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Daily Archives: November 21, 2019
To Improve Public Health, Medicine Regulators Worldwide Should Collaborate, Remove Barriers to Sharing Information, Says New Report – National…
Posted: November 21, 2019 at 5:46 pm
Nov. 21, 2019
WASHINGTON Medicine regulatory authorities including the U.S. Food and Drug Administration (FDA) should strengthen cooperation with other countries regulators to ensure the quality, safety, and efficacy of medicines, says a new report from the National Academies of Sciences, Engineering, and Medicine. Regulating Medicines in a Globalized World: The Need for Increased Reliance Among Regulators contains recommendations to promote information sharing among RAs with the aim of protecting public health, ensuring faster access to critical medicines, and encouraging innovation in medicine and technology.
Today, drug development is increasingly global. An estimated 40 percent of medicines and 80 percent of active pharmaceutical ingredients used by Americans are made overseas. Different countries have different rules, regulations, and standards for the review and approval of new medicines. However, they are often unable to share inspection reports and other critical safety information with each other, because such reports are heavily redacted to protect trade secrets and other confidential information.
No regulator has all the human and technical resources it needs to meet all of its public health responsibilities, especially as their workloads increase due to the growing complexity of medicines; societal expectations for faster drug approvals; and the rising demand for inspections of manufacturing facilities overseas. Reliance and recognition arrangements enable regulators to share information and increase the transparency of each others activities; to optimize limited human and financial resources; to build expertise in specialized and emerging regulatory areas (such as gene therapies and biosimilars); and to mobilize resources in the event of a drug shortage or public health emergency.
Reliance is when a regulatory authority considers anothers work (such as inspection and scientific assessment reports) to inform its own regulatory decisions. Recognition the highest level of which is a mutual recognition agreement (MRA) is when a regulator not only relies on the work of another regulator, but also accepts and adopts the other regulators decisions. Smaller and under-resourced regulators often enter these arrangements with better-resourced countries to strengthen their capacity. However, it is up to the countrys regulatory authority to decide whether to approve a medicine. Entering one of these arrangements does not mean giving up decision-making responsibilities, the report says.
In order for regulatory authorities to build upon and enter new recognition and reliance arrangements, impediments to information sharing should be removed. Medicine regulatory authorities should consider sharing full, unredacted reports to help countries make better-informed, sovereign decisions about the approval of medicines, the report says. In addition, the FDA and Congress should re-evaluate such confidentiality restrictions and ensure that current redaction practices promote information sharing while protecting personal data.
The report identifies several potential public health benefits of reliance and recognition arrangements. These arrangements could allow for patients and consumers to gain faster access to quality medicines. For example, following the Zika outbreak of 2016, the World Health Organization (WHO) encouraged reliance as a way to expedite market access to tests, vaccines, and treatments for priority diseases. In the aftermath of Hurricane Maria in Puerto Rico a pharmaceutical manufacturing hub the use of reliance arrangements would have allowed regulators to share information to assess alternative manufacturing sites.
Greater cooperation between national regulators could help identify substandard or falsified medicines before they are approved or exported, says the report. It could also prevent duplicative activities, such as multiple RAs inspecting the same low-risk manufacturing site, which diverts time and resources from more urgent inspections as well as other regulatory priorities.
Many industries such as banking and telecommunication operate seamlessly across national borders. Todays medicines are global commodities, so the regulation of medicines should function just as seamlessly, said Alastair Wood, emeritus professor of medicine and pharmacology at Vanderbilt University, who chaired the committee that wrote the report. Regulatory authorities need to be able to use the best science, the best expertise, and the best resources to make informed decisions to protect the health of millions of people.
Improve the Design of Mutual Recognition Agreements The report outlines a stakeholder-driven strategy to improve cooperation and collaboration among regulators, which includes:
Respond to Evolving Science and Technology Formal MRAs are not currently agile enough to respond to rapid changes in science and technology, or to public health emergencies. Regulatory authorities should consider potential areas for scope exploration of both formal recognition agreements such as MRAs and less formal reliance arrangements (e.g., collaborative activities) including: guidelines for reliable and high-quality laboratory data, guidance for studies involving human subjects, and guidance for the manufacturing, production, and distribution of medicines.
Expand the Scope of the European Union (EU)-U.S. MRA Currently, the EU-U.S. MRA only applies to manufacturing site inspections. The EU-U.S. MRA should be expanded to include reliance in additional areas and for a broader range of medicine types, the report recommends. In addition, the provisions in the MRA for inspections that the FDA and European Medicines Agency conduct outside of the U.S. and EU (third country inspections) should be implemented immediately.
Formally Evaluate the Public Health Impacts of Reliance and Recognition Arrangements Most reliance and recognition arrangements do not explicitly call for evaluation of public health benefits, and there is a lack of data on their successes and challenges. Regulatory authorities should create a results framework with clear indicators, metrics, and processes for monitoring and evaluating recognition and reliance arrangements, the report recommends. This would increase understanding of their public health benefits, and enable benefit-risk and cost-benefit analysis over time.
The study undertaken by the Committee on Mutual Recognition Agreements and Reliance in the Regulation of Medicines was sponsored by the U.S. Food and Drug Administrations Office of Global Policy and Strategy.
The National Academies of Sciences, Engineering, and Medicine are private, nonprofit institutions that provide independent, objective analysis and advice to the nation to solve complex problems and inform public policy decisions related to science, technology, and medicine. They operate under an 1863 congressional charter to the National Academy of Sciences, signed by President Lincoln.
Contact:Stephanie Miceli, Media Relations OfficerOffice of News and Public Information202-334-2138; e-mail firstname.lastname@example.org
Posted: at 5:46 pm
Growing up in Tanzania, I knew that fruit trees were useful. Climbing a mango tree to pick a fruit was a common thing to do when I was hungry, even though at times there were unintended consequences. My failure to resist consuming unripened fruit, for example, caused my stomach to hurt. With such incidents becoming frequent, it was helpful to learn from my mother that consuming the leaves of a particular plant helped alleviate my stomach pain.
This lesson helped me appreciate the medicinal value of plants. However, I also witnessed my family and neighboring farmers clearing the land by slashing and burning unwanted trees and shrubs, seemingly unaware of their medicinal value, to create space for food crops.
