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It's the second time for her — she underwent the surgical procedure 19 months ago when her twins were born.\u003c/p>\n\u003cp>This time Danielle wants to try something different, something that might sound strange. As soon as her daughter is born, a doctor will wipe bacteria fluid from Danielle's birth canal all over her baby's body.\u003c/p>\n\u003cp>\"I haven't told many people about this yet,\" Vukadinovich says, laughing. \"I understand why people would be like, 'Oh my gosh. That's so weird.' But I don't think it's yucky. It's normal. It's natural really.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The procedure, known as \"\u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/vaginal-seeding/faq-20380881\" target=\"_blank\" rel=\"noopener\">vaginal seeding\u003c/a>,\" is designed to help babies develop healthy microbiomes — the collection of friendly bacteria that inhabit every person's body. Some people call it a \"bacterial baptism.\"\u003c/p>\n\u003cp>\"It's a little bit like that baby's first dunk,\" says \u003ca href=\"https://www.inova.org/indirectory/clinicaltrials.aspx?design=true&dirId=1&LoadCategory=ITMI&LoadSubCategory=Microbiome&memberID=280\" target=\"_blank\" rel=\"noopener\">Shira Levy\u003c/a>, the microbiome research manager at the Inova hospital. \"That's their first religious experience. You know, they get the water and that changes their spirituality.\u003c/p>\n\u003cp>\"In this case, they get the bacteria and that changes their microbiome,\" Levy says. \"This is their first microbiome experience.\"\u003c/p>\n\u003cp>The procedure was developed in response to the sharp rise in C-section births in recent years. That increase has been accompanied by \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/30/444746094/missing-microbes-provide-clues-about-asthma-risk\" target=\"_blank\" rel=\"noopener\">more cases of asthma\u003c/a>, allergies, eczema, obesity, and other diseases.\u003c/p>\n\u003cp>The theory is that the rise in these diseases might be happening, in part, because babies aren't getting exposed to their mother's microbes the way they would if they were passing naturally through the birth canal.[contextly_sidebar id=\"0AllfLEduBOKAavkhBROexZnBFbtKljt\"]\u003c/p>\n\u003cp>\"We think that one of the reasons that babies born by C-section are at increased risk for these diseases is because they don't receive that first beneficial exposure to their mother's vaginal microbiome,\" says \u003ca href=\"https://www.inova.org/Physician_Directory/Suchitra-K-Hourigan-MD/824530\" target=\"_blank\" rel=\"noopener\">Suchitra Hourigan\u003c/a>, a pediatric gastroenterologist at Inova.\u003c/p>\n\u003cp>One very small study \u003ca href=\"https://www.npr.org/sections/health-shots/2016/02/01/464905786/researchers-test-microbe-wipe-to-promote-babies-health-after-c-sections\" target=\"_blank\" rel=\"noopener\">indicated \u003c/a>that swabbing C-section babies with their mother's microbes immediately after birth could make their microbiomes develop more like those of babies born vaginally.\u003c/p>\n\u003cp>But the appeal of vaginal seeding has outpaced evidence that it is safe and effective.\u003c/p>\n\u003cp>Some couples have started trying vaginal seeding on their own. Vukadinovich jokes that she considered doing it herself. After all, she says, she's a nurse and her husband is a high school biology teacher.\u003c/p>\n\u003cp>\"I even told my mom: 'Nobody has to know. My husband would help me out,' \" she says, laughing. \"But I try not to take unnecessary risks.\"\u003c/p>\n\u003cp>Vukadinovich knows the procedure could be risky. Babies could be inadvertently exposed to disease-causing microbes, such as herpes virus or streptococcus bacteria.\u003c/p>\n\u003cp>In fact, medical groups such as the American College of Obstetrics and Gynecology \u003ca href=\"https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Vaginal-Seeding\" target=\"_blank\" rel=\"noopener\">warn\u003c/a> women against doing this. \"While there are data to suggest that there may be some scientific plausibility to the concept, it is not without significant risks,\" says \u003ca href=\"http://newsroom.ucla.edu/experts/preview/578561302cfac209100154a4/\" target=\"_blank\" rel=\"noopener\">Neil Silverman\u003c/a>, a clinical professor of obstetrics and gynecology at the UCLA School of Medicine, who represents ACOG. The group notes that mothers also transfer microbes to their newborns through skin-to-skin contact and breastfeeding.\u003c/p>\n\u003cp>So Vukadinovich was thrilled when she found out she could be part of the first \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03298334?term=vaginal+seeding&rank=1\" target=\"_blank\" rel=\"noopener\">study\u003c/a> the Food and Drug Administration is allowing to rigorously test whether the procedure is safe and helps improve babies' health.[contextly_sidebar id=\"kMHzgUs0dutTuVHV7G0EJpefrLt2hB8h\"]\u003c/p>\n\u003cp>\"Who knows what's going to happen with the results? But if it does show something positive, I just think that would be great for kids and parents,\" she says.\u003c/p>\n\u003cp>Hourigan, who's helping lead the study, agrees. \"Just to be able to reduce one risk factor for obesity, especially when there are such high [C-section rates] in the U.S., would be huge,\" she says.\u003c/p>\n\u003cp>In the study, half of the babies will get swabbed with their mother's microbes; half will get swabbed with a sterile solution. All of the mothers will be carefully screened for dangerous infections.\u003c/p>\n\u003cp>All of the babies will then be followed for three years to see if they become obese or develop other health problems. A \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03567707?term=vaginal+seeding&rank=2\" target=\"_blank\" rel=\"noopener\">similar study\u003c/a> is starting at the Icahn School of Medicine at Mount Sinai in New York City.\u003c/p>\n\u003cp>Vukadinovich agreed to let an NPR reporter and photographer observe her baby's birth and the swabbing. It's the first time journalists have been allowed to watch a baby go through the study.\u003c/p>\n\u003cp>\u003cstrong>Evelyn Marie is Born\u003c/strong>\u003c/p>\n\u003cp>As the nurses wheel Vukadinovich into the operating room, Hourigan, Levy and Dr. Varsha Deopujari follow. Deopujari, the study's clinical manager, will do the actual swabbing.\u003c/p>\n\u003cp>Inside the OR, everyone quickly takes their places. As the surgeon starts, Hourigan explains what's happening. It goes very fast.\u003c/p>\n\u003cp>\"An incision is being made into mom, and they are getting ready to take out the baby,\" Hourigan says. \"They can see the head. And the head is now coming out of the C-section incision. Baby's head is out.\"\u003c/p>\n\u003cp>In less than a minute after the surgery starts, the baby girl is completely out. A nurse rushes the newborn to a nearby table to clear her breathing. After the baby is breathing smoothly, Deopujari starts swabbing with a gauze pad.\u003c/p>\n\u003cp>First, she swabs the baby's mouth, cheeks and face. After turning the gauze over to expose more bacteria, Deopujari wipes the baby's hands and arms. Next, she wipes down her chest, goes over her abdomen, up the other arm and then over her back.[contextly_sidebar id=\"umm131VoK2OKqBWygztDrKkMjOgsaGeH\"]\u003c/p>\n\u003cp>\"And the swabbing is now over,\" Hourigan says.\u003c/p>\n\u003cp>Deopujari hands the baby back to a nurse. Hourigan and her team quickly head out of the OR.\u003c/p>\n\u003cp>\"That went perfectly,\" she says. \"Baby came out and was crying. We waited until baby was stable, and the swabbing went just as planned.\"\u003c/p>\n\u003cp>Hourigan and her colleagues will swab 50 babies to make sure their procedure is safe. If it is, they plan to expand the study to 800 babies, who would randomly receive either the bacterial swab or a placebo, throughout the Inova hospital system.\u003c/p>\n\u003cp>The results could prove important. \"We need more data and we need better data,\" says Silverman, of ACOG. \"If it shows that there is a clear benefit, then this process can be re-evaluated.\"\u003c/p>\n\u003cp>The next morning, Vukadinovich, her husband, Nick, 41, and their new daughter are together in a hospital room.\u003c/p>\n\u003cp>\"I'm good — feeling good today,\" she says, cradling her baby.\u003c/p>\n\u003cp>The couple doesn't know if their new daughter, who they would later name Evelyn Marie, was exposed to her mother's microbes or a sterile placebo solution. But they have their fingers crossed she was swabbed with bacteria.\u003c/p>\n\u003cp>\"I really hope that she was,\" Vukadinovich says. \"If there's a decreased chance of her having any health issues, that would be awesome.\"\u003c/p>\n\u003cp>Her husband, Nick, agrees.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\"We're not terribly religious so we won't baptize with water — holy water,\" Nick says. \"But since we're scientists, we like the idea of a bacterial baptism instead of a holy baptism — because now she's been initiated with bacteria, friendly bacteria, that should protect her down the road.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors+Test+Bacterial+Smear+After+Cesarean+Sections+To+Bolster+Babies%27+Microbiomes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"After a C-section, does swabbing a baby with the mother's microbes reduce the risk of obesity and other health problems later in life? An ambitious study to help answer the question is underway.","status":"publish","parent":0,"modified":1540921365,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":42,"wordCount":1252},"headData":{"title":"Doctors Test Bacterial Smear After C-sections To Bolster Babies' Health | KQED","description":"After a C-section, does swabbing a baby with the mother's microbes reduce the risk of obesity and other health problems later in life? An ambitious study to help answer the question is underway.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"445306 https://ww2.kqed.org/futureofyou/?p=445306","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/30/doctors-test-bacterial-smear-after-c-sections-to-bolster-babies-health/","disqusTitle":"Doctors Test Bacterial Smear After C-sections To Bolster Babies' Health","source":"DIY Health","nprByline":"Rob Stein, NPR","nprImageAgency":"Mary Mathis/NPR","nprStoryId":"658254175","nprApiLink":"http://api.npr.org/query?id=658254175&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/10/30/658254175/doctors-test-bacterial-smear-after-cesarean-sections-to-bolster-babies-microbiom?ft=nprml&f=658254175","nprRetrievedStory":"1","nprPubDate":"Tue, 30 Oct 2018 09:58:00 -0400","nprStoryDate":"Tue, 30 Oct 2018 05:03:00 -0400","nprLastModifiedDate":"Tue, 30 Oct 2018 12:45:06 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/10/20181030_me_doctors_test_bacterial_smear_after_cesarean_sections_to_bolster_babies_microbiomes.mp3?orgId=1&topicId=1128&d=421&p=3&story=658254175&ft=nprml&f=658254175","nprAudioM3u":"http://api.npr.org/m3u/1662009687-72e5e0.m3u?orgId=1&topicId=1128&d=421&p=3&story=658254175&ft=nprml&f=658254175","audioTrackLength":422,"path":"/futureofyou/445306/doctors-test-bacterial-smear-after-c-sections-to-bolster-babies-health","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/10/20181030_me_doctors_test_bacterial_smear_after_cesarean_sections_to_bolster_babies_microbiomes.mp3?orgId=1&topicId=1128&d=421&p=3&story=658254175&ft=nprml&f=658254175","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Danielle Vukadinovich is sitting up in a hospital bed at the Inova Women's Hospital in Falls Church, Va., waiting to give birth.\u003c/p>\n\u003cp>\"I feel good, I'm excited!\" says Vukadinovich, 35, of Annandale, Va., \"Nervous, but good!\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Vukadinovich is getting a \u003ca href=\"https://medlineplus.gov/cesareansection.html\" target=\"_blank\" rel=\"noopener\">cesarean section\u003c/a> today. It's the second time for her — she underwent the surgical procedure 19 months ago when her twins were born.\u003c/p>\n\u003cp>This time Danielle wants to try something different, something that might sound strange. As soon as her daughter is born, a doctor will wipe bacteria fluid from Danielle's birth canal all over her baby's body.\u003c/p>\n\u003cp>\"I haven't told many people about this yet,\" Vukadinovich says, laughing. \"I understand why people would be like, 'Oh my gosh. That's so weird.' But I don't think it's yucky. It's normal. It's natural really.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The procedure, known as \"\u003ca href=\"https://www.mayoclinic.org/healthy-lifestyle/infant-and-toddler-health/expert-answers/vaginal-seeding/faq-20380881\" target=\"_blank\" rel=\"noopener\">vaginal seeding\u003c/a>,\" is designed to help babies develop healthy microbiomes — the collection of friendly bacteria that inhabit every person's body. Some people call it a \"bacterial baptism.\"\u003c/p>\n\u003cp>\"It's a little bit like that baby's first dunk,\" says \u003ca href=\"https://www.inova.org/indirectory/clinicaltrials.aspx?design=true&dirId=1&LoadCategory=ITMI&LoadSubCategory=Microbiome&memberID=280\" target=\"_blank\" rel=\"noopener\">Shira Levy\u003c/a>, the microbiome research manager at the Inova hospital. \"That's their first religious experience. You know, they get the water and that changes their spirituality.\u003c/p>\n\u003cp>\"In this case, they get the bacteria and that changes their microbiome,\" Levy says. \"This is their first microbiome experience.\"\u003c/p>\n\u003cp>The procedure was developed in response to the sharp rise in C-section births in recent years. That increase has been accompanied by \u003ca href=\"https://www.npr.org/sections/health-shots/2015/09/30/444746094/missing-microbes-provide-clues-about-asthma-risk\" target=\"_blank\" rel=\"noopener\">more cases of asthma\u003c/a>, allergies, eczema, obesity, and other diseases.