Parkinson’s, cancer, type 2 diabetes share a key element that drives disease

Parkin protein (green signal) is in a different part of the cell than the mitochondria (red signal) at time 0 (left image) but then co-localizes with the mitochondria after 60 minutes (right image). CREDIT Salk Institute

When cells are stressed, chemical alarms go off, setting in motion a flurry of activity that protects the cell’s most important players. During the rush, a protein called Parkin hurries to protect the mitochondria, the power stations that generate energy for the cell. Now Salk researchers have discovered a direct link between a master sensor of cell stress and Parkin itself. The same pathway is also tied to type 2 diabetes and cancer, which could open a new avenue for treating all three diseases.

“Our findings represent the earliest step in Parkin’s alarm response that anyone’s ever found by a long shot. All the other known biochemical events happen at one hour; we’ve now found something that happens within five minutes,” says Professor Reuben Shaw, director of the NCI-designated Salk Cancer Center and senior author of the new work, detailed in Science Advances on April 7, 2021. “Decoding this major step in the way cells dispose of defective mitochondria has implications for a number of diseases.”

Parkin’s job is to clear away mitochondria that have been damaged by cellular stress so that new ones can take their place, a process called mitophagy. However, Parkin is mutated in familial Parkinson’s disease, making the protein unable to clear away damaged mitochondria. While scientists have known for some time that Parkin somehow senses mitochondrial stress and initiates the process of mitophagy, no one understood exactly how Parkin was first sensing problems with the mitochondria–Parkin somehow knew to migrate to the mitochondria after mitochondrial damage, but there was no known signal to Parkin until after it arrived there.

Shaw’s lab, which is well known for their work in the fields of metabolism and cancer, spent years intensely researching how the cell regulates a more general process of cellular cleaning and recycling called autophagy. About ten years ago, they discovered that an enzyme called AMPK, which is highly sensitive to cellular stress of many kinds, including mitochondrial damage, controls autophagy by activating an enzyme called ULK1.

Following that discovery, Shaw and graduate student Portia Lombardo began searching for autophagy-related proteins directly activated by ULK1. They screened about 50 different proteins, expecting about 10 percent to fit. They were shocked when Parkin topped the list. Biochemical pathways are usually very convoluted, involving up to 50 participants, each activating the next. Finding that a process as important as mitophagy is initiated by only three participants–first AMPK, then ULK1, then Parkin–was so surprising that Shaw could scarcely believe it.

To confirm the findings were correct, the team used mass spectrometry to reveal precisely where ULK1 was attaching a phosphate group to Parkin. They found that it landed in a new region other researchers had recently found to be critical for Parkin activation but hadn’t known why. A postdoctoral fellow in Shaw’s lab, Chien-Min Hung, then did precise biochemical studies to prove each aspect of the timeline and delineated which proteins were doing what, and where. Shaw’s research now begins to explain this key first step in Parkin activation, which Shaw hypothesizes may serve as a “heads-up” signal from AMPK down the chain of command through ULK1 to Parkin to go check out the mitochondria after a first wave of incoming damage, and, if necessary, trigger destruction of those mitochondria that are too gravely damaged to regain function.

The findings have wide-ranging implications. AMPK, the central sensor of the cell’s metabolism, is itself activated by a tumor suppressor protein called LKB1 that is involved in a number of cancers, as established by Shaw in prior work, and it is activated by a type 2 diabetes drug called metformin. Meanwhile, numerous studies show that diabetes patients taking metformin exhibit lower risks of both cancer and aging comorbidities. Indeed, metformin is currently being pursued as one of the first ever “anti-aging” therapeutics in clinical trials.

“The big takeaway for me is that metabolism and changes in the health of your mitochondria are critical in cancer, they’re critical in diabetes, and they’re critical in neurodegenerative diseases,” says Shaw, who holds the William R. Brody Chair. “Our finding says that a diabetes drug that activates AMPK, which we previously showed can suppress cancer, may also help restore function in patients with neurodegenerative disease. That’s because the general mechanisms that underpin the health of the cells in our bodies are way more integrated than anyone could have ever imagined.”

