Gene Might Boost Risk for Obesity

SUNDAY, Feb. 19 (HealthDay News) -- A new animal study suggests that a genetic mutation could put certain people at higher risk for becoming obese if they eat high-fat diets.

At the moment, the practical uses of the research seem to be limited, but physicians could conceivably test people for the mutation and recommend that they avoid certain kinds of diets, said study co-author Dr. Gozoh Tsujimoto, a professor at Kyoto University's department of genomic drug discovery science in Japan. It may also be possible, Tsujimoto said, to eventually give people drugs to combat the effects of the mutation.

If that happens, there would be "a new avenue for personalized health care," Tsujimoto said.

Scientists have been busy studying genetic links to obesity that could make some people more prone to gain extra weight. Two-thirds of Americans are either overweight or obese, the U.S. Centers for Disease Control and Prevention estimates. Excess pounds contribute to a variety of diseases, including heart disease and cancer.

In the new study, researchers looked at the component of the body's internal communication system that plays a role in the regulation of appetite and the production of fat cells.

The investigators found that mice that didn't have the component were 10 percent fatter than other mice when all were fed a high-fat diet. Mice without the component also developed higher intolerance to glucose.

Research conducted in animals does not always translate into humans, and much more research is needed. However, the researchers found that Europeans with the genetic mutation, known as GPR120, were more likely to be obese.

"Our study for the first time demonstrated the gene responsible for diet-induced obesity," Tsujimoto said.

According to Tsujimoto, more than 3 percent of Europeans have the trait. The next step for researchers is to study its prevalence in Japanese, Korean and Chinese people.

What can be done with the knowledge from the study?

Tsujimoto said physicians could advise people with the trait to avoid high-fat diets. A test is available to detect the trait and it costs about $200 in Japan, Tsujimoto said.

While medications could potentially be developed that would reverse the effects of the genetic trait, there are no such drugs now, Tsujimoto added.

Ruth Loos, director of Genetics of Obesity and Related Metabolic Traits at Mount Sinai School of Medicine in New York City, said "these findings provide another piece of what turns out to be the very large puzzle that describes the causes of obesity."

Consistent findings in mice and humans have put the trait "more firmly on the obesity map and provides a new starting point for more research into the function of this gene," said Loos.

"This is only the beginning of likely many years of research to disentangle the physiological mechanisms that lie behind the link between this gene and obesity risk," she said. "It is only when we understand the physiology and biology better that one can start thinking of developing a drug."

The study appears online Feb. 19 in the journal Nature.

More information

For more on obesity, visit the U.S. National Library of Medicine.

View the original article here

Genome Map Might Help Save Tasmanian Devil From Extinction

THURSDAY, Feb. 16 (HealthDay News) -- Researchers have sequenced the genomes of the animal known as the Tasmanian devil and the transmissible facial cancer that threatens the species with extinction.

The findings may help efforts to save the meat-eating marsupials found only on the Australian island of Tasmania, according to the study in the Feb. 17 issue of the journal Cell.

"There are targeted drugs that work against cancer genes," Elizabeth Murchison, a Tasmanian native working at the Wellcome Trust Sanger Institute in the United Kingdom, said in a journal news release "We hope some of the mutations that we have found in genes in the devil cancer may point to therapeutic strategies."

The facial cancer ravaging the Tasmanian devil population is spread through bites that transfer living cancer cells. Tasmanian devils bite each other often. The first recorded case of the disease was noted in 1996. By the early 2000s, "it was clear that this was a new type of infectious disease," Murchison said.

The genomes of the Tasmanian devil and the facial cancer suggest that the cancer first arose in a female Tasmanian devil.

"The cancer genome has evolved as it has spread through the population, but overall it appears to be rather stable," study senior author Michael Stratton said in the news release. "The genetic differences between 104 Tasmanian devil tumors from all around the island present us with a remarkably clear picture of how the cancer has spread in time and space over the last couple of decades, which may help with strategies for disease containment."

More than 17,000 mutations in the devils' cancer genome have been cataloged and researchers must now determine which of those are most important. Early indications suggest that changes in immunity genes may explain how the cancer evades the immune system.

More information

The Tasmania Parks and Wildlife Service has more about the Tasmanian devil.

