July 27, 2012
NIH Podcast Episode #0164
Balintfy: Welcome to episode 164 of NIH Research Radio. NIH Research Radio bringing you news and information about the ongoing medical research at the National Institutes of Health – NIH… Turning Discovery Into Health®. I'm your host Joe Balintfy, and coming up in this episode, details and news from the AIDS 2012 conference in Washington, DC, understanding molecules that may help fight bacteria, and the father of NIH. But first, this news update with Craig Fritz. Craig there were some announcement coinciding with the AIDS 2012 conference recently…
Fritz: that’s right, Joe. NIH-funded researchers will launch a large, multinational clinical trial this month to test the effectiveness and extended safety of a vaginal ring containing an experimental antiretroviral drug to prevent HIV infection in women. With nearly 3,500 participants in five countries, the study aims to determine whether the drug can safely prevent HIV infection when continuously released from a silicone ring replaced once a month. Results are expected in early 2015.
For this NIH news update – I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up later in the program, learning how and when NIH got its start, research into fighting bacteria, and much more from the AIDS 2012 conference. That’s next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
AIDS 2012 opening plenary on ending the HIV/AIDS pandemic
Balintfy: Globally, more than 34 million people are infected with HIV, the virus that causes AIDS. In the United States there are more than 1.1 million people infected. Nearly half of HIV-infected people living in low- and middle-income countries who are eligible for therapy still, are not receiving needed antiretrovirals. Only a fraction of the people infected with HIV worldwide, including those living in wealthy countries, can effectively navigate the HIV care process from testing to successful treatment. Yet, Dr. Anthony Fauci at the NIH says, ending the pandemic is possible.
Fauci: We want to get to the end of AIDS. That will only occur with some fundamental foundations. And these foundations are the basic and clinical research which will give us the tools which will ultimately lead to interventions and then ultimately these will need to be implemented, together with studies with how best to implement them.
Balintfy: Dr. Fauci, delivering remarks at the XIX International AIDS Conference in Washington, D.C., says science, in particular advances in basic and clinical research, has made the achievement of an AIDS-free generation a real opportunity.
Fauci: Probably the most important of the culmination of scientific advances is understanding the HIV replication cycle from the binding fusion, insertion of its RNA, reverse transcription, integration and then viral budding, because each of that, year after year, has given us targets of vulnerability on the part of the virus. And it’s that kind of basic science which brings us to the next step. And that is the step of interventions, predominantly in the arena of treatment and prevention
Balintfy: Dr. Fauci points out that there is a robust arsenal of antiretroviral drugs and scientifically proven interventions now available to treat and prevent HIV infection.
Fauci: We have now up to 30 anti-HIV approved drugs by the FDA, multiple classes used in combinations that have completely transformed things, but we can't stop there, because there are still those who are not responding to these drugs and we still need long acting drugs, particularly with regard to adherence.
Balintfy: To improve treatment adherence, researchers are working to develop longer-acting antiretrovirals that could be given monthly or even less frequently, such as by injection or topically in vaginal rings. These and other significant scientific challenges remain in HIV research — notably, developing a vaccine and a cure. Dr. Fauci emphasizes that things have changed significantly since 30 years ago.
Fauci: The median survival of my patients was six to eight months - 50% dead within six to eight months - now, if a person walks into our clinic at the NIH, or any other place that has availability of treatment, is young, 25, has been recently infected, you put them on combination therapy and you can look them in the eye and tell them that it is likely that if they adhere to that regimen, that they will live an additional 50 years.
Balintfy: Dr. Fauci notes another positive step in the battle against HIV.
Fauci: Prevention of mother-to-child transmission. The breakthrough study of 076 indicating that by treating the mother, you can actually decrease dramatically, now we treat mothers for their disease, and then secondarily, together with the mother's health, the baby is born uninfected and can be breast fed.
Balintfy: Other proven HIV prevention methods include voluntary medical male circumcision, which was shown in clinical trials in Kenya and Uganda to reduce a heterosexual man's risk of acquiring HIV by 50 to 60 percent — an effect that increases over time.
