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September 21, 2012
NIH Podcast Episode #0168
Balintfy: Welcome to episode 168 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: two awareness campaigns for September, one about pulmonary fibrosis and the other on cholesterol:
It’s important to look at your saturated fat intake, your fiber intake, maintain a healthy weight or if you are overweight try and lose weight and be physically active daily.
Also, the first of a new partnership between NIH Radio and the NCI Cancer Bulletin – we’ll learn about a biobank program. But first, this news update. Here’s Craig Fritz.
News Update
Fritz: NIH has announced that six projects have been awarded to fund development of robots that can interact and work cooperatively with people and respond to changing environments in a variety of healthcare applications. The awardees for the National Robotics Initiative (NRI) will work on projects that would accelerate the development of the next generation of robotics, called co-robotics. These projects include robots that help engineers design better prosthetic legs for amputees, miniature robot pills that help doctors diagnose and treat disease, and even microrobots that help researchers make artificial tissues. NIH director, Dr. Francis Collins said robots that can adapt to new situations and support the work and activities that people do on a daily basis are not just the future of robotics, they are already here. This work could result in more successful surgeries, better and faster recovery for stroke patients, and improvements in drug development and testing. Affordable, accessible robotic technology can facilitate wellness and personalized, home-based health care, especially for the growing elderly and disabled population. NIH is funding the projects along with the National Science Foundation, NASA, and the United States Department of Agriculture.
For this NIH news update – I’m Craig Fritz.
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up insight into your lungs and arteries, and a story of biobanks on NIH Research Radio.
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September is Pulmonary Fibrosis Awareness Month
Balintfy: September is Pulmonary Fibrosis Awareness Month. To learn more, I asked Dr. James Kiley here at the NIH, what is important for people to know about this lung disease?
Kiley: The important things for the public to know about pulmonary fibrosis is that it is a serious lung disease in which the tissues deep in the lung become thick, they become scarred, they become stiff and over time they prevent or cause difficulty with breathing. That scarred tissue is what’s called fibrosis. So when you have pulmonary fibrosis, you have lung impairment due to scarring of the lung tissue, which makes it very difficult to breathe and it then becomes a very debilitating disease.
Balintfy: What does it mean that most cases of pulmonary fibrosis are referred to as idiopathic pulmonary fibrosis?
Kiley: Well idiopathic pulmonary fibrosis means that at the present time, we cannot find the cause for pulmonary fibrosis. We don’t know the inciting agents responsible for pulmonary fibrosis and we don’t know exactly all of the pathology, pathobiology, the mechanisms that underline why some individuals are exposed to certain agents and get this pulmonary scarring that leads to pulmonary fibrosis and why some don’t. So the whole idea of how do we identify people early is a critical element in this disease because oftentimes it’s very slow in its onset and as such many individuals don’t recognize that they have something going on in their lungs. When they do, if it is pulmonary fibrosis, the prognosis is relatively poor.
Balintfy: Dr. Kiley, what are some of the signs and symptoms – how does someone know if they have it?
Kiley: Sure. With many of the lung diseases, you will often experience a shortness of breath, difficulty breathing. You may be fatigued. You may have some aching muscles. You may actually have some unintended weight loss that you really can’t explain. There’s also in pulmonary fibrosis a very obvious clubbing that occurs in the fingers, which means they become somewhat enlarged and rounded at the tips and that may also be an indication that something is going on that’s may be related to the lung condition. There’s sometimes a very dry cough that goes on. So these are some of the signs and symptoms, the biggest of all are the shortness of breath, the difficulty breathing in doing just normal activities and that’s one that you would want to be certainly aware of and discuss with your physician.
Balintfy: Is pulmonary fibrosis common – do you know who and how many people are affected Dr. Kiley?
Kiley: Pulmonary fibrosis is actually classified as a rare condition and we have estimates based on the published literature that it affects approximately 150,000 persons in the United States and that there’s an incidence of about 20,000 to 50,000 new cases per year. But it still maybe an underdiagnosed disease and what’s important about pulmonary fibrosis, September being pulmonary fibrosis month, is that this is an attempt to raise awareness about a very serious and important lung condition. It oftentimes affects older people but not necessarily only older people and that we know that there is some risk factors associated with pulmonary fibrosis, that people if they can take account of those would maybe be able to diagnose or get some attention to the disease much earlier than usual.
