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Saturday, December 22, 2018

Some Diabetes Drugs Linked to Higher Heart Risks


Two common classes of type 2 diabetes drugs may lower blood sugar levels, but new research suggests those same drugs might boost the risk of heart attack, stroke and heart failure.
The drug classes in question are sulfonylureas and basal insulin. Sulfonylureas cause the body to release more insulin. They’re taken orally and have been used since the 1950s. Basal insulin is given as an injection, and it’s engineered to be released slowly throughout the day.
Meanwhile, the study found that newer — and typically more expensive — drugs appear to lower the risk of heart disease and stroke.
Study author Dr. Matthew O’Brien said the new findings call for a “paradigm shift in how we’re treating diabetes.”
Currently, people with type 2 diabetes are given metformin, and if they need a second treatment, they’re often given sulfonylureas or basal insulin. But these findings call that practice into question.
“People who started taking sulfonylureas and basal insulin have a much higher incidence of cardiovascular disease. So, if all the new drugs lower cardiovascular disease risk, that’s where we should go first to treat type 2 diabetes,” O’Brien explained. He is an assistant professor of general internal medicine, geriatrics and preventive medicine at Northwestern University Feinberg School of Medicine in Chicago.
But that doesn’t seem to be what’s happening in practice. Endocrinologist Dr. Joel Zonszein, director of the Clinical Diabetes Center at Montefiore Medical Center in New York City, said that only 10 percent to 15 percent of patients are being treated with the newer diabetes medications.
“Most patients are getting medications that are less effective and may be causing cardiovascular problems,” Zonszein said.
There are about a dozen different classes of diabetes medications, according to information from the American Diabetes Association (ADA). O’Brien and his colleagues began the study because there isn’t a strong consensus on which of these many drugs to use if the standard first-line treatment doesn’t work.
“When we diagnose people with type 2 diabetes, we give them metformin because that’s what the expert groups all recommend. But if metformin is no longer effective or a patient has gastrointestinal intolerance, it’s kind of a dealer’s choice for what to treat with next. No one knows which is best. We wanted to get some clarity on what the next best medication is,” O’Brien said.
The study looked at more than 130,000 insured adults with type 2 diabetes who were starting therapy with a second-line anti-diabetes medication. The information came from U.S. insurance claims data from 2011 to 2015.
The study participants were aged 45 to 64, and the average follow-up time was 1.3 years.
Treatment with the medication classes known as DPP-4 inhibitors (Januvia, Tradjenta, Onglyza), SGLT-2 inhibitors (Invokana, Farxiga, Jardiance) and GLP-1 agonists (Byetta, Trulicity, Victoza) were all associated with approximately a 20 percent reduction in the risk of complications, such as heart disease and stroke.
Sulfonylureas were associated with 36 percent higher odds of complications, while basal insulin was associated with nearly twice the risk of heart disease and stroke complications, the investigators found.
O’Brien said because the study is observational, it cannot prove whether it’s the medications or an issue with the people taking them that causes the increased cardiovascular risk. He said that people taking insulin tended to be sicker, which may have influenced those findings. However, the researchers controlled the data to account for a number of factors, such as age, blood sugar control and other illnesses.
O’Brien thinks there should be a change in practice now. “I think we have enough evidence from our study and others that sulfonylureas and basal insulin should no longer be the default for a second choice,” he said.
Zonszein agreed, and noting the benefits of newer medications, he suggested that they should be used sooner rather than later.
“I think the newer diabetes medications should be used with metformin from the beginning. These newer drugs help with weight loss, they don’t really cause hypoglycemia [low blood sugar] and they help prevent cardiovascular disease,” Zonszein said.
O’Brien stressed, however, that no one should stop taking medication without talking to their doctor. Instead, he said to have a conversation with your doctor and ask whether or not your current medication is the best choice for you. If it’s a matter of insurance payment, he said your doctor may be able to work with your insurance company to get you a newer diabetes medication, if that’s the best choice for you.
Examples of sulfonylureas include chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol) and glyburide (Micronase, Glynase, and Diabeta). Examples of basal insulins include glargine (Lantus, Toujeo), detemir (Levemir) and degludec (Tresiba).
The findings were published online Dec. 21 in JAMA Network Open.
More information
Learn more about diabetes medication options from the American Diabetes Association.
SOURCES: Matthew O’Brien, M.D., assistant professor of general internal medicine, geriatrics and preventive medicine, Northwestern University Feinberg School of Medicine, Chicago; Joel Zonszein, M.D., director, Clinical Diabetes Center, Montefiore Medical Center, New York City; Dec. 21, 2018, JAMA Network Open, online
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Takeda Pharmaceutical to fund Shire purchase with cash, cancels credit deal


