November 18, 2011
NIH Podcast Episode #0147
Balintfy: Welcome to episode 147 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 this is a special edition of NIH Research Radio – it is my 100th as your host. Can you believe it? In the past 100 episodes, I’ve shared with you hundreds of spokespeople: from institute directors and presidents, to researchers and scientists, even mosquitoes. We discussed more health topics than I can count. And, I’m grateful to report that you have more and more company, listing to the program. Don’t worry, big brother isn’t watching, but I recently noticed that NIH Research Radio has more than 21,000 subscribers now – that’s about three times as many since back in 2009. So thanks for tuning in. For this special anniversary episode, I’ll be sharing a couple of my favorite reports, one on President Obama’s visit to the NIH and another on mosquito research, plus a new report on Secretary of State Clinton’s recent visit and speech here. But first, as usual, here’s our news update with Craig Fritz.
Fritz: Influenza researchers funded by NIH have found that flu strains migrate back and forth between different regions of the world, evolving along the way. This is contrary to the common belief that flu strains from the tropics are the source of global seasonal epidemics. Previous studies had shown that in general, influenza viruses in tropical regions tend to be more varied and circulate year-round rather than seasonally, like flu viruses found in temperate regions with more moderate climates. The researchers found that in temperate regions where flu seasons are relatively short, many new virus strains arise every year, but they rarely persist from one season to the next. However, in tropical regions strains do persist between seasons.
For this NIH news update – I’m Craig Fritz
Balintfy: Thanks Craig. News updates are compiled from information at www.nih.gov/news. Coming up more thanks to share after doing 100 episodes, audio from two presidents and a mosquito. Plus, Secretary Clinton and highlights from her HIV/AIDS speech here at NIH. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Creating an AIDS-Free Generation
Balintfy: On November 8, U.S. Secretary of State Hillary Rodham Clinton visited the NIH and spoke about creating an AIDS-free generation.
Clinton: Now, by an AIDS-free generation, I mean one where, first, virtually no children are born with the virus; second, as these children become teenagers and adults, they are at far lower risk of becoming infected than they would be today thanks to a wide range of prevention tools; and third, if they do acquire HIV, they have access to treatment that helps prevent them from developing AIDS and passing the virus on to others.
Balintfy: Secretary Clinton admits that this is an ambitious goal:
Clinton: Creating an AIDS-free generation has never been a policy priority for the United States Government until today, because this goal would have been unimaginable just a few years ago. Yet today, it is possible because of scientific advances largely funded by the United States and new practices put in place by this Administration and our many partners.
Balintfy: Funders and partners include the U.S. President’s Emergency Plan for AIDS Relief, or PEPFAR, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Health Organization and many countries worldwide. Secretary Clinton emphasizes that no institution in the world has done more than the United States Government.
Clinton: Researchers right here at the NIH conducted pivotal research that identified HIV and proved that it did cause AIDS. The first drug to treat AIDS was supported by the United States. Today we are making major investments in the search for a vaccine; for tools like microbicides, which give women the power to protect themselves; and other lifesaving innovations.
Balintfy: She says she wants the American people to understand the irreplaceable role the U.S has played in the fight against HIV/AIDS; that it is tax dollars that have made innovations possible, and that fight needs to keep going. Secretary Clinton notes that the fight against AIDS has already been going on for three decades.
Clinton: We know, of course, about its horrific impact. AIDS has killed 30 million people around the world, and 34 million are living with HIV today. In Sub-Saharan Africa—where 60 percent of the people with HIV are women and girls—it left a generation of children to grow up without mothers and fathers or teachers. In some communities, the only growth industry was the funeral business.
Thirty years later, we also know a great deal about the virus itself. We understand how it is spread, how it constantly mutates in the body, how it hides from the immune system. And we have turned this knowledge to our advantage—developing ingenious ways to prevent its transmission and dozens of drugs that keep millions of people alive. Now, AIDS is still an incurable disease, but it no longer has to be a death sentence.
Balintfy: Secretary Clinton focuses on the three key interventions that can make it possible to achieve an AIDS-free generation: preventing mother-to-child transmission; voluntary medical male circumcision; and treating HIV-positive people with antiviral drugs to make it far less likely that they will transmit the virus. She says none of these interventions can create an AIDS-free generation by itself.