Balintfy: What are some of those risk factors?
Kiley: Well we know that some of the things that cause pulmonary fibrosis are various environmental pollutants, some of the inorganic dusts like hard metal dust and silica. Even some of the organic dust like animal proteins and bacteria may also have a role in initiation or inciting as an exciting agent for pulmonary fibrosis. Also, more recently, we’ve learned that chronic herpes virus infections seem to be associated with this disease. Certainly tobacco smoke and cigarette smoking has been associated with pulmonary fibrosis and interestingly enough, some individuals have gastroesophageal reflux which is also something that seems to be more common in the pulmonary fibrosis patient population. These are all potential risk factors that may be associated with the disease.
Balintfy: And again you say this is a serious disease.
Kiley: Yes. That’s the sad part about this disease that over what we’ve learned is that once the diagnosis is made that the disease progresses relatively rapidly and as such we know that the mortality is very high, three to five years out post diagnosis.
Balintfy: If somebody has IPF or pulmonary fibrosis, is there something they can do to manage the disease?
Kiley: There are a number of things that can be done and if pulmonary fibrosis is severe enough then supplemental oxygen may be helpful. There are therapies to manage the patient’s symptoms some of which could be diuretics to deal with reduce leg swelling, sometimes pulmonary rehabilitation can be helpful and your doctor can identify some approaches that may be useful. In the very end if some of these medical behavioral interventions don’t work or are not successful and the patient continues to deteriorate, either single or double lung transplant could be available for selected individuals with pulmonary fibrosis without certain comorbidities that may complicate that procedure.
Balintfy: Is the NIH currently supporting any IPF-related research or clinical trials?
Kiley: Yes, we have a very active and robust research program in pulmonary fibrosis and it’s certainly a priority area for the National Heart, Lung and Blood Institute. Many IPF projects are covering some very basic science, translational research, some clinical research. The NHLBI supports a clinical research network called the IPF Network. Right now, it’s sponsoring two clinical trials, one of them looking at current ways to manage IPF through pharmacotherapy, another looking at carbon monoxide as a treatment for IPF. So there are a number of trials going on that are addressing the problem. We also know that the pharmaceutical industry is very interested in this disease and they’re conducting a couple of trials of some very novel agents that may be prospects for the future. So we’re optimistic that maybe down the road there may be some interventions, some new agents that might be available for patients with pulmonary fibrosis.
Balintfy: Thank you Dr. Kiley. Before we finish, is there anything you would want to reemphasize for Pulmonary Fibrosis Month?
Kiley: I think that the important thing that we want to reemphasize in this whole awareness month effort is that it is a serious lung condition. It’s one that gradually develops and it’s one that has a poor prognosis. And it’s not good. So we’re very actively engaged in research to try to look for new therapies and look for ways to best manage this disease and try to do better with reducing the mortality and the suffering related to it.
Balintfy: Again, that’s Dr. James Kiley at the NIH’s National Heart Lung and Blood Institute. For more information on IPF and pulmonary fibrosis, visit www.nhlbi.nih.gov.
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National Cholesterol Education Month
Balintfy: September is also National Cholesterol Education Month, experts say it’s a good time to get your blood cholesterol checked. And why?
De Jesus: High cholesterol is a major risk factor for heart disease, which is the number one killer of Americans.
Balintfy: That’s NIH nutritionist Janet De Jesus. I asked her, what exactly is high cholesterol.
De Jesus: Just to back up a bit, cholesterol is a waxy, like fatty type substance that’s in your body. It circulates through the body naturally, but if there’s too much of it, it can cause problems and basically it builds up as plaque in your arteries and it causes hardening of the arteries, which is called atherosclerosis if it’s in the coronary arteries and this leads to coronary artery disease, which is the major type of heart disease.
Balintfy: And can people feel cholesterol as it builds up?