Takeda Pharmaceutical Company announced on Friday that it intended to fund the cash consideration due on completion of the proposed acquisition of Shire from its cash resources and other financing sources.
The Japanese pharmaceuticals giant said that as a result, it had cancelled in full the remaining commitments under the 364-day bridge credit agreement, which it entered into in connection with the acquisition on 8 May.
In addition, certain technical amendments are being made to the term loan credit agreement dated 8 June, the senior short-term loan facility agreement dated 26 October, and the loan agreement with the Japan Bank for International Cooperationdated 3 December entered into by Takeda, the firms board said in its statement.
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Sun Pharmaceutical Industries: Pharma arm gets USFDA nod for epilepsy drug


Sun Pharmaceutical Industries on Friday said one of its subsidiaries has received approval from the US health regulator to market Elepsia XR, an antiepileptic drug.
The United States Food and Drug Administration (USFDA) has granted approval for the New Drug Application to a wholly-owned subsidiary of Sun Pharma for Elepsia XR in the strengths of 1,000 mg and 1,500 mg, the company said in a regulatory filing.
The product was filed from Sun Pharma`s Halol (Gujarat) facility, it added.
The subsidiary concerned had in-licensed Elepsia XR from Sun Pharma Advanced Research Company (SPARC) in July 2016.
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Ready for a close-up: The science behind face massage rollers


Imaging using laser-speckle flowgraphy revealed red colors, indicating higher skin blood flow, in the massaged area.
Credit: Naoyuki Hayashi
Facial massaging using a roller can increase skin blood flow for more than ten minutes after the massage. It can also improve vasodilation — the widening of blood vessels, — in the long-term, according to a study by researchers in Japan.
Beauty experts rave about them, and millions of us buy them, but what do scientists make of face massage rollers? Few studies have so far investigated the effects of using facial massage rollers over time.
To address this gap, Naoyuki Hayashi of the Institute for Liberal Arts, Tokyo Institute of Technology (Tokyo Tech) and colleagues at Tokyo Healthcare University and the Research and Development Center, MTG Co. Ltd., conducted short- and long-term experiments involving participation of healthy male and female volunteers to examine the effects of using a massage roller on facial skin and blood flow.
In the short-term experiment, even a five-minute massage can significantly increase facial skin blood flow in the massaged cheek, with a relative change of up to around 25%. Visualization of the change in blood flow was achieved using a non-invasive technique called laser speckle flowgraphy.
One surprising outcome was the duration of the effect immediately after the five-minute massage. “The increase in skin blood flow after applying the massage roller persisted much longer than we had expected,” the researchers say in their study published in Complementary Therapies in Medicine. “Short-term mechanical stimulation by a facial massage roller increased skin blood flow for more than ten minutes solely in the massaged cheek.”
In the long-term experiment, the researchers examined the effects of daily massage on the right cheek over a five-week period. They also examined the reactivity of facial blood vessels to a heat stimulus, involving application of a heating probe set at 40°C, in order to test whether there were any changes in vascular dilation response.
Findings from the long-term study suggested that using a roller improved blood flow response, or the so-called vasodilatory response, to heat stimulation. One explanation for this could be that endothelial cells in the massaged area produce more nitric oxide, which is known to be a potent vasodilator.
Story Source:
Materials provided by Tokyo Institute of Technology. Note: Content may be edited for style and length.
Journal Reference:
  1. Akane Miyaji, Kaori Sugimori, Naoyuki Hayashi. Short- and long-term effects of using a facial massage roller on facial skin blood flow and vascular reactivity. Complementary Therapies in Medicine, 2018; 41: 271 DOI: 10.1016/j.ctim.2018.09.009
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Energy-efficient way to stay warm: Sew high-tech heating patches to your clothes


