Posted on October 21, 2021October 21, 2021 Weight Loss

Weight-loss drugs, revisited

Drugs that promise to help people lose weight have had a checkered past, such as the infamous fen-phen that was pulled from the market in 1997 after reports of heart valve damage. But now, drug company pipelines are filling up with new molecules that aim to help people safely shed extra pounds, according to a cover story in Chemical & Engineering News, an independent news outlet of the American Chemical Society.

About 42% of U.S. adults are considered clinically obese because they have a body mass index of 30 or higher, according to the U.S. Centers for Disease Control and Prevention. Being at a heavier weight is associated with an increased risk of other health conditions, such as diabetes, heart disease and high blood pressure. Because of these risks, and the tendency of people to cycle between weight loss and regain throughout their lives, many doctors now consider being fat a chronic disease called obesity, rather than a behavioral issue, as it was seen in the past, writes C&EN reporter Megha Satyanarayana. However, recent findings indicate that 29% of people who are fat are otherwise metabolically healthy, causing some to question whether calling many people’s normal state a disease is stigmatizing.

The legions of people who want to lose weight for health or aesthetic reasons promise large financial gains for pharmaceutical companies who can bring safe, effective weight-loss drugs to market. But the troubling history of the field has raised the U.S. Food and Drug Administration’s regulatory bar. Now, a new drug must not only show that it allows someone to maintain a loss of 5–10% of their starting weight for a year, but it also must have longer-term studies proving it is safe. Novo-Nordisk’s popular new weight-loss drug Wegovy (semaglutide), which mimics a hormone that helps regulate glucose, caused an average 15% weight loss when combined with lifestyle counseling, compared with a 2.5% loss for a placebo and counseling. Moreover, a different formulation of Wegovy’s active compound has been safely used to treat diabetes since 2017. Pharmaceutical companies are exploring other molecules that regulate hormone receptors involved in appetite and energy expenditure. If these drugs are being prescribed to treat a chronic condition, many people will need to keep taking the drugs for the rest of their lives to sustain their weight loss, and in the case of Wegovy and similar drugs, deal with long-lasting side effects of nausea, vomiting and constipation. Meanwhile, some people say that is too high a price to pay for society’s thin-at-all-costs obsession.

The article, “New Weight-Loss Drugs Could Shift the Scales,” is freely available here.

Posted on October 21, 2021October 21, 2021 Arthritis

Discovery of a potential new therapy for inflammatory arthritis

In a paper published today in the journal Science Translational Medicine, researchers at the Schroeder Arthritis Institute, part of University Health Network (UHN) in Toronto, have made a discovery that could lead to new treatments for axial spondyloarthritis (SpA), a painful and debilitating form of arthritis which affects 1-2% of Canadians and causes inflammation in the spine, joints, eyes, gut and skin.

“We currently have very few therapeutic options for the majority of patients living with SpA and this is a devastating disease that directly impacts quality of life,” says Dr. Nigil Haroon, a rheumatologist, Co-Director of the spondylitis program and senior author on the paper.

“Although several treatments including biologic drugs have been approved for SpA, 40-50 % of patients do not respond to any treatments and develop severe pain and abnormal new bone formation,” says Dr. Akihiro Nakamura, first author on the paper and a spondylitis fellow and PhD candidate in Dr. Haroon’s lab. “So, there is a desperate need to find new treatments that are effective and cover all of the clinical symptoms of SpA.”

The study focuses on the role of the Macrophage migration inhibitory factor (MIF), which functions as a protein that induces an inflammatory or immune response in the body. Until now, the role that MIF plays in the disease progression of SpA was unknown.

In this study, researchers observed that the expression of MIF and its receptor CD74, is increased in the blood and tissues of pre-clinical models. They also found that human neutrophils (a type of white blood cell that induces the immune system’s response) from SpA patients secreted higher concentrations of MIF, compared to healthy individuals. This, in turn, drives other cells to cause more inflammation.

“What this means is that if the body has been exposed to a trigger, too much MIF could be produced in susceptible individuals that could then lead to a diagnosis of SpA later in life. If we can block the excess production of MIF early, we may be able to induce disease remission and prevent disability and mortality linked to SpA,” explains Dr. Haroon.

In a 2017 paper, the researchers found that the concentration or expression of MIF is substantially increased in the blood, joint fluids and gut tissues of SpA patients, compared to those of a different type of arthritis patients or healthy volunteers. In the same paper, they also demonstrated that MIF might be involved in promoting the development of new bone formation. These recent findings have helped to solidify those results and take our understanding of the role of MIF in SpA, further.

The specific blocker of MIF, called MIF098, successfully prevented and restricted the disease onset and development of SpA, in the pre-clinical model. The team will focus now on testing the potential of other therapies targeting MIF, which could lead to finding a novel treatment in SpA.

