Breathalyzers could be used to “sniff” out diseases

Breathalyzers get a bad rap because most of us associate them with tipsy drivers and DUI's. California-based, medical technology company, Metabolomx, has a different perspective, and it's one that could breathe new life into early disease detection processes. Their mission is to sniff out killers like lung cancer, by capturing and analyzing patients' breath. Sound like the plot of a movie? The National Cancer Institute doesn't think so. In October 2011, they bestowed a million-dollar grant for research and development.

So how does it work?

This technology collects the patient's breath for about five minutes, grabbing air from specific portions of the natural breathing cycle. It then filters out molecular components in the breath, leaving a molecular fingerprint for physicians to sample. Paul Rhodes, CEO of Metabolomx says, "…the pattern of small-molecule metabolites produced by active tumors can be observed in exhaled breath." So what does that mean in laymen's terms? These special breathalyzers can "smell" certain diseases by detecting molecules associated with them, even specific strains. Existing upper respiratory infections are found at the beginning of the breath collection cycle, while lung cancer is detected at the end.

What does this mean?

Higher accuracy: It's not a cure but this breakthrough is significant for many reasons. First, and what amazes me most is the accuracy. CT scans and biopsies aren't always conclusive. I've learned from painful, personal experience with grandfather's cancer struggles, doctors can misdiagnose cancer. It's often sneaky and hard to detect accurately. So far, the accuracy rate with this technology is over 80 percent -- astounding in the medical world.

Less recovery time: Unlike my grandfather, I won't have to rely on surgical procedures to determine if certain diseases are present. The process takes less than half an hour and recovery time is zero! That's much better than missing weeks of work or months of your life.

Less expensive: Your life might depend on them but that doesn't make the normal diagnostic procedures less expensive. Bulky, massive CT machines cost close to $10K and surgery costs are unpredictable. Physicians are hoping that Metabolomx 's breath analysis instrument can bring down the cost curve and make detecting cancer less of a financial burden for patients. The machine is simple to use, techs aren't required - also a cost cutter!

The sky could be the limit with this new technology. Imagine walking into the doctor's office with your crying toddler and leaving with an accurate cold/flu/strep diagnosis without undergoing screaming shot fests. That's a day at the doctor's office I could live with.

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Postal Service Warns It Could Lose $18 Billion a Year

In a letter to Congress, Patrick Donahoe, the postmaster general, described an updated five-year cost-cutting plan put together in coordination with a Wall Street adviser, Evercore Partners. It reiterates many of the mail agency’s proposals to switch to a five-day delivery schedule, raise stamp prices and close about 252 mail-processing centers and 3,700 local post offices.

The Postal Service has already asked Congress for permission to make service cuts and reduce annual payments of about $5.5 billion in funding retiree health benefits. But in recent weeks, the Senate and House have stalled as lawmakers differ widely on costs, the level of financial oversight and the prospect of widespread postal closures.

On Thursday, Mr. Donahoe said the mail agency’s proposals would enable it to save $20 billion a year by 2015, repay its $12.9 billion debt to the Treasury and return to profitability. The plan, for instance, notes that if the post office could raise stamp prices from 45 cents to 50 cents, either in a single year or over a multiyear period, it could bring in new revenue of about $1 billion.

In contrast, Congressional inaction would result in significant annual losses and a “long-term burden to the American taxpayer.”

In a news briefing, Joe Corbett, the chief financial officer, said that no formal proposals had been made to increase the price of a first-class stamp. He said the plan described the additional revenue the mail agency could realize over a single or multiyear period if it could increase stamp prices above the rate of inflation.

Since 2006, the Postal Service has increased the price of the stamp four times, from 39 cents to 45 cents.

About half of the Postal Service’s cost-cutting proposals require legislative approval. Some Congressional proposals have focused on providing short-term relief through a cash infusion to prevent the mail agency’s bankruptcy but also postpone major decisions on cuts until later.

Last week, the Postal Service said its quarterly loss rose to $3.3 billion amid declining mail volume and said it could run out of money by October.

The agency forecasts a record $14.1 billion loss by the end of this year.

