The Bright Future of Stem Cell Therapy: Part 2 – Sahuarita Sun

Last month, we talked about using Mesenchymal Stem Cells (MSC) in Regenerative Medicine to heal degenerative joints and other tissues and organ systems.

When we inject MSCs into damaged areas, we augment the bodys regenerative capacity. MSCs heal damaged tissue by orchestrating the entire healing cascade, providing building blocks for new tissue as well as necessary messenger signaling molecules.

Harvesting cells from C-Section deliveries

Mesenchymal stem cells are harvested from full-term C-section deliveries after the donor has been screened for infectious diseases. The umbilical cord including Whartons Jelly along with the amniotic fluid and sac are harvested and carefully processed.

They are further tested to determine the number of MSCs, structural proteins, cytokines (IL-1, TGF-, TGF-), and growth factors the tissue in question contains. Then they are frozen in liquid nitrogen until needed.

Care is given to inject them in the desired joint or region of the body immediately upon thawing, to preserve viability and increase effectiveness.

Amniotic tissue has been described as fertilizer, while MSCs are new seed, and our tissues are like the soil. The healthier the soil, the better the outcome when new seed and fertilizer are introduced.

There is a bright future for stem cells in many aspects of healing and regeneration. An added benefit is much less recovery time than with surgical procedures.

For information about Nature Cures health programs and retreat, contact the Nature Cure Clinic in Green Valley at 520-399-9212.

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The Bright Future of Stem Cell Therapy: Part 2 - Sahuarita Sun

Droitwich schools urged to hold ‘Oscar Day’ to help five-year-old’s cancer battle – Droitwich Standard

A RALLYING call has gone out for schools across Bromsgrove and Droitwich to join a fund-raiser for potentially life-saving treatment for Oscar Saxelby-Lee.

Oscars school in Worcester has declared October 11 Oscar Day and is holding a non-uniform day for a 1-per-person donation and staff there are hoping other schools across the county will join them.

A major fund-raising drive was launched a fortnight ago after it was discovered the brave five-year-olds cancer had returned just months after successful stem-cell treatment. His heartbroken parents need 500,000 to pay for the treatment.

After being told Oscars leukaemia had returned, mum Olivia Saxelby and dad Jamie Lee were dealt a further blow when they were told there may be no further treatment options left for Oscar on the NHS.

At present children with B-cell Acute Lymphoblastic Leukaemia in Oscars position are able to undergo CAR-T therapy in the UK. Unfortunately, there is no such therapy for children such as Oscar with T-cell Acute Lymphoblastic Leukaemia.

Oscars care team is looking at the possibility of the youngster receiving this treatment as part of a trial. They are also examining the possibility of a second bone marrow transplant that would most likely need to take place outside the NHS.

Currently, the NHS can typically only offer a second transplant to patients 12 months on from their first transplant. But Olivia admitted her little boy may not have that long to keep the disease at bay.

We were so grateful earlier this year when thousands of people across the globe signed up to become stem cell donors in the faith Oscar would find a donor and we finally got the go ahead with a 10/10 match, she said.

After further chemotherapy, full body radiotherapy and three months of gruelling recovery post-transplant, we were told the devastating news that Oscars leukaemia is back.

Having been told options are very limited from the beginning of this journey, we have never lost hope, with Oscars strength and determination throughout.

This is why we have made the decision to give our warrior the best shot at a lasting cure that we can. This is the least he deserves after such a torturous battle.

Visit https://uk.virginmoney giving.com and search for Hand in Hand for Oscar for more information.

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Droitwich schools urged to hold 'Oscar Day' to help five-year-old's cancer battle - Droitwich Standard

Now in development: off-the-shelf stem cells – Knowable Magazine

Its the promise of stem cell medicine: Someday soon, clinics will rebuild diseased or broken hearts, kidneys, pancreases or blood by growing and reprogramming human cells, then adding them back to the bodies of the patients they came from.

If only it were that easy.

After two decades of human stem cell research, researchers have learned how to create what appear to be reasonably functional versions of several types of cells, first using genetic tricks to turn cells back to an uncommitted state and then molding them into the type of cell needed say, an insulin-producing cell or a particular kind of nerve cell. And many early clinical trials of stem cell medicine have shown genuinely promising results.

But applying such techniques en masse simply wont be practical, because the lengthy processes for extracting and preparing an individuals own cells wont scale up, some scientists say.

For one thing, everyones cells will behave a little bit differently, says Lonnie Shea, a biomedical engineer at the University of Michigan, Ann Arbor. And then theres the bottom line. It is beyond too expensive, says Douglas Melton, cofounder of the Harvard Stem Cell Institute, a network of more than 1,000 Harvard-affiliated scientists.

Instead, increasingly, labs around the world are seeking to design off-the-shelf cell therapies using universal donor cells that are genetically altered to avoid the many-armed responses of the immune system against foreign tissues. Scientists want to create a suite of such cells tailored for specific tissue repairs: universal muscle cells, universal skin cells or universal insulin-producing pancreatic beta cells.

The big dream is a cell that would be like a pill, which could go into any patient, says Melton, who called for a global push to realize this vision at a stem cell meeting in Los Angeles in June.

This trend in regenerative medicine parallels events in cancer medicine. Personalized treatments that genetically reengineer the T cells of patients with certain blood cancers are often effective, but such therapies cost hundreds of thousands of dollars per patient and it can take years for manufacturing to get up and running. Cancer researchers around the world now are working to create off-the-shelf versions.

Its all part of a broader effort to bring the rapidly advancing power of genetic engineering more deeply into regenerative medicine, says pediatric hematologist Leslie Kean of Harvard Medical School, director of the Stem Cell Transplant Center at Boston Childrens Hospital. This is not just science fiction anymore.

Our bodies normally are quick to reject any cell that isnt our own. While that response often can be overridden by drugs designed to suppress the immune system, these medicines bring significant risks and side effects. So the goal is for universal donor cells to be hypoimmunogenic able to hold off the immune systems many lines of defense without requiring immunosuppression.

In one development, scientists at the University of California, San Francisco and colleagues reported in Nature Biotechnology in February that theyd created hypoimmunogenic mouse and human cells through a several-step process. The starting ingredients were iPS cells (induced pluripotent stem cells). These are adult cells engineered to lose their specific cell identities so they can once again become many different cell types, a condition known as pluripotency. By tinkering with a few genes in these iPS cells, the researchers could produce heart cells, muscle cells and endothelial cells (which line the inside of blood vessels). All showed stealth behavior to the two main branches of the immune system adaptive and innate when transplanted into mice.

