StemCell Therapy

Singapore: Researchers at the Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, The Netherlands, have discovered that stem cells harvested from fat (adipose) are more potent than those collected from bone marrow in helping to modulate the body's immune system. The research, which was led by led by Dr Helene Roelofs, has been published in in the current issue of Stem Cells Translational Medicine.

For the study, the team used stem cells collected from the bone marrow and fat tissue of age-matched donors. They compared the cells' ability to regulate the immune system in vitro and found that the two performed similarly, although it took a smaller dose for the adipose tissue-derived stem cells (AT-SCs) to achieve the same effect on the immune cells. When it came to secreting cytokines, the cell signaling molecules that regulate the immune system, the AT-SCs also outperformed the bone marrow-derived cells.

The finding could have significant implications in developing new stem-cell-based therapies, as AT-SCs are far more plentiful in the body than those found in bone marrow and can be collected from waste material from liposuction procedures.

Dr Roelofs said that, "Adipose tissue is an interesting alternative since it contains approximately a 500-fold higher frequency of stem cells and tissue collection is simple. Moreover, 400,000 liposuctions a year are performed in the U.S. alone, where the aspirated adipose tissue is regarded as waste and could be collected without any additional burden or risk for the donor. This all adds up to make AT-SC a good alternative to bone marrow stem cells for developing new therapies."

Dr Anthony Atala, editor, Stem Cells Translational Medicine, and director, Wake Forest Institute for Regenerative Medicine, US, said that, "Cells from bone marrow and from fat were equivalent in terms of their potential to differentiate into multiple cell types. The fact that the cells from fat tissue seem to be more potent at suppressing the immune system suggest their promise in clinical therapies."

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Stem cells from fat outperform those from bone marrow ...

What is diabetes?

Diabetes is a disease in which the body is unable to properly use and store glucose (a form of sugar). Glucose backs up in the bloodstream causing ones blood glucose (sometimes referred to as blood sugar) to rise too high.

There are two major types of diabetes. In type 1 (fomerly called juvenile-onset or insulin-dependent) diabetes, the body completely stops producing any insulin, a hormone that enables the body to use glucose found in foods for energy. People with type 1 diabetes must take daily insulin injections to survive.This form of diabetes usually develops in children or young adults, but can occur at any age. Type 2 (formerly called adult-onset or non insulin-dependent) diabetes results when the body doesnt produce enough insulin and/or is unable to use insulin properly (insulin resistance).This form of diabetes usually occurs in people who are over 40, overweight, and have a family history of diabetes, although today it is increasingly occurring in younger people, particularly adolescents.

People with diabetes frequently experience certain symptoms. These include:

In some cases, there are no symptoms this happens at times with type 2 diabetes. In this case, people can live for months, even years without knowing they have the disease. This form of diabetes comes on so gradually that symptoms may not even be recognized.

Diabetes can occur in anyone. However, people who have close relatives with the disease are somewhat more likely to develop it. Other risk factors include obesity, high cholesterol, high blood pressure, and physical inactivity. The risk of developing diabetes also increases as people grow older. People who are over 40 and overweight are more likely to develop diabetes, although the incidence of type 2 diabetes in adolescents is growing. Diabetes is more common among Native Americans, African Americans, Hispanic Americans and Asian Americans/Pacific Islanders. Also, people who develop diabetes while pregnant (a condition called gestational diabetes) are more likely to develop full-blown diabetes later in life.

There are certain things that everyone who has diabetes, whether type 1 or type 2, needs to do to be healthy. They need to have a meal (eating) plan. They need to pay attention to how much physical activity they engage in, because physical activity can help the body use insulin better so it can convert glucose into energy for cells.Everyone with type 1 diabetes, and some people with type 2 diabetes, also need to take insulin injections. Some people with type 2 diabetes take pills called "oral agents" which help their bodies produce more insulin and/or use the insulin it is producing better.Some people with type 2 diabetes can manage their disease without medication by appropriate meal planning and adequate physical activity.

Everyone who has diabetes should be seen at least once every six months by a diabetes specialist (an endocrinologist or a diabetologist). He or she should also be seen periodically by other members of a diabetes treatment team, including a diabetes nurse educator, and a dietitian who will help develop a meal plan for the individual. Ideally, one should also see an exercise physiologist for help in developing a physical activity plan, and, perhaps, a social worker, psychologist or other mental health professional for help with the stresses and challenges of living with a chronic disease. Everyone who has diabetes should have regular eye exams (once a year) by an eye doctor expert in diabetes eye care to make sure that any eye problems associated with diabetes are caught early and treated before they become serious.

Also, people with diabetes need to learn how to monitor their blood glucose. Daily testing will help determine how well their meal plan, activity plan, and medication are working to keep blood glucose levels in a normal range.

Your healthcare team will encourage you to follow your meal plan and exercise program, use your medications and monitor your blood glucose regularly to keep your blood glucose in as normal a range as possible as much of the time as possible. Why is this so important? Because poorly managed diabetes can lead to a host of long-term complications among these are heart attacks, strokes, blindness, kidney failure, and blood vessel disease that may require an amputation, nerve damage, and impotence in men.

But happily, a nationwide study completed over a 10-year period showed that if people keep their blood glucose as close to normal as possible, they can reduce their risk of developing some of these complications by 50 percent or more.

Maybe someday. Type 2 diabetes is the most common type of diabetes, yet we still do not understand it completely. Recent research does suggest, however, that there are some things one can do to prevent this form of diabetes.Studies show that lifestyle changes can prevent or delay the onset of type 2 diabetes in those adults who are at high risk of getting the disease. Modest weight loss (5-10% of body weight) and modest physical activity (30 minutes a day) are recommended goals.

Find more information about diabetes in What You Need to Know about Diabetes A Short Guide available from the Joslin Online Store.

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Diabetes Facts & Information | Joslin Diabetes Center

Arthritis is a broad term that covers a group of over 100 diseases. It has everything to do with your joints -- the places where your bones connect -- such as your wrists, knees, hips, or fingers. But some types of arthritis can also affect other connective tissues and organs, including your skin.

About 1 out of 5 adults have some form of the condition. It can happen to anyone, but it becomes more common as you age.

With many forms of arthritis, the cause is unknown. But some things can raise your chances of getting it.

Arthritis mainly causes pain around your joints. You might also have:

The symptoms can be constant, or they may come and go. They can range from mild to severe.

More-severe cases may lead to permanent joint damage.

Osteoarthritis and rheumatoid arthritis are the most common kinds.

In osteoarthritis,the cushions on the ends of your bones, called cartilage, wear away. That makes the bones rub against each other. You might feel pain in your fingers, knees, or hips.

It usually happens as you age. But if underlying causes are to blame, it can begin much sooner. For example, an athletic injury like a torn anterior cruciate ligament (ACL) or a fracture near a joint can lead to arthritis.

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An Introduction to What Arthritis Is All About

Starting at around the age of 30, human growth hormone production starts declining for both men and women at about 10% per decade. Sermorelin therapy intends to replace this lost HGH with the use of a compound called Sermorelin acetate. Sermorelin is not HGH, it is an amino acid (growth hormone releasing peptide) that stimulates the body to producemore HGH, and it is now widely used as an anti-aging treatment. The release of HGH results in the liver releasing IGF-1 along witha wide range of other effects on the body that will be explained in this article. Sermorelin therapy is a gradual anti-aging therapy that can take a few monthsbefore the effects start to be noticed, although many patients experience positive health effects within just days or weeks of starting the program. If you have even a smallHGH deficiency, you will very likely start noticing positive health effects very soon after starting the treatment.