But this lack of appreciation for the medicinal value of plants extends beyond my childhood community. As fires continue to burn in the Amazon and land is cleared for agriculture, most of the concerns have focused on the drop in global oxygen production if swaths of the forests disappear. But Im also worried about the loss of potential medicines that are plentiful in forests and have not yet been discovered. Plants and humans also share many genes, so it may be possible to test various medicines in plants, providing a new strategy for drug testing.
As a plant physiologist, I am interested in plant biodiversity because of the potential to develop more resilient and nutritious crops. I am also interested in plant biodiversity because of its contribution to human health. About 80% of the world population relies on compounds derived from plants for medicines to treat various ailments, such as malaria and cancer, and to suppress pain.
Future medicines may come from plants
One of the greatest challenges in fighting diseases is the emergence of drug resistance that renders treatment ineffective. Physicians have observed drug resistance in the fight against malaria, cancer, tuberculosis and fungal infections. It is likely that drug resistance will emerge with other diseases, forcing researchers to find new medicines.
Plants are a rich source of new and diverse compounds that may prove to have medicinal properties or serve as building blocks for new drugs. And, as tropical rainforests are the largest reservoir of diverse species of plants, preserving biodiversity in tropical forests is important to ensure the supply of medicines of the future.
Plants and new cholesterol-lowering medicines
The goal of my own research is to understand how plants control the production of biochemical compounds called sterols. Humans produce one sterol, called cholesterol, which has functions including formation of testosterone and progesterone - hormones essential for normal body function. By contrast, plants produce a diverse array of sterols, including sitosterol, stigmasterol, campesterol, and cholesterol. These sterols are used for plant growth and defense against stress but also serve as precursors to medicinal compounds such as those found in the Indian Ayurvedic medicinal plant, ashwagandha.
Humans produce cholesterol through a string of genes, and some of these genes produce proteins that are the target of medicines for treating high cholesterol. Plants also use this collection of genes to make their sterols. In fact, the sterol production systems in plants and humans are so similar that medicines used to treat high cholesterol in people also block sterol production in plant cells.
I am fascinated by the similarities between how humans and plants manufacture sterols, because identifying new medicines that block sterol production in plants might lead to medicines to treat high cholesterol in humans.
New medicines for chronic and pandemic diseases
An example of a gene with medical implications that is present in both plants and humans is NPC1, which controls the transport of cholesterol. However, the protein made by the NPC1 gene is also the doorway through which the Ebola virus infects cells. Since plants contain NPC1 genes, they represent potential systems for developing and testing new medicines to block Ebola.
This will involve identifying new chemical compounds that interfere with plant NPC1. This can be done by extracting chemical compounds from plants and testing whether they can effectively prevent the Ebola virus from infecting cells.
There are many conditions that might benefit from plant research, including high cholesterol, cancer and even infectious diseases such as Ebola, all of which have significant global impact. To treat high cholesterol, medicines called statins are used. Statins may also help to fight cancer. However, not all patients tolerate statins, which means that alternative therapies must be developed.
Tropical rainforests are medicine reservoirs
The need for new medicines to combat heart disease and cancer is dire. A rich and diverse source of chemicals can be found in natural plant products. With knowledge of genes and enzymes that make medicinal compounds in native plant species, scientists can apply genetic engineering approaches to increase their production in a sustainable manner.
Tropical rainforests house vast biodiversity of plants, but this diversity faces significant threat from human activity.
To help students in my genetics and biotechnology class appreciate the value of plants in medical research, I refer to findings from my research on plant sterols. My goal is to help them recognize that many cellular processes are similar between plants and humans. My hope is that, by learning that plants and animals share similar genes and metabolic pathways with health implications, my students will value plants as a source of medicines and become advocates for preservation of plant biodiversity.
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Walter Suza, Adjunct Assistant Professor of Agronomy, Iowa State University
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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The Medicine Plant That Could Have Changed the World. - The National Interest Online
Posted: at 5:46 pm
At the start of this decade, the federal government called out consumer DNA testing as a burgeoning scam industry. Little did we know how it would explode in popularity.
In 2010, the U.S. Government Accountability Office (GAO) published an investigative report that bashed consumer DNA test companies for misleading the public. It accused them of deceptively claiming their products could predict the odds of developing more than a dozen medical conditions; some even went as far to offer equally dubious dietary supplements. The report had followed a similar lambasting of the industry by the GAO in 2006.
Also in 2010, the FDA publicly warned 23andMe and other companies that genetic health tests were considered medical devices and needed to be cleared by the FDA before they could be sold to the public. Three years later, following a lack of response from 23andMe, the agency took the harsh step of temporarily banning 23andMe from selling its health-related tests at all.
Despite these hurdles, the DNA testing industry has nonetheless exploded. According to a report by MIT Technology Review this February, more than 26 million people have had their DNA tested by the biggest names in the industry, with AncestryDNA, 23andMe, and MyHeritage being the top three.
Consumer DNA testing is undoubtedly now mainstreambut its not much less scammy than it was when the decade started.
The industry has existed since the late 1990s. But in 2007, the new kid on the block, 23andMe, became the first company to offer a particular kind of at-home DNA test that was cheap, easy to use, and promised to track back your origins further back than ever before.
23andMes testsand eventually those of its competitorssearch for and analyze the most common genetic variations, called single nucleotide polymorphisms (SNPs), in our autosomal DNA, the 22 of 23 pairs of chromosomes not used to determine sex. For as little as $99 and a spit sample, these SNP-based tests are advertised to determine a persons ancestry or genetic health risks. But much of this realm of consumer DNA testing, as the GAO report showed, can uncharitably be described as complete bullshit.
The crux of the problem is that our genetics are only a piece of the puzzle that influences our health. Sure, you can sometimes point to a specific gene mutation that always makes someone sick in a specific way if they carry it. But much more often, its a complex, barely understood mix of gene variants that predispose us to develop cancer or heart diseaseand that risk can be amplified or muted by our environment (including the crucial months we spend in the womb).
In the earliest days, companies didnt much care for this complexity, using weak evidence to make sweeping health claims about which genes ought to make you more of a fish eater or develop diabetes.
Following the FDAs ban in 2013, 23andMe spent the next two years devising genetic health tests that wouldnt overpromise. In 2015, it was allowed to sell tests that told people if they carried a recessive mutation for genetic conditions like Bloom syndrome and sickle-cell disease. A positive test meant their children would have a 25 percent chance of having the condition if both parents were carriers. Two years later, it became the first company with FDA-approved tests that were allowed to tell people about their risk of developing one of 10 diseases or conditions, such as late-onset Alzheimers or celiac disease.