Fauci: Probably the most game-changing advance over the last couple of years has been treatment as prevention with the now very famous HPTN052 trial which reduced by 96% the likelihood that someone will transmit to their uninfected partner if you treat early, a great argument for getting people on treatment.
Balintfy: Dr. Fauci says ending the HIV/AIDS pandemic is an enormous, multifaceted challenge, but it can be done. It will require continued basic and clinical research, and the development and testing of additional treatment and HIV prevention interventions and, implementing these interventions on a much wider scale. For more information on HIV/AIDS research, and news from the AIDS 2012 conference, visit www.niaid.nih.gov.
AIDS 2012 extra
Balintfy: The theme of the AIDS 2012 conference is Turning the Tide Together, and more than 23,000 delegates from about 195 countries have participated. NIH Director Dr. Francis Collins also participated in a special session about the science of HIV. As a panel chair, he asked what lies ahead.
Collins: There was a lot of interesting science talked about in the panel that just meant excitement about the possibility of actually getting an effective vaccine based upon some early indications that we might understand in that one vaccine trial in Thailand, why it worked when it worked, and that's really critical; about new developments in terms of therapeutics of other sorts; and about the idea of a cure that we could actually figure out how to eradicate the virus completely from somebody who is infected so that they wouldn't have to take therapy for the rest of their lives. Very uncertain, very much built upon one patient in many situations, but still exciting.
And also, a really important conversation we had at this panel about what's going on in the rest of the world, in Malaysia, in Uganda, how do we achieve a complete elimination of mother-to-child transmission which we've pretty much managed to do in the US but not yet throughout the rest of the world; and a perspective from our advocates about research and where they think the priority should be, which in this field of HIV-AIDS has always been a very important voice and certainly not any less so now. And it was great that in this meeting all of that is mixed together in a way where we learn from each other, we both talk but we also listen.
Balintfy: The AIDS 2012 program included presentation of more than 3,600 scientific abstracts across the range of HIV-related disciplines.
Collins: There's a real sense of optimism here in 2012 that we have learned enough from hard one rigorous science that many people have pitched in and lots of inputs from advocates, lots of hard work around the globe that we can say with some confidence that we could achieve an AIDS-free generation with the tools that we have now. But it will not happen without an enormous sense of commitment across the globe and a willingness to roll our sleeves up and say, "We're not done here." We finally have a path forward to an outcome that we've dreamed of but we're not going to get there unless we all decide to make that a priority.
Balintfy: While the battle against AIDS continues, the fight against bacteria, and in-particular antibiotic-resistant bacteria, is also a major point of interest for researchers. Margot Kern reports that there may be a natural side-kick in the fight against bacterial infections.
Kern: The number of bacteria that are resistant to antibiotics continues to escalate, and with it, increases in the number of hospitalizations and healthcare costs. But scientists are coming up with new ways to reduce the amount of antibiotic needed to fight infections making it less likely that a bacteria will become resistant. Dr. Richard Okita is a program director at the NIH’s National Institute of General Medical Sciences. He comments on a recent study published by Dr. Charles Serhan of Brigham and Women’s Hospital in which a group of molecules found naturally in the body were used to help fight off an E. Coli infection in mice.
Okita: So if it’s a low grade bacterial infection and these molecules are released, what he’s found is that the amount of antibiotic that is needed to remove the bacteria from the site is actually less which was really surprising.
Kern: The molecules are called specialized pro-resolving mediators or SPMs. Resolve is the key word here. They put an end to acute inflammation before it becomes chronic and harmful to tissues. So how do they work?
When foreign bacteria enter the body, the body’s initiates an inflammatory response. Part of this response involves white blood cells which rush to the site of the infection and begin gobbling up the bacteria. SPMs aid this process by increasing the rate at which white blood cells can consume bacteria. As a result, the duration of the inflammatory response is decreased.
Okita: What they dream of is that these molecules may assist antibiotics to help them do their job of killing bacteria. So they will be an additive but in doing so they’ll be able to allow the body to respond quicker to that antibiotic.
