i on NIH Vodcast
February 27, 2009
“i on NIH” Vodcast Episode #0018
Welcome to “i on NIH”!
Featured in this month's episode are segments about the NIH-OXCAM Scholarship Program (an innovative training path for exceptional students in biomedical and research doctoral training) and an in-depth interview about bipolar disorder.
From the national institutes of health in Bethesda, Maryland – America's premiere medical research agency – this is “i on NIH”!
Covering health-research topics important to you and the nation, this public service vodcast is your information source from inside all 27 institutes and centers at NIH.
Half an hour, once a month, we'll show you the excitement of advances and the important information that comes from medical research.
And now, here's your host, Joe Balintfy.
Host: Welcome to the 18th episode of I on NIH. Thanks for tuning in! In this edition, we take a look at a unique scholarship opportunity. We get the perspective of students enrolled in the OXCAM Scholarship Program and talk to the program's director. Also, we'll have an eye-to-eye interview about bipolar disorder. But first, we have our research update with Harrison Wein from the NIH News Desk. What do you have for us this month, Harrison?
Harrison: Today I'll tell you about a new way to detect cataracts, an online tool for predicting colorectal cancer risk, and a treatment for Parkinson's disease.
Joe: So the first study is about cataract detection. That's a clouding of the eye lens. Can't an eye doctor just see there's a problem?
Harrison: Well, Joe, by that time, it's too late to fend off the cataract. You might be able to do that by making simple lifestyle changes we already know about: reduce sun exposure, quit smoking, stop taking certain medications and control your diabetes. So it could make a big difference if you could detect changes in the eye that might lead to a cataract before the cataract forms.
Joe: Now I see the researchers used space technology.
Harrison: It was actually a NASA scientist who first brought an idea to the attention of vision researchers at NIH. He learned that his father's cataracts were caused by changes in proteins in the lens of the eye. He knew of a laser light technique called dynamic light scattering. It was developed to analyze the growth of protein crystals in space. He thought it also might be used to develop a simple, safe eye test for detecting the lens protein changes that lead to a cataract.
They developed and tested the device in animals, and this new study is the first clinical trial. They found that the device was able to detect early damage to the lens, before you could see any cloudiness. So this could be an early warning system for cataract formation and blindness.
Joe: Very good. The next story is about an online tool that NIH researchers developed to assess colorectal cancer risk.
Harrison: Yes. There are several screening options for colorectal cancer. Now, if there were a better way to assess a person's risk, it could help doctors and patients decide which of these tests to get.
Joe: So how did they go about making this tool?
Harrison: First they created a model for assessing risks, and then they made sure it could accurately predict risk. The model takes into account several factors: age, a family history, diet, physical activity and a list of other factors too long to mention here.
The online tool they came up with is pretty easy to use, and it gives you an estimate of your risk of developing colorectal cancer over 5 years, 10 years and over the course of a lifetime.
Joe: And that's available at www.cancer.gov/colorectalcancerrisk, all one word.
Harrison: Yes. Let me give you a couple of caveats, though. This was developed using data from mostly non-Hispanic white people 50 or older. The researchers are working to expand the tool for others. Second, keep in mind that a risk prediction tool for a health condition is kind of like one of those financial planning tools you see on the web. They can help you decide what to do, but they're no guarantee of how things are going to turn out. So if you use it, make sure to work with your doctor to interpret the results and plan what to do about them.
Joe: The last story you mentioned was about Parkinson's disease. Now, this is a story we've covered before.
Harrison: You actually had a feature story about this procedure. It's called deep brain stimulation. It's been used for more than a decade to treat patients whose Parkinson's symptoms can't be controlled with medication.
It involves implanting tiny electrodes into brain regions that control movement. When the electrodes are stimulated, they inhibit the brain signals that cause the movement abnormalities of Parkinson's disease. But despite this procedure's long-term use, few randomized trials have tested its effectiveness against other, less invasive therapies.
This latest study involved 255 patients with advanced Parkinson's disease. They were randomly assigned to receive either deep brain stimulation or standard therapy. By 6 months after the surgery, movement control improved in 71% of patients who received brain stimulation, compared to 32% in the standard therapy group. But on the down side, there were also more serious problems in patients who received deep brain stimulation.
Joe: So what can people with Parkinson's take from this?
Harrison: Well, the researchers are now looking at the longer term effects of the procedure. Until more data comes in, they recommend that doctors and patients carefully weigh these benefits and risks when they're deciding on a treatment.
Joe: And where can people find out more about these studies?
Harrison: You can read about these and many other research studies in "NIH Research Matters." Go to the NIH home page and look for the link on the right-hand side, under "In the News" that says, "eColumn: NIH Research Matters"
Joe: And what's in this month's health newsletter?
Harrison: Our cover story for "NIH News in Health" in February is about how pets can affect your health. We also have a story about thyroid diseases and more.
Joe: And where can people find that?
Harrison: That's at news-in-health-dot-nih-dot-gov.
Host: Thanks Harrison. Now for our first feature. Nearly 100 of the United States' most promising biomedical PhD students have been admitted to the NIH-Oxford-Cambridge Scholars program. Dr. Michael Lenardo is the director of the OXCAM program, and explains what it is.
