Wisdom Wednesday: The 'London Patient' New HIV Remission Raises Hope

A London man has not had detectable HIV in his system for 18 months, despite not having received treatment during that period. The remission came after the patient underwent a stem cell transplant. This makes him the second man in history — after the Berlin patient — to have achieved HIV remission after such a transplant. And that has raised questions about whether he might be cured of HIV.

"The Berlin patient was not an anomaly," Ravindra Gupta, MD, from University College London, and his team write in their report published online today in Nature. But it is unlikely that this will lead to widespread stem cell transplants for people infected with HIV, said Gupta It is only "a small step in the right direction," he told Medscape Medical News. "But with enough small steps, we can get where we need to be."

As well as HIV, both Berlin patient Timothy Brown and the new patient — referred to as the London patient — had acute cancers that called for a stem cell transplant, a painful and invasive treatment used after other treatments have failed. For Brown, it was leukemia. For the London patient, it was stage 4 Hodgins’s lymphoma, a non-AIDS-related cancer more common among people with HIV. Both patients also had stem cell donors with two genetic mutations that remove the CCR5 receptor from the surface of the CD4 T-cell. Without that receptor, most HIV strains can't gain access to the cell and can't spread, and — bingo — that's the end of HIV.

Lifestyle Changes Do a Number on PSA Values

Simple, temporary lifestyle changes may be able to spare men with mildly increased prostate-specific antigen (PSA) levels from having to endure a prostate biopsy, results of a controlled study suggest.

Men who avoided eating spicy foods, drinking alcohol or coffee, and riding a bicycle had a repeat PSA reading approximately 1.5 ng/mL lower than their first reading a median of 8 weeks earlier.

Nearly half of men who adopted the lifestyle changes had a drop-in PSA below the minimum threshold for biopsy, reported Alexandre Zlotta, MD, director of Uro-Oncology at Mount Sinai Hospital and professor of surgery (urology) at the University of Toronto, Ontario, Canada.
In an interview with Medscape Medical News here at the European Association of Urology (EAU) 2019 Congress, Zlotta said that spicy food has something in common with alcohol, caffeine, and biking. "Spicy food induces inflammation, and inflammation directly translates into increase in PSA," he said.

Zlotta explained that repeat biopsy decisions are not based on a single PSA but that the new intervention might be a good idea before a repeat PSA test.

US adults do not consume enough protein, study warns

New research in the Journal of Nutrition, Health & Aging reveals that older people in the United States do not consume enough protein. Insufficient protein is a marker of poor diet and health overall, the study also suggests.

With age, the human body loses muscle mass. Sarcopenia, or the age-related gradual loss of muscle function, can slash muscle strength by around 50 percent. Also, loss of muscle mass and strength can lead to poor overall quality of life and increase the risk of falls and fractures in older age. So, as we age, intake of protein becomes increasingly important. However, few adults consume as much protein as they should, for a variety of reasons.

Older people often lose their appetite with age, have lower energy needs, or sometimes eat less due to financial and social difficulties. However, researchers do not know precisely how much protein older adults consume, so a new study aimed to fill this gap in research. Christopher A. Taylor, Ph.D. — a registered dietitian and associate professor at the Ohio State
University in Columbus — is the last and corresponding author of the new study.

Taylor and his team examined data from the 2005–2014 National Health and Nutrition Examination Survey to investigate the protein intake of 11,680 adults aged 51 and above. The scientists looked at the link between protein intake, dietary patterns, and physical function in these older adults. They stratified the study sample, used the Healthy Eating Index to assess the quality of the adults' diet, and weighted the data analyses "to create a nationally representative sample."

Wisdom Wednesday: Omega-3s and NLRP3 Inflammasom Signaling in Human Obesity

In a recent study in the Journal of Endocrinology, the relationship between fish oil derived long chain polyunsaturated fatty acids (n-3 PUFA) and the suppression of NLRP3 inflammasomes in human obesity through downregulation of inflammasome gene expression in adipocytes and macrophages was investigated. The NRLP3 inflammasome serves as a critical link between adipose inflammation and insulin resistance. This placebo-controlled clinical trial lasted 8 weeks, using 4 grams of EPA/DHA or placebo.