There are many benefits to restoring your normal HGH production levels. The decline in human growth hormone levels is associated with several aging symptoms such as a lower energy level, lower libido, decreased muscle mass, increased body fat, a slower metabolism, skin aging signs, and more. These symptoms can be treated with Sermorelin therapy, and some of the health benefits are seen more quickly than others. For instance, it may take a while before skin wrinkling and tone improves, but energy levels and libido can often improve much sooner than this. It also can take several weeks before patients start to see weight loss or improved muscle mass, but the effect does occur for a large number of patients. The changes in body composition can be substantial even if you dont exercise, but if you do exercise you will get the most out of the treatment and may see very fast results.

One of the most beneficialSermorelin results is that it can greatly improve your exercise performance and help you recover more quickly and put on muscle faster than before. As you age, your exercise recovery starts to diminish, and you may not be able to perform as much exercise as you were able to when you were younger. Sermorelin can restore your HGH levels so that exercise is easier and so that you have more energy to get through more strenuous workouts. It can take longer for the treatment to improve exercise performance, but the effect does occur, and it can usually be seen within three to six months after starting the treatment. You will also notice that your body fat will start to decrease even without working out at all.

Your body composition gets more and more difficult to change as you start to age. This occurs partially as the result of a lower HGH production, as well as the long term effects of carrying excess fat, which can change your bodys chemistry and metabolism and make it more difficult to lose weight. Sermorelin can help you lose weight by improving fat metabolism. When your body produces HGH, it starts burning adipose tissue for energy, and the treatment can improve a slow metabolism. Several studies have found a correlation between increased HGH production and the burning of visceral fat and abnormal fat, and patients who are exercising while taking Sermorelin see a much faster gain in muscle mass than they would without the therapy. The changes in body composition occur more gradually without exercise, and with regular exercise they can be dramatic and occur within a matter of weeks.

There are some studies that suggest that a human growth hormone deficiency is associated with a higher risk of heart disorders, and Sermorelin may help protect against heart diseases and cardiovascular problems by restoring normal HGH levels. For example, supplementation with HGH has proven to be effective at improving symptoms for patients who are suffering from congestive heart failure. Many patients who develop heart disease and other heart disorders also suffer from a decline in HGH production which can be corrected with Sermorelin therapy. Another major health benefit of the treatment is that bone density can increase back to youthful levels, and this is very important for preventing debilitating injuries as a person ages along with bone and joint disorders.

A decline in HGH is often associated with mood disorders and a low libido, because lower hormone levels can be associated with decreased energy levels. Restoring normal human growth hormone levels can provide a boost in energy and improve mood, and this can be helpful for treating mood disorders like anxiety and depression. Also, a decreased libido is often associated with a human growth hormone decline, and is also associated with a decline in testosterone and estrogen production, but restoring normal HGH levels has been shown to improve libido for both men and women. Patients also often experience an overall general feeling of well-being as the result of the treatment, even for patients who do not have any mood disorders or a low libido. The effects with improved libido and a higher energy level will vary from one patient to another, and these effects sometimes take several months before they are seen.

You may see some of the quicker results mentioned above within a few weeks of time, but to see real results with the therapy you need to continue it for at least three to six months or longer. There is no reason why you cant try Sermorelin for up to twelve months or even longer, because it is a safe treatment and there is no indication that there are any long term health effects from it. To see some of the results like improved skin quality, a more youthful body composition, higher bone density, improved sleep quality and more, you may need to use the therapy for a long period of time, but after you have used it for several months in a row, the higher level of HGH production often maintains itself and you may be able to stop the therapy for a period of time.

First, before you start the treatment, your hormone levels should be measured by a licensed medical provider. In general, you should avoid any hormone therapy program that is not administered by licensed medical doctors because of the potential of serious medical mistakes. The treatment should never be self-administered because the dosage needs to be carefully selected, and there are important considerations for some patients who may not be able to safely try the treatment. The appropriate dosage for Sermorelin can only be known once your hormone deficiency level is known.

Any treatment programs that neglect this important step should be avoided, as it is crucial to perform this test at the start of treatment. Also, you need to be able to consult with a medical provider to ask questions about the treatment, and your medical history needs to be reviewed prior to starting it as well. If you have any questions about the effects of Sermorelin therapy and how the treatment can benefit you and protect your body from aging, contact a medical provider at Nu Image Medical today.

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What Sermorelin Results Can You Expect? - Nu Image Medical

Every sportsfishing captain I know would love just to see a Albino Marlin and to catch the most prized game fish in the World ... well thats just something you can ONLY dream about. These pictures are truly once-in-a-lifetime images. Billfish "experts" agree that these rare albino blue marlin pictures may be the first ever captured on camera. Marlin are among the most prized saltwater game fish in the world. They fight hard, swim fast and jump high once hooked, which makes them a [Read More...]

A week ago, a friend, from the world-class resort Crocodila Bay published an awesome video of a sailfish jumping into a boat and in a heat of panic, the angles jumping out. Within days, the hits to the video numbered over 26,000. A while back, we published a short video on Costa Rica sportsfishing captain, Captain Bobby McGuinness, holder of over 200 world records, and within a short time over 10,000 hits. If you view the videos, notice one thing in common, all have targeted the business using [Read More...]

Two thousand, one hundred and seventy billfish released in three days! If this doesn't make all you avid saltwater anglers scurry to get on the next plane to Costa Rica, we don't know what will. Los Suenos Marina, reputedly the finest marina on the Pacific coast south of the US border (Cabo San Lucas in Mexico and Via del Mar in Chile might beg to differ, but who cares), just hosted Leg 1 of the First Annual Los Suenos Signature Triple Crown Tournament. Forty-two boats [Read More...]

It has always been the policy of Tico Times Directory to be neutral, and only on rare occasions will we write something political and/or controversial, like what we did on the release of a pedophile, the poaching of Costa Rica sea turtle eggs, and real estate scams. However, this morning we received (not one, but many) of the same cookie-cutter emails: Dear Tico Times Directory, I just signed Daniel Woodall's petition "Disassociate, cease financial support and endorsement of the [Read More...]

This August, twenty students, teachers, alumnus and parents from the Meadowbrook School of Weston, Massachusetts, along with three guides from Costa Rican Adventures, traveled through Costa Rica to revisit some of the communities they had been introduced to during the schools class trip in February 2013. The group came with two very ambitious service goals: 1. Building a library at the PANI transitional home in Limon, and 2. Installing solar electricity at the Melleruk School in [Read More...]

About a year and a half ago I made my first Bitcoin (the controversial digital currency) transaction and several weeks ago another one. People have asked me, "Why?" My answer was simple, "To see what it was all about." In the last several months, I have been following the outcome of the Bitcoin ETF Backers Winklevoss Twins, who were made famous by suing Facebook founder, Mark Zuckerberg, for $140 million, claiming he stole their idea to create the popular social networking [Read More...]