View the original article here

Implanted Microchip Might Be Future of Drug Delivery

THURSDAY, Feb. 16 (HealthDay News) -- Remote controls may not be for just appliances anymore. In a new small study, women with severe osteoporosis were implanted with a microchip that releases bone-building drugs at the push of a button, a delivery method that could someday become common for various health conditions.

Roughly 1.5-by-2.5 inches in size, the microchip significantly improved patient compliance with a drug regimen that normally requires painful daily self-injections, study authors said. The clinical trial, conducted on seven osteoporosis patients in Denmark, was the first to test a wirelessly controlled microchip in this capacity.

"It frees patients from the burden of managing their disease on a daily basis," said Robert Farra, co-author of the study and president and chief operating officer of MicroCHIPS Inc., the Waltham, Mass., company that funded and supervised the trial. "I think there will be a class of drugs [for other conditions] that will be very suitable to use the chip for . . we were very pleased with the results."

The study is published Feb. 16 in the journal Science Translational Medicine, coinciding with its presentation at the American Association for the Advancement of Science annual meeting in Vancouver, Canada.

Along with researchers from MIT, Harvard Medical School and other companies and institutions, Farra implanted the microchip just under the skin near the waistline of the seven women, who ranged from ages 65 to 70 and had been using pre-filled injection pens containing teriparatide (brand name Forteo) for their severe osteoporosis, a bone-thinning disease.

Although a fibrous membrane grew around the device, which was expected, the microchip delivered the drug as effectively as daily injections, the study said. Blood tests done after the 12-month study period indicated rates of bone formation similar to when the women self-injected the drug.

Because daily injections can be psychologically and physically challenging, Farra said, only 25 percent of patients on teriparatide actually finish a typical 24-month regimen. But with the implant -- which delivered 20 timed doses controlled by doctors -- the compliance rate rose to 100 percent.

About 50,000 Americans take the drug each year at a cost of $10,000 to $12,000, which would be comparable to the cost of the microchip and the minor surgery to embed it, he said. The microchip can be implanted under local anesthesia in a doctor's office.

"It not only should offer a better quality of life, we should see improved outcomes because of the compliance boost," Farra said, adding that his company is developing a model that will deliver a year's worth of doses. He said he hopes it is approved by the U.S. Food and Drug Administration and on the market within four years.

Dr. Robert Recker, director of the Osteoporosis Research Center at Creighton University in Omaha, Neb., said he was skeptical that the microchip could keep the Forteo stable at body temperature since the drug is normally refrigerated when contained in injection pens.

However, Farra said that researchers had modified the drug to make this possible, an effort made easier because each dose was also sealed in tiny air- and moisture-proof compartments in the microchip.

The reservoirs pop open on a pre-programmed schedule or via a wireless signal, which can be sent from a doctor's computer or smartphone, Farra said.

"I do not see how this can be done with [a] reservoir, either above or below the skin surface," Recker said. "I think the claim must be corroborated with more studies. They must explain how they preserve the drug at body temperature."

More information

The University of New Hampshire has more about human microchip implantation.

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Erectile drugs might help premature ejaculation

NEW YORK (Reuters Health) - Most studies looking at whether erectile dysfunction drugs can help men overcome premature ejaculation problems agree that the pills make a difference, but much of the research is flawed, according to a new review of the evidence.

Of the 14 studies included in the review, 11 found that the medications helped extend the length of time men could have intercourse before orgasm, but Dr. Anastasios Asimakopoulos, lead author of the report, urged caution in interpreting the findings.

"There is still inadequate evidence to propose the use of (these types of drugs) in treating (premature ejaculation)," he wrote in an email to Reuters Health.

The drugs, which go by the brand names Viagra, Levitra and Cialis, are intended to treat men who have problems getting and keeping an erection.

There's been an interest in also using them to address the problem of premature ejaculation, because one of the side effects of the drugs is a delay in ejaculation, the authors write in the Journal of Sexual Medicine.

Asimakopoulos, from the University of Tor Vergata in Rome, Italy, said that anywhere from four to 39 percent of men suffer from premature ejaculation.

His group collected data from 14 studies that measured the effect of medications on extending the time during intercourse before orgasm, technically referred to as the "intravaginal ejaculatory latency time."

