Saturday, November 30, 2013

New nanoparticle opens doorway to oral treatment of chronic diseases

November 28, 2013
A newly developed nanoparticle may signal the end of injections for treatment of some comm...
A newly developed nanoparticle may signal the end of injections for treatment of some common diseases (Image: Christine Daniloff)
Most of us would swallow a pill before being poked by a needle, yet sufferers of chronic illnesses such as diabetes and cancer are regularly required to administer their medicine intravenously. A team of researchers from MIT and Brigham and Women's Hospital (BWH) has developed a new type of nanoparticle that could afford patients the choice – potentially making uncomfortable injections a thing of the past in the treatment of a range of chronic diseases.
Nanoparticles carrying drugs or short interfering RNA have shown great potential for the treatment of a variety of diseases, including cancer. If taken orally, however, they need to cross the intestinal lining into the bloodstream. This lining consists of a layer of epithelial cells that come together to form a barrier that is impenetrable to the nanoparticles, thereby necessitating the use of injections to be an effective form of treatment.
In developing the new nanoparticle, the researchers led by Omid Farokhzad MD built on previous research revealing how babies absorb antibodies from their mother's milk. When ingested, these antibodies attach themselves to a cell surface receptor called FcRN, which allows them to slip through into the bloodstream through the otherwise impenetrable cellular barrier.
As FcRN receptors are also found in adult intestinal cells, coating the nanoparticles with Fc proteins (the part of the antibody that attaches to the FcRN receptor) and administering them orally in mice, caused the particles to grab hold of the FcRN in the intestinal lining and gained them and their payload entry into the bloodstream.
"It illustrates a very general concept where we can use these receptors to traffic nanoparticles that could contain pretty much anything," said Rohit Karnik, MIT Associate Professor and one of the study's authors. "Any molecule that has difficulty crossing the barrier could be loaded in the nanoparticle and trafficked across."
Using the same principle, the researchers are hopeful of designing nanoparticles with the ability to cross other barriers, which could be used to treat other conditions, such as arthritis and high cholesterol.
"If you can penetrate the mucosa in the intestine, maybe next you can penetrate the mucosa in the lungs, maybe the blood-brain barrier, maybe the placental barrier," says Farokhzad.
The team's research is published in the online edition of Science Translational Medicine.
Source: MIT

Cholesterol 'fuels' breast cancer

Doctor inspecting x-rays

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A by-product of cholesterol can fuel the deadly growth and spread of breast cancer, according to a group of scientists.
It raises the prospect that taking cholesterol-lowering drugs called statins could prevent cancer.
The work, published in the journal Science, helps explain why obesity is a major risk factor for the disease.
However, cancer charities cautioned that it was too soon to advise women to take statins.
Obesity has been linked with many cancers including those of the breast, bowel and womb.

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The results from this early study are promising”
Dr Hannah BridgesBreakthrough Breast Cancer
The fat in overweight people can pump out hormones, such as oestrogen, which drive the growth of cancers.
A team at Duke University Medical Centre, in the US, showed that cholesterol was having a similar effect.
Cholesterol is broken down by the body into 27HC, which can mimic oestrogen and produce the same effect as the hormone in some tissues.
Experiments on mice showed that a high fat diet increased levels of 27HC in the blood and led to tumours that were 30% larger than in mice on a normal diet.
Tumours were also more likely to spread. And human breast cancer tissue grew more quickly in the laboratory when it was fed 27HC.
One of the researchers Prof Donald McDonnell said: "A lot of studies have shown a connection between obesity and breast cancer, and specifically that elevated cholesterol is associated with breast cancer risk, but no mechanism has been identified.
"What we have now found is a molecule - not cholesterol itself, but an abundant metabolite of cholesterol - called 27HC that mimics the hormone oestrogen and can independently drive the growth of breast cancer."
Treatment
The researchers say their findings raise the prospect that lowering cholesterol can lower the risk of breast cancer developing.
Statins are already taken by millions of people to cut the risk of heart disease. However, studies have already suggested statins can cut the risk of breast cancer.
A healthier diet is another way to cut levels of cholesterol in the bloodstream.
Dr Hannah Bridges, from leading charity Breakthrough Breast Cancer, says: "Up until now research into the links between cholesterol levels, use of statins and breast cancer risk has been inconclusive.
"The results from this early study are promising and if confirmed through further research could increase our understanding of what causes some breast cancers to develop."
Dr Emma Smith, from Cancer Research UK, said: "This study is intriguing as it shows for the first time a direct link between cholesterol and breast cancer in mice - but it's too early to say how this knowledge might help tackle breast cancer in the future.
"As things stand, until we know more about the effects of statins on cancer risk, the best ways to cut the risk of developing breast cancer are to stay a healthy weight, cut down on alcohol and keep active."

