- Video Games
Three-year outcomes from an ongoing clinical trial suggest that high-dose immunosuppressive therapy followed by transplantation of a person's own blood-forming stem cells may induce sustained remission in some people with relapsing-remitting multiple sclerosis (RRMS).
RRMS is the most common form of MS, a progressive autoimmune disease in which the immune system attacks the brain and spinal cord. The trial is funded by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and conducted by the NIAID-funded Immune Tolerance Network (ITN) .
Three years after the treatment, called high-dose immunosuppressive therapy and autologous hematopoietic cell transplant or HDIT/HCT, nearly 80 percent of trial participants had survived without experiencing an increase in disability, a relapse of MS symptoms or new brain lesions. Investigators observed few serious early complications or unexpected side effects, although many participants experienced expected side effects of high-dose immunosuppression, including infections and gastrointestinal problems. The three-year findings are published in the Dec. 29, 2014, online issue of JAMA Neurology.
“These promising results support the need for future studies to further evaluate the benefits and risks of HDIT/HCT and directly compare this treatment strategy to current MS therapies,” said NIAID Director Anthony S. Fauci, M.D. “If the findings from this study are confirmed, HDIT/HCT may become a potential therapeutic option for people with this often-debilitating disease, particularly those who have not been helped by standard treatments.”
Scientists estimate that MS affects more than 2.3 million people worldwide. Symptoms can vary widely and may include disturbances in speech, vision and movement. Most people with MS are diagnosed with RRMS, which is characterized by periods of relapse or flare up of symptoms followed by periods of recovery or remission. Over years, the disease can worsen and shift to a more progressive form.
In the study, researchers tested the effectiveness of HDIT/HCT in 25 volunteers with RRMS who had relapsed and experienced worsened neurological disability while taking standard medications. Doctors collected blood-forming stem cells from participants and then gave them high-dose chemotherapy to destroy their immune systems. The doctors returned the stem cells to the participants to rebuild and reset their immune systems.
“Notably, participants did not receive any MS drugs after transplant, yet most remained in remission after three years,” said Daniel Rotrosen, M.D., director of NIAID’s Division of Allergy, Immunology and Transplantation. “In contrast, other studies have shown that the best alternative MS treatments induce much shorter remissions and require long-term use of immunosuppressive drugs that can cause serious side effects.”
The study researchers plan to follow participants for a total of five years, recording all side effects associated with the treatment. Final results from this and similar studies promise to help inform the design of larger trials to further evaluate HDIT/HCT in people with MS.
The work was sponsored by NIAID, NIH, and conducted by the ITN (contract number N01 AI015416) and NIAID-funded statistical and clinical coordinating centers (contract numbers HHSN272200800029C and HHSN272200900057C). The ClinicalTrials.gov identifier for the study High-Dose Immunosuppression and Autologous Transplantation for Multiple Sclerosis (HALT-MS) is NCT00288626.
NIAID conducts and supports research — at NIH, throughout the United States, and worldwide — to study the causes of infectious and immune-mediated diseases, and to develop better means of preventing, diagnosing and treating these illnesses. News releases, fact sheets and other NIAID-related materials are available on the NIAID Web site athttp://www.niaid.nih.gov.
About the National Institutes of Health (NIH): NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit www.nih.gov.
by Jodi Parsley, Lawrence Co. Circuit Court Clerk
This time of year, most of us are busy buying gifts, making plans, and celebrating with family. Two years ago, Kenedy Maze and her family were just trying to make it through the holidays alive. Kenedy, of Fleming County, Kentucky, was missing a lot. She missed her friends because she was not allowed to go to school due to the advancing Cystic Fibrosis (CF) disease taking over her lungs. She missed being able to run and play because she was now tethered to 6 liters of oxygen just to breathe. She missed her sister, Kaylee, who lost her fight against CF in 2007.
In January 2013, Kenedy and her mother left family and friends to move to their transplant hospital St. Louis because Kenedy was getting so sick. “When I hear of someone talk about registering as an organ donor, I hear them talking about a hero,” Kenedy has said.
