Pages

Friday 23 March 2012

I can only describe this piece as "true and heart-wrenching"

Slaves to Science by William Speed Weed


Sally bounds up the stairs two at a time. She fumbles with the key, then bursts into the lab. With fingers still frozen from the morning air, she takes a tray of hockey-puck-size clear plastic cups out of an incubator. The cups contain fish embryos and water. She drops some of the fluid onto a slide and looks through the microscope. There they are, little spheres with dark paisley inlays.

These particular fish are growing without hearts because Sally knocked out a gene fish need to grow hearts. She can now study this missing gene by watching what doesn’t happen in its absence. She had to get the fish out of the incubator at exactly this stage of development — just as the organs are forming, but before these fishlings die when they discover they have no hearts. Having not left the lab until midnight, Sally overslept the 6 a.m. alarm.

Monday 19 March 2012

Bionic man is not just science fiction

Woman considers hand removal for bionic replacement

Nicola Wilding meets Viennese surgeon Oskar Aszmann for a consultation

Nicola Wilding, 35, lost the use of her right arm in a car crash 12 years ago.
Nerve transplants have returned some movement to her upper arm, but she's been told she'll never be able to use her hand again.

Now, having seen a Newsnight film on the work of Austrian surgeon Oskar Aszmann, she is actively considering having her hand cut off and replaced with a bionic prosthesis.

"Twelve years ago on the motorway coming back from Brighton I had a crash," she says, in the kitchen of the Surrey home she shares with her parents and son.

"In the impact I brought my arm up to protect my head and it's pulled the nerves and the shoulder back. I broke the bones straight across - compound fractures I think here and here," she continues, slicing her good hand across the sites of the breaks.

Nicola sustained severe injuries to the nerves in her shoulder, leaving her arm initially paralysed  
Nicola sustained severe injuries to the nerves in her shoulder, leaving her arm initially paralysed. The bones could be fixed, but the injuries to her brachial plexus, the complex set of nerves which run from the neck via the shoulder to the arm, were always going to prove more problematic.
 
Her entire right arm was left paralysed by the crash, so surgeons performed nerve transplants, taking tissue from her leg and the side of her torso, to try to restore some movement.

Slowly and with the help of physiotherapy, movement returned to her upper arm. But the hand remained paralysed and withered.

"My doctors are like 'That's all we can do for you'," she recalls.
Nicola remained frustrated, and still is.

"It's the everyday things. If you go to butter toast you can't hold it. I've used my teeth to open bottles and chipped some teeth. Taking my clothes off, having a shower. I have to have meals prepared for me - I can't peel a potato as much as I've tried. I'd probably end up injuring myself.

"There are things I just can't do."

Then, last May, she saw a Newsnight film in which Austrian resident Milo underwent elective amputation to have his withered hand replaced with a prosthesis. He had suffered a brachial plexus injury in a motorbike accident, and had also lost the use of his hand.

The film also featured Patrick, the first patient to undergo the procedure, who was already showing off his bionic hand, opening bottles and tying his shoelaces.
The surgeon was Oskar Aszmann.

"I saw the clip of Oskar, and I was just filled with hope, because it could be life changing."

Nicola contacted Mr Aszmann immediately, but it's only this month that she has had the chance to meet him.

The surgeon was giving a lecture on his work to doctors at St Thomas' Hospital, London. Nicola attended the lecture and then met the surgeon for an initial consultation.

In a small room off a hospital ward, Mr Aszmann asked her how she was injured and what treatment she had had. He examined the arm, asking her what she can and cannot feel, and saw what movement she has.

But he was also keen to quiz her on her motivations and her expectations for elective amputation.
Elective amputee Patrick shows what he can do with his bionic hand and tests a new hand with additional wrist movement.

"These are risky decisions - they are irreversible. Once the extremity is gone it's gone, you cannot put it back on again," he says after the meeting, but he believes Nicola is a good candidate.

"She's already ready to go. She says she wants to have a functional hand and arm, so I think for her there's no question in her mind.

"What we have to figure out is what she still needs to qualify for an elective amputation and I think for that she will need to come to Vienna for us to conduct thorough tests."

That will involve testing the electrical output of nerves in her lower arm, to see whether they will provide sufficient signals to steer a bionic hand.
More surgery might be necessary to improve movement in the arm, he says. There may also be surgery he can perform to reduce the persistent pain Nicola suffers in her arm.

Nicola herself seems inspired by the lecture and by her meeting with Mr Aszmann.
"If the possibility is there and I feel that I haven't gone through with that, then I'll feel that I've let myself down.

"I've come this far and this is another door to be opened, so yes, I'm all for it, whatever the outcome, whatever happens, it's all good."

She now has to plan her trip to Vienna, and then, should she be selected for elective amputation, she'll have to think about where she can raise the money, not just for the surgery, but for a lifetime's worth of prosthetic hands and maintenance.

Einstein's Theory of Relativity made easy

Saturday 17 March 2012

Killer fashion: Does it hurt to look good?

Baila Steinman first noticed the numbness in her leg on a trip to Israel in December. "From the knee to the pelvis, it was numb to the point of being painful," recalls the 52-year-old occupational therapist.