23andMes return to the health side of things wasnt the only fuse that lit a fire under the consumer DNA industrythe tens of millions in annual advertising now being spent by companies like MyAncestry certainly helped, too. But regardless, the FDAs approval of these tests signaled a new opening in the industry. And unsurprisingly, the industry as a whole has ballooned, as has the glut of scammy services on offer.
Many of these companies now steer clear of making blanket health claims, but it doesnt make them any less laughable. Your DNA results can apparently tell you whether youve found your romantic match, how to be good at soccer, and, like a decade ago, how to find the perfect diet and avoid bloating. Just dont pay attention to the studies showing that theres no consistent link between genes seemingly tied to our nutrition and any actual diet-related conditions.
Its not only the tests vaguely connected to our health that are the problem. As Gizmodo once illustrated, even relying on these DNA tests to figure out your ancestry is a dicey proposition. At best, youre roughly estimating where your recent ancestors lived, but that estimate can vary widely depending on which company does the testing, thanks to the different algorithms they use. And the farther away your lineage is from Europe, the less accurate these tests will be for you, thanks to the fact that the algorithmsas well as the research linking genes to our healthare largely based on the DNA of white Americans and Europeans.
Health and ancestry aside, sharing your DNA with the outside world can have unintended consequences. Law enforcement agencies are now using genealogy databases to solve criminal cases, by connecting anonymous crime scene DNA to DNA submitted to these family tree companies, working backward through distant relatives to identify their suspect. And while some people may be fine with this genetic sleuthing, there are no clear rules on how this data can be used by law enforcementtheres merely the promise by private companies that they will share responsibly. This November, police in Florida obtained a warrant to search through a third-party genealogy database, months after the service had enforced a new opt-in policy meant to let users decide if they wanted their data to be searchable by police in these cases.
At a certain point, it wont even matter whether youve decided to share your DNA. A study last October estimated that once enough peoples DNA is in a databasea scant 2 to 3 percent of any given populationanyone could conceivably track the identity of every person in that population using the same techniques genetic detectives are using now. And researchers have already demonstrated how less scrupulous forces, including hackers, could actively manipulate these databases.
None of this is meant to diminish the real potential of genetics as a field of research and medicine, nor the progress that has been made over the past decade.
Companies like 23andMe rely on detecting thousands of genetic markers still only a tiny slice of our DNA. But the technology that allows a persons entire genome to be sequenced has vastly improved, scaling down its costs and upkeep over the past decade. These techniques can scan a persons whole genome as well as the smaller part of the genome that codes for the proteins our bodys cells make, called the exome.
In 2010, for instance, the company Illumina initially offered its whole genome sequencing at $50,000 a person; this year, Veritas dropped the price of its service to only $600 and says it may soon charge as little as $100.
These innovations have led to large-scale research projects that collect genetic data from hundreds of thousands of people at once. Scientists can scour through these large datasets to find new links between our genes, traits, and medical conditions. This research has helped us better understand longstanding questions about our biology and health. Someday soon, genetic sequencing may also help us optimize the existing medical treatments people get, particularly for conditions like cancer.
Right now, though, its still up in the air how useful this info dump really is to the average person looking to stay healthy.
In March, 23andMe debuted (or more accurately, reintroduced) a service that tells people about their genetic risk of type 2 diabetes. Unlike the tests approved by the FDA, it relies on whats known as a polygenic risk score. This adds up the very small contribution of many genetic markers to a particular condition, which combined might be enough to nudge your overall risk upwards.
The trouble is that these markers have little to do with why you get type 2 diabetesyour age or weight play a much bigger role. And even if the test does consider you genetically unlucky (an average risk difference of 5 percent from a typical person), the advice youll get is the same that anyone hoping for a long, healthy life would get: eat more vegetables and exercise more. This test, as well as many of those offered by the hundreds of big and small DNA testing companies on the market, illustrates the uncertainty of personalized consumer genetics.
The bet that companies like 23andMe are making is that they can untangle this mess and translate their results back to people in a way that wont cross the line into deceptive marketing while still convincing their customers they truly matter. Other companies have teamed up with outside labs and doctors to look over customers genes and have hired genetic counselors to go over their results, which might place them on safer legal and medical ground. But it still raises the question of whether people will benefit from the information they get. And because our knowledge of the relationship between genes and health is constantly changing, its very much possible the DNA test you take in 2020 will tell you a totally different story by 2030.
Given how popular at-home DNA testing has become, theres really no sealing the genie back in the bottle. So if you want to get your genetic horoscope read this holiday, dont let me stop you. But its a big decision you should sleep on. After all, once your DNA is out there, theres no going back.
Genetically Modified Babies? Possible Within the Next Two Years, Scientists Claim – Nature World News
Posted: at 5:46 pm
Nov 21, 2019 08:42 AM EST
(Photo : Josh Reddekopp, Unsplash)Genetic modification is expected to free or at least delay hereditary diseases.
When you heard of the word GMO, the first thing that you will probably think of is food items you find at the grocery store that was modified by scientists to change their appearance or just improved their overall qualities.
However, a recent scientific paper claimed that the same gene-altering method might be able to apply to human embryos ethically within two years.
According to bioethicist Kevin Smith, this method will give hope to parents who want their children to be free from genetically-transmitted diseases.
He also said that from a "utilitarian standpoint", gene-altering is the only "conceivable" way of dealing with these conditions. Some conditions he mentioned are cancer, cardiovascular diseases, and dementia.
And since this practice is generally opposed by the public due to the fear of abusing it, Smith suggested simply delaying the conditions, which can still extend the disease-free lifespan of future individuals.
Yet he still believed that this method would be "ethically justified" within two years, especially since current gene-editing technologies present low risks even if used on human embryos.
The study was criticized by other health experts, mostly pointing out the insufficiency of experimentation to prove its safety.
Joyce Harper of the University College London (UCL) Institute for Women's Health said that while gene editing has used potential, she also wants public debate and lawmakers' interventions to ensure its ethicality.
The director of Progress Educational Trust (PET), Sarah Norcross, said that we should have learned the controversial genome-edited babies introduced by a Chinese scientist last year. She also mentioned the need for "higher scientific and ethical standards" if this practice will strive.
The study was published last week in the journal Bioethics.
Last year, Chinese scientist He Jiankui announced in Youtube that he had successfully created the first genetically modified babies -- twin girls that are immune to HIV -- using the gene-editing tool CRISPR-Cas9.
