October 3, 2008
NIH Podcast Episode #0068
Balintfy: Welcome to the 68th episode 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. Coming up in this episode a couple of resources from NIH: one to help diabetic women have safe pregnancies, another helps cancer patients keep treatments uninterrupted. And later, we learn about the importance of bio-specimens. But first news on how a common treatment can help reduce the risk of cerebral palsy. That's right now, on NIH Research Radio.
Common Treatment to Delay Labor Decreases Preterm Infants' Risk for Cerebral Palsy
Balintfy: Preterm infants born to mothers receiving intravenous magnesium sulfate—a common treatment to delay labor—are less likely to develop cerebral palsy than preterm infants whose mothers do not receive it.
Spong: Cerebral palsy is a devastating condition that affects most commonly infants who are born pre-term and, to date, we don't have any treatments for that.
Balintfy: Dr. Cathy Spong is the Chief of the Pregnancy and Perinatology Branch at the Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Spong: Our goal is always to optimize pregnancy outcome and to try to improve the outcome for the children. When you're looking at infants who are born pre-term, we know that there are lots of things that can go wrong and one of the things is cerebral palsy, which is so common in these infants. And anything we can do to try to prevent that would be beneficial.
Balintfy: Researchers theorized that magnesium sulfate protects against cerebral palsy because it can stabilize blood vessels, protect against damage from oxygen depletion, and protect against injury from swelling and inflammation. Dr. Deborah Hirtz, a pediatric neurologist at the National Institute of Neurological Disorders and Stroke says, a recent study is the largest, most comprehensive effort to date that looked at using this inexpensive and commonly used treatment to reduce the occurrence of cerebral palsy after preterm birth.
Hirtz: This study shows that if women who are about to deliver pre-term, more than two months early, are given this treatment of intravenous magnesium sulfate, that the risk of cerebral palsy in the babies that are born early can be decreased.
Balintfy: The study was undertaken by the Fetal-Maternal Medicine-Unit-Network, with substantial support from two NIH institutes: NICHD and NINDS. The study results appear in the August 28, 2008 edition of the New England Journal of Medicine. For more information on the study, visit www.nih.gov.
Balintfy: Stay tuned there's more to come. After this short break, another report on safe pregnancies, and a valuable resource for cancer patients.
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NIDDK Resource to Help Guide Diabetic Women Through a Healthy Pregnancy
Balintfy: In these next two reports from Wally Akinso, we first learn about a booklet available for women who have diabetes, then a wallet card for cancer patients. First, what diabetic women need to know about having a safe pregnancy.
Akinso: Pregnancy in women who have diabetes is automatically considered high-risk. But a new, easy-to-read booklet has information to help women with diabetes experience safe and healthy pregnancies.
Fradkin: The name of the booklet is For Women with Diabetes: Your Guide to Pregnancy.
Akinso: Dr. Judith Fradkin is the Director of the National Institute of Diabetes and Digestive and Kidney Diseases' Division of Diabetes, Endocrinology and Metabolic Diseases.
Fradkin: This booklet is very helpful because it gives information about changing your diet during your pregnancy, tips for exercising, gives information about many of the test that maybe done in a pregnant woman to make sure that her baby is healthy and it also talks about steps that a woman can take after pregnancy and particularly the importance of breastfeeding.
Akinso: The booklet is illustrated, has 44-pages and includes information about all sorts of ways for women to manage their diabetes while pregnant.
Fradkin: What's particularly important is that with good control of the diabetes they can have really good pregnancy outcome.
Akinso: The booklet emphasizes the importance of planning for pregnancy and getting blood glucose levels under control before pregnancy to decrease the risk of birth defects associated with diabetes. Dr. Fradkin wants pregnant diabetic women to know that they to can have healthy outcomes.
Fradkin: It's a lot of work to take care of yourself. It's a team approach. But it is absolutely worth it, because both the health of the mother and the health of the baby can really be improved by good control.
Akinso: To order a free copy of the booklet go to www.catalog.niddk.nih.gov or call 1-800-860-8747. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Disaster Relief Wallet Card to Help Displaced Cancer Patients
Balintfy: Hurricane season doesn't reach everyone, but can serve as a reminder that there are disruptions in our lives. For those with cancer, it's crucial not to have treatment disrupted. In this next report from Wally Akinso, we learn about a resource to keep cancer patients' treatments from being interrupted.
