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PSC Partners Seeking a Cure Announces Ninth Annual Conference

Posted by UPMC Physician Resources on Tuesday, February 26th 2013     

UPMC is proud to be a sponsorof the PSC Partners Seeking a Cure’s ninth annual conference for physicians and those affected by primary sclerosing cholangitis (PSC). The conference will be held April 26 to 28, 2013, at the DoubleTree Hotel & Suites, located in downtown Pittsburgh.

The purpose of the conference is to discuss the latest medical advances in the search for better treatments and a cure for PSC, and to offer PSC patients and caregivers the chance to network in an informal setting.

Highlights from UPMC experts include:

  • Natural History of PSC – Kapil Chopra, MD
  • New Advances in the Evaluation of Biliary Strictures – Adam Slivka, MD
  • PSC in Children: The Same Disease? – Benjamin Shneider, MD
  • Improving Quality of Life in PSC: Targeting Pain, Sleep, and Fatigue – Eva Szigethy, MD, PhD
  • Living-Donor Liver Transplant – Abhinav Humar, MD

To register and for more conference information, visit www.pscpartners.org/nextannual or email us at contact@pscpartners.org.

category: Abdominal Transplant, Gastroenterology, Liver Transplantation, Transplantation, UPMC
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Even Limited Physical Activity is Linked to Lower Rates of Depression in Bariatric Surgery Patients

Posted by andrewsj3 on Thursday, February 14th 2013     
PITTSBURGH, Feb. 14, 2013 – Adults undergoing bariatric surgery who are more physically active are less likely to have depressive symptoms and to have recently received medication or counseling for depression or anxiety than their less active counterparts, according to new research led by the University of Pittsburgh Graduate School of Public Health.
 
“Typically, clinical professionals manage their patients’ depression and anxiety with counseling and/or antidepressant or anti-anxiety medication,” said Wendy C. King, Ph.D., epidemiologist at Pitt Public Health and lead author of the research, which is reported in this month’s issue of the Journal of Psychosomatic Research. “Recent research has focused on physical activity as an alternative or adjunct treatment.”
 
Adults with severe obesity are nearly twice as likely to have a major depressive disorder (13.3 percent) or anxiety disorder (19.6 percent) when compared to the general population (7.2 and 10.2 percent, respectively). Dr. King noted the importance of treating these conditions prior to surgery, as preoperative depression and anxiety increase the risk of these conditions occurring after surgery and have been shown to have a negative impact on long-term surgically induced weight loss.
 
As part of the Longitudinal Assessment of Bariatric Surgery-2, an observational study designed to assess the risks and benefits of bariatric surgery, Dr. King and her colleagues assessed participants’ physical activity for a week prior to undergoing bariatric surgery using a small electronic device worn above the ankle. Participants also completed surveys to assess mental health functioning, depressive symptoms and treatment for psychiatric and emotional problems, including depression and anxiety.
 
A total of 850 adults who were seeking bariatric surgery between 2006 and 2009 from one of 10 different hospitals throughout the United States were included in the study.
 
Approximately one-third of participants reported depressive symptoms, while two in five reported taking medication or receiving counseling for depression or anxiety. “Those who reported treatment were more likely to report impaired mental health functioning and depressive symptoms, highlighting the need for better treatment modalities,” said Dr. King.
 
The association between physical activity and these outcomes was strongest when only moderate intensity physical activity was considered. However, the number of steps a person walked each day, no matter the pace, also was related.
 
“Another goal of this study was to determine physical activity thresholds that best differentiated mental health status,” said Dr. King. “We were surprised that the thresholds were really low.” Just one hour of moderate-intensity physical activity a week—or eight minutes a day—was associated with 92 percent lower odds of treatment for depression or anxiety among adults with severe obesity. Similarly, just 4,750 steps a day—less than half the 10,000 steps recommended for a healthy adult—reduced odds of depression or anxiety treatment by 81 percent. 
 
“It could be that, in this population, important mental health benefits can be gained by simply not being sedentary,” said Dr. King.
 
Because this was an observational, cross-sectional study—meaning patients’ regular physical activity behavior and depressive symptoms were measured at the same time—it could not prove that a patient’s physical activity influenced mental health status.
 
