Newswise — WASHINGTON — In what is believed to be the first study of its kind, researchers at Georgetown University Medical Center’s Institute for Reproductive Health (IRH) are recruiting as many as 1,200 women to study, in real time, a smartphone app that calculates a woman’s chance for pregnancy on a daily basis. The app, called Dot™, (Dynamic Optimal Timing™), was created based on data from several published studies. Dot has been available for about a year and is increasingly being used globally. Dot is one of the few fertility tracking apps — there are estimated to be about 100 such apps — that is based on empirical evidence, says Victoria Jennings, PhD, director of IRH. In the current issue of the European Journal of Family Planning and Reproductive Health Care, Jennings and a group of statisticians report the data upon which Dot is based. This includes a detailed fertility analysis of about 1,000 women in six geographical and cultural diverse settings. The World Health Organization provided most of the data, with additional data from clinical research in the U.S. The researchers say their analysis determined that Dot, from the beginning, would be 96-98 percent effective in women if used correctly. And as a woman continues to use it, the app increases its individual accuracy. Recognizing that each woman’s menstrual cycle can vary, the app allows for menstrual cycles that last as little as 20 days or as long as 40 days. It relies solely on a woman’s period start date to provide her with tailored, accurate information about her chance of pregnancy for each day of her cycle — and it alerts a woman if she is on a high or low risk day for the purpose of planning or avoiding pregnancy. “The more you use Dot — the more Dot gets to know you,” Dot’s creator, Cycle Technologies, says on its homepage. Now Jennings and her team at Georgetown’s IRH will study how women use the app. “To our knowledge this is the first prospective study on the effectiveness of a ‘fertility app,’” Jennings says. They are recruiting study volunteers in the U.S. who have downloaded and are using Dot. “Our goal is to test the efficacy of Dot as a method to avoid unplanned pregnancy in a real-time situation,” says Rebecca Simmons, MPH, a senior research officer at IRH. Not only will the Georgetown researchers calculate how efficient and effective Dot is, they will collect social factors related to an individual woman’s use of Dot, such as how the app might affect a couple’s relationship and if a woman tires of using the app and why, among other questions. The participants will be interviewed four times in the yearlong study, and they will answer questions that pop-up in the app that are sent by the researchers. “We are all smartphone based, and this study will be conducted on the phone and the app — which is novel but quite appropriate,” says Simmons. To enroll in the study, women must download the app. When they use it as a means to avoid pregnancy, they will be invited to participate. More than 220 million women worldwide have an unmet need for family planning, says Jennings. “Our work has shown that simple fertility awareness messages are extremely attractive to a wide range of women and can address their family planning needs. A method that only requires a user to enter her period start date is likely to appeal to many women.” The study is being funded by a grant from U.S. Agency for International Development called the Fertility Awareness for Community Transformation (FACT) project. About the Institute for Reproductive HealthThe Institute for Reproductive Health at Georgetown University Medical Center has more than 25 years of experience in designing and implementing evidence-based programs that address critical needs in sexual and reproductive health. The Institute’s areas of research and program implementation include family planning, adolescents, gender equality, fertility awareness, and mobilizing technology for reproductive health. The Institute is highly respected for its focus on the introduction and scale-up of sustainable approaches to family planning and fertility awareness around the world. For more information, visit http://www.irh.org. About Georgetown University Medical CenterGeorgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis -- or "care of the whole person." The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award (UL1TR001409-01) from the National Institutes of Health.###
Newswise — While many people view college drinking as the norm, less understood is that how students drink can place them at a higher risk for multiple problems. Drinking on an empty stomach usually means that someone will get drunk faster, given that food helps to absorb alcohol, slowing down alcohol absorption into the bloodstream. A growing trend among college drinkers is called “drunkorexia,” a non-medical term that refers to a combination of alcohol with diet-related behaviors such as food restriction, excessive exercising, or bingeing and purging. “Drunkorexia refers to a complex pattern of drinking-related behaviors that take place before, during, and after a drinking event,” explained Dipali V. Rinker, a research assistant professor in the department of psychology at the University of Houston. “College students appear to engage in these behaviors to increase alcohol effects or reduce alcohol-related calories by