Nine of the studies used an erectile dysfunction drug by itself, while four combined the drug with an antidepressant medication, and one combined the drug with behavioral therapy.

Most of the studies asked men to use a stopwatch before and after treatment, to measure if they were able to extend the time having sex.

Some also asked the men to rate changes in their anxiety and sexual satisfaction.

Asimakopoulos and his colleagues ran into problems trying to compare the studies. For one, they didn't always agree on the definition of premature ejaculation.

He said that future studies should use the definition provided by the International Society for Sexual Medicine, which says the disorder involves an inability to last longer than one minute before ejaculating, and includes problems such as frustration or avoiding sexual intimacy.

The other stumbling block to the group's analysis was that fewer than half of the studies compared the drugs to a placebo, a standard for high-quality studies that helps researchers determine whether the drug itself is responsible for any effects seen.

Among four studies, including about 300 men, that did compare an erectile dysfunction medication to a placebo, Asimakopoulos found a positive effect.

After taking a placebo, men had intercourse lasting from about a minute to a little more than a minute and a half.

Among the men who used a medication, intercourse lasted from more than two and a half minutes to about six.

Similarly, the erectile dysfunction drugs, when combined with an antidepressant, worked better than an antidepressant alone.

Asimakopoulos said the results show that these drugs have "a high impact...on prolonging ejaculatory times."

"There seems to be a global positive effect of these drugs in delaying ejaculation; however, the existing evidence is still partial and their role remains controversial," he said.

The drugs are worth further investigation for the treatment of premature ejaculation because antidepressants and topical anesthetics are the only alternatives demonstrated to be effective so far, the team notes in their report.

In future studies, Asimakopoulos said, researchers should not only use a standard definition of premature ejaculation and conduct studies comparing the drug to a placebo, but also shoot for developing a standard and more convenient method of measuring the disorder other than relying on a stopwatch.

SOURCE: http://bit.ly/zrye69 The Journal of Sexual Medicine, online January 16, 2012.

View the original article here

New Therapy Might Help Relieve Painful Foot Condition

WEDNESDAY Feb. 8 (HealthDay News) -- For people struggling with plantar fasciitis --- a painful and sometimes disabling foot condition -- a small, preliminary study suggests that a new type of therapy is more effective than standard cortisone injections in restoring mobility.

So-called "platelet-rich plasma" therapy is injected directly into the foot. It harnesses two main ingredients found in blood -- plasma and platelets -- to promote inflammation, connective-tissue growth and vascular healing. This contrasts with cortisone injections, which are designed to reduce inflammation.

"The focus here is on very difficult patients for whom well-recognized nonsurgical and surgical approaches are not effective," said study author Dr. Raymond Monto, an orthopedic surgeon with Nantucket Cottage Hospital in Nantucket, Mass. "Because while 90 percent of patients usually get better with standard treatment, about 10 percent don't.

"For these patients cortisone shots just don't help," Monto added. "The initial benefit degrades very quickly, and eventually by six months, and certainly by one year out -- you are back where you started.

"But among these sorts of patients I was very encouraged by the results with [platelet-rich plasma therapy]," Monto continued. "For most, after just one shot, we saw dramatic improvements. We're talking about the restoration of well over 90 percent of normal function lasting at least a year after treatment."

Monto was slated to present his findings Tuesday at a meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

According to the American Academy of Podiatric Sports Medicine, plantar fasciitis is the most common musculoskeletal problem in the United States, typically prompted by aerobic injury or poor shoe support.

The painful condition arises from inflammation of the connective tissue running from the heel to the ball of the foot, tissue known as plantar fascia, which in turn places heavy stress on the bottom of the foot. Commonly, the condition will begin when a person feels a sharp pain in their heel as they step down after being at rest.

Standard treatment can involve a mix of nonsteroidal anti-inflammatory drugs, stretching exercises, steroid injections, rest, orthotics, improved arch support, shockwave therapy and, in some cases, surgery.

The new study focused on 36 patients (16 men and 20 women), aged 21 to 74, struggling with a severe and chronic form of plantar fasciitis. None had experienced any relief following standard nonsurgical treatments.

The participants were divided into two groups. One received an ultrasound-guided injection of methylprednisolone (a steroid) at the injury site, while the other was treated with platelet-rich plasma.