Back home in Brooklyn, a neurologist had her balance on her toes, walk backward on her heels and push back when he put pressure on her legs. Then he asked, "Do you wear tight clothes? Control-top pantyhose? Tight belts?" When she nodded yes, the doctor, Irving Friedman, exclaimed "That's it!"

The culprit: the cinch belts Mrs. Steinman loves to wear. Dr. Friedman said they can compress a major nerve, the lateral, femoral cutaneous nerve, that runs from the abdomen to the outer thigh. He said he frequently sees the condition—called meralgia paresthetica—in policemen who carry guns on their hips and ballet dancers who wear tight tutus. "Anything that puts pressure on that nerve can cause it," he said. "It's very, very common."

Kim Kardashian in tightly cinched belt. Source: Inland Empire Magazine

Mrs. Steinman still wears the belts she loves, just not buckled quite so tight. "I told my friends about this and they cracked up," she says. "I said, 'I'm just letting you girls know, this can happen to you.' "

Apparel and accessories that are too tight, too loose, too heavy, too high or too floppy can all create health issues. Wearers sometimes have no idea that the culprit is their clothes. Of course, modern sartorial trends aren't nearly as punishing as Chinese foot binding or Victorian-era corsets, which could crush women's ribs and displace internal organs.

Here's a look at perhaps what not to wear:


Heidi Klum in skinny jeans. Source: thestyleandbeautydoctor.com

Tight jeans: Squeezing into matchstick jeans with cheese-stick legs cannot only cause nerve compression, it can interfere with digestion, as the Archives of Internal Medicine noted in 1993. Internist Octavio Bessa of Stamford, Conn., wrote that he was seeing 20 to 25 patients a year, usually middle-aged or older men, suffering from abdominal discomfort, distention, heartburn and belching a few hours after eating. "The diagnosis can be made easily in the office by comparing the size of the trousers with the abdominal girth. There is usually a discrepancy of 7.5 centimeters or more," Dr. Bessa wrote, coining the term "tight pants syndrome."
Since then, jean styles have gotten even skinnier and have also been blamed for lower back pain, yeast infections in women and a rare condition called lipoatrophia semicircularis, in which horizontal lesions appear around the thighs.


Body shapers. Source: zimbio.com

Body shapers: Worn too tight or too long, Spanx and other body-tamers can cause both nerve compression and digestive issues—not to mention painful welts where fabric ends and flesh begins. (They're really made for smoothing, not squeezing the wearer down a size.)

Shapers that compress the upper abdomen can also prevent the lungs from fully inflating, reducing oxygen intake, which can lead to lightheadedness. Stomach-flattening "compression wear" for men runs the same risk—and won't really train those abs to stay in place, no matter what the advertising says.

Colin Firth and Matthew Goode from A Single Man in shirts and ties.
Source: famewatcher.com
Shirts and ties: Get headaches, blurred vision or tingling around the ears—particularly at the office? Tight shirt collars and neckties can reduce circulation to the brain and increase intraocular pressure, a risk factor for glaucoma, experts warn. Tight ties can also decrease rangeofmotion in the neck and increase muscle tension in the back and shoulders, according to a study of South Korean office workers in the journal Work last year.
Many men need to loosen up: 67% buy shirts that are smaller than their necks, according to a 1993 study at Cornell University.
And since they tend not to be cleaned as often as other clothing items, neckties can be transmit infection. Some hospitals have sought to ban doctors from wearing them.

Undergarments by Victoria Secrets. Source: wallpaperswide.com

 Undergarments: Lingerie experts say 75% of women wear the wrong size bra. A bra that is too big gives no support, which can cause breast pain and back strain. One that is too tight could presumably cut into the flesh.
Boxers or briefs? Fertility experts advise men who want to become fathers not to spend long periods in tight bike shorts that can raise the temperature of the testes, reducing sperm production.

Fabric and detergent: Allergies to specific fibers are relatively rare, although they occur more often with synthetics and blends than all wool, cotton or silk, according to Apra Sood, a contact dermatitis expert at the Cleveland Clinic. More often, people who develop rashes and other irritations from clothes are reacting to dyes, fabric softeners and finishers that can include formaldehyde. "Washing new clothes a couple of times before wearing can reduce that," Dr. Sood says.
Kid's clothes with zipper
Kids' clothes: Despite years of regulation making children's clothes safer, a few babies and even older children still strangle on drawstrings or get them caught in playground equipment. Skin can get caught in zippers, which are not recommended for children's clothing.

Lately, pediatricians have been warning of another issue: sock-line hyperpigmentation, raised reddish welts that can appear around ankles from socks with tight elastic. The marks are harmless but can last for years, doctors warn, and can also occur around wrists with tight mittens.

Super high heels. Source: dailymail.co.uk

Shoes: Heels higher than two inches have been linked to bunions, hammer toes, stress fractures and ankle sprains. Other ailments include "pump bumps" (bony protrusions on the back of heels), Morton's neuroma (an injury to the nerve between the toes) and Freiberg infraction (in which some foot bones die due to lack of circulation.) After years of wearing high heels, some fashionistas find that their Achilles tendons shorten, making flat shoes uncomfortable.