\u003c/p>\n\u003cp>The theory is that the rise in these diseases might be happening, in part, because babies aren't getting exposed to their mother's microbes the way they would if they were passing naturally through the birth canal.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"We think that one of the reasons that babies born by C-section are at increased risk for these diseases is because they don't receive that first beneficial exposure to their mother's vaginal microbiome,\" says \u003ca href=\"https://www.inova.org/Physician_Directory/Suchitra-K-Hourigan-MD/824530\" target=\"_blank\" rel=\"noopener\">Suchitra Hourigan\u003c/a>, a pediatric gastroenterologist at Inova.\u003c/p>\n\u003cp>One very small study \u003ca href=\"https://www.npr.org/sections/health-shots/2016/02/01/464905786/researchers-test-microbe-wipe-to-promote-babies-health-after-c-sections\" target=\"_blank\" rel=\"noopener\">indicated \u003c/a>that swabbing C-section babies with their mother's microbes immediately after birth could make their microbiomes develop more like those of babies born vaginally.\u003c/p>\n\u003cp>But the appeal of vaginal seeding has outpaced evidence that it is safe and effective.\u003c/p>\n\u003cp>Some couples have started trying vaginal seeding on their own. Vukadinovich jokes that she considered doing it herself. After all, she says, she's a nurse and her husband is a high school biology teacher.\u003c/p>\n\u003cp>\"I even told my mom: 'Nobody has to know. My husband would help me out,' \" she says, laughing. \"But I try not to take unnecessary risks.\"\u003c/p>\n\u003cp>Vukadinovich knows the procedure could be risky. Babies could be inadvertently exposed to disease-causing microbes, such as herpes virus or streptococcus bacteria.\u003c/p>\n\u003cp>In fact, medical groups such as the American College of Obstetrics and Gynecology \u003ca href=\"https://www.acog.org/Clinical-Guidance-and-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Vaginal-Seeding\" target=\"_blank\" rel=\"noopener\">warn\u003c/a> women against doing this. \"While there are data to suggest that there may be some scientific plausibility to the concept, it is not without significant risks,\" says \u003ca href=\"http://newsroom.ucla.edu/experts/preview/578561302cfac209100154a4/\" target=\"_blank\" rel=\"noopener\">Neil Silverman\u003c/a>, a clinical professor of obstetrics and gynecology at the UCLA School of Medicine, who represents ACOG. The group notes that mothers also transfer microbes to their newborns through skin-to-skin contact and breastfeeding.\u003c/p>\n\u003cp>So Vukadinovich was thrilled when she found out she could be part of the first \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03298334?term=vaginal+seeding&rank=1\" target=\"_blank\" rel=\"noopener\">study\u003c/a> the Food and Drug Administration is allowing to rigorously test whether the procedure is safe and helps improve babies' health.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"Who knows what's going to happen with the results? But if it does show something positive, I just think that would be great for kids and parents,\" she says.\u003c/p>\n\u003cp>Hourigan, who's helping lead the study, agrees. \"Just to be able to reduce one risk factor for obesity, especially when there are such high [C-section rates] in the U.S., would be huge,\" she says.\u003c/p>\n\u003cp>In the study, half of the babies will get swabbed with their mother's microbes; half will get swabbed with a sterile solution. All of the mothers will be carefully screened for dangerous infections.\u003c/p>\n\u003cp>All of the babies will then be followed for three years to see if they become obese or develop other health problems. A \u003ca href=\"https://clinicaltrials.gov/ct2/show/NCT03567707?term=vaginal+seeding&rank=2\" target=\"_blank\" rel=\"noopener\">similar study\u003c/a> is starting at the Icahn School of Medicine at Mount Sinai in New York City.\u003c/p>\n\u003cp>Vukadinovich agreed to let an NPR reporter and photographer observe her baby's birth and the swabbing. It's the first time journalists have been allowed to watch a baby go through the study.\u003c/p>\n\u003cp>\u003cstrong>Evelyn Marie is Born\u003c/strong>\u003c/p>\n\u003cp>As the nurses wheel Vukadinovich into the operating room, Hourigan, Levy and Dr. Varsha Deopujari follow. Deopujari, the study's clinical manager, will do the actual swabbing.\u003c/p>\n\u003cp>Inside the OR, everyone quickly takes their places. As the surgeon starts, Hourigan explains what's happening. It goes very fast.\u003c/p>\n\u003cp>\"An incision is being made into mom, and they are getting ready to take out the baby,\" Hourigan says. \"They can see the head. And the head is now coming out of the C-section incision. Baby's head is out.\"\u003c/p>\n\u003cp>In less than a minute after the surgery starts, the baby girl is completely out. A nurse rushes the newborn to a nearby table to clear her breathing. After the baby is breathing smoothly, Deopujari starts swabbing with a gauze pad.\u003c/p>\n\u003cp>First, she swabs the baby's mouth, cheeks and face. After turning the gauze over to expose more bacteria, Deopujari wipes the baby's hands and arms. Next, she wipes down her chest, goes over her abdomen, up the other arm and then over her back.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>\"And the swabbing is now over,\" Hourigan says.\u003c/p>\n\u003cp>Deopujari hands the baby back to a nurse. Hourigan and her team quickly head out of the OR.\u003c/p>\n\u003cp>\"That went perfectly,\" she says. \"Baby came out and was crying. We waited until baby was stable, and the swabbing went just as planned.\"\u003c/p>\n\u003cp>Hourigan and her colleagues will swab 50 babies to make sure their procedure is safe. If it is, they plan to expand the study to 800 babies, who would randomly receive either the bacterial swab or a placebo, throughout the Inova hospital system.\u003c/p>\n\u003cp>The results could prove important. \"We need more data and we need better data,\" says Silverman, of ACOG. \"If it shows that there is a clear benefit, then this process can be re-evaluated.\"\u003c/p>\n\u003cp>The next morning, Vukadinovich, her husband, Nick, 41, and their new daughter are together in a hospital room.\u003c/p>\n\u003cp>\"I'm good — feeling good today,\" she says, cradling her baby.\u003c/p>\n\u003cp>The couple doesn't know if their new daughter, who they would later name Evelyn Marie, was exposed to her mother's microbes or a sterile placebo solution. But they have their fingers crossed she was swabbed with bacteria.\u003c/p>\n\u003cp>\"I really hope that she was,\" Vukadinovich says. \"If there's a decreased chance of her having any health issues, that would be awesome.\"\u003c/p>\n\u003cp>Her husband, Nick, agrees.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"We're not terribly religious so we won't baptize with water — holy water,\" Nick says. \"But since we're scientists, we like the idea of a bacterial baptism instead of a holy baptism — because now she's been initiated with bacteria, friendly bacteria, that should protect her down the road.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Doctors+Test+Bacterial+Smear+After+Cesarean+Sections+To+Bolster+Babies%27+Microbiomes&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/445306/doctors-test-bacterial-smear-after-c-sections-to-bolster-babies-health","authors":["byline_futureofyou_445306"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_631","futureofyou_1635","futureofyou_61","futureofyou_68","futureofyou_520"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_445307","label":"source_futureofyou_445306"},"futureofyou_444953":{"type":"posts","id":"futureofyou_444953","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444953","score":null,"sort":[1539187421000]},"guestAuthors":[],"slug":"big-data-gives-a-boost-to-immunology-research-and-potentially-treatments","title":"Big Data Gives a Boost to Immunology Research and Potentially, Treatments","publishDate":1539187421,"format":"standard","headTitle":"Women’s Health | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Researchers at UC San Francisco have unveiled the largest \u003ca href=\"http://10kimmunomes.org/\" target=\"_blank\" rel=\"noopener\">searchable database\u003c/a> of immunology data, gathered from 10,000 people of various ages, ethnicity, and backgrounds. It could lead to more effective treatments for a wide range of immune disorders.[contextly_sidebar id=\"lms9rSPdk5pG72xqgRdVMiGv0hv7IpdH\"]\u003c/p>\n\u003cp>The new data pool represents the \u003ca href=\"https://www.cell.com/cell-reports/fulltext/S2211-1247(18)31451-7\" target=\"_blank\" rel=\"noopener\">largest control group\u003c/a> ever compiled on the human immune system, according to the study published on Tuesday in the journal, \u003cem>Cell Reports\u003c/em>.\u003c/p>\n\u003cp>Called the \u003ca href=\"http://10kimmunomes.org/\" target=\"_blank\" rel=\"noopener\">10,000 Immunomes Project\u003c/a> (10KIP), it's the culmination of four years of work and provides an instant comparison group for researchers studying the immune system and immune dysfunction.\u003c/p>\n\u003cp>UCSF researchers created the tool using immunology data from 83 studies representing 10,000 healthy subjects, according to senior author Atul Butte, director of the \u003ca href=\"http://bakarinstitute.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">Bakar Computational Health Sciences Institute\u003c/a> at UCSF.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘If the field of genetics is able to compile large collections consisting of millions of people, why does immunology lag behind?’\u003ccite>Atul Butte, UCSF\u003c/cite>\u003c/aside>\n\u003cp>The data comes from studies on organ transplants, autoimmune disease trials, vaccine studies and other research funded by the National Institute of Allergy and Infectious Diseases (NIAID).\u003c/p>\n\u003cdiv>\n\u003cp>\"We have sub-populations in the U.S. that don't really participate in studies so why not just gather all this massive data on the immune system in one central place,\" says Butte. \"We can turn to this data to see what is going on in a healthy immune system spanning different populations in the U.S.\"\u003c/p>\n\u003cp>Butte says the ability to manipulate immune system activity will benefit a wide range of patients, including transplant recipients, cancer and AIDS patients, and those suffering from some form of immune dysfunction.\u003c/p>\n\u003cp>Autoimmune Disease (AD) in particular, an historically underfunded field, could benefit greatly from the availability of a large and diverse control group, according to Butte.\u003c/p>\n\u003cp>\u003cstrong>Rise of Autoimmine Disease\u003c/strong>\u003c/p>\n\u003cp>AD is one of the fastest growing illnesses in the U.S., with 20 percent of the population or one in five people, suffering from the disorder.[contextly_sidebar id=\"KPqEb6LD9ky4mDsIDJAEnoEvgzkEna45\"]\u003c/p>\n\u003cp>Despite AD being \u003ca href=\"https://www.aarda.org/who-we-are/our-mission/\" target=\"_blank\" rel=\"noopener\">one of the top 10 leading causes\u003c/a> of death in females up to 64 years of age, research has continued to lag behind, according to Butte.\u003c/p>\n\u003cp>The National Institutes of Health\u003ca href=\"https://ww2.kqed.org/science/2018/10/09/voting-on-daylight-saving-time-animal-confinement-and-water-propositions-3-7-and-12-explained/\" target=\"_blank\" rel=\"noopener\"> has spent\u003c/a> $591 million dollars on AD research compared to the $6.1 billion spent on cancer. Current treatments consist of risky immunosuppressants that can lead to devastating long-term side effects.[contextly_sidebar id=\"ZbtYikLAiggPmeNWkxr4kKECzkkjZf4Z\"]\u003c/p>\n\u003cp>UCSF researchers developed the new searchable database in part to boost AD research. Typically, studies done on immune systems are smaller and it's rare to get 10,000 participants, according to Butte.\u003c/p>\n\u003cp>Plus, the human immune system is a moving target.\u003c/p>\n\u003cp>\"It's a difficult field to study because unlike DNA for example, your immune system changes from morning to night. So which aspect of the immune system scientists focus on, and \u003cem>when\u003c/em> they study it, these are all problems we are getting better at. We just need more studies.\"\u003c/p>\n\u003cp>To test their new tool, researchers created a custom control group comprised of women between 18 and 40 years of age and compared it to 56 pregnant women who participated in a prior study tracking immune changes during pregnancy.\u003c/p>\n\u003cp>Using this control group, researchers were able to detect how various immune cells and cell signaling proteins, called cytokines, changed from pre-pregnancy levels— measurements that the original study failed to pick up.\u003c/p>\n\u003cp>Researchers also used the new tool to compare immunity in people from different racial and ethnic backgrounds. The findings showed both known differences as well as new information that could only be seen by combining data from dozens of different studies.\u003c/p>\n\u003cp>For instance, researchers found that regulatory T cells, which suppress the immune response, are present at higher levels in African Americans, compared to all other groups.\u003c/p>\n\u003cp>\u003cstrong>Shareable Science\u003c/strong>\u003c/p>\n\u003cp>Butte sees the searchable database as part of a broader trend in science, promoting open access where more scientists are willing to share their raw data with others.\u003c/p>\n\u003cp>\"It's really hundreds of people who have essentially contributed to this work,\" he notes.\u003c/p>\n\u003cp>Butte says he hopes his work will bring immunology to the forefront and inspire others to rethink their approach to the field.\u003c/p>\n\u003cp>\"If the field of genetics is able to compile large collections consisting of millions of people,\" he wonders, \"why does immunology lag behind? I want to get people in the field thinking about larger collections of samples that cut across race, age and gender.