engaging in bulimic-type or diet/exercising/calorie/restricted eating behaviors.” Rinker will present this research at the 39th Annual Research Society on Alcoholism in New Orleans June 25-29, 2016. Rinker said there are a number of consequences. “Potential outcomes may include less inhibition that could lead to more negative alcohol-related consequences,” she said. “Additionally, restricting caloric intake to those from alcohol could lead to vitamin depletion, as it may keep the individual from eating more nutrient-dense foods.” Rinker said her research is designed to flesh out the definition of drunkorexia as well as identify different types of “drunkorexic” behaviors. “Our information examines the association between these different types of drunkorexic behaviors and other predictors of problem drinking among college students, such as gender differences.” The association between gender and drunkorexia is a complex one, she noted. “While it is clear that college women who drink more are more likely than men to engage in bulimic-type behaviors, and with greater frequency, and to experience more alcohol-related problems as a result of these behaviors, there were no gender differences for engaging in drunkorexia to increase the effects of alcohol or engaging in bulimic-type behaviors to compensate for alcohol-related calories. In some cases, men were more likely to engage in bulimic-type and diet/exercising/calorie-restricted eating behaviors to reduce alcohol-related calories. Further research is needed to more fully understand these differences,” she said. “It is important to realize that, in addition to the amount and/or frequency of alcohol consumption, the manner in which college students drink puts them at greatest risk for experiencing problems,” emphasized Rinker. “Students who engage in compensatory dieting/exercise behaviors before, during, or after a drinking event to either increase the effects of alcohol or reduce alcohol calories by either engaging in bulimic-type or extreme dieting, exercise, or restrictive behaviors – such as skipping meals – are putting themselves at risk for serious negative consequences related to alcohol use. In addition to reducing risky drinking levels, college students should also make sure to stay well-hydrated and not drink on an empty stomach. Additionally, college students should make sure that they are eating healthily and engaging in healthy exercise behaviors, particularly if they choose to drink.” ###
Newswise — CHICAGO – Coffee is enjoyed by millions of people every day and the ‘coffee experience’ has become a staple of our modern life and culture. While the current body of research related to the effects of coffee consumption on human health has been contradictory, a study in the June issue of Comprehensive Reviews in Food Science and Food Safety, which is published by the Institute of Food Technologists (IFT), found that the potential benefits of moderate coffee drinking outweigh the risks in adult consumers for the majority of major health outcomes considered. Researchers at Ulster University systematically reviewed 1,277 studies from 1970 to-date on coffee’s effect on human health and found the general scientific consensus is that regular, moderate coffee drinking (defined as 3-4 cups per day) essentially has a neutral effect on health, or can be mildly beneficial. The review was used to create an exhaustive list of the potential health benefits and risks of coffee consumption on the following health outcomes: - Total Mortality- Cardiovascular Disease- Cancer- Metabolic Health- Neurological Disorders- Gastrointestinal Conditions- Other Miscellaneous Health Outcomes The authors noted causality of risks and benefits cannot be established for either with the research currently available as they are largely based on observational data. Further research is needed to quantify the risk-benefit balance for coffee consumption, as well as identify which of coffee’s many active ingredients, or indeed the combination of such, that could be inducing these health benefits. Read the full article in Comprehensive Reviews in Food Science and Food Safety here. ###
Newswise — Residents on the South Side say cancer, violence prevention and sexually transmitted infections are among their top health concerns, according to the latest comprehensive assessment conducted by the University of Chicago Medicine. The 2016 Community Health Needs Assessment (CHNA), published online in mid-June, also identifies diabetes among adults, pediatric asthma and pediatric obesity as other critical health issues faced by South Siders. In addition to uncovering the community’s health needs, the report also includes a plan to advance outreach, prevention and education in those six health areas. “This assessment is our strategic compass that guides us to support programs and initiatives that will better meet the community’s health needs,” said Brenda Battle, vice president of care delivery innovation and chief diversity and inclusion officer. “Fortunately, much of the work under way points us in the right direction, but we have more work to do.” UChicago Medicine plans to address the six health concerns in the following ways: • Violence prevention. Develop a comprehensive trauma program that includes linking affected individuals to post-trauma services and training community leaders to help provide counseling and other support. This program will build on the current Level 1 pediatric trauma center and include the forthcoming Level 1 adult trauma center, which is expected to open in early 2018.