To accomplish this, the lab did two things. First, it knocked out several molecules of the human leukocyte antigen (HLA) system components of the adaptive immune system. The proteins of this system normally stud the surface of cells and signal otherness to T cells if they dont match with the bodys.

If you take that away, the T cells cannot recognize a cell as foreign, and you dont see T cell activation anymore, says Sonja Schrepfer, the studys senior author and head of UCSFs Transplant and Stem Cell Immunobiology Lab and a founding scientist for the Seattle-headquartered startup company Sana Biotechnology.

This image shows insulin-producing beta cells that were made from stem cells. Cells like this could one day be transplanted into people with type I diabetes, but they would need to be protected by immune-suppressing drugs or encapsulation. Cost and complexity will remain huge barriers for most therapies based on pluripotent stem cells until scientists can create cells that dont trigger immune responses.

CREDIT: MELTON LAB / HARVARD UNIVERSITY

But removing HLA activity still leaves other, innate aspects of the immune system intact. For example, natural killer cells will normally wipe out cells that no longer make certain HLA proteins. To solve that problem, Schrepfer and colleagues tapped into a long-studied phenomenon of pregnancy known as fetal-maternal tolerance: why the mothers immune system will not reject a fetus even though half the proteins are from the father.

The fetus, it turns out, avoids attack by boosting or tamping down the activity of various genes, including one called CD47. And by increasing activity of CD47 as well as removing some HLA molecules, Schrepfers team got the results they wanted.

Less is more in modifying iPS cells, Schrepfer says. Editing of each molecule has risks, so you want to find the minimum combination you need to achieve hypoimmunity.

Another example of preliminary success with hypoimmunogenic human cells came from a team within the Harvard Stem Cell Institute network, led by stem cell researcher Chad Cowan, now with Sana Biotechnology.

Like the UCSF group, the scientists lowered the activity of certain HLA genes and boosted activity of the CD47 gene in pluripotent cells. But they also increased the production of a different class of HLA molecules: ones that help the fetus dodge the mothers immune system.

And they added another step, taking lessons learned from cancer cells that evade the immune system. Through genetic tinkering, the team boosted the production of a protein called PD-L1 that these tumor cells use to turn away T cells.

The complex set of genetic modifications, reported in the journal PNAS in April, significantly dialed down immune reaction when the cells were infused in mice. T cell responses were blunted, and attacks by natural killer cells and macrophages (another class of immune cell) were minimal.

As research on universal donor cell therapies moves forward, one of the biggest concerns is that these cells which are made pluripotent again, then turned into the required adult tissues, using imperfect gene editing tools may generate tumors. To garner FDA approval, cell lines will have to be extensively vetted for any signs of danger, but there are worries that no process can provide complete protection.

There are always theoretical concerns about cells retaining some measure of pluripotency, which would mean that they wouldnt have a signal to stop growing, says Kean of Boston Childrens Hospital. Still, she says, theres been a ton of research to suggest that really wont be an issue with the iPS-derived cells that are being produced now; a lot of those potential risks have been engineered out.

Labs also can add an insurance policy in the form of suicide genes, a technique long studied in clinical trials for cancer, in which cells are engineered to kill themselves if exposed to a certain chemical compound. If the cell starts to do anything thats troublesome, youll take a pill like doxycycline, and itll kill those cells and only those cells, Melton says.

Teratomas tumors comprising a variety of tissue types such as hair, bone and teeth are a particular worry in the use of pluripotent stem cells in therapies, including for regulatory agencies, says stem cell researcher Juan Domnguez-Bendala of the Diabetes Research Institute in the University of Miami Miller School of Medicine. Nobody can be certain of what may happen when you start transplanting thousands of patients. One single case of a teratoma may set the field back for years.

And so Domnguez-Bendala, who is developing insulin-producing pancreatic beta cells to treat type I diabetes, has generated human pluripotent stem cells with two kinds of suicide genes. One of them is designed to spring to life in any implanted cell that transforms into something other than a beta cell. The other can be activated in cells that show molecular signs of forming a tumor.

The immune system is there 24/7, always knocking at the door.

Reporting in the journal Stem Cell Reports in March, Domnguez-Bendala and colleagues found that they could largely prevent tumor formation when the cells were transplanted in mice, and any that slipped through the net could be destroyed. Our strategy allows us to selectively preserve the cells of interest while killing off everything else, he says, and it can be easily adapted to any specific cell.

Tumors are not the only risk, though. The excitement about universal donor cells is tempered with caution because the immune system has such a full bag of tricks, says Shea, who coauthored an overview of the technology in the Annual Review of Biomedical Engineering. The immune system is there 24/7, always knocking at the door. If you can do something to protect the cells, thats a great start, but it has to be on, 24/7 it cant weaken.

Its unclear, he says, how the immune system as a whole will react if certain cells in the body are chronically making immune-suppressing molecules. Perhaps the universal donor cells initially will engraft and function well, but problems may crop up over time. Maybe the grafted cells will eventually be destroyed. Or what if those cells are infected with a virus will the immune system be able to eliminate it?

Given such concerns, many immunologists believe that it may be necessary to retrain the immune system rather than just find ways for cells to dodge its bullets.

Keans lab, for example, is looking for a combination of drugs that can be administered for a limited time to reset the immune system so that the transplant is tolerated without interrupting normal protective immunity.

Different types of cells may require different degrees of immune stealthiness, Kean points out. Insulin-producing beta cells ideally will last a lifetime, while heart muscle cells may not need to persist for long if their job is just to offer temporary support while the heart repairs itself.

Generating universal donor cells is not the only approach to off-the-shelf regenerative medicine, and this concept may be combined with other therapeutic techniques.

Shea, for instance, works with immunologist Haval Shirwan of the University of Louisville School of Medicine on a method that transplants insulin-producing cells on a microporous scaffold that is coated with molecules designed to blunt T cell attacks. If a short regimen of an immunosuppressant drug is given at the same time, these transplanted cells survive well in lab mice.

Other labs take an even more radical approach they want to develop drugs that trigger cells in the patients own body to reprogram themselves and repair their own tissues. Sana and the biotech startup Oxstem in Oxford, England, are both pursuing this approach.

Overall, researchers say its an exciting time in off-the-shelf regenerative medicine though with plenty of work still to do.

