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Space Nerd Alert: Very Bright Pass of International Space Station Over Perth Tonight – So Perth (blog)
Posted: June 30, 2017 at 4:52 pm
A very bright International Space Station will pass over Perth and South-West Western Australia tonight just after 6pm.
If you look up and the sky is clear as forecast, Perths 2 million inhabitants will be able to view the ISS for around 6-minutes, as it passes from north-west to south-est.
If you look up around 6.04pm youll see it appear to the north-west of the city, as it travels over the Indian Ocean.
By 6.07pm the ISS will be directly over Perth city, with a -3.2 magnitude brightness, meaning the Space Station will be quite clearly visible.
The ISS has been circling our planet for nearly 20-years, but rarely does it pass right over the city at such a convenient time for us.
We were alerted to the Passover by Space enthusiast Ingnazio Magnani, who is often confused by media as an actual ISS astronaut.
When, where and what are we looking at?
Look up at 6.04pm (maybe go outside a few minutes earlier to adjust your eyes)
Look about 10 degrees above the horizon to the north-west, itll appear to be moving at speed toward Perth, flying over about 50km to the north-east of the Perth CBD at 6.07pm, at 75 degrees above the horizon.
The Passover should be visible right up to 6.10pm as the ISS moves to the SE.
Live Video: ISS over the Earth HD Video Viewing Experiment
Perth from Space
What Perth looks like from the ISS while it passes over Perth. Photo from NASA taken by Astronauts in the ISS. Western Australia as seen from Space
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Toddler’s Hair Stands Up Like Troll Doll Thanks To Rare Genetic Condition – HuffPost
Posted: at 4:50 pm
A 21-month-old girl in North Carolina is turning heads thanks to her unusual hair.
Phoebe Brasswell, of Smithfield, was born with a rare genetic condition that makes her locks always look as if theyve just been hit with static electricity.
The condition, uncombable hair syndrome, causes her hair follicles to be kidney-shaped instead of round. It also affects the hairs protein, which gives it shape, according to Inside Edition.
As a result, Phoebes hair is fine, coarse, constantly tangled and constantly staticky, according to SWNS.com.
SWNScom
Phoebe is one of only around 100 children worldwide with the condition, according toProfessor Regina Betz, who researches UHS at the Institute for Human Genetics at the University of Bonn, Germany.
Betz told SWNS, There may be many more which have not been reported.
Some believe Albert Einstein may have had the condition. [ADD LINK]
Phoebes mom, Jamie, said no haircare products seem to work on her daughters hair, but she loves it anyway.
Every morning it is sticking straight up and throughout the day, she told SWNS.com. I try and spray stuff in it to keep it down, but within 30 minutes its spiky again.
Jamie Brasswell has nicknamed her little girl, Poppy, after a character in the movie Trolls, according to Inside Edition.
SWNS
Still, people unfamiliar with the condition arent shy about making suggestions to Phoebes mom when they are in public.
We were in the grocery store once and a lady said, She is going to hate you when she looks at her baby photos because you let her go out in public like that, Jamie told SWNS.com.People say, You should brush it better. Why dont you put it in a ponytail? But that hurts her.
Jamie has tried to minimize those comments by having Phoebe wear a headband when out in public.
SWNS
Although Phoebes hair sticks out in a crowd and pretty much everywhere else doctors expect it will become more manageable when she reaches puberty.
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Toddler's Hair Stands Up Like Troll Doll Thanks To Rare Genetic Condition - HuffPost
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Timing of mutation determines the outcome – Medical Xpress
Posted: at 4:50 pm
June 30, 2017
A single genetic mutation can lead to completely different diseases, depending on the time and location at which the mutation occurs. This finding emerged from the PhD study conducted by Rocio Acua-Hidalgo of Radboudumc. For example, a mutation in the SETBP1 gene that occurs early in development leads to Schinzel-Giedion syndrome, but later in life it results in myeloid leukemia. "Determining the timing of mutation is crucial for its interpretation and for providing careful genetic counseling," explained Acua-Hidalgo.
Our inherited characteristics are recorded in our DNA. Children receive half of their DNA from the sperm cell of the father, and the other half from the egg cell of the mother. But during life, mutations also occur in the DNA, resulting in new genetic characteristics. These characteristics can be beneficial, neutral or pathogenic. Known as de novo mutations, these changes can take place during the formation of sperm and egg cells, resulting in a mutation in all cells throughout the body. But mutations can also occur later in development, resulting in their presence in only part of the body.
