication operate seamlessly across national borders. Todays medicines are global commodities, so the regulation of medicines should function just as seamlessly, said Alastair Wood, emeritus professor of medicine and pharmacology at Vanderbilt University, who chaired the committee that wrote the report. Regulatory authorities need to be able to use the best science, the best expertise, and the best resources to make informed decisions to protect the health of millions of people.

Improve the Design of Mutual Recognition Agreements The report outlines a stakeholder-driven strategy to improve cooperation and collaboration among regulators, which includes:

Respond to Evolving Science and Technology Formal MRAs are not currently agile enough to respond to rapid changes in science and technology, or to public health emergencies. Regulatory authorities should consider potential areas for scope exploration of both formal recognition agreements such as MRAs and less formal reliance arrangements (e.g., collaborative activities) including: guidelines for reliable and high-quality laboratory data, guidance for studies involving human subjects, and guidance for the manufacturing, production, and distribution of medicines.

Expand the Scope of the European Union (EU)-U.S. MRA Currently, the EU-U.S. MRA only applies to manufacturing site inspections. The EU-U.S. MRA should be expanded to include reliance in additional areas and for a broader range of medicine types, the report recommends. In addition, the provisions in the MRA for inspections that the FDA and European Medicines Agency conduct outside of the U.S. and EU (third country inspections) should be implemented immediately.

Formally Evaluate the Public Health Impacts of Reliance and Recognition Arrangements Most reliance and recognition arrangements do not explicitly call for evaluation of public health benefits, and there is a lack of data on their successes and challenges. Regulatory authorities should create a results framework with clear indicators, metrics, and processes for monitoring and evaluating recognition and reliance arrangements, the report recommends. This would increase understanding of their public health benefits, and enable benefit-risk and cost-benefit analysis over time.

The study undertaken by the Committee on Mutual Recognition Agreements and Reliance in the Regulation of Medicines was sponsored by the U.S. Food and Drug Administrations Office of Global Policy and Strategy.

The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.

Resources:RecommendationsReport Highlights

Contact:Stephanie Miceli, Media Relations OfficerOffice of News and Public Information202-334-2138; e-mail news@nas.edu

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To Improve Public Health, Medicine Regulators Worldwide Should Collaborate, Remove Barriers to Sharing Information, Says New Report - National...

Growing up in Tanzania, I knew that fruit trees were useful. Climbing a mango tree to pick a fruit was a common thing to do when I was hungry, even though at times there were unintended consequences. My failure to resist consuming unripened fruit, for example, caused my stomach to hurt. With such incidents becoming frequent, it was helpful to learn from my mother that consuming the leaves of a particular plant helped alleviate my stomach pain.

This lesson helped me appreciate the medicinal value of plants. However, I also witnessed my family and neighboring farmers clearing the land by slashing and burning unwanted trees and shrubs, seemingly unaware of their medicinal value, to create space for food crops.

But this lack of appreciation for the medicinal value of plants extends beyond my childhood community. As fires continue to burn in the Amazon and land is cleared for agriculture, most of the concerns have focused on the drop in global oxygen production if swaths of the forests disappear. But Im also worried about the loss of potential medicines that are plentiful in forests and have not yet been discovered. Plants and humans also share many genes, so it may be possible to test various medicines in plants, providing a new strategy for drug testing.

As a plant physiologist, I am interested in plant biodiversity because of the potential to develop more resilient and nutritious crops. I am also interested in plant biodiversity because of its contribution to human health. About 80% of the world population relies on compounds derived from plants for medicines to treat various ailments, such as malaria and cancer, and to suppress pain.

Future medicines may come from plants

One of the greatest challenges in fighting diseases is the emergence of drug resistance that renders treatment ineffective. Physicians have observed drug resistance in the fight against malaria, cancer, tuberculosis and fungal infections. It is likely that drug resistance will emerge with other diseases, forcing researchers to find new medicines.

Plants are a rich source of new and diverse compounds that may prove to have medicinal properties or serve as building blocks for new drugs. And, as tropical rainforests are the largest reservoir of diverse species of plants, preserving biodiversity in tropical forests is important to ensure the supply of medicines of the future.

Plants and new cholesterol-lowering medicines

The goal of my own research is to understand how plants control the production of biochemical compounds called sterols. Humans produce one sterol, called cholesterol, which has functions including formation of testosterone and progesterone - hormones essential for normal body function. By contrast, plants produce a diverse array of sterols, including sitosterol, stigmasterol, campesterol, and cholesterol. These sterols are used for plant growth and defense against stress but also serve as precursors to medicinal compounds such as those found in the Indian Ayurvedic medicinal plant, ashwagandha.

