Platelet E-News – March 23, 2009

This e-newsletter is a monthly publication of the Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

ITP Research and Treatments

Hospitals, Insurance, and Medical Care

General Health and Medicine

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General Health and Medicine

PLATELETS ARE IMPORTANT FOR FIGHTING MALARIA INFECTION
Platelets play a protective role in the early stages of malaria infection, according to Australian scientists. In their study, mice with low platelet levels and those treated with aspirin (which inhibits platelet function) were more susceptible to death from the malaria parasite than mice given placebo. The platelets appeared to slow parasite maturation and kill the parasite.

McMorran BJ, Marshall VM, deGraaf C, Drysdale KE, Shabbar M, Smyth GK, Corbin JE, Alexander WS, Foote SJ. Platelets kill intraerythrocytic malarial parasites and mediate survival to infection. Science Feb 6, 2009;323:797.

LONG-TERM TREATMENT WITH ROMIPLOSTIM IN CHRONIC ITP APPEARS SAFE

In patients treated up to 3 years (with an average of 69 weeks) on romiplostim, efficacy of the drug was maintained and safety appears to be reasonable, according to an ongoing single-arm, open label extension study in 142 patients with ITP. 87% of patients achieved a platelet response that was sustained throughout the study. Bleeding events decreased over time and many patients were able to give themselves the weekly injections at home. An accompanying editorial noted that the high sustained response may be inflated due to drop out of those who did not respond. There are still concerns, also, about bone marrow fibrosis. The true incidence of fibrosis is unclear from this study because bone marrow was not routinely tested.

Bussel JB, Kuter DJ, Pullarkat V, Lyons RM, Guo M, Nichol JL. Safety and efficacy of long-term treatment with romiplostim in thrombocytopenic patients with chronic ITP. Blood March 5, 2009;113 (10):2161-2171.

Cuker A, Abrams CS. Romiplostim: chronic therapy for a chronic disease? Blood March 5, 2009;113 (10):2122-2123.

RITUXIMAB REVERSES T CELL ABNORMALITIES AND RAISES PLATELETS IN ITP
The role of T cell regulation is coming clearer in ITP, as is rituximab’s role in reversing T cell abnormalities, according to a review of 4 studies. T cells appear to be less able to suppress the immune response in patients with ITP. With rituximab treatment, T-cell and B-cell interactions are altered and T-cell abnormalities can be reversed, restoring platelet counts to normal (in 40% of patients in one study).

Green D. Fresh insights into chronic immune thrombocytopenic purpura. Journal Watch Oncology and Hematology. September 23, 2008

ELTROMBOPAG EFFECTIVE FOR CHRONIC ITP IN INTERNATIONAL TRIAL
Oral eltrombopag was effective in a phase 3 randomized, double-blind, placebo-controlled study of adults in 23 countries with chronic ITP. 59% of patients on eltrombopag (and 16% on placebo) achieved platelet counts of at least 50,000 per uL. Bleeding events went down as platelet counts rose. Platelet counts returned to baseline within 2 weeks after treatment ended.

Bussel JB, Provan D, Shamsi T, Cheng G, Psaila B, Kovaleva L, Salama A, Jenkins JM, Roychowdhury D, Mayer Bhabita, Stone N, Arning M. Effect of eltrombopag on platelet counts and bleeding during treatment of chronic idiopathic thrombocytopenic purpura: a randomised, double-blind, placebo-controlled trial. The Lancet, February 21, 2009; 373(9664):641-648.

NEW ESTIMATES ON HOW MANY PEOPLE HAVE ITP
PDSA has updated the ITP incidence and prevalence estimates on its Web site with the following: “Estimates of the incidence, number of new cases of ITP per year, and the prevalence, how many people have ITP, vary since they are often based on small population samples or review of insurance records. The incidence of ITP in children is estimated at 4.3 to 5.3 per 100,000 children per year. Since children with ITP usually recover, the prevalence of childhood ITP is about equal to the incidence. The incidence of adult ITP is from 1.6 to 6.6 per 100,000 and the prevalence is approximately 9.5 cases per 100,000.

In children, an equal number of boys and girls are diagnosed with ITP. In adults, more women than men have the disease, however, the gender difference disappears in people over 60 years old.”