• Sexually transmitted infections and HIV. Promote STI/HIV screenings among high-risk populations and link HIV-positive patients to care and support services. UChicago Medicine will take advantage of programs that have been advancing HIV testing and improving the lives of those living with HIV and other infections in disproportionately affected populations in Chicago.• Cancer. Conduct breast and colorectal screenings, and promote educational sessions about screenings in the community. The plan will leverage current programs, community relationships, and research and expertise at UChicago. • Diabetes. Find ways to formally educate patients with diabetes and pre-diabetes and promote health lifestyle habits among this population. Coordinators will continue to use UChicago Medicines’ South Side Diabetes Project and Kovler Diabetes Center to improve the health and quality of life for people with diabetes.• Pediatric asthma. Deploy staff throughout the community to increase awareness of asthma and potential triggers and improve the management of the condition at home through the Asthma Care Coordination program.• Pediatric obesity. Promote regular physical activity, healthy eating and nutrition education in community settings — with a focus on schools — using current and new programs. The assessment and an action plan that addresses the health concerns are requirements of the federal Patient Protection and Affordable Care Act. The report, conducted every three years in partnership with other organizations, examined health status, barriers to care, demographics and socioeconomic factors that affect children and adults living in 12 ZIP codes from 35th Street to 199th Street and east of Western Avenue. This area spans 31 locally defined communities and has a population of about 640,000 people. 2013 CHNA Report and Action Plan The 2016 CHNA builds on the findings from the 2013 report, which identified access to care, cancer, diabetes, and pediatric asthma and obesity as the community’s primary health concerns. UChicago Medicine tackled those health needs by: • Providing direct health or wellness services using UChicago Medicine resources and partnering with community health centers and community-based clinical services.• Supporting grants to community organizations that have relevant programs within UChicago Medicine’s service area.• Promoting community-based learning and educational forums on wellness and better health self-management.• Fostering medical education and engagement on the South Side through medical students who serve at community health centers, participate in service-learning projects, and engage in scholarship and mentorship.• Forming partnerships to help UChicago Medicine engage residents and improve their health. RESULTS FROM THE 2013-2016 CYCLE HEALTH CONCERN # OF PROGRAMS # OF ENCOUNTERS # OF PARTNERSAccess to care 17 70,789 57Diabetes 11 2,143 17Cancer 17 702 mammograms N/A189 colonoscopies N/APediatric asthma 6 4,281 30Pediatric obesity 7 702 39 To read the latest Community Health Needs Assessment and for more information about how UChicago Medicine provides services and other benefits to the community, visit uchospitals.edu/community.
The New England Journal of Medicine Taenia solium infects humans who have eaten contaminated pork. Larvae migrate to tissues, which can lead to neurocysticercosis, a major cause of seizures in developing countries. Can transmission be stopped on a population level? New research findings are summarized in a new NEJM Quick Take video. Learn more at http://nej.md/1WoeHdF Newswise — ATLANTA— The transmission of Taenia solium, a pork tapeworm species that infects humans and causes late-onset seizures and epilepsy, can be stopped on a population-wide level with mass treatments of both pigs and humans, researchers have shown. Researchers from several institutions, including Georgia State University, contributed to the study and published their findings in The New England Journal of Medicine. Humans can become infected after eating contaminated pork or through fecal-oral exposure. This study was aimed at eliminating Taenia solium from the villages of Tumbes Province in Peru, a highly endemic region for the disease. Researchers screened and treated pigs and humans in the first two phases of the program. In the final phase, mass treatment was given to 81,170 people in 107 villages, and 55,638 pigs received treatment and vaccination. Mass treatment included chemotherapy with niclosamide in humans and with oxfendazole in pigs, in combination with pig vaccination. The researchers found only three of 342 pigs had live, nondegenerated cysts, but no infected pigs were found in 105 of 107 villages. The researchers showed the transmission of Taenia solium infection can be interrupted on a regional scale in a highly endemic region.The researchers say they expect this effect will only be temporary if it is not bolstered by additional activities. Read the study →