Costa Rica is known around the world for its big-game saltwater fishing done on the Pacific and Caribbean coasts, which is done from boats to catch large open-water species such as tuna, wahoo, dorardo and billfish (marlin, sailfish and swordfish). Recently, Sport Fishing Magazine sought input from seven angling experts, historians and authorities and did their top 100 worlds records most amazing and best saltwater catches. Even if Costa Rica has had 100s of world records, they [Read More...]

Travelers to Costa Rica may acquire dengue fever, a potentially life-threatening viral illness, during visits to tropical and subtropical countries. Dengue is transmitted by the bite of infective Aedes mosquitos which are found primarily in urban areas. This disease occurs in most of tropical Asia, the Pacific Islands, the Caribbean Islands, Central and South America, and Africa. There is generally greater risk in urban areas and less risk of dengue in rural areas and at altitudes above 1500 [Read More...]

Costa Rica is no stranger to surveillance; it has always been Central/South America's hub of eavesdropping. Back in the early 1980s the U.S. Embassy in San Jose, Costa Rica was undergoing a remodeling and when finished, the roofs were covered with various sizes of satellite dishes and antennas. These CIA surveillance equipment targeted the conflict areas of Nicaragua, El Salvador, and various hot zones in South America. With support of the U.S. Government, Costa Ricas internet [Read More...]

Each year, around one million individuals, a large part of whom are kids, need to be hospitalize for severe dengue. And each year, numerous Costa Rica media outlets warn about it. Costa Rica Minister of Health stated in 2012, 23,000 dengue cases were reported. Dengue fever and dengue hemorrhagic fever (DHF) are viral diseases transmitted by Aedes mosquitoes, usually Ae. aegypti. The four dengue viruses (DEN-1 through DEN-4) are immunologically related, but do not provide cross-protective [Read More...]

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Annapolis Endocrinology 108 Forbes St, Annapolis, MD 21401 USA

I have had nothing but bad experiences with this group. I had to wait well beyond my appointment time. I was harassed to provide my driver's license for scanning. I don't like having my driver's license scanned every medical appointment.... (More)

I have had nothing but bad experiences with this group. I had to wait well beyond my appointment time. I was harassed to provide my driver's license for scanning. I don't like having my driver's license scanned every medical appointment. No other physician's office has had an issue with this. I've been waiting as calmly as possible for results. In the medical room, they send the nurse supervisor in to tell me my results weren't back. No one was on top of the day's appointments apparently. Blah, blah, blah later, I walked out. This is ridiculous!!!! The doctor didn't even have the decency to give me the information herself!! Time to find a new practice. This website makes me rate the practice. I would give it a 0, but have to provide at least a 1. (Hide)

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Annapolis Endocrinology in Annapolis, MD | 108 Forbes St ...

Dr. Varsha Rathod, MD is board certified in internal medicine and rheumatology and has been successfully enhancing traditional medicine with the benefits of holistic healing since 1995. She is an expert in the field of Functional Medicine.

Dr. Rathod and her staff are committed to your long-term health and happiness. They partner with their patients in a compassionate and caring relationship and empower them with knowledge and hope to bring about healing.

At Preventive Medicine, we get to know you by taking your history and using the latest diagnostic tools and labs. The wisdom from holistic practices is used to target the balancing of key biological functions in your body to keep you healthy and feeling good.

We use the term Holistic because we believe that each one of us is made up of three components: body, mind and spirit. Holistic healing addresses all three of these aspects to bring about your healing as opposed to the conventional way of thinking in which only certain bodily ailments or dysfunctions require the attention of a physician.

Most dysfunction that leads to disease comes from disturbances in key biological processes in your body and mind. These functions pertain to proper digestion, proper and controlled immune and inflammatory responses, proper detoxification, hormonal balance, maintaining our structure and alignment as well as managing our rusting process (oxidative stress-aging), and finally taking care of our psycho-emotional needs.

A Functional Medicine doctor actively works to restore balance to key systems. It is with these functions in mind that we are able to order appropriate testing. All of our patients leave with their lab results and a copy of their office notes, which we review with them after each visit.

We are patient-centered and passionate about working with you to ensure your long-term health and happiness. We take time to listen to you, explain your lab and test results and answer your questions. We then develop an individualized treatment plan that focuses on you as a whole person, rather than just managing a disease that you may have.

If you are tired of being ill, if you would like to understand what made you ill and what you need to do to get better, or if you simply want to maintain your good health, then we believe that you can achieve all these goals at Preventive Medicine.

To learn more about how Dr. Rathod and her staff can help you, please call the office at 314-997-5403 or attend one of our monthly free educational meetings.

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Did you know that kidney stone plagued even the ancient Egyptians [source: NKUDIC]? Or that 26 million Americans have chronic kidney disease [source: National Kidney Foundation]? Hundreds of thousands of people suffer from renal failure each year and undergo dialysis or await a kidney transplant.

But what do your kidneys do? Why are they so important? Don't they just produce urine? In this article, we'll take a close look at our kidneys and find out exactly what they do.

Your kidneys are two bean-shaped organs, each about the size of your fist. They are located in the middle of your back, just below your rib cage, on either side of your spine. Your kidneys weigh about 0.5 percent of your total body weight. Although the kidneys are small organs by weight, they receive a huge amount -- 20 percent -- of the blood pumped by the heart. The large blood supply to your kidneys enables them to do the following tasks:

Your kidneys receive the blood from the renal artery, process it, return the processed blood to the body through the renal vein and remove the wastes and other unwanted substances in the urine. Urine flows from the kidneys through the ureters to the bladder. In the bladder, the urine is stored until it is excreted from the body through the urethra.

Now let's take a look inside your kidneys.

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How Your Kidneys Work - HowStuffWorks

Kidney,male kidneys in situ; human renal systemEncyclopdia Britannica, Inc. in vertebrates and some invertebrates, organ that maintains water balance and expels metabolic wastes. Primitive and embryonic kidneys consist of two series of specialized tubules that empty into two collecting ducts, the Wolffian ducts (see Wolffian duct). The more advanced kidney (metanephros) of adult reptiles, birds, and mammals is a paired compact organ whose functional units, called nephrons, filter initial urine from the blood, reabsorb water and nutrients, and secrete wastes, producing the final urine, which is expelled.

Reptilian and avian kidneys are made up of many tiny lobules that, in birds, are combined into three or more lobes. Collecting tubules from each lobule empty into a separate branch of the ureter. Reptiles have relatively few nephrons (from 3,000 to 30,000 in lizards), while birds have a great number (around 200,000 in a fowl, twice as many as in a mammal of comparable size).

Mammalian kidneys have a somewhat granular outer section (the cortex), containing the glomeruli and convoluted tubules, and a smooth, somewhat striated inner section (the medulla), containing the loops of Henle and the collecting tubules. As the ureter enters the kidney it enlarges into a cavity, the renal pelvis; urine passes into this pelvis from the collecting tubules. Nephrons are numerous (20,000 in a mouse).

kidney: left kidney, and right kidney with cut section viewEncyclopdia Britannica, Inc.In humans the kidneys are about 10 centimetres long and are located beneath the diaphragm and behind the peritoneum. Each kidney contains 1,000,0001,250,000 nephrons that filter the entire five-quart water content of the blood every 45 minutesan equivalent of 160 quarts a day. Of this, only 1 1/2 quarts are excreted; the remainder is reabsorbed by the nephrons.

