June 17, 2011
NIH Podcast Episode #0136
Balintfy: Welcome to episode 136 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – the nation's medical research agency. I'm your host Joe Balintfy and coming up in this episode: an effective screening test for the leading cause of hearing loss in children; an anniversary in AIDS research; and a gene that may hold the key to repairing muscles; plus how the U.S. population is changing shape:
“By 2050, it will be a population rectangle rather than a pyramid…”
But first, this news update. Here’s Craig Fritz.
Fritz: According to researchers at the National Institutes of Health, taking folate supplements or eating fortified grain products is unlikely to worsen problems related to low levels of vitamin B12. In the United States, bread, cereal and other enriched flour products have been fortified a synthetic form of folate since 1998. Women with low levels of folate are at increased risk for conceiving a child with birth defects of the brain and spinal cord known as neural tube defects. The number of infants born with these birth defects has fallen since fortified foods were introduced. Researchers were concerned that the level of folate in fortified grains might be too high for other people. Scientists note that they found no evidence that folate could worsen health problems and that consuming higher amounts of folate does not seem to interfere with the body’s use of vitamin B12 in otherwise healthy individuals. The body uses B12 to make red blood cells. People with low levels of B12 can develop anemia, a condition in which the body does not make enough red blood cells to carry oxygen throughout the body.
An NIH-funded study encouraging people to write down the date and time when they plan to get their flu shots increased the number of people who were vaccinated. The researchers analyzed the effects of different reminder mailings sent to employees of a large utility firm who were considered at risk for the flu. All eligible employees received one of three possible reminder mailings that listed the times and locations of free on-site flu vaccination clinics. Past research has shown that reminder mailings are among the most cost-effective ways to increase patient compliance. In this case, those who were encouraged to write down both the date and time when they planned to receive the vaccination had a significantly higher rate of vaccination than those who received the mailing listing only the times and locations of the clinics. Researchers note that these findings have the potential to strengthen efforts to improve public health by increasing vaccination rates, as well as other constructive health activities. It also shows that positive health effects can be achieved at a very low cost.
A new NIH competition seeks to bring hands-on science into classrooms nationwide. The K-12 Lab Challenge asks teachers, students, parents, scientists, and science enthusiasts to submit their favorite experiments for elementary, middle, and high school students. The best experiments will become part of an official collection that NIH will distribute for free. Experiments form the basis of scientific inquiry but aren’t used often enough in the K-12 science classroom because of expense, complexity, or time issues. The challenge seeks to address these problems by identifying experiments that are engaging and inexpensive. The challenge is open to any resident of the United States or a U.S. Territory. The entry deadline is December 1, 2011. For more details, visit the website http://lab.challenge.gov.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Later in the program, 30 years in HIV/AIDS research, a discovery regarding Duchenne muscular dystrophy, baby boomers are turning 65, and babies may get a better test for CMV. That’s next in NIH Research Radio
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Saliva is effective in screening for CMV infection in newborns, says NIH-funded research
Balintfy: Researchers have been trying to find a simple, effective way to screen newborns for congenital cytomegalovirus infection. Often called CMV, it is a leading cause of hearing loss in children. The researchers had published a study in 2010 which concluded that the common heel stick test may not always be effective. Wally Akinso reports that this current study shows that a saliva test is. 
Akinso: A mouth swab of saliva can be used to quickly and effectively screen newborns for congenital cytomegalovirus infection compared to the traditional procedure.
Watson: There are ways to test infants and adults to determine weather or not they have the cytomegalovirus or CMV.
Akinso: Dr. Bracie Watson is a program officer at the National Institutes of Health.
Watson: The way that it is normally tested for, it takes a lot of time it’s very expensive and it’s not a test that’s amenable to newborn screening.
Akinso: In a National Institute on Deafness and Other Communication Disorders study, researchers at the University of Alabama at Birmingham were seeking to find the most effective test for CMV in newborns. To conduct the screening, researchers used a molecular diagnostic procedure called real-time polymerase chain reaction analysis.
Watson: Polymerase chain reaction is a pretty common laboratory technique these days and it is a method of going in and amplifying DNA sequences in large numbers. It gives you enough of the DNA to be able to manipulate the DNA itself and to study it. So in this case there are certain parts of the CMV virus that are specific to the CMV virus itself. It will let you get a polymerase chain reaction product of DNA it will let you know whether or not the virus is present or absent.
Akinso: CMV is the most common infection passed from a mother to her newborn. Of the 20,000-30,000 infants who are born infected with CMV each year, about 10-15 percent are at risk for developing hearing loss. The study enrolled nearly 35,000 infants between June 2008 and November 2009. Dr. Watson explains why researchers decided to explore another approach when screening for CMV.
