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The most common form of malignant brain cancer in adults, glioblastoma multiforme (GBM), is not a single disease but appears to be four distinct molecular subtypes, according to a study by The Cancer Genome Atlas (TCGA) Research Network. The researchers of this study also found that response to aggressive chemotherapy and radiation differed by subtype. Patients with one subtype treated with this strategy appeared to succumb to their disease at a rate approximately 50 percent slower than patients treated with less aggressive therapy. This effect was seen to a lesser degree in two of the subtypes and not at all in the fourth subtype.

Although the findings do not affect current clinical practice, the researchers said the results may lead to more personalized approaches to treating groups of GBM patients based on their genomic alterations. The study, published Jan. 19, 2010 in Cancer Cell, provides a solid framework for investigation of targeted therapies that may improve the near uniformly fatal prognosis of this cancer. The research team for TCGA is a collaborative effort funded by the National Cancer Institute (NCI) and the National Human Genome Research Institute (NHGRI), both parts of the National Institutes of Health.

“TCGA is mobilizing the entire cancer community to find new strategies in detecting and treating cancer faster,” said NIH Director Francis Collins, M.D., Ph.D. “These findings are just a hint of what we expect to result from the comprehensive data generated by TCGA over the next few years.”

GBM is a very fast-growing type of tumor. In recent years, 3 of every 100,000 Americans have been diagnosed with GBM, representing the highest incidence rate among malignant brain tumors. Most patients with GBM die of the disease within approximately 14 months of diagnosis.

“These new findings offer critical insights into stratifying patients based on the unique molecular characteristics of their disease,” said John E. Niederhuber, M.D., NCI director. “As we learn more and more about the genetic underpinnings of cancer, we hope to achieve a similar level of molecular understanding for all cancers and eventually to generate recipes of highly targeted therapies uniquely suited to the individual patient.”

The TCGA researchers expanded on previous studies, which had established gene expression profiling as a means to identify distinct subgroups of GBM.

“We discovered a bundle of events that unequivocally occur almost exclusively within a subtype,” said lead author D. Neil Hayes, M.D., University of North Carolina at Chapel Hill. “These are critical events in the history of the tumor’s development and spread, and evidence is increasing that they may relate to the initial formation of the tumors.”

TCGA researchers reported that the nature of these events indicate that the underlying pathology of each subtype may begin from different types of cells. This may provide a better understanding of which cell types undergo changes that ultimately drive initial cancer formation. This finding has potential clinical significance since determining the types of cells that form GBM is critical for establishing effective treatment regimens. Because the response to aggressive chemotherapy and radiation differed by subtype, some classes of drugs would be expected to work for some tumor subtypes and not others.

“The ability to differentiate GBM tumors based on their altered genetic code lays the groundwork for more effective treatment strategies to combat this deadly cancer,” said Eric D. Green, M.D., Ph.D., NHGRI director. “These findings demonstrate the power of using a cancer’s genome to unravel the molecular changes that occur in the various cancer types targeted by TCGA. I’m optimistic that this type of knowledge will someday lead to improved personalized therapies and care for cancer patients.”

The new findings build on TCGA’s detailed view of GBM genomic changes reported in Nature in October 2008. TCGA, launched in 2006, is a comprehensive and coordinated effort to accelerate understanding of the molecular basis of cancer through the application of genome analysis technologies, including large-scale genome sequencing.

TCGA data are being made rapidly available to the research community through a database, http://cancergenome.nih.gov/dataportal. The database provides direct access to most analytic datasets, with other data, such as patient treatment records, available to qualified researchers through an NIH review and approval process.

The TCGA Research Network consists of more than 150 researchers at dozens of institutions across the nation. A full list of participants is available at http://cancergenome.nih.gov/wwd/program.

Treating depression may help people with diabetes get their blood sugar under control.

In a study of low-income minorities with poorly controlled diabetes, researchers found that antidepressant therapy was associated with improved long-term blood sugar control and reduced blood pressure.