Akinso: To help link patients and their health care providers in the event of a national or natural disaster, the National Cancer Institute and the American Society of Clinical Oncology have developed a Disaster Response Wallet Card. Cancer patients in the Gulf Coast states may find themselves evacuated from their homes and without access to their physicians or medical records during the hurricane season. The wallet card is designed to serve as an aid to displaced patients seeking continued cancer treatment. Ms. Madeline La Porta, Associate Director of the NCI's Office of Partnerships and Dissemination Initiatives, describes the wallet card.
La Porta: The front of the card basically has the cancer information service number-the 1-800-4-cancer number as well as the cancer.gov NCI website. And then it has the ASCO patient website. So people can use the front of the card to know where to look for information to reconnect with their physician. And then the back of the card has a space for their name, their diagnosis, what the name of their treating physician is, and what treatment regimen they're on.
Akinso: Ms. La Porta talks about the benefits of having a card in case of a hurricane.
La Porta: If a person is evacuated who's in the midst of chemotherapy, say for colon cancer, they will know what type of cancer they have, the stage of the cancer, and the drugs that they're on. And that way if they can't connect to their physician they can still go to another cancer center or physician and continue their treatment.
Akinso: The wallet card will be distributed as part of a pilot program during the hurricane season, which runs from June through November. To order a wallet card, call 1-800-4-cancer. This is Wally Akinso at the National Institutes of Health, Bethesda Maryland.
Balintfy: To find newer treatments for cancer, researchers need bio-specimens. We'll find out more about that next. Stay tuned.
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Balintfy: In our last episode, we talked to the Deputy Director of the National Cancer Institute about studying the cancer genome. This next interview is a great follow-up, because researchers can't study things like cancer tumors - or healthy cells and tissues for that matter—without samples, or bio-specimens. So this month, we're talking with Dr. Carolyn Compton. She's the director of the Biorepositories and Biospecimen Research Office at the National Cancer Institute. We started by asking her, what exactly is a bio-specimen?
Dr. Compton: A bio-specimen is anything that comes out of or off of the human body and reflects the biology of the person from whom it was derived. So it can be a tissue, an organ, a fluid, like urine or blood that's derived from a person and reflects their unique biology.
Balintfy: What are the key issues facing bio-specimens, in particular regarding collection, processing and storage?
Dr. Compton: I think the most important thing to remember about bio-specimens is that they are alive. That they are living entities; they are living cells and living tissues that we kill by fixing or freezing in order to store them. But up until the point when we stabilize them by fixing them or freezing them for use in the future, research use in the future, they are still living and still capable of reacting to biologic stress. And so the way that we derive them, the way we collect them, the way we process them and even the way we store them over time can affect the integrity of their biology, can in fact produce stresses that change their biology and can affect the quality of the bio-molecules that are in the cells. So what we're looking at is a challenge to make sure that we are using processes of collection processing and storage that are of the highest possible quality, consistency, and are standardized across the country.
Balintfy: Consistency and standardization are important in any kind of research, aren't they?
Dr. Compton: It's true. It's important for any research in any disease process using human specimens, but it's especially important in cancer research because that's where most of the specimen collections in this country are targeted, is towards cancer research.
Balintfy: Dr. Compton, can you explain the NCI's role with bio-specimens and issues surrounding them?
Dr. Compton: So we create and distribute standards and guidance, and we educate people about the implementation of those standards and guidance. We are also in the process of exploring the possibility of creating a national resource for this country, a national bio-bank which we do not have in the United States, which other countries ironically do have in countries that are much smaller than the United States but are ahead of us because they have national healthcare and are able to coordinate the collection of human specimens through their health care system. We don't have that advantage, so we have to create an ingenious way to collect standardized specimens in our rather heterogeneous health care system. And we're exploring a way to do that to create a center that would be accessible to all researchers to be able to find bio-specimens that would match their needs and that would be of known standards with known amounts and types of clinical annotation, that is data about the patient from whom the specimens were derived.
Balintfy: Who are some of the different players involved with bio-specimens?
Dr. Compton: There are many people involved in what I like to think of as the life cycle of a bio-specimen. It certainly does start with the patient and the patient consenting to allow the banking of his or her bio-specimen. And most of the bio-specimens in cancer research are derived from therapeutic procedures. In other words, the tissue is removed for a medical reason; you undergo a cancer operation for example.
