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Monday, June 24, 2019

Performance-enhancing bacteria found in the microbiomes of elite athletes

New research has identified a type of bacteria found in the microbiomes of elite athletes that contributes to improved capacity for exercise. These bacteria, members of the genus Veillonella, are not found in the guts of sedentary people.
By taking a closer look at the bacteria, the researchers from Joslin Diabetes Center determined Veillonella metabolizes lactic acid produced by exercise and converts it into propionate, a short chain fatty acid. The human body then utilizes that propionate to improve exercise capacity. The results were reported today in Nature Medicine.
“Having increased exercise capacity is a strong predictor of overall health and protection against cardiovascular disease, diabetes, and overall longevity,” says Aleksandar D. Kostic PhD, TITLE., a co-author on the paper. “What we envision is a probiotic supplement that people can take that will increase their ability to do meaningful exercise and therefore protect them against chronic diseases including diabetes.”
The work began in 2015 with fecal samples from Boston Marathon runners. Jonathan Scheiman, PhD, then a researcher in the lab of George Church, PhD, at Harvard Medical School, collected samples during a time span of one week before the Marathon to one week after the Marathon. He also collected samples from sedentary individuals. Dr. Scheiman then brought the samples to Dr. Kostic, who analyzed them to determine the species of bacteria in both cohorts.
“One of the things that immediately caught our attention was this single organism, Veillonella, that was clearly enriched in abundance immediately after the marathon in the runners. Veillonella is also at higher abundance in the marathon runners [in general] than it is in sedentary individuals.” says Dr. Kostic.
They confirmed the link to improved exercise capacity in mouse models, where they saw a marked increase in running ability after supplementation with Veillonella. Next, they wanted to figure out how it worked.
“As we dug into the details of Veillonella, what we found was that it is relatively unique in the human microbiome in that it uses lactate or lactic acid as its sole carbon source,” he says.
Lactic acid is produced by the muscles during strenuous exercise. The Veillonella bacteria are able to use this exercise by-product as their main food source.
“Our immediate hypothesis was that it worked as a metabolic sink to remove lactate from the system, the idea being that lactate build-up in the muscles creates fatigue,” he says. “But talking to people like Sarah Lessard, [a clinical researcher at Joslin] and other people in the exercise physiology field, apparently this idea that lactate build-up causes fatigue is not accepted to be true. So, it caused us to rethink the mechanism of how this is happening.”
Dr. Kostic and his team returned to the lab to figure out what could be causing the increase in exercise capacity. They ran a metagenomic analysis, meaning they tracked the genetics of all the organisms in the microbiome community, to determine what events were triggered by Veillonella’s metabolism of lactic acid. They noted that the enzymes associated with conversion of lactic acid into the short chain fatty acid propionate were at much higher abundance after exercise.
“Then the question was maybe it’s not removal of lactic acid, but the generation of propionate,” says Dr. Kostic. “We did some experiments to introduce propionate into mice [via enema] and test whether that was sufficient for this increased running ability phenotype. And it was.”
Dr. Kostic and his team plan to investigate the mechanisms of how propionate affects exercise capacity in a collaboration with Dr. Lessard.
Colonies of bacteria residing in our guts have a powerful impact on our health. Exercise is an important component of a healthy lifestyle meant to ward off diseases such as type 2 diabetes. Many people with metabolic disorders are not able to exercise at the level needed to see such benefits. Supplementing their microbiome using a probiotic capsule containing Veillonella could give them the boost they need for effective exercise. (Direct dosing with propionate pill would not work, as the short chain fatty acid would be broken down by digestive juices before it could take effect.) Dr. Scheiman has since spun this idea off into a company targeted at athletes.
“The microbiome is such a powerful metabolic engine,” says Dr. Kostic. This is one of the first studies to directly show a strong example of symbiosis between microbes and their human host.
“It’s very clear. It creates this positive feedback loop. The host is producing something that this particular microbe favors. Then in return, the microbe is creating something that benefits the host,” he says. “This is a really important example of how the microbiome has evolved ways to become this symbiotic presence in the human host.”
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This work was funded by the Synthetic Biology platform at the Wyss Institute for Biologically Inspired Engineering at Harvard University; National Institutes of Health/National Human Genome Research Institute (NIH/NHGRI); National Institute of Diabetes Digestive and Kidney Diseases (NIH/NIDDK); National Science Foundation (NSF); National Library of Medicine; Smith Family Foundation Award for Excellence in Biomedical Research; American Diabetes Association (ADA).