\"\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"UCSF scientists have created the largest searchable database consisting of immunology data gathered from 10,000 people spanning different ages, ethnicity, and backgrounds. ","status":"publish","parent":0,"modified":1539129653,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":26,"wordCount":755},"headData":{"title":"Big Data Gives a Boost to Immunology Research and Potentially, Treatments | KQED","description":"UCSF scientists have created the largest searchable database consisting of immunology data gathered from 10,000 people spanning different ages, ethnicity, and backgrounds. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444953 https://ww2.kqed.org/futureofyou/?p=444953","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/10/big-data-gives-a-boost-to-immunology-research-and-potentially-treatments/","disqusTitle":"Big Data Gives a Boost to Immunology Research and Potentially, Treatments","source":"Health","path":"/futureofyou/444953/big-data-gives-a-boost-to-immunology-research-and-potentially-treatments","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Researchers at UC San Francisco have unveiled the largest \u003ca href=\"http://10kimmunomes.org/\" target=\"_blank\" rel=\"noopener\">searchable database\u003c/a> of immunology data, gathered from 10,000 people of various ages, ethnicity, and backgrounds. It could lead to more effective treatments for a wide range of immune disorders.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The new data pool represents the \u003ca href=\"https://www.cell.com/cell-reports/fulltext/S2211-1247(18)31451-7\" target=\"_blank\" rel=\"noopener\">largest control group\u003c/a> ever compiled on the human immune system, according to the study published on Tuesday in the journal, \u003cem>Cell Reports\u003c/em>.\u003c/p>\n\u003cp>Called the \u003ca href=\"http://10kimmunomes.org/\" target=\"_blank\" rel=\"noopener\">10,000 Immunomes Project\u003c/a> (10KIP), it's the culmination of four years of work and provides an instant comparison group for researchers studying the immune system and immune dysfunction.\u003c/p>\n\u003cp>UCSF researchers created the tool using immunology data from 83 studies representing 10,000 healthy subjects, according to senior author Atul Butte, director of the \u003ca href=\"http://bakarinstitute.ucsf.edu/\" target=\"_blank\" rel=\"noopener\">Bakar Computational Health Sciences Institute\u003c/a> at UCSF.\u003c/p>\n\u003caside class=\"pullquote alignright\">‘If the field of genetics is able to compile large collections consisting of millions of people, why does immunology lag behind?’\u003ccite>Atul Butte, UCSF\u003c/cite>\u003c/aside>\n\u003cp>The data comes from studies on organ transplants, autoimmune disease trials, vaccine studies and other research funded by the National Institute of Allergy and Infectious Diseases (NIAID).\u003c/p>\n\u003cdiv>\n\u003cp>\"We have sub-populations in the U.S. that don't really participate in studies so why not just gather all this massive data on the immune system in one central place,\" says Butte. \"We can turn to this data to see what is going on in a healthy immune system spanning different populations in the U.S.\"\u003c/p>\n\u003cp>Butte says the ability to manipulate immune system activity will benefit a wide range of patients, including transplant recipients, cancer and AIDS patients, and those suffering from some form of immune dysfunction.\u003c/p>\n\u003cp>Autoimmune Disease (AD) in particular, an historically underfunded field, could benefit greatly from the availability of a large and diverse control group, according to Butte.\u003c/p>\n\u003cp>\u003cstrong>Rise of Autoimmine Disease\u003c/strong>\u003c/p>\n\u003cp>AD is one of the fastest growing illnesses in the U.S., with 20 percent of the population or one in five people, suffering from the disorder.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Despite AD being \u003ca href=\"https://www.aarda.org/who-we-are/our-mission/\" target=\"_blank\" rel=\"noopener\">one of the top 10 leading causes\u003c/a> of death in females up to 64 years of age, research has continued to lag behind, according to Butte.\u003c/p>\n\u003cp>The National Institutes of Health\u003ca href=\"https://ww2.kqed.org/science/2018/10/09/voting-on-daylight-saving-time-animal-confinement-and-water-propositions-3-7-and-12-explained/\" target=\"_blank\" rel=\"noopener\"> has spent\u003c/a> $591 million dollars on AD research compared to the $6.1 billion spent on cancer. Current treatments consist of risky immunosuppressants that can lead to devastating long-term side effects.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>UCSF researchers developed the new searchable database in part to boost AD research. Typically, studies done on immune systems are smaller and it's rare to get 10,000 participants, according to Butte.\u003c/p>\n\u003cp>Plus, the human immune system is a moving target.\u003c/p>\n\u003cp>\"It's a difficult field to study because unlike DNA for example, your immune system changes from morning to night. So which aspect of the immune system scientists focus on, and \u003cem>when\u003c/em> they study it, these are all problems we are getting better at. We just need more studies.\"\u003c/p>\n\u003cp>To test their new tool, researchers created a custom control group comprised of women between 18 and 40 years of age and compared it to 56 pregnant women who participated in a prior study tracking immune changes during pregnancy.\u003c/p>\n\u003cp>Using this control group, researchers were able to detect how various immune cells and cell signaling proteins, called cytokines, changed from pre-pregnancy levels— measurements that the original study failed to pick up.\u003c/p>\n\u003cp>Researchers also used the new tool to compare immunity in people from different racial and ethnic backgrounds. The findings showed both known differences as well as new information that could only be seen by combining data from dozens of different studies.\u003c/p>\n\u003cp>For instance, researchers found that regulatory T cells, which suppress the immune response, are present at higher levels in African Americans, compared to all other groups.\u003c/p>\n\u003cp>\u003cstrong>Shareable Science\u003c/strong>\u003c/p>\n\u003cp>Butte sees the searchable database as part of a broader trend in science, promoting open access where more scientists are willing to share their raw data with others.\u003c/p>\n\u003cp>\"It's really hundreds of people who have essentially contributed to this work,\" he notes.\u003c/p>\n\u003cp>Butte says he hopes his work will bring immunology to the forefront and inspire others to rethink their approach to the field.\u003c/p>\n\u003cp>\"If the field of genetics is able to compile large collections consisting of millions of people,\" he wonders, \"why does immunology lag behind? I want to get people in the field thinking about larger collections of samples that cut across race, age and gender.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444953/big-data-gives-a-boost-to-immunology-research-and-potentially-treatments","authors":["11428"],"series":["futureofyou_219"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_1198","futureofyou_1594","futureofyou_1623","futureofyou_327","futureofyou_271"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_444955","label":"source_futureofyou_444953"},"futureofyou_444942":{"type":"posts","id":"futureofyou_444942","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444942","score":null,"sort":[1539118849000]},"guestAuthors":[],"slug":"crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","title":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth","publishDate":1539118849,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">Nearly 40 years after surgeons first \u003ca href=\"https://www.ucsf.edu/news/2011/02/9366/ucsf-surgeon-reflects-performing-worlds-first-fetal-surgery-30-years-ago\" target=\"_blank\" rel=\"noopener\">operated on fetuses\u003c/a> to cure devastating abnormalities, researchers have taken the first step toward curing genetic disease before birth via genome editing: scientists reported on Monday that they used the genome editing technique CRISPR to alter the DNA of laboratory mice in the womb, eliminating an often-fatal liver disease before the animals had even been born.[contextly_sidebar id=\"kLt87B75fzdQ6XiJiVHbmy8S3RDMp2KF\"]\u003c/p>\n\u003cp class=\"danger-zone\">The research, by a team at the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP), is a very early proof of concept. But while CRISPRing human fetuses is years away, at best, the success in mice bolsters what Dr. William Peranteau, who co-led the study, calls his dream of curing genetic diseases before birth.\u003c/p>\n\u003cp class=\"danger-zone\">“A lot more animal work needs to be done before we can even think about applying this [fetal genome editing] clinically,” said Peranteau, a pediatric and fetal surgeon at CHOP. “But I think fetal genome editing may be where fetal surgery [which is now routine] once was, and that one day we’ll use it to treat diseases that cause significant morbidity and mortality.”\u003c/p>\n\u003cp>Simon Waddington of University College London, a leader in research to develop fetal gene therapy who was not involved in the new study, called the CRISPR approach “an elegant refinement of the brute-force technology” that’s been the focus of \u003ca href=\"https://www.nature.com/articles/s41591-018-0106-7\" target=\"_blank\" rel=\"noopener\">animal studies\u003c/a> of fetal genetic therapy.\u003c/p>\n\u003cp>The success in mouse fetuses raises the possibility that, even before \u003ca href=\"https://www.statnews.com/2018/07/25/can-gene-therapy-halt-diseases-in-babies-before-theyre-even-born/\">traditional gene therapy\u003c/a> is ready to treat inherited disorders in utero, genome editing might emerge as a safer, more effective approach. In traditional gene therapy, an entire healthy gene is ferried, typically by a virus, into cells containing a disease-causing gene. With CRISPR, only the mutated bit of a defective gene is changed. It’s the difference between retyping a whole 5,000 word document and using Word’s “find and replace” to correct a typo.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>“We think this represents a safer and more precise way to make changes in the genome,” said Dr. Kiran Musunuru of Penn and a co-leader of the study. “It’s is the better way forward if you want to take CRISPR into the clinic.”[contextly_sidebar id=\"WspKwnRfkmuJ8Ui6Pu5mBgKtCSqZqfJ5\"]\u003c/p>\n\u003cp>The rationale for fetal genetic therapy is simple: it could halt a disease before it causes irreversible and even fatal damage. In people, the inherited liver disease that the scientists targeted in mice, called hereditary tyrosinemia type 1, starts damaging the liver months before birth. Another rationale: because a fetus’s immune system is immature, it is less likely than even a newborn’s to attack the alien CRISPR molecules.\u003c/p>\n\u003cp>For their study, \u003ca href=\"https://www.nature.com/articles/s41591-018-0184-6\" target=\"_blank\" rel=\"noopener\">published in Nature Medicine\u003c/a>, Musunuru and his colleagues gently opened the uterus of a pregnant mouse, removed the fetus from the amniotic sac, and injected CRISPR into the vitelline vein, which is near the surface of the sac and connects to the liver. “We wanted to make sure we got the genome editor into the liver rather than everywhere else,” Musunuru said. The fetus was then replaced in the uterus and was born normally.\u003c/p>\n\u003cp>Instead of using the original form of CRISPR, which cuts DNA where a gene is mutated and inserts a replacement string of A’s, T’s, C’s, and G’s, the scientists used the form of CRISPR called base editing. \u003ca href=\"https://www.statnews.com/2016/04/20/clever-crispr-advance-unveiled/%5D\">Invented\u003c/a> just two years ago, base editing changes an incorrect DNA letter, or base, to the correct one, such as a C to a T or a G to an A. Its advantage is that it doesn’t need to cut DNA to do this, as CRISPR 1.0 does; those cuts can wreak \u003ca href=\"https://www.statnews.com/2018/07/16/crispr-potential-dna-damage-underestimated/\">genetic havoc\u003c/a>, with unknown consequences for CRISPR’d cells.\u003c/p>\n\u003cp>For a dry run, the scientists first made a CRISPR base editor that changes a \u003ca href=\"https://ghr.nlm.nih.gov/gene/PCSK9\" target=\"_blank\" rel=\"noopener\">gene called PCSK9\u003c/a>, which makes a protein that helps regulate the amount of cholesterol in the bloodstream, into a super-cholesterol-lowering form. When injected into mouse fetuses, the base editor changed liver cells as intended and left other organs alone. Crucially, the mouse mother showed no effects of the CRISPR treatment. After birth, the baby mice had ultra-low cholesterol levels, showing that the CRISPR base editor had worked. Only about 15 percent of the liver cells of the baby mice had been edited, but that fraction remained stable through the animals’ adulthood.[contextly_sidebar id=\"7RKromVt2cYnSDdz2L7SJg04iooF89dn\"]\u003c/p>\n\u003cp>The amount of genetic havoc from the base editing was low: about 2 percent, compared to 40 percent for many uses of traditional CRISPR. And none of the likely spots for “off target” effects — DNA sites that resemble the target and so might be inadvertently edited — showed any sign of being altered.\u003c/p>\n\u003cp>The Philadelphia scientists then tried their technique on hereditary tyrosinemia type 1. HT1, which strikes 1 in 100,000 newborns worldwide, is \u003ca href=\"https://rarediseases.info.nih.gov/diseases/2658/tyrosinemia-type-1\" target=\"_blank\" rel=\"noopener\">caused by\u003c/a> any of several mutations in a \u003ca href=\"https://ghr.nlm.nih.gov/gene/FAH\" target=\"_blank\" rel=\"noopener\">gene called FAH\u003c/a>. All the mutations cause the build-up of toxic breakdown products of the amino acid tyrosine, a component of protein, and ultimately destroy the liver. Treatment with the drug nitisinone and a strict tyrosine-free diet is not always effective, with the result that children sometimes develop fatal liver failure or liver cancer.