Intellectual disability and cancer
Acua-Hidalgo studied the timing of de novo mutations and their effect on health and disease. She performed the study in a group of patients with the rare Schinzel-Giedion syndrome. This developmental disorder, which is associated with intellectual disability, is the result of a mutation in the SETBP1 gene during the development of sperm or egg cells. The mutation leads to a surplus of SETBP-1 protein, which disturbs neurological development. But this protein accumulation is also seen in patients with leukemia who do not have this syndrome. In this group, the mutation occurred later in life.
Timing of mutations
Acua Hidalgo: "We see that malignant tumors result from very severe mutations in SETBP1, while children with Schinzel-Giedion syndrome have milder mutations in the same gene and occasionally develop cancer. Other xamples of syndromes that are associated with an increased risk of cancer are also known. A mutation that occurs at birth can have multiple consequences later in life. A malfunctioning gene can appear in various organs and at different times during development."
Mixed blood
Acua Hidalgo also looked at mutations in blood-forming stem cells. Because these stem cells transmit the mutation to the blood cells they form, the amount of mutated blood increases gradually with age: "Previously, we could detect mutations if these occurred in at least 4% of the blood cells. But with Next Generation Sequencing we can now identify mutations that occur in only 0.5% of the blood cells." In a study led by Alexander Hoischen, which is published in the American Journal of Human Genetics on June 29, Acua-Hidalgo estimates that approximately two out of ten people between the age of 60 and 70 have blood with a genetically mixed composition. For people older than 70, this percentage is even higher. This is twice as much as previously assumed: "This is a universal phenomenon. The idea that every cell in our body is genetically identical is simply not true."
Small risk of cancer
"We see that our somatic cells accumulate mutations during our lifespan. This is an important step in the development of diseases of aging and cancer. However, it is important to realize that the development of a disease such as leukemia from this mutation takes a long time. If you examine the blood carefully, you can find potentially precancerous cells. But there are so many steps between these precancerous stages and actual cancer that only a few people go through the entire process. Only 0.5% to 1% of people with these mutations actually develop cancer."
Population studies
Acua-Hidalgo's findings are important for genetic population studies: "With large-scale population studies, we often look for genetic deviations in the blood. But we now understand that many mutations occur in blood. This makes it difficult to interpret such genetic deviations. Does the mutation occur throughout the body, or only in mutated blood stem cells? It is important to use multiple sources for genetic research, especially with the elderly." Alexander Hoischen adds: "Our study highlights the accuracy with which we can detect somatic mutations; this is of particular interest as a very recent study by scientists from the U.S. have shown that these types of mutations may give an increased risk for coronary artery disease and myocardial infarction."
Explore further: Skin disease caused by sperm cell transmission of keratin mutation
More information: Rocio Acuna-Hidalgo et al. Ultra-sensitive Sequencing Identifies High Prevalence of Clonal Hematopoiesis-Associated Mutations throughout Adult Life, The American Journal of Human Genetics (2017). DOI: 10.1016/j.ajhg.2017.05.013
Journal reference: American Journal of Human Genetics
Provided by: Radboud University Nijmegen Medical Centre
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Timing of mutation determines the outcome - Medical Xpress
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From Chelsea Manning’s DNA Springs an Art Show – New York Times
Posted: at 4:50 pm
The 3D-printed portraits, titled Probably Chelsea, will hang on fishing line from a dropped ceiling in the center of the gallery. The gallerys director, Iliya Fridman, said, The Probably Chelseas will be in a lot of different places on the gender and race spectrum. It really demonstrates that there are so many elements of DNA that are common to humans.
The show isnt supposed to be about WikiLeaks, Mr. Fridman said, but sometimes the political parallel is too powerful to resist. A super-powerful dynamic happening here is that the freedom one could gain by defining ones own DNA in a variety of ways is really metaphorical to the freedom the entire country could gain from releasing secret data, Mr. Fridman said.
Mr. Fridman said the show would also feature images from a graphic short story illustrated by Shoili Kanungo, Suppressed Images, that recounts the collaboration between Ms. Manning and Ms. Dewey-Hagborg. The story ends with an image of Ms. Manning going to a gallery after her release.