Damaged kidneys secrete an enzyme called renin that stimulates constriction of the blood vessels. When the damage has been caused initially by high blood pressure, the increase in pressure from the constricted vessels causes more kidney damage.

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kidney | anatomy | Britannica.com

Kidneys are two organs in the abdomen of vertebrates that are shaped like beans. They make urine (the yellow waste water that comes out of the urethra.) They are part of the urinary system. When medical professionals discuss the kidneys, they typically refer to the word renal. For example, renal failure is when the kidneys are sick and do not work.

The prefix nephro- is also used in words to mean "kidneys". For example, a nephrologist is a doctor who studies kidneys.

The kidney makes hormones. The two most important ones that it makes are erythropoetin and renin.

Erythropoetin is made by the kidneys if there is less oxygen in the kidney. Erythropoetin tells the bone marrow to make more red blood cells. So this means there will be more oxygen carried in the blood.

Renin is made by the kidney if there is low blood pressure, low volume of blood, or too low salts in the blood. Renin makes the blood vessels smaller and tells the adrenal gland to make aldosterone (which tells the kidneys to save salts). It also makes a person feel thirsty. All of this makes the blood pressure go up.

The kidney's most important work is keeping homeostasis. Homeostasis means that the body keeps a stable environment inside itself. The body needs to have the consistent and proper amount of water, salt, and acid in the blood. The kidney keeps these things constant.

If there is too much water, the kidney puts more water in the urine. If there is not enough water, the kidney uses less water in the urine.This is why people make less urine when they are dehydrated.

There are many types of kidney diseases. A kidney disease makes the kidneys unable to work perfectly but they do work in part. People can have mild kidney failure and have no symptoms. As long as it does not become worse, people may not even know they have it. Severe kidney failure means very bad failure. The kidneys do not work very much at all. People with severe kidney failure always have symptoms. They may need special care from doctors.

The main kinds of kidney diseases are:

If a person's kidneys do not work properly, they are very sick. If they have severe kidney failure, they cannot live unless they have a replacement for their kidneys.

There are two ways to replace the kidneys: dialysis and transplantation.

Dialysis is when doctors use a machine and medicines to do the work of the kidneys. There are two kinds of dialysis: hemodialysis and peritoneal dialysis.

Peritoneal dialysis is when doctors put a plastic tube into the person's abdomen. Every day the person fills the abdomen with fluid. The extra salts, waste, and water that the body does not need goes into the fluid. Then the fluid comes out and takes the wastes with it. This does part of the job that kidneys do.

Hemodialysis is when doctors take blood from a person, clean the blood with a special kind of filter, called a haemodialyser, and put it back in the person. When the blood is cleaned; water, salts and wastes are taken out of it. This must be done 24 times every week (usually 3 times.) It takes 24 hours to do this each time.

Hemodialysis and peritoneal dialysis are not perfect. They do some of the work of the kidney, but it is not as good as a real kidney. So people who need dialysis are not as healthy. They must take medicines. For example, in kidney failure, the kidneys do not make any erythropoetin. Doctors have to give people erythropoetin so they make enough red blood cells.

A better way to do the kidneys' work is to give the person another kidney. This is called a kidney transplant. Kidney transplants are the most common type of organ transplant. It is the most common because we have two kidneys, but only need one kidney to live. People who are alive can donate a kidney to another person.

Even transplanted kidneys are not the same as kidneys people were born with. A person who gets a renal transplant must take strong medicines to stop their body from attacking the new kidney. Sometimes, after years, the transplanted kidney stops working. But sometimes a patient can get a new transplanted kidney after the first one stops working.

It was widely believed in Europe that the conscience was actually located in the kidneys. This idea was taken from the Hebrew Bible. In modern times, medical scientists have shown kidneys do not have this kind of psychological role.

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Kidney - Simple English Wikipedia, the free encyclopedia

Evidence reviews Increased water intake may help reduce the risk of recurrence of kidney stones but more studies are needed

Kidney stones (also known as calculi) are masses of crystals and protein and are common causes of urinary tract obstruction in adults. For a long time, increased water intake has been the main preventive measure for the disease and its recurrence. In this review only one study was found that looked at the effect of increase water intake on recurrence and time to recurrence. Increased water intake decreased the chance of recurrence and increased the time to recurrence. Further studies are needed.

Stones in the urinary tract are a common medical problem. Half of patients with previous urinary stones have a recurrence within 10 years. Kidney stones can cause pain, blood in the urine, infection, decreased kidney function, and kidney failure. The treatment is to remove the stones from kidney. Extracorporeal shock wave lithotripsy (ESWL) disintegrates stones using shock waves and is a minimally invasive technique. Other minimally invasive methods (percutaneous nephrolithotomy (PCNL)) and retrograde intrarenal surgery (RIRS)) are widely used for kidney stones management because ESWL had limited success rate. This review aimed to compare the effectiveness and complications between ESWL and stones removing using the nephroscopy through the skin at kidney level (PCNL) or ureteroscope through the bladder and ureter to the kidney (RIRS). Five small randomised studies (338 patients) were included. Four studies compared ESWL with PCNL and one study compared ESWL with RIRS. Patients with kidney stones who undergo PCNL have a higher success rate than ESWL whereas RIRS was not significantly different from ESWL. However, ESWL patients spent less time in hospital, duration of treatment was shorter and there were fewer complications.

Lower pole kidney stones are challenging to treat effectively. Many people with lower pole kidney stones undergo shock wave lithotripsy to break up stones so they can be passed from the body in the urine. In some cases, stone fragments can be retained, and these can be difficult to eliminate. Better techniques are needed to help people pass small lower pole kidney stones or fragments that remain following shock wave lithotripsy.

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Kidney stones (also known as calculi) are masses of crystals and protein and are common causes of urinary tract obstruction in adults. For a long time, increased water intake has been the main preventive measure for the disease and its recurrence. In this review only one study was found that looked at the effect of increase water intake on recurrence and time to recurrence. Increased water intake decreased the chance of recurrence and increased the time to recurrence. Further studies are needed.

Stones in the urinary tract are a common medical problem. Half of patients with previous urinary stones have a recurrence within 10 years. Kidney stones can cause pain, blood in the urine, infection, decreased kidney function, and kidney failure. The treatment is to remove the stones from kidney. Extracorporeal shock wave lithotripsy (ESWL) disintegrates stones using shock waves and is a minimally invasive technique. Other minimally invasive methods (percutaneous nephrolithotomy (PCNL)) and retrograde intrarenal surgery (RIRS)) are widely used for kidney stones management because ESWL had limited success rate. This review aimed to compare the effectiveness and complications between ESWL and stones removing using the nephroscopy through the skin at kidney level (PCNL) or ureteroscope through the bladder and ureter to the kidney (RIRS). Five small randomised studies (338 patients) were included. Four studies compared ESWL with PCNL and one study compared ESWL with RIRS. Patients with kidney stones who undergo PCNL have a higher success rate than ESWL whereas RIRS was not significantly different from ESWL. However, ESWL patients spent less time in hospital, duration of treatment was shorter and there were fewer complications.

