Intake of dietary copper helps Alzheimer’s patients

As one of the services for patients with Alzheimer’s disease, the Department of Psychiatry at the Saarland University Medical Center offers participation in a clinical phase II trial. This clinical trial aims to elucidate a potential beneficial effect of copper orotate (an organic copper salt), which is given together with a standard cholinesterase inhibitor. A diagnosis of mild to moderate dementia of the Alzheimer type is a prerequisite. Besides clinical investigations, laboratory investigations of blood and cerebrospinal fluid, and magnet resonance imaging of the brain will be carried out. The study is being conducted by Professor Dr. Thomas Bayer, the Head of the Division of Neurobiology, and Dr. Frank Pajonk, a Psychiatrist, at the Department of Psychiatry, Saarland University Medical Center.

Treatment starts after all prerequisites to participate have been met. Half of the patients receive 8 mg copper orotate per day, the other half a placebo. Both patients and psychiatrists are blinded. During the 12-month long double-blind phase, there will be extensive laboratory, clinical and neuropsychological tests. After the double-blind phase, we offer an open-label phase for all patients. At present, 15 patients have finished the double-blind phase. The copper medication is well tolerated.

Alzheimer is characterized by the presence of amyloid plaques, which are composed primarily of A? peptide. A? is produced within neurons and is liberated from the larger amyloid ? protein precursor (A?PP). Lower levels of copper have been reported in the brain of A?PP transgenic mice and post-mortem in AD patients. This concept has been found to be true also in vitro by Professor Dr. Gerd Multhaup (FU Berlin) in 1999. Two recent papers, which have been published in PNAS in 2003 have proven a beneficial effect of elevated copper in transgenic A?PP mice. In the present study, the teams led by Bayer and Multhaup have found that low copper level in blood correlates with advanced memory deficits, as tested by the well established ADAS-cog neuropsychological test battery. Patients with higher blood copper levels make fewer mistakes in this memory test. This result supports the notion of a mild copper deficiency in AD patients. An increased uptake of dietary copper may therefore be therapeutically relevant.

The study has been published in the September 2005 issue of the Journal of Alzheimer’s Disease, Volume 8, Issue 1 published by IOS Press: “Cognitive decline correlates with low plasma concentrations of copper in patients with mild to moderate Alzheimer’s disease” (JAD, Vol. 8, Issue 1).

About the Journal of Alzheimer’s Disease

The Journal of Alzheimer’s Disease (j-alz) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer’s disease. The journal publishes research reports, reviews, short communications, book reviews, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research that will expedite our fundamental understanding of Alzheimer’s disease.

About IOS Press

Commencing its publishing activities in 1987, IOS Press (iospress) is a rapidly expanding scientific, technical, medical and professional publishing house focusing on a broad range of subject areas. Headquartered in Amsterdam, IOS Press publishes approximately 100 new books per annum and 70 international journals, covering topics ranging from computer science and mathematics to medicine and the natural sciences. Electronic access to all journals is now available. IOS Press also maintains offices in the Washington, DC area and Berlin and a co-publishing relationship with Ohmsha, Ltd (Tokyo).

Dr. Thomas Bayer
Case Western Reserve University

Senate Passes Foreign Aid Bill That Increases Funds To Fight HIV/AIDS, Malaria, TB Worldwide

The Senate on Thursday voted 81-12 to approve the fiscal year 2008 foreign aid spending bill (HR 2764) that would increase funds to fight HIV/AIDS, tuberculosis and malaria worldwide, the AP/International Herald Tribune reports. The $34 billion measure would increase President Bush’s $4.2 billion request for funds to fight HIV/AIDS globally by $940 million (Taylor, AP/International Herald Tribune, 9/6). The measure would increase the U.S. contribution to the Global Fund To Fight AIDS, Tuberculosis and Malaria to $590 million (HR 2764 text, 9/7). The bill would allow President Bush and future presidents to waive the President’s Emergency Plan for AIDS Relief’s abstinence spending requirement.

By law, at least one-third of HIV prevention funds that focus countries receive through PEPFAR must be used for abstinence-until-marriage programs (Kaiser Daily HIV/AIDS Report, 6/22).

