Platelet E-News – November 16, 2007

This e-newsletter is a monthly publication of The Platelet Disorder Support Association. The information in this newsletter is for educational purposes only. For advice on your unique medical condition, please consult a health care professional.

Contents:

  • Getting Clarity on Rituximab’s Mode of Action
  • GlaxoSmithKline Begins Trial of Eltrombopag in Hepatitis C
  • Rigel Reports Phase 2 Results on R788 in ITP
  • Amgen Filing for FDA Approval of AMG531 as “romiplostim”
  • Sleep is a Biological Necessity
  • Shared Decision Making Catching on with Doctors
  • Folic Acid’s Pros and Cons
  • More Good News on Vitamin D
  • Organic Produce May Be Best for Nutrients
  • Mold Can Be Depressing
  • Convenience Foods, Not So Much

 

GETTING CLARITY ON RITUXIMAB’S MODE OF ACTION

B cell depletion from rituximab therapy is only part of the story of the therapy’s effectiveness in ITP, according to a study from Italy and the U.K. The research suggests that it is the action against abnormal T-cell subsets that correlates with increased platelet counts. In an accompanying Comment, Toronto’s John Semple calls the finding “convincing” and “quite astonishing,” lending credence to the notion that “attacking T cells in ITP, even if via the slaughter of B cells, is perhaps the real way to design successful therapies for this disorder.”

Stasi R, Del Poeta G, Stipa E, Evangelista ML, Trawinska MM, Cooper N, Amadori S. Response to B-cell-depleting therapy with rituximab reverts the abnormalities of T-cell subsets in patients with idiopathic thrombocytopenic purpura. Blood. Oct. 15, 2007; 110(8):2924-2930.

Stemple, JW. Rituximab disciplines T cells, spares platelets. Blood. Oct. 15, 2007; 110(8):2784-2785.

GLAXOSMITHKLINE BEGINS TRIAL OF ELTROMBOPAG IN HEPATITIS C

Patients with hepatitis C infection who have low platelet counts are unable to take antiviral therapy to fight the hepatitis C. GlaxoSmithKline is launching two phase 3 studies of eltrombopag to see if platelet counts will rise enough to enable antiviral therapy for these patients. Eltrombopag is an investigational oral platelet growth factor that stimulates growth of megakaryocytes, the bone marrow cells that give rise to blood platelets. Promacta is the proposed trademark name to be used in the U.S.  The name Revolade would be used in certain European countries.

http://www.gskcancermedia.com

RIGEL REPORTS PHASE 2 RESULTS ON R788 IN ITP

Rigel Pharmaceuticals (South San Francisco) reported that its Syk kinase inhibitor, R788, can improve platelet counts in patients with refractory ITP. The single-center, open-label, dose-escalating study showed that R788 (tamatinib fosdium) improved platelet counts in 9 of 14 patients. R788 is being tested in rheumatoid arthritis and ITP.
 
http://www.rigel.com

AMGEN FILING FOR FDA APPROVAL OF AMG531 AS “ROMIPLOSTIM”

Amgen has filed for FDA approval of AMG531 for treatment of thrombocytopenia (low platelet count) in adults with chronic ITP. The filing is under the trade name romiplostim. The company plans to file in the EU, Canada, and Australia by the end of 2007.

SLEEP IS A BIOLOGICAL NECESSITY

Without sleep, people may overreact to negative events, according to brain studies by researchers at Harvard and University of California, Berkeley. They found that lack of sleep elevates activity in the emotional centers of the brain most closely associated with depression. Sleep deprivation has been known to cause a breakdown of the immune system, as well as impair metabolism and learning and memory. Lack of sleep has also been linked to weight gain and increased risk of type 2 diabetes. For tips on how to get a good night’s sleep, read NIH’s guide to healthy sleep at http://www.nhlbi.nih.gov/health/public/sleep/healthysleepfs.pdf
 
Yoo S, Gujar N, Hu P, Jolesz FA, Walker MP. The human emotional brain without sleep — a prefrontal amygdala disconnect. Current Biology, Oct. 23, 2007. 17(20):R877-R878.