“Results of the study are provocative, but we would need further research to verify that physical activity was responsible for lower levels of depressive symptoms in this patient population,” said study co-author Melissa A. Kalarchian, Ph.D., associate professor at Western Psychiatric Institute and Clinic of UPMC. “Nonetheless, physical activity is a key component of behavioral weight management, and it is encouraging to consider that it may have a favorable impact on mental health as well.”
 
Additional collaborators on this research include Kristine J. Steffen, PharmD., Ph.D., and James E. Mitchell, M.D., both of the Neuropsychiatric Research Institute; Bruce M. Wolfe, M.D., Oregon Health & Science University; and Katherine A. Elder, Ph.D., Pacific University.
 
This research was funded through a cooperative agreement by the National Institute of Diabetes and Digestive and Kidney Diseases.
category: UPMC
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Large Study Shows Substance Abuse Rates Higher in Teenagers with ADHD

Posted by andrewsj3 on Monday, February 11th 2013     
PITTSBURGH, Feb. 11, 2013 – A new study published online in the Journal of the American Academy of Child and Adolescent Psychiatry revealed a significantly higher prevalence of substance abuse and cigarette use by adolescents with attention deficit hyperactivity disorder (ADHD) histories than in those without ADHD. Researchers from the University of Pittsburgh School of Medicine and six other health centers across the United States also found that, contrary to previous findings, current medications for ADHD do not counter the risk for substance abuse and substance use disorder (SUD) among teenagers. 

This study is the first to examine teenage substance abuse and treatment for ADHD in a large multi-site sample. It also is the first to recognize that increased use of cigarettes in teenagers with ADHD histories commonly occurs with use of other substances such as alcohol and marijuana.
“This study underscores the significance of the substance abuse risk for both boys and girls with childhood ADHD,” said Brooke Molina, Ph.D., professor of psychiatry and psychology at the University of Pittsburgh School of Medicine and lead author of the report. “These findings also are the strongest test to date of the association between medication for ADHD and teenage substance abuse.”

  
Researchers studied nearly 600 children over an eight-year period from childhood through adolescence to test the hypothesis that children with ADHD have increased risk of substance use and abuse or dependence in adolescence. Molina and colleagues also examined substance abuse patterns, the effects of ADHD medications over time, and the relationship between medication and substance use.
The findings showed:
• When the adolescents were an average of 15 years old, 35 percent of those with ADHD histories reported using one or more substances, as compared to only 20 percent of teens without ADHD histories.
• Ten percent of the ADHD group met criteria for a substance abuse or dependence disorder, which means they experienced significant problems from their substance use, as compared to only 3 percent of the non-ADHD group.
• When the adolescents were an average of 17 years old, marijuana was particularly problematic with 13 percent versus 7 percent of the ADHD and non-ADHD groups, respectively, having marijuana abuse or dependence.
• Daily cigarette smoking was very high at 17 percent of the ADHD group, a significantly higher rate than national estimates for this age. The smoking rate of non-ADHD teens was only 8 percent.
• Alcohol use was high in both groups, highlighting its common occurrence for teenagers in general.
• Substance abuse rates were not different for children who were still being treated with ADHD medication compared to children who were not.
The authors noted the important finding that substance abuse rates were the same in teenagers still taking medication and in those no longer on medication, even after considering multiple factors that might cause teenage medication use. They noted that these results suggest a need to identify alternative approaches to substance abuse prevention and treatment for boys and girls with ADHD.
“We are working hard to understand the reasons why children with ADHD have increased risk of drug abuse. Our hypotheses, partly supported by our research and that of others, is that impulsive decision making, poor school performance, and difficulty making healthy friendships all contribute,” added Molina.
“Some of this is biologically driven because we know that ADHD runs in families. However, similar to managing high blood pressure or obesity, there are non-medical things we can do to decrease the risk of a bad outcome. As researchers and practitioners, we need to do a better job of helping parents and schools address these risk factors that are so common for children with ADHD.”
Collaborators on this study include Stephen P. Hinshaw, Ph.D., of the University of California, Berkeley; Eugene Arnold, M.D., of Ohio State University; James M. Swanson, Ph.D., of the University of California, Irvine; William E. Pelham, Ph.D., Florida International University; Lily Hechtman, M.D., of McGill University; and others.
This research was supported by cooperative agreement grants and contracts from the National Institute of Mental Health (NIMH) and the National Institute on Drug Abuse

category: UPMC
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Evaluating Evolutionary Rates Could Provide Insight into Functions of Uncharacterized Genes

Posted by andrewsj3 on Friday, February 8th 2013     
PITTSBURGH, Feb. 8, 2013 – Genes that have roles in the same biological pathways change their rate of evolution in parallel, a finding that could be used to discover their functions, said a researcher at the University of Pittsburgh School of Medicine in the February issue of GENETICS.
 