The spending bill also would allocate $1.2 billion for the Millennium Challenge Corporation, a program meant to encourage economic and political reforms in developing countries. Bush requested $3 billion for MCC, according to the AP/Herald Tribune (AP/International Herald Tribune, 9/6). “A reduction of this magnitude is unacceptable and would severely undermine MCC’s efforts to reduce poverty in countries that practice good governance, particularly in Africa, and make it more difficult for the United States to meet its commitment to double aid to Africa by 2010,” the Office of Management and Budget said in a statement (Pulizzi, Dow Jones/Nasdaq, 9/6). Similar legislation passed the House in June, and the Senate bill must be reconciled with the House-approved measure (AP/International Herald Tribune, 9/6).

Reprinted with kind permission from kaisernetwork. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at kaisernetwork/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork, a free service of The Henry J. Kaiser Family Foundation© 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.

NICE appraisal of Alzheimer’s drugs, UK

Speaking about press coverage of the Institute’s technology appraisal on the use of donepezil, rivastigmine, galantamine
and memantine for the treatment of Alzheimer’s disease, NICE Chief Executive Andrew Dillon stated:

“The Institute would like to make it clear that contrary to recent press reports (The Observer 13 March and Daily Mail 14
March) it has not been asked or told by Ministers to reverse its advisory committee’s provisional recommendations on the use
of these drugs.

“Consultation on the provisional recommendations will continue until 22 March and anyone with an interest in the appraisal
can comment via our web site. The advisory committee will meet in June to consider the responses received and will prepare
final advice shortly afterwards.

“The Institute’s methodology and process for evaluating medicines has been assessed by the World Health Organisation to be of
the highest standard and the Board has full confidence in the conduct of the appraisal of the Alzheimer’s drugs.”

NICE has not yet issued new guidance to the NHS on the use of donepezil, rivastigmine, galantamine and memantine for the
treatment of Alzheimer’s disease; the final guidance is expected in October 2005. Until final guidance is issued the existing
NICE guidance no. 19 continues to apply.

About NICE

1 NICE is currently consulting on the use of rivastigmine, galantamine and memantine for the treatment of Alzheimer’s
disease, the closing date for comments is the 22 March 2005. If you would like to comment please go to the NICE website nice/page.aspx?o=245909.

2 NICE produces guidance in three areas of health:

– the use of new and existing medicines and treatments within the NHS in England and Wales – technology appraisals

– the appropriate treatment and care of patients with specific diseases and conditions within the NHS in England and Wales –
clinical guidelines.

– whether interventional procedures used for diagnosis or treatment are safe enough and work well enough for routine use –
interventional procedures.

3. NICE guidance and recommendations are prepared by independent groups that include professionals working in the NHS
and people who are familiar with the issues affecting patients and carers.

4. From 1 April 2005, the National Institute for Clinical Excellence will take on the functions of the Health
Development Agency. The new organisation will be the National Institute for Health and Clinical Excellence (also to be known
as NICE). It will be the independent organisation responsible for providing national guidance on the promotion of good
health and the prevention and treatment of ill health. The web address will continue to be nice.

About technology appraisals

5. The stakeholders involved in the appraisal are:

– Eisai Ltd
– Shire Pharmaceuticals LtdPatient/carer groups
– Age Concern Cymru
– Age Concern England
– Alzheimer’s Society
– Carers UK
– Carers Wales
– CJD Support Network
– Counsel and Care for the Elderly
– Dementia Care Trust
– Different Strokes
– Help the Aged
– Huntington’s Disease Association
– Mental Health Foundation
– Network of Self Help HIV & Aids Groups
– Neurological Alliance
– Parkinson’s Disease Society
– Pick’s Disease Support Group
– Stroke Association
– Terence Higgins Trust
– UK Coalition of People Living With HIV and AIDS
– Professional groups
– British Association of Neurologists
– British Association of Stroke Physicians
– British Geriatrics Society
– British Neuropsychiatry Association
– For Dementia• Royal College of General Practitioners
– Royal College of Nursing• Royal College of Physicians
– Royal College of Psychiatrists
– Royal Pharmaceutical Society


– Bath and North East Somerset PCT
– Department of Health
– North Tees PCT
– Welsh Assembly Government
– Commentators (no right of appeal)
– British Medical Association
– British National Formulary
– National Collaborating Centre for Chronic Conditions
– National Public Health Service for Wales
– NHS Confederation
– NHS Purchasing and Supplies Agency
– NHS Quality Improvement Scotland

Research groups

– Alzheimer’s Research Trust
– British Stroke Research Group
– Cochrane Stroke Group
– Creutzfeldt-Jakob Disease Surveillance Unit
– Dementia Research Group and Department of Old Age Psychiatry, Institute of — Psychiatry
– Institute for Ageing and Health
– Institute of Neurology

– Research Institute for the Care of the Elderly

6. Technology appraisals are recommendations on the use of new and existing medicines and treatments within the NHS in
England and Wales, such as:

a. medicines (for example, drugs)
b. medical devices (for example, hearing aids or inhalers)
c. diagnostic techniques (tests used to identify diseases)
d. surgical procedures (for example, repairing hernias)
e. health promotion activities (for example, patient education models for diabetes).

