- Blood Journal Reports on TPO Receptor Agonists
- “Protein A” Drug Tested in ITP in Australia
- Anti-D and IVH Risk
- H. Pylori Treatment Improves with Two Additions
- NIH Resources:
- How to Talk to Your Doctor About CAM
- Understanding Clinical Research
- NHLBI Supports Training in Non-Malignant Hematology
- NHLBI Website Carries New Information and Animations
- Turn Down the Cooking Heat
- Tips for Safer Grilling
- Boosting Immunity with Tai Chi
- Poison Ivy Is in its Hey Day
BLOOD JOURNAL REPORTS ON TPO RECEPTOR AGONISTS
A research report, a commentary and a review paper discussed thrombopoietin (TPO) receptor agonists in the June 1 issue of Blood. Scientists from GlaxoSmithKline reported on a phase 1 clinical trial in healthy volunteers of eltrombopag, an oral TPO receptor agonist. 73 healthy male volunteers were randomized into 6 groups to receive eltrombopag or placebo at various doses for 10 days. The drug increased platelet counts in a dose-dependent manner, and no differences in adverse events occurred between placebo and treatment groups. In a related Commentary, Douglas B. Cines, University of Pennsylvania, expressed excitement about this class of drugs, noting that other studies of eltrombopag and another TPO receptor agonist, AMG531, have yielded good responses with acceptable tolerability in patients with severe ITP.
Developers of thrombopoietic growth factors have learned well from the problems of the first generation of these drugs, and the newer generation is showing promise in clinical trials, according to the review article by David J. Kuter, Massachusetts General Hospital. The first generation of these drugs was pulled from testing when patients began developing autoantibodies. Second-generation drugs, however, are proving to be potent stimulators of platelet production, without urging the immune system to react negatively. He points to AMG 531 and eltrombopag as examples that markedly increase platelet counts in patients with ITP, without significant adverse effects.
Kuter DJ. New thrombopoietic growth factors. Blood, 1 June 2007. Vol 109(11):4607-16.
Jenkins JM, Williams D, Deng J, Uhl J, Kitchen V, Collins D, Erickson-Miller CL. Phase 1 clinical study of eltrombopag, an oral, nonpeptide thrombopoietin receptor agonist. Blood, 1 June 2007. Vol 109(11):4739-41. Cines DB. Pumping out Platelets, Blood, 1 June 2007. Vol 109(11):4591-2.
Note: Patients can receive complementary copies of all articles in Blood.
“PROTEIN A” DRUG TESTED IN ITP IN AUSTRALIA
Six sites in Australia will begin clinical testing of a new drug, called PRTX-100, in ITP patients, according to the drug’s maker, Protalex. Chronic ITP patients will be enrolled to evaluate safety and pharmacokinetic data. According to company information, “PRTX-100 is a highly purified form of the Staphylococcal bacterial protein known as Protein A.” The drug binds to and down regulates activation of human B lymphocytes and macrophages to block inflammation in autoimmune diseases.
ANTI-D AND IVH RISK
After FDA staff raised questions about the risks of intravascular hemolysis (IVH—abnormal breakdown of red blood cells in the blood vessels) in patients with ITP taking intravenous anti-D therapy, clinicians at University of Illinois College of Medicine made four recommendations to enable the continued use of “an important and useful option in the treatment of ITP in adults and children”: 1) encourage clinicians to monitor patients closely for systemic complaints and macroscopic hematuria/hemoglobinuria in the 48 hours after infusion; 2) consider alternative therapies in patients with evidence of underlying hemolysis; 3) consider alternatives for patients with comorbid conditions, such as compromised renal function; and 4) obtain a complete blood count, reticulocyte count, DAT and dipstick urinalysis prior to treatment with anti-D and monitor for IVH/renal failure after treatment in patients experiencing untoward side effects.
Blood. June 15, 2007;109(12):5527;5528.
H. PYLORI TREATMENT IMPROVES WITH TWO ADDITIONS
Standard treatment for H. Pylori infection fails for 1 in 4 patients. Italian researchers have found that adding two products to standard therapy can boost eradication and reduce side effects. Standard treatment is a triple therapy consisting of the antibiotics amoxicillin and clarithromycin, plus a proton pump inhibitor. To this regimen, the researchers added lactoferrin and a probiotic supplement. Lactoferrin is a glycoprotein found in the body involved in immune defense. Probiotics contain multiple lactic-acid producing bacteria, and have been shown effective against gastroenteric illnesses, such as inflammatory bowel disease and viral infections. Eight weeks after treatment, patients taking standard therapy plus the two other products had better eradication of H. Pylori infection and fewer episodes of nausea, diarrhea, or other side effects.
Am J Gastroenterol. 2007;102:951-956.