“Patients with SpA experience inflammation, pain, stiffness and over time, this can lead to spinal fusion and loss of mobility. But it’s not just the disease itself that these patients have to worry about,” says Dr. Haroon. “Compared to the general population, there is also a 60% increased chance of stroke, and a 30% increase that they may experience a cardiovascular event or a mental illness.”

For Dr. Nakamura, a clinician from Japan who came to the Schroeder Arthritis Institute to become a leading researcher in the area of inflammatory arthritis, these new findings are nothing short of ‘exciting.’

“In research, once we make a new discovery, that has the potential to help many more patients than I could in my clinic, back in Japan,” says Dr. Nakamura. “So that motivates me a lot.”

Researchers are next hoping to test the efficacy of MIF blockers in patients with SpA through clinical trials, where they would look to determine the optimal concentration and administration frequency of MIF-targeted drugs for humans, as well as study potential side effects, to ensure safety.

“The drugs we have currently don’t work for half of all SpA patients,” says Dr. Haroon. “At the same time, rates of arthritis are going up worldwide. We believe this treatment could be effective for a good proportion of SpA patients including those who don’t respond to other currently available treatments.”

Posted on October 21, 2021October 21, 2021 Autism

Excess risk of self-injury linked to autism

People with autism spectrum disorder (ASD) are at substantially increased risk of self-injury and suicide, according to a new study at Columbia University Mailman School of Public Health and Columbia College of Physicians and Surgeons. Researchers found that the odds of self-harm in people with autism spectrum disorder were over three times that of people without ASD. The odds existed in both children and adults, though a slightly higher odds was identified in adults. The findings are published in JAMA Network Open.

It is estimated that 5,437,988 of U.S. adults (2 percent) have autism. In the pediatric population, prevalence estimates have increased over the past several decades due in part to improved awareness, changes in documentation, and identification of milder cases.

“The findings from our systematic review and meta-analysis underscore the need for targeted interventions to reduce the risk of self-harm in people with autism,” said Ashley Blanchard, MD, MS, assistant professor of emergency medicine at the Vagelos College of Physicians and Surgeons. “Among the myriad of health problems facing people with ASD is the excess risk of injury morbidity and mortality. The emergency department presents a unique clinical setting for interventions to reduce self-harm and other injuries in people with autism.”

The researchers used PubMed, Embase, CINAHL, PsychInfo, Web of Science databases from 1999 through June of 2020 to identify studies that examined the relationship between ASD and self-injurious behavior and suicide. They identified 31 studies with a wide range of ages and self-harm outcomes from the initial five-database search of 5,304 records. Twenty-nine of the 36 results showed statistically significant positive associations between ASD and self-harm and people with ASD were at similarly increased risk of self-injury behavior and suicide.

According to the researchers, several factors may explain the excess risk of self-harm associated with ASD. The prevalence of self-injurious behavior, such as hand-hitting, self-cutting and hair pulling, is as high as 42 percent in the autism population. Estimates also show that 28 percent of people with ASD have co-occurring attention deficit hyperactivity disorder, 20 percent have co-occurring anxiety disorders, and 11 percent have co-occurring depressive disorders. There is also a known link between self-injury and suicide.

“Our findings are of public health importance in light of the continuing increase in the reported prevalence of autism and the high prevalence of self-injurious behavior in this population — especially relevant during a period of heightened rates of depression, anxiety, and suicide associated with the COVID-19 pandemic,” said Guohua Li, MD, DrPH, professor of epidemiology at the Mailman School of Public Health and professor of anesthesiology at the Vagelos College of Physicians and Surgeons and senior author. “Further research should aim to determine the impact of co-occurring diagnoses, develop injury surveillance systems for the autism population, and develop effective prevention strategies to ensure the safety and well-being for people with ASD.”

Co-authors include Stanford Chihuri, Columbia College of Physicians and Surgeons; and Carolyn DiGuiseppi, University of Colorado Anschutz Medical Campus.

The study was supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development of the National Institutes of Health (grant R21 HD098522).

Posted on October 20, 2021October 20, 2021 Patient Talk

Addressing the Mental Health Needs of People on the Autism Spectrum

The purpose of the 2019 IACC Workshop, Addressing the Mental Health Needs of People on the Autism Spectrum, is to discuss mental health issues that affect people on the autism spectrum, including anxiety, depression, suicide, self-injurious and aggressive behavior, and mental health services. The workshop will be open to the public, will include time for public comments, and will be accessible by live webcast and conference call.

Posted on October 20, 2021October 20, 2021 Diet, Weight Loss

10 AMAZING Benefits Of PUMPKINS | Pumpkins for weight loss + inflammation and more

There’s definitely a lot more to pumpkins beyond the marketing and hype around them in the fall season. They are actually a superfood! Not convinced? Watch the video and then share in comments if you’re now a pumpkin fan.