How are immunocompromised patients dealing with the pandemic? | COVID-19 Special

How are immunocompromised patients dealing with the pandemic? | COVID-19  Special - YouTube


our immune system is critical for fighting off disease, but millions of people around the world are immunocompromised. This means their immune systems have been weakened either by a genetic disorder or by chronic illnesses like AIDS, Cancer or Diabetes. Living with such diseases is hard enough at the best of times, but in the age of COVID-19 a positive test could be a death sentence. As nations race to get their populations vaccinated those with an already compromised immune system are often not at the top of the list. How can overburdened medical systems keep these at risk people from falling behind?

Metformin may affect risk of breast cancer in women with type 2 diabetes

Are there actually 5 types of diabetes?

A study of 44,541 women has found that there appears to be no association between type 2 diabetes and developing breast cancer overall. This may be because most women in the study with type 2 diabetes were taking metformin, a medication widely used to treat type 2 diabetes, whose actions may help to reduce the risk of developing oestrogen positive (ER-positive) breast cancer.

ER-positive breast cancer (cancer that has receptors on cell surfaces for the hormone oestrogen) accounts for about 80% of breast cancer diagnosed in the USA. Associations uncovered in the study suggested that the link between type 2 diabetes and breast cancer varied by breast cancer subtype and was affected by the use of metformin to treat diabetes. The study is published in the leading cancer journal Annals of Oncology [1] today (Friday).

Over the period of the study, which had an average of more than eight years of follow-up, the researchers found that type 2 diabetes was associated with a 40% increased risk of triple negative breast cancer (TNBC, breast cancer that lacks receptors for the hormones oestrogen and progesterone and the HER2 protein) when compared with women who did not have diabetes. In contrast, there was a small (8%) decrease in risk for ER-positive breast cancer. These results were not statistically significant.

When the researchers considered women according to the type of treatment they received, type 2 diabetes treated with metformin was associated with a 14% decreased risk of developing ER-positive breast cancer but a 25% increased risk of developing ER-negative breast cancer (breast cancer that lacks receptors for the hormone oestrogen) when compared to non-diabetic women. These results were also not statistically significant. However, there was a statistically significant 74% increased risk of developing TNBC among those treated with metformin.

Professor Dale Sandler, chief of the Epidemiology Branch at the US National Institute of Environmental Health Sciences (NIEHS), National Institutes of Health (USA), who led the research, said: “We also found that having type 2 diabetes for 15 years or more seemed to be associated with a 39% reduced risk of ER-positive breast cancer, and we think this is most likely to be because of long-term use of metformin. We found that, compared to non-diabetic women, the risk of developing ER-positive breast cancer was reduced by 38% among women with type 2 diabetes who had used metformin for ten years or more.

“Taken together, these findings suggest that having type 2 diabetes may increase the risk of developing breast cancer, but that taking metformin may protect against developing ER-positive breast cancer, the most common type of breast cancer. Metformin did not appear to protect against ER-negative or triple negative breast cancer. We can’t say for sure if the increased risk of triple negative breast cancer is because metformin doesn’t protect women against the negative effects of having type 2 diabetes or because metformin use can cause triple negative breast cancer. Since there are no mechanistic data supporting a causal effect of metformin, the former interpretation seems more likely.”

The researchers also found that among women who developed type 2 diabetes after joining the study, those who were treated with medications other than metformin had twice the risk of developing any type of breast cancer compared to non-diabetic women, and 2.6 times the risk of developing ER-positive breast cancer. However, the numbers in this group were small, only 13 women developed any type of breast cancer, and so this result needs to be treated with caution.

Previous studies have reported an increase risk of breast cancer in women with type 2 diabetes, but there has been conflicting evidence from more recent studies and on the association between metformin and breast cancer. The current study analysed data from the Sister Study, which enrolled women from the USA and Puerto Rico between 2003 and 2009 using follow-up data through to the end of 2017 (although women continue to be followed after that date). At enrolment, the women were 35-74 years old, had no previous diagnosis of breast cancer, but were sisters or half-sisters of women diagnosed with breast cancer. The women completed annual health updates and follow-up questionnaires every three years.