This resulted in an international outcry. Feng Zhang, one of the inventors of CRISPR, told CNN that nobody, including the scientific community, has expected someone to use the tool on humans. Other scientists were refusing to do this since the technology is still not quite complete and the possible genetic complications on humans in their later years are still unknown.
The Chinese authorities called He, who is also a professor at the Southern University of Science and Technology in Shenzhen, to halt his activities. Fellow Chinese scientists condemn him and called him an insult to the biochemical research in China.
Because of He's practice, the country was also scrutinized due to its previous reputation of favoring innovation too much even if it means setting aside ethical questions.
The Journal Nature Medicine recently published a study that claims genetically modifying embryos would result in a shorter lifespan.
Despite the massive backlash, He defended his project at the Second International Summit on Human Genome Editing held at Hongkong in November last year. According to him, this method had given hope to the parents of the twins, whose father is infected with HIV.
He also announced that he is working on the third genetically modified baby but no further information was given.
READ: It's in the Genes: Study Discovers 79 Forms of Genetic Obesity, More Than Previously Thought
2018 NatureWorldNews.com All rights reserved. Do not reproduce without permission.
A 17-gene expression signature to distinguish patients who are likely to achieve long-term remissions following front-line FCR chemoimmunotherapy from…
Posted: at 5:46 pm
In this paper, Carmen D Herling, Department I of Internal Medicine, Center for Integrated Oncology, Aachen-Bonn-Cologne-Duesseldorf, Cologne, Germany, and colleagues hypothesized that the duration of response to FCR chemoimmunotherapy depends on differences in the expression of protein-coding genes. Therefore, they developed and validated a 17-gene expression signature to identify patients that might achieve durable remissions following front-line FCR chemoimmunotherapy.
Study design and patients1
After the gene expression data analysis for the MDACC cohort, the authors identified 1,136 probes associated with time to progression. Using these probes, patients with similar gene expression patterns were divided into favorable, intermediate, and unfavorable prognosis subsets. The intermediate prognosis and unfavorable prognosis subset had a shorter time to progression compared with patients in the favorable subset.
Genes highly expressed in unfavorable cases (n= 424) were associated with metabolic pathways, including oxidative phosphorylation and ribonucleoside metabolism. Genes highly expressed in favorable or intermediate cases (n= 401) encoded products involved in ATP binding, purine ribonucleoside triphosphate binding, nucleic acid binding, and DNA-template transcription.
The authors developed a prognostic model with 17 genes to distinguish IGHV-unmutated patients that had an intermediate outcome from those with an unfavorable outcome after front-line FCR therapy. The development process included:
These 17 genes were validated in 109 patients with an IGHV-unmutated status from the CLL8 cohort. In this cohort, patients classified as high risk (unfavorable prognosis; median time to progression of 39 months [IQR 2269]) had a hazard ratio of 1.90 (95% CI 1.183.06; P = 0.008) compared with low-risk (intermediate prognosis; median time to progression of 59 months [IQR 2884]) patients. Of the 17 genes, 13 came from the cluster of genes highly expressed in unfavorable cases with shorter time to progression, and increased expression corresponds to increased risk of progression. Three of the 17 genes came from the cluster of genes highly expressed in favorable or intermediate cases with longer time to progression and increased expression corresponds to decreased risk.
Posted: at 5:46 pm
Researchers strive to address societal health issues through gene editing
In October, three researchers at UC Davis were awarded a $1.5 million grant to fund their project which attempts to demonstrate the effectiveness of gene editing through use of CRISPR, a powerful technology that allows alteration of DNA sequences to change gene function.
This kind of design can help enhance personalized medicine, said R. Holland Cheng, a professor of molecular and cellular biology in the College of Biological Sciences. Specific patients with specific illnesses can be treated in specific ways.
Cheng, along with Kit Lam, a distinguished professor and chair of the Department of Biochemistry and Molecular Medicine in the School of Medicine, and David Segal, a professor in the Department of Biochemistry and Molecular Medicine, were awarded this highly competitive and sought-after grant from the National Institute of Health (NIH).
UC Davis is part of the NIHs Somatic Cell Genome Editing (SCGE) consortium which has awarded grants to 45 other research institutes across the nation so they can begin groundbreaking work on gene editing. Through this consortium, the NIH hopes to find an efficient and safe way to conduct gene editing. Research programs are investigating the best delivery mechanism as well as the most dynamic gene editing tool.
The major problem with gene editing currently is the inability of cells to be edited within a living organism. It has become fairly easy and efficient to edit genes in a cell culture outside of the body but extremely difficult to do the same processes inside the body. Cheng, Lam and Segal are focused on changing this.
The question is how to do it inside of an animal and eventually a human, Lam said.
They are answering this question by utilizing Chengs work in engineering a non-toxic nanoparticle that they hope can transport the gene editing tool CRISPR into the cells of a living organism. Cheng has been able to create a Hepatitis E viral nanoparticle (HEVNP) that when manipulated could be a delivery system for CRISPR. They plan to take this nanoparticle and encase CRISPR inside of it, producing a mechanism for delivery of CRISPR.
The Hepatitis E nanoparticle has the capacity to be a highly efficient way to deliver gene editing to cells in the body due to its unique nature. HEVNP is resistant to the gastric acid environment of the intestines and stomach, enabling it to survive once its entered the body. Given its resistant abilities, HEVNP can be taken orally, making it a useful form of medicine. If able to successfully get HEVNP to the target cells in the body and deploy CRISPR, gene editing abilities could drastically change.
The addition of a cell-type specific targeting ligand to the HEVNP would code the nanoparticle to deliver CRISPR to a specific cell. The abilities of this method to be precise and safe will determine its success.
With five years of funding from the NIH, these three researchers are eager to begin work on this project and see the strides that can be made in gene editing. They have impressive goals for this research, as it has the capacity to reshape medicine.
This will redefine precision medicine as currently there is broad medicine that can cause side effects to people and not be effective, yet by making it specialized it is becoming more precise and effective, Cheng said.
As more effective and safe tools to cure illnesses are being tested and created, the benefits to society could be expansive. With so much potential to help improve the health of society, the NIH is dedicated to coming to new solutions at a quick rate. All programs that received grants will be required to share and utilize the research occurring at other funded programs. The NIH is hoping to eliminate the private nature of research through enforcing the sharing of ideas, as scientists are often constrained by the institutions they work for. It is their hope that by having communication between the programs, positive results will arise faster.