Humans have nearly 21,000 genes that make as many proteins, but the functions of most of those genes have not been fully determined, said lead investigator Nathan Clark, Ph.D., assistant professor of computational and systems biology at the Pitt School of Medicine. Knowing what a particular gene does could help unravel the workings of the body, foster understanding of disease processes and identify targets for new drugs.
 
“For our study, we took a close look at the way genes evolved between species and we found an interesting signature,” he said. “Genes that perform biological functions together have similar evolutionary histories in that the rates at which they change parallel each other. This could allow us to identify partner genes that we might never have suspected to work together in biochemical pathways.”
 
The researchers studied the evolving genomes of 18 yeast species and 22 mammalian species, looking particularly at genes that are involved in meiosis, a cell division process, and in DNA repair. They found parallel changes, such as acceleration or deceleration, in evolutionary rates among not only genes encoding proteins that physically interact with each other, but also among those that had no direct contact but still participated in meiosis or DNA repair pathways.
 
All genes mutate over time, which can be beneficial, harmful or meaningless. Some yeast species evolved a different method of reproduction and meiosis stopped as it was no longer essential for survival, Dr. Clark said. Through subsequent generations, the rate of change in the genes involved in making meiosis proteins accelerated, leading to deterioration of the unnecessary DNA sequences.
 
“A key question is: How important is that gene at that time?” he said. “If a species encounters a new challenge in its environment, the genes associated with it might have to evolve through subsequent generations in order to adapt that important pathway and ensure species survival.”
 
By tracking those complementary rate changes, it could be possible to identify which genes participate in the same important pathways, providing clues to their function.
 
“In the future, a researcher studying a particular disease process might be able to plug in a couple of known genes in a database of evolutionary rate changes to find others that have a parallel history,” Dr. Clark said. “That could provide new insight into the workings of the biological pathway of interest.”
 
The paper’s other authors are Eric Alani, Ph.D., and Charles F. Aquadro, Ph.D., both of Cornell University. The project was supported by National Institutes of Health grants GM53085 and GM36431.
category: UPMC
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Biomarkers May Predict Acute Kidney Injury in Critically Ill Patients

Posted by UPMC Physician Resources on Wednesday, February 6th 2013     

PITTSBURGH, Feb. 6, 2013 – An international, multi-center study led by UPMC researchers found biomarkers that can tell a physician if a patient is at risk for acute kidney injury (AKI), a condition that often affects those in intensive care and can occur after serious infections, surgery, or taking certain medications. The results, now available online and published in the current edition of the journal Critical Care, provide insight into the potentially deadly condition that affects up to 7 percent of all hospitalized patients.

Existing methods of determining kidney function, such as measuring serum creatinine and urine output, may not indicate changes for several days, allowing time for significant kidney damage to occur. Biomarkers, which are naturally occurring proteins or other molecules in the blood, urine, or other body fluids or tissues, may help physicians more accurately determine the risk of AKI in critically ill patients so that early treatment can minimize progression and save lives. 

“If unchecked, AKI can lead to loss of kidney function, often resulting in lower quality of life or even death. Our data show that these biomarkers provide more information than traditional tests for kidney function and give us a better understanding of what physically happens when a kidney is damaged,” said senior investigator John Kellum, M.D., a critical care physician at UPMC and professor of critical care at the University of Pittsburgh.

AKI risk is difficult to determine because the condition is typically caused by something outside of the kidney, including sepsis, nephrotoxins and oxygen deprivation. The study aimed to identify early markers in order to detect AKI when interventions could provide benefit. Researchers collected blood and urine samples of more than 1,000 critically ill patients in North America and Europe. The biomarkers, known as TIMP-2 and IGFB7, signal that the kidneys are stressed and not functioning properly but may still recover. They are indicators of cell damage, a key component in the onset of AKI.