The first author of the study, Dr Yong-Moon Mark Park, a postdoctoral fellow at the NIEHS, NIH, when the study was conducted (now an assistant professor at the University of Arkansas for Medical Sciences, USA), said: “Our study is the first to try to disentangle the effects of type 2 diabetes and the effects of metformin use. Having information about subtypes of breast cancer that may have different causes helped us to reach our conclusions. However, it’s important to note that some of our findings, especially for triple negative breast cancer, were based on a small number of cases and those results need replication. Further studies are needed to discover whether the apparent increased risk of triple negative breast cancer is caused by metformin or is due to the absence of protection from metformin.”

Possible mechanisms by which metformin may reduce breast cancer risk include that it improves insulin sensitivity, and corrects high insulin levels by reducing the amount of insulin and insulin-like growth factor circulating in the body, which may activate cell signals involved in cancer; it may slow breast cancer growth by activating an enzyme called adenosine monophosphate activated protein kinase (AMPK), which inhibits a pathway involved in the proliferation of cancer cells; and it may reduce the risk of ER-positive breast cancer by inhibiting oestrogen receptors that plays a role in the development and progression of breast cancer.

Strengths of the study include its prospective design, a large group of women and high rates of follow-up (90%). Limitations include the fact that the researchers were unable to account for glucose control and progression or improvement of type 2 diabetes, which could affect the risk of breast cancer; it was difficult to disentangle the effects of diabetes from the effects of medication as so many women were prescribed metformin and used it for many years; there was no information on metformin dose, which could reflect severity of diabetes or duration, but also might play a role in the degree of protection it provided.

In an accompanying editorial [2], Dr Ana Lohmann from the University of Western Ontario, and Dr Pamela Goodwin from the University of Toronto, Canada, write: “Despite the inclusion of 44,541 subjects, there were only 277 BCs [breast cancers] diagnosed in women with T2D [type 2 diabetes], including 25 TNBC; 177 and 20, respectively of these received metformin. The significant association of T2D with risk of TNBC in the subgroup treated with metformin (n=20) may have reflected chance and/or uncontrolled bias and confounding.”

They conclude: “The report by Park adds to the growing evidence linking T2D and its treatment to BC risk but definitive conclusions regarding these associations are not yet possible. Clearly, this is an important area and additional research is needed to untangle the web of inter-related associations of T2D, its treatment and BC risk . . . Over time, consistency of associations across studies should be sought and the biologic plausibility of any associations that are identified established.”

World Cancer Day 2020: International survey reveals unacceptable cancer awareness divide

Today’s World Cancer Day, led by the Union for International Cancer Control (UICC), aims to mobilise urgent action from individuals, governments, and the global cancer community to close the clear and unacceptable gaps in cancer risk awareness between higher and lower socioeconomic groups and the subsequent impact on their health-promoting behaviours.

To mark the 20th anniversary of World Cancer Day, UICC commissioned a global survey to form an up-to-date picture of the public’s experiences, views, and behaviours around cancer. Conducted by Ipsos, the survey includes more than 15,000 adults across 20 countries in the first multi-country public survey on cancer perceptions in a decade. The survey’s results, detailed in UICC’s report released today, International Public Opinion Survey on Cancer 2020: What people feel, think and believe about cancer today, indicate a clear divide between higher and lower socioeconomic groups when it comes to knowledge and awareness of cancer risks and, as a result, the practice of behaviours to limit such risk.


Chief Executive Officer, Union for International Cancer Control, Dr Cary Adams said:

“It is unacceptable that millions of people have a greater chance of developing cancer in their lifetime, because they are simply not aware of the cancer risks to avoid and the healthy behaviours to adopt – information that many of us take for granted. And this is true around the world.”

Awareness of cancer risks

The survey’s results show that there is generally a high level of cancer awareness among the surveyed population globally. Tobacco use (63%), exposure to harmful UV rays (54%) and exposure to tobacco smoke from others (50%) appear to be the most recognised factors that can increase a person’s risk of cancer. Meanwhile, a lack of exercise (28%), exposure to certain viruses or bacteria (28%) and being overweight (29%) appear to be the least recognised cancer risk factors.