Widely available antibiotics could be used in the treatment of ‘superbug’ MRSA

Some MRSA infections could be tackled using widely-available antibiotics, suggests new research from an international collaboration led by scientists at the University of Cambridge and the Wellcome Sanger Institute.
Since the discovery of penicillin, the introduction of antibiotics to treat infections has revolutionised medicine and healthcare, saving millions of lives. However, widespread use (and misuse) of the drugs has led some bacteria to develop resistance, making the medicines less effective. With few new antibiotics in development, antibiotic resistance is widely considered a serious threat to the future of modern medicine, raising the spectre of untreatable infections.
One of the most widely used and clinically important groups of antibiotics is the family that includes penicillin and penicillin derivatives. The first type of penicillin resistance occurred when bacteria acquired an enzyme, known as a beta-lactamase, which destroys penicillin. To overcome this, drug manufacturers developed new derivatives of penicillin, such as methicillin, which were resistant to beta-lactamase.
In the escalating arms race, one particular type of bacteria known as Methicillin-resistant Staphylococcus aureus – MRSA – has developed widespread resistance to this class of drugs. MRSA has become a serious problem in hospital- and community-acquired infections, forcing doctors to turn to alternative antibiotics, or a cocktail of different drugs which are often less effective, and raises concerns that even these drugs will in time become ineffective.
In previous research, a team of researchers in Cambridge identified an isolate of MRSA (a sample grown in culture from a patient’s infection) that showed susceptibility to penicillin in combination with clavulanic acid. Clavulanic acid is a beta-lactamase inhibitor, which prevents the beta-lactamase enzyme destroying penicillin; it is already used as a medicine to treat kidney infections during pregnancy.
In a study published today in Nature Microbiology, a team of scientists from the UK, Denmark, Germany, Portugal, and USA used genome sequencing technology to identify which genes make MRSA susceptible to this combination of drugs. They identified a number of mutations (changes in the DNA sequence) centred around a protein known as a penicillin-binding protein 2a or PBP2a.
PBP2a is crucial to MRSA strains as it enables them to keep growing in the presence of penicillin and other antibiotics derived from penicillin. Two of these mutations reduced PBP2a expression (the amount of PBP2a produced), while two other mutations increased the ability of penicillin to bind to PBP2a in the presence of clavulanic acid. Overall the effect of these mutations means that a combination of penicillin and clavulanic acid could overcome the resistance to penicillin in a proportion of MRSA strains.
The team then looked at whole genome sequences of a diverse collection of MRSA strains and found that a significant number of strains – including USA300 clone, the dominant strain in the United States – contained both mutations that confer susceptibility. This means that one of the most widespread strains of MRSA-causing infections could be treatable by a combination of drugs already licensed for use.
Using this knowledge, the researchers used a combination of the two drugs to successfully treat MRSA infections in moth larvae and then mice. Their next step will be to conduct the further experimental work required for a clinical trial in humans.
Dr Mark Holmes from the Department of Veterinary Medicine at the University of Cambridge, a senior author of the study, says: “MRSA and other antibiotic-resistant infections are a major threat to modern medicine and we urgently need to find new ways to tackle them. Developing new medicines is extremely important, but can be a lengthy and expensive process. Our works suggests that already widely-available medicines could be used to treat one of the world’s major strains of MRSA.”
First author Dr Ewan Harrison, from the Wellcome Sanger Institute and the University of Cambridge, adds: “This study highlights the importance of genomic surveillance – collecting and sequencing representative collections of bacterial strains. By combining the DNA sequencing data generated by genomic surveillance with laboratory testing of the strains against a broad selection of antibiotics, we may find other unexpected chinks in the armour of antibiotic-resistant bacteria that might give us new treatment options.”
The research was funded by the Medical Research Council (MRC), Wellcome and the Department of Health.
Dr Jessica Boname, Head of Antimicrobial Resistance at the MRC, says: “This study demonstrates how a mechanistic understanding of resistance and access to clinical data can be used to find new ways to contain and control infections with existing resources.”
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Reference
Harrison, EM et al. Genomic identification of cryptic susceptibility to penicillins and β-lactamase inhibitors in methicillin-resistant Staphylococcus aureusNature Microbiology; 24 June 2019; DOI: 10.1038/s41564-019-0471-0