Researchers have made progress in determining the number of people diagnosed with ITP and refined the estimates of how many people have it. This new wording on the PDSA Web site brings our information in line with the upcoming ITP guidelines, other ITP sites, and widely referenced research articles.

http://www.pdsa.org/itp-information/index.html

META-ANALYSIS FINDS H. PYLORI SCREENING MAY BE WORTHWHILE IN ITP
Detection and eradication of Helicobacter pylori infection is worthwhile in patients with ITP, especially in countries with high rates of infection, according to a meta-analysis of 25 studies that evaluated 696 patients. From this systematic review it appears that a particular strain of H. pylori, common in Japan and other countries with high infection rates, may create an immunologic environment that enables ITP. The authors note that even in the U.S., the cost of screening the small number of ITP patients for H. pylori infection and treatment with antibiotics is much lower than the high-cost treatments for ITP.

Stasi R, Sarpatwari A, Segal JB, Osborn J, Evangelista ML, Cooper N, Provan D, Newland A, Amadori S, Bussel JB. Effects of eradication of Helicobacter pylori infection in patients with immune thrombocytopenic purpura: a systematic review. Blood, February 5, 2009; 113(6):1231-1240.

HEPATITIS C VIRUS INFECTION—AND ITS TREATMENT—INCREASE RISK FOR ITP
Both hepatitis C virus (HCV) infection and treatment with interferon alpha increase risk for ITP, according to a study of more than 100,000 U.S. veterans with HCV and 400,000 matched controls. Almost all were male. The interferon treatments also increased risk for autoimmune hemolytic anemia. Patients with untreated HCV had a 1.7 fold increased risk of developing ITP and HCV patients treated with interferon alpha had a 2.4-fold increased risk, compared to vets without HCV. The authors propose three possible mechanisms: 1) HCV infection may stimulate autoantibody production, 2) HCV may specifically bind to a receptor on platelets, causing autoantibody production against the HCV-bound platelets or, 3) HCV may infect and replicate in megakaryocytes (parent cells of platelets), leading to their depletion.

Chiao EY, Engels EA, Kramer JR, Pietz K, Henderson L, Giordano TP, Landgren O. Risk of immune thrombocytopenic purpura and autoimmune hemolytic anemia among 120,908 U.S. veterans with hepatitis C virus infection. Archives of Internal Medicine, February 23, 2009;169 (4):357-363.

ELTROMBOPAG STUDIED AS A POSTRADIATION PILL TO RAISE PLATELET COUNTS
Could a treatment developed for ITP be useful following a radiation attack or nuclear accident? With U.S. government funding, researchers at the University of Rochester are studying the utility of the pill eltrombopag (Promacta) as a convenient therapy in case of a radiation-related emergency. Reduced platelet levels are a life-threatening result of exposure to high levels of radiation. The drug boosts platelet counts and is used to treat ITP. It’s not clear how the drug would be distributed before or during an emergency. The article appears in the magazine Scanner, published by the American Society of Radiologic Technologists (ASRT).

Stephens M. Preparing for the worst. ASRT Scanner, February/March 2009

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Hospitals, Insurance, and Medical Care

NIH LAUNCHES UNDIAGNOSED DISEASES PROGRAM

The National Institutes of Health (NIH) has launched a program to evaluate patients with medical problems that have evaded a diagnosis. The number of patients evaluated at NIH will be small, up to 100 annually. Patients must be referred by a physician. For patients selected for evaluation there is no cost for medical or travel costs. To learn details, call 866-444-8806, or visit http://rarediseases.info.nih.gov/Resources.aspx?PageID=31.

NONPROFITS CAN PARTNER ON PERSONALIZED MEDICINE
A new generation of nonprofits devoted to the search for treatments and cures for specific diseases need to jump in to help companies move personalized medicine to patients. The author suggests that nonprofits could link companies that are developing personalized diagnostics and treatments with patient populations that the companies aim to help. She also points to a November 2008 HHS report: Personalized Health Care: Pioneers, Partnerships, Progress, which calls for making personalized medicine a top priority for the U.S. government.