\u003c/p>\n\u003cp>The scientists used their base editor on a gene related to the disease-causing one. If this gene, \u003ca href=\"https://ghr.nlm.nih.gov/gene/HPD\" target=\"_blank\" rel=\"noopener\">called HPD\u003c/a>, is disabled, then no toxic metabolites of tyrosine ever get to where FAH is unable to handle them.\u003c/p>\n\u003cp>Changing a C to a T in the HPD gene disabled it. No toxic molecules built up in the livers of the fetal mice. No other organs showed signs of editing, no off-target effects were detected, and having only 15 percent of their liver cells edited was enough to cure the mice and keep them cured into adulthood. “We weren’t expecting it, but the genome-edited mice did much better” than mice treated with nitisinone, Musunuru said. “They survived longer and gained more weight.”\u003c/p>\n\u003cp>The scientists hope to study fetal base editing for other severe congenital diseases. It remains to be seen whether this technique or conventional gene therapy, which provides an entire replacement gene, will work better.\u003c/p>\n\u003cp>“I’d consider that CRISPR isn’t a replacement” for the latter, Waddington said, “but will be an additional tool” for curing genetic diseases in the womb.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/08/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\n","blocks":[],"excerpt":"In mice with a fatal genetic disease, toxic proteins begin accumulating in the liver before birth. CRISPR performed in utero reversed the condition.","status":"publish","parent":0,"modified":1539042769,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":16,"wordCount":1141},"headData":{"title":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth | KQED","description":"In mice with a fatal genetic disease, toxic proteins begin accumulating in the liver before birth. CRISPR performed in utero reversed the condition.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444942 https://ww2.kqed.org/futureofyou/?p=444942","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/09/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/","disqusTitle":"CRISPR Cures Inherited Disorder in Mice, Paving Way for Genetic Therapy Before Birth","source":"Hope/Hype","nprByline":"Sharon Begley\u003cbr />STAT","path":"/futureofyou/444942/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">Nearly 40 years after surgeons first \u003ca href=\"https://www.ucsf.edu/news/2011/02/9366/ucsf-surgeon-reflects-performing-worlds-first-fetal-surgery-30-years-ago\" target=\"_blank\" rel=\"noopener\">operated on fetuses\u003c/a> to cure devastating abnormalities, researchers have taken the first step toward curing genetic disease before birth via genome editing: scientists reported on Monday that they used the genome editing technique CRISPR to alter the DNA of laboratory mice in the womb, eliminating an often-fatal liver disease before the animals had even been born.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">The research, by a team at the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP), is a very early proof of concept. But while CRISPRing human fetuses is years away, at best, the success in mice bolsters what Dr. William Peranteau, who co-led the study, calls his dream of curing genetic diseases before birth.\u003c/p>\n\u003cp class=\"danger-zone\">“A lot more animal work needs to be done before we can even think about applying this [fetal genome editing] clinically,” said Peranteau, a pediatric and fetal surgeon at CHOP. “But I think fetal genome editing may be where fetal surgery [which is now routine] once was, and that one day we’ll use it to treat diseases that cause significant morbidity and mortality.”\u003c/p>\n\u003cp>Simon Waddington of University College London, a leader in research to develop fetal gene therapy who was not involved in the new study, called the CRISPR approach “an elegant refinement of the brute-force technology” that’s been the focus of \u003ca href=\"https://www.nature.com/articles/s41591-018-0106-7\" target=\"_blank\" rel=\"noopener\">animal studies\u003c/a> of fetal genetic therapy.\u003c/p>\n\u003cp>The success in mouse fetuses raises the possibility that, even before \u003ca href=\"https://www.statnews.com/2018/07/25/can-gene-therapy-halt-diseases-in-babies-before-theyre-even-born/\">traditional gene therapy\u003c/a> is ready to treat inherited disorders in utero, genome editing might emerge as a safer, more effective approach. In traditional gene therapy, an entire healthy gene is ferried, typically by a virus, into cells containing a disease-causing gene. With CRISPR, only the mutated bit of a defective gene is changed. It’s the difference between retyping a whole 5,000 word document and using Word’s “find and replace” to correct a typo.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>“We think this represents a safer and more precise way to make changes in the genome,” said Dr. Kiran Musunuru of Penn and a co-leader of the study. “It’s is the better way forward if you want to take CRISPR into the clinic.”\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The rationale for fetal genetic therapy is simple: it could halt a disease before it causes irreversible and even fatal damage. In people, the inherited liver disease that the scientists targeted in mice, called hereditary tyrosinemia type 1, starts damaging the liver months before birth. Another rationale: because a fetus’s immune system is immature, it is less likely than even a newborn’s to attack the alien CRISPR molecules.\u003c/p>\n\u003cp>For their study, \u003ca href=\"https://www.nature.com/articles/s41591-018-0184-6\" target=\"_blank\" rel=\"noopener\">published in Nature Medicine\u003c/a>, Musunuru and his colleagues gently opened the uterus of a pregnant mouse, removed the fetus from the amniotic sac, and injected CRISPR into the vitelline vein, which is near the surface of the sac and connects to the liver. “We wanted to make sure we got the genome editor into the liver rather than everywhere else,” Musunuru said. The fetus was then replaced in the uterus and was born normally.\u003c/p>\n\u003cp>Instead of using the original form of CRISPR, which cuts DNA where a gene is mutated and inserts a replacement string of A’s, T’s, C’s, and G’s, the scientists used the form of CRISPR called base editing. \u003ca href=\"https://www.statnews.com/2016/04/20/clever-crispr-advance-unveiled/%5D\">Invented\u003c/a> just two years ago, base editing changes an incorrect DNA letter, or base, to the correct one, such as a C to a T or a G to an A. Its advantage is that it doesn’t need to cut DNA to do this, as CRISPR 1.0 does; those cuts can wreak \u003ca href=\"https://www.statnews.com/2018/07/16/crispr-potential-dna-damage-underestimated/\">genetic havoc\u003c/a>, with unknown consequences for CRISPR’d cells.\u003c/p>\n\u003cp>For a dry run, the scientists first made a CRISPR base editor that changes a \u003ca href=\"https://ghr.nlm.nih.gov/gene/PCSK9\" target=\"_blank\" rel=\"noopener\">gene called PCSK9\u003c/a>, which makes a protein that helps regulate the amount of cholesterol in the bloodstream, into a super-cholesterol-lowering form. When injected into mouse fetuses, the base editor changed liver cells as intended and left other organs alone. Crucially, the mouse mother showed no effects of the CRISPR treatment. After birth, the baby mice had ultra-low cholesterol levels, showing that the CRISPR base editor had worked. Only about 15 percent of the liver cells of the baby mice had been edited, but that fraction remained stable through the animals’ adulthood.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The amount of genetic havoc from the base editing was low: about 2 percent, compared to 40 percent for many uses of traditional CRISPR. And none of the likely spots for “off target” effects — DNA sites that resemble the target and so might be inadvertently edited — showed any sign of being altered.\u003c/p>\n\u003cp>The Philadelphia scientists then tried their technique on hereditary tyrosinemia type 1. HT1, which strikes 1 in 100,000 newborns worldwide, is \u003ca href=\"https://rarediseases.info.nih.gov/diseases/2658/tyrosinemia-type-1\" target=\"_blank\" rel=\"noopener\">caused by\u003c/a> any of several mutations in a \u003ca href=\"https://ghr.nlm.nih.gov/gene/FAH\" target=\"_blank\" rel=\"noopener\">gene called FAH\u003c/a>. All the mutations cause the build-up of toxic breakdown products of the amino acid tyrosine, a component of protein, and ultimately destroy the liver. Treatment with the drug nitisinone and a strict tyrosine-free diet is not always effective, with the result that children sometimes develop fatal liver failure or liver cancer.\u003c/p>\n\u003cp>The scientists used their base editor on a gene related to the disease-causing one. If this gene, \u003ca href=\"https://ghr.nlm.nih.gov/gene/HPD\" target=\"_blank\" rel=\"noopener\">called HPD\u003c/a>, is disabled, then no toxic metabolites of tyrosine ever get to where FAH is unable to handle them.\u003c/p>\n\u003cp>Changing a C to a T in the HPD gene disabled it. No toxic molecules built up in the livers of the fetal mice. No other organs showed signs of editing, no off-target effects were detected, and having only 15 percent of their liver cells edited was enough to cure the mice and keep them cured into adulthood. “We weren’t expecting it, but the genome-edited mice did much better” than mice treated with nitisinone, Musunuru said. “They survived longer and gained more weight.”\u003c/p>\n\u003cp>The scientists hope to study fetal base editing for other severe congenital diseases. It remains to be seen whether this technique or conventional gene therapy, which provides an entire replacement gene, will work better.\u003c/p>\n\u003cp>“I’d consider that CRISPR isn’t a replacement” for the latter, Waddington said, “but will be an additional tool” for curing genetic diseases in the womb.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/08/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003cspan style=\"font-weight: 400\">\u003cbr>\n\u003c/span>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444942/crispr-cures-inherited-disorder-in-mice-paving-way-for-genetic-therapy-before-birth","authors":["byline_futureofyou_444942"],"programs":["futureofyou_54"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_94","futureofyou_927","futureofyou_324"],"collections":["futureofyou_1097","futureofyou_1094"],"featImg":"futureofyou_1194","label":"source_futureofyou_444942"},"futureofyou_444933":{"type":"posts","id":"futureofyou_444933","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444933","score":null,"sort":[1539111653000]},"guestAuthors":[],"slug":"how-does-your-brain-construct-your-conscious-reality","title":"How Does Your Brain Construct Your Conscious Reality?","publishDate":1539111653,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>https://www.youtube.com/watch?v=lyu7v7nWzfo\u003c/p>\n\u003cp>\u003cem>Part 4 of the \u003c/em>TED Radio Hour \u003cem>episode \u003c/em>\u003ca href=\"http://www.npr.org/programs/ted-radio-hour/485704159/what-makes-us-us\" target=\"_blank\" rel=\"noopener\">What Makes Us ... Us\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>About Anil Seth's TED Talk\u003c/strong>\u003c/p>\n\u003cp>When we look around, it feels like we're seeing an objective reality. But neuroscientist Anil Seth says everything we perceive, from objects to emotions, is an act of informed guesswork by the brain.\u003c/p>\n\u003cp>\u003cstrong>About Anil Seth\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.anilseth.com/\">Anil Seth\u003c/a> is a professor of cognitive and computational neuroscience at the University of Sussex, where he studies consciousness and its role in health and disease.\u003c/p>\n\u003cp>He co-directs the \u003ca href=\"http://www.sussex.ac.uk/sackler/\" target=\"_blank\" rel=\"noopener\">Sackler Centre for Consciousness Science\u003c/a> and is the Editor-in-Chief of the academic journal \u003cem>Neuroscience of Consciousness\u003c/em>. Seth was also the 2017 President of the British Science Association (Psychology Section). He is the co-author of \u003ca href=\"http://www.anilseth.com/books\" target=\"_blank\" rel=\"noopener\">\u003cem>30-Second Brain\u003c/em>,\u003c/a> a best-seller that explores how the brain works.\u003c/p>\n\u003cp>Seth is a regular contributor to the \u003cem>New Scientist, The Guardian\u003c/em>, and the BBC.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Anil+Seth%3A+How+Does+Your+Brain+Construct+Your+Conscious+Reality%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"When we look around, it feels like we're seeing an objective reality. But neuroscientist Anil Seth says everything we perceive, from objects to emotions, is an act of informed guesswork by the brain.","status":"publish","parent":0,"modified":1539042068,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":9,"wordCount":168},"headData":{"title":"How Does Your Brain Construct Your Conscious Reality? | KQED","description":"When we look around, it feels like we're seeing an objective reality. But neuroscientist Anil Seth says everything we perceive, from objects to emotions, is an act of informed guesswork by the brain.