Commonly prescribed drugs can increase the risk of dementia

A study from the University of Nottingham and funded by the NIHR School for Primary Care Research found that there was nearly a 50% increased risk of dementia among patients aged 55 and over who had used strong anticholinergic medication daily for three years or more.
Anticholinergic drugs help to contract and relax muscles. They work by blocking acetylcholine, a chemical that transmits messages in the nervous system.
Doctors prescribe the drugs to treat a variety of conditions, including chronic obstructive pulmonary disease, bladder conditions, allergies, gastrointestinal disorders and symptoms of Parkinson’s disease.
These medicines can have short-term side effects, including confusion and memory loss, but it is less certain whether long-term use increases the risk of dementia.
The research, published in the JAMA Internal Medicine journal and led by Professor Carol Coupland from the University’s Division of Primary Care, looked at the medical records of 58,769 patients with a diagnosis of dementia and 225,574 patients without a diagnosis of dementia, all aged 55 and over and registered with UK GPs contributing data to the QResearch database, between 1 January 2004 and 31 January 2016.
The study findings showed increased risks of dementia for anticholinergic drugs overall and specifically for the anticholinergic antidepressants, antipsychotic drugs, antiparkinsons drugs, bladder drugs and epilepsy drugs after accounting for other risk factors for dementia.
No increased risks were found for the other types of anticholinergic drug studied such as antihistamines and gastrointestinal drugs.
Professor Tom Dening, Head of the Centre for Dementia at the University of Nottingham and a member of the research study team, said: “This study provides further evidence that doctors should be careful when prescribing certain drugs that have anticholinergic properties. However, it’s important that patients taking medications of this kind don’t just stop them abruptly as this may be much more harmful. If patients have concerns, then they should discuss them with their doctor to consider the pros and cons of the treatment they are receiving.”
The 58,769 patients with dementia had an average age of 82 and 63% were women. Each dementia case was matched to five control patients of the same age, sex, and general practice.
Anticholinergic drug exposure was assessed using prescription information over a complete period of 10 years from 1 to 11 years before diagnosis of dementia or the equivalent dates in control patients, and was compared between the two patient groups. Further analysis looked at prescriptions for anticholinergic drugs up to 20 years before diagnosis of dementia.
This is an observational study so no firm conclusions can be drawn about whether these anticholinergic drugs cause dementia, and it is possible that the drugs were being prescribed for very early symptoms of dementia.
Professor Coupland said: “Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs.
“The risks of this type of medication should be carefully considered by healthcare professionals alongside the benefits when the drugs are prescribed and alternative treatments should be considered where possible, such as other types of antidepressants or alternative types of treatment for bladder conditions. These findings also highlight the importance of carrying out regular medication reviews.
“We found a greater risk for people diagnosed with dementia before the age of 80 which indicates that anticholinergic drugs should be prescribed with caution in middle-aged people as well as in older people.”
These results, along with those of a similar study published in 2018 help to clarify which types of anticholinergic drug are associated with the highest risks of dementia.
In the 1-11 years before the dementia diagnosis date or equivalent in controls, nearly 57% of cases and 51% of controls were prescribed at least one strong anticholinergic drug, with an average of six prescriptions in cases and 4 in controls. The most frequently-prescribed types of drugs were antidepressants, anti-vertigo and bladder antimuscarinic drugs – which are used to treat an overactive bladder.
The increased risk associated with these drugs indicates that if the association is causal around 10% of dementia diagnoses could be attributable to anticholinergic drug exposure, which would equate to around 20,000 of the 209,600 new cases of dementia per year in the UK.
This is a sizeable proportion and is comparable with other modifiable risk factors for dementia, including 5% for midlife hypertension, 3% for diabetes, 14% for later life smoking and 6.5% for physical inactivity.

Trump administration plans to require hospitals to list ‘shoppable’ prices

Hospitals could be required to provide prices in an “easy-to-read, patient-friendly format” before they provide services to patients under rules that will be proposed in an executive order signed by President Donald Trump.
In an announcement held by White House officials Monday morning, Department of Health and Human Services (HHS) Secretary Alex Azar said the order would “put American patients in control and address the fundamental drivers of high American healthcare costs.”
“Patient empowerment, of course, requires transparency around price and quality,” Azar said.