And flats can cause problems too, especially those with thin, unsupportive soles. In fact, any shoes without arch support can lead to plantar fasciitis, an inflammation in the band of tissue that runs along the bottom of the foot.

Flip-flops are even worse, according to the American Podiatric Medical Association. Researchers at Auburn University videotaped 39 volunteers and noticed they had to clench their toes to keep them on, leading to foot fatigue, sore calf muscles and an altered gait, which could cause long-term ankle and hip problems.
J Lo, Hillary Duff and Leighton Meester in Uggs. Source: whataretheywearing.com
 Think winter footwear is safer? Those popular fleece-lined, flat-soled boots have some of the same issues. Plus, the lining can be a breeding ground for athlete's foot and nail fungus. "Yes, they absorb moisture, but the moisture has nowhere to go," says Jeffrey Benabio, a dermatologist with Kaiser Permanente in San Diego, Calif. He recommends wearing fleece boots only outdoors, with socks, for short periods, and letting them dry out in between.

Accessory to a Crime of Fashion
Katie Holmes and her big bag

Fashion accessories have their own health hazards. Heavy handbags worn on one shoulder can throw the back out of line, especially if they have long straps and slouchy construction, which allows contents to shift. The American Chiropractic Association recommends that women carry no more than 10% of their body weight in a bag.

Cheryl Cole's hair extensions. Source: headkandy.com
 Wearing hair extensions for long periods or changing them frequently can create bald spots. Tight headbands, ponytails and braids can cause headaches

Even minute amounts of nickel in rings, earrings, belt buckles, watch backs and jeans rivets can cause an itchy red rash on people who have nickel allergy, which can begin suddenly even in adulthood.

Trapped soap and moisture can cause a rash under any kind of ring, but it tends to happen particularly with channel-set rings, with open spaces underneath stone settings.

Tattoo and body piercing. Source: bodypiercing-tattoos.blogspot.com

About 20% of body piercings develop a bacterial infection, according to a review by Northwestern University dermatologists published in the American Journal of Clinical Dermatology this month. 

References: "Tight Ties, Killer Heels: Clothes Make the Fashion Victims" Wall Street Journal Feb 2012

Friday 16 March 2012

No sex? Have some booze.

Sex-starved fruit flies turn to drink


Drosophila SEM
Male fruit flies that have been rejected by females drink significantly more alcohol than those that have mated freely, scientists say.

In an article in Science, researchers suggest that alcohol stimulates the flies' brains as a "reward" in a similar way to sexual conquest.

The work points to a brain chemical called neuropeptide F, which seems to be regulated by the flies' behaviour.

Human brains have a similar chemical, which may react in a similar way. The connection between alcohol and this chemical, which in humans is known as neuropeptide Y, has already been noted in studies involving hard-drinking mice.

The new work explores the link between such reward-seeking and the study of social interactions, said the lead author of the report Galit Shohat-Ophir, now of the Howard Hughes Medical Institute in Virginia, US.

"It is thought that reward systems evolved to reinforce behaviours that are important for the survival of both individuals and species, like food consumption and mating," Dr Shohat-Ophir told BBC News.

"Drugs of abuse kind of hijack the same neural pathways used by natural rewards, so we wanted to use alcohol - which is an extreme example of a compound that can affect the reward system - to get into the mechanism of what makes social interaction rewarding for animals."

'Control system' Working in the laboratory of Ulrike Heberlein at the University of California, San Francisco, Dr Shohat-Ophir and colleagues subjected a number of flies to a wide variety of fates.

In one set of experiments, male flies were put in a box with five virgin females, which were receptive to the males' advances. In another, males were locked up with females that had already mated and which thus roundly rejected the males' attempts at sex.

Offered either their normal food slurry or a version charged with 15% alcohol, the mated males avoided the alcohol, whereas the sexually deprived males went on a comparative bender.

The team then went on a hunt for a chemical that could tie the two parts of this story together, hitting on neuropeptide F (NPF).
Neuropeptide Y 
 In mammals, the "rewarding" brain chemical is called neuropeptide Y
They found that the heavy-drinking rejected males had a lowered level of the chemical, and sated, mated males had an elevated level.

"What we think is that these NPF levels are some kind of 'molecular signature' to the experience," Dr Shohat-Ophir explained.

To show that the NPF is actually responsible for the change rather than just associated with it, the researchers actively manipulated just how much NPF was in the flies' brains.

Those with depressed levels acted like the rejected males, and those with elevated levels behaved like the mated males.

"What this leads us to think is that the fly brain - and presumably also other animals' and human brains - have some kind of a system to control their level of internal reward, that once the internal reward level is down-regulated it will be followed by behaviour that will restore it back," Dr Shohat-Ophir said.
It is tempting, given that humans share a similar brain chemical, to imagine that NPF drives human behaviour as well.

However, in an accompanying article in Science, Troy Zars of the University of Missouri wrote that "anthropomorphising the results from flies is difficult to suppress, but the relevance to human behaviour is obviously not yet established".
Nevertheless, he suggested that the work linked "a rewarding social interaction with a lasting change in behaviour".

"Identifying the NPF system as critical in this linkage offers exciting prospects for determining the molecular and genetic mechanisms of reward and could potentially influence our understanding of the mechanisms of drugs of abuse."