7. Our technology appraisal recommendations are prepared by an independent Committee, who include healthcare professionals
working in the NHS and people who are familiar with the issues affecting patients and carers. The Committee considers the
evidence on the clinical and cost effectiveness of the technology – this includes hearing the views of, and evidence from,
clinical health professionals, experts and patients.

8. NHS organisations in England and Wales have to make the resources and facilities available to enable NICE guidance to
be implemented. In January 2002 the Government announced a legal obligation for the NHS to provide funding for treatments and
drugs recommended by NICE as a part of its technology appraisals work programme.

9. NICE is currently in the process of developing a clinical guideline on the management of dementia, including use of
antipsychotic medication in older people. This will address the wider issue of care of patients with dementia (including
Alzheimer’s disease). This guideline is expected to be published in February 2007. More details can be found from nice/page.aspx?o=63355.

National Institute for Clinical Excellence (NICE)
MidCity Place
71 High Holborn
Tel: 020 7067 5800 (switchboard)
Fax: 020 7061 9815 (fax)
Please note that from 1 April 2005 NICE will join with the Health Development Agency to become the new National Institute for
Health and Clinical Excellence (also to be known as NICE). The web address for the new organisation will continue to be nice and contact details will remain unchanged.

Terry Pratchett: Living With Alzheimer’s For BBC TWO, UK

Bestselling author, Terry Pratchett, is 60 years old and has recently been diagnosed with early onset Alzheimer’s disease – but he’s not going to take it lying down. He wants Alzheimer’s to be sorry that it ever caught him.

As part of BBC TWO’s documentary strand focusing on mental health and wellbeing subjects, BBC Headroom, where high-profile personalities tackle a subject matter of personal importance to them – we join Terry Pratchett as he journeys into his uncertain future living with Alzheimer’s – a world ultimately without words.

Having sold almost 60 million books worldwide, Terry is a man whose imagination is in constant overdrive. The prospect of living without memories or words frightens him.

“I used to be a high speed touch typist. I laughed in the face of the spell checker. But then one day last year, it all started to go wrong.”

The first film begins in early 2008 soon after Terry’s diagnosis. As he battles with tying his tie and struggles to cope at a public reading of his new book, he explicitly discusses his anger at being diagnosed with an illness for which there remains no cure. The film follows Terry as he tackles the disease head on, tries out some alternative treatments, and confronts leading scientists about how close they are to ‘the secret cure, bubbling in a cauldron.’

Surprised by how subtle the effects and symptoms of the disease actually are, Terry meets other people who share the same rare diagnosis as him, each at various stages along this ‘dark and unknowing path.’ He visits his specialist for tests, using mini mental state examinations to determine the severity of his condition and which parts of his brain are being affected the most. His PA, Rob is probed to reveal more about Terry than Terry might know himself – after all ‘this is the disease that hides itself even from the person who has it.’

In the second film, Terry contemplates his future and the difficulty of facing the inevitable ‘end game.’ Terry travels across the pond to learn, first hand, how Americans are dealing with the ‘tsunami of Alzheimer’s’ that is threatening their health care to find out if they are closer to beating the disease.

“If you’re diagnosed with early onset Alzheimer’s, you feel as though you’re standing on a beach and the tide has gone out and so has everybody else. There’s no one there.”

In LA, Terry meets the unlikely doctor who has recently come across a controversial new Alzheimer’s treatment which he claims produces remarkable results in minutes, and in New York State he meets one of the leading experts in PCA (Posterior Cortical Atrophy), Terry’s variant form of the illness.

He confronts his probable future by visiting a care home devoted to residents with dementia, whilst evaluating the difficult dilemma thousands of carers are faced with when dealing with a loved one who can’t look after themselves.