SHARED DECISION MAKING CATCHING ON WITH DOCTORS        

A small but growing number of doctors are helping patients understand their options among diagnostic tests and treatments to improve patient satisfaction and reduce the use of procedures with unclear benefits. Dartmouth Hitchcock Medical Center in Hanover, N.H., a leader in the field, offers 30 decision aids (videos, questionnaires, interactive computer programs) for surgeries such as mastectomy and lumpectomy, prostatectomy, and back surgery. The Foundation for Informed Medical Decision Making has a website with more resources, including many decision aids: http://www.fimdm.org

Brownlee S. Giving patients a larger voice. The Washington Post, October 23, 2007, pg. F1, 4.

FOLIC ACID’S PROS AND CONS

Folic acid promotes cell growth, and helps form red and white blood cells. The B vitamin also decreases breast cancer and stroke risk. However, since cereals and other grains began being fortified with the vitamin to reduce birth defects, along with a drop in spina bifida in newborns, epidemiologists have noticed a rise in colorectal cancer rates. The scientists urge caution and debate before further fortification of foods with folic acid. Until then, foods that are natural sources of folic acid are probably the best source: lentils, dried beans and peas, and leafy greens.

Iris Cantor Women’s Health Center Newsletter, October 2007, Pg. 4-5
Tufts University Health & Nutrition Letter, October 2007, Pg. 1-2.

Mason JB, Dickstein A, Jacques PF, Haggarty P, Selhub J, Dallal G, Rosenberg IH.  A temporal association between folic acid fortification and an increase in colorectal cancer rates may be illuminating important biological principles: A hypothesis

Cancer Epidemiology Biomarkers & Prevention, July 2007, 16: 1325-1329.

MORE GOOD NEWS ON VITAMIN D

Vitamin D has multiple benefits—and many Americans don’t get enough. Vitamin D helps build bones, preserve muscle strength, prevent falls, and protects against certain cancers and heart disease. Humans can make vitamin D, just by getting some sun without sunscreen for 10 to 15 minutes every few days. But the body’s ability to make vitamin D decreases with age. Food sources include oily fish (salmon and sardines); egg yolks; and fortified milk, soy milk, orange juice, and cereals. Vitamin D also helps regulate immunity. Certain autoimmune disorders are less common in sunny climes. Finally, vitamin D seems to reduce gum bleeding by decreasing inflammation. Experts are beginning to recommend higher intake than the current RDA, which is 400 IU for people ages 51 to 70 and 600 IU for those over age 70. Instead, they recommend that people take between 800 and 1,000 IU each day. If taking supplements to boost vitamin D intake, choose those containing the D3 (cholecalciferol) form of vitamin D, which the body uses more easily than the D2 form.

For more on vitamin D, visit dietary-supplements.info.nih.gov/factsheets/vitamind.asp

(Note:  Be sure to discuss supplement taking or complementary treatments with your doctor or health care provider.)

ORGANIC PRODUCE MAY BE BEST BET FOR NUTRIENTS     

Today’s farmers raise more bushels of corn, pecks of apples, and pounds of broccoli from a given piece of land than they did decades ago, according to a September report by the nonprofit Organic Center.  However, today’s high-yield crops are less nutritious and deliver fewer nutrients per serving and calorie consumed. Their study goes on to note that organic tomatoes deliver significantly more flavonoids, an antioxidant that protects the heart, than non-organic tomatoes.
The report, “Still No Free Lunch,” is available at http://www.organic-center.org

MOLD CAN BE DEPRESSING        

Mold toxins can affect the nervous and immune systems. A study of close to 3,000 households in Europe found an association between depression and living in a damp, moldy home. A perceived lack of control over the housing environment appeared to play a role.

Shenassa ED, Daskalakis C, Liebhaber A, Braubach M, Brown MJ. Dampness and Mold in the Home and Depression: An Examination of Mold-Related Illness and Perceived Control of One’s Home as Possible Depression Pathways. American Journal of Public Health, August 2007, 97(10):1893-1899.

CONVENIENCE FOODS—NOT SO MUCH

Although people turn to packaged and processed “convenience foods” to save time on dinner preparation, a 3-year study by UCLA researchers indicates that dinner preparation is no faster but convenience foods add sugar, fat, and salt.
Convenience foods don’t’ save time. Tufts University Health & Nutrition Letter, November 2007, pg. 3.

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