During the holidays, many of us wish to give back, but we struggle to find the time and means to do so. This Christmas, there is something everyone can do that costs nothing, takes less than a minute, and helps children like Kenedy. Joining the Kentucky Organ Donor Registry gives hope to thousands of children, adults, and their families.
“Although we may not be able to save their life today, we are able to give them hope simply by registering,” explains Lawrence Circuit Clerk, Jodi Parsley. “There are over 124,000 patients waiting for a lifesaving organ transplant this Christmas. Each day, 21 of those patients will lose their fight, and their life, waiting.”
The Kentucky Circuit Court Clerks’ Trust For Life works to educate Kentucky about the vital mission of organ donation and encourage everyone to be hope for patients in need.
“As your Circuit Court Clerk, I’ve been involved with our Trust For Life for many years. My staff and I ask every person obtaining a license or ID if they would like to donate $1 to raise awareness about this lifesaving mission. We are also required to ask everyone to join the Kentucky Organ Donor Registry. It only takes a moment to say ‘yes’ and be hope,” says Parsley.
Everyone, regardless of medical history or age can join the Kentucky Organ Donor Registry simply by saying “yes” while renewing a driver’s license or going online to www.donatelifeky.org.
“We feel honored to give everyone the opportunity to be hope and save lives - in a quick and simple way - every day. Thanks to the kindness of this community and the dedication of my hardworking staff, many of you have already joined the Registry over the years. However, the need is still there. Only 45% of Kentuckians are registered donors. Everyone, regardless of medical history, can join the Registry to give hope to those waiting today. It’s easy. Do you have questions about organ donation? You can call 1-866-945-5433 and talk to Shelley at the Trust For Life,” explains Parsley.
Kenedy received her Gift of Life in April 2013 after several months on the Waiting List. “Kenedy’s lung transplant is still proving to be a success. Her lung functions are at 98%, and she is living life. Cystic fibrosis (CF) has stopped her from doing so much, but she is showing CF that she is stronger. Her Sophomore year of high school has been exciting,” explains Kenedy’s mom, Sandra Maze. Kenedy adds how grateful she is for her second chance at life, “I have chosen to live my life not only for myself, but for my organ donor. I am living because of organ donation.”
Enclosed is a photo of Kenedy heading to her Sophomore Winter Formal last month.
Kentucky Department for Public Health (DPH) officials reported to the Centers for Disease Control and Prevention (CDC) this week that the influenza (flu) activity level in the state has increased from “regional” to “widespread.” Widespread activity is the highest level of flu activity, which indicates increased flu-like activity or flu outbreaks in at least half of the regions in the state. The activity levels for states are tracked weekly as part of the CDC’s national flu surveillance system.
"With current widespread flu activity being reported in Kentucky and National Influenza Week still ongoing, now is a good time to protect yourself and your family by putting a flu shot on your holiday to do list," said Dr. Stephanie Mayfield, commissioner of DPH. “As the holidays approach, people will be traveling and families will gather together, increasing the potential for exposure to the flu. We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”
National Influenza Vaccination Week began Dec. 7 and will run through Dec. 13, coinciding with the holiday season to help reduce the spread of illness as Kentuckians gather for shopping, travel and holiday parties and family events.Flu vaccinations are widely available at local health departments, provider offices, local clinics and pharmacies. Many health plans cover the cost of the vaccine.Public health officials emphasized that it isn’t too late for the vaccine to be effective. The flu season can begin as early as October and last through May.
The holiday season is still a good time to get vaccinated against the flu because it takes about two weeks for immunity to develop and offer protection against flu. However, vaccination can be given any time during the flu season, and this year there is a plentiful vaccine supply.
The CDC’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals 6 months of age and older. People who are especially encouraged to receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:• Children ages 6 months to 19 years;• Pregnant women;• People 50 years old or older;• People of any age with chronic health problems;• People who live in nursing homes and other long-term care facilities;• Health care workers;•Caregivers of or people who live with a person at high risk for complications from the flu; and•Out-of-home caregivers of or people who live with children less than 6 months old.