Clinton: But used in combination with each other and with other powerful prevention methods, they do present an extraordinary opportunity. Right now, more people are becoming infected every year than are starting treatment. We can reverse this trend. Mathematical models show that scaling up combination prevention to realistic levels in high-prevalence countries would drive down the worldwide rate of new infections by at least 40 to 60 percent. That’s on top of the 25 percent drop we’ve already seen in the past decade.
Balintfy: To have success, Secretary Clinton says there are three steps that need to be taken together to get ahead of the pandemic and be on the path to an AIDS-free generation: First, she says, let science guide efforts.
Clinton: Success depends on deploying our tools based on the best available evidence.
Balintfy: The second step, she explains, is to put more emphasis on country ownership of HIV/AIDS programs.
Clinton: We know we can’t create an AIDS-free generation by dictating solutions from Washington. Our in-country partners – including governments, NGOs, and faith-based organizations – need to own and lead their nation’s response.
Balintfy: And the third step:
Clinton: We’re calling on other donor nations to do their part, including by supporting and strengthening the Global Fund.
Balintfy: While these steps may have costs according to Secretary Clinton, she notes that treating HIV-positive people before they become ill also has indirect economic benefits.
Clinton: It averts social costs, such as caring for orphans whose parents die of AIDS-related illnesses. A study published just last month weighed the costs and benefits and found that – I quote – “the economic benefits of treatment will substantially offset, and likely exceed, program costs within 10 years of investment.” In other words, treating people will not only save lives, it will generate considerable economic returns as well.
Balintfy: Secretary Clinton asks what the world will look like without AIDS.
Clinton: It’s the world I think we all would like to live in. An AIDS-free generation would be one of the greatest gifts the United States could give to our collective future.
Balintfy: Also announced in Secretary Clinton’s speech: Ellen Degeneres has been named Special Envoy for Global AIDS Awareness.
Clinton: I know we can look forward to many contributions from Ellen and her loyal fans across the globe.
Balintfy: To see and hear the complete speech given by Secretary of State Hillary Clinton at the NIH, visit the website http://videocast.nih.gov. You can search by the November 8 date, or subject. [http://videocast.nih.gov/summary.asp?Live=10787]
President Obama Visit to NIH – Recovery to Discovery
Balintfy: It was a couple years ago, September 30th in 2009, when Secretary Clinton’s boss, President Barak Obama visited the NIH campus in here Bethesda, Maryland. This is one of my favorite stories not just because I got to shake hands with the President, but because I got to mix the audio of Presidents Obama and Roosevelt. The story is about how as of that day, NIH had awarded more than 12-thousand recovery act grants totaling five billion dollars. NIH Director, Dr. Frances Collins, in his introduction of the President, announced the important milestone:
Collins: These grants will fund trail-blazing research into treating and preventing many of our most scary diseases from cancer to heart disease to HIV/AIDS.
Balintfy: Dr. Collins added that these new grants propose some of the most innovative and creative directions for biomedical research.
Collins: You see this unprecedented NIH Recovery and Discovery program is not just about doubling the recipe; we’re investigating new programs with powerful new tools and looking at old problems from entirely new perspectives. We can’t know exactly where that research will lead—that’s the nature of science. But I am confident that millions of Americans alive today, and millions more in future generations, will live longer healthier lives because of the grants we are announcing today.
Balintfy: Dubbing the President as "Scientist in Chief," Dr. Collins expressed his gratitude to have the support of a president who is excited about the potential of this work.
Collins: President Obama began his administration by making a strong commitment to listening to scientists. This is not just because he didn’t want to hurt our feelings. It’s because he sees great opportunities to use science to improve lives, whether it’s creating new medicines, developing better prevention strategies, or devising smarter policies whether they are to reducing greenhouse gas emissions to building a more effective health care system.
Balintfy: President Obama acknowledged that commitment to the NIH audience and medical research community.
Obama: The work you do is not easy. It takes a great deal of patience and persistence. But it holds incredible promise for the health of our people and the future of our nation and our world. That’s why I’m here today. For decades, the NIH has been at the forefront of medical invention and innovation, helping to save countless lives and relieve untold suffering. And yet, if we’re honest, in recent years we’ve seen our leadership slipping as scientific integrity was at times undermined and research funding failed to keep pace.