Watson: Our first paper came out last year, showed that using the dry blood spot and the polymerase chain reaction was likely missing a significant number of babies with CMV. So we went on to develop a different test using saliva rather than blood.
Akinso: The researchers are now looking to find out how much CMV infection contributes to overall hearing loss at birth and between ages of 3 ½ to 4 years old. For this reason, infants who tested positive for CMV in the study are being enrolled in a follow-up program to monitor their hearing every six months until they are four years of age. For more information on this study, visit www.nidcd.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Thirtieth anniversary of the first reported cases of AIDS
Balintfy: It has been 30 years since the appearance of an article concerning five previously healthy, young gay men in Los Angeles diagnosed with an infection that usually appears only in individuals with substantial immune system damage. The disease ultimately would be referred to as AIDS. Today, experts are gratified by the progress that has been made in understanding, treating and preventing HIV/AIDS over the past 30 years. But Dr. Anthony Fauci, an institute director here at NIH emphasizes that there is still much more to do.
Fauci: The amount of medical and biomedical research advances has been breathtaking, but in the same time we must realize that even 30 years into the pandemic, we still have a number of important challenges, both scientific challenges and implementation challenges. We need a vaccine, we are hoping that we might get a cure and also need to get to people who infected who don’t know that they are infected to get them into care and to put them on therapy.
Balintfy: Dr. Fauci points out that when he first started working with HIV infected people, their prognosis was grim – they would only be expected to live a matter of months. Now with antiretroviral drugs, a patient with HIV who starts treatment quickly, may live an additional 50 years. Dr. Fauci adds that the 30th anniversary of the recognition of the first cases of what ultimately turned out to be AIDS back in the summer of 1981 is a very important date.
Fauci: Because over the past three decades, we have come such a long way and made such extraordinary progress in a variety of areas with regard to HIV/AIDS from the initial demonstration of HIV as being the causative agent to the development of a diagnostic test and importantly to development of effective therapies that have transformed in a positive way, the lives of HIV infected individuals.
Balintfy: He points out that the NIH is the single largest public funder of HIV/AIDS research in the world, adding that HIV/AIDS pandemic will remain one of the most serious public health crises of our time until better, more effective and affordable prevention and treatment regimens are developed and universally available.
Fauci: What we need to do is to just at this time reconfirm our commitment that there is still a long way to go, although we have accomplished much, there is still much to do, and this 30-year commemoration and anniversary should serve for us as a remembrance of what we still need to do.
Balintfy: Dr. Fauci reminds that despite the global public health community’s best efforts to prevent new infections, 2.6 million people around the world became newly infected with HIV in 2009 alone. He also highlights recent research showing that an HIV-infected individual can dramatically reduce the risk of transmitting the virus to an uninfected heterosexual partner by starting treatment when his or her immune system is relatively healthy. For more information on HIV/AIDS research, visit www.niaid.nih.gov.
NIH scientists identify gene that could hold the key to muscle repair
Balintfy: When a young person experiences muscle loss after a period of inactivity, muscle rebuilds as soon as the activity is resumed. However, in the elderly, muscles lose that capacity. The same is true for people with Duchenne muscular dystrophy. Duchenne muscular dystrophy, sometimes called DMD, is a rapidly-worsening form of muscular dystrophy – that’s a group of more than 30 inherited diseases that cause muscle weakness and muscle loss. Wally Akinso reports that a gene may be involved in muscle repair for both the elderly, and DMD patients.
Akinso: Researchers at the National Institutes of Health have found a gene that could be the key to treating the condition known as Duchenne muscular dystrophy. Patients with the condition tend to manage well through childhood and adolescence, yet succumb to their disease in early adulthood.
Sartorelli: Usually children are in wheelchairs by twelve thirteen years old and they usually succumb to the condition when they are 20.
Akinso: Duchenne muscular dystrophy is an inherited disorder that involves rapidly worsening muscle weakness, explains Dr. Vittorio Sartorelli, a senior investigator at the NIH.
Sartorelli: And because of the mechanical properties of the muscle every time that there is contraction there is some sort of wear and tear effect. And so the muscle gets damaged, because the cell membrane is not intact. If the cell membrane is not perfectly ceiled every time that we have contraction you get a little big of damage and that is responsible for the degeneration of the muscle.
Akinso: This is also why elderly people who lose muscle strength following bed rest find it difficult or impossible to regain. The causes may lie in a specialized population of cells called satellite cells. Satellite cells are key to the development of skeletal muscle of the embryo and fetus, and they continue to actively increase muscle mass through infancy. After that, they decrease in number and become inactive, until they are activated by injury or degeneration to proliferate. Dr. Sartorelli and researchers have looked at a particular gene to see how it affected satellite cell growth.