While the steroid group showed notable improvement within the three months following treatment, foot function started to decline by the sixth month and continued on a downward trend through to the one-year mark.

The platelet-rich plasma group experienced better initial improvement and maintained increased function throughout the following year.

"Pretty much, if the patient treated with [platelet-rich plasma therapy] saw function go up by the four-week mark, then that function was maintained," Monto said.

"But, of course, one study doesn't change patterns of treatment," he noted. "So this should be viewed as a beginning point that raises awareness of the potential of [platelet-rich plasma therapy] for this type of treatment, and hopefully initiates more research."

Dr. Howard Luks, chief of sports medicine at Westchester Medical Center and N.Y. Medical College, both in Hawthorne, N.Y., described the platelet-rich plasma therapy exploration as "worthwhile," but added that questions remain.

"The reason there has been such an interest in [platelet-rich plasma therapy] is because cortisone is degenerative," he said. "It doesn't heal tissue. It actually can damage tissue with repeated injections. So we never, as orthopedists, really had a regenerative injection option available to us."

However, platelet-rich plasma therapy "is somewhat of a controversial subject, because at this point not all [platelet-rich plasma therapy] is equal," Luks added. "Different manufacturers take a different level of the blood. Some take the white cells, some don't; some exclude platelets, some don't. So the orthopedics community at large is still sort of saying that before we adopt this widely, let's figure out exactly what we're doing and what's the best preparation. And those studies are now under way."

Unlike cortisone treatments, platelet-rich plasma therapy is not covered by insurance. Luks said that, in his experience, costs for the new treatment can range anywhere from $270 an injection to as much as $3,000.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

For more on plantar fasciitis, visit the U.S. National Library of Medicine.

View the original article here

Erectile drugs might help premature ejaculation

NEW YORK (Reuters Health) - Most studies looking at whether erectile dysfunction drugs can help men overcome premature ejaculation problems agree that the pills make a difference, but much of the research is flawed, according to a new review of the evidence.

Of the 14 studies included in the review, 11 found that the medications helped extend the length of time men could have intercourse before orgasm, but Dr. Anastasios Asimakopoulos, lead author of the report, urged caution in interpreting the findings.

"There is still inadequate evidence to propose the use of (these types of drugs) in treating (premature ejaculation)," he wrote in an email to Reuters Health.

The drugs, which go by the brand names Viagra, Levitra and Cialis, are intended to treat men who have problems getting and keeping an erection.

There's been an interest in also using them to address the problem of premature ejaculation, because one of the side effects of the drugs is a delay in ejaculation, the authors write in the Journal of Sexual Medicine.

Asimakopoulos, from the University of Tor Vergata in Rome, Italy, said that anywhere from four to 39 percent of men suffer from premature ejaculation.

His group collected data from 14 studies that measured the effect of medications on extending the time during intercourse before orgasm, technically referred to as the "intravaginal ejaculatory latency time."

Nine of the studies used an erectile dysfunction drug by itself, while four combined the drug with an antidepressant medication, and one combined the drug with behavioral therapy.

Most of the studies asked men to use a stopwatch before and after treatment, to measure if they were able to extend the time having sex.

Some also asked the men to rate changes in their anxiety and sexual satisfaction.

Asimakopoulos and his colleagues ran into problems trying to compare the studies. For one, they didn't always agree on the definition of premature ejaculation.

He said that future studies should use the definition provided by the International Society for Sexual Medicine, which says the disorder involves an inability to last longer than one minute before ejaculating, and includes problems such as frustration or avoiding sexual intimacy.

The other stumbling block to the group's analysis was that fewer than half of the studies compared the drugs to a placebo, a standard for high-quality studies that helps researchers determine whether the drug itself is responsible for any effects seen.

Among four studies, including about 300 men, that did compare an erectile dysfunction medication to a placebo, Asimakopoulos found a positive effect.

After taking a placebo, men had intercourse lasting from about a minute to a little more than a minute and a half.

Among the men who used a medication, intercourse lasted from more than two and a half minutes to about six.

Similarly, the erectile dysfunction drugs, when combined with an antidepressant, worked better than an antidepressant alone.

Asimakopoulos said the results show that these drugs have "a high impact...on prolonging ejaculatory times."