I think this is great because scientists inherently want to work with each other but have real world concerns especially with money, Segal said.
The research results, when groundbreaking, can provide incredible monetary gains and credibility to the institutions that made the discovery. Ultimately, scientists collaborating with one another will serve society as people are able to benefit earlier from this innovative research.
We want the public to know that we are working in their best interest, Segal said.
The NIH grant is competitive and still the third research program to join the consortium at UC Davis. Innovation has never been more prevalent than in this field at UC Davis. With three different programs researching gene editing, UC Davis stands out as a hotspot for this field of research.
Written by: Alma Meckler-Pacheco email@example.com
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UC Davis leads in innovative gene editing research with NIH grants - The Aggie
Posted: at 5:46 pm
During the process ofin vitrofertilization (IVF), it is not unusual for embryos to undergo preimplantation genetic diagnosis (PGD) identify specific inherited disease-causing mutations for single-gene disorders, like cystic fibrosis. Recently, new developments in genetics have given the ability to assign individuals "polygenic scores," which can somewhat explain the variability seen in complex human traits. This concept, applied to IVF embryos, has raised the prospect of "designer babies." However, there has been no research published to indicate the potential success of polygenic embryo selection.
"The notion that you could accurately choose your child's height or select for a higher IQ, like in the movie 'Gattaca,' has never been tested," said Dr. Lencz, professor in the Institute of Behavioral Science at the Feinstein Institutes and co-corresponding author of the Cell paper. "Through our research, we can confidently say that trait predictions for embryos based on polygenic scores are not very accurate."
Dr. Lencz and the team analyzed embryo selection for height and IQ in the context of a hypothetical IVF cycle. Investigators used three sources of data to evaluate the efficacy of trait selection, including a mathematically-derived genetic model, simulated embryo genomes, and a real dataset of nuclear families with large numbers of offspring (10 on average) who are now fully-grown adults with available genetic and trait (height) data.
The results concluded that screening for such traits using polygenic scores would leave a large margin for error. For example, children with the highest polygenic score for height were only the tallest in a quarter of families analyzed.
"Dr. Lencz's study adds important data highlighting the unreliability of trait selection by current methods of embryo genetic screening," saidKevin J. Tracey, MD,president and CEO of the Feinstein Institutes.
The ethical and legal debate surrounding polygenic embryo selection is already underway, but, until now, without a solid scientific foundation. The research team hopes that this work will promote an open and evidence-based discussion of these aspects among the public and policymakers.
Previously, an overview of this research was presented at the American Society for Human Genetics Annual Meeting in October by Dr. Lencz's co-lead, Dr. Shai Carmi of the Hebrew University of Jerusalem.
About the Feinstein Institutes The Feinstein Institutes for Medical Researchis the research arm of Northwell Health, the largest health care provider and private employer in New York. Home to 50 research labs, 2,500 clinical research studies and 4,000 researchers and staff, the Feinstein Institutes is raising the standard of medical innovation through its five institutes of behavioral science, bioelectronic medicine, cancer, health innovations and outcomes, and molecular medicine. We're making breakthroughs in genetics, oncology, brain research, mental health, autoimmunity, and bioelectronic medicine a new field of science that has the potential to revolutionize medicine. For more information about how we're producing knowledge to cure disease, visit feinstein.northwell.edu.
SOURCE The Feinstein Institutes for Medical Research
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New research casts doubt on near reality of 'designer babies' - PRNewswire
Researchers Working to Understand Why Some Patients with Autoimmune Diseases Develop Diabetes Instead of Arthritis – BioSpace
Posted: at 5:46 pm
Autoimmune diseases are immune system disorders where the bodys immune system attacks its own tissues. Examples of common autoimmune diseases include rheumatoid arthritis, systemic lupus erythematosus, inflammatory bowel disease, type 1 diabetes, multiple sclerosis (MS) and others.
A peculiarity of autoimmune diseases is that they have many genes in common, but they develop differently. For example, why does a patient with an autoimmune disease become a type 1 diabetic rather than have rheumatoid arthritis?
Decio L. Eizirik, a researcher at Universit Libre de Bruxelles Centre for Diabetes Research in Belgium, who is also a senior research fellow at the Indiana Biosciences Research Institute, recently published research in the journal Nature Genetics that found significant insight into this question. Eizirik took time to speak with BioSpace about the research and how a researcher in Belgium came to collaborate with researchers in Indiana, Spain, the UK and the U.S. National Institutes of Health.
Several autoimmune diseases, such as type 1 diabetes, rheumatoid arthritis, multiple sclerosis, etc., have as much as 30 to 50% of their candidates genes in common, said Eizirik, raising the question on why in some individuals the immune system attacks, for instance, the insulin-producing beta cells, causing type 1 diabetes, while in others it targets joint tissues, leading to rheumatoid arthritis. Most of the research in the field has focused on the role for these candidate genes on the immune system, but our work indicated that many of these candidates genes affect the function and survival of pancreatic beta cells, leading to a misguided dialogue between them and the immune system that culminates in diabetes.
The early stages of type 1 diabetes, for example, show local autoimmune inflammation and progressive loss of the pancreatic beta cells that produce insulin. How these genetic transcription factors, or cytokines, interact with the beta-cell regulatory environment, and the changes that occur, suggest a key role in how the immune system gets triggered to attack the beta cells.
The research was conducted by Eizirik, Lorenzo Pasquali from the Institucio Catalana de Recerca I Estudis Avancats (ICREA) in Barcelona, Spain, and colleagues from Oxford, UK; Pisa, Italy, and the NIH. For about 20 years, Eizirik has run a diabetes-focused laboratory in Brussels. In August 2019, he launched a new laboratory at the IBRI, where, he said, three top scientists and assistants, Donalyn Scheuner, senior staff scientist at IBRI, Bill Carter, research analyst at IBRI, and Annie Rocio Pineros Alvarez, postdoctoral fellow in medicine at Indiana University, are already working. These two laboratories are working closely togetherfor instance, we have weekly meetings by videoconference, and besides my regular visits to the IBRI, scientists are moving between our European and USA labs on a temporary or permanent basis.
The IBIR was created by the State of Indiana and the states leading life science companies, academic research universities and medical school, as well as philanthropic organizations. The focus is on metabolic disease, including diabetes, cardiovascular disease obesity and poor nutrition. Its laboratories and offices are housed in about 20,000 square feet of space in Indian University School of Medicines Biotechnology Research and Training Center in Indianapolis. It expects to move into a new 68,000-square-feet site in mid-2020.