“These biomarkers send an early ‘alarm’ from the site of the injury and offer a better chance at treatment that can prevent further damage,” Dr. Kellum said.

Co-authors of the study include researchers from 35 medical centers worldwide.

The study was sponsored by Astute Medical Inc. Dr. Kellum has received consulting fees from Astute Medical.

category: Kidney, UPMC

Return-to-Play Decisions Should Commonly Follow Post-Exertion Neurocognitive Testing, Researchers Find

Posted by andrewsj3 on Wednesday, January 30th 2013     
PITTSBURGH, Jan. 30, 2013 – Too many athletes may be going back onto the field, court or rink too soon after a concussion, according to a new study that recommends athletes undergo post-exertion neurocognitive testing before being cleared to return to play.
 
Three UPMC clinicians and researchers were co-authors of a study published in the January edition of Brain Injury showing that cognitive concussion issues may linger undetected in athletes at rest. That’s what the Boston-based study, by lead investigator Neal McGrath, Ph.D., and Wayne Dinn, Ph.D., of Sports Concussion New England, found in more than one in four high-school age athletes. They reported being symptom-free and returned to baseline neurocognitive-test levels, meaning most clinicians and state laws would allow them to return to their sports. Yet, in spite of feeling ready to return, 27.7 percent of these athletes displayed at least one area of cognitive decline after moderate physical exertion.
 
Those players were then kept from contact sports, allowed more time to heal and ultimately passed post-exertion cognitive testing before being cleared to return to play. Thus, the researchers concluded that computerized neurocognitive testing following moderate exertion should be part of the standard procedure when making return-to-play decisions for athletes for whom activity or exercise shows that they remain cognitively impaired.
 
“For years now, it has been widely understood that no contact-sports athlete should return to play until all signs point to a full recovery,” McGrath said. “We have also known that computerized neurocognitive testing can show lingering cognitive deficits even when recovering athletes feel symptom-free. It has been standard practice to progress symptom-free athletes back through increasing physical activity over a few days while checking for a recurrence of symptoms. These findings suggest that post-exertion neurocognitive testing may be an important way to help verify that recovering athletes are ready to sustain hits again in football, hockey, soccer and other contact sports.”
 
“We feel the issue is less related to heart rate and more related to the vestibular system, which is responsible for helping us to navigate our environment—space, motion, movement, balance,” said Michael “Micky” Collins, Ph.D., executive and clinical director of the UPMC Sports Medicine Concussion Program and a participating investigator in the study. “The role and importance of exertion in recovery from concussion is ubiquitous; that’s why we have a full-time exertional physical therapists in our program. This study looked at physical exertion. But I think in future studies we need to look at return-to-school and cognitive function back in the classroom as well.”
 
From a pool of more than 800 concussion cases reviewed over a two-year period, 54 contact-sports athletes from 15 high schools and a junior-hockey team met the criteria for the study, which used their scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) and clinical examinations by an attending sports-medicine professional. McGrath, a clinical neuropsychologist, also independently confirmed the findings of a concussion in each athlete. When the players exhibited no more symptoms and their neurocognitive scores returned to baseline levels—determinants used by most clinicians and state laws in permitting athletes to return to play—participants were put through moderate exercise for approximately 15 to 25 minutes on a treadmill, elliptical or stationary bicycle. After a brief rest period, they completed neurocognitive testing again.
 
Fifteen of those athletes (the aforementioned 27.7 percent) displayed cognitive deficiencies that would categorize them as still injured with a concussion and therefore unfit to return to play. In particular, these athletes scored significantly lower in the verbal and visual memory portions of the neurocognitive testing. However, processing speed and reaction scores did not worsen following exertion.
 
“This suggests that tests focusing primarily on reaction time or processing speed may not be as effective at detecting post-exertion impairment,” said Anthony Kontos, Ph.D., assistant research director of the UPMC Sports Medicine Concussion Program. “As such, a comprehensive test that includes verbal and visual memory in addition to these other tests should be used by clinicians.”
 
“Moving forward, we plan additional research involving a larger sample that includes more girls,” Kontos added, citing this study’s small number of female participants (11 of the 54). “We also plan to examine the effects of different levels of exertion on cognitive performance.”
 