We know that the work you do would not get done if left solely to the private sector. Some research does not lend itself to quick profit. And that’s why places like the NIH were founded. And that’s why my administration is making a historic commitment to research and the pursuit of discovery. And that’s why today we’re announcing that we've awarded $5 billion—that's with a "b"—in grants through the Recovery Act to conduct cutting-edge research all across America, to unlock treatments to diseases that have long plagued humanity, to save and enrich the lives of people all over the world. This represents the single largest boost to biomedical research in history.
Balintfy: The President also gave an historic perspective, quoting President Franklin D. Roosevelt, from his address at the dedication of NIH in October of 1940:
Obama: And he said, and I quote: "Neither the American people, nor their government, intends to socialize medical practice any more than they plan to socialize industry. In American life the family doctor, the general practitioner..."
Roosevelt: . . . performs a service which we rely upon and which we trust as a nation. No one has a greater appreciation than I of the skill and self-sacrifice of the medical profession. And there can be no substitute for the personal relationship between doctor and patient which is a characteristic and a source of strength of medical practice in our land.
Obama: It was here, in the years after President Roosevelt's visit, that polio vaccines would be tested to end a scourge that affected millions, including obviously the President that helped make the research possible. We can only imagine the new discoveries that will flow from the investments we make today.
Balintfy: President Obama emphasized that breakthroughs in medical research take time and hard work. But hold promise like no other area of human endeavor.
Obama: And here at the National Institutes of Health, and at universities and research institutions across this country, you are demonstrating our capacity not just as a nation but as human beings to harness our creativity and our ingenuity to save lives, to spare suffering—to build a better world for ourselves, our children, and our grandchildren. That is our great promise. And it is one that we've once again begun to fulfill.
Balintfy: President Obama’s speech is also available at the website, videocast.nih.gov. You can also get up-to-date details on the research funded by the American Recovery & Reinvestment Act at the website recovery.nih.gov. And to hear more of President Roosevelt’s address, check out episode 96 of NIH Research Radio. Coming up, my interview with a mosquito and a look back to World Mosquito Day. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
World Mosquito Day
Balintfy: I know its November and we’re not thinking about mosquitoes much, but this was one of my favorite stories in the past 100 episodes because I got to visit an insectary, a place where they grow insects. Recording a mosquito was not as easy as finding that Roosevelt archival audio. But it does set the stage for a worldwide problem. Mosquitoes are a vector – meaning they are an animal that transmits a pathogen – for several diseases.
Costero: Malaria, dengue, yellow fever, West Nile virus, those are all mosquito-borne disease.
Balintfy: That’s Dr. Andrea Costero, a vector biology program officer at NIH. She explains that NIH is supporting a lot of research on mosquito-borne disease and on mosquitoes because they are the most important vectors of diseases to humans worldwide.
Costero: For malaria, it’s like millions of cases per year. For dengue, it’s millions of cases per year globally. So yeah, they’re pretty prevalent.
Balintfy: And deadly. Malaria alone kills nearly one million people each year; and more than 40 percent of the world’s population lives in areas where there is a risk of contracting malaria. Malaria is caused by a single-celled parasite, but again infection in humans is a result of transmission by mosquitoes.
Costero: We want to find a better way to either control them or avoid them transmitting disease.
Balintfy: Transmission occurs when the mosquito bites a person or animal to get their blood-meal.
Miesfeld: Mosquitoes have been around for millions of billions of years and they’re going to be around.
Balintfy: That’s Dr. Rodger Miesfeld, an NIH-funded researcher at the University of Arizona.
Miesfeld: And mosquito-borne diseases are something we have to deal with all the time.
Balintfy: He says mosquitoes become resistant to insecticides so researchers need to stay one step ahead of that resistance. So Dr. Miesfeld and his team have been looking at stopping a molecular process involved in the mosquitoes’ digestive system. NIH’s Dr. Costero summarizes the science:
Costero: When mosquitoes blood feed, the blood needs to be digested. In order to digest the blood, there are proteins, enzymes that come out of the mosquito gut that degrade the blood and break it down into the proteins that the mosquito needs to generate eggs. So that’s a very complex biochemical process.
Miesfeld: We’re targeting specifically her ability to digest this gigantic blood meal in a quick enough, short enough time that she can’t lay eggs.