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From Chelsea Manning's DNA Springs an Art Show - New York Times
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CRISPR Platform Scans DNA to Predict Off-Target Effects – Genetic Engineering & Biotechnology News (press release)
Posted: at 4:50 pm
If youre reworking a genome, you might want to heed the old saying, Measure twice, cut once. Otherwise, your attempts to right the genome or modify it for special purposes could end in genomic wrongsoff-target effects. For example, the popular gene-editing tool known as CRISPR could go astray, altering genes other than the ones it was meant to alter. If only CRISPRs potential slips could be foreseen! Then, perhaps, they could be avoided, and CRISPR would realize its potential not only in research, but also in medicine.
Scientists from The University of Texas at Austin took an important step toward safer gene-editing cures for life-threatening disorders, from cancer to HIV to Huntington's disease, by developing CHAMP, which stands for chip-hybridized association-mapping platform. It repurposes next-generation sequencing chips to enable the massively parallel profiling of proteinnucleic acid interactions.
The scientists used CHAMP to provide the first comprehensive survey of DNA recognition by a type I-E CRISPR-Cas (Cascade) complex and Cas3 nuclease. CHAMP, the scientists showed, was able to simultaneously measure the interactions between proteins and 107 unique DNA sequences.
Additional details appeared June 29 in the journal Cell, in an article entitled, Massively Parallel Biophysical Analysis of CRISPR-Cas Complexes on Next Generation Sequencing Chips. These details suggest that CHAMP provides a framework for high-throughput, quantitative analysis of proteinDNA interactions on synthetic and genomic DNA.
Analysis of mutated target sequences and human genomic DNA reveal that Cascade recognizes an extended protospacer adjacent motif (PAM), the articles authors wrote. Cascade recognizes DNA with a surprising 3-nt [nucleotide] periodicity. The identity of the PAM and the PAM-proximal nucleotides control Cas3 recruitment by releasing the Cse1 subunit.
Essentially, these findings led to a model for the biophysical constraints governing off-target DNA binding. This model, for example, suggests that Cascade pays less attention to every third letter in a DNA sequence than to the others.
"So, if it were looking for the word 'shirt' and instead found the word 'short,' it might be fine with that," explained Stephen Jones, Ph.D., a postdoctoral researcher at UT Austin and one of three co-lead authors of the Cell paper.
Knowing such rules could lead to better computer models for predicting which DNA segments a specific CRISPR molecule is likely to interact with. And that can save time and money in developing personalized gene therapies.
"You and I differ in about 1 million spots in our genetic code," said Ilya Finkelstein, Ph.D., an assistant professor in the department of molecular biosciences at UT Austin and the project's principal investigator. "Because of this genetic diversity, human gene editing will always be a custom-tailored therapy."
The researchers took a DIY approach to developing the equipment and software for their technique, using existing laboratory technology. The heart of the test is a standard next-generation genome sequencing chip already widely used in research and medicine. Two other key elementsdesigns for a 3D printed mount that holds the chip under a microscope and software the team developed for analyzing the resultsare open source. As a result, other researchers can easily replicate the technique in experiments involving CRISPR.
"Next-generation genome sequencing was invented to read genomes, but here we've turned the technology on its head to allow us to characterize how CRISPR interacts with genomes," noted Andy Ellington, Ph.D., a professor in the department of molecular biosciences, vp for research of the Applied Research Laboratories at UT Austin, and a co-author of the paper.
"If we're going to use CRISPR to improve peoples' health, we need to make sure we minimize collateral damage, commented Dr. Jones. And this work shows a way to do that."
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CRISPR Platform Scans DNA to Predict Off-Target Effects - Genetic Engineering & Biotechnology News (press release)
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Cisco faces challenges in building DNA network management center – TechTarget
Posted: at 4:50 pm
LAS VEGAS, Nev. -- Cisco has entered the nascent market for intent-based networking systems with a grand vision of leading customers to a new era of network management. But realizing that vision will depend on whether Cisco can successfully integrate complex products and build effective support operations.
Cisco launched its intent-based networking system (IBNS) June 20 with the unveiling of the Digital Network Architecture (DNA) Center, the software console for creating and deploying configuration policies for a new line of campus switches called the Catalyst 9000s. This week, at its Cisco Live user conference, the company dedicated a considerable amount of time educating its customers on the use and capabilities of the modernized campus network infrastructure.