De Jesus: Absolutely not, not until you might feel angina or chest pain, which can happen after there’s quite a bit of buildup and the cholesterol or plaque buildup actually starts in children. You know, we have a lot of evidence on that. So it’s important to start early with these behaviors that we’ll talk about.
Balintfy: OK. So what behaviors or lifestyle changes can people take to treat high blood cholesterol?
De Jesus: So there’s two main portions, nutrition and physical activity and we call it the therapeutic lifestyle changes. The main portion of nutrition is to lower your saturated fat intake. So this type of fat is the solid fat so it’s in high fat dairy, high fat beefs and meats, it’s on the skin of poultry those types of things. Also, it’s important to maintain a healthy weight so losing weight will actually help you lower your cholesterol and there’s a couple of other items. There’s now an additive in foods called stanols and sterols. So this is naturally in plants but they found that it lowers LDL cholesterol. So if you do have high cholesterol, you can buy these products. They’re putting it in butters, salad dressings, even some like orange juice. But it’s better to prevent. If you can prevent, you know, keep a healthy weight, have a low intake of saturated fat, another point is physical activity can definitely help keep your numbers low.
Balintfy: You mention the TLC or therapeutic lifestyle changes programs. Can you explain more about how that program can help adults lower their cholesterol?
De Jesus: Sure, you usually start off with the nutrition part. So lowering your saturated fat intake, increasing your dietary fiber, which I didn’t mention before. It’s important to start slowly like take one step at a time because there’s a lot of features. You know, there’s saturated fat, the fiber intake, the healthy weight, the physical activity so it’s really important to start slowly and pick one of the items, kind of look at what you’re eating. If you don’t know what of your foods are high in saturated fat, you can work with a registered dietician or even start reading the food labels. So it’s really – it could take up to three months so you really have to give it a chance to work and then get your cholesterol rechecked by your doctor.
Balintfy: So people can use TLC both as treatment or prevention.
De Jesus: Absolutely.
Balintfy: Either way you want to get things measured first.
De Jesus: Definitely. I mean we encourage everyone to practice these behaviors not just those with high cholesterol. So it’s easier to prevent than to treat so we definitely encourage people to prevent before this happens. Know your numbers.
Balintfy: How can people get their numbers – how is blood cholesterol measured?
De Jesus: It’s measured by a blood test so the best type is a fasting lipid panel, which has to be done in your doctor’s office. You can go to screenings. You know they have them at the mall, they’re non-fasting and those will give you some results but not all of the details. So it could give you some high level results that may cause you to go to your doctor and get your fasting lipid panel measured.
Balintfy: NIH nutritionist Janet De Jesus, anything about National Cholesterol Education Month you would want to mention or reemphasize?
De Jesus: Just one thing to mention, there’s different things that affect your cholesterol level so for example hereditary. So some people it’s in your genes unfortunately, so there’s something called familial hypercholesterolemia where for example if your dad had it and perhaps it’s genetic, you may have harder time. It doesn’t mean that you have to live with high cholesterol, but it’s just something to be aware of especially in children, they’re now watching out for that. Age and gender affects blood cholesterol. So it starts rising naturally at age 20 so that’s when they encourage you know if you haven’t had it measured, definitely get it measured. So those are the things you really can’t change, but then the things you can change, you know, we talked about the lifestyle behaviors.
Balintfy: Thank you very much Janet De Jesus at the NIH’s National Heart, Lung and Blood Institute. For more information about cholesterol and the TLC program, visit the website, www.nhlbi.nih.gov. Coming up, how researchers are not just banking tissue samples, but creating a system to preserve and learn from our genes. That’s next on NIH Research Radio.
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Genotype-Tissue Expression Project
Balintfy: Welcome back to NIH Research Radio. In this episode, we are starting a new, reoccurring segment in partnership with the NCI Cancer Bulletin, a publication of the NIH’s National Cancer Institute. Writers from the Bulletin will talk about the stories they are covering. Our first writer is Ted Winstead. Welcome to NIH Research Radio. Ted can you first explain a little about the NCI Cancer Bulletin?