But the patient, him or herself, must consent to allow that tissue to be used for research. So it certainly does start with the patients consent. And then the people who explain the use of the specimen in research are also key to this process. Those would be mostly nurses or clinical research assistants who educate the patient about the use of the specimen in research so they know what they're consenting to. And then there's the surgeons who actually remove the tissue and the way that they handle the tissue and their communication with the pathologist to whom they pass the tissue after it's removed from the body. They're also absolutely key in the process.
So there are a number of individuals who are involved in this entire process, and the entire process must be optimally coordinated, which means that all of these people must do their jobs very well, and there must be communication among them.
Balintfy: Dr. Compton, would you say that the patient has an especially important roll with regards to bio-specimens?
Dr. Compton: The patient is key. Without the patient's consent and understanding and full participation in the process of research, we will never change medicine for the better. And so despite all of the bio-bankers efforts, we could create the perfect standard operating procedures and everyone in the operating room and the pathology suite and the bio-bank could be doing a perfect job, but in fact if the patient hasn't consented to use the specimen in the project for which its intended, we wouldn't be able—all would be lost. We wouldn't be able to use the specimen at all for those all-important projects that are going to change medicine.
Balintfy: How is medicine being changed and what is the role of bio-specimens in that change?
Dr. Compton: Well, I think we are standing at a watershed between what we now know as standard of care medicine that is rather generic in terms of cancer treatment, where we have one drug that we generically use to treat all cancers of a certain type. Say colon cancer, and we are looking forward on the other side of this watershed to an era of what we're thinking of as molecular medicine where the treatment will be tailored to the specific colon cancer from the specific patient. And there will be targeted therapies that will target the specific molecular defects in that patient's cancer.
Well, the only way we're going to get to this new era of molecular medicine is through the bio-specimen, which is both the fuel that will drive the research that will get us to this new era of medicine but will also be the currency of the practice of molecular medicine in the future. Because, in fact, that's where the molecules are so we must optimally preserve the molecular integrity of the specimens because that is the reflection of the biology of the patient and the biology of the patient's disease. And it will be the basis on which we will treat patients in the future, and certainly it is exactly the anaglyph of importance, it is the centerpiece for our research, our ongoing research that is going to take us to this new era of medicine.
Balintfy: Can the public get involved with this new era of medicine, perhaps by donating bio-specimens?
Dr. Compton: Absolutely. And it's timely that you ask this question because some of the biggest scientific initiatives that are now being launched surround normal human biology. In fact, we have powerful technologies now that we can direct at this study of disease, but it's ironically easier to get diseased tissue because it's removed for therapy for the patient than it is to get normal tissue. Obviously if you're a human being with normal tissues you like to hang on to them for your own purposes, and so they're very difficult to come by, and we are, here at the NIH, are just starting a brand new project. It's an NIH roadmap project, with the National Human Genome Research Institute taking the lead, to study the transcriptome [spelled phonetically], in other words, how genes are transcribed in different cells and tissues in the body. Obviously, every cell in your body has exactly the same genome, but those genes are transcribed differently in different cells and tissues because they do different jobs biologically.
But we have never had the opportunity to use our most powerful technologies to understand how these molecular differences occur. And in order to do that, we need large numbers of normal tissues from normal people, and those are challenging to acquire. And some of the ways that we are thinking about addressing this is through, again, something that the patients can participate in, in terms of education and direct participation is rapid autopsy programs, where you actually leave a living will to consent to having your tissues used in research. And although everyone is very familiar with the consent that we give, say at the Bureau of Motor Vehicles when we go to get our driver's license to consent to have our normal tissues used for transplantation, for therapeutic reasons, we don't think to consent to have our normal tissues used for research where they are just as valuable.
Balintfy: Thank you Dr. Compton. Is there anything else you'd like to add?
Dr. Compton: Just remember that the bio-specimen is the fuel for translational research that is taking us towards a new era of molecular medicine. And in the era of molecular medicine will be the center of the universe. It's where the molecules are.
Balintfy: Thanks again to Dr. Carolyn Compton, Director of the Biorepositories and Biospecimen Research Office at the National Cancer Institute. For more information about her office and bio-specimens, visit the website biospecimens.cancer.gov.
Balintfy: That's it for this episode of NIH Research Radio. Please join us again on Friday, October 17 when our next edition will be available for download. I'm your host, Joe Balintfy. Thanks for listening.
NIH Research Radio is a presentation of the NIH Radio News Service, part of the News Media Branch, Office of Communications and Public Liaison in the Office of the Director at the National Institutes of Health in Bethesda, Maryland, an agency of the US Department of Health and Human Services.