So far, Melton notes, only a handful of functionally mature cells have been created from stem cells, including beta cells, heart muscle cells and certain kinds of skin, retinal and nerve cells. And its still years before universal donor cells will be tested in humans.

But he also stresses the potential of the quest. The promise of this kind of regenerative medicine is not to just find new treatments, he says, but to literally find cures for diseases.

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Now in development: off-the-shelf stem cells - Knowable Magazine

Immunity Against Cancer? Engineered Killer T Cells May Be the Key. – SciTechDaily

Theyve been called the special forces of the immune system: invariant natural killer T cells. Although there are relatively few of them in the body, they are more powerful than many other immune cells.

In experiments with mice, UCLA researchers have shown they can harness the power of iNKT cells to attack tumor cells and treat cancer. The new method, described in the journal Cell Stem Cell, suppressed the growth of multiple types of human tumors that had been transplanted into the animals.

Whats really exciting is that we can give this treatment just once and it increases the number of iNKT cells to levels that can fight cancer for the lifetime of the animal, said Lili Yang, a member of theEli and Edythe Broad Center of Regenerative Medicine and Stem Cell Research at UCLA and the studys senior author.

Scientists have hypothesized that iNKT cells could be a useful weapon against cancer because it has been shown that they are capable of targeting many types of cancer at once a difference from most immune cells, which recognize and attack only one particular type of cancer cell at a time. But most people have very low quantities of iNKT cells; less than 0.1% of blood cells are iNKT cells in most cases.

Lili Yang, PhD. Credit: UCLA Broad Stem Cell Research Center

Still, Yang and her colleagues knew that previous clinical studies have shown that cancer patients with naturally higher levels of iNKT cells generally live longer than those with lower levels of cells.

They are very powerful cells but theyre naturally present in such small numbers in the human blood that they usually cant make a therapeutic difference, said Yang, who also is a UCLA assistant professor ofmicrobiology, immunology and molecular genetics and a member of the UCLA Jonsson Comprehensive Cancer Center.

The researchers goal was to create a therapy that would permanently boost the bodys ability to naturally produce more iNKT cells. They started with hematopoietic stem cells cells found in the bone marrow that can duplicate themselves and can become all types of blood and immune cells, including iNKT cells. The researchers genetically engineered the stem cells so that they were programmed to develop into iNKT cells.

They tested the resulting cells, called hematopoietic stem cell-engineered invariant natural killer T cells, or HSC-iNKT cells, on mice with both human bone marrow and human cancers either multiple myeloma (a blood cancer) or melanoma (a solid tumor cancer) and studied what happened to the mices immune systems, the cancers and the HSC-iNKT cells after they had integrated into the bone marrow.

They found that the stem cells differentiated normally into iNKT cells and continued to produce iNKT cells for the rest of the animals lives, which was generally about a year.

One advantage of this approach is that its a one-time cell therapy that can provide patients with a lifelong supply of iNKT cells, Yang said.

While mice without the engineered stem cell transplants had nearly undetectable levels of iNKT cells, in those that received engineered stem cell transplants, iNKT cells made up as much as 60% of the immune systems total T cell count. Plus, researchers found they could control those numbers by how they engineered the original hematopoietic stem cells.

Finally, the team found that in both multiple myeloma and melanoma, HSC-iNKT cells effectively suppressed tumor growth.

The studys co-first authors are Yanni Zhu, a UCLA project scientist, and Drake Smith, a UCLA doctoral student.

More work is needed to determine how HSC-iNKT cells might be useful for treating cancer in humans and whether increasing the number of HSC-iNKT cells could cause long-term side effects. But Yang said hematopoetic stem cells collected either from a person with cancer or a compatible donor could be used to engineer HSC-iNKT cells in the lab. The procedure for transplanting stem cells into patients bone marrow is already well-established as a treatment for many blood cancers.

Funding for the study was provided by the National Institutes of Health, the California Institute for Regenerative Medicine, the Concern Foundation, the STOP CANCER Foundation, aUCLA Broad Stem Cell Research Center Rose Hills Foundation Innovator Grant, and the centers training program, supported by the Sherry, Dave and Sheila Gold Foundation.

Reference: Development of Hematopoietic Stem Cell-Engineered Invariant Natural Killer T Cell Therapy for Cancer by Yanni Zhu, Drake J. Smith, Yang Zhou, Yan-Ruide Li, Jiaji Yu, Derek Lee, Yu-Chen Wang, Stefano Di Biase, Xi Wang, Christian Hardoy, Josh Ku, Tasha Tsao, Levina J. Lin, Alexander T. Pham, Heesung Moon, Jami Mc Laughlin, Donghui Cheng, Roger P. Hollis, Beatriz Campo-Fernandez, Fabrizia Urbinati, Liu Wei, Larry Pang, Valerie Rezek, Beata Berent-Maoz, Mignonette H. Macabali, David Gjertson, Xiaoyan Wang, Zoran Galic, Scott G. Kitchen, Dong Sung An, Siwen Hu-Lieskovan, Paula J. Kaplan-Lefko, Satiro N. De Oliveira, Christopher S. Seet, Sarah M. Larson, Stephen J. Forman, James R. Heath, Jerome A. Zack, Gay M. Crooks, Caius G. Radu, Antoni Ribas, Donald B. Kohn, Owen N. Witte and Lili Yang, 5 September 2019, Cell Stem Cell.DOI: 10.1016/j.stem.2019.08.004

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Immunity Against Cancer? Engineered Killer T Cells May Be the Key. - SciTechDaily

Plymouth Argyle trio get special injections to speed up their recoveries from injury – Plymouth Live

Ryan Lowe has revealed that three of Plymouth Argyles injured players have had PRP (platelet-rich plasma) injections.

The Pilgrims boss says it will speed up the recoveries of midfielder Jose Baxter, as well as strikers Byron Moore and Dom Telford.

PRP is a concentrate of platelet-rich plasma protein derived from whole blood which is centrifuged to remove red blood cells.

Lowe had the injections when he was a player and they are becoming increasingly common in not just football, but others ports too.

He said: I had them every other week. It speeds the recovery up. When you have got a bit of soft tissue injury, whats probably reoccurred, it helps it heal.

If you get the needle and the blood flow right into where it is, it helps it heal. Your blood helps heal the tears the muscle injuries.

So thats what they have had. I have insisted they had that because its a big help in recovery from any muscle injury.