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Friday, November 29, 2013

Living With Cancer: Giving Thanks and Latkes

Andrew Scrivani for The New York Times
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Living With Cancer
LIVING WITH CANCER
Susan Gubar writes about life with ovarian cancer.
When I consider how this Hanukkah will be different from all other Hanukkahs, I wonder if my giddiness can be attributed to cancer and the treatments that have governed my life for the past five years.
Some time ago, an email I received from a reader explained that this year Thanksgiving and the first day of Hanukkah will fall on the same date. A 9-year-old, Asher Weintraub, has come up with the idea of a menorah in the shape of a turkey, “a menurkey.” Never before and never again will the two holidays coincide in most of our lifetimes.
While I reside in a state of anticipatory glee at the visit of my girls and their boys, I loathe the idea of ascribing my pleasure to a horrible disease. How, then, can I make sense of the fact that cancer has apparently given me a number of gifts and opportunities for growth — including a deepening capacity for joy?
Every two weeks, as I leave the hospital with another brown bag of experimental drugs, I consider the nurses and doctors who have performed what seems like a miracle to me. This year, 2013, was supposed to be the year of my death. When diagnosed in 2008, I was informed that I had three to five years left. Because of a clinical trial, I am living on borrowed time, which is experienced as a daily marvel. I realize, of course, that the trial extending my life will not cure me, that recurrence will probably be inevitable, along with palliative end-of-life care. Yet it is precisely this realization that intensifies my gratitude for being able to attend family gatherings at momentous events like a wedding, a birthday or a holiday during a succession of pain-free months.
Without cancer, I would never have encountered the six women in my support group. Nor would we have learned each other’s histories or cultivated the arts of empathy. We do not seek to give what we would want but what we think the person in need wants at any particular stage of treatment.
I have been kept alive by my family, the clinical trial, the support group, and by Tara Parker-Pope, who encouraged me to embark on the Living With Cancer series of essays at just the moment I was accepted into the clinical trial. Lest you judge me daft for ranking a blog among my life-support systems, let me explain that writing these columns and reading your comments — which would never have happened without cancer and without the models provided by the other New York Times writers Dana Jennings and Suleika Jaouad — have buoyed me up and cast me down and kept me thoroughly absorbed every day this year, engaged in what feels like a virtual community.
How can I refuse to grant cancer a positive role in my life, given these substantial rewards? Obstinate, I can and do.
For it is not cancer but rather a heightened sense of impending mortality that bestows these gifts, along with an appreciation of ongoing life never before lived, never again to be lived. Such awareness of embracing the impermanence and unpredictability of life and of those in our lives also sparks the urgency of testimony.
A famous line of poetry by Wallace Stevens — “Death is the mother of beauty”— comes into focus in a new way. Only when we realize not that the other guy is going to die but that I am going to die do we see the beauty of transient existence and the beauty of trying to engage with its every facet, even the most fraught. The exaltation, the sheer pleasure of having been alive, of being alive, catches in the throat, brims tears in the eyes, for which we can only be glad. As for those cherished: no words are commensurate, just a delicate treasuring.
Like a one-of-a-kind existence, a one-of-a-kind holiday makes me think that the question always asked at the Passover Seder — “Why is this night different from all other nights?”– should be asked not only on Thanksgiving Hanukkah but on every night.
Never before and never again will I write such a happy essay, I suspect. To celebrate before I return to my usual muddles, I want to rejoice over the potato: a stolid epitome of ephemerality, since it discolors so quickly after being skinned.

Susan Gubar’s Potato Latkes
My holiday latkes are distinguished from traditional versions in only three modest ways. First, half of the potatoes are finely chopped, half more roughly grated. Second, the pancakes are finished in the oven so the exhausted cook can rest before enjoying them with guests. Third, the toppings are a tad zany. This recipe to serve four can be easily multiplied for more since it uses a food processor.
3 baking potatoes
1 onion
2 eggs
3 tablespoons matzo meal or flour
2 teaspoons kosher salt
Pepper
Vegetable oil for frying
1. Preheat oven to 250 degrees. Skin the potatoes and onion and cut into chunks. Using the chopping blade of a food processor, pulse half the potatoes and the onion until finely minced. Using the grater blade, grate the other half of the potatoes. Squeeze as much liquid as possible out of this mixture by pushing it against a strainer or wringing it in cheesecloth. In a large bowl, mix the potatoes and onions with the other ingredients.
2. In a heavy skillet, heat about one quarter of an inch of oil until a fleck of onion sizzles.  Put in two tablespoons of the mixture and flatten into a three inch round.  Fry four or five pancakes at a time, flipping when golden brown—about five minutes on each side.  Lay them on a paper towel and then on a cookie sheet while you do the next batch. The potato pancakes can stay in the oven for an hour.
3. A standard topping like applesauce or sour cream can be supplemented with bowls of chutney, salsa, olive salad, caviar or (yes!) cranberry relish.
Yield: 4 servings