In general, an IBNS replaces manual configuration of switches, firewalls and other infrastructure components. On switches, it means a network operator no longer has to make configuration changes through the command-line interface (CLI) of each piece of equipment. Today, roughly 75% of organizations manage network infrastructure manually, according to Gartner.
Having a network management center that executes policy-based configurations makes a company's network more agile because changes can be made quickly based on the demands of business operations. Also, an intent-based networking system solves the leading cause of network outages -- misconfigurations and errors on the part of network operators.
Cisco has told customers that DNA Center will eventually become the central console for an intent-based networking system that touches the entire enterprise WAN, including data center, campus and cloud. For that to happen, however, a lot of other Cisco products will have to be integrated into DNA Center.
Those products include the Tetration network analytics engine, CloudCenter, which lets companies manage applications running on multiple clouds, and the Application Policy Infrastructure Controller (APIC) that is the heart of Cisco's software-defined networking (SDN) system for the data center.
"Until [DNA Center] is integrated with those solutions, it's not a single pane of glass," said Brandon Carroll, the CEO of IT training company Global Config Technology Solutions Inc.
One area analysts will watch closely is how well Cisco can incorporate analytics to help customers do network monitoring, troubleshooting and identify threats through DNA network management center. Good analytics can also help customers create the most effective policies.
"Analytics is one of the most daunting pieces and one of the most challenging pieces and also one of the most important ones," said Brad Casemore, an analyst at IDC.
Beyond technology, Cisco also has business challenges. For example, the company will have to provide a way for customers to transition from old switches to the new gear that supports DNA Center. Today, the software communicates to the Catalyst 9000s through significant changes in IOS, the network operating system in the switches. Older Catalysts either wont work or will only support a limited number of the DNA Centers capabilities.
[For now] you still have that underlying infrastructure that you have to manage thats not part of the overall solution, Carroll said. Thats going to be the hardest part getting older equipment out [of customers environments] and the newer equipment in.
Also, each business unit responsible for selling a product that will go into DNAs network management center has to learn to work together in preparing the technology for testing through Ciscos online simulation platform, called the Virtual Internet Routing Lab.
We see little bits of them not getting along when you look at the VIRL product, Carroll said. There are a lot of other Cisco products that could be in VIRL if the business units work together to get their products into that solution.
Cisco has time to work out the kinks. Customers got technical details on the DNA network management center and related products for the first time at Cisco Live. Also, intent-based networking, in general, is just beginning to emerge, so no vendor has all the technology needed for a WAN deployment. Other vendors providing some form of intent-based networking include Apstra, Forward Networks, Veriflow and Waltz Networks. Industry experts expect Juniper Networks Ciscos largest competitor in the space to launch an IBNS soon.
The concepts behind intent-based networking have been around for more than a dozen years. Analysts are optimistic that current products are mature enough to start gaining traction in the market. Gartner estimates the number of companies with the technology in production will grow from fewer than 15 today to more than 1,000 by 2020.
Gartner lists four capabilities for a system to qualify as intent-based.
First, the user has to be able to create a high-level business policy that the product converts into network configurations. The system also has to be able to tell the user the potential impact of the changes before they are deployed;
An IBNS carries some risks, according to Gartner. These include the reliability of the algorithms that power the software. No one can say for sure how well they will work across all enterprise networks.
Other risks include the immaturity of many of the vendors in the market and whether typically conservative network operators will embrace the technology, particularly if early implementations result in high-profile failures.
Key features of a unified network management tool
Network functions virtualization requires a new network management model
The ABCs of unified network management
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Cisco faces challenges in building DNA network management center - TechTarget
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Li Ching-Yuen, The Man Who Lived For 256 Years- Hoax Or Reality? – PagalParrot
Posted: at 4:49 pm
In modern times, this is one of the most unusual and unbelievable cases of the human longevity.Chinese resident Li Ching-Yuen is believed to have lived for over 190 years or for 256 years. Yes, it seems impossible but there are still some unofficial data which stated some of the unproven facts about Li Ching-Yuen.
Source:India.com
Li Ching-Yuen was a martial artist and Chinese herbalist claimed to be born in either 1677 or 1736 (his true date of birth was never known) according to some US newspaper. He was a resident of Kaihsien, in the Province of Szechwan.