Eizirik said, The IBRI offers a unique opportunity to translate our basic research findings to the clinic, and we are working closely together with colleagues at Indiana University, particularly Carmella Evans-Molina, director of the Indiana Diabetes Research Center (IDRC) and the IDRC Islet and Physiology Core, to confirm our basic research findings in patients samples, and to eventually bring them to the clinic.
The specific research study looked at the binding of tissue-specific transcription factors. Transcription factors are basically proteins whose job it is to turn genes on or off by binding to DNA. So, for example, there are specific transcription factors whose job it is to regulate insulin production in pancreatic beta cells. In the case of this research, Eizirik and his team studied tissue-specific transcription factors that open the chromatin. Chromatin is a complex of DNA and protein found in the nucleus of the cell. It allows long DNA molecules to be packaged, typically in the form of chromosomes.
For gene transcription to occur, Eizirik said, chromatin must open and provide access to transcription factors. This allows binding of pro-inflammatory transcription factors induced in the beta cells by local inflammation.
For certain people who are genetically predisposed to type 1 diabetes, this leads to the generation of signals by the beta cells, Eizirik said, that contribute to attract and activate immune cells, rendering beta cells a potential target to the immune system.
Eizirik said, These observations have clarified the role for pancreatic beta cells in type 1 diabetes and provided an explanation for the reasons behind the immune system targeting beta cells.
The amplifying loop mechanism observed potentially explains other autoimmune diseases. Eizirik notes, Binding of tissue-specific transcription factors, within an inflammatory context and in genetically predisposed individuals, could generate signals that would attract and activate immune cells against specific target tissues.
Testing the theory in other autoimmune diseases will be required to verify it, but potentially could open up new therapies or preventive treatments for type 1 diabetes and other autoimmune diseases.
Type 1 diabetes has a strong genetic component, Eizirik said. At least 50% of the disease risk is due to genetic causesand understanding the role for candidate genes in the disease may point to novel therapies. For instance, up to now, nearly all therapeutic approaches to prevent type 1 diabetes have targeted the immune system, with little success. Our findings suggest that we must also take steps to directly boost beta cell survival.
He compared targeting the immune system only in type 1 diabetes to trying to fly a plane with only one wing. Our present and previous data suggest that we need two wings: first, to re-educate the immune system to stop its attack on the beta cells, and second, to increase the beta cell resistance to the immune attack, and to find means to restore the lost beta cell mass. Unfortunately, to achieve these goals in both type 1 diabetes and other autoimmune diseases is not easy, and we must redouble our efforts.
The next stages of the research will be to study the function of two novel candidate genes for type 1 diabetes that were discovered in the research. They both act at the beta cell level. He expects to conduct that research with Pasquali. The second stage is to evaluate the impact of other immune mediators that act earlier in the disease course at the beta cell level. And the third stage is to test their hypothesis regarding the role for the target tissue in other autoimmune diseases.
In addition to that ambitious agenda, Eizirik and his group are establishing an Inducible Pluripotential Cell Core at the IBRI.
Eizirik said, This will allow us to de-differentiate, for instance, skin cells from patients into pluripotential cells, and then to differentiate them into pancreatic beta cells. This will allow us to study the impact of the novel candidate genes we are discovering on beta cell function and survival, again in collaboration with Lorenzo Pasquali and Carmella Evans-Molina. This will also provide an excellent model to test new drugs to protect the beta cells in early type 1 diabetes.
Global Cancer Biomarkers Market, Forecast to 2026 – Emerging Economies & Personalized Medicine to Provide Ample Industry Opportunities -…
Posted: at 5:46 pm
DUBLIN--(BUSINESS WIRE)--The "Global Cancer Biomarkers Market Analysis 2019" report has been added to ResearchAndMarkets.com's offering.
The Global Cancer Biomarkers market is expected to reach $37.99 billion by 2026 growing at a CAGR of 14.2% from 2018 to 2026.
Factors such as rise in technological advancements and increase in Incidence of Cancer diseases are driving the market growth. Though, high capital investment and technical issues related to sample collection and storage are projected to inhibit the growth of the market. Moreover, emerging economies and personalized medicine may provide ample opportunities for the market growth.
By biomarker type, protein biomarkers segment acquired significant growth in the market is mainly attributed to the tremendous capability of protein biomarkers in cancer detection, diagnostics, prognostics, and clinical & therapeutic applications; and minimal cost of the protein biomarker tests as contrasted with genetic biomarker tests. The rising focus of pharmaceutical organizations towards the discovery of protein biomarkers is additionally expected to fuel the development of this market during the forecast period.
The key vendors mentioned are Qiagen N.V., Thermo Fisher Scientific, GE Healthcare, Roche Diagnostics, Abbott Laboratories, Illumina, Danaher Corporation, Agilent Technologies, Sysmex Corporation, Merck & Co., Quest Diagnostics, Becton, Dickinson and Company, Hologic, Myriad Genetics, Bio-Rad Laboratories and Biomrieux S.A.