Humans produce cholesterol through a string of genes, and some of these genes produce proteins that are the target of medicines for treating high cholesterol. Plants also use this collection of genes to make their sterols. In fact, the sterol production systems in plants and humans are so similar that medicines used to treat high cholesterol in people also block sterol production in plant cells.

I am fascinated by the similarities between how humans and plants manufacture sterols, because identifying new medicines that block sterol production in plants might lead to medicines to treat high cholesterol in humans.

New medicines for chronic and pandemic diseases

An example of a gene with medical implications that is present in both plants and humans is NPC1, which controls the transport of cholesterol. However, the protein made by the NPC1 gene is also the doorway through which the Ebola virus infects cells. Since plants contain NPC1 genes, they represent potential systems for developing and testing new medicines to block Ebola.

This will involve identifying new chemical compounds that interfere with plant NPC1. This can be done by extracting chemical compounds from plants and testing whether they can effectively prevent the Ebola virus from infecting cells.

There are many conditions that might benefit from plant research, including high cholesterol, cancer and even infectious diseases such as Ebola, all of which have significant global impact. To treat high cholesterol, medicines called statins are used. Statins may also help to fight cancer. However, not all patients tolerate statins, which means that alternative therapies must be developed.

Tropical rainforests are medicine reservoirs

The need for new medicines to combat heart disease and cancer is dire. A rich and diverse source of chemicals can be found in natural plant products. With knowledge of genes and enzymes that make medicinal compounds in native plant species, scientists can apply genetic engineering approaches to increase their production in a sustainable manner.

Tropical rainforests house vast biodiversity of plants, but this diversity faces significant threat from human activity.

To help students in my genetics and biotechnology class appreciate the value of plants in medical research, I refer to findings from my research on plant sterols. My goal is to help them recognize that many cellular processes are similar between plants and humans. My hope is that, by learning that plants and animals share similar genes and metabolic pathways with health implications, my students will value plants as a source of medicines and become advocates for preservation of plant biodiversity.

[ Expertise in your inbox. Sign up for The Conversations newsletter and get a digest of academic takes on todays news, every day. ]

Walter Suza, Adjunct Assistant Professor of Agronomy, Iowa State University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Image: Reuters

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The Medicine Plant That Could Have Changed the World. - The National Interest Online

At the start of this decade, the federal government called out consumer DNA testing as a burgeoning scam industry. Little did we know how it would explode in popularity.

In 2010, the U.S. Government Accountability Office (GAO) published an investigative report that bashed consumer DNA test companies for misleading the public. It accused them of deceptively claiming their products could predict the odds of developing more than a dozen medical conditions; some even went as far to offer equally dubious dietary supplements. The report had followed a similar lambasting of the industry by the GAO in 2006.

Also in 2010, the FDA publicly warned 23andMe and other companies that genetic health tests were considered medical devices and needed to be cleared by the FDA before they could be sold to the public. Three years later, following a lack of response from 23andMe, the agency took the harsh step of temporarily banning 23andMe from selling its health-related tests at all.

Despite these hurdles, the DNA testing industry has nonetheless exploded. According to a report by MIT Technology Review this February, more than 26 million people have had their DNA tested by the biggest names in the industry, with AncestryDNA, 23andMe, and MyHeritage being the top three.

Consumer DNA testing is undoubtedly now mainstreambut its not much less scammy than it was when the decade started.

The industry has existed since the late 1990s. But in 2007, the new kid on the block, 23andMe, became the first company to offer a particular kind of at-home DNA test that was cheap, easy to use, and promised to track back your origins further back than ever before.

23andMes testsand eventually those of its competitorssearch for and analyze the most common genetic variations, called single nucleotide polymorphisms (SNPs), in our autosomal DNA, the 22 of 23 pairs of chromosomes not used to determine sex. For as little as $99 and a spit sample, these SNP-based tests are advertised to determine a persons ancestry or genetic health risks. But much of this realm of consumer DNA testing, as the GAO report showed, can uncharitably be described as complete bullshit.

The crux of the problem is that our genetics are only a piece of the puzzle that influences our health. Sure, you can sometimes point to a specific gene mutation that always makes someone sick in a specific way if they carry it. But much more often, its a complex, barely understood mix of gene variants that predispose us to develop cancer or heart diseaseand that risk can be amplified or muted by our environment (including the crucial months we spend in the womb).

In the earliest days, companies didnt much care for this complexity, using weak evidence to make sweeping health claims about which genes ought to make you more of a fish eater or develop diabetes.

Following the FDAs ban in 2013, 23andMe spent the next two years devising genetic health tests that wouldnt overpromise. In 2015, it was allowed to sell tests that told people if they carried a recessive mutation for genetic conditions like Bloom syndrome and sickle-cell disease. A positive test meant their children would have a 25 percent chance of having the condition if both parents were carriers. Two years later, it became the first company with FDA-approved tests that were allowed to tell people about their risk of developing one of 10 diseases or conditions, such as late-onset Alzheimers or celiac disease.