"There seems to be a global positive effect of these drugs in delaying ejaculation; however, the existing evidence is still partial and their role remains controversial," he said.

The drugs are worth further investigation for the treatment of premature ejaculation because antidepressants and topical anesthetics are the only alternatives demonstrated to be effective so far, the team notes in their report.

In future studies, Asimakopoulos said, researchers should not only use a standard definition of premature ejaculation and conduct studies comparing the drug to a placebo, but also shoot for developing a standard and more convenient method of measuring the disorder other than relying on a stopwatch.

SOURCE: http://bit.ly/zrye69 The Journal of Sexual Medicine, online January 16, 2012.

View the original article here

Gauging hype during Heart Month: 5 tests you might not need

NEW YORK (Reuters Health) - February is American Heart Month and consumers will be bombarded with advice to keep their ticker healthy -- whether it's from the American Heart Association's Go Red For Women or the National Heart, Lung, and Blood Institute's The Heart Truth.

Doctors may suggest a screening test to make sure cardiovascular health is in top shape. But if a person lacks symptoms -- like chest pain or shortness of breath -- they might want to hit pause for a second and look closer at the costs and benefits.

The fact is, there is no good evidence that any of the common tests are that helpful if a person is symptom-free.

"If you do a test like a stress test in someone who doesn't have any symptoms, then you are more likely to get a false-positive test than a true positive," said Dr. Malissa Wood, a spokesperson for the American Heart Association.

Such false alarms trigger more unnecessary tests, which often carry significant risks.

"We really want to go based on symptoms," Wood said.

The government-backed U.S. Preventive Services Task Force also advises against routine screening for heart disease for people at low risk.

Even for those at higher risk -- like smokers, diabetics and the obese -- there is insufficient evidence to support routine screening, according to the USPSTF, which bases all of its advice on rigorous science.

Still, groups with ties to drug and heart device makers often recommend the tests routinely, and several companies promote them, to the chagrin of experts in the field.

"There are no 'heart tests' that any asymptomatic man or woman should get," said Dr. Patrick O'Malley, an internist at the Uniformed Services University of the Health Sciences in Bethesda, Maryland. "There are many that are done which they shouldn't get."

Here's a brief guide to the common heart tests:

TEST 1: ECG (EKG)

What is it? An electrocardiogram, or ECG, is simply a readout of your heart's electrical activity recorded by electrodes placed on the chest. It can pick up abnormalities that might, or might not, signal heart disease in the making.

Does it work? ECGs are used to study irregular heart rhythms, heart attacks and other problems. They're also used before some types of surgery, but no trials have looked at whether ECGs help stave off disease in people without symptoms.

What's the harm? An ECG typically costs about $50. Because it's not invasive, the test itself is safe. What someone should worry about is what happens if the results look abnormal. A patient might end up with another test that carries more risks, like a CT scan or a coronary angiogram, during which a catheter is threaded into the heart.

TEST 2: CAROTID ULTRASOUND

What is it? A carotid ultrasound allows doctors to see if the arteries in the neck that supply blood to the brain, called the carotids, are clogged by cholesterol buildups, or plaque. That is considered a risk factor for stroke.

Does it work? This test is used to check the blood flow to the brain. There is no evidence that carotid plaque screening, which is becoming increasingly popular, saves lives. The USPSTF says the harm of routine scans outweighs the benefits.

What's the harm? An ultrasound of the carotids costs between $200 and $300. Routine scans produce more false alarms than "true positives," and may lead to invasive imaging or carotid surgery or stenting. Between one and three percent of patients who get carotid surgery die due to the procedure, and even more suffer strokes from it.

TEST 3: ECHOCARDIOGRAM

What is it? An echocardiogram is a moving ultrasound picture of the heart. It allows the doctor to test how well the heart pumps out blood and whether it has structural problems.

Does it work? While the test might help doctors diagnose conditions like heart failure and atrial fibrillation, it hasn't been proven to help people without symptoms. One recent study found screening for heart disease with echocardiography and other tests didn't change what drugs doctors prescribed, nor people's diet and exercise habits or whether they smoked.

What's the harm? An echocardiogram costs between $200 and $300. Ultrasound scans are generally safe, but can trigger false alarms and may lead to more-invasive tests and treatments later.