This summary will tell you about: Changes you can make to your diet and/or medicines you can take that could help lower your chance of getting another calcium stone What research says about how well making changes to your diet and taking medicines work to lower the chance of getting another calcium stone Possible side effects of the medicines This summary can help you talk with your doctor about options to help lower your chance of getting another calcium stone.

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Kidney Stones - National Library of Medicine - PubMed Health

The National Sports Medicine Institute is a full-service sports medicine and orthopaedic clinic situated in Lansdowne, Virginia. The clinic services include state of the art sports injury evaluation and treatment by highly trained orthopaedic sports medicine specialists. The clinic also offers coordinated state of the art diagnostic imaging and physical therapy services. MissionStatement The goal of NSMIis to establish in the field of Orthopaedic Sports Medicine, a local, national and international leadership role, by providing the highest standard of sports orthopaedic care combined with outstanding programs of education, research and performance enhancement to benefit athletes at all levels of competition. The clinic has the ability to care for the most distinguished elite athlete and offer the same level of care to the recreational athlete as well as those desiring mobility and active lifestyles. Our Philosophy Our practice is founded on achieving excellence in Orthopaedic Surgery, demonstrating integrity in our physician-patient relationships, providing compassionate care for our injured clients and promoting wellness as a priority in life. We strive for teamwork among health care professionals as a means to optimize both non-surgical and surgical outcomes. Our Physicians Dr. David C. Johnson is graduate of the University of Virginia School of Medicine. He completed his orthopedic surgery residency at the Hospital for Special Surgery in New York, NY. Dr. Johnathan Bernard was born in Los Angeles, California. The son of a U.S. Naval Pilot, he lived in various countries including the Philippines, Japan, Cuba, Jamaica and several states including Florida, Texas, and Wisconsin. Dr. Timothy Johnson is an Engineer from Yale. He is also a graduate of the Yale University School of Medicine. He completed his Orthopedic Surgery residency at the Hospital for Special Surgery in New York, NY. Dr. Nathan W. Coleman grew up in Minnesota and graduated from St. Thomas University in St. Paul, MN with a B.S. degree in Biochemistry. He is a graduate of Johns Hopkins University School of Medicine. Our Physicians Assistants Polly A. Porter, Physician Assistant is the President Elect for the Virginia Academy of Physician Assistants and is a Regional Director for the Physician Assistants in Orthopaedic Surgery. Shannon Leigh Nicholson,Nurse Practitioner DNP George Mason University, Doctorate of Nursing Practice Fairfax, Virginia, May 2012 Research Topic: Orthopedic, re-injury prevention

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National Sports Medicine Institute, Dr. David Johnson and Dr ...

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sports medicine and injuries treatment in Ashburn, VA ...

Sports Medicine

Concussion Clinic

Fairfax Family Practice has a robust Sports Medicine Program. The program is staffed by two fellowship trained family medicine providers and two sports fellows in training. Services provided in the office include injury assessment, evaluation of overuse injuries in children and adults, and evaluation of exercise performance. Our care is enhanced by on-site radiology and physical therapy. Stress testing and ultrasound for diagnostics and guided injections are also available onsite.

The Sports Medicine Program works in conjunction with a sports nutrition therapist for the management of musculoskeletal problems. Other specialized therapies include stem cell regenerative injections and therapies aimed at relieving nerve entrapments with injections.

Fairfax Family Practice Comprehensive Concussion Centers 30 minute lecture style presentation for athletes parents and coaches delivered by a concussion specialist providing the essential information about recognition of signs and symptoms of a concussion, the importance of providing appropriate immediate response to a concussion and procedures to follow for post trauma care including return to play. Individuals, teams, or youth associations will benefit from the online tracking we provide. Call 703.391.2020 to learn more about our concussion education and testing programs.

Fairfax Family Practice Center also provides posttrauma concussion evaluation, treatment and return to play as well as other sports related injuries. The staff at Fairfax Family Practice include concussion specialists who have been involved in concussion research for almost 20 years, and collectively have provided care for over 5000 concussed athletes. Knowing that each concussion is unique, the FFPC concussion specialists work together evaluating, managing, treating, and rehabilitating the different facets of concussions. Call 703.391.2020 for an appointment to see one of our concussion specialists.

To register for a Concussion Education session, please go to http://www.youthsportsconcussion.org or emailjon@youthsportsconcussion.org for more info.

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Fairfax Family Practice Center Sports Medicine

(703) 988-7750

Sports Medicine Specialists - Ashburn, VA

44355 Premier Plaza, Ste 130, Ashburn, VA 20147

Dr. Shawn Keegan is dedicated to providing Northern Virginia with the finest health care available. Using state of the art techniques and delivering them in a caring, friendly environment, we strive to be your primary choice for pain relief, and health and sports performance enhancement.

Our team of professionals will help you to achieve the results you desire or even exceed your expectations. We are happy to work with your current providers to together find the best solutions for every individual case.

We look forward to helping you!

Providing massage, low level laser therapy, exercise/physical therapy, and corrective orthotics for athletes and non athletes alike.

Please feel free to contact us to schedule a consultation!

Most insurance plans are accepted at our office. We accept auto accident, workers compensation, personal injury and most health insurance plans, including Medicare. Since there are so many plans and coverage varies widely, please call us to find out if your plan covers care in our office. Our staff will verify and explain your benefits before treatment, at no charge.

Services Offered 20146: Sports Therapist, Orthopedic Care, Sports Medicine, Workers Comp/Rehabilitation, TMJ Dysfunction Program, Neuro Rehabilitation, Pediatrics, Geriatrics, Women's Health, Manual Therapy

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Ashburn VA Sports Medicine | 20146 Core Orthopedics ...

Those who study sports medicine may look for careers as coaches, personal trainers or teachers. Sports medicine degrees can be found at the bachelor's, master's and doctoral levels.

The sports medicine field offers a wide range of careers for students studying at the bachelor's, master's or doctoral degree levels. Educational programs similar to sports medicine may be called exercise science and athletic training.

Sports medicine degrees take between two and four years and may offer opportunities for specialization. Students may choose to concentrate on different focus areas such as strength and conditioning or sport management. Programs include classroom instruction and hands-on learning regarding human movement, physical activity and healthcare. Internships or assistantships may be offered depending on the degree program. Programs may be available online or partially online as well as on campus.

Students who earn a bachelor's degree in sports medicine can prepare for several types of careers in allied healthcare. Graduates provide guidance, preventative care and rehabilitation services to physically active individuals. Some private and public universities and colleges offer bachelor's degrees in sports medicine or related subjects, such as exercise science or athletic training.

Gaining entry into a college or university generally requires a high school diploma or its equivalent. Admission into a sports medicine bachelor's degree program usually has additional requirements that vary for each program. Completing specific courses, being certified in first aid and cardiopulmonary resuscitation (CPR) and spending a certain number of hours observing a certified athletic trainer in a professional setting are required for admission by some programs.

Students in sports medicine bachelor's degree programs receive classroom instruction in addition to practical experience through internships. Some schools also provide students with hands-on training through assistance at campus health and wellness centers or within the athletic department. Common class topics include:

Master's degrees are necessary for many sports medicine careers. The degree is typically offered as a Master of Science and takes two years to complete. Students can gain thorough sports medicine knowledge while conducting and critiquing research. Some programs allow students to select specialties within the sports medicine field, such as strength conditioning and athletic training.