Sunday 26 February 2012

Unlimited human eggs for fertility treatment

With the ability to produce "unlimited supply" of human eggs from stem cells, looks like I can put aside the regret of not freezing my eyes/ovary when I was younger... :D


Unlimited human eggs 'potential' for fertility treatment

Egg  
Researchers say stem cells in ovaries may one day improve fertility treatment

It may be possible to one day create an "unlimited" supply of human eggs to aid fertility treatment, US doctors say.

Researchers have shown it is possible to find stem cells in adult women which spontaneously produced new eggs in the laboratory.

Further experiments on mice showed such eggs could be fertilised, according to a study in the journal Nature Medicine.

One British expert said the study re-wrote the rule book with "exciting possibilities" for improving fertility.
The long-established theory is that women are born with all the eggs they will ever have. Lead researcher Dr Jonathan Tilly, from Massachusetts General Hospital, said this study, a follow up to one on mice in 2004, disproves that.

His team has reported finding and isolating the stem cells which go on to produce eggs in the ovaries of reproductive age women. It was done by searching for a protein, DDX4, which was unique to the surface of the stem cells. This allowed researchers to fish out the right cells.
When grown in the laboratory, the cells "spontaneously generated" immature eggs - or oocytes, which looked and acted like oocytes in the body.
The cells were "matured" when surrounded by living human ovarian tissue, which had been grafted inside mice.

There are tight legal and ethical restrictions on research on human eggs. The same experiments repeated using stem cells taken from mice showed the eggs could be fertilised with sperm and produced embryos. 

'Unprecedented' Dr Tilly said: "The primary objective of the current study was to prove that oocyte-producing stem cells do in fact exist in the ovaries of women during reproductive life, which we feel this study demonstrates very clearly.
"The discovery of oocyte precursor cells in adult human ovaries, coupled with the fact that these cells share the same characteristic features of their mouse counterparts that produce fully functional eggs, opens the door for development of unprecedented technologies to overcome infertility in women and perhaps even delay the timing of ovarian failure."

He told Nature: "These cells, when maintained outside of the body, are more than happy to make cells on their own and if we can guide that process I think it opens up the chance that sometime in the future we might get to the point of having an unlimited source of human eggs."

Dr Allan Pacey, a fertility expert at the University of Sheffield, said: "This is a nice study which shows quite convincingly that women's ovaries contain stem cells that can divide and make eggs.

"Not only does this re-write the rule book, it opens up a number of exciting possibilities for preserving the fertility of women undergoing treatment for cancer, or just maybe for women who are suffering infertility by extracting these cells and making her new eggs in the lab."

'Potential landmark' Stuart Lavery, a consultant gynaecologist and director of IVF at Hammersmith Hospital, said the findings were "extremely significant" and "a potentially landmark piece of research".

He told the BBC: "If this research is confirmed it may overturn one of the great asymmetries of reproductive biology - that a woman's reproductive pool of gametes may be renewable, just like a man's."

While cautioning that the cells were "some way" from any clinical use, Mr Lavery said they had potential, "particularly in young women facing sterilising treatment such as chemotherapy".

Monday 13 February 2012

HAPPY VALENTINE'S DAY


Sent this to my friends to show some love on Valentine's Day...

To my surprise, I got similarly geeky reply...... .


Awesome photoshop skills I have to say!

Happy Valentine's Day everyone!!!!
xoxo

Sunday 12 February 2012

Unusual Treatment

Here's some rather peculiar research. 
This research group at Michigan State University discovered that stuffing the nose with a tampon made of cured pork could stop nose bleed. 

Well... now I know what I could do with the left over Bak Kwa from Chinese New Year. :D

Tuesday 7 February 2012

Blood pressure should be taken from BOTH ARMS


Take home message from this paper:

1) Blood pressure checks should be done on both arms
2) A difference in systolic blood pressure of 10 mm Hg or more, or of 15 mm Hg or more, between arms might help to identify patients who need further vascular assessment. A difference of 15 mm Hg or more could be a useful indicator of risk of vascular disease and death.

The next time I have my blood pressure taken, I better make sure the nurse/GP does it on both arms! 

Monday 6 February 2012

Go on, have a good rub down.




Great! Solid scientific evidence showing how massage therapy is good for your muscles, at the cellular, molecular level.

This Canadian group, led by Dr. Mark Tarnopolsky, studied the effects of massage therapy on the quadriceps of young healthy young men with exercise-induced muscle damage.

Talking muscle biopsies from each subject's massaged leg, and comparing with tissues from his unmassaged leg, Tarnopolsky and his team found that massage therapy reduced the production of inflammation related proteins like TNFa and IL6, and the activity of HSP27, thereby ameliorating the stress on the cells due to muscle fiber injuty.  

Moreover, massage also reportedly helps cells recover by boosting amounts PGC-1alpha, which encourages production of new mitochondria —organelles inside cells that are crucial for muscle energy generation and adaptation to endurance exercise.

Interestingly, this study reported no effect of massage on lactic acid concentrations, overthrowing a common belief that massage eases pain by helping the body clear away lactic acid buildup after exercise.

Ahhhhh....

