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Archive for the ‘Oncology’ Category

n of 1 medicine

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The history of modern medicine begins around late 18th century with Edward Jenner’s discovery of smallpox vaccine and Humphrey Davy’s discovery of nitrous oxide, whose anesthetic properties proved very useful for making surgeries painless. Since then medicine has made tremendous strides in eradicating major diseases like smallpox, polio, malaria, cholera, and tuberculosis, in most parts of the world. Indeed, the list is long and impressive. Because of these advances, mortality rates have gone down significantly across the globe with a concomitant increase in life expectancy.

Western or allopathic medicine,  as currently practiced, treats the average. This approach has been very effective in treating a wide range of conditions – from the common cold to heart attacks, provided the underlying medical condition or disease has a common physiological basis that is broadly applicable across the entire human population. But, over the years, the field of medicine has discovered there are numerous diseases that have a genetic basis – examples include cancer, diabetes, cardiovascular, and others such as Tay-Sachs disease, sickle cell anemia, which have an even more specific pedigree. These diseases have yet to be corralled and contained.  Recent advances in microbiology have spawned the -omics revolution: microbiomics, proteomics, genomics, metabolomics, to name a few. In an earlier post – the dawn of omics ,  I had tried to captured some of the excitement surrounding these emerging fields of study.

Numerous articles, on these topics, continue to be written in the popular press. Recently, microbes made the cover page of the Economist and the attendant articles can be found here- Microbes maketh the man ; Me,myself, us. The upshot is we have symbiotic partnerships with multiple strains of bacteria that make their home in different nook and crannies of the body.  Here are some specific examples (quoted from the article) on how these microbiomes help us “….The microbiome does many jobs in exchange for the raw materials and shelter its host provides. One is to feed people more than 10% of their daily calories. These are derived from plant carbohydrates that human enzymes are unable to break down. And not just plant carbohydrates. Mother’s milk contains carbohydrates called glycans which human enzymes cannot digest, but bacterial ones can….”

Disturbing this ecosystem results in a myriad of consequences. So,  “…these links are most visible when they go wrong. A disrupted microbiome has been associated with a lengthening list of problems: obesity and its opposite, malnutrition; diabetes (both type-1 and type-2); atherosclerosis and heart disease; multiple sclerosis; asthma and eczema; liver disease; numerous diseases of the intestines, including bowel cancer; and autism….” Probiotic foods then are supposedly targeted at restoring the balance…” If you missed it, yes, autism is on this list !!

The other branch of -omics that has gained a lot of currency in the media is genomics. The holy grail for these practitioners – $1000 genome (to sequence, that is). Matthew Herper of Forbes has put together a nice summary article( The Gene Machine) on the most recent developments in gene sequencing. One of the characters he mentions is Jonathan Rothberg, probably the reigning rockstar of this industry, for having invented among other things, the Personal Genome Machine (the article has more specifics). But the point here is gene sequencing has moved from the purview of giant labs to your desktop! Also, the turn around times for having a genome sequenced, for a panel of genes, have come down dramatically. Because of these advances, places like Baylor College of Medicine, MD Anderson and others are undertaking vigorous research efforts to understand and actively treat various cancers.

I was lucky enough to attend a few sessions over two days at the ION World 2012 conference where Rothberg and other luminaries gave keynote speeches. It was really exciting to hear these folks talk of the coming revolution in medicine. This is when I first heard the phrase “n of 1 medicine”.  N of 1 (or personalized medicine)  refers to the practice of medicine based on an individual’s “omic profile” as opposed to the traditional approach of medicine, which is based on the average profile (derived from large populations).

Clearly, we are witnessing medicine’s new frontier. For me, and I am sure for many others, the view from this frontier is breathtaking. Of course, there is a lot of hype surrounding all this. But discounting the hype, there is significant and steady progress being made through multidisciplinary collaborative efforts (cloud computing, bioinformatics, semiconductor technologies, and fundamental science). As of now, next generation sequencing (NGS) efforts are primarily focused on building the tools that allow us to ask the basic questions and get answers in the shortest possible time. Once past this, we will need to focus on translating the science into clinical practice. Because of its very nature, n of 1 medicine may require a throwback to the old fashioned pharmacies where your medication will be mixed in real time based on personalized omit profiling.

Opportunities, to participate in this revolution, abound.