TEST 4: STRESS TEST

What is it? To spot signs of pumping problems, a doctor will stress the heart by putting a person on a treadmill or stationary bike while doing an echocardiogram or an ECG. In a nuclear stress test, radioactive dye is injected into the bloodstream to create a better picture.

Does it work? Stress tests can help diagnose heart problems but haven't been shown to be helpful screening tools. Some studies have shown they may miss signs of heart disease.

What's the harm? A stress test may cost anywhere from a few hundred dollars to $1,000. It carries the usual risks of exercise, but largely for people with heart problems -- including very rare cases of heart attack. Some tests will result in false alarms, meaning further procedures with possible complications will be done unnecessarily.

TEST 5: CARDIAC CT SCAN

What is it? CT (computed tomography) scans use high-dose x-rays to get a detailed picture of the heart. In a coronary calcium scan, the doctor looks for calcium deposits in the heart's arteries, which have been tied to an increased risk of heart disease. Patients may also have a dye injected to make it easier to spot blockages.

Does it work? CT scans may help separate women at moderate risk of heart disease into those who would benefit from aggressive treatment and those who wouldn't. But for people without symptoms, CT scans still haven't proved more valuable than medical advice based on well-known risk factors like diabetes and obesity.

What's the harm? The radiation from CT scans, which may cost several hundred dollars, may increase one's cancer risk slightly. When dye is used, about one in 10 people develop kidney damage and some may get thyroid problems, too. False alarms may lead to invasive tests, which carry more risks.

HEALTHY LIVING, NOT TESTS

Experts say the best way to prevent heart disease has little to do with technology and everything to do with lifestyle.

"Tests do not prevent heart disease," said Dr. Rita Redberg, a cardiologist at the University of California, San Francisco. "To prevent heart disease, women (and men) should eat healthy diets with lots of fruits and vegetables, get regular physical activity and not smoke."

The American Heart Association also recommends keeping your blood pressure and cholesterol levels under control, although the USPSTF says there is too little evidence to recommend cholesterol tests when women don't have other heart risks.

(Editing By Peter Bohan)

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Fasting Might Boost Chemo's Cancer-Busting Properties

Cancer treatment can be brutal for patients. Many of the tools we have—chemotherapy, radiation—are big, blunt weapons that deal punishing blows to healthy tissues along with cancerous ones. So the hunt has been on for more and more finely targeted therapies that will attack malignant cells yet minimize damage to patients' bodies.

But a new study shows that we might be able to catch cancer cells off guard by using an ancient and body-wide tactic: fasting.

Fasting has long been practiced as part of various cultural traditions and has, more recently, gained favor in alternative and complementary medicine practices. But researchers are still figuring out whether nutritional deprivation can prevent or cure some diseases—and if so, how.

The new study found that in mice with cancer, fasting prior to chemotherapy often led to more tumor shrinkage than chemo alone. And in some cases, the combination apparently eliminated certain kinds of cancer. This fasting–chemo combo, the researchers suggest, "could extend the survival of advanced stage cancer patients by both retarding tumor progression and reducing side effects," they noted in their study, published online Wednesday in Science Translational Medicine. It might be able to help early-stage patients, too, they say.

One–two punch?
The new work builds on a 2008 mouse study that found fasting helped to protect healthy cells against chemotherapy's toxic effects. That finding raised flags in the cancer field. "The concern was we were also protecting the cancer cells," says Valter Longo, a professor of biology and gerontology at the University of Southern California Davis School of Gerontology and co-author of the new paper. So he and his colleagues embarked on five years of research to see whether that was the case, testing different fasting and chemotherapy regimens on a variety of cancers—glioma, melanoma, neuroblastoma, breast and ovarian—in mice. "We not only saw that the cancer was not protected but that it was sensitized" to the chemo, he says.

In the new work, fasting mice were allowed to drink water but were not given food for at least two days. When mice with breast cancer, glioma or melanoma were subjected to two rounds of 48-hour fasting before their chemo, their tumors shrunk more than those in mice that received chemotherapy alone.

