Chronic, unresolved inflammation can be quite harmful, right down to the cellular level. At the macro level, it has links to cancer, diabetes, heart disease and other degenerative conditions.
This is why the body keeps a tight rein on the inflammatory response and maintains a host of factors that resolve inflammation once the need for it (for instance, to clear an infection or heal an injury) has passed.
We know pretty well which factors work between cells to turn on and turn off inflammation. That knowledge has led to the development of drugs like ibuprofen, acetaminophen and naproxen, all of which temper pro-inflammatory factors.
However, when you look at the signals and signaling pathways within cells, things get more complex, especially when it comes to factors that turn off inflammation. We haven’t completely grasped the full complement of proteins that transmit these internal anti-inflammatory signals. If we did, we could potentially add new drugs to our pharmacopeia to regulate or resolve inflammation or maintain cells in a non-inflamed state, and perhaps help prevent rejection of transplanted organs and tissues.
David Briscoe, MD, and his team at Boston Children’s Hospital’s Transplant Research Program, has taken the field one step closer to grasping those internal pathways by studying a cellular protein called DEPTOR. Full story »
B cells learn early on how to make many kinds of antibodies. What role do microbes in the gut play in teaching them to do so?
Your immune system’s B cells can produce antibodies against an amazing number of pathogens—viruses, bacteria, etc.—without ever having encountered them. That’s because, as they develop, your B cells reshuffle their antibody-producing genes into an amazing number of possible combinations
—more than 100 million—to produce what’s called your primary pre-immune B cell repertoire.
It’s long been thought that in people and in mice this reshuffling process—called V(D)J recombination, after the B cells’ antibody-coding V, D and J gene segments—takes place in two places: the bone marrow and the spleen. But new research from a team led by Frederick Alt, PhD, and Duane Wesemann, MD, PhD, suggests that there may be one more place B cells go to undergo recombination: the gut. What’s more, that reshuffling in the gut may be influenced by the microbes that live there.
Full story »
Do you have a fever?
Do you have a cough?
If you’re sitting at home with a sore throat, your answers to those two questions could be enough to tell whether you should see a doctor for a strep test, thanks to a new risk measure created by Kenneth Mandl, MD, MPH, and Andrew Fine, MD, MPH, at Boston Children’s Hospital.
Called a “home score,” the measure combines the two questions above, your age, and data on the level of strep activity in your geographic area. The basic idea is that your symptoms, plus the big picture of what’s happening in your neighborhood, is a strong enough predictor to for you to go to the doctor for a throat swab.
Thought it’s just a research tool for now, if it were it were packaged into an app and fed the right data (localized strep test results from a health center or medical testing company, for example), the home score could allow someone with a sore throat to make an informed decision about whether they should consider going to the doctor.
Full story »
Twenty or thirty years ago, no one would have expected babies born extremely prematurely—between 23 and 25 weeks’ gestation, considered the edge of viability—to survive long enough for their performance as elementary schoolers to be an issue.
But times change. Treatments like surfactants and prenatal steroids, along with improvements in ventilators and nutrition, have often enabled extremely premature children to survive.
The question is now one of long-term development. How will a child born at the edge of viability do—physically, cognitively, intellectually—in the long run? What impairments might he or she face, and how severe will they be?
The typical approach to answering those questions is to carry out a series of physical and cognitive assessments when the child is around 18 to 22 months old. But, as Mandy Brown Belfort, MD, MPH—one of Boston Children’s Hospital’s neonatologists—notes, assessments at that age may not tell you much about how the child will do later on.
Full story »
It’s music to the ear of any cancer patient: “Your scans are clear.” It means you’ve won, and the treatments you’ve endured have driven cancer from your body.
But once you hear those four magic words, are you also free of the need for future scans? There’s an argument to be made that continued scanning or surveillance imaging is a good thing. After all, if you have a relapse, you want to detect it as early as possible.
But that argument may not hold up in the face of data. Continued imaging can be expensive, can expose survivors to additional radiation, can have false positive results leading to additional worry and unnecessary medical care, and may not be any better at detecting tumor relapses than a physical exam or simply a survivor’s feeling that something is “wrong.”
Stephan Voss, MD, PhD, the director of Nuclear Medicine and Molecular Imaging and chief of Oncologic Imaging at Boston Children’s Hospital, decided to crunch the numbers, using Hodgkin lymphoma (HL) as a model for testing whether post-treatment surveillance with computed tomography (CT) scans makes clinical sense. His conclusion: not really.
“The conventional wisdom is that early detection of relapse means that we spare the patient side effects and poorer outcomes,” Voss says, referring to the belief that HL survivors should have a follow-up CT scan every year for up to five years after treatment. “But with Hodgkin disease, that’s not the case.” Full story »
The impact on science of this month’s federal government shutdown is still being calculated. But even before the shutdown, research across the U.S. was on rough footing.