Wednesday, November 27, 2013

I was misinformed: Bad Thanksgiving





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The worst Thanksgiving I had came two days after they sliced me open, belly to pubic line, and the surgeon, coming to see me in recovery said, “We got most of it.”

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“Go to Ken’s,” I tell my friend Herb, trying to send him to the old friend in Brooklyn with whose family we’d spent the holiday for years. They did a great Thanksgiving; crazy newspaper stories; relatives we’d known so long they felt like ours; little tables with antique linens and dishes of chocolates and nuts, chocolates before you even started the meal.
“How could I enjoy anything with you here like this?” Herb says.
Like this: Staples in my belly. A morphine drip. My surgeon from when I had breast cancer, the easy cancer, coming in to visit saying, “They tell me it isn’t as dire as it looks.”
Herb isn’t my husband. At the time this is happening, he has been my best friend for 20 years, a feature writer like me. The first night after surgery, he sleeps in a chair next to my bed. He stays in the room when the nurses change the dressings. He sees the sanitary pads with the blood, the kind you get when they take out your ovaries and your fallopian tubes but cannot remove the uterus because it is stuck to the colon with what the doctors at Memorial Sloan-Kettering euphemistically call “disease.”
Love does not come as expected in a cancer hospital. I had seen this a few years earlier, sharing a room with a woman who was dying. She looked like what I had once thought cancer looked like: emaciated, skin and bones. Her husband was with her. In the middle of the night the woman moved her bowels. The sharp stink of it pervaded the room. Her husband stayed by her side and murmured comforting things and emptied the bedpan, and I, staying overnight for a minor procedure, thought that this is what real love was and how different it is from what you think love is when you are 22 and what you see in the magazines: the romantic dates, the sexy lingerie, the beautiful young woman, the rich, handsome man helping her out of the expensive car. Love was emptying the bedpan. Love was sleeping in a chair.
Food does not interest me during the bad Thanksgiving, which is good because I cannot eat. I suck on ice cubes and sometimes there is a broth and eventually I work up to Jello. Herb is indifferent to holidays though not to food, but Thanksgiving that year does not interest him either. Thanksgiving evaporates. I seem to remember sending him to the cafeteria Thanksgiving Day and talking about a very bad hamburger, but I am on morphine, I am stoned, so who knows. And when I am not stoned, I think about death. It has a presence as strong as Herb’s, it’s sitting in its own chair, it’s talking to me.
You dodged me once, kiddo, but I’m back. Refuse to think about me? Yeah, right. How’s that working out?”
When I come home after Thanksgiving there is food. My friends Sybil and Martin send a cooked chicken and mashed potatoes from the Jefferson Market, because they know I do not cook; my college roommate Christie sends a pound of chocolate with a note, “Eat it all”; my friend Carol drops off her spectacular meatloaf through a year of chemotherapy, just leaving it at the door, because she knows what’s going on. When I have chemo every three weeks Herb comes to my house and sleeps on a blow-up bed and when he has to go out of town my friend Cheryl comes down to New York from Boston and fills in.
I try to avoid the stats, but there comes a time I have to decide between protocols, so I go to Sybil’s to do research because her computer is faster. These are the early days of the web, the mid-90s; research is harder. The survival rate we measure everything against is five years, though sometimes the reports deal with two. The numbers are bad: 25 percent of patients lived two years on this trial; 20 percent lasted five years on that one.
“So you think you have time for a cup of coffee?” Sybil asks finally. “If I make it instant?”
I am laughing. I am doubled over, laughing. Here is my big insight: You can have a Stage 3 cancer but when a friend cracks you up, you are as alive as anyone else.
So here we are 18 years later. Not all of us. My friend Heidi Handman, lost to cancer; my friend Vic Ziegel, lost to cancer; my friend Jack Newfield, lost to cancer; my Aunt Shirley Wadler, lost to cancer. The older you get, the more the losses.
On Thursday, Herb and I will get on the train to my niece’s and the family in New Jersey. I will carry two remote-control toy cars, a jeep and a fire engine, so my nephews can smash them into one another. Herb will carry two bottles of red wine. We will tell stories and crack one another up.
It’s Thanksgiving. I am thankful.
Joyce Wadler is the author of “Cured: My Ovarian Cancer Story.” Follow Joyce Wadler on Facebook: facebook.com/joyce.wadler and on Twitter: @joyce_wadler.  Previous “I Was Misinformed” columns can be found here.
Booming: Living Through the Middle Ages offers news and commentary about baby boomers, anchored by Michael Winerip. Sign up for our weekly newsletter here. You may also follow Booming via RSS here or visit nytimes.com/booming. Our e-mail isbooming@nytimes.com.

