October 31, 2008
NIH Podcast Episode #0070
Balintfy: Welcome to the 70th 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, we kick off Alzheimer’s Disease Awareness Month with an in depth interview about the latest research and treatments. But first, we have two reports on pelvic disorders. That's right now, on NIH Research Radio.
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About One Quarter of U.S. Women are Affected by Pelvic Floor Disorders
Balintfy: There are a variety of problems related to the pelvic floor. We find out in this report from Wally Akinso, that about a quarter of women are affected with one of these disorders at some point in her lifetime.
Akinso: Nearly 24 percent of U.S. women are affected with one or more pelvic floor disorders according to a National Institutes of Health study. Dr. Susan Meikle is the Project Scientist for the NIH Pelvic Floor Disorders Network.
Meikle: Pelvic floor disorders are a group of disorders that have to do with the supporting muscle and tissue of the pelvis.
Akinso: Dr. Meikle explains that these muscles and ligaments form a sling across the opening of a woman's pelvis, holding the bladder, uterus, bowel, and rectum in place.
Meikle: So when there is a weakness or a tear — say from a vaginal delivery, a birth — the bladder can kind of actually fall down, the uterus can fall down, intestines can fall down through different kinds of spaces between the muscles and the thick connective tissue.
Akinso: Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institute of Diabetes and Digestive and Kidney Diseases and the Office of Research on Women's Health, researchers used data from the National Health and Nutrition Examination Survey. Dr. Meikle explains what the survey shows.
Meikle: The results were that it is quite common for women in the United States to have symptoms of at least one pelvic floor disorder. Overall almost 24 percent of women had symptoms of at least one pelvic floor disorder. And the most common was urinary incontinence, followed by fecal incontinence, and then the least common was the systematic pelvic organ prolapse, which is feeling the organs in a place that there not suppose to be.
Akinso: Dr. Meikle highlights the importance of the findings.
Meikle: What it underscores is that this is a big public health problem. It really lays the groundwork for trying to do more research on prevention, because it is actually common.Akinso: Treatment for pelvic floor disorders varies with the severity of symptoms. Dr. Meikle says treatment may involve behavioral therapies, exercises to strengthen muscles, vaginal devices to hold up the bladder or other pelvic organs, medications or surgery. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
NIDDK Launches Effort to Advance Study of Urologic Chronic Pelvic Pain Disorders
Balintfy: From pelvic floor, to pelvic pain. Here’s another report from Wally Akinso focusing on that area between the hip and belly-button.
Akinso: Urologic pelvic pain disorders such as interstitial cystitis and chronic prostatis have been assumed to be bladder and prostate problems. However, no other causes have been identified and there is no uniformly effective treatment for either disorder. That's why the National Institute of Diabetes and Digestive and Kidney Diseases will launch a new research network, which will help conduct collaborative studies of urologic chronic pelvic pain disorders by looking for clues outside the bladder and prostate. Dr. Leroy Nyberg, NIDDK's Director of Urology Programs at the Division of Kidney, Urologic and Hematologic Diseases, talks about how this research network came to pass.
Nyberg: What makes this unique is that before these two disorders interstitial cystitis and chronic prostatis have been studied mainly by urologists. We at the NIH have been studying them for years and really have not been able to get a foothold on what causes them or what is the most effective way to treat them. So we have decided that we have to look outside of the specialty of urology and enlist other investigators to look at these diseases as well.
Akinso: The research network, Multidisciplinary Approach to the Study of Chronic Pelvic Pain, known by the acronym MAPP, requires investigators to conduct highly collaborative research of the most common urologic pelvic pain syndromes from a broadened systemic perspective. Dr. Nyberg says MAPP will help address many persistent questions about urologic chronic pain disorders.
Nyberg: The MAPP research is to find the underline basic causes of this disorder-by taking samples of bladder and prostate and finding it, whether we can find it in the blood as some sort of an abnormal substance which is found in the blood or in the urine.
Akinso: Dr. Nyberg is optimistic about what this program can lead to down the road.
Nyberg: Ideally we would like to say that we can find the cause and we can prevent these disorders, the chronic pelvic pain disorders, and we can effectively treat them, but basically we would hope that first it leads to a greater understanding of what are some of the causes of the disorder. Once we find the cause or what changes occur in the body we can start to target medications and effective therapy.
Akinso: Recent studies have shown that interstitial cystitis and chronic prostatis are frequently associated with other chronic pain disorders such as chronic fatigue syndrome, and irritable bowel syndrome. For more information on MAPP, visit www.niddk.nih.gov. This is Wally Akinso at the National Institutes of Health, Bethesda, Maryland.
Balintfy: Coming up next, the latest on Alzheimer’s disease. Stay tuned.
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Balintfy: Scientists think that as many as 4.5 million Americans suffer from Alzheimer’s disease. With November being Alzheimer’s Disease Awareness Month, we’re featuring an interview with an expert on the topic: Dr. Laurie Ryan with the National Institute on Aging. We started by asking Dr. Ryan for a refresher on what exactly is Alzheimer’s disease?
Ryan: Alzheimer's disease is a type of dementia, and actually it's the most common form of dementia in those who are over the age of 65. And dementia, simply, is a term that means you have a loss of cognitive function, of memory and thinking skills. It deteriorates over time.
Balintfy: Are the number of cases of Alzheimer’s disease increasing?
Ryan: Yes, unfortunately, because the population is getting older, and age is the biggest risk factor for Alzheimer's, we are seeing more people, and that trend is only going to continue unless we find a treatment that either stops or slows the progression of the disease.
Balintfy: So Dr. Ryan, what kind of treatments are available for Alzheimer’s disease?