The executive order included several major components, Azar said. Among them:
  • It directs HHS to issue a rule requiring hospitals to disclose “in an easy-to-read, patient-friendly format” prices that reflect what patients and insurers actually pay.
  • The order requires HHS to put forth a proposal to require providers and insurers to provide patients with information about out-of-pocket costs before they receive healthcare services.
  • It calls for the administration to lay out a road map for consolidating quality measures across all federal healthcare programs.
  • It calls for the administration to expand access to de-identified healthcare claims data to provide data sets for supporting researchers in identifying opportunities for improving American healthcare.
  • It directs the Department of the Treasury to expand consumers’ ability to take advantage of health savings accounts (HSAs) and other medical accounts by expanding the range of services for which HSA dollars can be used. It also requires HHS to work with other departments to determine how to better address surprise billing and other barriers to transparency and “shoppability in healthcare.”
Officials did not give a timeline for the plan, which is almost certain to draw ire across the hospital industry over concerns of competition as well as complexity. Administration officials acknowledged those concerns and said they would be putting out regulations focused on requiring hospitals to disclose “information based on negotiated rates” and to make it publicly available.

However, they said the level of detail that would be required to comply will be made available as part of the proposed rule-making process. The administration will also include industry input, the officials said.
That said, they indicated the requirement would need to result in prices for common or “shoppable” items and services to be available in an “easy-to-understand” customer-friendly format.
“Every time any one of us goes to a doctor or a hospital, within a couple of weeks in our mailbox arrives an explanation of benefits. That explanation of benefits contains the list price for the procedure you got, what the negotiated rate between the insurance plan and the provider and what your out-of-pocket is,” a senior administration official said. “The rates are there. This is not some great state secret out there. What we’re saying is, you’ve got the right to know the information before you get the service.”

Docs Applaud Exec Order on Health Care Costs, Opening to Direct Primary Care

At an event today at The White House, physicians from the Docs4PatientCare Foundation (D4PCF), the only health care organization composed of practicing physicians with hands-on, practical knowledge of the American health care system joined President Trump as he signed an Executive Order demanding transparency in what has become an opaque cost/pricing system.
At the event, physicians applauded the recognition of Direct Primary Care options allowing patients to use Health Savings Accounts for their care.  These innovative relationships established between a physician and patient without the distraction of an insurance company or other third-party interference are increasing in the health care marketplace.
“In this age of information, we can compare prices on everything, except our health care, which places patients at a disadvantage,” stated Dr. Lee Gross, President of the Docs4PatientCare Foundation. “The prices patients pay for health care must be driven by the costs of that care, not a patients ability to pay nor a result of secret negotiations where the only motive is profit – at the expense of the patient.”
The Executive Order will compel disclosures of details on what it costs for insurers, doctors, hospitals etc., to provide health services. There is often a major delta between the costs of these services and the prices paid by patients, insurance companies, and the government.
“Until we know what the true costs are, having a fair pricing system is impossible,” Dr. Gross continued. “By developing rules that force everyone to show their cards simultaneously, we will finally achieve truth in the health care marketplace.”
The current system keeps patients and their doctors in the dark about pricing considerations – especially for the vast majority of predictive health care decisions.
More than 15 members of Docs4PatientCare Foundation attended as guests of the White House and were recognized for their expertise and leadership in these transformational endeavors.
“While this Executive Order and subsequent rule changes may expose some warts in the previous contracting process, the patient will come out ahead. An informed consumer will be healthier and make better decisions. And doctors who pledge to first do no harm can take that a step farther and to do no financial harm to their patients too,” Dr. Gross continued.
Please visit:  http://d4pcfoundation.org/

Aldeyra Therapeutics (ALDX) Schedules Webcast, Conference Call

to Announce Top-Line Results from SOLACE Trial in Noninfectious Anterior Uveitis

Encompass Health Corporation (EHC) announces investment in Medalogix

Encompass Health Corp. (NYSE: EHC), a leader in integrated healthcare services, today announced it has made a minority equity investment in Medalogix