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444933 https://ww2.kqed.org/futureofyou/?p=444933","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/09/how-does-your-brain-construct-your-conscious-reality/","disqusTitle":"How Does Your Brain Construct Your Conscious Reality?","source":"Hope/Hype","nprByline":"NPR/TED Staff","nprImageAgency":"Bret Hartman / TED","nprStoryId":"654730916","nprApiLink":"http://api.npr.org/query?id=654730916&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/2016/07/15/654730916/how-does-your-brain-construct-your-conscious-reality?ft=nprml&f=654730916","nprRetrievedStory":"1","nprPubDate":"Fri, 05 Oct 2018 10:48:00 -0400","nprStoryDate":"Fri, 05 Oct 2018 09:24:00 -0400","nprLastModifiedDate":"Fri, 05 Oct 2018 10:48:03 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/ted/2018/10/20181003_ted_04.mp3?orgId=1&topicId=1130&d=801&p=57&story=654730916&ft=nprml&f=654730916","nprAudioM3u":"http://api.npr.org/m3u/1654731360-48125d.m3u?orgId=1&topicId=1130&d=801&p=57&story=654730916&ft=nprml&f=654730916","audioTrackLength":801,"path":"/futureofyou/444933/how-does-your-brain-construct-your-conscious-reality","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/ted/2018/10/20181003_ted_04.mp3?orgId=1&topicId=1130&d=801&p=57&story=654730916&ft=nprml&f=654730916","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/lyu7v7nWzfo'\n title='//www.youtube.com/embed/lyu7v7nWzfo'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>\u003cem>Part 4 of the \u003c/em>TED Radio Hour \u003cem>episode \u003c/em>\u003ca href=\"http://www.npr.org/programs/ted-radio-hour/485704159/what-makes-us-us\" target=\"_blank\" rel=\"noopener\">What Makes Us ... Us\u003c/a>\u003c/p>\n\u003cp>\u003cstrong>About Anil Seth's TED Talk\u003c/strong>\u003c/p>\n\u003cp>When we look around, it feels like we're seeing an objective reality. But neuroscientist Anil Seth says everything we perceive, from objects to emotions, is an act of informed guesswork by the brain.\u003c/p>\n\u003cp>\u003cstrong>About Anil Seth\u003c/strong>\u003c/p>\n\u003cp>\u003ca href=\"http://www.anilseth.com/\">Anil Seth\u003c/a> is a professor of cognitive and computational neuroscience at the University of Sussex, where he studies consciousness and its role in health and disease.\u003c/p>\n\u003cp>He co-directs the \u003ca href=\"http://www.sussex.ac.uk/sackler/\" target=\"_blank\" rel=\"noopener\">Sackler Centre for Consciousness Science\u003c/a> and is the Editor-in-Chief of the academic journal \u003cem>Neuroscience of Consciousness\u003c/em>. Seth was also the 2017 President of the British Science Association (Psychology Section). He is the co-author of \u003ca href=\"http://www.anilseth.com/books\" target=\"_blank\" rel=\"noopener\">\u003cem>30-Second Brain\u003c/em>,\u003c/a> a best-seller that explores how the brain works.\u003c/p>\n\u003cp>Seth is a regular contributor to the \u003cem>New Scientist, The Guardian\u003c/em>, and the BBC.\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Anil+Seth%3A+How+Does+Your+Brain+Construct+Your+Conscious+Reality%3F&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444933/how-does-your-brain-construct-your-conscious-reality","authors":["byline_futureofyou_444933"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1"],"tags":["futureofyou_56","futureofyou_1576","futureofyou_59","futureofyou_1224"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444934","label":"source_futureofyou_444933"},"futureofyou_444897":{"type":"posts","id":"futureofyou_444897","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444897","score":null,"sort":[1539027168000]},"guestAuthors":[],"slug":"some-apps-may-help-curb-insomnia-others-just-put-you-to-sleep","title":"Some Apps May Help Curb Insomnia, Others Just Put You To Sleep","publishDate":1539027168,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Paige Thesing has struggled with insomnia since high school. \"It takes me a really long time to fall asleep — about four hours,\" she says. For years, her mornings were groggy and involved a \"lot of coffee.\"[contextly_sidebar id=\"SWkBBNCnUWhPf7KOuvUyV7If0Ca3ug47\"]\u003c/p>\n\u003cp>After a year of trying sleep medication prescribed by her doctor, she turned to the internet for alternate solutions. About four months ago, she settled on a mobile phone meditation app called \u003ca href=\"https://www.inscape.life/\" target=\"_blank\" rel=\"noopener\">INSCAPE\u003c/a>.\u003c/p>\n\u003cp>\"It's about a 30-minute soundtrack, and it starts with a woman kind of telling you to relax and instructing your breathing,\" explains Thesing. \"Then it goes into sounds — relaxing noises. There's wind chimes, some atmospheric music playing...\"\u003c/p>\n\u003cp>She uses the app every night and falls asleep within 15 or 20 minutes. \"So, definitely a big improvement from four hours,\" she says.\u003c/p>\n\u003cp>Thesing is not alone. Chronic insomnia affects an estimated \u003ca href=\"https://www.ajmc.com/journals/supplement/2006/2006-05-vol12-n8suppl/may06-2307ps214-s220\" target=\"_blank\" rel=\"noopener\">10-15 percent of adults\u003c/a>, and another 25-35 percent struggle with sleep issues occasionally. And like Thesing, a growing number of insomniacs are turning to mobile phone apps to lull them to sleep.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>On \u003ca href=\"https://twitter.com/NPRHealth/status/1046884648167624711\" target=\"_blank\" rel=\"noopener\">Twitter\u003c/a> and Facebook, NPR asked its audience if they have used a mobile phone app to help manage insomnia. Nearly 100 people wrote back suggesting a range of apps, including podcasts created to put a listener to sleep.\u003c/p>\n\u003cp>\"These are usually relaxation strategies, white noise, meditation,\" \u003ca href=\"https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=35378\" target=\"_blank\" rel=\"noopener\">Jason Ong\u003c/a>, an associate professor of neurology specializing in sleep at Northwestern University's Feinberg School of Medicine. He studies non-pharmacological treatments for various sleep disorders and treats patients at the university's Sleep Medicine clinic. \"It's not that there's something wrong with those apps. It's a reasonable first thing to try.\"[contextly_sidebar id=\"ljN7S8LuvqENw8QrvBPFbhASn6EIv1oE\"]\u003c/p>\n\u003cp>But, he adds, these kinds of apps aren't based on scientifically-proven solutions, and they don't really fix the problem of why someone is not sleeping.\u003c/p>\n\u003cp>Ong wanted to do something about that, so a few years ago, he consulted for a team that developed an app that uses a science-based approach to address insomnia called \u003ca href=\"https://www.sleepio.com/cbt-for-insomnia/\" target=\"_blank\" rel=\"noopener\">Sleepio\u003c/a>. (However, he doesn't have any ongoing financial interest in the product, he says.)\u003c/p>\n\u003cp>Sleepio and a few other apps like \u003ca href=\"http://www.myshuti.com/\" target=\"_blank\" rel=\"noopener\">SHUT-i\u003c/a> and a free one developed by the Veterans Administration use the most sustainable and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15451764\" target=\"_blank\" rel=\"noopener\">evidence-based\u003c/a> solution for insomnia. It's a kind of therapy called Cognitive Behavioral Therapy for Insomnia — \u003ca href=\"https://www.sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia\" target=\"_blank\" rel=\"noopener\">CBT-I\u003c/a> for short, he says. It helps the patient understand the biology of sleep and gives them a bag of tools and tricks to change their own thought patterns and behaviors to treat their underlying sleep issues.\u003c/p>\n\u003cp>\"CBT for insomnia is a specific package ... [that] includes different techniques like spending less time in bed [and] what to do if you are in bed and can't sleep,\" says Ong. \"It's teaching you how to change your behavior to better work with your brain to give you confidence that you're going to be able to sleep on a regular basis.\"\u003c/p>\n\u003cp>It may be surprising to us, but our own thought patterns and sleep habits \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621793/\" target=\"_blank\" rel=\"noopener\">affect our biology\u003c/a>, in this case how our brains regulate sleep. \"If you modify some of your behaviors, you can work better with how your brain regulates sleep and wake,\" he says.\u003c/p>\n\u003cp>The American College of Physicians \u003ca href=\"https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia\" target=\"_blank\" rel=\"noopener\">first recommended\u003c/a> Cognitive Behavioral Therapy for Insomnia as the first-line treatment for insomnia in 2016. \"The evidence is quite strong to support the effectiveness of CBT-I treatment and there really aren't a lot of side effects,\" says Ong. And, because it changes behavior, \"in the long run CBT-I tends to perform quite well in maintaining the benefits.\"\u003c/p>\n\u003cp>In the past the only way for people to get Cognitive Behavioral Therapy for Insomnia was to see a therapist, now they can access the therapy on their mobile phones.\u003c/p>\n\u003cp>\"In Sleepio, it's like an avatar of a real therapist that's walking the patient through that process,\" explains Ong. Sleepio also allows users to keep a sleep diary so the app can use its algorithm to suggest a better bedtime schedule. It also reminds people to get up when they've spent too much time in bed trying to fall asleep, for example.[contextly_sidebar id=\"wEwpbDeWifEPnKULBpzGtSdpZ0ZUBzcu\"]\u003c/p>\n\u003cp>Like a real therapist, the apps that use Cognitive Behavior Therapy for Insomnia also provide practical tools to help the user worry less about their sleep and over time, be less anxious and more confident about their ability get a good night's rest. \"It's very similar to what we do face-to-face with patients,\" adds Ong.\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427093/\" target=\"_blank\" rel=\"noopener\">Studies show\u003c/a> that CBT-I delivered digitally through mobile phone apps is effective in treating insomnia. And a \u003ca href=\"https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2704019\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a> of Sleepio by Ong and the team that developed the product found that participants who used the product reported an improvement in insomnia symptoms and overall wellbeing.\u003c/p>\n\u003cp>\"It's an impressive study in size and scope,\" says \u003ca href=\"http://www.johntorousmd.com/\" target=\"_blank\" rel=\"noopener\">John Torous\u003c/a>, the director of digital psychiatry at Beth Israel Deaconess Medical Center. \"But like any study, we have to interpret it within reason.\"\u003c/p>\n\u003cp>The participants in the study were mostly white and female, he notes, and so it's hard to generalize the findings to the larger population. And, he adds that the study was designed and funded by Big Health, the company that created the app and is now marketing it.\u003c/p>\n\u003cp>Also, Sleepio is only available on a limited basis. You can get it through employers, health insurance and national health systems at the moment, says Mike Radocchia, the marketing and business development lead at Big Health. Although the company does give it to researchers and charities for free.\u003c/p>\n\u003cp>And while apps that use Cognitive Behavior Therapy for Insomnia cost less than in-person therapy, they can be pricey. A 26-week subscription of SHUTi \u003ca href=\"http://www.myshuti.com/shuti-pricing/\" target=\"_blank\" rel=\"noopener\">costs $149\u003c/a>.\u003c/p>\n\u003cp>That's why Torous often directs his patients with insomnia to a free app developed by the Veterans Administration called \u003ca href=\"https://mobile.va.gov/app/cbt-i-coach\" target=\"_blank\" rel=\"noopener\">CBT-I Coach\u003c/a>.\u003c/p>\n\u003cp>\"Anyone can access it. You don't have to be a veteran,\" Torous says.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nextbreathcounseling.com/credentials/\" target=\"_blank\" rel=\"noopener\">Jake Hanks\u003c/a>, a mental health counselor based in Glenwood Springs, Colorado, agrees. \"CBT-I Coach would be my absolute favorite,\" he says. \"It includes a lot of the cognitive restructuring, the true things about sleep that we want patients to keep in mind.\" And so, he too, recommends the free app to his patients.\u003c/p>\n\u003cp>However, Torous notes that these apps don't work for everyone. The recent study by Ong and his colleagues hints at why.\u003c/p>\n\u003cp>\"Even in this clinical study, less than 50 percent [of people who were assigned to use the app in a randomized controlled trial] are able to make it through the entire course of CBT delivered through digital platforms,\" he notes. \"For some people it may be hard to make it through all the sessions of CBT.\"\u003c/p>\n\u003cp>This is true of most health and wellness apps, he says. Torous \u003ca href=\"https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2616170\" target=\"_blank\" rel=\"noopener\">has studied\u003c/a> this and found that of the 10,000 mental health apps out there, very few are actually being used. \"I don't think we really understand how people are using technology towards their health and recovery,\" he notes.[contextly_sidebar id=\"LqkvTN1dfENdC3n50jRUdIl6PSPHOHGb\"]\u003c/p>\n\u003cp>But in some ways, he says, people with insomnia may be ahead of scientists in figuring out what works well for them.\u003c/p>\n\u003cp>\"If you find something that works [for you], I think that's always a good first step,\" he says. \"Quick fixes or simple solutions may get you feeling better right away.\"\u003c/p>\n\u003cp>But, he notes, insomnia is a complex disorder with many underlying causes. Sometimes it can be caused by a medical condition that's easily treatable, like a thyroid problem, he adds.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>So, no matter what app you are considering, always talk to your doctor about your sleep issues, he advises. \"Until you know the diagnosis or what you're working with, you don't want to start treating something that's not what you think it is.