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New malaria method could boost drug production

BERLIN (AP) — German scientists have developed a new way to make a key malaria drug that they say could easily quadruple production and drop the price significantly, increasing the availability of treatment for a disease that kills hundreds of thousands every year.

Chemists at the Max Planck Institute take the waste product from the creation of the drug artemisinin — artemisinic acid — and convert it into the drug itself.

The entire apparatus is compact, about the size of a carry-on suitcase, and inexpensive. That means it can be easily added to production sites anywhere around the world.

"Four hundred of these would be enough to make a world supply of artemisinin," said unit director Peter Seeberger, pointing to the machine on a table in his lab in Berlin's Dahlem neighborhood. "The beauty of these things is they're very small and very mobile."

A paper on the new technique was published this month in chemistry journal Angewandte Chemie.

Artemisinin is extracted from sweet wormwood, a plant that primarily grows in China and Vietnam and varies in its availability according to the season. In the extraction process, for every part artemisinin produced, there is 10 times the amount of artemisinic acid discarded as waste.

Past attempts to convert the acid using ultraviolet light to trigger the conversion have been unsuccessful because the process took several steps in a large tank of acid, making production inefficient and far too expensive.

So the Max Planck chemists thought small — creating a machine that pumps all of the required ingredients through a thin tube wrapped around a UV lamp in a continuous process that takes 4 1/2 minutes from start-to-finish to produce the artemisinin.

The technique can convert about 40 percent of the waste acid into artemisinin — producing four times more of the drug from what had in the past been discarded, Seeberger said.

Colin Sutherland, a malaria expert at the London School of Hygiene and Tropical Medicine who was not involved in the Max Planck research, said the development could be significant in boosting production of the key malaria drug. He noted that currently very little artemisinin can be made from a large amount of the sweet wormwood, which is also difficult to grow.

"If it's a simple process, given a certain amount of plant material, you can generate more drugs, that will make things cheaper and faster," he said.

Since the end product is the same molecule, there should be no decrease in effectiveness of the synthetic product, Sutherland said.

Seeberger said a commercial prototype of the Max Planck machine could be ready in about six months and that it could go into production in about a year. He said current price estimates are around euro100,000 (US$132,000).

When it's in production, the idea is to make it available for a minimal fee to cover costs, he said.

"The goal is to make sure that the drug is produced and made available to as many people as possible," said Seeberger, a former Massachusetts Institute of Technology professor who now teaches at Berlin's Free University.

Sabine Haubenreisser, a spokeswoman at the European Medicines Agency, said that if the new drug is close enough to the original, its producers could apply for it to be considered as a generic product or use older data proving artemesinin's effectiveness — which could speed the approval process.

Malaria cases and deaths have been dropping since 2004, due largely to campaigns to distribute bednets, spray homes with insecticide and make better drugs available. The World Health Organization estimates that at least 655,000 people die of malaria every year, mostly children under 5 in Africa.

At the moment, artemisinin-based therapies are considered the best treatment, but cost about $10 per dose — far too much for impoverished communities.

Former U.S. President Bill Clinton's Clinton Foundation currently has a program to purchase the treatments, then sell them at a deeply discounted 50 cents to communities where they're most needed.

Cutting the price further while increasing production could "make a big difference," said Sutherland.

"Many times more children will have access to the right drug early in their disease and that's likely to have an impact on mortality."

___

AP Medical Writer Maria Cheng contributed to this report from London.

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Aspirin could beat cancer spread: Australian study

Aspirin and other household drugs may inhibit the spread of cancer because they help shut down the chemical "highways" which feed tumours, Australian researchers said Tuesday.

Scientists at Melbourne's Peter MacCallum Cancer Centre said they have made a biological breakthrough helping explain how lymphatic vessels -- key to the transmission of tumours throughout the body -- respond to cancer.

"We've shown that molecules like the aspirin... could effectively work by reducing the dilation of these major vessels and thereby reducing the capacity of tumours to spread to distant sites," researcher Steven Stacker said.

Doctors have long suspected that non-steroidal anti-inflammatory drugs such as aspirin may help inhibit the spread of cancer but they have been unable to pinpoint exactly how this is done.