This image shows how to make a personal heating patch from polyester fabric fused with tiny silver wires, using pulses of intense light from a xenon lamp.
Credit: Hyun-Jun Hwang and Rajiv Malhotra/Rutgers University-New Brunswick
What if, instead of turning up the thermostat, you could warm up with high-tech, flexible patches sewn into your clothes — while significantly reducing your electric bill and carbon footprint?
Engineers at Rutgers and Oregon State University have found a cost-effective way to make thin, durable heating patches by using intense pulses of light to fuse tiny silver wires with polyester. Their heating performance is nearly 70 percent higher than similar patches created by other researchers, according to a Rutgers-led study in Scientific Reports.
They are inexpensive, can be powered by coin batteries and are able to generate heat where the human body needs it since they can be sewed on as patches.
“This is important in the built environment, where we waste lots of energy by heating buildings — instead of selectively heating the human body,” said senior author Rajiv Malhotra, an assistant professor in the Department of Mechanical and Aerospace Engineering at Rutgers University-New Brunswick. The department is in the School of Engineering.
It is estimated that 47 percent of global energy is used for indoor heating, and 42 percent of that energy is wasted to heat empty space and objects instead of people, the study notes. Solving the global energy crisis — a major contributor to global warming — would require a sharp reduction in energy for indoor heating.
Personal thermal management, which focuses on heating the human body as needed, is an emerging potential solution. Such patches may also someday help warm anyone who works or plays outdoors.
The Rutgers and Oregon State engineers created highly efficient, flexible, durable and inexpensive heating patches by using “intense pulsed-light sintering” to fuse silver nanowires — thousands of times thinner than a human hair — to polyester fibers, using pulses of high-energy light. The process takes 300 millionths of a second, according to the study funded by the National Science Foundation and Walmart U.S. Manufacturing Innovation Fund.
When compared with the current state of the art in thermal patches, the Rutgers and Oregon State creation generates more heat per patch area and is more durable after bending, washing and exposure to humidity and high temperature.
Next steps include seeing if this method can be used to create other smart fabrics, including patch-based sensors and circuits. The engineers also want to determine how many patches would be needed and where they should be placed on people to keep them comfortable while reducing indoor energy consumption.
Story Source:
Materials provided by Rutgers University. Note: Content may be edited for style and length.
Journal Reference:
  1. Hyun-Jun Hwang, Harish Devaraj, Chen Yang, Zhongwei Gao, Chih-hung Chang, Howon Lee, Rajiv Malhotra. Rapid Pulsed Light Sintering of Silver Nanowires on Woven Polyester for personal thermal management with enhanced performance, durability and cost-effectiveness. Scientific Reports, 2018; 8 (1) DOI: 10.1038/s41598-018-35650-7
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GMO houseplant can clean your home’s air


Researchers at the University of Washington have genetically modified a common houseplant — pothos ivy — to remove chloroform and benzene from the air around it.
Credit: Mark Stone/University of Washington
We like to keep the air in our homes as clean as possible, and sometimes we use HEPA air filters to keep offending allergens and dust particles at bay.
But some hazardous compounds are too small to be trapped in these filters. Small molecules like chloroform, which is present in small amounts in chlorinated water, or benzene, which is a component of gasoline, build up in our homes when we shower or boil water, or when we store cars or lawn mowers in attached garages. Both benzene and chloroform exposure have been linked to cancer.
Now researchers at the University of Washington have genetically modified a common houseplant — pothos ivy — to remove chloroform and benzene from the air around it. The modified plants express a protein, called 2E1, that transforms these compounds into molecules that the plants can then use to support their own growth. The team will publish its findings Wednesday, Dec. 19 in Environmental Science & Technology.
“People haven’t really been talking about these hazardous organic compounds in homes, and I think that’s because we couldn’t do anything about them,” said senior author Stuart Strand, who is a research professor in the UW’s civil and environmental engineering department. “Now we’ve engineered houseplants to remove these pollutants for us.”
The team decided to use a protein called cytochrome P450 2E1, or 2E1 for short, which is present in all mammals, including humans. In our bodies, 2E1 turns benzene into a chemical called phenol and chloroform into carbon dioxide and chloride ions. But 2E1 is located in our livers and is turned on when we drink alcohol. So it’s not available to help us process pollutants in our air.
“We decided we should have this reaction occur outside of the body in a plant, an example of the ‘green liver’ concept,” Strand said. “And 2E1 can be beneficial for the plant, too. Plants use carbon dioxide and chloride ions to make their food, and they use phenol to help make components of their cell walls.”
The researchers made a synthetic version of the gene that serves as instructions for making the rabbit form of 2E1. Then they introduced it into pothos ivy so that each cell in the plant expressed the protein. Pothos ivy doesn’t flower in temperate climates so the genetically modified plants won’t be able to spread via pollen.
“This whole process took more than two years,” said lead author Long Zhang, who is a research scientist in the civil and environmental engineering department. “That is a long time, compared to other lab plants, which might only take a few months. But we wanted to do this in pothos because it’s a robust houseplant that grows well under all sort of conditions.”
The researchers then tested how well their modified plants could remove the pollutants from air compared to normal pothos ivy. They put both types of plants in glass tubes and then added either benzene or chloroform gas into each tube. Over 11 days, the team tracked how the concentration of each pollutant changed in each tube.
For the unmodified plants, the concentration of either gas didn’t change over time. But for the modified plants, the concentration of chloroform dropped by 82 percent after three days, and it was almost undetectable by day six. The concentration of benzene also decreased in the modified plant vials, but more slowly: By day eight, the benzene concentration had dropped by about 75 percent.
In order to detect these changes in pollutant levels, the researchers used much higher pollutant concentrations than are typically found in homes. But the team expects that the home levels would drop similarly, if not faster, over the same time frame.
Plants in the home would also need to be inside an enclosure with something to move air past their leaves, like a fan, Strand said.
“If you had a plant growing in the corner of a room, it will have some effect in that room,” he said. “But without air flow, it will take a long time for a molecule on the other end of the house to reach the plant.”
The team is currently working to increase the plants’ capabilities by adding a protein that can break down another hazardous molecule found in home air: formaldehyde, which is present in some wood products, such as laminate flooring and cabinets, and tobacco smoke.
“These are all stable compounds, so it’s really hard to get rid of them,” Strand said. “Without proteins to break down these molecules, we’d have to use high-energy processes to do it. It’s so much simpler and more sustainable to put these proteins all together in a houseplant.”
Civil and environmental engineering research technician Ryan Routsong is also a co-author. This research was funded by the National Science Foundation, Amazon Catalyst at UW and the National Institute of Environmental Health Sciences.
Story Source:
Materials provided by University of Washington. Note: Content may be edited for style and length.
Journal Reference:
  1. Long Zhang, Ryan Routsong, Stuart E. Strand. Greatly Enhanced Removal of Volatile Organic Carcinogens by a Genetically Modified Houseplant, Pothos Ivy (Epipremnum aureum) Expressing the Mammalian Cytochrome P450 2e1 Gene. Environmental Science & Technology, 2018; DOI: 10.1021/acs.est.8b04811
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Sight-saving treatment for eye infection or trauma