Results showed that “treatment of obese human subjects with fish oil supplements reduced expression of adipose inflammatory genes including inflammasome-associated IL-18 and IL-
1β and circulating IL-18 levels. Both EPA and DHA reduced inflammasome gene expression in obese human adipose and human adipocyte and macrophages.”

This study highlights the importance of N-3 PUFAs in reducing NLRP3 inflammasome in human adipose tissue, and its relevance in helping support healthy inflammatory pathways as they related to obesity.

My Take:
This all sounds pretty technical, but basically fish oil reduces the inflammatory compounds that are produced in fat cells of the human body. These inflammatory compounds are linked to insulin resistance and ultimately diabetes.

Tramadol Linked to Higher Mortality Risk in Osteoarthritis

New tramadol use among patients with osteoarthritis is associated with increased mortality risk, an observational study in JAMA suggests. Some guidelines recommend tramadol, a weak opioid agonist, to manage osteoarthritis pain.

Using U.K electronic medical records, researchers matched patients with hip, knee, or hand osteoarthritis who began taking tramadol to those who began naproxen, diclofenac, celecoxib, etoricoxib (not approved in U.S.), or codeine. Nearly 90,000 patients aged 50 and older were included.

Patients who started using tramadol had a higher mortality rate over the ensuing year than users of every other medication except codeine. For example, the mortality rate was 23.5 per 1000 person-years with tramadol versus 13.8 per 1000 with naproxen.
The authors caution that the findings "were susceptible to confounding by indication," given that tramadol users had greater comorbidity than NSAID users before propensity score matching.

My Take:
Some guidelines are recommending Tramadol as a replacement for Oxycodone in light of the skyrocketing death rate associated with its’ use. Tramadol is used in opioid agonist therapy (OAT), a treatment used to help addicts overcome opioid addiction. While it is an effective pain killer, it has addiction and overuse issues as well.

Napping may be as good as drugs for lowering blood pressure

A midday nap may be just what you need, not just to boost your energy levels but also to lower high blood pressure. This, at least, is what new research from Greece suggests.

A new study that investigators from the Asklepieion General Hospital in Voula, Greece conducted now suggests that taking a nap at midday can effectively help people lower their blood pressure levels.

In this study, the investigators worked with 212 participants who had a mean blood pressure of 129.9 mm Hg. The participants were, on average, 62 years old, and close to one in four of them smoked, had a diagnosis of type II diabetes, or both.

The team split the participants into two groups — one that practiced midday napping and one that did not take up this practice. Over 24 consecutive hours, the researchers took note of the participants' blood pressure measurements, the duration of their midday naps, their general lifestyle choices (such as alcohol consumption and physical activity), and their pulse wave velocity, which measures artery stiffness.

Wisdom Wednesday: Alzheimer's: 'Holy herb' extracts shows promise as future treatment

Yerba santa, a plant with a long history of medicinal use in its native California, contains an active compound that could treat people with Alzheimer's disease one day. This was the conclusion that scientists at the Salk Institute for Biological Studies in La Jolla, CA came to after testing 400 plant extracts with known medicinal properties. Using a new drug-discovery screen, they tested the compounds for their ability to deter the effects of aging on the brain. The initial round of tests yielded several extracts that protected against a type of cell death that occurs in Alzheimer's and other aging-related diseases. Further tests revealed that sterubin, an extract of Eriodictyon californicum, or Yerba santa, was the most able to shield against inflammation and other triggers of brain cell death.

Native tribes of California have long valued Yerba santa, which is the Spanish for "holy herb," very highly as a medicine for respiratory illnesses, fever, infections, bruising, pain, and headaches.

According to a 2018 Alzheimer's Disease International report, dementia affects 50 million people worldwide, two-thirds of whom have Alzheimer's disease. In the U.S., the number of people living with Alzheimer's disease is set to rise from approximately 5.7 million people today to nearly 14 million by 2050.