The trio will all miss the match at Mansfield Town on Saturday but could return to training next week.

Baxter has had a calf problem while Moore and Telford have picked up hamstring injuries, although none of them are as bad as first feared.

Lowe said: If it was a cup final tomorrow, them three players would be playing trust me, but its not, so thats why they are not.

In terms of helping them to recover the best they can, its certainly worth it.

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Plymouth Argyle trio get special injections to speed up their recoveries from injury - Plymouth Live

Non-viral Gene Therapy will now accelerate cancer study – Industry Reporter

Researchers at RMIT University have proved effective in laboratory tests and safer than standard viral approaches by developing a non-viral, bio-inspired gene delivery method.

Gene therapy, which is widely considered to be the next limit of cancer research, includes the addition of new genes to cells of a patient to replace missing or malfunctioning cells causing the illness.

Since cells do not use genes or any foreign DNA material naturally, therapeutic genes enter cells are the main challenge for gene therapy.

However, the risk of bringing a virus into the body has slowed progress from the laboratory to the clinic and only three FDA virus-based therapies have always been approved. Research focuses on the use of viral delivery technologies.

Although the non-viral techniques are safer and comparatively cheap, less than 0.25% of gene therapy studies focused on different outcomes.

Lead investigator Dr. Shukla said it will be the main move for gene therapies to be taken out of the lab and into clinics to deal with the gap in appropriate non-viral procedures.

With Metal-Organic Frameworks (MOFs), Shukla and his team are developing the new technique which can be used to store, separate, release or safeguard almost any biomolecule with extremely flexible and super-porous Nanos.

The study is endorsed by the CSIRO, which has established a technology to produce industrial-scale amounts of MOF. This technology is based on the Commonwealth.

MOFs have increasingly gained ground, and these newest findings show great potential in non-viral gene therapy, mostly for industrial or chemical purposes.

Researchers used a MOF subset known to convey the DNA into their cell, which was biocompatible and biodegradable.

The MOF-based therapy technique for the therapy of lung and breast cancer and other gender illnesses is efficient in prostate cancer cells.

Arpita Poddar, Ph.D. Researcher who has worked on the discovery with Shukla, said the results represent the first step towards opening up a study line that has been disregarded so far.

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Non-viral Gene Therapy will now accelerate cancer study - Industry Reporter

Social Impact Heroes: How Lynn OConnor Vos and the Muscular Dystrophy Association are helping to raise billions of dollars to fund research to…

I get an early memory from my dad which I say to myself every dayYou cant park up front unless you drive there. The bottom line is, nothing ventured, nothing gained. Youve got to go for it. Urgency is also kind of in my DNA, which is important for MDA right now. As a CEO driving this organization, you need somebody with urgency because every day that goes by that we dont treat these patients, they lose muscle and we are on the hunt to make a difference for every one of these patients.

I had the pleasure to interview Lynn OConnor Vos, the President & CEO of the Muscular Dystrophy Association. Lynn brings broad leadership capacity to the Muscular Dystrophy Association. She held her CEO position at greyhealth (ghg) for nearly 23 years and is credited with creating, building and acquiring companiesspecifically, nine acquisitionsto grow ghgs global footprint. While at ghg, Vos led global expansion and diversification strategies and within two years, grew the company from a small, domestic professional player into an award-winning global enterprise with fully integrated, multi-channel offerings. She is a recognized thought leader in the industry with published white papers and articles outlining new, successful approaches to health care technology and communications.

Thank you so much for joining us Lynn! Can you tell us a story briefly about what brought you to this specific career path?

I spent my entire career in healthcare, starting out as a pediatric nurse at Childrens Hospital of Philadelphia. Ive always been extremely interested in improving patient outcomes and really making a big difference in healthcare and had a dual track in my career. I did a lot of board work at the nonprofit level, including with the Multiple Myeloma Research Foundation, where I helped Kathy Giusti for 10 years. I was also a founding member of the Jed Foundation and there, our mission was to prevent suicide in teens and young adults, so I have had a tremendous nonprofit run from a board perspective.

At the same time, I ran a global healthcare communication firm called greyhealth, which had a focus on the pharmaceutical industry and focused on my interest level, which is entrepreneurialism. I just love to identify opportunities, gaps and new programs; a great example is text4baby which is the largest mobile health program for mothers. Mothers can use the program to track their due date and the progress of their pregnancy. That was a very successful program.

Fast forward to todaythe MDA came by as an opportunity. The MDA has been funding over a billion dollars of research and today, we have breakthrough therapies on the market, gene replacement therapy for SMA and many disease modifying therapies in the pipeline. I saw this opportunity as a chance to transform the organization and move them in the direction of driving cures and hopefully eliminating neuromuscular diseases someday through all the research we support.

My job is the perfect combination of carebecause I was a nurseand driving research. Not to mention the fact that you cant run an organization this size unless you can bring great marketing to bear.

Can you share the most interesting story that happened to you since you began leading your company?

The MDA is privileged to have had a significant number of sponsors who have been with us for decades. I think one of the most interesting stories was with one of our largest partners, the International Association of Fire Fighters. Last year, the first year I was at MDA, was the 100-year anniversary of the IAFF and I had this amazing opportunity to go to their anniversary in Seattle. I have to say I was completely blown awaythere was a massive movie and diorama and a gorgeous depiction of what the last 100 years have looked like from the firefighters perspective and how many amazing and challenging situations they have addressed, including 9/11. I was absolutely proud and privileged to be in the company of the general president Harold Schaitberger and his entire constituents. So, you join a nonprofit organization expecting to be very engaged in the medical community and fundraisers as well, but at MDA, we are very lucky to have some of the highly respected individuals in America working for us to drive fundraising for children with neuromuscular diseases.

Can you share a story about the funniest mistake you made when you were first starting? Can you tell us about the lesson you learned from that?

When I joined MDA, we were at a pivotal point where we had to turn to really focus on driving care and better treatment for patients. There was a lot of transition in certain departments. I cant say this is a funny mistake, but its certainly something every leader knows. My tendency as an individual and leader is, I always get in there and I want to fix things quickly. I think leaders have to adjust to understand the level of change management that might be necessary to actually get to that new place. We probably made the right move, but we probably could have slowed down in certain areas because we all know that change happens slower than that.

Are there three things the community, society and politicians can do to help you address the root of the problem youre trying to solve?