The Cancer Divide:Tzippy Choices after BRCA diagnosis

http://www.nytimes.com/video/health/100000002567349/the-cancer-divide-tzippy.html?emc=edit_tnt_20131127&tntemail0=y

Tzippy, 38, an Orthodox Jew and a mother of seven children, recounts the choices she faced after testing positive for the harmful BRCA genetic mutation.

Tuesday, November 26, 2013

My Breast Cancer Online Friends Get Me

By ABC News
Nov 14, 2013 7:00am
HT emilyhelck tk 131021 2x3 608 My Breast Cancer Online Friends Get Me
Emily Helck was diagnosed with breast cancer when she was 28. (Credit: Courtesy Emily Helck)
By Emily Helck
I’m in Las Vegas, and I’ve lost my breast.
To be completely truthful, it isn’t my real breast. It’s a prosthetic (hand crocheted and stuffed with wool) that is filling in for my absent left one. I’m here with 14 other women, all members of an online cancer support group. We’re here, and we’re flouting warnings about meeting strangers from the Internet.
I don’t remember when the idea of Vegas first floated through the ether, but it became something we would say when things got bad. “We’ll meet in Vegas next year” became this crucial glimmer, an affirmation that yes, there will be a next year, and yes, it will be better.
The villa we’ve rented is cream stucco, and sidles up to a mountain to the east. There is a swimming pool with rocks and lights and palm trees and a water slide, and it’s lush and green. Our expanse of sky is blue and cloudless. When I peer over the fence, the surroundings are arid and rocky. It’s a true oasis, in the middle of a hell of a lot of desert.
We had started out online as usernames and collections of diagnoses and treatments, reporting timelines of our hair loss, and other side effects. At the risk of stating the obvious, chemo is hard. Physically, yes, but even more so, emotionally. I plodded along for most of the autumn, chiming in with the group here and there, sharing things I’d learned. Over time, it became easy to send things out into our snug little corner of the vast virtual world.
Toward the end of my chemo regimen, a couple of weeks after superstorm Sandy, I had something of a breakdown. I had reported an innocuous seeming symptom to my oncologist, which concerned her enough to send me to a neurologist. She got me an appointment for a few days later.
I woke up the next morning full of dread. I sobbed into my pillow while my husband tried to comfort me. There was nothing to do but wait, so I vowed to stay in bed. I refused to walk around and eat breakfast and buy groceries as if nothing were happening. It made sense to me, but my husband didn’t get it.
“It feels like you’re giving up,” he said.
I lay in bed, curtains drawn, with my dog and a mountain of crumpled tissues. I cried more, and watched a lot of bad TV, and around 3 p.m. wondered if I was going crazy. I logged onto the message board on my phone. I tapped out a message, an SOS, and sent it out of my darkened bedroom and into a blue-white world made of millions of pixels. My message traveled into outer space and back again, while I turned my pillow over, looking for the cool side. Replies trickled in, some commiserating, some offering practical advice, some affirmation. They told me to take care of myself, whatever that meant in that moment.
And when, a few days later, the neurologist put my fears to rest, my group cheered right along with me. I felt supported, in the truest sense of the word.
I lost my prosthetic breast on the second day of the Vegas trip. I had been taking it out to sleep and to swim, and somewhere during all that in and out, it disappeared. After a quick, fruitless search, I join a few of the women on a visit to Red Rock Canyon. We take a short hike, helping each other on the rocks when we need it. In the afternoon, I go with another group to the Atomic Testing Museum, where we pose for goofy pictures with a Geiger counter wand positioned over our radiation-burned chests.
Here’s the thing: When you have cancer it becomes your whole world. It informs my experiences as much as the fact that I grew up in New Jersey or went to college or have a dog. Yet I rarely speak aloud about it. To be able to spend four days talking about this experience freely, as often as it popped into my head (I think about breast cancer probably about as often as an adolescent boy thinks aboutbreasts), was a gift.
The future for all of us is uncertain, a mix of statistics, hopes and hunches. But whatever it holds, we have existed in this place together. There is a surrealness to transforming virtual space into real space — and what better locale than Las Vegas, that weird imitation of life. Each of us materialize, seemingly from nowhere, all of us in these transitional moments: finishing treatment, growing out our hair, in various stages of reconstruction. Being together is exquisite, and temporal.
Flying home, the sun sets behind me. Soon the stars are visible, and the night cozies around the plane. I could have stayed a week, a year. The world outside had ceased to exist at times. There was just that pool, and our voices and the sky.
I couldn’t tell you what they all did for a living or their children’s names or where they went to high school. But I could tell you what they thought about when they couldn’t sleep at night. I could tell you what would make them laugh in the emergency room. I could tell you what they needed in their darkest moments, because, in all likelihood, I was needing the same thing.
I think of my lost breast, and how at home, on my way to work, I would sometimes panic that I forgot it, and clutch at my chest till I felt its familiar mushiness. But in Vegas, I went hiking, to museums, to restaurants, without it, and was fine. Later, once I’m home and folding laundry, I will find it again. It will have accidentally gone through the washer and dryer, and the wool inside will have turned into felt.
The plane banks, and my window, which had been full of stars, is suddenly filled with the ground below. The lights from houses and cars twinkle against velvety blackness, and if I soften my eyes I can’t tell the difference between the earth and the sky.
Emily Helck is a 29-year-old artist from Jersey City, N.J. When she began chemotherapy in September 2012, she started her blog, “Real Tumors of New Jersey.”  She posted a video containing a year of self portraits to her blog on Sept. 29, which has since gone viral.
“A Day in the Life” is a series of blogs written by people who are living with medical conditions.