A professor from theMinkuo University said that he had evidencewhich showed that Li was in fact born in 1677. According to the article which was published in 1933 in The New York Times, and was later reported by Snopes, the Imperial Chinese Government congratulated him on his 150th and200th birthdays.
Li had learned the secret of living from a warlord namedWu Pei-fu. Li advised one of his classmates to keep a quiet heart, sit like a tortoise, walk sprightly like a pigeon and sleep like a dog. Li reportedly married 24 times and had 200 children.
Source: Youtube
No one will ever know how exactly old Li Ching-Yuen was at the time of his death. Also, experts are not sure about the authenticity of the documents which are in the support of the story. The question remains as it is- the story is Hoax or Reality?
Jeanne Louise Calment was a French woman who lived for 122 years, which is officially recorded. She has thelongest confirmed human lifespanon record.
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Li Ching-Yuen, The Man Who Lived For 256 Years- Hoax Or Reality? - PagalParrot
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Some scientists think there’s no upper limit on ageing. Let’s hope they’re wrong – The Guardian
Posted: at 4:49 pm
The post-bingo exchange of a bunch of geriatric amateurs may seem an act of trespass, but if anyone is a specialist in ageing, it is the aged themselves. We have life cred. Photograph: Christopher Thomond for the Guardian
A hundred and ruddy 20 within 30 years, thats what theyre saying just imagine, being 50 again after all, we are simply material cells ah, but what about the mind?
A post-bingo conversation with some of my crumbly friends in the community centre. We are discussing the new prospect of amortality. It has created a major row among academics, with the publication of a paper by Jan Vijg, an eminent geneticist, suggesting there is an upper limit of around 115 years before we shuffle off this mortal coil being vigorously challenged by Professor Jim Vaupel, a specialist in ageing, and colleagues, who maintain there is no ceiling on longevity.
So the post-bingo exchange of a bunch of geriatric amateurs may seem an act of trespass on bio-techie turf. However, what the learned men in the ivory towers observe is daily experience among us crumbling edifices. What they talk, we walk. If anyone is a specialist in ageing, it is the aged themselves. We have life cred.
Yet amortality is the current cherry on the scientific cake. From the beginning of human time, death has defined human life. Now science has achieved a degree of biological understanding and technological capacity that allows it to hold out the possibility of making lifetimes infinite. Man has become a god.
The basic creed of amortalist theology seems to be that all our organs are simply machines that, like car parts, start to malfunction with use and age, and that, to continue the analogy, can be either repaired or replaced. The idea is that we report in every few years for a service that not only keeps the motor running but, with progress, will positively enhance its performance. This proposal offers a socio-political vindication with an ethical twist. Its exponents cite the right to life clause in international charters, leading to the conclusion that death is therefore a crime against humanity.
Ageing is an issue on which, as a member of the crumbly generation, I feel I can comment with authority. Not only am I old, I also spend a day a week working with people with early-onset dementia. From my perspective, the amortality proposal is the product of academic hubris. It does not factor in the reality of longevity.
That reality is that the body is the least of our worries. It is all in the mind. And, as Noah Yuval Harari and many other experts insist, we simply do not understand the mind. But we do know the consequences of its decline. As the cells misfire, the chemicals unbalance, the synapses disconnect, we are losing our mental faculties along with our keys, spectacles, directions. We are demoralised as our cognitive triggers fail and we alienate neighbours and confuse friends with our social dyspraxia. These memento moris of growing frailty are reinforced by increasingly frequent attendance at the interment or combustion of erstwhile companions. This marble deficit further humiliates us as citizens, unable to separate the ideological wheat from the factional chaff.
The prospect of another 20 years or more of this appals me and my geriatric companions. For the vast majority of us, our aspiration is for a dignified culmination that will impose the minimum burden and distress on our friends and families. We are all too aware of the strain that we put on society through our increasing dependence on medical resources. We are conscious of the calls we make on our own elderly children, who too often are torn between us and their own grandchildren.
Amortalists' theology is that organs are like car parts that, when they malfunction, can be either repaired or replaced
Indeed it goes further; as a community worker, I am witness to the exhaustion of our childrens generation in their 60s; they used to be the material that maintained the social fabric, as trustees, administrators, facilitators of the third sector, of the myriad small voluntary groups, the Rotaries, Lions, the Akelas. Now they have neither the time nor energy to repair its cloth due to their extended family and work commitments.