Kentuckians should receive a new flu vaccination each season for optimal protection. Healthy, non-pregnant people ages 2 through 49 can be vaccinated with either the flu shot or the nasal vaccine spray. Children younger than 9 years old who did not receive a previous seasonal flu vaccination should receive a second dose at least four weeks after their first vaccination.
Infection with the flu virus can cause fever, headache, cough, sore throat, runny nose, sneezing and body aches. Flu is a very contagious disease caused by the flu virus, which spreads from person to person.
Approximately 23,000 deaths due to seasonal flu and its complications occur on average each year in the U.S., according to recently updated estimates from the CDC. However, actual numbers of deaths vary from year to year.
The Centers for Disease Control and Prevention released information last week that some of the nation’s circulating influenza A (H3N2) type viruses, the most common so far, may not be covered well by this year’s vaccine. This situation is not unusual. It is challenging to anticipate the strains that will circulate during the season since flu vaccine is made months before the season begins. Despite the possibility of a poor vaccine match for one of the circulating strains, vaccination still provides the best protection against influenza. The vaccine appears to be a good match for many of the strains which are being transmitted and because of antibody cross-protection should help to reduce hospitalizations and deaths, even in persons who may contract the mismatched strain of influenza.
In addition to flu vaccine, DPH strongly encourages all adults 65 years and older and others in high risk groups to ask their health care provider about the pneumococcal vaccines. These vaccines can help prevent a type of pneumonia, one of the flu’s most serious and potentially deadly complications. The CDC now recommends that adults 65 years or older receive the pneumococcal conjugate vaccine (PCV13, Prevnar-13) in addition to the pneumococcal polysaccharide vaccine (PPSV23, PNEUMOVAX-23). Getting both vaccines offers the best protection against pneumococcal disease. Between 3,000 and 49,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older.
For more information on influenza or the availability of flu vaccine, please contact your local health department or visit http://healthalerts.ky.gov.
Though marijuana is the most commonly used illegal drug in the country, little is definitively known about its impact on the brain.
A study taking place at Indiana University in Bloomington is designed to help change that.
Clinical psychologist Brian O'Donnell and colleague Sharlene Newman are recruiting current and former marijuana users to participate in a study in which their brains will be analyzed for changes in structure and function.
"From animal studies, there's reason to believe it (marijuana use) will affect parts of the brain and also the connections between them, and some of our preliminary studies suggest that is the case," said O'Donnell, a professor in the Department of Psychological and Brain Sciences.
The study — funded by a $275,000 grant from the National Institutes of Health — is taking place as marijuana is gaining more acceptance in some parts of the country. For example, marijuana has been legalized for adult use in such places as Colorado, Washington state, Alaska and Oregon, and many states now have medical marijuana programs, according to the National Conference of State Legislatures.
"It's being decriminalized, but without knowledge of really its long-term effects on brain structure or function," O'Donnell said. People who choose to use marijuana need to know "what aspects of physical or mental function it might affect."
Recreational use of marijuana is illegal in both Indiana and Kentucky, but Gov. Steve Beshear signed a bill into law in April, allowing limited prescribing of cannabidiol, a marijuana derivative. The product, sometimes called cannabis oil, has shown promise in treating children who have epileptic seizures, said Van Ingram, director of Kentucky's Office of Drug Control Policy. In general, efforts to legalize medical marijuana in Kentucky have failed.
The IU researchers — who will use magnetic resonance imaging (MRI) techniques to conduct the study — are recruiting 90 people, ages 18-35, to participate in their research. Along with current and past users of marijuana, the study, which is one of the first of its type, will include people who've never used the drug.
"We're comparing the subjects in the different groups," said Newman, who's an associate professor and the director of IU's Brain Imaging Facility. "... The group that's never used marijuana is our baseline group."
The users will go through drug screening to verify that they aren't taking other drugs. "We want to study the effects of marijuana, not the effects of marijuana plus cocaine or marijuana plus a lot of alcohol," O'Donnell said.