Our problem is a health problem and because there were no treatments for so long, we werent really mobilized to handle that. We can make it easier for people with our diseases to acquire all the treatments and devices they need to live a very successful and productive life. And I think were going to be looking at that more closely. We know we are committed to innovations in care. And when you think about care, were thinking about that broadly, even with their retail experience. Can we make a better retail experience for these individuals? For example, can we deliver all of the products they need on a timely basis? Can we bring community together so that they get best practices and best ideas of how to live with their disease through digital platforms?

In terms of politicians, society and community, we can have a lot of community engagementour IAFF and Jiffy Lube partnerships are locally driven (view our MUSCLE UP Campaign with Jiffy Lube here). Our intention is to do much more at the local level to connect and bring best in class services to individuals who have these diseases. And we also are moving in the direction of really understanding how we can create greater access for the drugs that are coming out. Thats something MDA is going to be looking at in the next year or so to actually get those care centers and bring those drugs to patients when they need them.

I also think that one of the most exciting things that definitely relates to the politicians and society is newborn screening. The way newborn screening works in America is you only get screened for four conditions where there are treatments and were starting to see that there are treatments now coming to market. And what were doing at MDA is mobilizing the entire community along with our chairman, whos devoted his life to newborn screening, to get newborn screening implemented across America. Those decisions are made federally, and the HHS has approved two of these. The next level is to actually go out and lobby every state and make sure that they adopt this practice. And so, what we need help with is local and national politicians to lobby for us. On the local level, we need to make sure that every baby is screened for these matters. If theyre screened at birth, and they are identified right away, and they get a drug for replacement therapy, for example, or disease modern modifying therapy, they will, in some cases, be cured of the disease. Because every day that they dont get treated, another motor neuron dies. Its really urgent to get newborn screening done right away.

How do you define leadership? Can you explain what you mean or give an example?

I think the best leaders are really good listeners and that doesnt always come naturally with people who have strong leadership traits. Its something that I certainly work on every day. But a leaders job is to really set the course to make a bold move, identify where we should be going and then hire incredible peopleteam members who want to work together. Those are people that complement each other in terms of skills. They shouldnt be all the same mindset. It should be a diversified team in terms of skills and everything else coming together and really the leader needs to be open to all of their input to meet that bold move.

I would also say that when youre a leader in a situation where youre trying to do a transformation, which is what were doing, you have to be extremely concerned that youre reaching high enough. To me, that makes you think if your move is bold enough and rooted in reality. Secondly, you really need to make sure that people have the right skill set to make that bold move. And third, which is where I think a lot of transformations fail, is an exquisitely designed and implemented change management program. A great example of leadership is the CEO of Microsoft. You know when you read his book Refresh, he talks about the pivotal moment in his life when he had a son born with cerebral palsy. But the charter and the mission and the vision to address accessibility and technology in the way that Microsoft is going about it is just really impressive.

What are your five things you wish someone told you when you first started and why? Please share a story or example for each.

I hadnt really understood the power of MDAs research and care. This week, I got a call from the CEO from AskBio. He called specifically to tell me that MDA was the only funder out there in the early 2000s right after there had been some setbacks in gene therapy, and he was looking for funding for his research, and we were the one that gave him the funding and convinced them to start. He also articulated very clearly the effect of MDAs research dollars, the conviction that we had with him and the support we gave them. I wish I had known a little bit earlier on how spectacular the research program that MDA has committed to really is. We all need to understand how important nonprofits can be in transforming disease. And this is what MDA has done. I want more people to know the absolutely critical role MDA has played over the last 70 years in terms of bringing cures to markets. The other story I would say is, you know social impact is obviously so attractive to me and in fact to others. You want to make a big difference. You want to really transform the lives of individuals working with neuromuscular disease in this case. What you dont really understand when you jump into a job like this is the absolute enormous task of engaging with donors and driving fundraising. We have to fund every single piece of the mission and that is a very big challenge. Its also an opportunity. But it goes with the territory.

You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger.

You look at all of the people that fundraised for us over the yearsthree hundred thousand firefighters, Harley Davidson, Jiffy Lube. We serve 250,000 patients and most of those people come to the MDA website to get information. Fifty thousand of those people go to MDAs clinics. Thousands of doctors are treating patients. We really believe at this point we need to create a movement. We are driving to bring to market, bring better care to our patients. And we want everyone out there to join us in this movement. And thats our big challenge going forward and a great opportunity in terms of marketing positioning. Were taking this brand that was known for Jerry Lewis. We now need to say, Join us again and help us to help others move again.

Can you please give us your favorite Life Lesson Quote? Can you share how that was relevant to you in your life?

I get an early memory from my dad which I say to myself every dayYou cant park up front unless you drive there. The bottom line is, nothing ventured, nothing gained. Youve got to go for it. Urgency is also kind of in my DNA, which is important for MDA right now. As a CEO driving this organization, you need somebody with urgency because every day that goes by that we dont treat these patients, they lose muscle and we are on the hunt to make a difference for every one of these patients.

Is there a person in the world or in the U.S. whom you would love to have a private breakfast or lunch with?

The CEO of Microsoft, because I find him to be an inspiring leader. What hes done at Microsoft is transformative. And the MDA is the right organization to partner with Microsoft because they want to make technology accessible for all. We service 250,000 people who want to work with technology. I think that our MOVR initiative is a great example of connecting all the care for patients that we can so that we can accelerate clinical trials and accelerate treatments to the right patient at the right time. And certainly, Microsoft is in that area of big data and A.I. The other thing thats really fun and something that weve done with Microsoft is that they have the adaptive controller that they launched last year at the Super Bowl. And weve done some really great gaming events at MDA Lets Play. Id love to talk to him about it because I think what Microsoft is doing is really impacting in a very positive way the children with neuromuscular disease and we just want to do more together. Hes also just an impeccable leader. Id love to learn from him.

Please visit MDA.org to learn more about MDA.

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Pollard and Norris in the race for Pos. 2 of the Public Hospital District 4 – Snoqualmie Valley Record

Dariel Norris and Gene Pollard are competing for Position 2 of the King County Hospital District No. 4. The district comprises the cities of Snoqualmie, North Bend and Carnation, as well as unincorporated and rural areas nearby.

Norris has a Bachelor of Science degree from the University of Washington and has the occupations of hospital registered nurse and small business owner. She has also served on the King County Parks Levy review board and the Snoqualmie Valley Community Network board.