Kern: In addition to helping get rid of the bacteria, SPMs also help dampen the inflammatory response. At the same time that white blood cells are gobbling up bacteria, they start producing proteins that increase inflammation. SPMs can inhibit the production of these proteins.
Okita: The work that Serhan’s group has done over the last ten years has really advanced the field of our understanding of how the inflammatory response can be resolved. So we’re hoping that over the next five years, next ten years, that again we can really see major advances where this can really be used to resolve and be used for medical treatment.
Kern: Dr. Okita explains one way in which Dr. Serhan’s group has contributed to scientist’s understanding of these powerful molecules.
Okita: One of the key problems has been these are molecules that are released in such small amounts that it takes really sophisticated technologies to identify the compounds. Because you have to find them in the tissues and so it becomes very complex and so he’s really made some major advancements in looking at or using the new technologies to identify these compounds.
Kern: Interestingly, SPMs are derived from polyunsaturated fatty acids such as Omega -3s which are found in foods such as salmon, sardines, flax seeds, and walnuts. The new findings by Dr. Serhan may help explain some of these foods exceptional health benefits.
Okita: You know, to me the exciting part is understanding. I mean 20 years ago, everybody used to talk about fish oils, omega-3 fatty acids. That’s all you saw was omega-3 fatty acids and now we’re getting a better understanding how the body uses the fish oil in human health, how do these molecules really help us in different states.
Kern: Dr. Serhan is also currently looking into how SPMs could help with treatment of chornic inflammatory diseases such as macular degeneration. One advantage of SPMs over typical anti-inflammatory such as aspirin, ibuprofen, and steroids, is that unlike these drugs, SPMS don’t suppress the immune system. For more information on SPMs, go to www.nigms.nih.gov. For NIH radio, I’m Margot Kern.
Balintfy: Coming up, NIH has a birthday some interesting history next on NIH Research Radio.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
The history, and birthday, of NIH
Balintfy: About one month from now, on August 27th, NIH will be exactly, 125 years old. To help understand the significance of this birthday, and the father of NIH, I’m talking with Dr. David Morens, an epidemiologist and senior advisor here. Dr. Morens has helped chronicle the triumphs and tribulations of the founder of NIH, Dr. Joseph Kinyoun.
Morens: Joe Kinyoun was an unknown physician, a young man in his 20s who joined the Marine Hospital Service in 1886, and set up a laboratory, one of the first microbiology laboratories in the United States and that laboratory became the National Institutes of Health.
Balintfy: Can you explain a little bit about his legacy for example, maybe his experience in San Francisco with the plague?
Morens: The San Francisco experience was kind of the fulcrum of his life and in many ways a tragic occurrence. Because he was assigned by the US surgeon general to go to San Francisco and set up quarantine operations to prevent plague from coming in and from being imported by ships coming from Asia. In that role as the representative of the federal government, he essentially ran afoul of California politics. The California politics were that California was then somewhat of a cowboy state and a strong defender of state’s rights against federal intervention in any sphere. When the federal government came in to institute quarantine, the California governor essentially declared war on the federal government. Kinyoun was the representative and he became the scapegoat in a big struggle between a powerful state and the federal government and he was sacrificed in that struggle.
Balintfy: You mentioned that cowboy time, he actually had to carry a gun with him.
Morens: He did. He carried a gun and he was under threat of physical harm and there was a $7000 reward for his death put out by shadowy interests in California supposedly. And he had to be protected by the police and by the United States Army. It was really a bad situation and he had to bear up under it with stoicism and tried to maintain his humanity during the whole thing.
Balintfy: Because the plague is actually, that was a very serious threat in those days.
Morens: Well it was. Plague was becoming pandemic in the world, pandemic meaning spreading all over the world. The plague had never been to the United States, but every physician and every educated person who had read history knew about the Black Death in the 14th century, which killed about 25% of the population in the known world at the time.