Sartorelli: The gene is called Ezh2. It helps in understanding the biology and before therapy you have to understand the biology. Before fixing a car you have understand how that car works when it’s fine. We have defined a molecule Ezh2 that is essential for satellite cells proliferation.
Akinso: Suspecting a genetic switch that might turn off satellite cell proliferation in these circumstances, the scientists looked to the Ezh2 gene. When they genetically inactivated Ezh2 in satellite cells of laboratory mice, the mice failed to repair muscle damage caused by traumatic injury – the satellite cells could not proliferate. Dr. Sartorelli cautions that while the identification of Ezh2’s role is a crucial step, any therapies are still many years away. For more information on this study, visit www.niams.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: The aging population is growing because baby boomers are turning 65. More on that next when NIH Research Radio continues.
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Baby boomers turning 65
Balintfy: Back in episode 134 of NIH Research Radio, we started talking about the implications of the baby boom generation – people born between 1946 and 1964 – reaching their 65th birthdays in 2011. While older drivers was the topic last time, this time, Dr. Marie Bernard a deputy director at an NIH institute, talks more about the phenomenon of the baby boom and what it means for the U.S. population.
Bernard: Well, as of January of 2011, the first of the baby boomers started turning 65 and there are quite a few of us. Based on the volume people have projected every 15 to 30 seconds, there's another boomer turning 65. And that means that what we used to have as a population pyramid where at the top of the pyramid you had people who were 80 years and older and at the bottom, at the base you had lots of younger individuals is being changed. It's anticipated because we boomers hope to live as long as the current cohort of older individuals that by 2050, it will be a population rectangle rather than a pyramid.
Balintfy: So it’s really changing the dynamic of the U.S. population?
Balintfy: And this rectangular population – how will that impact healthcare? Are there conditions and issues to consider, like chronic diseases?
Bernard: Yes, with the aging of the population and the rectangularization of the population pyramid, we can anticipate that there will be many more individuals that have chronic illness. The longer we live, the more likely we are to develop heart disease, cancer, diabetes, high blood pressure, Alzheimer's disease, and there will then be a need for those individuals to be cared for in our healthcare system. So we can anticipate there will be quite a bit of demand as people reach towards the end of their life. They will often become frail either physically or cognitively or both and the need not only for a healthcare system but a social system to be able to support those individuals. And that will be even more challenging because proportionately there will be fewer younger individuals to provide that support.
Balintfy: How does the current generation of older individuals, and baby boomers, compare to their predecessors?
Bernard: The current generation of older individuals are healthier and living longer than their predecessors. Thus again, we baby boomers hope we will be able to do the same. A challenge, however, is that for baby boomer, the cohort of individuals born between 1946 and 1964, many of us have been subject to the obesity and the epidemic in our country, and with obesity you're more likely to develop high blood pressure, diabetes, heart problems. So it's not clear yet. The jury is yet to come in relative to whether we will have the same level of health with the current cohort of older individuals.
Balintfy: Dr. Bernard, what are the factors that are leading to a healthier older generation?
Bernard: The factors have led to the current cohort of individuals being healthier are things that occurred really at the beginning of the 20th century in terms of better public health, better perinatal care. The availability of antibiotics and vaccines and then towards the end of the 20th century more advanced technological things, intensive care units, means of treating heart disease, bringing down cholesterol levels, smoking cessation. So all of those things combined seem to be contributing to people living on average to age 72 from birth or older depending upon your ethnicity and gender. And if you make it to age 65 currently, you're likely to make it to 85. If you make it to 85, you're very likely to make it to 92.
Balintfy: So baby boomers potentially have a lot to look forward to.
Bernard: I would simply add that this is an exciting time to be aging in America and globally. As I said, if you make it to 65, you're likely to make it to 85. That's 20 years. If you make it to 85, you're likely to make it 92. That's 30 years of additional life. And if we are healthy as the current cohort of older individuals are, then there's an opportunity to use that time creatively and constructively to be supportive to our society and to explore things that perhaps we didn’t get to explore when we were younger, responsible for getting our careers started or taking care of our families.
Balintfy: Thank you Dr. Marie Bernard. To see video excerpts of this interview, tune into the I on NIH vodcast. You can find that at the NIH homepage, www.nih.gov, on the “News & Events” tab. And for more information on healthy aging, visit www.nia.nih.gov.
For now, that’s it for this episode of NIH Research Radio. Please join us again on Friday, July 1st when our next edition will be available. It will include a story on parasites infecting marine mammals.
“Yes and that's the big surprise here is how are these land animal parasites getting into and infecting these marine mammals”
If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Best to reach me by email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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