Passionately determined to ‘name the demon’ and rid patients of the shame and stigma attached to this illness, Terry’s desire is to find a treatment, if not a cure, which will allow him to carry on writing for as long as possible – he doesn’t have any time to waste.

Terry Pratchett: Living With Alzheimer’s is produced by IWC Media for BBC TWO and commissioned by BBC Learning for BBC Headroom – the BBC’s two-year mental health and wellbeing initiative. This two-part series will be broadcast in January 2009.


- 2 x 60 minutes, BBC TWO, TX January 2009 (Date TBC)

- Launched in May 2008, BBC Headroom is a two-year mental health and wellbeing project. It aims to raise awareness of the importance of good mental health and de-stigmatise the problems surrounding the mental illness issues which face up to one in four of the population including anxiety, stress, depression and nervous breakdown.

- Previous BBC TWO documentaries in this strand for BBC Headroom where well-known personalities explore their personal mental health problems have included Losing It, a film charting Griff Rhys Jones’ issues with anger; Cracking Up, in which Alastair Campbell talked about the nervous breakdown he suffered in 1986, giving his first in depth account of this life changing event, revisiting the people, places, and landmarks of his breakdown and subsequent recovery; and Michael Portillo: Death Of A School Friend where Michael explored suicide as he looked back to when a close friend in his school class killed himself.

- Further documentaries announced for BBC TWO’s Headroom documentary strand include Self Harm and Meera, a sensitive film in which Meera Syal looks at the issue of self-harm in the UK. *TX date TBC

- bbc/headroom – home to the BBCHeadroom campaign – will host a range of advice, webcasts and wellbeing guides relating to Alzheimer’s disease.

- BBC Headroom has launched a mental health action line – 08000 933 193 – which offers callers advice about where to get support if they, or someone they know, is suffering from Alzheimer’s or dealing with other mental health issues.

BBC Headroom

Link Between Excessive Drinking, Poor Brain Health, Obesity

Prior research has shown that alcohol abuse and dependence are typically associated with higher rates of obesity, as evidenced by a high body mass index (BMI). Findings from a new study of the relationship between BMI and regional measures of brain structure, metabolite concentrations, and cerebral blood flow suggest that alcohol-related brain injuries may result from a complicated fusion of hazardous drinking, chronic cigarette smoking, and even elevated BMI.

Results will be published in the December 2010 issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

“Although alcohol doesn’t contain fat, it contains seven calories per gram, which comes second only to fat, which has nine calories per gram,” said Stefan Gazdzinski, who was a researcher at Northern California Institute for Research and Education in San Francisco when the study was carried out but is now a researcher at Jagiellonian University in Poland. “These calories add up over time. In fact, daily consumption of more than 30 grams of ethanol – the amount of alcohol in two to three 12-ounce beers – is associated with risk for abdominal obesity.”

“Abdominal obesity has higher health risks that fat deposition in other body areas, for example, legs and hips,” added Susan F. Tapert, a professor of psychiatry at the University of California, San Diego and director of Substance Abuse/Mental Illness in the VA San Diego Healthcare System. “As obesity rates are increasing rapidly among alcoholics and non-alcoholics, these relationships are important to understand.”

“Excessive weight is not only a risk factor for cardiovascular disease or diabetes, but it is also a risk factor for developing dementia,” said Gazdzinski, also the study’s lead author. “Obesity has been shown to be associated with worse decision making and problem solving throughout lifetime. We had previously observed lower concentrations of some brain metabolites, markers of brain injury, in healthy non-alcohol dependent people with BMIs in the overweight to obese range. Knowing that individuals in developed countries who overuse alcohol are usually heavier than individuals enjoying alcohol in moderation – because of the caloric intake – we wanted to investigate if excess weight accounts for some of the brain injury usually observed in alcoholics.”

Gazdzinski and his colleagues retrospectively analyzed data gathered from 54 alcohol-treatment seeking men who had been abstinent from alcohol for about one month. BMI, as well as imaging that assessed volume, blood flow, and metabolite concentrations of the brain were obtained from a 1.5 Tesla magnetic resonance scanner.

“It is commonly believed that it is the large amount of consumed alcohol by itself that leads to brain injury in alcoholics,” said Dieter J. Meyerhoff, professor of radiology at the University of California San Francisco and San Francisco Veteran’s Affairs Medical Center, and the principal investigator of this study. “This is only partly correct. In previous studies, we have shown that alcoholics who smoke cigarettes have greater brain injury than nonsmoking alcoholics. This new study suggests that a high BMI, independent of drinking and smoking, is also associated with brain injury.”