Love it when science justifies all that money that I have spent on massages and spas... :D
Picture from Spa ESPA

Sunday 29 January 2012

The Price For Sexy Legs

We already knew that wearing high heels is bad for you. Now, some proper science has been done to verify this.



A Scientific Look at the Dangers of High Heels


Not long ago, Neil J. Cronin, a postdoctoral researcher, and two of his colleagues at the Musculoskeletal Research Program at Griffith University in Queensland, Australia, were having coffee on the university’s campus when they noticed a young woman tottering past in high heels. “She looked quite uncomfortable and unstable,” Dr. Cronin says.

Some observers, particularly women, might have winced in sympathy or, alternatively, wondered where she’d bought stilettos. But the three researchers, men who study the biomechanics of walking, were struck instead by the scientific implications of her passage. “We began to consider what might be happening at the muscle and tendon level” in women who wear heels, Dr. Cronin says.

How shoes affect human gait is a controversial topic these days. The popularity of barefoot running, for instance, has grown in large part because of the belief, still unproven, that wearing modern, well-cushioned running shoes decreases foot strength and proprioception, the sense of how the body is positioned in space, and contributes to running-related injuries.

Whether high heels might likewise affect the wearer’s biomechanics and injury risk has received scant scientific attention, however, even though millions of women wear heels almost every day. So, in one of the first studies of its kind, the Australian scientists recruited nine young women who had worn high heels for at least 40 hours a week for a minimum of two years. The scientists also recruited 10 young women who rarely, if ever, wore heels to serve as controls. The women were in their late teens, 20s or early 30s.

The scientists asked the heel-wearing women to bring their favorite pair of high-heeled shoes to the lab. There, both groups of women were equipped with electrodes to track leg-muscle activity, as well as motion-capture reflective markers. Ultrasound probes measured the length of muscle fibers in their legs.
All of the women strode multiple times along a 26-foot-long walkway that contained a plate to gauge the forces generated as they walked. The control group covered the walkway 10 times while barefoot. The other women walked barefoot 10 times and in their chosen heels 10 times.

It was obvious, as the scientists had suspected watching the woman during their coffee break, that the women habituated to high heels walked differently from those who usually wore flats, even when the heel wearers went barefoot. But the nature and extent of the differences were surprising. In results published last week in The Journal of Applied Physiology, the scientists found that heel wearers moved with shorter, more forceful strides than the control group, their feet perpetually in a flexed, toes-pointed position. This movement pattern continued even when the women kicked off their heels and walked barefoot. As a result, the fibers in their calf muscles had shortened and they put much greater mechanical strain on their calf muscles than the control group did.

In that control group, the women who rarely wore heels, walking primarily involved stretching and stressing their tendons, especially the Achilles tendon. But in the heel wearers, the walking mostly engaged their muscles.

That biomechanical distinction is important, says Dr. Cronin, who is now a researcher at the University of Jyvaskyla in Finland. “Several studies have shown that optimal muscle-tendon efficiency” while walking “occurs when the muscle stays approximately the same length while the tendon lengthens. When the tendon lengthens, it stores elastic energy and later returns it when the foot pushes off the ground. Tendons are more effective springs than muscles,” he continues. So by stretching and straining their already shortened calf muscles, the heel wearers walk less efficiently with or without heels, he says, requiring more energy to cover the same amount of ground as people in flats and probably causing muscle fatigue.
The obvious question raised by the findings, though, is so what? Does it fundamentally matter if a woman’s calf muscle fibers shorten and she neglects her tendons while walking, especially if she loves the looks of her Louboutins?
That question is difficult for a biomechanist to answer, Dr. Cronin admits.

Aesthetics are outside the realm of his branch of science. But the risk of injury is not. “We think that the large muscle strains that occur when walking in heels may ultimately increase the likelihood of strain injuries,” he says. (This risk is separate from the chances that a woman, if unfamiliar with heels, may topple sideways and twist an ankle or bruise her self-image, which is an acute injury and happened to me only the one time.)

The risks extend to workouts, when heel wearers abruptly switch to sneakers or other flat shoes. “In a person who wears heels most of her working week,” Dr. Cronin says, the foot and leg positioning in heels “becomes the new default position for the joints and the structures within. Any change to this default setting,” he says, like pulling on Keds or Crocs, constitutes “a novel environment, which could increase injury risk.”

It should be noted, he adds, that in his study, the volunteers “were quite young, average age 25, suggesting that it is not necessary to wear heels for a long time, meaning decades, before adaptations start to occur.”

So, if you do wear heels and are at all concerned about muscle and joint strains, his advice is simple. Try, if possible, to ease back a bit on the towering footwear, he says. Wear high heels maybe “once or twice a week,” he says. And if that’s not practical or desirable, “try to remove the heels whenever possible, such as when you’re sitting at your desk.” The shoes can remain alluring, even nestled beside your feet.
 _________________________________________________________

With research on the dangers of wearing heels getting headlines all over the world, will ladies cut down on the wearing of heels? Well, not till we change the image of what a pair of sexy legs should look like. Which of the following is sexier?