Rates of depression in people with diabetes are double those in the general population, and even higher among minorities, who are more prone to worse blood sugar control, more diabetes complications, and more severe depression, the researchers point out. Yet few studies have focused on the effect of depression treatment among minorities with uncontrolled diabetes.

To investigate, Dr. Mayer B. Davidson and his colleagues at Charles Drew University in Los Angeles screened low-income patients attending a diabetes clinic for depression.

Ultimately, the study included 89 patients; 45 were randomly assigned to receive the antidepressant medication sertraline (sold as Zoloft) and 44 to a placebo. Everyone in the study also attended monthly diabetes group education programs.

Thirty-nine patients in each group were Hispanic, five were African American, and 1 in the sertraline group was listed as “other.”

According to the investigators, after six months, blood sugar levels had fallen significantly in the sertraline group. That is, hemoglobin A1C levels, a standard measure of long-term blood sugar control, fell 2.0 percent, from 10.0 percent at the outset to 8.0 percent at six months. In general, it’s recommended that people with diabetes strive for an A1C level below 7.0 percent.

In contrast, there was only a 0.9 percent drop in A1C levels in the placebo group (from 9.7 percent at the outset to 8.8 percent at six months).

Blood pressure also fell to a greater degree with sertraline than with placebo, while both groups had similar significant improvements in depression, pain and quality of life.

These results, the researchers say, suggest that patients with diabetes should be screened for depression. For those found to have depression, “an antidepressant should be considered,” they advise.

In this manner, both depression and uncontrolled diabetes and blood pressure “may be improved.”

While the war against HIV/AIDS is still far from over, 2009 could prove to be a watershed year in terms of advances in prevention and treatment, experts say.

The view on this World AIDS Day, Dec. 1, does seem a bit brighter. In fact, just last month a United Nations report found that the number of people infected with HIV globally has remained unchanged, at about 33 million, for the past two years, and may have peaked in the late 1990s.

Why the change? One big reason could be expanded access to antiretroviral drugs. A report released in October by the World Health Organization, UNICEF and UNAIDS found that 42 percent of people in the developing world who carry HIV now have access to life-extending medications. By the end of 2008, more than 4 million people worldwide were on antiretroviral medicines — 2.9 million of them in sub-Saharan Africa, where the bulk of HIV-positive people live. That’s a tenfold increase in access over the prior five years.

“I think this has come about through a number of organizations that have been trying to get drugs to be available to people in the developing world,” said Dr. Anthony Fauci, director of the U.S. National Institute of Allergy and Infectious Diseases. He especially credited the President’s Emergency Plan for AIDS Relief (PEPFAR), begun under the second Bush presidency, which he said “is responsible for over 2 million people being on therapy.”

Other nonprofit groups — most notably the Clinton Foundation and the Gates Foundation — have also led the charge, helping to broker price-reduction schemes with pharmaceutical companies for the cheap distribution of AIDS drugs in poorer nations.

More widespread access to treatment may also pay dividends in prevention, one expert noted.

“I think this is an interesting story that’s been emerging this year, as well — the possibility that people who are on antiretroviral therapy are less infectious,” said Rowena Johnston, director of research for the Foundation for AIDS Research (amfAR), based in New York City. She said that while the effect of widespread treatment on infectivity has yet to be proven, decreased viral load in infected people might help reduce the odds of their passing HIV on to others.

In fact, the U.S. Centers for Disease Control and Prevention and the U.S. National Institutes of Health are planning major studies in New York City and Washington, D.C., to see if better identification and treatment of HIV-positive people can help keep infection rates down across the community as a whole, Johnston said.

There was also promising news this year in terms of the search for an effective AIDS vaccine.

In October, researchers reporting in the New England Journal of Medicine confirmed that a combination of two vaccines brought about a modest, 31 percent reduction in infection rates among a cohort of 16,000 young adult volunteers in Thailand who were tracked for about three years. Analysis of the trial data suggested that the vaccines’ effect faded with time, however, and was less effective in those at highest risk of HIV, such as sex workers or IV drug abusers.