“In other words, weight also is related to brain health among those with alcoholism,” said Tapert. “BMI may be a very important factor to consider when examining other potential consequences of alcohol use. Since individuals who consume substantial amounts of alcohol are at risk for obesity, it is important to understand the influence of body fat deposition on the measures we are examining. It could be that metabolic changes resulting from or causing obesity cause harm to the brain, at least among alcoholics.”

The relationship between alcohol dependence and BMI is complicated, added Gazdzinski. “Alcoholics who drink the most are not necessarily the heaviest,” he said. “In our sample, there was no correlation between drinking severity and BMI. Factors such as availability of funds for drinking may play a role, especially in countries where alcohol is heavily taxed. For example, the drinker may have not enough money to eat properly after drinking.”

“While it is fortunate that tobacco use, violent crime, and some other unhealthy behaviors have declined in recent years, heavy drinking has remained relatively stable, and obesity rates have greatly increased,” said Tapert. “These findings point to another deleterious outcome of becoming overweight: poor brain health. While it may be that poor brain cell functioning has led to the challenges these men faced with overconsumption of food and alcohol, it is also possible that the obesity itself contributed to poor brain health. If so, weight loss, exercise, and improved self-care in addition to stopping drinking could result in improvements to brain health.”

Stefan Gazdzinski, Ph.D.

Jagiellonian University

Susan F. Tapert, Ph.D.

University of California, San Diego

Alcoholism: Clinical & Experimental Research

First High-Res 3D Structures Of Mammalian HSP90 Protein Solved

Dr. Dan Gewirth, Hauptman-Woodward senior research scientist, has just solved the structure of the first mammalian GRP94 protein implicated in immune diseases such as sepsis, AIDS and certain cancers. His work is published in a cover article in a top scientific journal — Molecular Cell.

Gewirth’s study confirms his 2001 hypothesis that this protein — GRP94 — is from the same family as the better known HSP90 proteins. As ligand-regulated chaperones — proteins that help other cellular proteins achieve their active shapes, the HSP90s are key players in cellular regulation and recognition. The HSP90 proteins have been the subject of increasing international interest as scientists have discovered that they can be targeted therapeutically with drugs that lead to either stimulation as well as inhibition. For example, inhibitors of HSP90s are being developed as therapies for diseases ranging from cancer to sepsis, and drugs that stimulate HSP90 action may be appropriate therapies for diseases involving protein folding, such as cystic fibrosis, prion diseases , and Alzheimer’s Disease.

Since 2001, Gewirth and his lab have been using the technique of X-ray diffraction to solve the first high-resolution structure of this protein from mammalian origins, to understand its function and to determine if it is indeed a member of the HSP90 family of proteins. The structure and activity patterns of this protein prove conclusively that this is indeed a member of the same family.

“Our work opens the door to a more intensive evaluation of this protein both from a mechanistic as well as a therapeutic point of view. In addition to aiding our understanding of the fundamental biology of chaperone-mediated protein folding, this work lays the foundation for the design of drugs that specifically target individual members of the hsp90 family” Gewirth, who also holds a post as an associate professor in the Structural Biology department of the University at Buffalo which is housed at the Hauptman-Woodward Medical Research Institute, said.

Why Is This Important?

This is groundbreaking work for a number of reasons: It is the first high resolution picture of any member of the hsp90 family. High resolution is needed for a detailed understanding of protein function. It is also the first structure of a mammalian member of the hsp90 family. This is important since drugs and other therapeutics need to be developed for human use, and thus must target the mammalian protein. Finally, the work shows for the first time how members of the hsp90 family of chaperone proteins can differ from each other, while still being part of the same overall family.

Scientific Understanding

The mammalian member of this protein family is different than those previously studied which were solved from either bacteria or yeast. Human energy production and consumption rates are more similar to those found in the GRP94 proteins than to the more widely studied HSP90 proteins. This means that the insights gained by a greater scientific understanding of how GRP94 works will have more direct applications to human diseases.