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Written by asterix98

September 30, 2012 at 2:49 am

eat me protein

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Cancer patients the world over take heart. We  may be on the cusp of a seminal breakthrough in cancer research and treatment. A few days ago, researchers from Stanford University reported that they have discovered a protein in abundance, on the surface of cancer cells. What is remarkable about this protein (calreticulin) is that it signals the immune system to engulf them and destroy them (hence the name “eat me” cells). But cancer cells also have a second molecule, CD47, which signals “don’t eat me”. Macrophages do not destroy cancer cells because CD47 counteracts Calreticulin.

In normal cells, Calreticulin is expressed when the cell is damaged, thus allowing the macrophages  to clean them up.

The same researchers found in a previous study that CD47 antibodies were very effective in curing leukemia and other cancers induced in mice, without affecting normal cells (ie., no side effects)!!

The thinking here is that by blocking the CD47, the eat me signal is stronger in the cancer cells, allowing the macrophages to clean up.

Key developments in cell biology related to this research can be found in this article

Apopstosis:eating sensibly

 

 

 

 

 

 

Written by asterix98

December 27, 2010 at 11:15 pm

Posted in cancer, Oncology

Emperor of all maladies

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Book Review : The Emperor of all Maladies

To use a contemporary metaphor, Cancer is the Voldemort of diseases, what with it vast array of Horcruxes and Death Eaters. Mukherjee’s narrative is lyrical, the language exquisite (here is a sample sentence from the book “..The gibbet and the graveyard – the convenience stores for the medieval anatomist-… “.) What an image! It is also a tale of innovation, creativity, serendipity, passion, and motivation on the part of a few key individuals driven to make a difference, where breaking the rules to advance the status quo is the norm.

Most of you know I lost my wife to this dreaded disease. I had been looking for such a book since her diagnosis and could’nt find one. I wish we had it then. Nevertheless, as Mukherjee traces the history, it is heartening to note that the fight to conquer this disease has made slow but steady progress. I hope, as many of you out there, as possible, can read this tour de force of science writing.

Much awareness raising is required for the more lethal forms (pancreatic cancer and metastatic melanoma, to name a couple). I hope after reading this book you are spurred into action to support the Harry Potter oncologists of the world in their fight to rid the earth of this dreadful malady.

This book is a keeper.Buy it, gift it, spread the word.

Written by asterix98

December 8, 2010 at 7:20 am

Biography of cancer

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Cancer is a topic near and dear to my heart, so I am now hypertuned to this topic. I came across a book called the “Emperor of all Maladies” by Dr.Siddharatha Mukherjee. It turned out that the author was on NPR’s Fresh Air a couple of days ago.

http://www.npr.org/2010/11/17/131382460/an-oncologist-writes-a-biography-of-cancer

It is a fascinating interview. I highly recommend it. I have reproduced below a partial transcript (full transcript –http://www.npr.org/templates/transcript/transcript.php?storyId=131382460).

ROSS: Is our genetic system programmed to get cancer?

Dr. MUKHERJEE: Well, you know, it’s always hard to answer questions which are -which speculate about evolution, but this much is for sure: The very genes that allow cells to proliferate, to survive, to move, to adapt to circumstances, to resist poisons, those very genes, when they become corrupted, are genes that are co-opted by cancer cells to become cancer.

So there is of course a deep link, and as the book suggests, if there’s a seminal discovery in oncology in the last 20 years, it’s exactly that. It’s the idea that cancer genes are often, this is not always true, but are often mutated versions of normal genes. And that moment, the arrival of that moment really chilled the world of cancer biology. The book describes that moment. It really sent a kind of a chill down the spine of cancer biology. Because here we were hoping that cancer would turn out to be some exogenous event, a virus or something that could be then removed from our environment or removed from our bodies and therefore we would be rid of it.

But the idea that cancer genes are sitting inside each and every one of our chromosomes, just waiting to be corrupted or inactivated and thereby unleashing cancer is of course one of the seminal ideas of oncology. But it also, it’s a -as you can imagine – a deep philosophical idea about what it means to be a human being and how sort of the seeds of cancer are sort of already inlaid into our chromosomes.

I plan (will) to read the book.

Update: 11/23/10.

I had a brief correspondence with  Dr.Mukherjee. He has indicated that he will highlight the need for more attention/research dollars, for the pancreatic cancer and metastatic melanoma, during his upcoming interviews and tours.

Written by asterix98

November 19, 2010 at 5:08 am

Posted in Oncology

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