Natural therapy: Predict

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Tuesday, July 16, 2013

Urine Test to Predict Kidney Transplant Rejection

by Sheela Philomena on? July 04, 2013 at 9:59 AM Organ Donation News Examination of three biomarkers in the urine of kidney transplant recipients can help diagnose transplant rejection, show results. This test for biomarkers -- molecules that indicate the effect or progress of a disease -- offers an accurate, noninvasive alternative to the standard kidney biopsy, in which doctors remove a small piece of kidney tissue to look for rejection-associated damage. The findings appear in the July 4 issue of the New England Journal of Medicine. Urine Test to Predict Kidney Transplant Rejection
"The development of a noninvasive test to monitor kidney transplant rejection status is an important advance that will allow doctors to intervene early to prevent rejection and the kidney injury it causes, which should improve long-term outcomes for transplant recipients," said NIAID Director Anthony S. Fauci, M.D.

Following a kidney transplant, patients receive therapy to prevent their immune systems from rejecting the organ. Even with this immunosuppressive therapy, approximately 10 to 15 percent of kidney recipients experience rejection within one year after transplantation.

Typically, a biopsy is performed only after a transplant recipient shows signs of kidney injury. Although the procedure seldom causes serious complications, it carries some risks, such as bleeding and pain. In addition, biopsy samples sometimes do not give doctors an accurate impression of the overall state of the kidney because the samples are small and may not contain any injured tissue.

"Potentially, a noninvasive test for rejection would allow physicians to more accurately and routinely monitor kidney transplant recipients," said Daniel Rotrosen, M.D., director of NIAID's Division of Allergy, Immunology and Transplantation. "By tracking a transplant recipient's rejection status over time, doctors may be able to modulate doses of immunosuppressive drugs to extend the survival of the transplanted kidney." In the study, part of the NIH-funded Clinical Trials in Organ Transplantation (CTOT), investigators at five clinical sites collected urine samples from 485 kidney transplant recipients from three days to approximately one year after transplantation. Researchers led by Manikkam Suthanthiran, M.D., of Weill Cornell Medical College in New York and Abraham Shaked, M.D., Ph.D., of the University of Pennsylvania School of Medicine, Philadelphia, assessed the urinary cell levels of several biomarkers that previously have been associated with rejection.

Statistical analysis revealed that a group of three urinary biomarkers formed a diagnostic signature that could distinguish kidney recipients with biopsy-confirmed rejection from those whose biopsies did not show signs of rejection or who did not undergo a biopsy. The biomarkers include two messenger RNA molecules that encode immune system proteins implicated in transplant rejection and one noncoding RNA molecule that participates in protein production. The researchers used the signature to assign values to each urine sample and identify a threshold value indicative of rejection. With this test, they could detect transplant rejection with a high level of accuracy. The investigators obtained similar results when they tested a set of urine samples collected in a separate CTOT clinical trial, thereby validating the diagnostic signature.

To determine whether the urine test also could predict future rejection, the scientists analyzed trends in the diagnostic signature in urine samples taken in the weeks before an episode of rejection. The values for patients who experienced rejection increased slowly but steadily leading up to the event, with a characteristic sharp rise occurring approximately 20 days before biopsy confirmed rejection had occurred. In contrast, the values for patients who did not show any clinical signs of rejection remained relatively constant and under the threshold for rejection. These findings suggest that it might be possible to treat impending rejection before substantial kidney damage occurs.

"The test described in this study may lead to better, more personalized care for kidney transplant recipients by reducing the need for biopsies and enabling physicians to tailor immunosuppressive therapy to individual patients," said NIAID Transplantation Branch Chief Nancy Bridges, M.D., a co-author of the paper. The CTOT cooperative research consortium provided the infrastructure and collaborative environment needed to conduct the large, rigorous, multicenter study that established the efficacy of this biomarker-based test, Dr. Bridges noted.

Source-Eurekalert

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Tuesday, June 18, 2013

Indicators of depression can predict the Disabilty work better

by Dr.Enozia Van Daele on June 15, 2013 at 4:58 pm new Lifestyle Indications of depression may predict the inability to work in the first best discoveries, new data from arthritis. Depression Indicators may Predict Work Disabilty Better
The study showed that in a multivariate analysis none of the activity of arthritis measures or cardiovascular, metabolic or studied lung were associated with early retirement, but a statement unique depression 'having little interest or pleasure in most days during the last 2 weeks of doing things' identified more patients to ask the disability pension.

"Our results demonstrate that if patients with early arthritis consider applying for the disability pension is more dependent on the mental states that the activity of the disease. "Arthritis having a financial impact on patients and society, attention focused on welfare in the early stages of the disease may help patients remain in the labour market", commented the lead author of the study by Professor Angela Zink, head of the unit of epidemiology at the Research Centre German rheumatism in Berlin.