Medical Implications and Drug Development

Inhibitors currently are being designed for HSP90 in an attempt to treat the diseases in which HSP90 plays a role. However, these are broad-spectrum inhibitors of all HSP90s which means that unwanted side effects may occur. The Gewirth lab’s work clarifies GRP94′s place in this family and has already stimulated interest in this chaperone as a drug target. This understanding would allow for the long-term development of a family of drugs that could be narrowly targeted for individual proteins, for example specifically treating sepsis only.

Economic Impact

Just as companies have been founded to develop HSP90 inhibitors, the same potential exists here. “This will spur a new line of inquiry into GRP94. While this work is its infancy, medicinal chemists will be interested in developing GRP94-targeted drugs,” Gewirth said.

Other authors of the publication include: D.Eric Dollins, recent Ph.D. graduate from Duke University, Joshua J. Warren, post-doctoral fellow at Duke University and Robert M. Immorrino, recent Ph.D. graduate from Duke University.

About Gewirth

In addition to his position as an HWI senior research scientist, Gewirth is an associate professor of Structural Biology at the University at Buffalo. Prior to joining HWI in 2005, Gewirth was an assistant professor in the Department of Biochemistry at Duke University. He completed post-doctoral research at both Yale and Harvard, received his Ph.D. from Yale University in 1988 and his bachelor’s degree from the University of Chicago in 1982. Gewirth’s research is focused primarily on structural studies of HSP90 chaperones, drug design, protein folding; nuclear hormone receptors; and basal transcription factors. Gewirth and his wife live in Buffalo.

About HWI

With more than 50 years of exceptional scientific research, HWI is an independent, non-profit facility specializing in the area of fundamental biomedical research known as structural biology. Hauptman-Woodward’s team of more than 75 staff members is committed to improving human health by studying the causes of diseases, as well as potential therapies, at their basic molecular level. HWI is located in the heart of the Buffalo Niagara Medical Campus in downtown Buffalo, New York, in a new state-of-the-art structural biology research center at 700 Ellicott Street. For more information, visit HWI’s website at hwi.buffalo/.

Source: Tara A. Ellis

Hauptman-Woodward Medical Research Institute

UNICEF Positions Emergency Supplies For Tropical Storm As Cholera Outbreak Continues In Haiti

UNICEF is rushing to ensure adequate emergency supplies in preparation for a severe tropical storm, as it works with UN and NGO partners to support the Government of Haiti’s response to the recent cholera outbreak.

“UNICEF staff have been working with our partners around the clock to help address and contain the cholera outbreak,” said Ms Francoise Gruloos-Ackermans, UNICEF Representative in Haiti. “Now, the potential landfall of this tropical storm endangers the work completed to date and poses a new threat of the water-borne cholera disease being spread by inland flooding.”

“This latest threat comes as the country is struggling to recover from the devastating earthquake that struck last January,” Ms Gruloos-Ackermans added.

UNICEF is working in close partnership with WHO, WFP and OCHA to coordinate this international response, particularly in light of the fact that in the combination of cholera, a tropical storm, and the aftermath of the January earthquake threaten to create the ideal conditions for an emergency of nation-wide proportions. A priority will be on safeguarding and reducing impacts on children and mothers.

UNICEF is also coordinating with its NGO partners throughout Haiti in responding both to the cholera outbreak and preparing for the forecasted arrival of tropical storm. Coordination with WHO-OPS is underway with the Ministry of Health for the development of the cholera multi-sectoral response plan.

According to information released today by the Haitian Ministry of Health, there have been 442 deaths and 6,742 hospitalizations attributed to cholera in numerous locations throughout the country, suggesting that the disease continues to spread rapidly.

Special emphasis for the cholera response has been on informing communities and families about the preventative actions they can take to protect themselves from cholera. Community mobilizers are sharing health and sanitation-related information with residents as they distribute UNICEF-supplied oral rehydration salts and water purification tablets. Patients and their families being treated at health care facilities are also receiving preventative information.

UNICEF is focusing supply distribution efforts in areas southwest of Port-au-Prince with the distribution of medical, nutrition, and sanitation stocks. Tropical storm contingency supplies are being prepositioned in communities throughout Haiti, including areas not directly affected by the cholera outbreak. These supplies include water purification kits, tarpaulins, oral rehydration salts, jerrycans, water purification tablets, and zinc tablets, which reduce the effects of diarrhoea.

UNICEF is also prepositioning additional health, nutrition, water, sanitation, and hygiene supplies, including essential drugs, therapeutic foods, buckets, soap, tarpaulins, water bladders, and chlorine purification powder, for Grande Anse, South and Southeast departments of this Caribbean nation, areas which risk being isolated due to heavy rain.