Monday 16 January 2012

Commercializing science

Stem-cell research: Never say die

Robert Lanza has been a public face for Advanced Cell Technology’s many ups and downs.
Sam Ogden
“Oh crap, this really puts us in the spotlight!” thought Robert Lanza when he first heard the news. Advanced Cell Technology (ACT), the biotechnology company in Marlborough, Massachusetts, of which Lanza is chief scientific officer, had for more than a year been operating in the shadow of Geron, a rival company in Menlo Park, California. Geron was bigger and better funded than ACT, and it was the first company to be approved by the US Food and Drug Administration (FDA) to test a therapy in humans based on embryonic stem (ES) cells. ACT was second. But in November, Geron announced that it was halting its trial to focus instead on cancer drugs. And with the announcement, Lanza says, he felt the weight of the ES-cell field fall on his shoulders.

Lanza and his company have had plenty of experience in the spotlight, but the attention has not always been flattering. Since the late 1990s, ACT has gained a reputation as a renegade company, accused of overhyping results to raise attention and money. Critics say that the company has damaged the field more than once with its high-profile, controversial announcements, such as one describing the company's attempts to clone a human embryo1 in 2001. ACT's actions — and the highly politicized nature of stem-cell research — scared off investors, leaving the company teetering on the verge of bankruptcy for most of the past decade.
But the scrappy biotech refused to die, in part because of Lanza's doggedness. ACT is now performing early-phase clinical trials testing the safety of implanting retinal cells derived from human ES cells into the eye to treat certain types of blindness.
Lanza says that this time, he aims to do things right: direct good science focused on treating disease, publish in reputable journals with rigorous peer-review processes and work with high-quality collaborators and clinical centres for its trials. “We're a different company now,” says Lanza.
Not everyone is convinced. Even if positive results emerge from these trials, ACT will still face major challenges in getting an ES-cell-based therapy approved for wider use. And some in the field are sceptical about ACT's reformation. “Can you really trust a company that has a spotty record?” says Arthur Caplan, a bioethicist at the University of Pennsylvania in Philadelphia.
It's not just Lanza who has a stake in the answer. With Geron out of the game, ACT's success or failure will be important for a field looking to prove itself worthy of further research funding. “If the trials are positive, that would fundamentally transform the debate,” says Christopher Thomas Scott, director of the Program on Stem Cells and Society at Stanford University in California.

Problem child

ACT began in the mid-1990s as an animal-cloning outfit owned by Avian Farms, a Maine-based poultry genetics company. ACT quickly shifted focus when Michael West — who founded Geron — became its chief executive in 1998. Human ES cells had just been isolated for the first time, and researchers were excited about their potential use in regenerative medicine.
But many were concerned that patients' immune systems would reject cells derived from unrelated embryos. To solve this, West proposed 'therapeutic cloning' — taking the nucleus out of a patient's cell, transferring it into an egg cell to create a cloned embryo, then using that embryo to derive patient-matched stem-cell lines.
In 1999, using money he had made at Geron, West bought ACT. Lanza, a physician who had spent the past 20 years working in academic research and biotech on organ and cell transplantation, was one of West's first recruits. The team moved quickly to try to make therapeutic cloning a reality.
If the American public had not yet heard of human cloning or ACT by the fall of 2001, it could hardly have missed the hype that began on 25 November that year. West appeared on Meet the Press, a nationally televised US political talk show, to discuss a paper, published that day, in which ACT scientists described the first cloning of a human embryo. “We've taken the first halting steps toward what we think is going to be a new area of medicine,” West said.
West appeared on several other news shows in the following days. CNN and US News and World Report heralded the work as a breakthrough, and West and his team hailed the “dawn of a new age in medicine” in a report for Scientific American (now owned by Nature Publishing Group).
In the paper1, published in the now-defunct online journal e-biomed, West, Lanza and their colleagues showed that they could pull a nucleus from a human egg cell, replace it with a whole adult ovarian cell and generate an embryo that divided into six cells. It then stopped growing, far short of the 100-cell blastocyst stage from which stem cells can be derived.
The work pressed a political hot button. That summer, President George W. Bush had approved federal funding for human ES-cell research, but only for a small number of cell lines that had already been created. He also voiced staunch opposition to human cloning of any kind, and a bill to ban it had been advancing through the US Congress, much to the chagrin of researchers who saw promise in therapeutic cloning.
ACT's announcement stoked fears that scientists were trying to clone humans for reproductive purposes — and conflated reproductive cloning and human-embryonic-stem-cell research in many people's minds. “It gave critics plenty of ammunition to insist that if stem-cell research was funded, human reproductive cloning would be funded too,” says Caplan. “It had a huge deleterious impact for years.”
Scientists, meanwhile, dismissed the finding. The ACT team hadn't gained new insight into the human developmental process, says George Daley, a stem-cell researcher at Children's Hospital Boston in Massachusetts. “I was not in a position to defend the cloning that they were doing because it was ineffective in what they were trying to do,” he says. “It was more for publicity than for science.”
Jose Cibelli, who was first author on the paper and left ACT in 2002 for a faculty position at Michigan State University in East Lansing, says that in an ideal world he would have waited until the team could grow the embryos to the blastocyst stage before publishing the work. But he had heard rumours that other groups were pursuing the same goal, and he was worried about getting scooped. (A successful derivation of stem cells from a cloned human embryo was not reported until October 2011, and these stem cells had three sets of chromosomes rather than two2.)
West says that he pushed ahead with publication in the interest of transparency. “It was our policy not to hide what we were doing and why,” he says. “We wanted to be honest, accurate and open.”
The announcement ended up hurting the company, however. ACT was trying to raise a needed round of venture-capital financing when the cloning news broke. The negative attention combined with the political uncertainty around stem-cell funding killed the deal, says Greg Bonfiglio, who was with Anthem Venture Partners of Santa Monica, California, at the time, and would have been the lead investor on that round.