On a personal level, longevity has become a pre-traumatic stress disorder, but at its core, it is a social and ethical issue. It is already creating massive intergenerational conflict. I am in the way of the young. I block the doorway, obstruct the pavement, hold up queues, cause tailbacks, block beds. I am becoming a waste of space a space that is already crowded enough without adding yet another generation to it. Longevity has transformed the human paradigm and our inherited moral compass is not fit for purpose in this new ocean.
From my personal experience of pre-early-onset dementia, and my communion with those who suffer the real thing, I would appeal to the scientific elite to stop squabbling over the medical equivalent of angels on pinheads and to use their privileged talents to attend to the real needs of the elderly. We need purpose not redundancy, meaning not irrelevance, dignity not distress. In other words, we simply want to lead better lives, not longer ones.
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Some scientists think there's no upper limit on ageing. Let's hope they're wrong - The Guardian
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Could humans live forever one day? A new study says it may be possible – Fox News
Posted: at 4:49 pm
Good news for those making plans for their 110th birthday: The human lifespan is perhaps far more robust than previously thought. The Guardian reports that new research disputes a high-profile claim last year that the human lifespan has maxed out at 114.9 years.
In an extraordinary scientific feud, five research teams banded together to trash that conclusion, publishing their findings in the journal Nature, which is where the original study appeared.
Author Jim Vaupel, a specialist in aging at the Max Planck Institute for Demographic Research in Germany, tells the paper there's no evidence for an upper limit on human longevity.
And if there were, he adds, "it is above 120, perhaps much aboveand perhaps there is not a limit at all." Vaupel calls the original study led by geneticist Jan Vijg of the Albert Einstein College of Medicine in New York "the worst piece of research I've ever read" in Nature, adding that he was "outraged" that the journal would publish "such a travesty." Vijg, who's standing his ground, had used existing data to show that after a period of steadily rising longevity, humans appeared to hit a ceiling of 115 in the mid-'90s.
But the new papers pooh-pooh the plateau prediction and, in a sci-fi twist, suggest humans could be blowing out 150 candles by the year 2300. Vijg suggests his nitpicky critics didn't read his work properly, and perhaps have issues with their own mortality.
"When you look at these super-old people, there are not many of them," he says. "That's kind of the point, isn't it?" (A rare aging disease killed the 2nd oldest patient to have it.)
This article originally appeared on Newser: Human Life May Have No Limit
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Could humans live forever one day? A new study says it may be possible - Fox News
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Progress On Psoriasis, From ‘Last In Line’ To Often First, But At A Price – WBUR
Posted: at 4:48 pm
wbur Narrating Medicine A new category of drugs, biologics, inhibits elements of the immune system that fuel inflammation. Humira is an example of a biologic. (David J. Phillip/AP)
My body is a walking encyclopedia covering 40 years of psoriasis treatments.
I've had hundreds of cortisone injections shot into my scalp, arms and legs. Thick black tar applied to my head so it could be absorbed into the scaly red plaques that surfaced when my condition flared. Salicylic acid shampoos that stunk like hot asphalt. Light box treatments. Methotrexate and cyclosporine, immune system suppressants prescribed variously for cancers, rheumatoid arthritis and organ transplant recipients.
And still, it was there. Always, or nearly always. The inflamed, flaking, cracking skin. Wavy ridges in my fingernails. Hundreds of hours spent in dermatology offices. Thousands of attempts to hide painful, embarrassing skin patches that would appear on elbows, knees, scalp and other surprising places when I was under stress, on a deadline, or for no obvious reason at all.
I am not alone. Last year, the World Health Organizations Global Report on Psoriasis called the disease a "serious global problem with at least 100 million individuals affected worldwide." That includes more than 7 million Americans. We are legion. With lesions.
Psoriasis is a mystery, a disease of the immune system with no clear cause or cure. For years, traditional medications that were developed initially for arthritis, Crohn's disease or other immune conditions eventually dropped down the pharmaceutical food chain to psoriasis patients.
Lately, though, that landscape has been shifting, with the advent of a new category of drugs: biologics, genetically engineered proteins derived from human genes. Usually injections that a patient administers at home, they inhibit elements of the immune system that fuel inflammation.