These emergency supplies are in addition to already prepositioned storm response stocks that have been depleted as a result of the unanticipated outbreak of cholera in the Artibonite region north of the capital.

Pre-positioned stocks, however, may not be sufficient. Urgently needed are additional water, hygiene, and sanitation supplies. UNICEF Haiti is sourcing many of its stocks directly from suppliers worldwide.



UNICEF Expands Its Cholera Response In Haiti And Launches A Massive Social Mobilisation Campaign

UNICEF, alongside international NGO partners, is reinforcing its outbreak response by assisting cholera medical structures. In coordination with the Health Ministry and the Pan American Health Organization (PAHO) UNICEF is scaling up its assistance to Cholera Treatment Centres, Unit Treatment Centres and ORS Points. The fatality rate remains worrisome and children continue to pay a heavy price since they represent over half of the Haitian population.

More than three weeks into the outbreak, a national community and social mobilisation strategy has been finalised with the use of mass media communication such as radio, television and SMS targeting at least 80 per cent of the total population. The strategy is being implemented in partnership with sectoral ministries, volunteers, civil society groups, wireless phone network Voil?  and other private sector groups. In alignment with this plan UNICEF has developed a national and community strategy and plan for massive social mobilisation.

UNICEF and partners have also been disseminating prevention messages to 5,000 vulnerable schools representing a total 1.2 million children and 600 Residential Care Centres serving more than 30,000 children.

“We are actively coordinating, with the government and our main partners, the delivery of emergency supplies along with a social mobilisation strategy” said Francoise Gruloos-Ackermans, UNICEF Representative in Haiti. “One of our teams was delivering messages at Sacr?© Coeur Church this Sunday in the capital. Our objective is to support more social networks in order to increase our reach in our mobilisation campaign.”

UNICEF is working to support communities where the outbreak has already taken hold, and is also providing supplies, such as soap, water disinfection tablets, and hygiene kits to help prevent the disease from spreading further. Forty medical structures and 74 partners – including MSF- have been assisted by UNICEF. Since the beginning of the cholera epidemic UNICEF has been supplying ongoing procurement of essential lifesaving supplies. The following includes available and sent items:

– 13.8 million aquatabs,

– 2 million ORS sachets,

– 610,000 soap items,

– 7,770 kg of chlorine products,

– 763 tents to set-up Cholera Treatment Centres/Units.

The scope of the epidemic will require a large-scale intervention at the national level, including efforts to promote health-seeking behaviors and sensitize the population on the need to urgently seek care as soon as symptoms occur. More specialized medical staff such as nurses and hygiene workers will be needed urgently in hospitals nationwide. “UNICEF is joining other partners in an urgent call to mobilize nurses with previous cholera treatment experience within and outside the country to assist the present response,” said Gruloos-Ackermans.



Rheumatoid Arthritis And Risk Of Heart Attack

Rheumatoid Arthritis (RA) patients face a two-fold increased risk of suffering a Myocardial Infarction (MI, heart attack) versus the general population, which is comparable to the increased risk of MI seen in diabetes patients, according to results of a new study presented at EULAR 2010, the Annual Congress of the European League Against Rheumatism in Rome, Italy.

In this Danish, nationwide, 10 year study, RA and diabetes patients were directly compared to assess their individual risk of having an MI over time. In those patients that developed RA, the Incidence Rate Ratio (IRR) of experiencing a MI was increased to 1.65 (95% Confidence Interval (CI) 1.46-1.86), comparable to the increased risk of MI seen in patients developing diabetes mellitus (IRR 1.73 95% CI (1.68-1.79)). Data was further analysed to examine increased risk in certain age groups and researchers found that the risk of MI was increased six-fold in women with RA younger than 50 years (IRR 6.01 95% CI (3.62-9.99)) comparable to diabetic women in the same age range (IRR 6.13 95% CI (4.99-7.54)). Overall, the risk of MI in patients with RA and diabetes was similar for male patients at IRR 1.66 (1.39-1.98) and 1.59 (1.53-1.66) respectively.