Newswise — She no longer recognizes a Van Gogh, but can tell you how to prepare a watercolor palette. She can’t recall a single famous composer, but knows the purpose of a viola’s bridge. She hasn’t flown a plane since 2007, when viral encephalitis destroyed her hippocampus, the part of the brain used to form new memories and retrieve old ones. And she couldn’t describe a single trip she’s ever taken. But in detail, she’ll list the steps needed to keep a plane from stalling and where to find the rudder controls. Johns Hopkins University cognitive scientists say the sharp contrasts in this patient’s memory profile — her inability to remember facts about pursuits once vital to her life as an artist, musician and amateur aviator, while clearly remembering facts relevant to performing in these domains — suggest conventional wisdom about how the brain stores knowledge is incorrect. Conventional wisdom about memory firmly separates declarative knowledge, or memories about facts, from memories for skills, or “muscle memory.” For instance, a severe amnesiac with muscle memory might never forget how to ride a bike, but probably couldn’t recall anything about the Tour de France. But because skilled performance, like playing music or flying airplanes, requires much more than mere muscle memory, and because this patient retained it despite losing most other aspects of her declarative memory, researchers conclude this type of skill-related declarative knowledge is different. “There is such a contrast between her not being able to tell us anything about her former life and not being able to tell us anything about many aspects of art and music that she once knew well, but when we ask her to tell us how to do a watercolor, she is articulate and full of detail,” said Barbara Landau, the Dick and Lydia Todd Professor of Cognitive Science at Johns Hopkins. “How can you talk about this knowledge of “how to” as distinct from declarative knowledge? It is declarative knowledge.”The findings, now online, are due to appear in an upcoming issue of the journal Cognitive Neuropsychology. Before her illness, Lonni Sue Johnson, 64, was an accomplished artist whose portfolio included six New Yorker magazine covers. She was also an amateur violist who played in orchestras and chamber groups and a licensed single-engine airplane pilot who flew more than 400 flights and owned two planes. Her illness left her with severe brain damage and catastrophic memory impairment, including severe losses of memory about her previous life and severely restricted ability to learn new facts. She has very little memory of her past — not even of her wedding day. She forgets having done something immediately after doing it. She also has very little memory for general world knowledge, including facts about the fields in which she once excelled. To determine whether Johnson’s “skill-related” memory was preserved despite extensive losses in memory for general world knowledge, the team tested her on her memory for facts related to performing four of her former top skills — art, music, flying and driving. They gave the same tests to people of similar age and experience in those areas, as well as to people with no experience in them. The oral tests, of about 80 questions each, covered information about the techniques, equipment and terminology involved in performing the various skills. They included queries such as “How might one remove excess paint when painting with watercolor?” and “How should one touch the strings of an instrument to produce a harmonic?” In art and driving, Johnson scored nearly as high as experts taking the test. In music and aviation, she did not perform as well, but knew considerably more than the novices. “Although Johnson had not created watercolors, had not flown a plane, and had not driven since her illness, she could still describe how one would go about carrying out these activities,” said Johns Hopkins cognitive scientist Michael McCloskey. “These findings suggest that skill-related knowledge can be spared even with dramatic losses in other kinds of knowledge.” The team also included first author Emma Gregory, a former Johns Hopkins post-doctoral fellow, and research assistant Zoe Ovans, also of Johns Hopkins. This research was supported by the Brain Science Institute at Johns Hopkins. ###
Newswise — Few threats to public health are as perilous as cigarette smoking, with more than 435,000 Americans dying each year of tobacco-related pulmonary illnesses such as chronic obstructive pulmonary disease (COPD). COPD ranks as the third-leading cause of tobacco-related morbidity and mortality worldwide in 2012 and the global cost of illness related to COPD is expected to rise to $4.8 trillion by 2030, yet there are currently no effective medical treatments to cure COPD or stop its progression. Since the identification of factors contributing to the development of COPD is crucial for developing new treatments, a team of scientists including Anna Blumental-Perry, PhD, from the department of surgery, and Xing-Huang Gao, PhD, from the department of genetics and genome sciences, at Case Western Reserve University School of Medicine embarked on a study to examine COPD development at the cellular level. Specifically, Blumental-Perry and her team sought to better understand the mechanisms of a relatively new scientific concept – the smoke induced collapse of protein homeostasis and its contribution to age-dependent onset of COPD. Knowing that upon inhalation of cigarette smoke (CS), the free radicals in it can reach the interior of lung