Sitting in his office, Randolph Watnick, PhD, points to a stack of file folders and papers on his desk. It’s a good six inches tall. “I usually send out 10 or 11 grant applications in a year,” he says. “This year, I sent out that many by July.”
Watnick, who studies cancer metastasis at Boston Children’s Hospital, is writing so many grants because it’s what he has to do to keep his lab afloat. Like thousands of researchers across the U.S., he is trying to make up for funding losses due to sequestration—the automatic across-the-board federal spending cuts that went into place in March of this year.
In conversations with researchers up and down the academic ladder, the picture that comes together of sequestration’s impact on research is not pretty. And the worst may be yet to come. Full story »
The demand for hematopoietic stem cell transplants is rising. But how can we get more cells? (Text from Bryder D, Rossi DJ and Weissman IL. Am J Pathol 2006; 169(2): 338–346.)
You need a lot of hematopoietic stem cells to carry out a hematopoietic stem cell transplant
, or HSCT. But getting enough blood stem cells can be quite a challenge.
There are many HSCs in the bone marrow, but getting them out in sufficient numbers is laborious—and for the donor, can be a painful process. Small numbers of HSCs circulate within the blood stream, but not nearly enough. And while umbilical cord blood from newborn babies may present a relatively rare but promising source for HSCs, a single cord generally contains fewer cells than are necessary.
And here’s the rub: The demand for HSCs is only going to increase. Once a last resort treatment for aggressive blood cancers, HSCTs are being used for a growing list of conditions, including some solid tumor cancers, non-malignant blood disorders and even a number of metabolic disorders.
So how do we get more blood stem cells? Several laboratories at Boston Children’s Hospital and Dana-Farber/Boston Children’s Cancer and Blood Disorders Center are approaching that question from different directions. But all are converging on the same end result: making more HSCs available for patients needing HSCTs. Full story »
Hackathons are quickly growing beyond Red Bull- and Dorito-fueled code-fests into fertile grounds for new technologies and products that potentially could improve medicine and health care.
But beyond individual events, could hackathons signal the beginnings of a new ecosystem for medical innovation?
That’s what groups like MIT’s H@cking Medicine, Brigham and Women’s Hospital (BWH)’s new iHub and the New Media Medicine group at the MIT Media Lab are betting on. By tapping the same creative entrepreneurial energy that hackathon culture has brought to the technology industry, they believe they can fundamentally reimagine health care, one device, app and system at a time.
“The Boston area is the most fertile ground for medical innovation you could ever imagine,” says Michael Docktor, MD, a gastroenterologist at Boston Children’s and one of the organizers, with the H@cking Medicine team, of this weekend’s Hacking Pediatrics hackathon. “We need to make the case with the local medical and technology community that hackathons are a viable way of innovating in this day and age, that this is the way we ought to be innovating.” Full story »
A mammography machine.
When the drug Velcade®
came on the market in 2003, it was seen as a godsend for patients with multiple myeloma, an intractable blood cancer that until then was uniformly fatal. Velcade was the first in a novel family of drugs called proteasome blockers, which make it hard for cancer cells to break down and recycle used, misfolded or excess proteins.
In the last decade, Velcade has been tested against a long list of other cancers, including melanomas, lymphomas, as well as prostate, lung and breast cancers. The results have been mixed, particularly for breast cancer.
But in the case of breast cancer, the uncertain outcomes may in part be because past trials looked in the wrong place. New research by Fabio Petrocca, MD, and Judy Lieberman, MD, PhD, in Boston Children’s Hospital’s Program in Cellular and Molecular Medicine, suggests that proteasome blockers like Velcade may indeed have a place in the breast oncologist’s armamentarium, but just for a particular aggressive kind of breast cancer called basal-like, triple-negative breast cancer (TNBC). Full story »
With the latest technologies and techniques, MRI (bottom) is in many cases just as good as, if not better than, CT (top) when taking images of a child's chest. (Courtesy Edward Y. Lee, MD, MPH)
Magnetic resonance imaging, or MRI, can produce stunningly detailed images of the body’s tissues and structures. Historically, however, the chest—and in particular, the lungs and airway—has proven challenging for radiologists to clearly visualize through MR images.
Why is that? Unlike most other solid organs, the lung and trachea aren’t really solid. The air spaces within them do not absorb the magnetic fields or produce the radio signals needed to generate high-quality diagnostic images. Also, they are in constant motion—we have to breathe, after all.
For these reasons, radiologists have long relied on x-rays and computed tomography (CT) scans to take pictures of the lungs. Both can produce very good, highly detailed diagnostic images, but both also come with risks related to their reliance on ionizing radiation.
The lung MRI’s time may now have come. In a review paper in Radiologic Clinics of North America (RCNA), an international team of radiologists led by Simon Warfield, PhD, and Edward Y. Lee, MD, MPH, of Boston Children’s Department of Radiology outlines several recent advances that have made MRI a more viable—radiation-free—alternative for diagnostic imaging of children’s lungs and airway. Full story »