Mice that had metastasized cancer and were put on the fasting-chemo plan showed a 40 percent greater reduction in their metastases than those that had been fed before receiving chemotherapy. They also seemed to live longer after getting this treatment. With two cycles of fasting and a high dose of chemo, 42 percent of mice with one of two types of metastatic neuroblastoma lived for more than 180 days, whereas all of their well-fed, chemo-treated mice had already died by then. Fasting and chemo together had an even more dramatic effect in a third type of metastatic neuroblastoma: about a quarter of mice lived for more than 300 days, at which point they still seemed to be cancer free.

Fasting appears to protect normal cells from chemotherapy's toxic effects by rerouting energy from growing and reproducing to internal maintenance. But cancer cells do not undergo this switch to self-repair and so continue to be susceptible to drug-induced damage—making for what the researchers call a differential stress resistance. Fasting, then, the authors wrote, should enhance the power of chemotherapies without having to resort to "the more typical strategy of increasing the toxicity of drugs."

The findings give a new boost to an old approach to medical research: generalized medicine. Personalized medicine will come around eventually, Longo says. But in the meantime, he is focused on finding treatments that can work across diseases. "Especially with cancer, we have an opportunity to look at what is common," he says. "What is it that, by definition, all cancer cells will have difficulty doing?" he asks. The fasting research suggests that the answer is adaptation.

As a cancer grows and its cells mutate, they become more specifically adapted to the environment—a tactic that often spell success for the malignancy. But, Longo says, "if you start changing the environment" by fasting, it has more trouble surviving chemo assaults than healthy tissue cells. Cancer cells, at least in breast cancer experiments, seemed to be fighting to stay alive in the starvation–chemo environment by eating up even more energy, which stresses the malignant cells and causes more damage in them.

Mary Helen Barcellos-Hoff, a professor at the New York University Langone Medical Center who was not involved in the new research, wonders if fasting is also having other effects in the body that is making it less hospitable to cancer, say by increasing immune system sensitivity to the cancer or helping to squelch vascularization of tumors. "I really think modifying the microenvironment to make it less permissive is really one of the untapped potentials for future cancer therapies, she says."

But as Longo notes, fasting—for two to three days in mice, which would be the equivalent of four to five days in humans—alters the body in myriad ways. "You look at their blood, everything changes," from the factors that control blood vessel growth to acids, he says. So now he and his team are going back to look for different signs of what is changing the fasting and chemo in hopes of further optimizing the timing and treatments.

From mice to people
The medical research field is strewn with promising cures-turned-casualties that had to be scrapped after showing promise in mice and failing to work in humans. The cancer battleground is one of the most littered. "Unfortunately we can cure cancer in mice, and we have a much harder time in humans," Barcellos-Hoff says.

The new study might help to quell some of the common reservations about promise in people. "One of the thing that's impressive about it is they used so many models of mouse cancer," Barcellos-Hoff says. The researchers tested more than a dozen different types of cancer lines in mice.

The other concern in translating this research to humans is that people with cancer—and especially those already undergoing treatment—have often already lost a substantial amount of weight. So prescribing days without food could be dangerous, especially for those who already have low blood pressure, diabetes or other metabolic conditions.

Most mice in the fasting groups were able to gain their weight back in five days or so. But humans, of course, are very different animals. Small fasting studies in cancer patients—some involving as long as 62 hours without food before treatment and 24 hours without food afterward—so far have produced only small side effects, Longo says, such as fatigue and headaches. And as Barcellos-Hoff notes, "I think humans would be much grouchier after two days without food." But so far the method seems to be relatively well tolerated in small, carefully controlled studies. And "chemotherapy does make you feel really bad," Barcellos-Hoff says. So fasting "is a lot less unpleasant than many of the things cancer patients are subjected to."

But the results from human trials are not conclusive yet, and Barcellos-Hoff emphasizes that even if it has looked promising in mouse studies, fasting alone (without chemotherapy) should not be something patients attempt on their own. Especially for a patient who already has decent odds of survival, undertaking an unproved approach can be quite risky.

And although many diets and alternative treatment regimens exist, Longo cautions, "if you do it without the science, you can end up doing more damage than good." For example, when a fast is too long the immune system starts to suffer, potentially leaving a patient even less protected.