A bachelor's degree is usually required for entrance into a master's degree program. Students with a bachelor's degree unrelated to sports medicine may need to take specific courses before gaining entry.

Students in sports medicine master's degree programs receive classroom instruction, participate in research projects and obtain practical training. Qualified students could acquire graduate assistantship positions that afford them the opportunity to learn and practice athletic training and rehabilitation services on campus. Common coursework includes the following:

Students interested in working in research or teaching at the university level can pursue their education further by enrolling in a doctoral program. The curriculum is often focused on research, and students typically choose an area within sports medicine in which to specialize, such as biomechanics, exercise nutrition or sport management. The program usually takes four years of full-time study to complete.

Each program sets its own admission requirements; however, requiring a master's degree or specific undergraduate studies in exercise science or sports medicine is common for admission into a doctoral program. Preference could also be given to applicants who are certified athletic trainers or physical therapists.

In addition to classroom instruction, doctoral students often receive laboratory training where they conduct research projects at campus labs. They might attend regular seminars and have opportunities to acquire research assistantship positions. Some possible class and research topics include:

Typically, bachelor's degree programs in sports medicine are pre-professional options that prepare students for graduate programs. Most job opportunities in the field require that candidates to have at least a master's degree. However, some entry-level careers may be available to bachelor's degree holders, such as:

An athletic trainer position is one of the career options for graduates of sports medicine master's degree programs. According to the U.S. Bureau of Labor Statistics (BLS), athletic training positions are expected to increase 21% from 2012-2022 (www.bls.gov). Many athletic trainers work for colleges, universities and professional schools.

In May 2014, athletic trainers earned an average annual salary of $43,730, according to the BLS. Some employers with the highest employment levels were postsecondary schools, elementary and secondary schools, hospitals, health practitioner offices and recreational facilities.

The American College of Sports Medicine (ACSM) offers certification for sports medicine professionals. Voluntary credentials help to validate a professional's education and expertise. Some of the certifications offered by ACSM include the Certified Personal Trainer, Certified Group Exercise Instructor and Certified Health Fitness Specialist.

Nearly all states require athletic trainers to obtain a state license and certification from the Board of Certification, Inc. If licensure or certification isn't required, athletic trainers can still earn voluntary board certification or get certified through other professional credentialing organizations, such as the National Academy of Sports Medicine or the American College of Sports Medicine. Master's degree holders can qualify to earn ACSM's Registered Clinical Exercise Physiologist certification.

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Sports Medicine Degree Programs with Course Information

Dental Pulp Stem Cells were primarily derived from the pulp tissues of exfoliated deciduous teeth, primary incisors and permanent third molar teeth. The dental pulp, third molars in particular, have been shown to be a significant stem cell source due to greater numbers of stem cells residing in the pulp. DPSCs from third molars have been shown to express developmentally important transcription factors, such as oct4, sox2, klf4, nanog and c-myc, which is an indicator of their pluri-potency. Flow-cytometry analysis revealed DPSCs were positive for CD73, CD90, CD105 and CD166, but negative for CD34, CD45 and CD133, suggesting that these cells are mesenchymal-like stem cells. Under specific culture conditions, DPSCs differentiated into osteogenic, adipogenic and neurogenic cells, as well as formed tube-like structures in Matrigel assay.

Stem Cells From Human Exfoliated Deciduous Teeth (SHED) are considered to be the most immature of the Dental Stem Cells and show the highest proliferative capacity when grown in culture. Similar to the DPSCs from third molars, SHED are very durable in culture and have been passaged over 80 times with no detectable signs of senescence or telomere shortening. SHED express the embryonic stem (ES) cell markers Oct4, Nanog, stage-specific embryonic antigens (SSEA-3, SSEA-4), and tumor recognition antigens (TRA-1-60 and TRA-1-81). When cultured in neurogenic medium, SHED form sphere-like clusters which adhere to the culture dish or float freely in the culture medium.

Dental Follicle Stem Cells is an ectomesenchymal tissue surrounding the enamel organ and the dental papilla of the developing tooth germ prior to eruption. The tissue contains the progenitor cells that form the periodontium, (cementum, PDL, and alveolar bone). In culture DFSC adhere to plastic, proliferate well and like other mesenchymal stem cells show a typical fibroblast-like morphology. DFSCs express the embryonic marker OCT4 and the neural progenitor markers Notch-1 and nestin.

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Dental Pulp Stem Cells, Human Dental Pulp Stem Cells ...

Welcome to the Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research at UCSF, one of the largest and most comprehensive programs of its kind in the United States.

In some 125 labs, scientists are carrying out studies, in cell culture and animals, aimed at understanding and developing treatment strategies for such conditions as heart disease, diabetes, epilepsy, multiple sclerosis, Parkinsons disease, Lou Gehrigs disease, spinal cord injury and cancer.

While the scientific foundation for the field is still being laid, UCSF scientists are beginning to move their work toward human clinical trials. A team of pediatric specialists and neurosurgeons is carrying out the second brain stem cell clinical trial ever conducted in the United States, focusing on a rare disease, inherited in boys, known as Pelizaeus-Merzbacher disease.

Others are working to develop strategies for treating diabetes, brain tumors, liver disease and epilepsy. The approach for treating epilepsy potentially also could be used to treat Parkinsons disease, as well as the pain and spasticity that follow brain and spinal cord injury.

The center is structured along seven research pipelines aimed at driving discoveries from the lab bench to the patient. Each pipeline focuses on a different organ system, including the blood, pancreas, liver, heart, reproductive organs, nervous system, musculoskeletal tissues and skin. And each of these pipelines is overseen by two leaders of international standing one representing the basic sciences and one representing clinical research. This approach has proven successful in the private sector for driving the development of new therapies.

The center, like all of UCSF, fosters a highly collaborative culture, encouraging a cross-pollination of ideas among scientists of different disciplines and years of experience. Researchers studying pancreatic beta cells damaged in diabetes collaborate with those who study nervous system diseases because stem cells undergo similar molecular signaling on the way to becoming both cell types. The opportunity to work in this culture has drawn some of the countrys premier young scientists to the center.

While the focus of the science is the future, UCSFs history in the field dates back to 1981, when Gail Martin, PhD, co-discovered embryonic stem cells in mice and coined the term embryonic stem cell. Two decades later, UCSFs Roger Pedersen, PhD, developed two of the first human embryonic stem cell lines, following the groundbreaking discovery by University of Wisconsins James Thomson, PhD, of a way to derive the cells.

Today, the Universitys faculty includes Shinya Yamanaka, MD, PhD, of the UCSF-affiliated J. David Gladstone Institutes and Kyoto University. His discovery in 2006 of a way to reprogram ordinary skin cells back to an embryonic-like state has given hope that someday these cells might be used in regenerative medicine.

Yamanakas seminal finding highlights the unexpected and dramatic discoveries that can characterize scientific research. In labs throughout UCSF and beyond, the goal is to move such findings into patients.

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Eli and Edythe Broad Center of Regeneration Medicine and ...