Ballantyne C. In tough times, personalized medicine needs specific partners. Nature Medicine. December 2008, 14(12):1294.

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General Health and Medicine

VITAMIN D DEFICIENCY LINKED TO AUTOIMMUNE DISEASES
Patients with both an autoimmune disease called undifferentiated connective tissue disease and vitamin D deficiency were more likely to progress to diseases including rheumatoid arthritis, systemic lupus erythematosus, Sjögren’s syndrome, and mixed connective tissue disease if they had lower vitamin D levels over a 2-year period. Immune system cells carry vitamin D receptors, which suggests that D may have a role in immune system regulation. Vitamin D, also known as cholecalciferol, is mainly generated in the skin of animals exposed to ultraviolet B (UV-B, sunlight). Dietary intake is insufficient, providing only 20 percent of the body’s requirements.

Significant association shown between vitamin D and autoimmune diseases. American Autoimmune Related Diseases Association (AARDA) Newsletter, March 2009;17(1):7.

Adapted from article: Vitamin D or hormone deficiency in autoimmune rheumatic disease, including undifferentiated connective tissue disease. Cutolo, M. Arthritis Research & Therapy, 2008, December 2, 2008.

COFFEE MAY BE PROBLEM FOR PLATELETS—BUT NOT DUE TO CAFFEINE
Coffee was found to have an antiplatelet effect, but not because of caffeine. It appears that coffee’s polyphenols are to blame. Both coffee and tea are rich in polyphenols, which appear to lower the levels of activated platelets in the blood, which is considered a benefit for people at risk of stroke or heart attack from blood clots, but may be a problem for people with ITP and low platelet counts.

Natella F, Nardini M, Belelli F, Pignatelli P, Di Santo S, Ghiselli A, Violi F, Scaccini C. Effect of coffee drinking on platelets: inhibition of aggregation and phenols incorporation. British Journal of Nutrition, 2008;100:1276-1282.

AS OIL PRICES RISE, ORGANIC PRODUCE BEGINS TO LOOK LIKE A BARGAIN
Conventional farming relies on fertilizers made from fossil fuels. Fertilizers have increased in price substantially as oil prices increase. With oil predicted to reach $200 a barrel within 5 to 10 years, local, organic farming begins to gain appeal for more than reasons of taste and nutrition. It becomes financially attractive since it doesn’t rely on chemical fertilizers or expensive transportation from farm to consumer.

www.mercola.com

Daily Telegraph, September 2, 2008

ARE FLUORESCENTS BETTER THAN INCANDESCENT BULBS?
Because fluorescent light bulbs have enough ultraviolet B radiation to cause photosensitivity in people with lupus, the Lupus Foundation of America, Sjögren’s Syndrome Foundation, and others have organized a coalition to challenge a ban on incandescent light bulbs in school rooms, homes, and businesses. The Lupus Foundation of America and the coalition are working with Congress and industry to determine whether a new, acceptable incandescent light bulb will be released before January 2012.

Ban on incandescent light bulbs challenged by health advocacy groups. American Autoimmune Related Diseases Association (AARDA) Newsletter, March 2009; 17(1):4, 10.

CALORIE REDUCTION MORE IMPORTANT THAN DIET COMPOSITION FOR WEIGHT LOSS
Reducing calories is more important for weight loss than the percentage of protein, carbohydrates, and fat, according to a randomized study of 811 overweight adults assigned to one of four diets (with varied levels of fat, protein, and carbohydrates) and followed for 2 years. All the diets reduced risk factors for heart disease and diabetes. Attendance at group sessions strongly predicted weight loss at 2 years across all groups. The authors conclude: “any type of diet, when taught for the purpose of weight loss with enthusiasm and persistence, can be effective.”

Sacks FM, Bray GA, Carey VJ, Smith SR, Ryan DH, Anton SD, et al. Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates. The New England Journal of Medicine, February 26, 2009; 360:859-873.

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This e-newsletter is published by the Platelet Disorder Support Association, 133 Rollins Avenue, Suite 5, Rockville, MD 20852, phone 1-87-Platelet, fax: 301-770-6638, web: http://www.pdsa.org, e-mail: pdsa@pdsa.org

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