In addition to Drs. Collins and Kontos, also working from Pittsburgh on the unfunded study were: founding UPMC Concussion Program director Mark Lovell, Ph.D., of ImPACT Technologies; and R.J. Elbin, Ph.D., fellow with the program’s research arm.
category: UPMC
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Physical Activity Counseling Can Result in Better Outcomes for Bariatric Surgery Patients

Posted by andrewsj3 on Wednesday, January 30th 2013     
PITTSBURGH, Jan. 30, 2013 – People who lose weight with bariatric surgery may have better results if they receive counseling about increasing physical activity before and after surgery, according to researchers from the University of Pittsburgh Graduate School of Public Health and Warren Alpert Medical School of Brown University.
 
The findings, as well as recommendations on how best to tailor physical activity counseling to patients, are published in the January issue of Exercise and Sports Sciences Reviews, a publication of the American College of Sports Medicine. The research was funded by the National Institutes of Health (NIH).
 
“On their own, bariatric surgery patients are not likely to significantly increase their physical activity following surgery,” said Wendy C. King, Ph.D., epidemiologist at Pitt Public Health and lead author of the paper. “However, with assistance, motivated patients can increase their activity level and get real health benefits.”
 
Using activity monitors that capture movement and the intensity of physical activity, Dr. King and her co-author, Dale S. Bond, Ph.D., an assistant professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University, found that without counseling, most bariatric surgery patients are insufficiently active prior to surgery and, without support, fail to substantially increase their physical activity after surgery, despite significant weight loss and improvements in their physical function. 
 
Drs. King and Bond used their previous and ongoing research, as well as the research of other scientists, to estimate that pre- and postoperative physical activity counseling could increase the physical activity level of bariatric surgery patients by about 50 percent.
 
Previous research suggests that even mild increases in physical activity preoperatively can reduce surgical complications and improve healing after surgery.  
 
“Because of patients’ health-related barriers to physical activity, clinicians may be inclined to hold off on advising their patients to become more physically active until after the surgery helps them lose weight,” Dr. King said. “However, the U.S. Department of Health and Human Services’ guidelines indicate that it is safe and beneficial for people with chronic medical conditions, such as obesity and diabetes, to be physically active according to their abilities.”
 
These guidelines are supported by preliminary findings from an ongoing trial called “Bari-Active” conducted by Dr. Bond.
 
“With brief, preoperative counseling about physical activity, patients increase their participation in moderate-intensity physical activity to levels that approximate national recommendations. The preoperative period may serve as a powerful ‘teachable moment’ for helping patients change their physical activity behaviors,” said Dr. Bond.
 
Recent studies also show that bariatric surgery patients’ postoperative physical activity levels can be increased when the patients are enrolled in exercise programs with a personal trainer or other structured support.
 
Despite these findings, only 22 percent of patients of bariatric surgical centers accredited by the American College of Surgeons Bariatric Surgery Center Network report having received postoperative exercise counseling.
 
“A major barrier to providing physical activity counseling is lack of insurance reimbursement,” Dr. King said. “However, another major barrier is lack of training and available information on what to recommend or how to effectively make recommendations, specifically to adults undergoing bariatric surgery.”
 
Drs. King and Bond currently are serving on the joint committee of the American College of Sports Medicine’s and the American Society for Metabolic and Bariatric Surgery to develop the first evidence-based preoperative or postoperative physical activity guidelines for bariatric surgery patients.
 
To aid surgeons and clinicians in advising their bariatric surgery patients, the researchers provide guidelines on how to tailor counseling to those patients to safely and effectively lead to increases in physical activity using proven counseling strategies.
 
Dubbed the “Five A’s,” the strategies that clinicians can implement consist of:
  • Assess: Determine the patient’s physical activity knowledge, experiences and preferences, as well as his or her ability to safely increase their physical activity level.
  • Advise: Educate the patient on the benefits of regular physical activity and help the patient develop realistic expectations and address safety concerns.
  • Agree: Work with the patient to set specific physical activity goals and develop a written exercise contract to reinforce a lifelong commitment to exercise.
  • Assist: Provide printed materials, online resources, tools (such as pedometers and physical activity diaries) and a list of community resources that support physical activity.
  • Arrange: Follow-up with the patient to reinforce the physical activity goals and answer questions, as well as schedule an in-person appointment to discuss the goals and make any necessary revisions.
“Bariatric surgery is the most effective treatment for severe obesity,” Dr. King said. “However, maintaining the resulting weight loss can be difficult. Providing physical activity counseling is an important way that clinicians can help their patients improve their health and experience long-term success.”
 