Lenardo: The NIH-Oxford-Cambridge Scholars Program is an attempt to create an innovative training path for exception students in biomedical research doctoral training. And the program was started originally in 2001 involving Oxford University, and then was expanded to Cambridge University in order to provide students the opportunity to do a collaborative degree between two outstanding international universities, Oxford and Cambridge, and the National Institutes of Health Intramural Laboratories in Bethesda, Md., and some of the satellite campuses, which is the largest biomedical research enterprise in the world.
Joe: OXCAM scholar Kristina Cook has an undergraduate degree from San Diego State in biology, molecular biology, and biochemistry, with a minor in chemistry. She explains her interest in the program.
Cook: Well, when I first read about it, it seemed like something completely different, something very new and exciting, and the fact, obviously, that the National Institutes of Health and the University of Oxford are, you know, great scientific institutions
Also, because of my background in chemistry and biology, I wanted a project that was very cross-disciplinary. And it gave me the opportunity to have two advisors, one in chemistry and one in biology that could come together, and so that was a big selling point.
Joe: OXCAM scholar Sam Day from Tucson, Arizona agrees that the program offers access to the insights and resources of multiple mentors at the collaborating institutions.
Day: You get two probably very successful mentors that may have very different outlooks or approaches to how they conduct scientific research, so you get to sort of pick and choose from those two worlds, and really sort of apply the strengths of each one to your particular work.
Cook: You learn a lot having two advisers, and from two different cultures as well. And being in different time zones, trying to communicate between the two, I think I’ve learned a lot about communicating, how to balance different researchers involved in different areas.
Lenardo: So one of the emphases in the program is to bring together mentors who come from different disciplines, and sometimes the students even have three or four mentors, in which they can put different disciplines together -- a component, say, in oncology, imaging, nanoparticles, to really create something new that draws a little bit from each of those different areas.
Joe: Molly Perkins, a student at the University of Oxford, sees another benefit:
Perkins: I think the major benefit of this program over all of the other programs that I applied to, in a lot of ways, is not just the advising that I get from my supervisors, but also the opportunities to collaborate with people outside of that.
Joe: Perkins studies HIV and its interaction with another virus called GBV-C.
Perkins: We’re interested in GBV-C because people who have HIV and GBV-C tend to live longer, on average, than people who just have HIV. And so by looking -- trying to understand the mechanism of that interaction, how GBV-C might interfere with HIV, we hope to understand how HIV causes disease, and maybe develop new treatments for HIV.
Day: Well, my research is primarily development of applications of magnetic resonance imaging for detection of tumor treatment response. So we’re trying to improve patient management, basically, through advancement of technology with imaging.
Cook: I’m looking into angiogenesis, which is blood vessel growth. So basically, we know that solid tumors cannot continue to grow without angiogenesis, without these new blood vessels coming in and bringing nutrients, so the idea is you could make an anti-cancer treatment by stopping the blood vessel growth, so I’m working on designing drugs that would stop the blood vessel growth, which enables the cancer cells to not grow -- they’re not getting nutrients, they’re not getting oxygen -- and they start to die. So that’s the theory behind what we’re trying to target.
Lenardo: One of the things that we feel is especially important about the program is that the students all carry out an individualized curriculum. We don’t have a uniform set of coursework or a uniform set of teaching experiences for the students, because every student comes to us with a different set of background in courses that they’ve taken, other scholarship or research that they’ve done, and so we try to build on that individual foundation to give the students the knowledge that they need to be successful in the particular field that they’ve chosen for their research.
Joe: OXCAM scholar Andy Johnson, originally from Ames, Iowa, chose his field, now combining genetics and immunology in his research, at an early age.
Johnson: When I was 11 years old, my grandma and great-grandma on my mother’s side died of cancer. And so, when I got back from the second funeral, I asked my fifth grade teacher -- you know, they’re always asking, “What do you want to do for your career?” and taking all these career days, and I said, “Well, I want to cure diseases, so what career is that?” And she told me: immunology. And so this is a small-town teacher that knew exactly what immunology was, so ever since I was 11 I’ve wanted to get my Ph.D. in immunology.
Schroeder: My undergraduate was in biology, and I did a master’s in bioengineering, where I focused on biomedical imaging, which is both where I see my career, and it’s been a useful research tool so far in my Ph.D. thesis.
Joe: Jamie Schroeder narrowed his thesis with help from mentors.
Schroeder: The narrowing of my thesis started to come when I met up with my current NIH mentor, and now my real topic is the cellular level of that physiology. So how do specific changes -- first of all, maybe a broad change, but in specific it’s still these dietary changes that I’m looking at, but how do they affect a cell’s ability to regulate its metabolism? So what we are doing is this in vivo microscopy -- this is just a microscope that’s looking at a living animal.
Schroeder: I think the most important thing that I’ve been able to do is to both work on technologies that I think will be relevant to the future of either diagnostics or research tools, and be in really cutting-edge labs, where I’m working with scientists that are -- they’re experts in their field.