SidneyAnne Stone

Dating and Breast Cancer

Posted: 10/16/2012 11:30 am

It's Breast Cancer Awareness Month, and I would be remiss if I did not write about one of the most challenging issues in my life to date. My struggle with breast cancer is not one I keep secret. However, something I don't talk much about is the challenges of being a single woman in the dating world after having major reconstructive surgery on my breasts.
I know this is an issue for many breast cancer survivors. Having spoken to many other women in my situation, it is met with mixed feelings. On the one hand, you are so grateful just to be alive and to have survived that you feel almost silly to complain about it, yet it is a very real issue. Many of us are young, single and have our whole lives ahead of us -- dating, sex and love should not be off the table. Granted, there is a time and a place for everything, but sometimes you just meet someone or want to continue to look for someone special if that was something you were interested in before you got sick. Once the dust settles and you realize that you have survived and you have a new body, it can be very challenging to feel comfortable with your body image. Not only is it a challenge for you, but it can be a particularly frightening thought when you imagine introducing your new body to someone else.
I have always been pretty comfortable with myself (inside and out). That is not to say that I am exceptional; I just have always been very self-accepting. I still feel that way. I adapted to my new body image with a fair amount of ease. However, I don't know how easily I could introduce my body to someone else in an intimate setting.
My friends and family have been wonderful throughout this whole experience and it has made it easier for me to discuss these body issues very openly and honestly with others. Attending a support group has helped as well. Between doctors, friends and family, more people have seen my new (and, might I add, nipple-less) breasts than I ever thought possible. I may have confidence but I'm not in the practice of flashing people, nor am I an exhibitionist. Shyness does tend to go out the window when you start down the breast cancer path, but that doesn't have to be a bad thing.
I mentioned that my breasts are currently nipple-less, right? I am about two-thirds of the way through the process of my reconstruction, so I still have some work to be done. That includes replacing the nipples. Hence, my apprehension about dating. I would think that may be a little off-putting to some but I've been very honest with people I date. I take things extremely slowly. I still love and accept myself fully and if someone can too, great! If they can't, that's a shame, because they are really missing out.
I guess where I'm going with this is that, yes, it is scary but so what? Anyone who has been through this has certainly been through scarier things and lived to tell about them. If there is anything this experience has taught us it should be that life is short and that we all deserve to have love, companionship, sex, fun, joy and whatever else we want in our lives. Any woman who has been through this and come out the other end has to be pretty amazing in my book! If someone else doesn't see that, they aren't looking hard enough and they're not worthy of you. As I wrote in one of my previous articles, "The Breasts Don't Make the Babe!" If all someone sees when they look at you are your breasts, they are missing out on so much and all you're missing out on is a shallow fool -- and those are a dime a dozen.
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