Key Questions Answered in this Report
Key Topics Covered
1 Market Synopsis
2 Research Outline
2.1 Research Snapshot
2.2 Research Methodology
2.3 Research Sources
2.3.1 Primary Research Sources
2.3.2 Secondary Research Sources
3 Market Dynamics
4 Market Environment
4.1 Bargaining power of suppliers
4.2 Bargaining power of buyers
4.3 Threat of substitutes
4.4 Threat of new entrants
4.5 Competitive rivalry
5 Global Cancer Biomarkers Market, By Category
5.2 Cancer Biomakers of Disease
5.3 Cancer Biomakers of Exposure
6 Global Cancer Biomarkers Market, By Method
6.2 Assay Development
6.3 Biomarkers and Testing
6.4 Sample Preparation
7 Global Cancer Biomarkers Market, By Biomarker Type
7.2 Cancer Antigen 15-3 (CA 15-3)
7.3 Cancer Antigen 27-29 (CA27-29)
7.4 Carbohydrate Antigen 19-9 (CA 19-9)
7.5 Carcinoembryonic antigen (CEA)
7.6 Epigenetic Biomarkers
7.7 Genetic Biomarkers
7.8 Glass Transition Temperature (Tg)
7.10 Glycomic Biomakers
7.11 Glycoprotein Biomarkers
7.12 Human Chorionic Gonadotropin (Hcg)
7.13 Human Epidermal Growth Factor Receptor 2 (HER2)
7.14 Human Epididymis Protein 4 (HE4)
7.15 Metabolic Biomakers
7.16 Microsatellite Instability (MSI) / Measles, Mumps and Rubella (MMR)
7.17 Protein Biomarkers
7.18 Proteomic Biomarkers
7.19 Risk of Ovarian Malignancy Algorithm (ROMA)
7.20 Tumor Mutational Burden (TMB)
7.21 Tumor-Infiltrating Lymphocytes (TILs)
8 Global Cancer Biomarkers Market, By Cancer Type
8.2 Bladder Cancer
8.3 Blood Cancer
8.4 Breast Cancer
8.5 Cervical Cancer
8.6 Colorectal Cancer (CRC)
8.7 Kidney Cancer
8.9 Liver Cancer
8.10 Lung Cancer
8.12 Non-Hodgkin's Lymphoma
8.13 Ovarian Cancer
8.14 Prostate Cancer
8.15 Stomach Cancer
8.16 Thyroid Cancer
9 Global Cancer Biomarkers Market, By Technology
9.3 Cytogenetics-based Tests
9.4 Imaging Technologies
9.6 IVD Multivariate Index Assays
9.7 Omic technologies
10 Global Cancer Biomarkers Market, By Test Type
10.2 Alpha-Fetoprotein (AFP) Tests
10.3 Anaplastic Lymphoma Receptor Tyrosine Kinase Gene (ALK) Tests
10.4 BReast CAncer gene (BRCA) Tests
10.5 Cancer Antigen (CA) Tests
10.6 Carcinoembryonic Antigen (CEA) Tests
10.7 Circulating Tumor Cell (CTC) Tests
10.8 Companion Diagnostic Tests (CDx)
10.9 Estimated Glomerular Filtration Rate (EGFR) Mutation Tests
10.10 Human Epidermal Growth Factor Receptor 2 (HER2) Tests
10.11 Kirsten Rat Sarcoma Viral Oncogene Homolog (KRAS) Mutation Tests
10.12 Laboratory Developed Tests (LDTs)
10.13 Prostate-specific Antigen (PSA) Tests
11 Global Cancer Biomarkers Market, By Analytical Technique
11.2 Immunohistochemistry (IHC)
11.3 Next Generation Sequencing (NGS)
11.4 Polymerase Chain Reaction (PCR)
12 Global Cancer Biomarkers Market, By Product
This miracle drug was designed and manufactured for just one person a 9-year-old Boulder girl – The Colorado Sun
Posted: at 5:46 pm
Mila Makovec has high pigtails in her dark hair and a cloth doll tucked under her arm as she wakes up in a hospital bed, where shes just been injected with a one-of-a-kind drug intended to save her life.
The drug works for only one person in the world this 9-year-old girl from Boulder.
In a spectacular example of what the future might hold for precision medicine, the drug was made only for her in a quest to save Mila from a neurological disease that is destroying her brain. Her DNA is in the formula. The 22-letter genome sequence in the drugs recipe matches the one in Milas cells that is broken.
It is the first time the FDA has approved a drug for a single person.
The drug appropriately called milasen might not have come soon enough to save Mila, as it can only slow the process of degeneration, not replace the brain cells that have already died.
But this story is no longer just about Mila; it never actually was.
This is not just for my daughter anymore, said Julia Vitarello, who took to social media to fundraise and find a researcher and drug manufacturer who would help her. This is for something much bigger.
Milas case catapulted specialized drug development at least a decade into the future, her doctors say, opening a new path for other children with rare genetic diseases that have no cure.
Childrens Hospital Colorado, where Mila was diagnosed three years ago and now receives her treatment, and Boston Childrens, where her drug was designed, are leading the way in creating a model in which academic researchers could help perhaps a handful of children each year by crafting one-of-a-kind medicines. Next year, Childrens Colorado will begin whole-genome sequencing with a new machine called a Novaseq, a major step in the process of finding mutations in DNA.
The whole concept raises ethical questions for sure: How safe is it to initiate a clinical trial for a single child? Who makes sure the children who could benefit most not just those whose families have money or the ability to raise money get the specialized treatment?
Vitarello, who created Milas Miracle Foundation and raised $3 million while trying to save her daughter, wants to establish funding for children who need drugs tailored to their own cellular biology. She suggests an admissions process where the researchers deciding whether to help a child do not know that childs name, face or ability to pay.
There are going to be parents who are going to do anything for their kid, Vitarello said. They are going to come with money. Thats totally fine, no judgment. I would do the same thing. But in an ideal world, there would be patients coming through a funnel with no names or faces or money attached. Whoever is at the table makes the best decision.
The path forward is likely in the academic, nonprofit space, Vitraello said. She is initiating talks with the National Institutes of Health, the largest public funder of biomedical research, as well as research institutions, the FDA and the pharmaceutical industry. An estimated 1.3 million people with rare genetic diseases could potentially benefit from a treatment like Milas, she said.
There are 1.3 million kids that are dying that have no other treatment, no pharma company is going to help them, there is nothing that we can do, and now suddenly, weve opened up a pathway for that, she said Tuesday at the hospital in Aurora, as Mila rested following her injection. The only way to get it is to have more academic institutions treat more kids one, two, five, 10. Open it up.
The goal is that kids with flaws in their DNA could receive precision medicine sooner, halting neurological diseases before they steal the ability to walk, talk, eat or see.
Mila was a perfectly healthy child the first three years of her life. She was learning to ski, went hiking with her parents and had a vocabulary advanced beyond her years.
Her mom noticed the subtle changes before anyone the way she pulled books close to her face because she couldnt see, how her feet turned inward, that she began bumping into things and fell for no reason, how she stuttered sometimes but it wasnt like typical stuttering.
Vitarello brought her to 100 doctors and therapists from the East Coast to the West and in Canada, many of whom told her to calm down and that her daughter seemed fine. I had doctors tell me I was pretty much crazy. Very top level doctors told me to chill out, she said. Well, I wasnt going to chill out. I just kept going.
By age 7, Mila was having trouble walking and eating and was going blind. Her body was wracked with multiple seizures each day.
I spent three years trying to figure out what was wrong with her, Vitarello said. I basically gave up and brought her to the ER at Childrens Colorado.
Mila was admitted and her case assigned to Dr. Austin Larson, a geneticist whose main job at the hospital is to figure out whats wrong with patients who have an undiagnosed disease. An MRI found that the part of Milas brain that is responsible for balance, the cerebellum, was smaller than expected. But it was a genetic test that for the first time gave Vitarello a name for Milas illness: Batten disease, and a specific type of Batten that is so rare, just 25 people in the world are known to have it.