cells where they react with a wide variety of cell proteins and affect their functions, the scientists formed the hypothesis that CS-free radicals can interfere with proper folding of the proteins within the cell. The scientists’ findings, recently published in The Journal of Biological Chemistry, demonstrated that free radicals—small, unstable molecules present in CS—can reach the endoplasmic reticulum, a cellular organelle that is critical in manufacturing and transporting fats, steroids, hormones and various proteins, and alter its function by oxidizing and damaging its most abundant and crucial to protein folding chaperone, Protein Disulfide Isomerase (PDI). Determining that PDI is a critical factor in the development of COPD, the researchers identified for the first time how cells adapt to the presence of less functional PDI, which is by increasing the levels of it through a novel mechanism at the protein synthesis level, as opposed to the level of gene transcription. Since adaptation wears off with age, the researchers have now identified one of the first clues to age-dependency in COPD onset. “Understanding the mechanisms of the collapse of protein homeostasis in COPD allows us to focus on maintaining functional levels of PDI. This could improve outcomes for the many patients with COPD as well as potentially giving us clues to improve health with aging.” said Blumental-Perry. “We discovered that PDI is a critical new factor in the pathogenesis of COPD, and that protein collapse in COPD is age dependent and unpredictable. Based on these fascinating findings, we plan to conduct future research targeting failed adaptive systems in an effort to maintain functional levels of PDI, and prevent it from acquisitions of ‘bad’ functions – discoveries that could ultimately help us to identify new therapeutic approaches for COPD.” This research was supported by Flight Attendants Medical Research Institute Young Clinical Investigator Award 092207; National Institute of Health grants 5P20GM103542 from the National Center for Research Resources; COBRE in Oxidants, Redox Balance and Stress Signaling; CO6 RR015455; R37-DK60596 and R01-DK53307. For more information about Case Western Reserve University School of Medicine, please visit: case.edu/medicine.
Newswise — Researchers at The Saban Research Institute of Children’s Hospital Los Angeles have identified a new genetic candidate for testing therapies that might affect fear learning in people with PTSD or other conditions. Results of the study have been published in theJournal of Neuroscience. Individuals with trauma- and stress-related disorders can manifest symptoms of these conditions in a variety of ways. Genetic risk factors for these and other psychiatric disorders have been established but do not explain the diversity of symptoms seen in the clinic – why are some individuals affected more severely than others and why do some respond better than others to the same treatment? “People often experience stress and anxiety symptoms, yet they don’t usually manifest to the degree that results in a clinical diagnosis,” says Allison T. Knoll, PhD, post-doctoral fellow at The Saban Research Institute of Children’s Hospital Los Angeles. “We felt that if we could understand differences in the severity of symptoms in a typical population, it might provide clues about clinical heterogeneity in patients.” The strategy was simple. Instead of focusing on a single gene identified for a given condition, the team at CHLA tried a different approach to discover genes that may impact symptom severity. Using a population-based mouse model, they studied normal variation in how well the mice detected threats and fears. They used mice that are well-characterized for learning behavior, and also exhibit a wide range of “high” and “low” anxiety, modeling the range found in humans. The investigators tested to see how well the mice learned to detect threats, a form of fear learning that all humans and animals do. When this learning is exaggerated in children or adults, symptoms of PTSD and anxiety are expressed. “By understanding the biological origins of individual behavioral differences – in this case a measure of anxiety – we can move beyond a single disorder diagnosis and treat the dimensions that produce a behavior spanning a multitude of diagnoses,” said Knoll. Newswise — Using genetic tools, the researchers found a number of candidate genes that might influence learning of fear, and ultimately narrowed down to a single gene, Hcn1. The researchers were able to further demonstrate the impact of the Hcn1 gene on fear learning by interfering with the function of this gene before the learning challenge. They found that the mice did not learn fear. Even when the researchers disrupted gene function after the mice learned the fear, the mice were unable to express it. “We’re suggesting that instead of focusing only on the genes that are thought to cause a disorder – for example, PTSD or anxiety disorder – it is important to discover those genes that can have a profound effect on how severely an individual is impacted by their disorder,” said Pat Levitt, PhD, Principal Investigator of the study, and the Simms/Mann Chair in Developmental Neurogenetics at CHLA. Levitt is also provost professor of Pediatrics, Neuroscience, Psychiatry and Pharmacy at the Keck School of Medicine of USC.