However, individuals from a lower-income household bracket in the countries surveyed are less likely to recognise cancer risk factors than those from higher-income households. In all areas except tobacco use, this trend can also be seen when comparing people surveyed who have not completed a university education to those with university educations.

Practicing cancer prevention

Irrespective of where people live in the world, those surveyed with a lower education and those on lower incomes appear less aware of the main risk factors associated with cancer and appear less likely to proactively take the steps needed to reduce their cancer risk than those from a high income household or with a university education.

What should be done: Prioritising awareness raising to support health-promoting behaviours

An overwhelming 84% of individuals surveyed felt that governments should be taking action in relation to cancer whilst nearly a third of individuals surveyed believed that it is most important for governments to improve the affordability of cancer services – a measure notably emphasised by people surveyed in lower middle-income countries.

UICC President HRH Princess Dina Mired of Jordan said: “To tackle the global cancer burden now and for the future, governments and decision makers across the international cancer community must come together to ensure that everyone is afforded every opportunity to take control over their cancer risk – no matter their education or income level.”

To help raise greater awareness around cancer and to support health-promoting behaviours so that no one gets left behind, UICC is calling for all governments to:

  • Prioritise cancer awareness raising and prevention through progressive health policies and education to support healthy decisions and health-promoting behaviour, with a focus on engaging lower socioeconomic populations
  • Ensure the public is provided with up-to-date information on cancer risks and cancer prevention, and importantly that the information is presented and delivered in a way that is accessible by individuals from lower socioeconomic backgrounds
  • Implement policy to help reduce the consumption of known cancer-causing products (e.g. tobacco, sugary food and beverages), to encourage health-promoting behaviours, particularly among lower socioeconomic groups
  • Invest proactively in national cancer control planning and the establishment of population-based registries to ensure the most effective resource allocation that benefits all groups
  • Continue to raise awareness with each new generation to help ensure that up-to-date information on cancer risks and cancer prevention is not taken for granted

As part of World Cancer Day’s ‘I Am and I Will’ campaign, which calls on each person to make a commitment – big or small – UICC recommends that everyone:

  • Use World Cancer Day as an opportunity to improve your understanding of cancer risk factors and share your knowledge with others
  • Make a personal commitment to reduce your cancer risks like quitting smoking, eating healthily, exercising regularly, and using sunscreen
  • Take advantage of what your health system can provide, including getting a check-up, getting screened, and getting vaccinated

What are the early signs and symptoms of a melanoma?




A melanoma

A melanoma

The first sign of a melanoma is often a new mole or a change in the appearance of an existing mole.

Normal moles are usually round or oval, with a smooth edge, and no bigger than 6mm (1/4 inch) in diameter (see first photo).




See your GP as soon as possible if you notice changes in a mole, freckle or patch of skin, particularly if the changes happen over a few weeks or months (see second photo, below).

Signs to look out for include a mole that’s:

getting bigger

changing shape

changing colour

bleeding or becoming crusty

itchy or sore

The ABCDE checklist should help you tell the difference between a normal mole and a melanoma:

Asymmetrical – melanomas have two very different halves and are an irregular shape.

Border – melanomas have a notched or ragged border.

Colours – melanomas will be a mix of two or more colours.

Diameter – melanomas are larger than 6mm (1/4 inch) in diameter.

Enlargement or elevation – a mole that changes size over time is more likely to be a melanoma.

See ABCDE of moles for a visual guide.

Melanomas can appear anywhere on your body, but they most commonly appear on the back in men and on the legs in women. They can also develop underneath a nail, on the sole of the foot, in the mouth, or in the genital areas, but these types of melanoma are rare.

Melanoma of the eye

In rare cases, melanoma can develop in the eye. It develops from pigment-producing cells called melanocytes.

Eye melanoma usually affects the eyeball. The most common type is uveal or choroidal melanoma, which occurs at the back of the eye. Very rarely it can occur on the conjunctiva (the thin layer of tissue that covers the front of the eye) or in the iris (the coloured part of the eye).




Noticing a dark spot or changes in vision can be signs of eye melanoma, although it’s more likely to be diagnosed during a routine eye examination.

Read more about melanoma of the eye.