This research was supported by NIH grants U01 DK066557 and K01-DK083438.
category: UPMC
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Pitt Team Finds ‘Achilles Heel’ of Key HIV Replication Protein

Posted by andrewsj3 on Thursday, January 24th 2013     
PITTSBURGH, Jan. 24, 2013 – Researchers at the University of Pittsburgh School of Medicine may have found an “Achilles heel” in a key HIV protein. In findings published online today in Chemistry and Biology, they showed that targeting this vulnerable spot could stop the virus from replicating, potentially thwarting HIV infection from progressing to full-blown AIDS.
 
Previous research demonstrated that a small HIV protein called Nef interacts with many other proteins in infected cells to help the virus multiply and hide from the immune system. The Pitt group developed a way to track Nef activity in high-throughput drug screening protocols by linking it to an enzyme called Hck, which is activated by Nef in HIV-infected cells, explained senior author Thomas E. Smithgall, Ph.D., William S. McEllroy Professor and Chair, Department of Microbiology and Molecular Genetics.
 
“We reasoned that agents that prevent Nef from its usual interactions with other proteins might be able to stop HIV from replicating and infecting other cells,” Dr. Smithgall said. “For this study, we devised an automated screening procedure and tested nearly 250,000 compounds to find ones that could block Nef activity.”
 
One of the compounds they discovered, called B9, seemed particularly potent at blocking Nef. In follow-up experiments, the research team examined how B9 accomplished this and found that it could prevent two Nef molecules from interacting to form dimers as effectively as a mutation in a critical area of the protein surface. The inability of Nef to dimerize consequently impairs its function in the viral replication process.
 
“This pocket where B9 binds to Nef and where Nef forms a dimer indicates it’s a hot spot, or Achilles heel, that could represent a new target for HIV drugs,” Dr. Smithgall said. “Our test tube and cell culture experiments show that blocking this site brings HIV replication to a halt.”
 
The team is working with medicinal chemists at the University of Pittsburgh Drug Discovery Institute (DDI) to find analogs of B9 that have therapeutic potential, and plan to assess them in animal models of HIV/AIDS.
 
Co-authors of the study include lead investigator Lori Emert-Sedlak, Ph.D., Purushottam Narute, Ph.D., Sherry Shu, Ph.D., and Jerrod A. Poe, Ph.D., all of the Department of Microbiology and Molecular Genetics, Pitt School of Medicine; Haibin Shi, Ph.D., Naveena Yanamala, Ph.D., John Jeff Alvarado, Ph.D., and Joanne Yeh, Ph.D., all of the Department of Structural Biology, Pitt School of Medicine; Paul Johnston, Ph.D., of DDI and the Department of Pharmaceutical Sciences, Pitt School of Pharmacy; and John Lazo, Ph.D., now of the University of Virginia.
 
The project was funded by National Institutes of Health grants R01 AI057083, R21 AI077444, and X01 MH083223.
category: UPMC
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National Experts Present: The Pittsburgh Gut Club Announces 2013 Schedule

Posted by UPMC Physician Resources on Thursday, January 10th 2013     

The Pittsburgh Gut Club is a gastroenterology education and networking series designed to bring novel and relevant subspecialty advancements to the Pittsburgh region. All gastroenterologists, interested physicians, and allied healthcare professionals are encouraged to attend.

Sponsored by
Division of Gastroenterology, Hepatology, and Nutrition
University of Pittsburgh School of Medicine
UPMC Center for Continuing Education in the Health Sciences

Course Director
Robert E. Schoen, MD, MPH
Professor of Medicine and Epidemiology
University of Pittsburgh School of Medicine

Schedule
All lectures are from 6:00 p.m. to 8:15 p.m. at The University Club, Pittsburgh, Pa.