Newswise — COLUMBUS, Ohio – In a surprising twist, benign brain tumors that have previously been tied to obesity and diabetes are less likely to emerge in those with high blood sugar, new research has found. The discovery could shed light on the development of meningiomas, tumors arising from the brain and spinal cord that are usually not cancerous but that can require risky surgery and affect a patient’s quality of life. Because previous research had established that the slow-growing tumors are more common among people who are obese and those who have diabetes, researchers led by The Ohio State University’s Judith Schwartzbaum set out to look for a relationship between meningiomas and blood markers, including glucose. After all, high blood sugar is a component of diabetes and a precursor to its development. Furthermore, Type 2 diabetes and obesity are closely linked. But when they compared blood tests in a group of more than 41,000 Swedes with meningioma diagnoses 15 or fewer years later, they found that high blood sugar, particularly in women, actually meant the person was less likely to face a brain tumor diagnosis. “It’s so unexpected. Usually diabetes and high blood sugar raises the risk of cancer, and it’s the opposite here,” said Schwartzbaum, an associate professor of epidemiology and a researcher in Ohio State’s Comprehensive Cancer Center. The work appears this month in the British Journal of Cancer. “It should lead to a better understanding of what’s causing these tumors and what can be done to prevent them.” Though meningiomas are rarely cancerous, they behave in a similar way, leading scientists to wonder if some relationships between possible risk factors and tumor development would be similar, Schwartzbaum said. The researchers, looking at data collected from 1985 to 2012, identified 296 cases of meningioma, more than 61 percent of them in women. Women with the highest fasting blood sugar were less than half as likely as those with the lowest readings to develop a tumor. The relationship was not statistically significant when researchers looked at men’s fasting sugar readings and tumor development. But when they compared the less-reliable non-fasting sugar readings (those taken without a period of no food or drink that could influence the results), they found that both men and women with high blood sugar had a lower likelihood of meningioma diagnosis. A diabetes diagnosis before meningioma also appeared to decrease the risk of this tumor, although Schwartzbaum said the data likely had incomplete information on diabetes. The results could lead to a clearer explanation of how the tumors develop and grow and could potentially start researchers down the road to improved diagnostic techniques, Schwartzbaum said. “These tumors take years to develop, and an earlier diagnosis would certainly lead to better surgical outcomes,” she said. About seven in 100,000 U.S. residents receive a meningioma diagnosis annually. Meningiomas can cause headaches, weakness in the limbs, seizures, vision problems and personality changes. They represent about a third of all tumors that originate in the brain, according to the American Brain Tumor Association. Possible explanations for the relationship could be found by closer examination of the role of sex hormones and the interplay between glucose levels and those hormones, Schwartzbaum said. It’s also possible that sugar levels dip during early tumor development because the tumor is using glucose to grow, she said. “There are so many things still to be learned, but I am glad that people are now serious about studying these so-called benign tumors,” Schwartzbaum said. Because information in the database is limited, the researchers weren’t able to account for all the confounding factors that could have contributed to their results, including body mass index, blood pressure and hormone levels. The research was supported by the National Cancer Institute. Schwartzbaum’s collaborators at Ohio State were Brittany Bernardo, Robert Orellana, and Yiska Lowenberg Weisband. Others who worked on the study at the Karolinska Institutet in Sweden were Niklas Hammer, Goran Walldius, Hakan Malmstrom, Anders Ahlbom and Maria Feychting. #
Newswise — Johns Hopkins Medicine researchers report that rising blood levels of a protein called hematoma derived growth factor (HDGF) are linked to the increasing severity of pulmonary arterial hypertension, a form of damaging high blood pressure in the lungs. Their findings, described online June 2 in American Journal of Respiratory and Critical Care Medicine, could, they say, eventually lead to a more specific, noninvasive test for pulmonary arterial hypertension that could help doctors decide the best treatment for the disease. “This has the potential to be a much more specific readout for the health of the lungs than what we currently measure using invasive cardiac catheterization,” says senior study author Allen Everett, M.D., professor of pediatrics and director of the Pediatric Proteome Center at the Johns Hopkins University School of Medicine. “It could really have value in making