Musculoskeletal diseases affect at least 100 million people in Europe, represents a half of all absences European labour and 60% of incapacity for work. If poorly managed, they represent a heavy economic burden on European society, estimated at up to 2% of GDP.2

573 patients<63 years="" enrolled="" in="" an="" early="" inflammatory="" arthritis="" (ia)="" cohort=""><6 months)="" were="" analysed="" with="" respect="" to="" their="" decision="" to="" request="" disability="" pension="" within="" the="" first="" 12="" months="" of="" treatment.="" patient="" reported="" parameters="" included="" pain,="" morning="" stiffness,="" fatigue,="" functional="" capacity,="" and="" the="" depression="" statement="" "having="" little="" pleasure="" or="" interest="" in="" doing="" things="" most="" of="" the="" day.="">

Patients had duration of the symptom of 13 + 7 weeks, 67% were rheumatoid factor (RF) and/or anti-Citrullinated protein antibody (ACPA) - positive, filled with 65% the new ACR - EULAR response criteria * initially and 87% took the disease-modifying antirheumatic drugs (DMARDs) in 12 months. Less than a year of care, 21% of patients with moderate depression indicators and 45% of people with severe depression had considered or entered an early retirement.

Source-Eurekalert

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Thursday, May 23, 2013

New Analysis to Predict Efficacy of Breast Cancer Treatment

by Dr.Enozia Vakil on? May 04, 2013 at 11:35 AM Cancer News A new analysis may help better determine which women with oestrogen-receptor positive breast cancer are at a risk of recurrence, and which ones benefit from endocrine treatment. New Analysis to Predict Efficacy of Breast Cancer Treatment
The promising new findings will likely benefit the many women with oestrogen-receptor positive breast cancer whose cancer recurs more than five years after diagnosis, researchers told the 5th IMPAKT Breast Cancer Conference in Brussels, Belgium.

The IMPAKT meeting presents cutting edge, 'translational' breast cancer research that is beginning to have an impact for patients.

In oestrogen-receptor positive women, half of all recurrences of breast cancer will occur after the women finish the standard 5 years of hormonal treatment, explains lead author Dr Ivana Sestak from the Wolfson Institute of Preventive Medicine in London, UK.

"There is great interest in establishing which women are at adequate high risk of late recurrence after the initial hormonal treatment period, which is currently 5 years," Dr Sestak says.

At the meeting, researchers reported the findings of a comparison of five different scores designed to predict which women may be at increased risk of developing a late recurrence of their cancer. This is the first time that all five scores have been compared within one dataset.

Knowing which women may be at increased risk of developing a late recurrence would enable doctors to identify those women who may be good candidates for extended hormonal therapy, she says.

The ATAC trial included nearly 10,000 women who were treated with surgery followed by five years of treatment with the drugs anastrozole, tamoxifen or a combination of both. Of these 1,125 from the monotherapy arms (tamoxifen, anastrozole) were included in the transATAC study.

The five scores being compared were the: Clinical Treatment Score, which includes information on the patient's disease and treatments so far; IHC4 score, which characterises the presence of cell surface markers on cancer cells; Three different gene expression scores -- the Oncotype Dx Recurrence Score; the PAM50 Risk of Recurrence Score; and the Breast Cancer Index score. The results showed that the clinical treatment score alone was the best for predicting late recurrence, the researchers report. The components of this score include some that are already widely used by doctors, such as whether the cancer has spread to sentinel lymph nodes, the tumour size and grade.

Among the other tests, the PAM50 risk of recurrence score and the Breast Cancer Index score added the most significant prognostic value between years 5 and 10 after diagnosis.

"The most promising new scores from this study are the PAM50 Risk of Recurrence score and the Breast Cancer Index score, both containing different genetic information that are not included in the clinical treatment score and at the moment not routinely measured in clinics," Dr Sestak says.

"Our further interest now lies in the investigation of which individual components of these scores attribute specifically to the prediction of late recurrence, since the Risk of Recurrence and Breast Cancer Index scores consist of several genes and other components. We are now undertaking these analyses and the results will hopefully tell us which genes specifically predict late recurrence. However, at this stage it is not possible to predict response to treatment."

Commenting on the results, Dr Peter Dubsky from the Medical University of Vienna, Austria, noted that oestrogen-receptor positive and Her2 negative breast cancers are prone to late recurrences.

"About half of all recurrences observed within 15 years of follow-up occur five years after diagnosis. Although there is a sustained benefit of adjuvant endocrine therapy beyond five years, we still see two-thirds of breast cancer deaths occurring after this time. Clearly, the identification of women that are at risk for these late types of recurrences is an important clinical research goal," said Dr Dubsky, who was not involved in the study.

"Sestak and colleagues provide highly relevant new data to meet this end: they have compared five different prognostic scores in order to predict outcome beyond the first five years of follow-up. Of note, none of these scores were primarily trained to specifically predict late recurrence. They show that a Clinical Treatment score (CTS) contained most of the prognostic information relevant to late distant metastases. Interestingly, only the Risk of Recurrence (ROR) score (PAM50) and the Breast Cancer Index (BCI) score provided additional information to the CTS. This data will need further validation before actually being incorporated into clinical decision-making concerning adjuvant endocrine therapy beyond five years."

These findings are similar to those proposed by the Austrian Breast and Colorectal Cancer Study Group recently, Dr Dubsky said. "The Endopredict Score was able to add additional prognostic information to clinical variables concerning distant metastases occurring later than five years after diagnosis. Future research should further address which are the biologic motifs behind late recurrences. Furthermore, molecular tools specifically designed to predict late metastasis should be developed."

Source-Eurekalert

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