February 21, 2013—Celiac Disease: From Soup to Nuts
Peter H.R. Green, MD
Professor of Clinical Medicine and Director, Celiac Disease Center
Division of Digestive and Liver Diseases
College of Physicians and Surgeons
Columbia University, New York, NY

March 7, 2013—Communicating the Risks and Benefits of Biologic Therapy for IBD
Corey A. Siegel, MD
Associate Professor of Medicine
The Dartmouth Institute for Health Policy and Clinical Practice
Director, Inflammatory Bowel Disease Center
Division of Gastroenterology and Hepatology
Dartmouth-Hitchcock Medical Center, Lebanon, NH

May 2, 2013—Hepatocellular Carcinoma: Epidemiology, Prevention via Treatment of Hepatitis, and Therapy
Hashem B. El-Serag, MD, MPH
Dan L. Duncan Professor of Medicine
Chief, Gastroenterology and Hepatology
Chief, Clinical Epidemiology and Outcomes
Baylor College of Medicine,  Houston, TX

Contact Information
For more information about The Pittsburgh Gut Club, including becoming a member, event registration, and associated fees, please contact:

Kimberly Luketic
Division of Gastrenterology, Hepatology, and Nutrition
200 Lothrop Street, Mezz. 2, C Wing
Pittsburgh, PA 15213
kil6@pitt.edu
 412.648.9241
 412.648.9378 (fax)

Continuing Medical Education
The University of Pittsburgh School of Medicine is accredited by the Accreditation Council for Continuing Medical Education for physicians. The University of Pittsburgh School of Medicine designates this educational activity for a maximum of 1.5 category one credits toward the AMA PRA Category 1 CreditsTM. Each physician should only claim credit commensurate with the extent of their participation in the activity. Other healthcare professionals are awarded .015 continuing education units (CEU’s) which are equal to 1.5 contact hours.

category: Gastroenterology, UPMC
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Pitt Enzyme Discovery May Lead to Better Tests for Tuberculosis

Posted by andrewsj3 on Monday, January 7th 2013     
PITTSBURGH, Jan. 7, 2013 – Researchers at the University of Pittsburgh Graduate School of Public Health have identified an enzyme that will trigger the rapid breakdown of several mycobacteria species, including the bacteria known to cause tuberculosis. This discovery could lead to better tests for the deadly disease.
 
The results of the study, funded by the National Institutes of Health (NIH), are published in the January edition of the Journal of Biological Chemistry.
 
Tuberculosis is one of the most deadly global bacterial infections, killing more than 2 million people worldwide annually. Doctors see 9 million new cases of the disease every year, mostly in Africa and Southeast Asian countries, although small outbreaks of the disease have been reported in urban areas of the United States. Tuberculosis is caused by bacteria called Mycobacterium tuberculosis. The TB bacteria usually attack the lungs and are spread through the air from one person to another. 
 
“It’s a huge public health burden,” said Anil Ojha, Ph.D., assistant professor in the Department of Infectious Diseases and Microbiology at Pitt Public Health, and senior author of the study. “Clearly, controlling the infection is heavily dependent upon an effective diagnosis.”
 
The current bacterial culture test for TB infections is highly accurate but time-consuming, taking up to several weeks.
 
“That may create a race against time for a patient who has acute tuberculosis infection,” said Dr. Ojha. “That’s why our process is so important. It can obtain results that are both rapid and accurate.”
 
The World Health Organization (WHO) currently recommends a diagnostic technique called nucleic acid-based amplification (NAA); however, this process faces difficulty in breaking open, or lysing bacteria, to access nucleic acids. Mycobacteria are shaped by a thick envelope of fats and sugars, and are resistant to most of the chemicals conventionally used to lyse bacteria.
 
Pitt Public Health researchers found that exposure to an esterase, an enzyme that targets fatty acids on the surface of the mycobacterial envelope, led to rapid lysis of the bacilli. Researchers also demonstrated that this quick lysis of Mycobacterium tuberculosis improved its detection at lower density.
 
“Discovery of enzyme-based mycobacteria lysis has the potential to increase the sensitivity of NAA,” said Dr. Ojha.
 
Collaborators on this study include: Yong Yang, Ph.D., Alexandra Bhatti, M.P.H., Danxia Ke, and Peijun Zhang, Ph.D., all of the University of Pittsburgh; Mercedes Gonzalez-Juarrero, Ph.D., and Anne Lenaerts, Ph.D., both of Colorado State University; Laurent Kremer, Ph.D., of the University of Montpellier; and Yann Guerardel, of the French National Center for Scientific Research.
 
The research was funded by NIH grants AI079288 and GM085043.
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