Gene therapy and cell therapy are overlapping fields of biomedical research with the goals of repairing the direct cause of genetic diseases in the DNA or cellular population, respectively. These powerful strategies are also being focused on modulating specific genes and cell subpopulations in acquired diseases in order to reestablish the normal equilibrium. In many diseases, gene and cell therapy are combined in the development of promising therapies.

In addition, these two fields have helped provide reagents, concepts, and techniques that are elucidating the finer points of gene regulation, stem cell lineage, cell-cell interactions, feedback loops, amplification loops, regenerative capacity, and remodeling.

Gene therapy is defined as a set of strategies that modify the expression of an individuals genes or that correct abnormal genes. Each strategy involves the administration of a specific DNA (or RNA).

Cell therapy is defined as the administration of live whole cells or maturation of a specific cell population in a patient for the treatment of a disease.

Gene therapy: Historically, the discovery of recombinant DNA technology in the 1970s provided the tools to efficiently develop gene therapy. Scientists used these techniques to readily manipulate viral genomes, isolate genes, identify mutations involved in human diseases, characterize and regulate gene expression, and engineer various viral vectors and non-viral vectors. Many vectors, regulatory elements, and means of transfer into animals have been tried. Taken together, the data show that each vector and set of regulatory elements provides specific expression levels and duration of expression. They exhibit an inherent tendency to bind and enter specific types of cells as well as spread into adjacent cells. The effect of the vectors and regulatory elements are able to be reproduced on adjacent genes. The effect also has a predictable survival length in the host. Although the route of administration modulates the immune response to the vector, each vector has a relatively inherent ability, whether low, medium or high, to induce an immune response to the transduced cells and the new gene products.

The development of suitable gene therapy treatments for many genetic diseases and some acquired diseases has encountered many challenges and uncovered new insights into gene interactions and regulation. Further development often involves uncovering basic scientific knowledge of the affected tissues, cells, and genes, as well as redesigning vectors, formulations, and regulatory cassettes for the genes.

While effective long-term treatments for anemias, hemophilia, cystic fibrosis, muscular dystrophy, Gauschers disease, lysosomal storage diseases, cardiovascular diseases, diabetes, and diseases of the bones and joints are elusive today, some success is being observed in the treatment of several types of immunodeficiency diseases, cancer, and eye disorders. Further details on the status of development of gene therapy for specific diseases are summarized here.

Cell therapy: Historically, blood transfusions were the first type of cell therapy and are now considered routine. Bone marrow transplantation has also become a well-established protocol. Bone marrow transplantation is the treatment of choice for many kinds of blood disorders, including anemias, leukemias, lymphomas, and rare immunodeficiency diseases. The key to successful bone marrow transplantation is the identification of a good "immunologically matched" donor, who is usually a close relative, such as a sibling. After finding a good match between the donors and recipients cells, the bone marrow cells of the patient (recipient) are destroyed by chemotherapy or radiation to provide room in the bone marrow for the new cells to reside. After the bone marrow cells from the matched donor are infused, the self-renewing stem cells find their way to the bone marrow and begin to replicate. They also begin to produce cells that mature into the various types of blood cells. Normal numbers of donor-derived blood cells usually appear in the circulation of the patient within a few weeks. Unfortunately, not all patients have a good immunological matched donor. Furthermore, bone marrow grafts may fail to fully repopulate the bone marrow in as many as one third of patients, and the destruction of the host bone marrow can be lethal, particularly in very ill patients. These requirements and risks restrict the utility of bone marrow transplantation to some patients.

Cell therapy is expanding its repertoire of cell types for administration. Cell therapy treatment strategies include isolation and transfer of specific stem cell populations, administration of effector cells, induction of mature cells to become pluripotent cells, and reprogramming of mature cells. Administration of large numbers of effector cells has benefited cancer patients, transplant patients with unresolved infections, and patients with chemically destroyed stem cells in the eye. For example, a few transplant patients cant resolve adenovirus and cytomegalovirus infections. A recent phase I trial administered a large number of T cells that could kill virally-infected cells to these patients. Many of these patients resolved their infections and retained immunity against these viruses. As a second example, chemical exposure can damage or cause atrophy of the limbal epithelial stem cells of the eye. Their death causes pain, light sensitivity, and cloudy vision. Transplantation of limbal epithelial stem cells for treatment of this deficiency is the first cell therapy for ocular diseases in clinical practice.

Several diseases benefit most from treatments that combine the technologies of gene and cell therapy. For example, some patients have a severe combined immunodeficiency disease (SCID) but unfortunately, do not have a suitable donor of bone marrow. Scientists have identified that patients with SCID are deficient in adenosine deaminase gene (ADA-SCID), or the common gamma chain located on the X chromosome (X-linked SCID). Several dozen patients have been treated with a combined gene and cell therapy approach. Each individuals hematopoietic stem cells were treated with a viral vector that expressed a copy of the relevant normal gene. After selection and expansion, these corrected stem cells were returned to the patients. Many patients improved and required less exogenous enzymes. However, some serious adverse events did occur and their incidence is prompting development of theoretically safer vectors and protocols. The combined approach also is pursued in several cancer therapies.

Further information on the progress and status of gene therapy and cell therapy on various diseases is listed here.

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Gene Therapy and Cell Therapy Defined | ASGCT - American ...

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For years, the cornerstones of cancer treatment have been surgery, chemotherapy, and radiation therapy. Over the last decade, targeted therapies like imatinib (Gleevec) and trastuzumab (Herceptin)drugs that target cancer cells by homing in on specific molecular changes seen primarily in those cellshave also emerged as standard treatments for a number of cancers.

Illustration of the components of second- and third-generation chimeric antigen receptor T cells. (Adapted by permission from the American Association for Cancer Research: Lee, DW et al. The Future Is Now: Chimeric Antigen Receptors as New Targeted Therapies for Childhood Cancer. Clin Cancer Res; 2012;18(10); 278090. doi:10.1158/1078-0432.CCR-11-1920)

And now, despite years of starts and stutter steps, excitement is growing for immunotherapytherapies that harness the power of a patients immune system to combat their disease, or what some in the research community are calling the fifth pillar of cancer treatment.

One approach to immunotherapy involves engineering patients own immune cells to recognize and attack their tumors. And although this approach, called adoptive cell transfer (ACT), has been restricted to small clinical trials so far, treatments using these engineered immune cells have generated some remarkable responses in patients with advanced cancer.

For example, in several early-stage trials testing ACT in patients with advanced acute lymphoblastic leukemia (ALL) who had few if any remaining treatment options, many patients cancers have disappeared entirely. Several of these patients have remained cancer free for extended periods.

Equally promising results have been reported in several small trials involving patients with lymphoma.

These are small clinical trials, their lead investigators cautioned, and much more research is needed.

But the results from the trials performed thus far are proof of principle that we can successfully alter patients T cells so that they attack their cancer cells, said one of the trial's leaders, Renier J. Brentjens, M.D., Ph.D., of Memorial Sloan Kettering Cancer Center (MSKCC) in New York.

Adoptive cell transfer is like giving patients a living drug, continued Dr. Brentjens.

Thats because ACTs building blocks are T cells, a type of immune cell collected from the patients own blood. After collection, the T cells are genetically engineered to produce special receptors on their surface called chimeric antigen receptors (CARs). CARs are proteins that allow the T cells to recognize a specific protein (antigen) on tumor cells. These engineered CAR T cells are then grown in the laboratory until they number in the billions.

