NEW DISEASE:PASLI P110 delta Activating mutation causing Senescent T-cells, Lymphadenopathy, Immunodeficiency

NIH Scientists Identify a New Immunodeficiency Disease Condition May be Treatable with Anti-Rejection Drug The NIAID Primary Immune Deficiency Clinic is located in the NIH Mark O. Hatfield Clinical Research Center. Credit: NIH. Scientists from the National Institute of Allergy and Infectious Diseases (NIAID) and National Human Genome Research Institute at the National Institutes of Health have identified a novel, genetic human immunodeficiency called PASLI disease. People with this disease have impaired immune responses, predisposing them to chronic infections and lymphoma, a form of cancer. After pinpointing the genetic cause of PASLI disease, researchers treated one patient with rapamycin, a drug approved by the Food and Drug Administration (FDA) to prevent transplant rejection. The therapy showed promise and will be further evaluated in other patients. The study appears in the October 28, 2013, online issue of Nature Immunology. Background Primary immune deficiency diseases (PIDDs) are rare, genetic disorders that impair the immune system. Without a functional immune response, people with PIDDs may be subject to chronic, debilitating infections, such as Epstein-Barr virus (EBV), which also can increase the risk of developing cancer. PIDDs may be diagnosed in infancy, childhood, or adulthood, depending on disease severity. They are estimated to affect more than 500,000 people in the United States. PIDDs usually are treated with therapies that broadly boost the immune response, such as regular infusions of antibodies from healthy blood donors. These therapies may not be completely effective or even target the underlying cause of disease. However, identification of the mutated gene responsible for a PIDD allows researchers to address the specific cause and test therapies that directly target the problem. NIAID runs a primary immune deficiency (PID) clinic, which operates on a referral basis. The goal of the clinic is to provide patients with an accurate disease diagnosis, particularly from a genetic standpoint, and help referring specialists improve patient care. Results of Study NIAID researchers and their collaborators identified a novel PIDD called PASLI disease, named after the mutated gene and its symptoms (p110 delta activating mutation causing senescent T cells, lymphadenopathy, and immunodeficiency). PASLI disease was initially detected in 6 patients who were referred to the NIAID PID Clinic. Upon further screening of the patients’ relatives, the disease was confirmed in 14 patients from 7 unrelated families of different ethnic and racial backgrounds. The patients have experienced recurring infections, including bacterial infections of the respiratory system and chronic viral infections with EBV, since childhood, and some have developed EBV-associated lymphoma. By studying this group, the researchers found that the patients have a mutation in their PIK3CD gene, resulting in an overactive protein called PI3K-p110 delta. PI3K proteins are essential for directing the growth and activity of many types of immune cells, and p110 delta is specifically involved in B and T cells, which make antibodies and recognize and eliminate infected cells, respectively. The mutated, overactive p110 delta protein causes a chain reaction of problems. By sending the wrong signals at the wrong times, it disrupts the normal development of B and T cells, increasing susceptibility to infection. The genetic information allowed the researchers to identify and target mTOR, an important signal that is excessively activated by p110 delta in PASLI patients. Drugs that block mTOR are already FDA-approved for the prevention of transplant rejection. One patient was treated with the drug rapamycin daily, which restored T cells to normal levels after 4 months. While the patient is not cured, normalization of T cells was adequate to improve disease symptoms. Significance The study has identified a novel immunodeficiency disease called PASLI, its underlying genetic cause, and a promising, targeted treatment that is already FDA-approved for other purposes. The discovery of PASLI disease also contributes to our understanding of the immune system and highlights the role of PI3K-p110 delta and mTOR in immunity. Next Steps NIAID researchers are currently treating more PASLI patients with rapamycin to better understand the drug’s clinical effects. In the future, patients also may be treated with drugs that target p110 delta, rather than mTOR. However, such drugs are still under development and some are being evaluated in human disease. Researchers also continue to optimize therapy for PASLI patients, who may eventually need to undergo bone-marrow transplantation to reboot their immune systems. Reference Lucas CL, Kuehn HS, Zhao F, Niemela JE, Deenick EK, Palendira U, Avery DT, Moens L, Cannons JL, Biancalana M, Stoddard J, Ouyang W, Frucht DL, Rao VK, Atkinson TP, Agharahimi A, Hussey AA, Folio LR, Olivier KN, Fleisher TA, Pittaluga S, Holland SM, Cohen JI, Oliviera JB, Tangye SG, Schwartzberg PL, Lenardo MJ, and Uzel G. Dominant-activating germ line mutations in the gene encoding the PI3K subunit p110d result in T cell senescence and human immunodeficiency.External Web Site Policy Nature Immunology (2013)

Obituary: Dr.Milton PUZISS developer of ANTHRAX VACCINE.