Ryan: Currently, what we have available for patients are drugs that work on the symptoms. They're called acetylcholine esterase inhibitors -- Aricept, people might have heard of, Exelon -- and those drugs treat symptoms. They don't stop the underlying disease pathology, though. And so, what's exciting now, is it’s in early-stage human trials, Phase I and Phase II, where drugs are actually trying to target the underlying disease to, like, stop or slow the progression of the illness.
Balintfy: You mention phase one and two trials as early phases. Can you explain that?
Ryan: So, in the first early phases of clinical trials, Phase I is really for safety. Phase II, they want to look at safety and dosing of the drug, as well as some effectiveness, and then Phase III are, really, the big test for the drugs. They have to go into a lot of patients and see if, you know, if they're effective.
Balintfy: So Dr. Ryan, are there some new or early trials going on now that may shed more light on Alzheimer’s disease?
Ryan: Oh, absolutely, the interesting thing now is, like I said, we're finding out more about the disease mechanism, so, the basic science has really helped us to identify a couple of areas that we want to target. One is the beta amyloid protein, which has an abnormal build-up in the brain, and the other one is the tau protein, and now, there are new, Phase II, like I said, early phase clinical trials actually targeting both of these mechanisms. So, one exciting thing that just came out of a recent international Alzheimer conference looked at a drug that actually targets the tau protein, and stops it from aggregating, or building up in the brain, abnormally.
Balintfy: Can you explain more about how Alzheimer’s disease works and how these drugs treat the disease?
Ryan: Well, basically, like I said, both the tau protein and the beta amyloid protein abnormally aggregate, or clump up, in the brain, and they cause what we call the hallmark signs of Alzheimer's -- are these plaques, which are the beta amyloid build-up, and tangles, which are the tau. So we're looking at drugs that, basically, will come in, and either stop the proteins from aggregating abnormally, and having the dementia associated with Alzheimer's, or clearing them out of the body so that they clear out. Normally, they clear out, and they don't build up to these levels in the brain.
Balintfy: What exactly are these drugs and how do they work?
Ryan: So, this tau aggregation inhibitor, it's called Rember, actually, is the trademark name of it. It's an old drug, actually, that was used to treat urinary tract infections: methylene blue. It turns out that it also, in test tubes and in animals, it breaks up the tangles, the tau protein.
Another interesting one is called Dimebon. It actually is an antihistamine, another older drug, and it was used in Russia, primarily, and they've actually done an early phase trial there, again, a Phase II. They did it in Russia, not in the U.S., but a lot of the investigators were from the United States, and they found that it, actually, not only did the cognition stop declining in patients who had Alzheimer's disease, mild to moderate Alzheimer's, but it actually got better.
Balintfy: Other than drugs, what kind of things are being researched as possible treatments for Alzheimer’s disease?
Ryan: I think some of the other interesting things are looking at diet and exercise. We have known for a long time, from observational studies, that people who have healthy lifestyles, who have, you know, who are not obese, who are not diabetic, who have healthy diets, like the Mediterranean diet, for example, actually show less or later onset of Alzheimer's, and less Alzheimer's than people who have the high fat, more Western diet, if you will.
Balintfy: Are there studies looking at other kinds of treatment?
Ryan: There was another very interesting one, of a nutritional drink, Suvenaid, where they gave a combination of things, like omega three fatty acids, and anti-oxidants, and, so, it's highly nutritious. They gave it to a group of patients and, again, mild Alzheimer's and they actually found that there was slowing of the progression of the illness. So, again, these are early phase studies, but very promising. And also very promising for prevention, which is what we ultimately want to do, is we want to stop people from getting the disease, which means that if we can target lifestyle, and it seems mid-life is particularly critical.
Another study found that diabetes at mid-life put you at greatest risk of having Alzheimer's later on than even if you had diabetes as an older adult. So, it seemed like that mid-life period was very critical. So, if we can, you know, potentially intervene there, we may be able to slow, at least slow the progression of this illness, which, if we did that, would save, obviously, people’s lives would be much improved, and also the economic costs, which are going to be tremendous of caring for people with Alzheimer's would also be lessened.
Balintfy: Dr. Ryan, what other areas of research are being explored to help fight this disease?
Ryan: The other very interesting area is diagnostics and early detection. We are making great strides, now, with imaging, and also biological markers, in human blood and in the cerebral spinal fluid, of the underlying Alzheimer's pathology, and they're finding that we can actually look early on. You know, people, at least with his mild cognitive impairment stage, and, hopefully, move it even further back, to identify people who are at risk, and also these biomarkers, as we call them, will also be helpful for treatment trials. We would be able to see if there were changes, something like you might see in cholesterol on somebody with heart disease, and so that you wouldn't have to wait, you know, years to see if you’re slowing down the progression of the cognitive changes, which are not quick. They’re actually fairly slow over time, so, if we had a marker in blood or in spinal fluid, or even imaging, or a combination, we would be able to see if drugs were working faster, and, hopefully, find out sooner whether or not they were working, and also find out who might be the people to respond to the drugs.
Balintfy: Where can people find more information about the disease, research, treatments and trials?
Ryan: Right, one of the best is actually the NIA's own Web site, which is the Alzheimer's Disease Education and Referral Center, ADEAR, and that Web site has a host of information, from what clinical trials are available, to information to help patients and family members with the disease, to professionals who may be looking for information, so, it's truly a very useful Web site, and it’s up-to-date. So, I encourage people to look at the NIA's ADEAR Web site.
Balintfy: Thanks to Dr. Laurie Ryan at the National Institute on Aging. The website she mentioned is www.nia.nih.gov/alzheimers. You can also call the ADEAR Center at 1-800-438-4380. Be sure to ask for or look up the new publication: “Alzheimer's Disease: Unraveling the Mystery.”
Balintfy: That's it for this episode of NIH Research Radio. Please join us again on Friday, November 14th 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.