Balintfy: Would you say that this legacy was perhaps his greatest accomplishment or where there other things that you would highlight from his experience?
Morens: You know, it’s hard to say what his greatest accomplishment is. He was an eclectic guy. He did a lot of different things and I would say his legacy is that he covered not only the depth but the breadth of the brand new field of microbiology. He was involved in many if not most of the major microbiology and public health infectious disease efforts of the late 19th century, everything from pasteurization of milk to clean water supply to treatment of diseases with brand new medical treatments. You know, he was not just a quarantine specialist or even a public health specialist, he was a physician who found multiple unique ways through public health and medical and immunological tools to improve life. I think that’s the way he looked at it. I think he’d want to be remembered as a person who did as much as he possibly could for the general health and wellbeing of people in the United States and the world.
Balintfy: He sounds like quite a Renaissance man and perhaps a visionary as well. Is there much known about him as a person?
Morens: Well, you know, very little has ever been published about Kinyoun. But it turns out that there is information about him that does give a flavor of him as a person.
I think you get a sense of him as being kind of on the one hand a by the books conformist, a follower of orders, an original thinker but not somebody who had a big ego. He was happy to be in the background. He was apparently very well read and humorous and knew a lot about things. He was said to be a great conversationalist, a wit. He wrote poetry and he wrote fanciful stories about plantation life. He was born in 1860 and his parents were not plantation owners, but he was born in that antebellum south, that old fashioned south of Gone with the Wind, you know, and it had a certain romantic appeal to young men of that era who were born in the south. So he carried that with him all the rest of his life and loved to be in and talk about and tell stories about the old south.
Balintfy: That kind of wraps up the questions I had prepared, but is there a question that maybe I didn’t ask that I should have or perhaps something that you would want to reemphasize about Dr. Kinyoun?
Morens: Probably not. The only thing I would probably add that might be of interest is that we now think we know -- just recently we’ve discovered this. We believe we know the exact date of the founding of the Hygienic Laboratory, which is now the National Institutes of Health. We’re certain that that date is in August 1887 and we’re reasonably certain it was 27 August. So NIH now has a birthday.
Balintfy: Why is that important?
Morens: Well because, you know, I think scientists and government workers are sort of just like people. When we’re a child, one of the first things a child wants to know is mommy where did I come from. We want to know. It tells us who we are to know where we came from and I think as NIH scientists, all of us have sort of a desire to know who we are and where we came from and now we can say where we came from. We came from the mind of Joe Kinyoun and a small number of people who envisioned the Hygienic Laboratory at that time and we even know our birthday.
Balintfy: And I also think that knowing about our history will maybe help an agency kind of or maybe even help the public keep from repeating history. What do you think? Do you think there are lessons learned and --
Morens: I think that’s a good point, and you know, I won’t get into that because I think your point speaks for itself. I think that for the public and for the scientists, knowing who we are and where we came from, you know, it’s not in our mission to be historians, we’re scientists and we do cutting-edge, world class science. But I think it really in intangible ways that are perhaps a bit hard to explain, I think that helping us know who we are, where we came from, and what our history is also helps us go forward. If we know our legacy, it inspires us and motivates us and tells us what track we’ve been on and it points us in the direction of where that track is going. So I think it’s a positive thing to know about who we are in many respects and hopefully a little bit more knowledge of that will be inspiring to the scientists who carry us forward into this century, into the future.
Balintfy: That’s great. Thank you very much.
Morens: Thank you.
Balintfy: That’s Dr. David Morens, an epidemiologist and senior advisor at the NIH. For more about Dr. Kinyoun, and a recent article published in the journal mBio, visit www.niaid.nih.gov.
Balintfy: That’s it for this episode of NIH Research Radio. Please join us again on Friday, August 10th when our next edition will be available. If you have any questions or comments about this program, or have story suggestions for a future episode, please let me know. Send an email to NIHRadio@mail.nih.gov. Also, please consider following NIH Radio via Twitter @NIHRadio, or on Facebook. Until next time, I'm your host, Joe Balintfy. Thanks for listening.
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