Date: 26 Oct 2013 Source: Washington Post [edited] Milton Puziss, a microbiologist who helped develop the 1st human vaccine against anthrax in the United States, died on 9 Oct 2013 at the Edenton retirement community in Frederick, Maryland. He was 93. The cause was congestive heart failure, said his daughter, Marla Puziss. Dr. Puziss was working for the Army Department at Fort Detrick, Md. when he developed an anthrax vaccine in the late 1950s with another scientist, George Wright. One purpose of the research was to find a vaccine to use in the case of a biological attack. Earlier anthrax vaccines had been developed in other countries. The Wright-Puziss vaccine was tested in clinical trials, and a version of it is widely used today. After 17 years with the Army Department, Dr. Puziss joined the National Institute of Allergy and Infectious Diseases in 1968. He conducted research on Legionnaire's disease and other bacterial and fungal diseases. He retired as chief of the NIAID bacteriology and virology branch in 1986. He was a recipient of the NIH Director's Award. Milton Puziss was born in Philadelphia and grew up in Shrub Oak, N.Y. After Army service in World War II, he graduated in 1948 from Kansas State University. In 1949, he received a master's degree in bacteriology and biochemistry from the University of Wisconsin, and in 1956, he received a doctorate in the same disciplines from the University of Southern California.

TORONTO GAIRDNER AWARDS ($100,000) : USA NIH Dr.Harvey J. ALTER co-discoverer of AUSTRALIA ANTIGEN

Lectured on Hepatitis C at the Sir Ka-shing LI GBM,KBE building of St.Michael's Teachimg hospital. Advised testing 48-68 age group. (Many used IV drugs between 1945 - 1965) 50% carriers not identified. 1-3% Worldwide infection. 60-70% show slow disease progress over 30 years 20- 30% develop cirrhosis in 15-40 years <5% develop cirrhosis in 5-10 years. Increased prevalence of Liver cancer due to Hep.C.

CT-011 (anti PD-1antibody)

J Immunother. 2011 June; 34(5): 409–418. doi: 10.1097/CJI.0b013e31821ca6ce PMCID: PMC3142955 NIHMSID: NIHMS292929 PD-1 blockade by CT-011, anti PD-1 antibody, enhances ex-vivo T cell responses to autologous dendritic/myeloma fusion vaccine Jacalyn Rosenblatt, MD,1 Brett Glotzbecker, MD,1 Heidi Mills,1 Baldev Vasir, PhD,2 Dimitrios Tzachanis, MD/PhD,1 James D. Levine, MD,1 Robin M. Joyce, MD,1 Kerry Wellenstein,1 Whitney Keefe,1 Michael Schickler, PhD,3 Rinat Rotem-Yehudar, PhD,3 Donald Kufe, MD,2 and David Avigan, MD1 Author information ► Copyright and License information ► The publisher's final edited version of this article is available at J Immunother See other articles in PMC that cite the published article. Go to: Abstract We have developed a cancer vaccine in which autologous tumor is fused with dendritic cells (DCs) resulting in the presentation of tumor antigens in the context of DC mediated costimulation. In clinical trials, immunologic responses have been observed, however responses may be muted by inhibitory pathways. The PD1/PDL1 pathway is an important element contributing to tumor mediated immune suppression. In this study, we demonstrate that myeloma cells and DC/tumor fusions strongly express PD-L1. Compared to a control population of normal volunteers, increased PD-1 expression was observed on T cells isolated from patients with myeloma. Interestingly, following autologous transplantation, T cell expression of PD-1 returned to levels seen in normal controls. We examined the effect of PD-1 blockade on T cell response to DC/tumor fusions ex-vivo. Presence of CT-011, an anti-PD1 antibody, promoted the vaccine induced T cell polarization towards an activated phenotype expressing Th1 as compared to Th2 cytokines. A concomitant decrease in regulatory T cells and enhanced killing in a cytotoxicity assay was observed. In summary, we demonstrate that PD-1 expression is increased in T cells of patients with active myeloma, and that CT-011 enhances activated T cell responses following DC/tumor fusion stimulation.

CureTech Ltd.Israel: PIDILIZUMAB (CT-011)

The company’s products are antibodies and peptide-therapeutics designed to modulate the immune response allowing it to exert its anti-cancer activity in an effective manner. Our lead product, pidilizumab (CT-011), is a humanized monoclonal antibody that interacts with PD-1, a B7 receptor-family-associated protein, and exhibits efficient anti-cancer immune response against a wide variety of mouse and human tumors. A Phase II program has been initiated including 3 sponsored studies: the first, a Phase II clinical trial in patients with diffuse large B cell lymphoma has been completed. Enrolment to 2 additional Phase II studies in patients with metastatic colorectal cancer and metastatic melanoma has been completed. In addition to these 3 studies, several investigator-initiated studies in different indications including follicular lymphoma, multiple myeloma, AML, renal cell carcinoma, pancreatic cancer and prostate cancer are ongoing.