By studying cells in lymphatic vessels, the researchers found that a particular gene changed its expression in cancers which spread, but not when the cancer did not spread.

The results published in Cancer Cell journal reveal that the gene is a link between a tumour's growth and the cellular pathway which can cause inflammation and dilation of vessels throughout the body.

Once these lymphatic vessels widen, the capacity for them to act as "supply lines" to tumours and become more effective conduits for the cancer to spread is increased.

But aspirin acts to shut down the dilation of the vessels.

"So it seems like we have found a pivotal junction point in a biochemical sense between all these different contributors," Stacker said.

The discovery could lead to new and improved drugs which could help contain many solid tumours, including breast and prostate cancer, as well as potentially provide an "early warning system" before a tumour begins to spread.

Last year, a study published in medical journal The Lancet found that rates of cancer of the colon, prostate, lung, brain and throat were all reduced by daily aspirin use.

Many doctors recommend regular use of aspirin to lower the risk of heart attack, clot-related strokes and other blood flow problems. A downside of extended daily use is the risk of stomach problems.

mfc/mp/jms

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Gonorrhea Could Join Growing List of Untreatable Diseases

cdc-gonorrhea5529_lores Gonorrhea under a microscope. Image: courtesy of CDC/Susan Lindsley

The arms race between humanity and disease-causing bacteria is drawing to a close and the bacteria are winning. The latest evidence: gonorrhea is becoming resistant to all standard antibiotic treatment.

Gonorrhea is one of the most common sexually transmitted diseases in the world with about 600,000 cases diagnosed in the U.S. each year. A few years ago, investigators started seeing cases of infection that did not easily respond to treatment with a group of drugs called cephalosporins, which are currently the last line of defense against this particular infection. Now, the number of drug-resistant cases has grown so much in the U.S. and elsewhere that gonorrheal infection may soon become untreatable, according to doctors writing in the February 9 issue of the New England Journal of Medicine.

If it seems to you that the drumbeat of bad news with respect to antibiotic resistance has become louder and more insistent in the past few years, you would be right:

Researchers reported in January that they had for the first time collected samples of E. coli bacteria from the Antarctic with particularly dangerous drug-resistance genes. The dispersal of drug resistance genes via E. coli is particularly worrisome because that bacterium lives normally in the human intestine along with thousands of other species of bacteria. From that fertile ground, there s practically no stopping the widespread dissemination of bacterial resistance genes.

Meanwhile reports surfaced in India of several cases of totally untreatable tuberculosis although further investigation suggested that they may have merely been extensively drug-resistant TB.

Hospitals in New York City are now struggling with how to deal with a deadly pneumonia that resists treatment with powerful, last-resort antibiotics called carbapenems, as reported by Maryn McKenna in a feature for Scientific American, entitled The Enemy Within: A New Pattern of Antibiotic Resistance (preview version here). Indeed, figuring out how to deal with the problem is the subject of an upcoming seminar on carbapenem resistance, at the New York Academy of Science on February 17.

Scientific American has actually written a fair amount on the problem of antibiotic resistance in all its guises. Check out our in-depth report on the Crisis of Antibiotic Resistance, which I just pulled together, for more detail.

Follow Scientific American on Twitter @SciAm and @SciamBlogs. Visit ScientificAmerican.com for the latest in science, health and technology news.
© 2012 ScientificAmerican.com. All rights reserved.

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New Criteria Could Change Who Is Diagnosed With Alzheimer's

MONDAY, Feb. 6 (HealthDay News) -- New guidelines for diagnosing the mental decline that can come with several diseases of aging may create confusion among doctors and patients about who has early Alzheimer's disease and who simply has mild cognitive impairment, a new report warns.

Mild cognitive impairment (MCI) is a mental decline in its earliest stages that's not a normal part of aging. Under previous guidelines, a patient was considered to have MCI if he or she had marked, but mild, memory problems but was otherwise functioning normally, explained Dr. John Morris, director of the Alzheimer's Disease Research Center at Washington University School of Medicine in St. Louis.