"Everything has to be timed so that it maximizes the damage to the cancer," he says. Research into that is still ongoing. Even just finding out whether fasting with chemo will be as successful in humans as it is in mice might not come quickly. "You have so many cancers and so many chemos that it's almost like a never-ending process," Longo says.

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

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New Therapy Might Help Relieve Painful Foot Condition

WEDNESDAY Feb. 8 (HealthDay News) -- For people struggling with plantar fasciitis --- a painful and sometimes disabling foot condition -- a small, preliminary study suggests that a new type of therapy is more effective than standard cortisone injections in restoring mobility.

So-called "platelet-rich plasma" therapy is injected directly into the foot. It harnesses two main ingredients found in blood -- plasma and platelets -- to promote inflammation, connective-tissue growth and vascular healing. This contrasts with cortisone injections, which are designed to reduce inflammation.

"The focus here is on very difficult patients for whom well-recognized nonsurgical and surgical approaches are not effective," said study author Dr. Raymond Monto, an orthopedic surgeon with Nantucket Cottage Hospital in Nantucket, Mass. "Because while 90 percent of patients usually get better with standard treatment, about 10 percent don't.

"For these patients cortisone shots just don't help," Monto added. "The initial benefit degrades very quickly, and eventually by six months, and certainly by one year out -- you are back where you started.

"But among these sorts of patients I was very encouraged by the results with [platelet-rich plasma therapy]," Monto continued. "For most, after just one shot, we saw dramatic improvements. We're talking about the restoration of well over 90 percent of normal function lasting at least a year after treatment."

Monto was slated to present his findings Tuesday at a meeting of the American Academy of Orthopaedic Surgeons in San Francisco.

According to the American Academy of Podiatric Sports Medicine, plantar fasciitis is the most common musculoskeletal problem in the United States, typically prompted by aerobic injury or poor shoe support.

The painful condition arises from inflammation of the connective tissue running from the heel to the ball of the foot, tissue known as plantar fascia, which in turn places heavy stress on the bottom of the foot. Commonly, the condition will begin when a person feels a sharp pain in their heel as they step down after being at rest.

Standard treatment can involve a mix of nonsteroidal anti-inflammatory drugs, stretching exercises, steroid injections, rest, orthotics, improved arch support, shockwave therapy and, in some cases, surgery.

The new study focused on 36 patients (16 men and 20 women), aged 21 to 74, struggling with a severe and chronic form of plantar fasciitis. None had experienced any relief following standard nonsurgical treatments.

The participants were divided into two groups. One received an ultrasound-guided injection of methylprednisolone (a steroid) at the injury site, while the other was treated with platelet-rich plasma.

While the steroid group showed notable improvement within the three months following treatment, foot function started to decline by the sixth month and continued on a downward trend through to the one-year mark.

The platelet-rich plasma group experienced better initial improvement and maintained increased function throughout the following year.

"Pretty much, if the patient treated with [platelet-rich plasma therapy] saw function go up by the four-week mark, then that function was maintained," Monto said.

"But, of course, one study doesn't change patterns of treatment," he noted. "So this should be viewed as a beginning point that raises awareness of the potential of [platelet-rich plasma therapy] for this type of treatment, and hopefully initiates more research."

Dr. Howard Luks, chief of sports medicine at Westchester Medical Center and N.Y. Medical College, both in Hawthorne, N.Y., described the platelet-rich plasma therapy exploration as "worthwhile," but added that questions remain.

"The reason there has been such an interest in [platelet-rich plasma therapy] is because cortisone is degenerative," he said. "It doesn't heal tissue. It actually can damage tissue with repeated injections. So we never, as orthopedists, really had a regenerative injection option available to us."

However, platelet-rich plasma therapy "is somewhat of a controversial subject, because at this point not all [platelet-rich plasma therapy] is equal," Luks added. "Different manufacturers take a different level of the blood. Some take the white cells, some don't; some exclude platelets, some don't. So the orthopedics community at large is still sort of saying that before we adopt this widely, let's figure out exactly what we're doing and what's the best preparation. And those studies are now under way."

Unlike cortisone treatments, platelet-rich plasma therapy is not covered by insurance. Luks said that, in his experience, costs for the new treatment can range anywhere from $270 an injection to as much as $3,000.

Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

More information

For more on plantar fasciitis, visit the U.S. National Library of Medicine.

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