CONN SYNDROME: Patient info.on adrenalectomy in Dutch.

http://www.nijsmellinghe.nl/1177/kijkoperatie-om-de-bijnier-te-verwijderen http://www.jeroenboschziekenhuis.nl/website/patientenfolders/URO/URO-063%20Laparoscopische%20verwijdering%20van%20de%20bijnier.pdf http://www.umcn.nl/Informatiefolders/4892-Laparoscopische_retroper-i.pdf http://www.erasmusmc.nl/cs-patientenzorg/2419534/2419537/214086/21416521/6088874-02_07aiOperatieaand1.pdf http://www.uza.be/behandeling/bijnierresectie http://www.nvacp.nl/page/Medisch/Aandoeningen/Bijnieren

USA "GARD": HEREDITARY ANGIOEDEMA

Who first described hereditary angioedema? Hereditary angioedema (HAE) was first described as a “syndrome” by Quincke in 1882 and was later detected in 1888 by William Osler to have a hereditary nature.[1] 1. Webb, M. et al. 2000. Management of children with hereditary angioedema: a report of two cases. Available at: http://www.aapd.org/assets/1/25/Webb-22-02.pdf. Accessed on October 11, 2013. The US Hereditary Angioedema Association Seven Waterfront Plaza 500 Ala Moana Blvd., Suite 400 Honolulu, HI 96813 Toll free: (866) 798-5598 Web site: http://www.haea.org/ Tamandra Carter Information Specialist The Genetic and Rare Diseases (GARD) Information Center is funded by two parts of the National Institutes of Health (NIH): the National Center for Advancing Translational Sciences Office of Rare Diseases Research (NCATS-ORDR) and the National Human Genome Research Institute (NHGRI). The GARD Information Center provides the public with access to current, reliable, and easy to understand information about rare or genetic diseases in English or Spanish. Information Specialists are available by phone Monday through Friday, 12:00 p.m. to 6:00 p.m. Eastern time (excluding Federal holidays). PO Box 8126 Gaithersburg, MD 20898-8126 Toll-free: 1-888-205-2311 Telephone: 301-251-4925 TTY: 1-888-205-3223 Fax: 301-251-4911 E-mail: GARDinfo@nih.gov Web site: http://rarediseases.info.nih.gov/GARD

DAILY MAIL : WORLD LITERACY

at the same level, whereas countries like Korea are showing huge improvement between generations Picture of Britain: This graph shows how the UK compared to other industrial nations when it came to numeracy Interesting: Countries like Japan, Netherlands and Sweden were the top performing in terms of literacy, even though children start school often years later than British youngsters Read more: http://www.dailymail.co.uk/news/article-2449481/Education-crisis-Up-8-5MILLION-numeracy-level-10-year-old.html#ixzz2hBd5fqRR

SCIENCE: NOBEL PRIZE FOR MEDICINE

Three researchers who studied how cells shuttle around essential molecules in tiny intracellular sacs have won this year’s Nobel Prize in physiology or medicine. James Rothman of Yale University; Randy Schekman of the University of California, Berkeley; and Thomas Südhof of Stanford University earned the award "for their discoveries of machinery regulating vesicle traffic, a major transport system in our cells," according to the announcement from the Nobel Assembly at Karolinska Institute in Stockholm. The three researchers independently unraveled basic cellular mechanisms several decades ago—in Schekman's case, almost 40 years ago. Although mistakes in cellular transport systems can cause a variety of diseases—including diabetes and neurological and immunological disorders—their work has not yet led to any new drugs or therapies, but it has helped others develop diagnostic tests. Schekman, who's also an investigator at the Howard Hughes Medical Institute (HHMI), a former editor of the Proceedings of the National Academy of Sciences, and the current editor-in-chief of the open access journal eLife, studied intracellular transport in yeast cells in the 1970s. He identified cells whose transport machinery didn't function properly, causing the vesicles to pile up in the cell, and identified the mutated genes responsible for those problems—a discovery that helped understand how intracellular traffic works under normal circumstances. Rothman, who has been at Yale since 2008, is honored for work he did on vesicular transport in mammalian cells while at Stanford University, Princeton University, and the Memorial Sloan-Kettering Cancer Center in the 1980s and 1990s. Rothman showed how a protein complex enables vesicles to dock and fuse with their target membranes, a process in which proteins on the sacs and their targets bind to each other like the two sides of a zipper. (Each half of the zipper complex has to match the other precisely, allowing the cell to direct compounds exactly where they need to do.) The mechanism is used both inside a cell and when a vesicle arrives at a cell from the outside to deliver its contents. Südhof was born in Germany and came to the University of Texas Southwestern Medical Center in Dallas in 1982 to work in the lab of Michael Brown and Joseph Goldstein, who both won a Nobel in 1985. Südhof receives his share of this year's prize for transport studies as well—in his case, of how neurotransmitters, an all-important class of chemical messengers, are transported between neighboring nerve cells. In the 1990s, Südhof—now also an HHMI investigator, like Schekman—identified proteins that respond to an influx of calcium into the neuron, allowing other, nearby proteins to bind to vesicles containing neurotransmitters and let their content flow into the nerve cell. His work helped explain how nervous systems can achieve their amazing speed and temporal precision.