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Some+Apps+May+Help+Curb+Insomnia%2C+Others+Just+Put+You+To+Sleep&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n","blocks":[],"excerpt":"People struggling with insomnia often turn to apps to help them fall asleep. But scientists say only some apps use proven methods that can help address the underlying causes of sleeplessness.","status":"publish","parent":0,"modified":1539016515,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":33,"wordCount":1348},"headData":{"title":"Some Apps May Help Curb Insomnia, Others Just Put You To Sleep | KQED","description":"People struggling with insomnia often turn to apps to help them fall asleep. But scientists say only some apps use proven methods that can help address the underlying causes of sleeplessness.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444897 https://ww2.kqed.org/futureofyou/?p=444897","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/08/some-apps-may-help-curb-insomnia-others-just-put-you-to-sleep/","disqusTitle":"Some Apps May Help Curb Insomnia, Others Just Put You To Sleep","source":"DIY Health","nprByline":"Rhitu Chatterjee, NPR","nprImageAgency":"Mary Mathis/NPR","nprStoryId":"654883409","nprApiLink":"http://api.npr.org/query?id=654883409&apiKey=MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004","nprHtmlLink":"https://www.npr.org/sections/health-shots/2018/10/08/654883409/some-apps-may-help-curb-insomnia-others-just-put-you-to-sleep?ft=nprml&f=654883409","nprRetrievedStory":"1","nprPubDate":"Mon, 08 Oct 2018 09:02:00 -0400","nprStoryDate":"Mon, 08 Oct 2018 05:00:00 -0400","nprLastModifiedDate":"Mon, 08 Oct 2018 05:43:21 -0400","nprAudio":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/10/20181008_me_some_apps_may_help_curb_insomnia_others_just_put_you_to_sleep.mp3?orgId=1&topicId=1128&d=247&p=3&story=654883409&ft=nprml&f=654883409","nprAudioM3u":"http://api.npr.org/m3u/1655529006-c4b480.m3u?orgId=1&topicId=1128&d=247&p=3&story=654883409&ft=nprml&f=654883409","audioTrackLength":247,"path":"/futureofyou/444897/some-apps-may-help-curb-insomnia-others-just-put-you-to-sleep","audioUrl":"https://ondemand.npr.org/anon.npr-mp3/npr/me/2018/10/20181008_me_some_apps_may_help_curb_insomnia_others_just_put_you_to_sleep.mp3?orgId=1&topicId=1128&d=247&p=3&story=654883409&ft=nprml&f=654883409","parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Paige Thesing has struggled with insomnia since high school. \"It takes me a really long time to fall asleep — about four hours,\" she says. For years, her mornings were groggy and involved a \"lot of coffee.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>After a year of trying sleep medication prescribed by her doctor, she turned to the internet for alternate solutions. About four months ago, she settled on a mobile phone meditation app called \u003ca href=\"https://www.inscape.life/\" target=\"_blank\" rel=\"noopener\">INSCAPE\u003c/a>.\u003c/p>\n\u003cp>\"It's about a 30-minute soundtrack, and it starts with a woman kind of telling you to relax and instructing your breathing,\" explains Thesing. \"Then it goes into sounds — relaxing noises. There's wind chimes, some atmospheric music playing...\"\u003c/p>\n\u003cp>She uses the app every night and falls asleep within 15 or 20 minutes. \"So, definitely a big improvement from four hours,\" she says.\u003c/p>\n\u003cp>Thesing is not alone. Chronic insomnia affects an estimated \u003ca href=\"https://www.ajmc.com/journals/supplement/2006/2006-05-vol12-n8suppl/may06-2307ps214-s220\" target=\"_blank\" rel=\"noopener\">10-15 percent of adults\u003c/a>, and another 25-35 percent struggle with sleep issues occasionally. And like Thesing, a growing number of insomniacs are turning to mobile phone apps to lull them to sleep.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>On \u003ca href=\"https://twitter.com/NPRHealth/status/1046884648167624711\" target=\"_blank\" rel=\"noopener\">Twitter\u003c/a> and Facebook, NPR asked its audience if they have used a mobile phone app to help manage insomnia. Nearly 100 people wrote back suggesting a range of apps, including podcasts created to put a listener to sleep.\u003c/p>\n\u003cp>\"These are usually relaxation strategies, white noise, meditation,\" \u003ca href=\"https://www.feinberg.northwestern.edu/faculty-profiles/az/profile.html?xid=35378\" target=\"_blank\" rel=\"noopener\">Jason Ong\u003c/a>, an associate professor of neurology specializing in sleep at Northwestern University's Feinberg School of Medicine. He studies non-pharmacological treatments for various sleep disorders and treats patients at the university's Sleep Medicine clinic. \"It's not that there's something wrong with those apps. It's a reasonable first thing to try.\"\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But, he adds, these kinds of apps aren't based on scientifically-proven solutions, and they don't really fix the problem of why someone is not sleeping.\u003c/p>\n\u003cp>Ong wanted to do something about that, so a few years ago, he consulted for a team that developed an app that uses a science-based approach to address insomnia called \u003ca href=\"https://www.sleepio.com/cbt-for-insomnia/\" target=\"_blank\" rel=\"noopener\">Sleepio\u003c/a>. (However, he doesn't have any ongoing financial interest in the product, he says.)\u003c/p>\n\u003cp>Sleepio and a few other apps like \u003ca href=\"http://www.myshuti.com/\" target=\"_blank\" rel=\"noopener\">SHUT-i\u003c/a> and a free one developed by the Veterans Administration use the most sustainable and \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/15451764\" target=\"_blank\" rel=\"noopener\">evidence-based\u003c/a> solution for insomnia. It's a kind of therapy called Cognitive Behavioral Therapy for Insomnia — \u003ca href=\"https://www.sleepfoundation.org/sleep-news/cognitive-behavioral-therapy-insomnia\" target=\"_blank\" rel=\"noopener\">CBT-I\u003c/a> for short, he says. It helps the patient understand the biology of sleep and gives them a bag of tools and tricks to change their own thought patterns and behaviors to treat their underlying sleep issues.\u003c/p>\n\u003cp>\"CBT for insomnia is a specific package ... [that] includes different techniques like spending less time in bed [and] what to do if you are in bed and can't sleep,\" says Ong. \"It's teaching you how to change your behavior to better work with your brain to give you confidence that you're going to be able to sleep on a regular basis.\"\u003c/p>\n\u003cp>It may be surprising to us, but our own thought patterns and sleep habits \u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3621793/\" target=\"_blank\" rel=\"noopener\">affect our biology\u003c/a>, in this case how our brains regulate sleep. \"If you modify some of your behaviors, you can work better with how your brain regulates sleep and wake,\" he says.\u003c/p>\n\u003cp>The American College of Physicians \u003ca href=\"https://www.acponline.org/acp-newsroom/acp-recommends-cognitive-behavioral-therapy-as-initial-treatment-for-chronic-insomnia\" target=\"_blank\" rel=\"noopener\">first recommended\u003c/a> Cognitive Behavioral Therapy for Insomnia as the first-line treatment for insomnia in 2016. \"The evidence is quite strong to support the effectiveness of CBT-I treatment and there really aren't a lot of side effects,\" says Ong. And, because it changes behavior, \"in the long run CBT-I tends to perform quite well in maintaining the benefits.\"\u003c/p>\n\u003cp>In the past the only way for people to get Cognitive Behavioral Therapy for Insomnia was to see a therapist, now they can access the therapy on their mobile phones.\u003c/p>\n\u003cp>\"In Sleepio, it's like an avatar of a real therapist that's walking the patient through that process,\" explains Ong. Sleepio also allows users to keep a sleep diary so the app can use its algorithm to suggest a better bedtime schedule. It also reminds people to get up when they've spent too much time in bed trying to fall asleep, for example.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Like a real therapist, the apps that use Cognitive Behavior Therapy for Insomnia also provide practical tools to help the user worry less about their sleep and over time, be less anxious and more confident about their ability get a good night's rest. \"It's very similar to what we do face-to-face with patients,\" adds Ong.\u003c/p>\n\u003cp>\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5427093/\" target=\"_blank\" rel=\"noopener\">Studies show\u003c/a> that CBT-I delivered digitally through mobile phone apps is effective in treating insomnia. And a \u003ca href=\"https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2704019\" target=\"_blank\" rel=\"noopener\">recent study\u003c/a> of Sleepio by Ong and the team that developed the product found that participants who used the product reported an improvement in insomnia symptoms and overall wellbeing.\u003c/p>\n\u003cp>\"It's an impressive study in size and scope,\" says \u003ca href=\"http://www.johntorousmd.com/\" target=\"_blank\" rel=\"noopener\">John Torous\u003c/a>, the director of digital psychiatry at Beth Israel Deaconess Medical Center. \"But like any study, we have to interpret it within reason.\"\u003c/p>\n\u003cp>The participants in the study were mostly white and female, he notes, and so it's hard to generalize the findings to the larger population. And, he adds that the study was designed and funded by Big Health, the company that created the app and is now marketing it.\u003c/p>\n\u003cp>Also, Sleepio is only available on a limited basis. You can get it through employers, health insurance and national health systems at the moment, says Mike Radocchia, the marketing and business development lead at Big Health. Although the company does give it to researchers and charities for free.\u003c/p>\n\u003cp>And while apps that use Cognitive Behavior Therapy for Insomnia cost less than in-person therapy, they can be pricey. A 26-week subscription of SHUTi \u003ca href=\"http://www.myshuti.com/shuti-pricing/\" target=\"_blank\" rel=\"noopener\">costs $149\u003c/a>.\u003c/p>\n\u003cp>That's why Torous often directs his patients with insomnia to a free app developed by the Veterans Administration called \u003ca href=\"https://mobile.va.gov/app/cbt-i-coach\" target=\"_blank\" rel=\"noopener\">CBT-I Coach\u003c/a>.\u003c/p>\n\u003cp>\"Anyone can access it. You don't have to be a veteran,\" Torous says.\u003c/p>\n\u003cp>\u003ca href=\"http://www.nextbreathcounseling.com/credentials/\" target=\"_blank\" rel=\"noopener\">Jake Hanks\u003c/a>, a mental health counselor based in Glenwood Springs, Colorado, agrees. \"CBT-I Coach would be my absolute favorite,\" he says. \"It includes a lot of the cognitive restructuring, the true things about sleep that we want patients to keep in mind.\" And so, he too, recommends the free app to his patients.\u003c/p>\n\u003cp>However, Torous notes that these apps don't work for everyone. The recent study by Ong and his colleagues hints at why.\u003c/p>\n\u003cp>\"Even in this clinical study, less than 50 percent [of people who were assigned to use the app in a randomized controlled trial] are able to make it through the entire course of CBT delivered through digital platforms,\" he notes. \"For some people it may be hard to make it through all the sessions of CBT.\"\u003c/p>\n\u003cp>This is true of most health and wellness apps, he says. Torous \u003ca href=\"https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2616170\" target=\"_blank\" rel=\"noopener\">has studied\u003c/a> this and found that of the 10,000 mental health apps out there, very few are actually being used. \"I don't think we really understand how people are using technology towards their health and recovery,\" he notes.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But in some ways, he says, people with insomnia may be ahead of scientists in figuring out what works well for them.\u003c/p>\n\u003cp>\"If you find something that works [for you], I think that's always a good first step,\" he says. \"Quick fixes or simple solutions may get you feeling better right away.\"\u003c/p>\n\u003cp>But, he notes, insomnia is a complex disorder with many underlying causes. Sometimes it can be caused by a medical condition that's easily treatable, like a thyroid problem, he adds.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>So, no matter what app you are considering, always talk to your doctor about your sleep issues, he advises. \"Until you know the diagnosis or what you're working with, you don't want to start treating something that's not what you think it is.\"\u003c/p>\n\u003cdiv class=\"fullattribution\">Copyright 2018 NPR. To see more, visit http://www.npr.org/.\u003cimg src=\"https://www.google-analytics.com/__utm.gif?utmac=UA-5828686-4&utmdt=Some+Apps+May+Help+Curb+Insomnia%2C+Others+Just+Put+You+To+Sleep&utme=8(APIKey)9(MDAxOTAwOTE4MDEyMTkxMDAzNjczZDljZA004)\">\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444897/some-apps-may-help-curb-insomnia-others-just-put-you-to-sleep","authors":["byline_futureofyou_444897"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73","futureofyou_1061"],"tags":["futureofyou_542","futureofyou_26","futureofyou_1593","futureofyou_787"],"collections":["futureofyou_1093","futureofyou_1097","futureofyou_1096"],"featImg":"futureofyou_444898","label":"source_futureofyou_444897"},"futureofyou_444844":{"type":"posts","id":"futureofyou_444844","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444844","score":null,"sort":[1538667576000]},"guestAuthors":[],"slug":"new-smartphone-app-aims-to-monitor-your-mental-health","title":"New Smartphone App Aims to Monitor Your Mental Health","publishDate":1538667576,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">In the world of digital health, Silicon Valley-based \u003ca href=\"https://www.statnews.com/2017/08/07/mindstrong-insel-mental-illness/\" target=\"_blank\" rel=\"noopener\">Mindstrong\u003c/a> stands out. It has a star-studded team and tens of millions in venture capital funding, including from Jeff Bezos’ VC firm.[contextly_sidebar id=\"KMLJnak6yPOdRS3TfVoiDTc6a7Cm51Xf\"]\u003c/p>\n\u003cp class=\"danger-zone\">It also has a captivating idea: that its app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.