Scraping by

The disappearance of the venture funding sent ACT on a financial downward slide from which it would take nearly ten years to recover, says Bonfiglio, who has dealt with the company on several more occasions. Researchers at Geron, meanwhile, had successfully derived neurons from human embryonic stem cells3 and were pursuing research that would eventually look to repair the damage caused by spinal-cord injuries, a possible use for embryonic stem cells that was much touted at the time. ACT was largely dismissed as a sideshow.
Lanza is now the longest-serving employee of the company. He says that a “tough childhood” in Stoughton, a town south of Boston, Massachusetts, helped him to develop a thick skin.
Unlike many Boston-area academics, Lanza has the 'R'-dropping accent of the region, most noticeable when he talks about one of his main preoccupations: Stargardt's disease. “Stahgahdt's” — as he says it — is one of the two types of degenerative blindness his company is targeting in its clinical trials. The other, the 'dry' form of age-related macular degeneration, is the most common cause of age-related blindness. Both diseases result from the death of retinal cells, a process that Lanza suspects can be slowed or even halted using stem-cell-derived replacements.
“It was our policy not to hide what we were doing and why. We wanted to be honest, accurate and open.”
After the venture funding fell through, West sold ACT's animal-cloning division to generate revenue. By 2004, however, money had again started to run low. But Lanza and West had recently hired Irina Klimanskaya, who, as a researcher at Harvard University in Cambridge, Massachusetts, had helped to derive many of the institution's first human ES-cell lines and who had a knack for working with scant resources. At ACT, she began optimizing a protocol for transforming ES cells (derived from embryos donated through fertility clinics) into retinal pigmented epithelial (RPE) cells. These are lost in both Stargardt's and dry age-related macular degeneration4.
Stopping vision loss didn't quite have the dramatic appeal of Geron's goal of reversing paralysis. But focusing on the eye may have been a wise decision, say experts.
“The eye is an ideal place to begin this type of experimental work,” says Michael Young, an ophthalmology researcher at the Schepens Eye Research Institute in Boston. Surgeons already have protocols for injecting cells directly into the eye, and they can measure changes in the retina just by peering into it. The eye is relatively sealed off from the immune system compared with other parts of the body, which may reduce the risk of cell rejection.
Moreover, transplanted RPEs do not need to form synapses, or connections, with neurons, unlike other retinal cell types. “If cell-based therapy in the eye is going work, it's got to work with the RPEs,” says Thomas Reh, a neurobiologist at the University of Washington in Seattle.
By 2004, Lanza and his team were ready to start testing the RPE cells in animals — but they were paralysed by a lack of money. The cells sat in a freezer for almost a year. Meanwhile, the company's phone service was turned off, purchases of basic lab supplies grew harder to justify and the skeleton crew of remaining scientists wondered week to week whether they would get paid.
Some left, but Klimanskaya opted to stay on. “I believe in the company, in the cells, in the technology and in my own skills,” she says. “Why should I quit?”
Out of desperation, West agreed at the end of 2004 to take the company public to gain access to a new source of funding. But the legal, accounting and marketing costs of going public through an initial public offering (IPO) were far beyond the company's reach. Instead, in early 2005, ACT merged with Two Moons Kachinas, an obscure, Utah-based outfit that sold Native American dolls. Two Moons was essentially a 'shell' company, allowing ACT to take it over and become a publicly traded firm. This 'reverse merger' was much cheaper than an IPO, but the US$8 million it raised had more strings attached.
As part of the deal, investors required the company to name a new chief executive. “The issue with ACT at that time was never about the quality of the science team,” says Bonfiglio, who led the deal. “The business skills were not resident on that team.” The new chief executive, William Caldwell, had more than 30 years of experience in banking, transportation and telecommunications, but none in biotech.