Winstead: The NCI Cancer Bulletin is an online newsletter that provides timely information about cancer research. Our readers include scientists, doctors, nurses, cancer patients, family members, advocates, and the interested public.
Balintfy: The most recent issue is from September 18th. What was the story that you had in that issue?
Winstead: One of the stories we had was about a project known as GTEx, which is about collecting normal tissue that can then be used to try to better understand how the body works.
Balintfy: What does GTEx stand for?
Winstead: GTEx stands for Genotype-Tissue Expression Project.
Balintfy: Basically, what's the project doing?
Winstead: The project is collecting multiple samples, little tiny pieces of tissue from people who have died and donated their bodies to research. Part of what's unique here is that they are collecting from up to 30 different kinds of tissue – from the body, from heart, muscles, skin, spleen – to try to understand how genes are regulated in each of these different tissues.
Balintfy: So it's more than just banking the tissues, right?
Winstead: That's right. Part of it is to develop a bank of tissues that researchers can use in the future, and it's also to try to learn how genetic variation, little differences in our DNA from one person to the next, how that may affect how genes are turned on and off in different tissues.
Balintfy: There's also a collection process. Can you explain a little bit about that?
Winstead: Yes. The collection process was overseen by the Cancer Human Biobank or caHUB, and they developed a whole new process, a whole new way for collecting all these tissues. As soon as tissue is removed from the body, it begins to change, and researchers like to know -- study tissue that's as close to how it is in the body as possible. And this project put into place more than 150 different standard operating procedures to try to make sure that the tissue changes as little as possible when it's removed from the body.
Balintfy: The government loves standard operating procedures.
Winstead: Sure.
Balintfy: It's also important for science for that standard, right, from measuring one sample to the next?
Winstead: That's correct. And right now there are many, many questions about what are the best ways to go about collecting and preserving and storing these issues, and many of the researchers on this project believe that the lessons learned and the procedures used in this study will guide future efforts to collect, process and store these tissues that are so important for scientific research.
Balintfy: While you were working on the story, were there some things that struck you about it?
Winstead: Yes, there were. I was struck by the basic approach which was the investigators wanted to leave nothing to chance, and they wanted to document everything they could in order to help biobankers going forward and researchers who use the tissues.
So one example is in the kits that were developed to ship the tissue from where it was collected to the biobanks, there are data loggers inside these kits that record the temperature every minute, and this could help researchers learn what are the best temperatures for shipping specimens. That question has never been asked before in a systematic way or on such a large scale.
Balintfy: What were some of the things that people you talked to said about the system and the whole topic?
Winstead: Everyone was enthusiastic. They said, “This has never been done and we are really excited to see what the results are.” The idea of being able to understand how inherited changes in our DNA have an impact on how genes are turned on and off would have many implications for researchers trying to understand both health and then disease as well.
Balintfy: Is there a question that I didn't ask that you think I should have or maybe something that you would want to reemphasize about your article?
Winstead: Many of the people I talked to said that without the donors and without their families, this would not be possible. Another aspect of this study is to also learn the best way to tell donors and donor families about the project and make sure that their consent is given, and that's another important area where researchers are still trying to learn the best ways to proceed.
Balintfy: I understand you're working on another story for this. You've done another story for this issue. Can you mention that one quickly as well?
Winstead: Yes. There have been five studies in the past two weeks describing the genetic landscape of lung tumors. This is being done on a larger scale than ever before and the Cancer Genome Atlas Project is taking a lead -- was the lead on one of these. And the good news is that all of the researchers found changes to genes or what they call pathways that could potentially be targeted by drugs, many of which exist right now.
Balintfy: Thank you very much Ted Winstead of the NCI Cancer Bulletin. For more on Ted’s stories visit the website, www.cancer.gov/ncicancerbulletin. There is a video available there as well. And for more on the GTEx program, visit the website, commonfund.nih.gov/GTEx. We’ll have more from Bulletin writers and editors in future episodes of NIH Research Radio.
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Balintfy: For now, that’s it for this episode of NIH Research Radio. Please join us again on Friday, October 5 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.
Announcer: 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.
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