\u003c/p>\n\u003cp class=\"danger-zone\">The promise of that technology has helped Mindstrong build incredible momentum since it launched last year; already more than a dozen counties in California have agreed to deploy the company’s app to patients.\u003c/p>\n\u003cp class=\"\">Does the app live up to its promise? There’s no way to tell. Almost no one outside the company has any idea whether it works. Most of the company’s key promises or claims aren’t yet backed up by published, peer-reviewed data — leading some experts to wonder if the technology is ready for the real world.\u003c/p>\n\u003cp class=\"\">“I wouldn’t waste all that time and money in the wild until they get sure that some of those things are as specific as they hope they are,” said Rosalind Picard, a researcher at MIT Media Lab who is familiar with Mindstrong’s work and tries to use data from smartphones and wearables to detect a person’s mood.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Even as one of the company’s executives, Dr. Tom Insel, acknowledged to STAT that the app isn’t perfect, the company’s CEO emphasized that Mindstrong could provide unprecedented insight into conditions like depression.[contextly_sidebar id=\"Kw9tNYwAAP3TxDDlzs24FDdim0qufSVP\"]\u003c/p>\n\u003cp>Mindstrong is not alone in pushing the frontiers of smartphone-based digital health. Many companies use so-called digital phenotyping, collecting scientific data on a person’s digital life, to gain insights into his or her physical or mental health.\u003c/p>\n\u003cp>The company’s app collects information about how people are typing and runs it through a machine learning algorithm to determine which data can predict their emotional state. Mindstrong has already used it in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a \u003ca href=\"https://www.statnews.com/2018/09/24/ketamine-clinics-severe-depression-treatment/\" target=\"_blank\" rel=\"noopener\">ketamine clinic\u003c/a>. The app is available in Apple’s app store, but requires a participant code to access it.\u003c/p>\n\u003cp>“We’ve done the validation work against the gold-standard clinical tests for depression, for anxiety, for cognitive decline, whether it’s memory or executive function,” said Dr. Paul Dagum, the company’s founder. “We’re confident, we’re already seeing some really exciting results.”\u003c/p>\n\u003cp>In the last year, Mindstrong’s footprint and reach have already grown exponentially. The Palo Alto-based company’s workforce has doubled to 42 employees and it made \u003ca href=\"https://www.hsph.harvard.edu/magazine/magazine_article/philanthropic-impact-digital-phenotyping/\" target=\"_blank\" rel=\"noopener\">a sizable gift\u003c/a> to Harvard’s school of public health. In February, it launched a partnership with Takeda to develop new biomarkers that will be able to aid the pharmaceutical giant’s clinical trials for depression treatments.\u003c/p>\n\u003cp>The idea is to use that data to establish a “normal” pattern — so it can be compared against someone’s typing habits on any given day. If the habits look off, slower or more agitated than normal, the app can alert a health care provider.\u003c/p>\n\u003cp>Abnormal patterns, Mindstrong says, might show up if a person is more depressed or anxious, or if just about anything else about their mental health changes. When asked which disorders Mindstrong might be able to detect, Dagum replied, “all of them.” (Dagum, a data scientist and physician, founded the company in 2017 with Rick Klausner, the founder and director of CAR-T pioneer Juno Therapeutics and \u003ca href=\"https://www.statnews.com/2018/06/02/grail-cancer-blood-test-asco/\" target=\"_blank\" rel=\"noopener\">Grail\u003c/a>, a liquid biopsy company.)[contextly_sidebar id=\"XHhLlvPBCoPTlN54jyme2G0wpse1GITN\"]\u003c/p>\n\u003cp>Mindstrong officials told STAT that among their most encouraging results is that its app can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.\u003c/p>\n\u003cp>The data behind this claim is being published soon, said Insel, who is the former head of the National Institute of Mental Health and came to the company in 2017 after a short stint at \u003ca href=\"https://www.statnews.com/2016/03/28/google-life-sciences-exodus/\" target=\"_blank\" rel=\"noopener\">Verily\u003c/a>.\u003c/p>\n\u003cp>The app can detect a seven-point change on the Hamilton scale, Insel said. That kind of difference could indicate a patient who is not normally depressed now shows signs of mild or moderate depression, or that a person with moderate depression is now showing signs of a very severe condition.\u003c/p>\n\u003cp>“For a clinician and for someone taking care of a patient, knowing that, it could be very, very powerful,” Dagum said.\u003c/p>\n\u003cp>The company’s momentum has taken it to the cusp of a real-world deployment in California. About 15 counties — including the most populous county in the United States, Los Angeles County — will be spending about $60 million over the next four years to bring companies like Mindstrong and other apps into their health care system.\u003c/p>\n\u003cp>These counties hope apps will help them get better services to people with mental illnesses like depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder.\u003c/p>\n\u003cp>The Mindstrong program itself is limited: Patients can choose voluntarily whether to use the app, which will be free to them, and that decision won’t affect the rest of the mental health services they can access.\u003c/p>\n\u003cp>\u003cstrong>Lack of Public Data\u003c/strong>\u003c/p>\n\u003cp>So far, the Mindstrong app has only been used in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a ketamine clinic. The company has also claimed that a “\u003ca href=\"https://mindstronghealth.com/clinical-programs/\" target=\"_blank\" rel=\"noopener\">nationwide employer\u003c/a>” and private substance abuse clinics in D.C. are using the app.[contextly_sidebar id=\"KGoxoWR6m8MUKnLishPvyacpod0HWpt7\"]\u003c/p>\n\u003cp>But other than the change on the Hamilton scale — which hasn’t yet gone through peer review and was disclosed to STAT in an interview — almost no data about how well Mindstrong’s technology works is available to independent observers.\u003c/p>\n\u003cp>The company’s website describes five completed clinical trials, but it has not yet published the results of any. Only a handful of other published works — all from the last year — have hinted at how well it works or its scope with data to back up the claims.\u003c/p>\n\u003cp>The company \u003ca href=\"https://www.nature.com/articles/s41746-018-0018-4\" target=\"_blank\" rel=\"noopener\">published\u003c/a> a 27-person pilot study in the journal npj Digital Medicine earlier this year. Dagum is also an author on a poster \u003ca href=\"https://www.nature.com/articles/npp2017265#t122-assessing-anhedonia-with-quantitative-tasks-digital-and-patient-reported-measures-in-a-multicenter-doubleblind-trial-with-btrx246040-for-the-treatment-of-major-depressive-disorder\" target=\"_blank\" rel=\"noopener\">presentation\u003c/a> given at the American College of Neuropsychopharmacology’s 2017 conference, another \u003ca href=\"https://isctm.org/public_access/Feb2018/PDFs/Smith-poster.pdf\" target=\"_blank\" rel=\"noopener\">poster\u003c/a> that reported results from a very wide variety of digital phenotyping techniques — not just typing — and a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29074231\" target=\"_blank\" rel=\"noopener\">paper\u003c/a> describing a clinical trial protocol — not results.\u003c/p>\n\u003cp>As Mindstrong steps toward a wider rollout, the scientific studies behind its claims will matter. Federal regulators, for one, have \u003ca href=\"https://www.ftc.gov/news-events/blogs/business-blog/2016/01/mind-gap-what-lumosity-promised-vs-what-it-could-prove\" target=\"_blank\" rel=\"noopener\">cracked down\u003c/a> on \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/12/marketers-blood-pressure-app-settle-ftc-charges-regarding\" target=\"_blank\" rel=\"noopener\">commercial apps\u003c/a>that misleadingly reference a study’s conclusions to market their app.\u003c/p>\n\u003cp>Based on her own research, at least one expert in digital health and mood said she’s skeptical that Mindstrong can, in a general population, work as well as the company claims. MIT’s Picard said that while there are ways to predict or detect mood changes, you usually need more than just a single type of data to do so.\u003c/p>\n\u003cp>“I’m suspicious that a single modality like typing is going to be sufficient. It would be like saying there’s a single question [on a screening questionnaire] that a doctor could be using,” said Picard, who is also CEO of a company that works on digital phenotyping, like Mindstrong does.\u003c/p>\n\u003cp>“My guess is that their specificity to depression is going to be relatively low,” Picard said.\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp>Her \u003ca href=\"https://www.jmir.org/2018/6/e210/\" target=\"_blank\" rel=\"noopener\">own\u003c/a> \u003ca href=\"https://ieeexplore.ieee.org/abstract/document/954607\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, for example, relies on temperature and skin conductivity as well as calls and the amount of time spent on a phone to predict mood changes. It is about 80 percent accurate.\u003c/p>\n\u003cdiv class=\"quote-inner\">\n\u003cp>Especially in the field of digital mental health, “we need more peer review,” said Dr. Steven Steinhubl, the director of digital medicine at Scripps Research Translational Institute. (Steinhubl is also the co-editor-in-chief of npj Digital Medicine.) Though he said he strongly believes in the potential of apps like Mindstrong, Steinhubl cautioned that peer review has a purpose.[contextly_sidebar id=\"8bFNH4xsL9O8lTSDRHnxnqtYwxOF2Z5k\"]\u003c/p>\n\u003cp>“[Peer review] is a very imperfect system, but there’s really nothing in the peer-reviewed literature. That means that other experts aren’t able to weigh in,” he said. “If you have committees and other people reviewing something who maybe don’t have the same level of expertise, you’ll have people saying, ‘Yeah, that sounds good.’”\u003c/p>\n\u003cp>Other researchers have also found that neuropsychological tests, more broadly, have relatively low accuracy rates.\u003c/p>\n\u003cp>In a study that examined people who were already being treated for depression, one computerized test could only accurately predict their condition in about 40 percent of cases. Another showed a 44 percent accuracy rate for a similar computerized test used to examine people with major depression.\u003c/p>\n\u003cp>A neuropsychological test — if it’s used as a screening test — is “going to miss a lot of people who are depressed,” said Richard Porter, a psychology researcher based at the University of Otago in New Zealand who conducted one of the studies.\u003c/p>\n\u003cp>And even if depressed people do show some kind of cognitive impairment, it’s impossible to tell what caused it.\u003c/p>\n\u003cp>Many things other than mental illness might cause a person to perform poorly on cognitive tests — like living with another disorder, having a lower baseline performance on cognitive tests, having a drink or taking prescription, over-the-counter, or illegal drugs.\u003c/p>\n\u003cp>Mindstrong’s leaders aren’t worried about that kind of noise in their data. Some of those factors are important to note, both for patients and the health care professionals working with them.\u003c/p>\n\u003cp>“You’re hungover, you didn’t sleep well, you didn’t take your medication, you have a medication side effects, you’re having stress and challenges at work and at home. Those are things that we want to measure,” Dagum said.\u003c/p>\n\u003cp>But even Insel admitted that there are plenty of issues that could affect typing speed — and which Mindstrong hasn’t figured out how to sort out yet. Sticky fingers after lunch, full hands at an airport, wearing gloves during winter, or a broken hand might also plausible affect a person’s typing speed — and, therefore, the app’s performance.\u003c/p>\n\u003cp>“One thing we’ve thought about is how we factor in those unusual environmental issues,” Insel said. “We’re working on that. But I can’t say that we’ve solved all of those possible issues.”\u003c/p>\n\u003cp>\u003cstrong>A Looming Launch in the Golden State\u003c/strong>\u003c/p>\n\u003cp>Insel and others linked with the company are fond of comparing their app to a smoke detector — something that’s intended to enhance humans’ senses to detect danger.\u003c/p>\n\u003cp>But part of the value of a smoke detector is that if it’s functioning properly, we know it isn’t going off at random. It only goes off in certain conditions and carries a specific message: Your house is on fire or about to be. Do something.\u003c/p>\n\u003cp>At least for now, that’s where Mindstrong differs from a smoke detector. There’s no way to tell, yet, how specific it is or how sensitive its algorithm is.\u003c/p>\n\u003cp>Insel said that information is coming. He said the company has the data about the app’s accuracy — but he declined to provide those figures, citing papers pending publication. “[They] square very well with clinically used biomarkers,” he said.\u003c/p>\n\u003cp>California authorities suggest they have been shown some of that data. But they’re nevertheless cautious about how the app will work in their new, different setting.\u003c/p>\n\u003cp>One official said there will be “clear writing” included with the state’s version of the app about what it can do, what it cannot do, and what goals the counties hope it will help them achieve.\u003c/p>\n\u003cp>Those goals are pretty lofty. At least some counties eventually plan to use it not only to supplement the existing system, but potentially to bring more people into its fold.\u003c/p>\n\u003cp>“We might be able to go to colleges, emergency departments, other places,” said Debbie Innes-Gomberg, a deputy director at the Los Angeles County Department of Mental Health. “There’s a process of identifying that they’re symptomatic, but [our target population is] people that are in our system and people who maybe need to be.”