HOW TO TALK TO YOUR DOCTOR ABOUT CAM
The top two reasons that people say they don’t talk to their doctors about complementary and alternative medicines: the doctors don’t ask, and the patients don’t know they should tell. The NIH National Center for Complementary and Alternative Medicine suggests patients get proactive: 1) When completing patient history forms, include all therapies and treatments you use. Make a list in advance. 2) Tell your health care providers about all therapies or treatments—over-the-counter and prescription medicines, as well as herbal and dietary supplements. 3) Don’t wait for your providers to ask about your CAM use. Be proactive. 4) If you are considering a new CAM therapy, ask your health care providers about its safety, effectiveness, and possible interactions with medications.
InFocus newsletter, Autoimmune Disease Association, June 2007, pg. 6.
UNDERSTANDING CLINICAL RESEARCH
People who participate in clinical studies help doctors learn how to better treat, prevent, and diagnose human diseases. There are plenty of good reasons to get involved in clinical research—and plenty of important questions to ask before you do. NIH News in Health covers the subject in its June 2007 issue, including questions to ask.
NIH SUPPORTING TRAINING IN NON-MALIGNANT HEMATOLOGY
Concerned about a shortage in young researchers in non-malignant hematology, the NIH’s National Heart, Lung, and Blood Institute has launched a new initiative to train young investigators in this field. Six centers were awarded grants to support early career development in non-malignant hematology, which includes ITP and thrombocytopenia. The centers are Washington University, Harvard University, Duke University/UNC Chapel Hill, Johns Hopkins University, University of Washington, and University of Pennsylvania.
Sadler, JE NHLBI Funds Clinical Research Training in Non-Malignant Hematology. The Hematologist, July/August 2007, pg. 2.
NHLBI WEBSITE CARRIES NEW INFORMATION AND ANIMATIONS
NHLBI’s Diseases and Conditions Index contains updates, animations, and illustrations for consumers. It includes a page on ITP and a new animation on How the Heart Works.
TURN DOWN THE COOKING HEAT
Lower-heat cooking, such as boiling, steaming or stewing, may be safer than high-temperature grilling, broiling and frying, for preventing inflammation and related conditions such as diabetes and heart disease. According to researchers at Mount Sinai School of Medicine, rapid, high-heat cooking generates toxins known as advanced glycogen endproducts (AGEs), which accumulate in the body over time. In animal studies, the researchers cut AGE intake of mice in half, which increased their lifespan and reduced oxidative stress.
Turn Down Heat to Reduce Aging Toxins. Tufts University Health & Nutrition Letter. July 2007, pg. 8.
TIPS FOR SAFER GRILLING
A second risk for grilled meats, specifically, is heterocyclic amines (HCAs), cancer-causing substances produced by grilling. To reduce HCAs in food, the Washington Post recommends: 1) microwave meats to partially cook them before grilling; 2) flip meat every minute, to keep internal temperature lower; 3) marinate the meat with fruits such as cherries, which are loaded with antioxidants that seem to suppress HCA formation. Garlic does the same; 4) don’t cook meat to well done; 5) eat cruciferous veggies (broccoli, cabbage, cauliflower, the day before barbecuing to detoxify HCAs.
Squires, S. Lean Plate Club, Washington Post, July 3, 2007, Pg. F1, F6.
BOOSTING IMMUNITY WITH TAI CHI
The slow movement exercise called Tai Chi may boost immune responses that prevent the painful nerve condition known as shingles, according to researchers at UCLA. The scientists compared two groups of healthy, older adults, ages 59 to 86. Half took Tai Chi classes three times a week, the other half attended classes about healthy diet and stress management. The Tai Chi group had a stronger immune response to the varicella virus, which causes chicken pox and shingles.
Tai Chi Boosts Defenses Against Shingles. Tufts University Health & Nutrition Letter. July 2007, pg. 6.
POISON IVY IS IN ITS HEY DAY
Current warming conditions are producing faster growing, hardier poison ivy plants. Rising carbon dioxide levels are creating ideal conditions for poison ivy growth, and the oil it produces is especially potent. The oil in the plant that triggers the itchy rash can hang on to clothing and penetrate rubber gloves and boots. Clothing should be removed and washed, and vinyl gloves are recommended for plant removal. If exposure occurs, wash immediately with soap and water. Other options are a wash called Tecnu, Goop, and Dial Ultra dishwashing soap. The Website www.poison-ivy.com, offers cards with life-size images to identify the plant, which comes in a wider variety of shapes than expected.
Parker-Pope, T. Climate Changes are Making Poison Ivy more Potent. The Wall Street Journal, June 26, 2007, pg. D1.
Note: We heard about several patients whose platelets dipped after exposure to poison ivy.