Pollard has degrees from the University of California, Riverside and Occidental College. He also attended the Naval War College where he earned a diploma. Pollard is a retired foreign service officer, Navy commander, according to his candidate statement on the King County Auditors Office website.

Biggest health care problem facing Snoqualmie/the health care district?

Norris: I would say the ability to meet the specific health care needs of the local community. The 2016 Community Health Data Report identified the following issues for the Hospital district: access, cancer, heart and lung disease, mental health, smoking, substance abuse, diabetes, homelessness for adults and youth, all with serious health consequences.

Pollard: The major problem facing the district is the long-term indebtedness of $100 million, the greatest of any comparable hospital in the U.S. This didnt just happen overnight; it took years to accumulate. I attribute this to poor financial planning and incompetent policy making, especially by the hospital boards finance committee headed up by commissioners David Speikers and Dariel Norris. Committee meetings were briefly open to other commissioners and the public under former superintendent Tom Parker, who left a year ago to take a position with Mammoth Hospital in California. But now the committee has decided to again close its meetings, so financial decisions come to the board for rubber-stamping without dissenting opinion or transparent discussion.

How do we address this problem?

Norris: At present, the hospital district hasnt been able to reach out to the local community with supporting programs that aggressively address the above issues. Many who live in the district dont realize the hospital has clinics, physical therapy or an infusion program. Lab services as well as endoscopy and colonoscopies are available. We have an X-ray department with not only an Xx-ray machine but also MRI and CAT scan machines. In addition, we also have an infusion program. Even if your primary doctor isnt part of the Snoqualmie system, you can still have your test done close to home and have the results sent to your primary doctor. I believe the district needs to aggressively reach out to our local community, find ways to let them know what we have to offer. I would like to see programs such as nutrition classes from a dietitian or exercise classes from the physical therapy department. I would like the district to have support groups for those caring for family members with Alzheimers or dementia. I think day surgery and particularly orthopedics would be an asset for the community. Snoqualmie Valley Hospital has significant strengths. I sit on the quality committee. We get data that compares us with other local facilities. Based on the data we consistently do very well. If there is an issue, the staff addresses it immediately.

Pollard: Any organization $100 million in debt is in trouble by definition, especially where public money is involved. Whats needed is change change at the top in the finance committee, and in the position of the interim superintendent. The district needs to do a national search to identify a superintendent with prior success in hospital leadership, preferably including experience restoring financially-troubled hospitals. The district also needs greater transparency and accountability in district operations. For example, the proposal for a new hospital was pitched to the community on the basis that the old hospital would be sold for $30 million to the Snoqualmie Tribe and a new hospital would cost $38.6 million. That sounded reasonable, but then the district failed to demand payment when due. With $28.5 million still owed, the district discounted the sale price by half, thereby losing about $10 14 million. I voted against the discounting. Ive often been criticized for my No votes, but the fact is that if other commissioners had voted the way I have during my tenure, there would be no $100 million debt. Equally important to the success of this or any hospital is its communication with the public. The district is deficient. In fact, a local newspaper gave the hospital the grade of F in communicating with the public. Public information and advice on health issues have been missing, especially regarding preventative health. The public is uninformed about whats going at the hospital. They dont attend board meetings, held in the hospital basement, and there is essentially no media coverage. Importantly, the district needs to complete the Community Health Needs Assessment (CHNA) required by the Affordable Care Act and also by the IRS to justify the hospitals tax-exempt status. This is required every three years and must follow specific instructions. The districts 2016 CHNA was a quick and dirty copy of Overlake data and did not comply with the instructions. The 2019 CHNA is becoming overdue, which means the district will be out of compliance. An updated CHNA would assist the district in choosing and budgeting for health care priorities that would benefit the community.

In which direction do you foresee health care in the city/district moving?

Norris: Health care, in Snoqualmie and throughout the country, is struggling with payer models as well as a physician shortage which is growing daily. To meet the needs of Snoqualmie, we need to provide additional services. Services for the very young to the very old and everyone in between. The services need to be close to home and readily available.

Pollard: Because of the indebtedness, the district is now desperately seeking an affiliation, currently with Overlake Medical Center of Bellevue. Overlake is considering a short-term lease arrangement, perhaps five to seven years, which I dont consider viable. More importantly, I dont find Overlake to be a suitable partner. This is based on evaluations by national rating organizations, which dont list Overlake among the top six hospitals in the Puget Sound area. Its also based on my own experience as a patient at Overlake. The district has made many mistakes over the years (witness the debt). I feel that any decision to affiliate with Overlake, whereby this private hospital would take over all hospital operations, would be a historic mistake. It should be noted that Overlake would not bring one dime to the partnership, in contrast to the merger that occurred between Swedish Medical Center and Stevens Hospital in Edmunds. The Everett Herald reported that Swedish planned to invest as much as $90 million in that partnership over 10 years. In contrast, Snoqualmie would receive no funds from Overlake that might be used to help offset its long-term debt.

What are your budget priorities?

Norris: I was appointed to the finance committee six years ago. I was shocked to see some of the unnecessary extravagant expenditures. This is no longer the case. We have streamlined the executive staff. We have continued to budget with priorities in mind to reduce the debt while meeting the health care needs of the community. The present hospital was built with revenue bonds, not tax-backed dollars. The revenue bonds require a sizeable amount of cash on hand. Which we continue to maintain. The finance director suggested we invest those funds instead of letting them sit in the bank at a low interest rate. After a presentation, the chair of the finance committee, made a recommendation to invest those dollars. I believe this to be one of the most responsible choices and decisions the board of commissioners has made. We have also benchmarked as a way of discovering what is the best performance being achieved. This information can be used to identify gaps in an organizations processes in order to achieve a competitive advantage.

Pollard: My budget priority is to focus on austerity throughout the district. This includes looking at every position to make sure its really needed and properly compensated. I believe that some remain only because of the cronyism of prior administrations. A properly qualified new superintendent would be able to tighten things up and ensure the effective and economical operation of the district. Snoqualmie Valley Hospital and the Ridge Clinic belong to the taxpayers and residents of the district, not to hospital administrators or to the personal agendas of commissioners. Everyone associated with hospital governance and operations must remember they have a sacred trust to be good stewards of public funds.