“While we already know that RA is an independent risk factor for cardiovascular disease, our data highlight that the increased risk of a heart attack faced by RA patients is of a similar magnitude as that faced by diabetes patients, who in contrast to RA patients are routinely considered for intensive cardiovascular risk management,” said Dr. Jesper Lindhardsen, Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark, and lead author of the study. “This study underlines the importance of implementing EULAR recommendations advocating early detection and management of cardiovascular risk factors, as well as providing sufficient RA treatment in order to reduce the significant burden associated with cardiovascular disease co-morbidity and mortality.”

The study, which was supported by the Danish Rheumatism Association, analysed data from the entire Danish population (n=4,614,840, minimum 10 years old) and monitored for incidence of diabetes and RA between 1997 and 2006 (or the date of patients first MI, whichever came first). A total of 10,547 people developed RA and 132,868 developed diabetes. IRR was calculated and analysed by multiple Poisson regression, a statistical technique utilised for modeling and analyzing several variables in a patient population.

Abstract Number: OP0164

Rory Berrie

European League Against Rheumatism

Studying Streptococcus Pneumoniae Bacteria Grown In Space

When the space shuttle Endeavour touched down at the Kennedy Space Center August 21, University of Texas Medical Branch at Galveston microbiology and immunology department chairman David Niesel was waiting by the runway, looking forward to a reunion with some of its passengers.

The space travelers Niesel was meeting weren’t astronauts. They were Streptococcus pneumoniae bacteria, members of a species commonly found in the human upper respiratory tract but in this case riding in sealed experimental containers in the shuttle’s mid-deck.

Streptococcus pneumoniae is what’s known as an “opportunistic bacterium,” one that’s normally harmless but always ready to exploit the right circumstances and cause full-blown disease. For infants, the elderly and others with weaker-than-normal immune systems — possibly including astronauts on long space flights — it can be quite dangerous.

“Strep pneumoniae is a very potent pathogen in people who are immunosuppressed — it’s the number-one cause of community-acquired pneumonia, and a leading mediator of bacteremia [bacterial blood infections] and meningitis,” Niesel said. “There’s a decline in people’s immune function the longer they’re in the space environment, and it’s been shown that other bacteria also alter their properties in microgravity — they grow faster, they tend to be more virulent and resistant to microbial treatment.”

Niesel and other investigators want to know exactly how Streptococcus pneumoniae changes in microgravity and whether those changes could pose a threat to crew members on a mission with no chance of a quick return to Earth — for example, a months- or years-long journey to Mars and back. In 1999, they began work on SPEGIS (Streptococcus pneumoniae Expression of Genes in Space), a project to grow the bacteria in orbit and bring them back home frozen in “zero-g mode” for study.

Eight years later, six tightly sealed vials of the bugs were launched into orbit in a cold-storage experiment locker that kept them inactivated at about 39 degrees Fahrenheit. To make sure that the shuttle crew would not be exposed to a potential pathogen, the vials themselves were also packed into two sealed aluminum canisters.

On day five of the mission, with the shuttle docked to the International Space Station, the crew raised the canisters and their contents to just above human body temperature and incubated them there for 15 and a half hours. Then they transferred them to a super-cold freezer on the ISS, which dropped the temperature of the canisters to 139 degrees below zero Fahrenheit.

“That locked the bacteria at whatever stage they were at, whatever genes they were expressing and whatever proteins they had present were locked in, because no more metabolism was occurring,” Niesel said. “So we get a picture of what they were like in space at that time, which is the cool part.”

Control experiments conducted on Earth followed every step of the process as it was done in orbit, with canister transfers even timed to the minute. “Now we have two snapshots of the bacteria frozen in time, grown with the same parameters except the microgravity part, and we should be able to see the differences that result when the bacteria see this unique space environment,” Niesel continued.

The bacteria are expected to arrive in Galveston later this week or early next week, kept cold with dry ice all the way to maintain them just as they were in orbit. Once he gets the bacteria in his lab, Niesel plans to conduct complete protein and genetic analyses, as well as possible virulence studies in laboratory mice.

“Seeing the Endeavour land was the culmination of many years of preparation, persistence and uncertainty — we were originally scheduled to fly shortly after the Columbia accident — but it’s been worth the wait to get the chance to make one of the first studies of an opportunistic pathogen in space,” Niesel said. “We think it will provide important information for understanding the adaptation of bacteria to unique environments, and begin to answer the question of whether this species is a cause for concern for long-duration space travelers.”

The University of Texas Medical Branch at Galveston
Public Affairs Office

Source: Jim Kelly

University of Texas Medical Branch at Galveston