Balintfy: And if a mosquito can’t lay eggs, the cycle of infection stops. Another NIH-funded researcher, Dr. Brian Foy at Colorado State University, has done a study following a drug used against worms. He explains that his study looked at mass treatments of whole villages in Senegal.
Foy: The whole point was that we know that the drug has an effect against mosquitoes, and we wanted to measure that effect in terms of the effect meaning that if the drug circulates in people’s body and the mosquito takes your blood, it will ingest a dose of that drug that could be lethal to the mosquito.
Balintfy: And like Dr. Miesfeld’s study, mosquito death was the apparent result. Looking at these two studies together, Dr. Costero says they’re both finding novel approaches to controlling disease transmission and for controlling mosquito populations.
Costero: Both approaches have resulted not only in the pathogen not being able to be transmitted but also in killing the mosquito. So at the same time you’re preventing transmission, you’re also reducing the population of mosquitoes which could have an impact.
Now, just to be clear, I mean this research is at a very early stage, especially Dr. Foy’s research. But he has found evidence of something very interesting, so he is going to pursue that.
Now, Dr. Miesfeld has found something that also is at the early stages because there are always more questions that need to be resolved in order to translate this kind of discoveries into some sort of intervention. That’s going to take a lot of years but the first step obviously is to find something that seems to be useful to prevent transmission or to bring mosquito populations down.
Miesfeld: Basically, what we’ve done is we used a genetic trick to identify proteins in the mosquito that could be good targets, and the next step is to collaborate with chemists to say, “Can you help us find small molecules, chemical compounds that will inhibit that protein and are soluble in many of the solvents that are used in normal insecticides?”
Costero: Somehow the mosquito has to ingest this compound or this thing that’s preventing this protein from doing its work. So that could either be from people taking a pill, as they say, that would not harm people but that would cause the mosquitoes to have this problem, or producing these in sugar-baited traps or nets. I mean the mosquito has to ingest this with the blood meal so that’s going to be the tricky part. But again, this is just the beginning of a long period of work to see if this can be exploited in our favor.
Balintfy: Dr. Foy’s research is also promising says Dr. Costero because it looks at a drug that’s already being used broadly. Dr. Foy adds that it is one of the few drugs in the world that can be given out in mass drug administration to entire villages by non-clinicians. But questions like how frequently and for how long still need to be answered.
Foy: We need to figure out that period of control and we need to do that sustained trial where we’re seeing actually if it correlates to disease and a reduction of disease in people.
Balintfy: And Dr. Foy points out there’s a small catch: they’re not just killing all the mosquitoes that are out there biting people, just the dangerous ones.
Foy: What we’re really doing is kind of killing off the old females and so the only ones that are left, which are still a lot of mosquitoes and are still biting people, are young. And those young ones haven’t had a chance to mature the parasite in their bodies for long enough, and so even though mosquitoes are still biting people after they’ve taken this drug, all those mosquitoes are young so they’re not transmitting malaria, and that’s the key reason why this whole concept works.
Balintfy: Dr. Costero reminds that these are just two examples of research being done on mosquitoes.
Costero: We’re trying to identify either better targets for insecticides or novel controls that are maybe not insecticide-based or could be insecticide-based. We’re supporting work on transgenic mosquitoes for example on traps, on repellents, how do mosquitoes identify humans as humans, as a blood meal, how to prevent them from doing that, etc. So we have a pretty broad portfolio.
Balintfy: For more information on the NIH-funded research being conducted by Drs. Foy and Miesfeld, [MEES-feld] as well as details on malaria and other mosquito-borne disease studies, visit www.niaid.nih.gov.
Balintfy: Before I wrap up my anniversary episode, I wanted to share some more thanks: first and foremost to all the folks that have participated in the show as interviewees or contributors, especially my esteemed colleague Wally Akinso. Also a big thanks to my predecessor Bill Schmallfeldt as well as the whole NIH communications and science communities that have helped start this program and keep it going, including Tim who does all the web-work. And of course, to you the listener: thanks for tuning in. I do mean it when I say if you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send me an email—my address is email@example.com. And now that’s it for this episode, my 100th, of NIH Research Radio. Please tune in again on Friday, December 2nd when the next edition will be available. I'm your host, Joe Balintfy. Thanks for listening.
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