Former marijuana users are being studied because it's possible that "smoking cannabis causes problems in the brain in terms of structure or in terms of function, but maybe, people recover after they stop using it for a little while," he said.
Study participants will undergo a series of brain scans so that the research team can do connectivity analysis.
"Connectivity analysis tells us something about the efficiency of the communication between brain regions," Newman said in an email. "I like to think of the brain as an electrical circuit. If the insulation on the wires is not intact, you can get current leakage resulting in faulty communication. ... If the connections between brain regions are faulty, then the functioning of the brain will be faulty/inconsistent. With the MRI techniques we will use, we will be able to examine the integrity of the insulation."
Prior to brain scanning, participants will undergo tests of perception, thinking and memory and take a questionnaire about problems they may be having, such as strange hallucinations, O'Donnell said.
In a previous study, the researchers found that connectivity in the brain was altered in cannabis users in a way that seemed to make the brain less efficient, he said.
O'Donnell noted that people who smoke a lot of marijuana in adolescence are at increased risk later in life of developing schizophrenia. But "we don't know whether marijuana smoking causes that. It might be that people who are becoming mentally ill tend to smoke marijuana," he said. In the new study, the research team will explore whether people who smoke more marijuana over their lives experience more symptoms that are similar to schizophrenics'.
"I think there's a big lack of knowledge about how marijuana might affect the brain and importantly, whether those changes last a long time or not," O'Donnell said. One thing that will be looked at is "whether people who started use earlier in life, say as middle-schoolers, show more problems with mental health or cognition than those who maybe started in college."
According to the National Institute on Drug Abuse, negative effects of marijuana include altered perceptions and mood, impaired coordination, difficulty with thinking and problem-solving, disrupted learning and memory, and impact on brain development. Marijuana also may affect cardiopulmonary health, according to the institute.
But "what most people don't know is that there hasn't been a lot of research focusing on marijuana — up until very recently in fact — at least (as) to how it affects the brain," said Dr. Francesca Filbey, an associate professor in the School of Behavioral and Brain Sciences at the University of Texas at Dallas.
"There's been a lot more attention toward alcohol, nicotine and other illicit drugs like cocaine," said Filbey, director of cognitive neuroscience research in addictive disorders at the Center for BrainHealth at UT Dallas. Also, the approaches have varied across studies and the findings have been inconsistent, she noted.
Filbey is the lead author of a recently published study that is similar to the research underway at IU. She and other researchers studied 48 chronic marijuana users and found that they had reduced gray matter volume in the orbitofrontal cortex, a part of the brain associated with addiction, decision-making, inhibition and adaptive learning. However, there was increased connectivity, which suggests that the brain may be able to compensate for that, Filbey said. But it's unclear how the changes that were noted affect marijuana users' behavior, and the researchers didn't find a correlation with users' IQ.
Filbey noted that those who started using marijuana earlier in life had greater abnormalities in the brain.
It's important to learn more about marijuana's impact on the body because changes in legislation suggest that more people in the United States will be using the drug, and existing studies "have suggested there are effects on the brain, but what's most important is that these effects are particularly detrimental when use is initiated during adolescence," Filbey said.
By Darla Carter
HEALTH INSURANCE OPTIONS FOR KENTUCKY RESIDENTS
Open Enrollment starts November 15, 2014 thru February 15, 2015
Do you need help in looking at the options available?
Don’t know where to start or don’t have access to the internet?
WE CAN HELP
Northeast KY Community Action Agency is offering FREE assistance to anyone interested in reviewing the health insurance options available through the Kentucky Health Benefit Exchange. No income limits apply to receive our assistance. Call one of our local offices for an appointment.
Boyd Raymond Graeves 606-225-7418
Carter Charity Brown 606-225-7419
Elliott Dawnita Lewis 606-225-7420
Greenup Tammy Moore 606-225-7421
Lawrence Mary Roberts 606-225-7422
This free service is available through:
Northeast Kentucky Community Action Agency
21039 W US 60
Olive Hill KY 41164