Recently, the U.S. National Institute on Aging and the Alzheimer's Association convened a work group to update criteria for MCI. Their revised guidelines cast a wider net for what qualifies. "As MCI was studied further, it was found that people with MCI often had other impairments in reasoning, visual-spatial skills and attention," Morris said.

Under the new guidelines, people with MCI can have also have problems doing daily activities, such as driving without getting disoriented, remembering to pay bills and paying the proper amount, and cooking safely. People can have MCI even if they depend on aids or assistance to complete those tasks.

Previously, what distinguished MCI from dementia was that ability to function, but the new guidelines blur the distinction, Morris noted.

"Now, there is no distinguishing line between mild cognitive impairment and mild Alzheimer's disease dementia," said Morris, who lays out his argument in an analysis published online Feb. 6 in the Archives of Neurology. "Broadening the criteria for MCI overlaps so much with the diagnosis of very mild Alzheimer's disease that physicians won't know whether to call it very mild Alzheimer's or MCI. It adds confusion to the field."

Morris' study included more than 17,500 people with a mean age of 75 who had either normal memory and thinking skills, MCI or Alzheimer's disease dementia.

He concluded that 99.8 percent of patients currently diagnosed with "very mild" Alzheimer's dementia and just under 93 percent of those diagnosed with "mild" Alzheimer's dementia could be reclassified as having MCI, based on the revised criteria.

Some 5.4 million Americans have Alzheimer's, according to the Alzheimer's Association.

While MCI can be a first sign of the Alzheimer's, it's not necessarily so. Other causes of MCI can include medications, stroke or depression, Morris explained.

Diagnosing Alzheimer's disease is typically done through a clinical examination with a neurologist. Neuroimaging tests are conducted, to rule out other conditions that might have caused the mental decline, such as a stroke or brain tumor.

Other means of diagnosing Alzheimer's include a spinal tap that looks for certain biomarkers in the spinal fluid or specialized MRIs that can detect amyloid protein, which is associated with Alzheimer's. However, these are not typically available outside of large metropolitan hospitals or as part of medical studies.

Dr. William Thies, chief medical and scientific officer for the Alzheimer's Association, said researchers now understand that Alzheimer's is a continuum of changes in the brain that begin years, and possibly decades, before the first MCI symptoms are noticed. Alzheimer's itself, Thies said, represents "the very last, devastating changes of the disease."

"You can do a lot of damage to the brain before it will not do all the functions it's supposed to do," Thies said. "There is a period of time when you will have silent changes in your brain structure and function, a pre-symptomatic period when the changes have already begun."

Because Alzheimer's is a continuum, that means that drawing a line between MCI and Alzheimer's is, by definition, "artificial," he noted.

"We recognize those lines are artificial, and at the moment because the criteria are relatively new, they remain somewhat fuzzy," Thies said. "This is an area where we will have continued discussion over the next few years to establish consistently where to categorize folks."

When Alzheimer's is believed to be the underlying cause of MCI, physicians can offer up a diagnosis of "MCI due to AD [Alzheimer's disease]," Morris said.

Even though the diagnosis of Alzheimer's is more devastating than MCI, it's important for patients and their families to hear the truth, so that they can come to terms with the diagnosis and make the necessary plans, Morris said.

"When we think the MCI is caused by underlying Alzheimer's disease, we should go ahead and call it very early Alzheimer's," Morris said. "It's artificial to call it MCI."

According to background information in the article, 30 percent to 60 percent of doctors conceal an Alzheimer's disease diagnosis because of causing distress to the family and the patient, even though 94 percent of the same doctors would reveal a diagnosis of terminal cancer.

Dr. Gayatri Devi, an attending neurologist at Lenox Hill Hospital in New York City, said that as a result of the new criteria, "large numbers of patients will be classified as having mild cognitive impairment when in fact they're suffering from Alzheimer's disease."

"This complicates research in the area, and confuses patients and families, not to mention physicians, who've relied on functional independence as the demarcation between Alzheimer's disease and MCI," Devi said.

More information

The U.S. National Institute on Aging has more on Alzheimer's.

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