Gene Pollard

Gene Pollard

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Pollard and Norris in the race for Pos. 2 of the Public Hospital District 4 - Snoqualmie Valley Record

Nearly Half of Poland’s SMA Patients on Track to Get Spinraza, Experts Say – SMA News Today

Poland is rolling out Biogensspinal muscular atrophy (SMA) therapy Spinraza (nusinersen) at a faster pace than any country that has approved it, Polish experts say.

Since the first injection in May 2019, about 400 of the 830 patients in Polands SMA registry have either started taking Spinraza or been put on a waiting list to obtain it, according to Kacper Rucinski, president of Warsaw-basedFundacja SMA. A commission of top neurologists is steadily adding patients to the list after determining that they qualify for National Health Service coverage of the treatment.

Longtime SMA expert Anna Lusakowska, a doctor at the Warsaw Medical University Neurology Clinic, predicted that Polish patients who want Spinraza will eventually get the medicine.

However, not all 830 will opt for it, said Rucinski, who along with Lusakowska spoke with SMA News Today by phone. Some patients with the muscle-wasting disease are receiving Roches risdiplam or Novartis branaplam in clinical trials. They would likely stay with their current treatments once those two medications are approved by the Health Ministry and covered by the national health insurance program.

Spinraza is very expensive; both risdiplam and branaplam also will be, upon approval. The U.S. retail price of Spinraza is $750,000 for the first year and $375,000 in subsequent years, although Poland, like all members of the European Union, negotiated its own price with Biogen.

Spinraza first became available in 2017 to a few dozen Polish patients under Biogens expanded-access program. In December 2018 18 months after Spinraza received European Union approval Poland authorized its National Health Service to pay for it.

Hospitals in three of Polands 16 regions spearheaded Spinraza treatment in 2017. Lusakowskas hospital, in the Masovia region which includes Warsaw joined them last year.

Not only did most of the regions outside Warsaw have no experience with Spinraza; they had never even treated SMA patients before, said Lusakowska, who started Polands SMA registry in 2010.

About 120 of Polands SMA patients live in the Warsaw area. As a result, the neurology programs at Warsaw Medical University and Childrens Memorial Health Institute in Warsaw became leaders in treating the disease decades ago.

After the national health insurance program began covering Spinraza, Lusakowskas neurology department decided to administer the medicine to as many people with SMA as possible. Thats led to long hours for staffers, but also has allowed Lusakowskas team to develop a level of expertise solid enough to share with inexperienced practitioners in other regions.

Patients with severe curvature of the spine are a special challenge, even if they have had previous surgery to correct their scoliosis, she said.Radiologists at Lusakowskas clinic use a computerized tomography (CT) scanner to administer injections to individuals with badly curved spines. The scanner shows the best locations for injecting those with scoliosis.

Four months after Polands first non-early-access injection, all regions are offering Spinraza, although it hasnt been easy, Lusakowska said. The surge in Spinraza patients since May has overwhelmed neurological clinics, which in addition to SMA deal with strokes, epilepsy and many other nerve-related conditions.

Lusakowska began her neurology career as an SMA specialist in the mid-1990s, just asscientists were discovering the cause of SMA defects in the SMN1 gene.She and other SMA specialists hoped researchers would develop a therapy quickly.

I worked with SMA patients for 30 years before a treatment came, Lusakowska said. Its really wonderful that I can finally do something for them.

The first Spinraza injection is emotional for patient, family and doctor alike, she said.

Usually the patient cries, the mother cries they have been waiting such a long time for this, she said.

Lusakowska said she can deal with the expressions of joy, even if they include tears. Its harder when the emotion is the anguish of patients calling to complain that they have had to wait such a long time for Spinraza but are still not receiving it, she said.

Like most countries, Poland prioritizes Spinrazas roll-out by age and disease severity. Children younger than 3 years old withSMA type 1 the worst form of the disease get top priority because research has shown they can benefit the most.

Adults with advanced stages of SMA are believed to gain less from treatment, though the main focus of Lusakowskas clinic is adults. She and her colleagues are administering Spinraza to 35 people in their 20s and older with different types of SMA, and expect to treat 70 eventually.

The 35 include seven type 1 patients. Six began taking Spinraza in Belgium under the expanded-access program, but returned to Poland after the National Health Service agreed to cover the treatment costs. The clinic also treats several children above the age of 3.

Lusakowska said Spinraza benefits all her SMA patients. Some improvements are obvious to doctors, while others are not but patients say it is helping them. Within a year, her clinic will have enough month-to-month, muscle-strength comparison data for a scientific assessment of Spinrazas effectiveness.

Some improvements have been amazing, Lusakowska said. That is the case, for example, with a 4-year-old Polish girl with SMA type 2 who began taking Spinraza in France when she was a few months old. Doctors had diagnosed her SMA in the womb after her older brother developed type 2. He also receives Spinraza.

Her brother is improving all the time with Spinraza, Lusakowska said. He is not walking, but he is much stronger. But his sister, who began receiving Spinraza when she was 3 months old, is walking, jumping, dancing shes a normal girl.

Another heartening sign is that, thanks to Spinraza, some patients who had been on detachable ventilation devices 16 hours a day have been able to reduce that to 10 hours a day.

Similarly, some patients say their voices are becoming much stronger as Spinraza strengthens their larynx muscles, Lusakowska said.

She praised the Health Ministry for deciding to cover all SMA patients who want Spinraza, rather than restricting it only to those in certain categories.

We dont have to turn anyone away, she said. We can tell all our patients that maybe not this month, but next month, we can treat you.

Hal Foster is a veteran journalist at the Los Angeles Times and other news organizations in the United States and Japan, and a longtime journalism professor.In addition to the LA Times, he worked at the Portland Oregonian and the Seattle Post-Intelligencer, was executive editor of Pacific Stars & Stripes in Tokyo, and wrote about the war in Ukraine for USA Today.He has a Ph.D. in journalism from the University of North Carolina, and has taught in the United States, Kazakhstan and Ukraine, where he was a Fulbright scholar.

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Ana holds a PhD in Immunology from the University of Lisbon and worked as a postdoctoral researcher at Instituto de Medicina Molecular (iMM) in Lisbon, Portugal. She graduated with a BSc in Genetics from the University of Newcastle and received a Masters in Biomolecular Archaeology from the University of Manchester, England. After leaving the lab to pursue a career in Science Communication, she served as the Director of Science Communication at iMM.