For these reasons, no one is calling the trial a success. However, “the reason that we think it is potentially important is that it’s the first time that we’ve ever seen the slightest positive signal” that immunization against HIV might work, Fauci said. “So, mild as [this result] is, at least it’s a step in the right direction.”

Johnston agreed, and called the trial an important stepping stone to further research.

“There’s going to be a lot of intensive effort looking at blood samples of the people who seem to have done well on the vaccine,” she explained. “If anybody can tease out what the magic ingredients are, that will form the cornerstone of how we move forward on AIDS vaccine development.”

There were also new glimmers of hope in terms of treatment. One major story was reported as a case study in February in the New England Journal of Medicine. The patient in question was both HIV-positive and had leukemia, and received a stem cell transplant to help cure the cancer. The transplant was unique, however, in that the donor carried a rare gene mutation providing virtual immunity to HIV.

The result: post-transplant, the patient now has no detectable level of HIV in his system.

Johnston stressed that such a therapy could never become a widespread treatment for HIV/AIDS, because the donor pool is so scarce and bone marrow transplants carry a 30 percent risk of death. But the case does offer intriguing possibilities.

“It’s a proof of concept that maybe you can cure HIV,” she said. “So, there’s been interest in finding out where you could do something similar with using gene therapy, for example,” bypassing the need for dangerous stem cell transplants.

Other advances in HIV/AIDS made headlines as well in 2009. In February, a topical microbicide gel was found to cut the odds of HIV infection in at-risk African women by 30 percent, while in September researchers at the International AIDS Vaccine Initiative said they’d discovered two immune-system antibodies that might become powerful, broad-spectrum targets for vaccine research in the future.

And in policy news, the Obama administration in late October lifted a decades-old ban on foreigners with HIV entering the United States. As reported by the Associated Press, Obama described the ban as a policy “rooted in fear rather than fact,” and said its removal would encourage HIV testing and help save lives.

Still, despite this year’s advances, HIV/AIDS continues its decades-long swath of destruction, both in the United States and globally.

As Fauci pointed out, the annual rate of new infections in the United States has been stuck at a dismal 56,000 for the past decade. “We’ve sort of hit a wall to get below that number,” he said. “We need to intensify the multifaceted prevention efforts that are ongoing.”

There are many things to do to prepare for your baby’s birth. That’s why establishing a birth plan — a list of preferences for labor and delivery — may be in order.

The Nemours Foundation offers these suggestions about what to include in a birth plan:
Your ideal scenario for pain management, fetal monitoring, which family members to have in the delivery room, and preferred birth positions.
Your wishes for baby’s treatment immediately following birth, including cutting the cord, and when you get to hold and feed the baby.
Your plan for feeding — do you want to breast-feed or use formula?
Your plan for the baby’s hospital stay. Should baby stay with you as much as possible, or should baby stay in the nursery?
Your emergency plan, including preparations for possible premature delivery or Cesarean section.

Your ability to make sense of Groucho’s words and Harpo’s pantomimes in an old Marx Brothers movie takes place in the same regions of your brain, says new research funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health.

In a study published in this week’s Early Edition of Proceedings of the National Academy of Sciences (PNAS), researchers have shown that the brain regions that have long been recognized as a center in which spoken or written words are decoded are also important in interpreting wordless gestures. The findings suggest that these brain regions may play a much broader role in the interpretation of symbols than researchers have thought and, for this reason, could be the evolutionary starting point from which language originated.

“In babies, the ability to communicate through gestures precedes spoken language, and you can predict a child’s language skills based on the repertoire of his or her gestures during those early months,” said James F. Battey, Jr., M.D., Ph.D., director of the NIDCD. “These findings not only provide compelling evidence regarding where language may have come from, they help explain the interplay that exists between language and gesture as children develop their language skills.”