Scientists at the University of Birmingham have developed a novel eye drop that rapidly reduces sight-threatening scarring to the surface of the eye.
The surface of the eye (the cornea) is usually transparent, but scars resulting from eye infection or trauma make it opaque causing blurred vision or in extreme cases complete blindness.
Their pre-clinical research, published today (Friday 21 December 2018) in npj Regenerative Medicine, shows that within a matter of days the eye drop speeds healing, reduces scarring and improves corneal transparency compared to the current standard of care for Pseudomonas aeruginosa, an eye infection commonly associated with poor contact lens hygiene.
The current standard of care for eye infection are eye drops containing antibiotics and corticosteroids to reduce inflammation, followed by intensive lubrication to prevent further damage to the eye during blinking. These treatments effectively sterilize the eye, although some patients are left with visual ‘hazing’ due to scars on the cornea.
The only option to correct this is costly and cumbersome surgical interventions, such as corneal transplants, which are fraught with risks of failure or rejection.
The Birmingham scientists, led by Professor Liam Grover from the University’s School of Chemical Engineering and Professor Ann Logan from the University’s Institute of Inflammation and Ageing, have developed the eye drop which consists of a fluid gel loaded with a natural wound-healing protein called Decorin.
Professor Ann Logan said: “This innovative fluid gel in the eye drop is designed to retain the Decorin on the surface of the eye, and form a ‘therapeutic bandage’ that promotes scarless healing.”
Professor Liam Grover explained: “The fluid gel is a novel material that can transition between a solid and liquid state. This means it contours itself to the surface of the eye, is retained there, and is only slowly removed by blinking.”
This research has shown for the first time that the fluid gel has a therapeutic effect in its own right, and the researchers believe it forms a protective barrier that protects the surface of the eye from further damage caused by blinking. The fluid gel has been patented by University of Birmingham Enterprise.
Dr Richard Moakes, also from the School of Chemical Engineering explained: “We are now continuing our work to test and refine the formulation for this novel anti-scarring eye ‘bandage’.”
Dr Lisa Hill, from the University’s Institute of Clinical Sciences, said: “The anti-scarring eye drop has the potential to vastly improve outcomes for patients with eye infection and trauma. It could also help save many people’s sight, particularly in the developing world where surgical interventions such as corneal transplants are not available.”
Story Source:
Materials provided by University of Birmingham. Note: Content may be edited for style and length.
Journal Reference:
  1. Lisa J. Hill, Richard J. A. Moakes, Chairut Vareechon, Gibran Butt, Aaron Ng, Kristian Brock, Gurpreet Chouhan, Rachel C. Vincent, Serena Abbondante, Richard L. Williams, Nicholas M. Barnes, Eric Pearlman, Graham R. Wallace, Saaeha Rauz, Ann Logan, Liam M. Grover. Sustained release of decorin to the surface of the eye enables scarless corneal regeneration. npj Regenerative Medicine, 2018; 3 (1) DOI: 10.1038/s41536-018-0061-4
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