Johnson: I really like the interdisciplinary action of it. So you combine all of these different types of sciences, and you have to -- there are, kind of, interpersonal relationships that are very important for scientists, and it kind of is -- it brings together chemistry, and biology, and all of these different backgrounds.
Lenardo: So for advanced students, this is really a very powerful pathway to allow them to get into the substance of their work much, much earlier, and begin to develop new ideas, and actually carry those ideas out at the bench.
Joe: For more information on the OXCAM Scholars Program, visit the website oxcam.gpp.nih.gov. You can also hear more from the interview with Dr. Lenardo in the NIH Research Radio Podcast. Check out episode 76 from January 23 for that interview.
Host: Now to wrap up this episode, we have an eye-to-eye interview about bipolar disorder. Our conversation is with Dr. Ellen Leibenluft (LEE-bin-loft), director of the pediatric bipolar research unit at the National Institute of Mental Health. We started by asking what exactly is bipolar disorder.
Dr. Leibenluft: Bipolar disorder is characterized by mood swings, and in particular, by episodes of dysfunctional mood, and those episodes are episodes of mania, and episodes of depression. So people with bipolar disorder experience both these kinds of mood swings.
Joe: How common is bipolar disorder?
Leibenluft: The prevalence of bipolar disorder in the general population is somewhere in the vicinity of two to three percent. It is equally -- it impacts equally on men and women, so there’s no gender difference in that. And there’s been an increased recognition of the fact that it can affect children. Although the usual age of onset is late adolescence or early adulthood.
Joe: Are there risk factors for bipolar disorder?
Leibenluft: There very definitely are risk factors for bipolar disorder. We do know that bipolar disorder does tend to run in families. It is one of the more heritable psychiatric illnesses. And one of the things that we’re doing is we’re studying children who are at risk for bipolar disorder, children who either have a parent or a sibling with the illness, so that we can see if there are very early signs, so we can see if we can predict who will develop the illness and who won’t. Because ultimately, we want to not just treat the illness and of course cure the illness, but we also want to be able to prevent it.
Joe: What treatments are available for bipolar disorder?
Leibenluft: There are a number of treatments available for bipolar disorder. Some of the mainstays of treatment include the so-called mood stabilizers, lithium being the one that was first identified. Also, valproate is another important mood stabilizer. In addition, some of the so-called atypical antipsychotics are often used to treat both mania and sometimes, now there’s some evidence that they can even help with the depression that goes along with bipolar disorder. And then the antidepressants, the so-called serotonergic antidepressants can also be used to treat the depression part of bipolar disorder. But really, the mainstay of it is the mood stabilizers.
Joe: Are there also non-pharmaceutical treatments for bipolar disorder?
Leibenluft: Some specific forms of psychotherapy have been used to help with bipolar disorder. They’re always used in addition to medication, not instead of. For example, psychoeducation, teaching people about their illness, so that they can identify early on when they’re getting into a mood state, and can take certain actions to head it off, either stabilizing their sleep/wake cycle, for example, or shifting around their medications. Also, certain kinds of family therapies have been used, again to help stabilize the situation, particularly when the patient is a young adult, or an adolescent.
Joe: Are there some special concerns when it comes to diagnosing bipolar disorder in adolescents and children?
Leibenluft: The issue that’s arisen is the question of whether bipolar disorder looks similar in children as it does in adults. Early on, I had mentioned that bipolar disorder in adults is characterized by episodes of mania and depression, and the question that has been raised is whether children who get very, very severely irritable, but don’t have those specific episodes, whether that’s also bipolar disorder or not. We know that some children do have classic episodes, so you can find children who look very similar to what adults with bipolar look like, but that’s relatively rare. So the more complex and problematic issue, in a certain sense, is how to think of children who don’t have episodes like that, but are very, very irritable.
Joe: What is the difference between severe mood disregulation and bipolar disorder?
Leibenluft: The children with mood disregulation are as impaired as the children with bipolar disorder. They’ve been hospitalized, on average, as many times. They’re on as many medications. And if you look at standardized ways of rating how impaired they are, at school and at home, they’re every bit as ill. So it’s a very, very important group for us to understand, but they don’t fit into the current diagnostic system very well. They don’t have the episodes that would give them the diagnosis of bipolar disorder, but you could call them ADHD, or Oppositional Defiant disorder, but that doesn’t really take into account how severe their mood problem is.
Joe: For more information on bipolar disorder, visit the NIMH website at www.nimh.nih.gov. You can also hear more from Dr. Leibenluft by checking out episode 74 of the NIH Research Radio podcast from December 26, 2008.
Host: And that’s it for another edition on I on NIH. If you’d like to see or forward individual segments from this program, they’re available on YouTube. Check out the NIHOD channel. There’s also many more NIH videos on the NIH4Health YouTube channel. Thanks for tuning in and please watch again next time. For I on NIH, I’m Joe Balintfy.
Host: “I on NIH” is a public service vodcast from the Department of Health and Human Servives. Produced by NIH News Media Branch, of the Office of the Director, Office of Communications and Public Liaison. Thanks for tuning in. We’ll be back again next month with another episode of “I on NIH.”
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