Scientists have known that sign language is largely processed in the same regions of the brain as spoken language. These regions include the inferior frontal gyrus, or Broca’s area, in the front left side of the brain, and the posterior temporal region, commonly referred to as Wernicke’s area, toward the back left side of the brain. It isn’t surprising that signed and spoken language activate the same brain regions, because sign language operates in the same way as spoken language does — with its own vocabulary and rules of grammar.

In this study, NIDCD researchers, in collaboration with scientists from Hofstra University School of Medicine, Hempstead, N.Y., and San Diego State University, wanted to find out if non-language-related gestures — the hand and body movements we use that convey meaning on their own, without having to be translated into specific words or phrases — are processed in the same regions of the brain as language is. Two types of gestures were considered for the study: pantomimes, which mimic objects or actions, such as unscrewing a jar or juggling balls, and emblems, which are commonly used in social interactions and which signify abstract, usually more emotionally charged concepts than pantomimes. Examples include a hand sweeping across the forehead to indicate “it’s hot in here!” or a finger to the lips to signify “be quiet.”

While inside a functional MRI machine, 20 healthy, English-speaking volunteers — nine males and 11 females — watched video clips of a person either acting out one of the two gesture types or voicing the phrases that the gestures represent. As controls, volunteers also watched clips of the person using meaningless gestures or speaking pseudowords that had been chopped up and randomly reorganized so the brain would not interpret them as language. Volunteers watched 60 video clips for each of the six stimuli, with the clips presented in 45-second time blocks at a rate of 15 clips per block. A mirror attached to the head enabled the volunteer to watch the video projected on the scanner room wall. The scientists then measured brain activity for each of the stimuli and looked for similarities and differences as well as any communication occurring between individual parts of the brain.

The researchers found that for the gesture and spoken language stimuli, the brain was highly activated in the inferior frontal and posterior temporal areas, the long-recognized language regions of the brain.

“If gesture and language were not processed by the same system, you’d have spoken language activating the inferior frontal and posterior temporal areas, and gestures activating other parts of the brain,” said Allen Braun, M.D., senior author on the paper, “But in fact we found virtual overlap.”

Current thinking in the study of language is that, like a smart search engine that pops up the most suitable Web site at the top of its search results, the posterior temporal region serves as a storehouse of words from which the inferior frontal gyrus selects the most appropriate match. The researchers suggest that, rather than being limited to deciphering words alone, these regions may be able to apply meaning to any incoming symbols, be they words, gestures, images, sounds, or objects. According to Dr. Braun, these regions also may present a clue into how language evolved.

“Our results fit a longstanding theory which says that the common ancestor of humans and apes communicated through meaningful gestures and, over time, the brain regions that processed gestures became adapted for using words,” he said. “If the theory is correct, our language areas may actually be the remnant of this ancient communication system, one that continues to process gesture as well as language in the human brain.”

The first-ever State Indicator Report on Fruits and Vegetables, 2009 provides information for each state on how many fruits and vegetables people are eating, and it highlights three key areas within communities and schools that can be improved to increase access, availability, and affordability of fruits and vegetables.
What does the State Indicator Report on Fruits and Vegetables, 2009 show?

The report shows that no state is meeting national goals for the amount of fruits and vegetables Americans should be eating. According to Healthy People 2010, a framework for the nation’s health priorities, the goal is for at least 75% of Americans to be eating at least 2 fruits daily and for 50% to be eating at least 3 vegetables daily. However, only 33% and 27% of adults are meeting these goals, respectively, and even lower proportions of adolescents in grades 9–12 are meeting them (32% and 13%, respectively).

Fruits and vegetables contain essential vitamins, minerals, and fiber that may help protect you from chronic diseases, including stroke, other cardiovascular diseases, and certain cancers. However, it can be difficult for many Americans to eat the recommended amounts of fruits and vegetables each day because they might not be easily accessible, available, or affordable.
Three key areas that can be improved

Retailers, such as supermarkets and grocery stores that stock a variety of high-quality fruits and vegetables, are an important asset for the health of residents.
Only 8 states have a state-level policy for healthier food retail improvements, which can help increase the number of full-service grocery stores in areas where they are unavailable, increase the availability of healthier foods in small food stores, and promote healthier foods through information at the point of purchase.