FRANCE: ADRENAL ASSOCIATION

http://www.surrenales.com/adherer

ProMed: MYCO. LEPRAE

(prevalence Leprosy in India increasing) Infect Genet Evol. 2012 Jan;12(1):121-6. doi: 10.1016/j.meegid.2011.10.023. Epub 2011 Nov 11. Dynamics of Mycobacterium leprae transmission in environmental context: deciphering the role of environment as a potential reservoir. Turankar RP, Lavania M, Singh M, Siva Sai KS, Jadhav RS. Source Stanley Browne Laboratory, TLM Community Hospital, Nand Nagari, Delhi 110093, India. Abstract Leprosy is a disease caused by Mycobacterium leprae. Various modes of transmission have been suggested for this disease. Transmission and risk of the infection is perhaps related to presence of the infectious cases and is controlled by environmental factors. Evidence suggests that humidity may favor survival of M. leprae in the environment. Several reports show that non-human sources like 'naturally' infected armadillos or monkeys could act as reservoir for M. leprae. Inanimate objects or fomites like articles used by infectious patients may theoretically spread infection. However, it is only through detailed knowledge of the biodiversity and ecology that the importance of this mode of transmission can be fully assessed. Our study focuses here to decipher the role of environment in the transmission of the disease. Two hundred and seven soil samples were collected from a village in endemic area where active cases also resided at the time of sample collection. Slit skin smears were collected from 13 multibacillary (MB) leprosy patients and 12 household contacts of the patients suspected to be hidden cases. DNA and RNA of M. leprae were extracted and amplified using M. leprae specific primers. Seventy-one soil samples showed presence of M. leprae DNA whereas 16S rRNA could be detected in twenty-eight of these samples. Samples, both from the environment and the patients, exhibited the same genotype when tested by single nucleotide polymorphism (SNP) typing. Genotype of M. leprae found in the soil and the patients residing in the same area could help in understanding the transmission link in leprosy. Copyright © 2011 Elsevier B.V. All rights reserved. (Comment: check for enlarged supratrochleal lymph node. Also Ulnar & Great auricular nerve thickening)

UK ROYAL SOC. MEDICINE : FUTURE of GP

New call for GPs to relinquish independent contractor status General practitioners should give up their independent contractor status and become NHS employees. This is the most radical alternative method of primary care funding considered by Professor Azeem Majeed, Head of the Department of Primary Care & Public Health at Imperial College London, in an editorial published today in the Journal of the Royal Society of Medicine. Professor Majeed, who also works as a part-time GP in South London, suggests that the funding of primary care should also be modified in favour of methods that link workload more closely to funding. In the last few years GPs have seen a dramatic transformation in their circumstances with reduced funding and higher clinical and administrative workload. Professor Majeed says:“Under the current capitation-based funding method, GPs face unrestricted demands for their services and on their time while having to operate on a fixed budget.” “When GPs are unable to cope with their workload, ” he says, “pressure will increase on other parts of the NHS – such as emergency departments – as well as impacting on access to primary care services and on how well GPs can manage patients with complex health needs.” If GPs gave up their independent contractor status, they could become NHS employees under similar employment terms to doctors working in acute, community and mental health trusts. This could, says Professor Majeed, allow GPs and their staff to be employed on national NHS terms of service and overcome the divide between self-employed GP principals and salaried GPs. Other options considered by Professor Majeed include the incorporation of tariff-based methods of funding in place of or in addition to capitation payments; The establishment of ‘super-partnerships’ involving the merger of general practices to allow the formation of larger primary care organisations; Or greater collaboration between general practices via the formation of general practice networks or federations. ENDS Notes for editors General practice in the United Kingdom: Meeting the challenges of the early 21st century (DOI: 10.1177/0141076813504326), by Azeem Majeed is published by the Journal of the Royal Society of Medicine today Friday 20 September 2013.

UK HEALTHCARE EUROPA: Euthanasia

"What impact will the right to die have on healthcare? The news that the number of Belgians opting to end their lives has jumped 25% in a year to over 1,400, with Dutch rates up 13% at over 4,188, suggests that, as the ‘right to die’ movement gathers force, so it will eventually impact demand, particularly for nursing home places." Oct.4,2013