23andMes return to the health side of things wasnt the only fuse that lit a fire under the consumer DNA industrythe tens of millions in annual advertising now being spent by companies like MyAncestry certainly helped, too. But regardless, the FDAs approval of these tests signaled a new opening in the industry. And unsurprisingly, the industry as a whole has ballooned, as has the glut of scammy services on offer.

Many of these companies now steer clear of making blanket health claims, but it doesnt make them any less laughable. Your DNA results can apparently tell you whether youve found your romantic match, how to be good at soccer, and, like a decade ago, how to find the perfect diet and avoid bloating. Just dont pay attention to the studies showing that theres no consistent link between genes seemingly tied to our nutrition and any actual diet-related conditions.

Its not only the tests vaguely connected to our health that are the problem. As Gizmodo once illustrated, even relying on these DNA tests to figure out your ancestry is a dicey proposition. At best, youre roughly estimating where your recent ancestors lived, but that estimate can vary widely depending on which company does the testing, thanks to the different algorithms they use. And the farther away your lineage is from Europe, the less accurate these tests will be for you, thanks to the fact that the algorithmsas well as the research linking genes to our healthare largely based on the DNA of white Americans and Europeans.

Health and ancestry aside, sharing your DNA with the outside world can have unintended consequences. Law enforcement agencies are now using genealogy databases to solve criminal cases, by connecting anonymous crime scene DNA to DNA submitted to these family tree companies, working backward through distant relatives to identify their suspect. And while some people may be fine with this genetic sleuthing, there are no clear rules on how this data can be used by law enforcementtheres merely the promise by private companies that they will share responsibly. This November, police in Florida obtained a warrant to search through a third-party genealogy database, months after the service had enforced a new opt-in policy meant to let users decide if they wanted their data to be searchable by police in these cases.

At a certain point, it wont even matter whether youve decided to share your DNA. A study last October estimated that once enough peoples DNA is in a databasea scant 2 to 3 percent of any given populationanyone could conceivably track the identity of every person in that population using the same techniques genetic detectives are using now. And researchers have already demonstrated how less scrupulous forces, including hackers, could actively manipulate these databases.

None of this is meant to diminish the real potential of genetics as a field of research and medicine, nor the progress that has been made over the past decade.

Companies like 23andMe rely on detecting thousands of genetic markers still only a tiny slice of our DNA. But the technology that allows a persons entire genome to be sequenced has vastly improved, scaling down its costs and upkeep over the past decade. These techniques can scan a persons whole genome as well as the smaller part of the genome that codes for the proteins our bodys cells make, called the exome.

In 2010, for instance, the company Illumina initially offered its whole genome sequencing at $50,000 a person; this year, Veritas dropped the price of its service to only $600 and says it may soon charge as little as $100.

These innovations have led to large-scale research projects that collect genetic data from hundreds of thousands of people at once. Scientists can scour through these large datasets to find new links between our genes, traits, and medical conditions. This research has helped us better understand longstanding questions about our biology and health. Someday soon, genetic sequencing may also help us optimize the existing medical treatments people get, particularly for conditions like cancer.

Right now, though, its still up in the air how useful this info dump really is to the average person looking to stay healthy.

In March, 23andMe debuted (or more accurately, reintroduced) a service that tells people about their genetic risk of type 2 diabetes. Unlike the tests approved by the FDA, it relies on whats known as a polygenic risk score. This adds up the very small contribution of many genetic markers to a particular condition, which combined might be enough to nudge your overall risk upwards.

The trouble is that these markers have little to do with why you get type 2 diabetesyour age or weight play a much bigger role. And even if the test does consider you genetically unlucky (an average risk difference of 5 percent from a typical person), the advice youll get is the same that anyone hoping for a long, healthy life would get: eat more vegetables and exercise more. This test, as well as many of those offered by the hundreds of big and small DNA testing companies on the market, illustrates the uncertainty of personalized consumer genetics.

The bet that companies like 23andMe are making is that they can untangle this mess and translate their results back to people in a way that wont cross the line into deceptive marketing while still convincing their customers they truly matter. Other companies have teamed up with outside labs and doctors to look over customers genes and have hired genetic counselors to go over their results, which might place them on safer legal and medical ground. But it still raises the question of whether people will benefit from the information they get. And because our knowledge of the relationship between genes and health is constantly changing, its very much possible the DNA test you take in 2020 will tell you a totally different story by 2030.

Given how popular at-home DNA testing has become, theres really no sealing the genie back in the bottle. So if you want to get your genetic horoscope read this holiday, dont let me stop you. But its a big decision you should sleep on. After all, once your DNA is out there, theres no going back.

Link:
Consumer DNA Testing May Be the Biggest Health Scam of the Decade - Gizmodo