Schools are in a unique position to influence and promote fruit and vegetable intake among youth, school staff, parents, and other community members.
Only 1 in 5 (21%) middle and high schools offer fruits and non-fried vegetables in vending machines, school stores, or snack bars.
Only 21 states have a state-level policy for farm-to-school programs that can increase fruit and vegetable access in schools, as well as increase nutrition and agriculture knowledge among children in school.

Food policy councils, which are organized, multi-stakeholder organizations, support systems changes to improve food environments. A systems approach to food considers many factors involved in getting fruits and vegetables from farms to consumers, including the roles of growers, processors, and retailers.
Only 20 states have a state-level food policy council, and 59 local food policy councils exist across the nation.

Decades of steady progress against heart disease may be on the wane, experts say, with a new study showing that only 7.5 percent of Americans are now in the clear when it comes to heart disease risk factors.

The continuing U.S. obesity epidemic may bear much of the blame for the downturn, the researchers added.

“Our results raise the concern that a worsening cardiovascular risk profile in the population could potentially lead to increases in the incidence and prevalence of cardiovascular disease,” said lead researcher Dr. Earl S. Ford, from the U.S. Centers for Disease Control and Prevention. “Potential increases in cardiovascular disease and diabetes could affect the nation’s medical costs.”

Another expert agreed. Dr. Gregg C. Fonarow, a professor of cardiology at the University of California, Los Angeles, called the study “a wake-up call to the entire country to take more responsibility for their health by knowing their own cardiovascular risk factor profile and, in consultation with their physician, to take proactive steps to reduce their cardiovascular risk.”

The report is published in the Sept. 14 online edition of Circulation.

For the study, Ford’s team collected data on adults 25 to 74 years of age. They specifically looked for low-risk factors for heart disease — items such as not smoking, having low blood cholesterol, normal blood pressure, normal weight and no sign of diabetes.

Using data from the U.S. National Health and Nutrition Examination Surveys, Ford’s group found that in 1971 to 1975, a paltry 4.4 percent of adults had all five of these heart-healthy factors. However, by 1994 that number had risen to 10.5 percent of adults.

But the latest data, from 2004, found that the fraction of American adults with all five healthy characteristics had dropped to 7.5 percent.

Minorities tended to fare worst, since whites tended to have more low-risk factors than either blacks or Mexican-Americans, the report found.

Why the slide back in terms of heart health? Ford cited three reasons: “decreases in the percentages of adults who were not overweight or obese, who had a favorable blood pressure, and who did not have diabetes.”

There was one “bright spot,” however, a “decrease in the percentage of adults who were not currently smoking,” Ford said.

Because excess weight is a major cause of diabetes and hypertension, it is critical that the percentage of adults who are overweight or obese be reduced, the researcher said.

“To effect such change, the efforts of many will be required,” he said. “Furthermore, efforts at reducing smoking and improving nutritional practices to lower cholesterol concentrations in the U.S. population should be sustained. Clearly, there is a lot of room for improvement.”

Rob M. van Dam, an assistant professor of medicine at Harvard Medical School and author of an accompanying journal editorial, said that “the decline in cardiovascular disease mortality in the U.S. seems to be coming to an end and may even reverse because obesity and obesity-related conditions such as hypertension and type 2 diabetes are on the rise.”

“This alarming development is occurring despite great improvements in medical interventions to prevent cardiovascular diseases,” he said. “It is of particular concern that these trends do not yet reflect the consequences of the current epidemic of childhood obesity.”

Millions of Americans are now beginning their adult lives obese, van Dam noted. That could greatly increase their risk of chronic diseases and premature mortality.

“To fundamentally address this issue, population-wide initiatives are needed to prevent obesity,” he said.

Fonarow agreed. “If these trends continue, the recent gains in life expectancy in the U.S. will be lost,” he said.