The expanded population of CAR T cells is then infused into the patient. After the infusion, if all goes as planned, the T cells multiply in the patients body and, with guidance from their engineered receptor, recognize and kill cancer cells that harbor the antigen on their surfaces.

Although adoptive cell transfer has been restricted to small clinical trials so far, treatments using these engineered immune cells have generated some remarkable responses in patients with advanced cancer.

This process builds on a similar form of ACT pioneered by Steven Rosenberg, M.D., Ph.D., and his colleagues from NCIs Surgery Branch for patients with advanced melanoma.

The CAR T cells are much more potent than anything we can achieve with other immune-based treatments being studied, said Crystal Mackall, M.D., of NCIs Pediatric Oncology Branch (POB).

Even so, investigators working in this field caution that there is still much to learn about CAR T-cell therapy. But the early results from trials like these have generated considerable optimism.

CAR T-cell therapy eventually may become a standard therapy for some B-cell malignancies like ALL and chronic lymphocytic leukemia, Dr. Rosenberg wrote in a Nature Reviews Clinical Oncology article.

More than 80 percent of children who are diagnosed with ALL that arises in B cellsthe predominant type of pediatric ALLwill be cured by intensive chemotherapy.

For patients whose cancers return after intensive chemotherapy or a stem cell transplant, the remaining treatment options are close to none, said Stephan Grupp, M.D., Ph.D., of the Childrens Hospital of Philadelphia (CHOP) and the lead investigator of a trial testing CAR T cells primarily in children with ALL. This treatment may represent a much-needed new option for such patients, he said.

Trials of CAR T cells in adults and children with leukemia and lymphoma have used T cells engineered to target the CD19 antigen, which is present on the surface of nearly all B cells, both normal and cancerous.

In the CHOP trial, which is being conducted in collaboration with researchers from the University of Pennsylvania, all signs of cancer disappeared (a complete response) in 27 of the 30 patients treated in the study, according to findings published October 16 in the New England Journal of Medicine.

Nineteen of the 27 patients with complete responses have remained in remission, the study authors reported, with 15 of these patients receiving no further therapy and 4 patients withdrawing from the trial to receive other therapy.

According to the most recent data from a POB trial that included children with ALL, 14 of 20 patients had a complete response. And of the 12 patients who had no evidence of leukemic cells, called blasts, in their bone marrow after CAR T-cell treatment, 10 have gone on to receive a stem cell transplant and remain cancer free, reported the studys lead investigator, Daniel W. Lee, M.D., also of the POB.

Dr. Crystal Mackall

Our findings strongly suggest that CAR T-cell therapy is a useful bridge to bone marrow transplant for patients who are no longer responding to chemotherapy, Dr. Lee said.

Similar results have been seen in phase I trials of adult patients conducted at MSKCC and NCI.

In findings published in February 2014, 14 of the 16 participants in the MSKCC trial treated to that point had experienced complete responses, which in some cases occurred 2 weeks or sooner after treatment began. Of those patients who were eligible, 7 underwent a stem cell transplant and are still cancer free.

The NCI-led trial of CAR T cells included 15 adult patients, the majority of whom had advanced diffuse large B-cell lymphoma. Most patients in the trial had either complete or partial responses, reported James Kochenderfer, M.D., and his NCI colleagues.

Our data provide the first true glimpse of the potential of this approach in patients with aggressive lymphomas that, until this point, were virtually untreatable, Dr. Kochenderfer said. [NCI Surgery Branch researchers have also reported promising results from one of the first trials testing CAR T cells derived from donors, rather than the patients themselves, to treat leukemia and lymphoma.]

Other findings from the trials have been encouraging, as well. For example, the number of CAR T cells increased dramatically after infusion into patients, as much as 1,000-fold in some individuals. In addition, after infusion, CAR T cells were detected in the central nervous system, a so-called sanctuary site where solitary cancer cells that have evaded chemotherapy or radiation may hide. In two patients in the NCI pediatric trial, the CAR T-cell treatment eradicated cancer that had spread to the central nervous system.

If CAR T cells can persist at these sites, it could help fend off relapses, Dr. Mackall noted.

CAR T-cell therapy can cause several worrisome side effects, perhaps the most troublesome being cytokine-release syndrome.

The infused T cells release cytokines, which are chemical messengers that help the T cells carry out their duties. With cytokine-release syndrome, there is a rapid and massive release of cytokines into the bloodstream, which can lead to dangerously high fevers and precipitous drops in blood pressure.

Cytokine-release syndrome is a common problem in patients treated with CAR T cells. In the POB and CHOP trials, patients with the most extensive disease prior to receiving the CAR T cells were more likely to experience severe cases of cytokine-release syndrome.

For most patients, trial investigators have reported, the side effects are mild enough that they can be managed with standard supportive therapies, including steroids.

The research team at CHOP noticed that patients experiencing severe reactions all had particularly high levels of IL-6, a cytokine that is secreted by T cells and macrophages in response to inflammation. So they turned to two drugs that are approved to treat inflammatory conditions like juvenile arthritis: etanercept (Enbrel) and tocilizumab (Actemra), the latter of which blocks IL-6 activity.

The patients had excellent responses to the treatment, Dr. Grupp said. We believe that [these drugs] will be a major part of toxicity management for these patients.

The other two teams subsequently used tocilizumab in several patients. Dr. Brentjens agreed that both drugs could become a useful way to help manage cytokine-release syndrome because, unlike steroids, they dont appear to affect the infused CAR T cells activity or proliferation.

Even with these encouraging preliminary findings, more research is needed before CAR T-cell therapy becomes a routine option for patients with ALL.

We need to treat more patients and have longer follow-up to really say what the impact of this therapy is [and] to understand its true performance characteristics, Dr. Grupp said.

We need to treat more patients and have longer follow-up to really say what the impact of this therapy is [and] to understand its true performance characteristics.

Dr. Stephan Grupp

Several other trials testing CAR T cells in children and adults are ongoing and, with greater interest and involvement from the pharmaceutical and biotechnology sector, more trials testing CAR T cells are being planned.

Researchers are also studying ways to improve on the positive results obtained to date, including refining the process by which the CAR T cells are produced.

Research groups like Dr. Brentjens are also working to make a superior CAR T cell, including developing a better receptor and identifying better targets.

For example, Dr. Lee and his colleagues at NCI have developed CAR T cells that target the CD22 antigen, which is also present on most B cells, although in smaller quantities than CD19. The CD22-targeted T cells, he believes, could be used in concert with CD19-targeted T cells as a one-two punch in ALL and other B-cell cancers. NCI researchers hope to begin the first clinical trial testing the CD22-targeted CAR T cells in November 2014.

Based on the success thus far, several research groups across the country are turning their attention to developing engineered T cells for other cancers, including solid tumorslike pancreatic and brain cancers.

The stage has now been set for greater progress, Dr. Lee believes.

NCI investigators, for example, now have a platform to plug and play better CARs into that system, without a lot of additional R&D time, he continued. Everything else should now come more rapidly.

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CAR T-Cell Immunotherapy for ALL - National Cancer Institute