Out of the ashes

With the infusion of cash, ACT went on a hiring spree. West, who became the company's president and chief scientific officer, moved to California and recruited several researchers in hope of starting a lab that could tap into funding from the San Francisco-based California Institute for Regenerative Medicine (CIRM), a $3-billion, state-backed fund for stem-cell research.
Meanwhile, Lanza built up his team in Massachusetts and forged ahead with the RPE transplantation studies in rats. In 2006, positive results began to materialize5 and ACT opened its new headquarters, a 1,400-square-metre research facility in Alameda, California, which included a lab capable of growing cells according to the strict standards required for human trials.
Just as optimism was running high, the company made another very public stumble. In August 2006, Lanza and his co-authors published a paper6 in Nature showing that a single cell could be plucked from an 8–10-cell human embryo and grown into stem cells. Lanza wanted to show that it was possible to derive stem cells without destroying the embryo, to sidestep ethical concerns.
In fact, the embryos were destroyed in the experiments, but that had not been made clear in the original version of the paper, the press releases about it or in some of Lanza's press interviews. Nature issued two clarifications after its original press release, but many news organizations had already reported that the embryos were unharmed. When the truth became clear, critics pounced.
Opponents of ES-cell research saw the debacle as an attempt to mislead the public, and scientists criticized the method as impractical and still ethically problematic. Biopsying embryos puts them at risk, says Daley, so some will be lost.
Lanza says that the Nature paper was only meant to be a proof of principle and that the company soon perfected the technique so that embryos survived. But the episode reinforced perceptions that the company hyped its results, this time to boost its stock value. If that was the intent, the effect was short-lived. The increase in share price on the day of the announcement — from $0.42 to $1.83 — would be reversed in the weeks and months that followed.
Unable to raise enough money from conventional sources, Caldwell turned to last-resort financing. ACT borrowed cash from investors and then repaid them in shares on a monthly basis, using the lowest share price of the previous month. As that price dropped, ACT had to issue more and more shares, forcing the price down even further. Caldwell completed several rounds of this 'death-spiral financing' between 2005 and 2010 to keep Lanza's RPE research going, and the company sank further into debt.
By 2007, West says, he was not getting along with Caldwell and left ACT to head another company to develop products for ES-cell research. In 2008, ACT closed its Alameda facility — the CIRM funding never materialized — but Caldwell stayed in Los Angeles. By the time the markets crashed later that year, ACT's stock price had dwindled to pennies. Caldwell lost all of his executives, and the entire RPE development team left.
Still, Lanza was convinced that RPE therapy held the key to the company's survival. He was, moreover, impressed with Caldwell's dedication to the project. “He got all excited [about the science], and that was important,” Lanza says. “He was really my partner.” The two worked tirelessly throughout 2009 to rebuild the company. Caldwell eked out funding so that Lanza and his team could do the studies needed for FDA approval of the clinical trials. “We knew we had one chance,” says Lanza.
In November 2010, when a fax arrived saying that the trial had been approved, a cheer went through the office. “We came out of the ashes,” says Lanza. “It was a long time coming.”
There was little time for celebration, however. The team still needed approval from the clinical centres conducting the trials before they could start treating patients.
Lanza usually began each morning by answering a slew of e-mails from Caldwell, who often worked later hours in Los Angeles. So he was concerned when, on the morning of 14 December, his inbox was empty. The call came later that afternoon from Caldwell's wife. The man who had kept ACT afloat for the past six years had died unexpectedly, aged 63. Describing the loss now, Lanza becomes quite emotional and almost can't continue. “It was like I lost a father,” he says.
The company faced yet another bleak period. But Gary Rabin, an investment banker who had been on ACT's board since 2007, stepped in as interim leader. Within two weeks, he had secured $25 million in financing from two firms that Caldwell had been courting. Rabin, who is now ACT's chairman and chief executive, says that the funding is enough to pay for the company's two ongoing trials and should last through 2012.

The challenges ahead

Now, the company's future hinges on the outcome of the trials. Final results won't be out until 2013, and they will show mainly whether the cell transplants are safe. The patients enrolled in the trial are in the late stages of vision loss, so the chances of dramatic improvement are remote, experts say.
Still, Rabin and Lanza are optimistic. If the treatment is safe and even moderately effective, they say they would consider partnering with a pharmaceutical company to help take the programme forward — although they are still working out their plan. Scott, with Stanford's Program on Stem Cells and Society, says that positive results could fire up patient advocacy groups, which can be powerful in building support. And a good outcome could encourage investment in other stem-cell therapy companies, says Bonfiglio, who is now managing partner at Proteus Venture Partners in Palo Alto, California.
But even if the trial results are positive, ACT will face enormous challenges in commercializing the technology. The company will have to show the FDA that its RPE cells can slow vision loss in bigger and more expensive clinical trials.
And even if the treatment works, storing and distributing the cells, which often have short shelf-lives, is expensive and logistically difficult, says Chris Mason, head of the Stem Cell and Regenerative Medicine Bioprocess Group at University College London.
These challenges were thrown into stark relief when Geron halted its stem-cell trial in November, having decided that the hurdles to commercializing the therapy were too great. Now, it is up to ACT to face them. “The departure of Geron from the field will ultimately place a greater burden on ACT in terms of educating the FDA and establishing standards for safety and efficacy,” Bonfiglio says.
ACT is not entirely alone: other stem-cell-based therapies are moving towards the clinic. For example, a consortium of research groups called the London Project to Cure Blindness aims to test RPE transplants from embryonic stem cells in patients with macular degeneration this year. A group in Japan hopes to test a similar approach in humans using stem cells from reprogrammed adult cells within the next three years.
Still, some who have tracked ACT's trajectory say that the company might have what it takes to succeed. “What has kept ACT going is persistence, tenacity and vision,” says Ronald Green, ACT's long-time ethics adviser and a professor of religion and ethics at Dartmouth College in Hanover, New Hampshire.
Lanza says that at times he considered giving up and working on something less controversial. “If I wasn't a stubborn Italian,” he says, “I would have thrown up my hands at least 25 times.”

Nature Volume: 481,Pages: 130–133