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Nearly Half of Poland's SMA Patients on Track to Get Spinraza, Experts Say - SMA News Today

Prospective Study Characterizes PCa Risk Linked to BRCA1, BRCA2 Mutations – Renal and Urology News

Fordecades, it has been known that the mutations in the tumor suppressor genes BRCA1 and BRCA2 are associated with high risks of breast and ovarian cancer,but a new prospective cohort study provides the strongest evidence to date thatthese mutations are associated with the development of prostate cancer (PCa).

TheBRCA2 mutation appears to be morestrongly associated with PCa development than the BRCA1 mutation. In addition, the increased risk of PCa varies byfamily history of the malignancy and the location of the mutation within thegenes.

Ourstudy is unique in that we have recruited healthy men across the UK and Irelandwho have hereditary BRCA1 or BRCA2 mutations, and then followed themprospectively for up to 17 years to see if they would develop prostate cancer,said corresponding author Tommy Nyberg, a PhD candidate at the Centre forCancer Genetic Epidemiology at the University of Cambridge in the UK.

Thestudy, which was published in EuropeanUrology, included 376 male BRCA1 mutationcarriers and 447 male BRCA2 mutation carrierswho were identified in clinical genetics centers in the United Kingdom and Ireland.Of these, 16 BRCA1 and 26 BRCA2carriers were diagnosed with PCa during follow-up. Nyberg and his colleagues foundthat the risk of PCa is more strongly influenced by BRCA2 than BRCA1 mutations.The BRCA2 mutation is associated witha nearly 4.5-fold increased risk of PCa, whereas the BRCA1 mutation is associated with an approximately 2.4-foldincreased risk. This translates into estimated absolute lifetime risks fordeveloping prostate cancer of 60% for BRCA2and 29% for BRCA1 mutation carriers.We also found an association with more aggressive prostate cancer for men with BRCA2, but not BRCA1 mutations, Nyberg told Renal& Urology News.

Forthe men with BRCA1/2 mutations, therisk was greater for those from families where several family members had beendiagnosed with PCa than for those without such a family history. This probablyreflects the complex genetic landscape of prostate cancer susceptibility, withseveral genetic variants besides BRCA1/2mutations being known to influence the risk, Nyberg said.

Amongcarriers of the BRCA2 mutation, therisk of PCa increased nearly 1.7-fold with each relative diagnosed with PCa.Compared with the general population, BRCA2mutations in the so-called ovarian cancer cluster region (bounded by positionsc.2831 and c.6401) were associated with a nearly 2.5-fold higher incidence ofPCa, a lower risk increase than for mutations elsewhere in the BRCA2 gene. BRCA2 mutations outside this region were associated with a 5.9-foldrelative risk of PCa. Additionally, the BRCA2mutation was associated with a 5-fold increased incidence of Gleason score 7PCa and 3-fold increased incidence of Gleason 6 or less PCa. The mutation alsowas associated with almost 3.9-fold increased incidence of PCa mortality.

Isee the primary clinical application of our research as facilitating geneticcounseling and the early detection of prostate cancer, Nyberg said. Men whoare discovered to carry a hereditary BRCA2mutation, even if currently healthy, are at considerable risk of developingprostate cancer during their lifetime. A greater understanding of genetic riskvariants is continuously occurring, and consequently genetic counseling forprostate cancer is getting more and more accurate.

AnthonyV. DAmico, MD, PhD, Chief of the Division of Genitourinary Radiation Oncologyat Dana-Farber Cancer Institute and Professor of Radiation Oncology at HarvardMedical School in Boston said drugs already are available that target BRCA2 mutations. Studies are needed inmen who harbor BRCA mutations to investigate whether these drugs such as PARPinhibitors and platnium based chemotherapy can reduce the risk of metastasisand death from prostate cancer, Dr DAmico said.

Moreover,the new findings support recommendations that men with a significant familyhistory for PCa, especially those with multiple first-degree relatives with PCa,undergo genetic testing for the BRCA2mutation and then to be seen by a genetics counselor to be considered for screening at an earlier age than recommendedin standard guidelines.

Themajor implication here is that men with BRCA2in particular are at a significantly increased risk of developing clinicallymeaningful prostate cancer, and this risk might be influenced by factors suchas family history and the type of mutation that is inherited, said Amar U.Kishan, MD, Assistant Professor of Radiation Oncology at the David GeffenSchool of Medicine of UCLA.

Althoughthe therapeutic implications of the new findings are unclear, it istheoretically possible that men with mutations in DNA repair genes may derivebenefit from drugs such as poly (ADP-ribose) polymerase (PARP) inhibitors, butthe data to support such a strategy are limited to patients with advanced,metastatic castration-resistant PCa. In this setting, olaparib and rucaparibare approved for men with BRCA1/2mutant-tumors, though these mutations can be either inherited or restricted tothe tumor, Dr Kishan said. Whether men with an inherited BRCA2 mutation, whodevelop an aggressive but early stage prostate cancer, would benefit from thistype of therapy, in combination with surgery or radiotherapy, is not known.Several studies are investigating this concept.

ToddMorgan, MD, Associate Professor of Urology and Chief of the Division ofUrologic Oncology at the University of Michigan in Ann Arbor, said the new studyadds important data to help guide patient counseling and may allow for improvedearly detection strategies in men with BRCA1/2 mutations. At his institution, DrMorgan and his colleagues have implemented an early detection clinic for menwith BRCA1 or BRCA2 mutations, which is modeled after similar clinics for femalecarriers of these mutations (https://www.rogelcancercenter.org/cancer-genetics/prostate-cancer-risk-clinic).

Medicaloncologist David Wise, MD, PhD of NYU Langone Health in New York, said the newfindings may change the conversation for men carrying the BRCA2 germline mutation. Based on this study and others, newguidelines are needed to personalize prostate cancer screening for men carryingthe BRCA2 germline mutation. Clinicaltrials testing PARP inhibitors, already FDA approved for ovarian and breastcancer, are ongoing in BRCA2-associatedprostate cancer. Based on promising data from these clinical trials, the FDAhas granted breakthrough therapy status for two PARP inhibitors, rucaparib andolaparib, for men with castration-resistant prostate cancer, Dr Wise said.

Reference

NybergT, Frost D, Barrowdale D, et al. Prostate cancer risks for male BRCA1 andBRCA2 mutation carriers: A prospective cohort study [published online September5, 2019]. Eur Urol. https://doi.org/10.1016/j.eururo.2019.08.025

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Prospective Study Characterizes PCa Risk Linked to BRCA1, BRCA2 Mutations - Renal and Urology News