Humira, Enbrel and Cosentyx are examples of biologics. And a recent paper in The Lancet shows promise for a new biologic called tildrakizumab. Designed primarily for psoriasis, it may ultimately have additional applications.
Tildrakizumab differs from earlier, similar biologics by targeting a very specific immune system pathway.
"The breakthrough is that we have continued to refine our treatments to those that are likely to be most effective against psoriasis but less likely to affect other important pathways at the same time," says study senior author Dr. Alexa Kimball, a dermatologist and presidentof Harvard Medical Faculty Physicians at Beth Israel Deaconess Medical Center in Boston.
From Accidental Findings To'First In Line'
Psoriasis treatments have mostly been accidental discoveries, Kimball said.
Occasionally, a psoriasis patient who needed an organ transplant would end up being treated with cyclosporine, and it was amazing how a drug like that cleared the skin, sheexplained. And so there was this sort of accidental-incidental way that early psoriasis treatments were discovered.
Treatment evolved with those incidental discoveries, including traditional medications such as cortisone and cyclosporine, which are still prescribed frequently for mild to moderate psoriasis.
The first generation of biologics to treat psoriasis entered the market in the early 2000s. They have fewer side effects than traditional medications (the cyclosporine Im currently taking can impact liver and kidney function), are generally well tolerated, and the majority of patients don't mind injecting themselves.
But they still carry the risks of immune suppression, including reactivation of tuberculosis, and increased susceptibility to viral infections and certain cancers.
Immune proteins evolved to protect us from infection, explained immunologist Dr. Sarah Gaffen of the University of Pittsburgh. So when you start blocking them, youre going to raise the specter of some sort of infectious disease.
The good news is that highly focused drugs, like tildrakizumab, do mean greater improvement on psoriasis symptoms with far fewer side effects. Gaffen refers to the targeted nature of biologics as exquisitely specific.
And because psoriasis isnt a life or death matter, patients who are enrolled in research protocols can also be put on placebos with limited risk to their overall health. Thats not an option with arthritis or Crohns disease, where irreversible harm might be done without ongoing treatment. And, as Kimball added, The results are right in front of your face with psoriasis. You can see such a dramatic improvement.
More good news: In drug development these days, psoriasis has been gaining traction as a proof of principle disease, according to Kimball. If a medication did well on psoriasis, it was pretty likely to do well in other [immune] areas.
"The paradigm has completely switched," she added. "Psoriasis was last in line 10 or 15 years ago. Now its often first.
High Hopes, High Prices
Now for the not-so-good news, long familiar to anyone who takes biologics: the price tags.
While tildrakizumab isnt yet on the market, other biologics are, and I was recently introduced to the challenge of acquiring them.
I was having a severe psoriasis flare. Red, cracked, inflamed skin, so painful it was difficult to bend my arms or sit. My dermatologist prescribed Humira.
The prescription was filled before my insurance company had a chance to determine coverage. I asked the pharmacist how much the medication would cost if I paid out of pocket.
She looked at the computer screen, and then at me. Then again at the computer. I raised my eyebrows.
Do you want to guess? she asked me.
$600, I ventured.
She shook her head.
$6,000?
She shook her head again. I shrugged. She paused. $30,000.
$30,000? I repeated. I might as well buy a car.
You should, she said. Because thats not even for the whole year.
Kimball confirmed the cost. Usually we expect these drugs at list prices to run around $50,000 a year. They are very expensive drugs, she said.
Needless to say, I postponed the Humira. I may start on it this fall, when it's fully covered.
In 2016, Humira grossed over $16 billion, putting it in first place for the best-selling drug of the year, according to Genetic Engineering & Biotechnology News, a trade publication.
According to the WHO report, treatments for psoriasis around the world --whether simple creams or complex biologics --are either unavailable or are not reimbursed for the majority of patients. And its hard to imagine anyone paying $50,000 to Walgreens out of a checking account.
Yet biologics offer the greatest advances yet in treating immune-regulated diseases. And tildrakizumab, while developed for moderate to severe psoriasis, may be one that also holds the potential to benefit other diseases in the future.
I hope those of us who need it will have access. Kimball recognizes this hurdle: "Figuring out how to get this right," she said, "so we ensure access to the patients who need these medications, is one of the things that absolutely keeps me up at night."
Beth Jones is a Boston-based writer and educator.
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Progress On Psoriasis, From 'Last In Line' To Often First, But At A Price - WBUR
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