The disease occurs when both of a childs two CNL7 genes are mutated one mutation from each parent.
Larson was able to identify the defective gene from Milas father, but could not find one from her mother. At the time, Childrens Colorado along with most places didnt have the technology to search that deeply into Milas DNA through whole-genome sequencing, and Larson warned Milas family that it was likely impossible to find a clinical lab that could. She would need a researcher.
Vitarello turned to Facebook, begging for help for Mila but also so she could find out if her son, who was 2 at the time and completely healthy, had the same devastating disease that was taking away her daughter.
I was going to get nowhere with Mila unless I just opened up my story fully, to everyone, her mom said.
Dr. Larson had given her enough information and the right words to make a plea. A Boston physician saw her message and connected her with Dr. Timothy Yu, a neurogeneticist at Boston Childrens.
At the same time, the FDA had just approved a new drug called Spinraza, the first drug to treat a separate genetic condition called spinal muscular atrophy. The drug, injected into the fluid around the spinal cord, helped babies in clinical trials improve head control, sitting and standing.
The way Spinraza was designed was a game-changer for medicine and key in helping Mila. Yu and his team in Boston wondered if they could make a similar drug for the Colorado girl.
The Boston team spent days staring at screens of Milas DNA sequences until they discovered the other piece of the genetic puzzle in addition to the gene mutation from her father, Mila had inherited extra genetic material from her mother. The combination meant that, in the most basic terms, Mila had a sequence of broken DNA in her cells.
The drug created only for Mila contains little pieces of synthetic genetic material that search for a specific 22-letter sequence and cover it up so that her cells cannot read it. We are taking a Band-Aid and sticking it onto that part, said Dr. Scott Demarest, a pediatric neurologist at Childrens Colorado and a specialist in rare genetic epilepsies. That is literally what is happening. It is sticking to that spot so that the cell skips over that and goes to the next part that is correct.
The only difference between Spinraza and milasen is the genetic sequence inside the drugs send Band-Aids to different addresses.
After discovering the genetic flaw, Yu in Boston and Larson in Colorado called Milas mom together to give her the news. Her son did not have either of the recessive genes, and her daughter had both.
It was a huge mix of extreme happiness and, within the same second, just extreme falling-to-the-floor sadness for Mila, Vitarello recalled. My daughter had gotten both of the bad mutations and my son had gotten both of the good ones.
Next, Vitarello had to persuade a drugmaker to make a drug for one, and the FDA to allow doctors to inject it in her daughters spinal fluid.
The stars aligned, she says, still in disbelief.
Milas team made it happen by emphasizing that although this drug had the potential to work only on one person, the process could become a blueprint for other patients. Only the DNA sequence in the medicine would change.
They persuaded a drug manufacturer in California, TriLink Biotechnologies, to make Milas drug. And the FDA agreed to speed up the clinical trial process by allowing Yu to test the drug on rats at the same time Mila was receiving her first dose. The doctor had first tested it on Milas skin cells.
Milasen is technically now in clinical trial a trial of one patient involving two childrens hospitals.
The night before Milas first injection in January 2018, as Vitarello went for a run in subzero Boston, she told herself she was OK with whatever happened. Mila was out of time. Vitarello had seen the descriptions online and knew where Mila was headed.
My daughters trajectory of not treating her was so black and white, Vitarello said. Everyone always wonders what is going to happen to your life. When you have a rare disease, you can see exactly what is going to happen to your child ahead of time and its not a good thing.
I figured the worst-case scenario was not her dying, it was her being in pain, Vitarello said, recalling that she asked Yu to tell the FDA that she thought the drugs potential benefits outweighed the risk. I said, If my daughter dies on the spot, Im OK with that.
Instead, the injections that first year seemed to stop the diseases progression. Mila quit eating through a g-tube and started eating her moms pureed food again. She could hold up her head and her upper body, and her walking improved. Her seizures decreased from 30 a day to two or three.
Quality of life, those are huge, Vitarello said.
Now in the second year of treatment, some of Milas symptoms have declined, but not as steeply as other children with her disease. Milas team has upped her doses and started injecting them every two months instead of every three, but they have no precedent to follow.
They could find out years from now that they were giving Mila 1,000 times too little, her mother said.
I honestly dont know if it was in time for Mila, Vitarello said. She was really progressed when she received her treatment. There is still hope.
The key to saving more children from rare genetic diseases is diagnosing them earlier ideally at birth.
What if we found this three years sooner? Larson asked. I think about that a lot. What would it have taken to have found this the first time that (Vitarello) took Mila to a physician and said, I am concerned about the subtle difference in the way she walks?
The answer is it takes having a very broad test and being very good at interpreting that very broad swath of information.
Science is a ways off from being able to detect diseases as rare as Milas in newborns. But breakthroughs are coming for other genetic diseases.
Starting in January, spinal muscular atrophy will become one of 38 genetic diseases newborn babies are screened for via blood tests, said Raphe Schwartz, chief strategy officer for Childrens.
Childrens intends to take what it has learned through Milas case, partner with other institutions and use it to help more children, Schwartz said. What we learn reveals the roadmap for the future, he said. The future ones we do are more effective and less expensive over time.
There is a sense of urgency, but also caution.
We want to make sure we are doing it right, we are doing it safely, we are doing it for kids who are going to benefit the most, Demarest said. There are ethical challenges around it. We need to be very thoughtful and careful that we are doing this the right way, but were also doing it in a way that allows this to be a reality for kids as soon as possible and for as many as possible.
For now, Vitarello is grateful that Mila can receive her treatments in Colorado. Until September, they were traveling to Boston every other month for 10 days, but now they can leave home after breakfast on treatment days and return by dinner.
On Tuesday, Vitarello recited Goldilocks and the Three Bears and sang camp songs while Mila, bundled in blankets, received the 10-minute injection in her lower back, which Vitarello said doesnt seem to hurt Mila. They celebrated Milas 9th birthday last week, and her little brother, now 5, picked out a squishy toy and a sequined mermaid for her birthday presents.
Im faced with a huge amount of sadness around this, but at the same time, its making such a huge difference that it gives a lot of purpose to her life and it gives a lot of purpose to my life, Vitarello said. We are still fighting hard for Mila. But I can see this making a much bigger impact.
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