decisions about when to escalate therapy and when to ease it because at present, it’s difficult to determine whether someone’s disease is getting better or worse, especially in children.” High blood pressure in the arteries that lead from the heart to the lungs is distinct from the most common forms of high blood pressure and can be difficult to diagnose, with shortness of breath frequently being the first or only symptom. Pulmonary hypertension is more common in women. Unlike many other forms of high blood pressure, the cause of pulmonary arterial hypertension isn’t always clear, but it can be genetic and/or associated with HIV and other infections, congenital heart disease, connective tissue disorders and living at high altitude. It often appears in otherwise healthy young people. While there’s no cure for pulmonary arterial hypertension — which is estimated to affect 200,000 Americans — there are an increasing number of drugs available to help relax the arteries in the lungs, and lung transplants are a last-resort therapy. Hoping to change the uncertainty surrounding diagnosis and therapy, Everett and his colleagues developed a new test to measure levels of HDGF in blood, which, Everett says, is a growth factor protein important for the formation of new blood vessels in the lung — a process known to readily occur in the lungs of patients with pulmonary hypertension. His research group compared blood samples from 39 patients with severe pulmonary arterial hypertension who had failed treatment for pulmonary arterial hypertension and were waiting for lung transplants, and a control group of 39 age, gender and race-matched healthy volunteers. They found median protein levels were about seven times higher than in controls, with a median of 1.93 nanograms per milliliter in patients and a median of 0.29 nanograms per milliliter in the controls. When the team followed up the new observation with blood tests of HDGF levels in an additional 73 patients over five years, the results were dramatic, Everett says. Patients with an HDGF level greater than 0.7 nanograms per milliliter had more extensive heart failure and walked shorter distances in a six-minute walking test. HDGF was also lower in survivors than nonsurvivors (0.2 nanograms per millilieter versus 1.4 nanograms per milliliter), with elevated levels associated with a 4.5-fold increased risk of death even after adjusting for age, pulmonary hypertension type, heart function and levels of a protein that in the blood that predicts heart failure. These findings, Everett says, suggest that HDGF has a distinct advantage to current clinical measures for predicting survival in patients with pulmonary hypertension. This kind of “dose response” information is critical to demonstrate in preliminary, proof-of-principle research, he says. Although the biochemical details of why there is a link between pulmonary arterial hypertension and HDGF remain unknown, Everett suspects levels of the growth factor might increase to spur blood vessel healing when arteries stretch in the lungs due to pulmonary arterial hypertension. HDGF is unique to current clinical measures of pulmonary hypertension, as it does not come from the heart and reflects more specifically how the disease affects the lungs, he says. Cautioning that the new findings need further examination and confirmation, Everett nevertheless says his team’s early results already point toward the value of using levels of HDGF in diagnosing and tracking pulmonary arterial hypertension in adults. “This could be a cheap and easy way to say: ‘Oh, good, your levels are going down. Let’s try to take away one of your medicines and see how that works,’” he explains. “Or if you know from the very beginning of their treatment that someone isn’t responding to any medicines, you can get them on the list for a lung transplant much sooner.” More research is needed to reveal whether levels change as drug therapy eases symptoms during the course of a disease, whether the results hold true in children with pulmonary arterial hypertension and whether HDGF can be used to predict patients at risk of developing pulmonary arterial hypertension in the future. Drug treatment is designed to thin the blood, relax arterial walls, and dilate or open up blood vessels. People with pulmonary arterial hypertension also can benefit from oxygen therapy and surgery to reduce pressure on the right side of the heart. Treatments are complicated and carry numerous serious side effects, Everett says, so finding measures that allow clinicians to minimize drug therapy will reduce side effects and cost. In addition to Everett, the study’s authors are Jun Yang, Melanie Nies, Zongming Fu, Rachel Damico, Frederick Korley and Paul Hassoun of The Johns Hopkins University; Ivy Dunbar of the University of Colorado; and Eric Austin of Vanderbilt University. Funding for the study was provided by the National Heart, Lung, and Blood Institute (grant numbers 1R03HL110830-01, R24HL123767, P50 HL084946/R01 and HL114910); the Cardiovascular Medical Research and Education Fund; and the Pulmonary Hypertension Association.