\u003c/p>\n\u003cp>And even before the app launched in the original five counties that had signed on, the pilot has expanded. Another 11 counties have recently decided to join.\u003c/p>\n\u003cp>Still, Innes-Gomberg said, it’s going to be rolled out with caution. “We’re not going to oversell this.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/04/mindstrong-questions-over-evidence/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003c/div>\n\n","blocks":[],"excerpt":"The app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage.","status":"publish","parent":0,"modified":1538668957,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":49,"wordCount":2272},"headData":{"title":"New Smartphone App Aims to Monitor Your Mental Health | KQED","description":"The app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444844 https://ww2.kqed.org/futureofyou/?p=444844","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/04/new-smartphone-app-aims-to-monitor-your-mental-health/","disqusTitle":"New Smartphone App Aims to Monitor Your Mental Health","source":"DIY Health","nprByline":"Kate Sheridan\u003cbr />STAT","path":"/futureofyou/444844/new-smartphone-app-aims-to-monitor-your-mental-health","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">In the world of digital health, Silicon Valley-based \u003ca href=\"https://www.statnews.com/2017/08/07/mindstrong-insel-mental-illness/\" target=\"_blank\" rel=\"noopener\">Mindstrong\u003c/a> stands out. It has a star-studded team and tens of millions in venture capital funding, including from Jeff Bezos’ VC firm.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">It also has a captivating idea: that its app, based on cognitive functioning research, can help detect troubling mental health patterns by collecting data on a person’s smartphone usage — how quickly they type or scroll, for instance.\u003c/p>\n\u003cp class=\"danger-zone\">The promise of that technology has helped Mindstrong build incredible momentum since it launched last year; already more than a dozen counties in California have agreed to deploy the company’s app to patients.\u003c/p>\n\u003cp class=\"\">Does the app live up to its promise? There’s no way to tell. Almost no one outside the company has any idea whether it works. Most of the company’s key promises or claims aren’t yet backed up by published, peer-reviewed data — leading some experts to wonder if the technology is ready for the real world.\u003c/p>\n\u003cp class=\"\">“I wouldn’t waste all that time and money in the wild until they get sure that some of those things are as specific as they hope they are,” said Rosalind Picard, a researcher at MIT Media Lab who is familiar with Mindstrong’s work and tries to use data from smartphones and wearables to detect a person’s mood.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Even as one of the company’s executives, Dr. Tom Insel, acknowledged to STAT that the app isn’t perfect, the company’s CEO emphasized that Mindstrong could provide unprecedented insight into conditions like depression.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mindstrong is not alone in pushing the frontiers of smartphone-based digital health. Many companies use so-called digital phenotyping, collecting scientific data on a person’s digital life, to gain insights into his or her physical or mental health.\u003c/p>\n\u003cp>The company’s app collects information about how people are typing and runs it through a machine learning algorithm to determine which data can predict their emotional state. Mindstrong has already used it in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a \u003ca href=\"https://www.statnews.com/2018/09/24/ketamine-clinics-severe-depression-treatment/\" target=\"_blank\" rel=\"noopener\">ketamine clinic\u003c/a>. The app is available in Apple’s app store, but requires a participant code to access it.\u003c/p>\n\u003cp>“We’ve done the validation work against the gold-standard clinical tests for depression, for anxiety, for cognitive decline, whether it’s memory or executive function,” said Dr. Paul Dagum, the company’s founder. “We’re confident, we’re already seeing some really exciting results.”\u003c/p>\n\u003cp>In the last year, Mindstrong’s footprint and reach have already grown exponentially. The Palo Alto-based company’s workforce has doubled to 42 employees and it made \u003ca href=\"https://www.hsph.harvard.edu/magazine/magazine_article/philanthropic-impact-digital-phenotyping/\" target=\"_blank\" rel=\"noopener\">a sizable gift\u003c/a> to Harvard’s school of public health. In February, it launched a partnership with Takeda to develop new biomarkers that will be able to aid the pharmaceutical giant’s clinical trials for depression treatments.\u003c/p>\n\u003cp>The idea is to use that data to establish a “normal” pattern — so it can be compared against someone’s typing habits on any given day. If the habits look off, slower or more agitated than normal, the app can alert a health care provider.\u003c/p>\n\u003cp>Abnormal patterns, Mindstrong says, might show up if a person is more depressed or anxious, or if just about anything else about their mental health changes. When asked which disorders Mindstrong might be able to detect, Dagum replied, “all of them.” (Dagum, a data scientist and physician, founded the company in 2017 with Rick Klausner, the founder and director of CAR-T pioneer Juno Therapeutics and \u003ca href=\"https://www.statnews.com/2018/06/02/grail-cancer-blood-test-asco/\" target=\"_blank\" rel=\"noopener\">Grail\u003c/a>, a liquid biopsy company.)\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Mindstrong officials told STAT that among their most encouraging results is that its app can even predict how a person will feel next week, or at least how a person will perform on the Hamilton Rating Scale for depression — kind of like a weather app for your mood.\u003c/p>\n\u003cp>The data behind this claim is being published soon, said Insel, who is the former head of the National Institute of Mental Health and came to the company in 2017 after a short stint at \u003ca href=\"https://www.statnews.com/2016/03/28/google-life-sciences-exodus/\" target=\"_blank\" rel=\"noopener\">Verily\u003c/a>.\u003c/p>\n\u003cp>The app can detect a seven-point change on the Hamilton scale, Insel said. That kind of difference could indicate a patient who is not normally depressed now shows signs of mild or moderate depression, or that a person with moderate depression is now showing signs of a very severe condition.\u003c/p>\n\u003cp>“For a clinician and for someone taking care of a patient, knowing that, it could be very, very powerful,” Dagum said.\u003c/p>\n\u003cp>The company’s momentum has taken it to the cusp of a real-world deployment in California. About 15 counties — including the most populous county in the United States, Los Angeles County — will be spending about $60 million over the next four years to bring companies like Mindstrong and other apps into their health care system.\u003c/p>\n\u003cp>These counties hope apps will help them get better services to people with mental illnesses like depression, schizophrenia, bipolar disorder, and post-traumatic stress disorder.\u003c/p>\n\u003cp>The Mindstrong program itself is limited: Patients can choose voluntarily whether to use the app, which will be free to them, and that decision won’t affect the rest of the mental health services they can access.\u003c/p>\n\u003cp>\u003cstrong>Lack of Public Data\u003c/strong>\u003c/p>\n\u003cp>So far, the Mindstrong app has only been used in controlled clinical settings and trials — including one run by a company developing new antidepressants and another done in a ketamine clinic. The company has also claimed that a “\u003ca href=\"https://mindstronghealth.com/clinical-programs/\" target=\"_blank\" rel=\"noopener\">nationwide employer\u003c/a>” and private substance abuse clinics in D.C. are using the app.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>But other than the change on the Hamilton scale — which hasn’t yet gone through peer review and was disclosed to STAT in an interview — almost no data about how well Mindstrong’s technology works is available to independent observers.\u003c/p>\n\u003cp>The company’s website describes five completed clinical trials, but it has not yet published the results of any. Only a handful of other published works — all from the last year — have hinted at how well it works or its scope with data to back up the claims.\u003c/p>\n\u003cp>The company \u003ca href=\"https://www.nature.com/articles/s41746-018-0018-4\" target=\"_blank\" rel=\"noopener\">published\u003c/a> a 27-person pilot study in the journal npj Digital Medicine earlier this year. Dagum is also an author on a poster \u003ca href=\"https://www.nature.com/articles/npp2017265#t122-assessing-anhedonia-with-quantitative-tasks-digital-and-patient-reported-measures-in-a-multicenter-doubleblind-trial-with-btrx246040-for-the-treatment-of-major-depressive-disorder\" target=\"_blank\" rel=\"noopener\">presentation\u003c/a> given at the American College of Neuropsychopharmacology’s 2017 conference, another \u003ca href=\"https://isctm.org/public_access/Feb2018/PDFs/Smith-poster.pdf\" target=\"_blank\" rel=\"noopener\">poster\u003c/a> that reported results from a very wide variety of digital phenotyping techniques — not just typing — and a \u003ca href=\"https://www.ncbi.nlm.nih.gov/pubmed/29074231\" target=\"_blank\" rel=\"noopener\">paper\u003c/a> describing a clinical trial protocol — not results.\u003c/p>\n\u003cp>As Mindstrong steps toward a wider rollout, the scientific studies behind its claims will matter. Federal regulators, for one, have \u003ca href=\"https://www.ftc.gov/news-events/blogs/business-blog/2016/01/mind-gap-what-lumosity-promised-vs-what-it-could-prove\" target=\"_blank\" rel=\"noopener\">cracked down\u003c/a> on \u003ca href=\"https://www.ftc.gov/news-events/press-releases/2016/12/marketers-blood-pressure-app-settle-ftc-charges-regarding\" target=\"_blank\" rel=\"noopener\">commercial apps\u003c/a>that misleadingly reference a study’s conclusions to market their app.\u003c/p>\n\u003cp>Based on her own research, at least one expert in digital health and mood said she’s skeptical that Mindstrong can, in a general population, work as well as the company claims. MIT’s Picard said that while there are ways to predict or detect mood changes, you usually need more than just a single type of data to do so.\u003c/p>\n\u003cp>“I’m suspicious that a single modality like typing is going to be sufficient. It would be like saying there’s a single question [on a screening questionnaire] that a doctor could be using,” said Picard, who is also CEO of a company that works on digital phenotyping, like Mindstrong does.\u003c/p>\n\u003cp>“My guess is that their specificity to depression is going to be relatively low,” Picard said.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Her \u003ca href=\"https://www.jmir.org/2018/6/e210/\" target=\"_blank\" rel=\"noopener\">own\u003c/a> \u003ca href=\"https://ieeexplore.ieee.org/abstract/document/954607\" target=\"_blank\" rel=\"noopener\">research\u003c/a>, for example, relies on temperature and skin conductivity as well as calls and the amount of time spent on a phone to predict mood changes. It is about 80 percent accurate.\u003c/p>\n\u003cdiv class=\"quote-inner\">\n\u003cp>Especially in the field of digital mental health, “we need more peer review,” said Dr. Steven Steinhubl, the director of digital medicine at Scripps Research Translational Institute. (Steinhubl is also the co-editor-in-chief of npj Digital Medicine.) Though he said he strongly believes in the potential of apps like Mindstrong, Steinhubl cautioned that peer review has a purpose.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“[Peer review] is a very imperfect system, but there’s really nothing in the peer-reviewed literature. That means that other experts aren’t able to weigh in,” he said. “If you have committees and other people reviewing something who maybe don’t have the same level of expertise, you’ll have people saying, ‘Yeah, that sounds good.’”\u003c/p>\n\u003cp>Other researchers have also found that neuropsychological tests, more broadly, have relatively low accuracy rates.\u003c/p>\n\u003cp>In a study that examined people who were already being treated for depression, one computerized test could only accurately predict their condition in about 40 percent of cases. Another showed a 44 percent accuracy rate for a similar computerized test used to examine people with major depression.\u003c/p>\n\u003cp>A neuropsychological test — if it’s used as a screening test — is “going to miss a lot of people who are depressed,” said Richard Porter, a psychology researcher based at the University of Otago in New Zealand who conducted one of the studies.\u003c/p>\n\u003cp>And even if depressed people do show some kind of cognitive impairment, it’s impossible to tell what caused it.\u003c/p>\n\u003cp>Many things other than mental illness might cause a person to perform poorly on cognitive tests — like living with another disorder, having a lower baseline performance on cognitive tests, having a drink or taking prescription, over-the-counter, or illegal drugs.\u003c/p>\n\u003cp>Mindstrong’s leaders aren’t worried about that kind of noise in their data. Some of those factors are important to note, both for patients and the health care professionals working with them.\u003c/p>\n\u003cp>“You’re hungover, you didn’t sleep well, you didn’t take your medication, you have a medication side effects, you’re having stress and challenges at work and at home. Those are things that we want to measure,” Dagum said.\u003c/p>\n\u003cp>But even Insel admitted that there are plenty of issues that could affect typing speed — and which Mindstrong hasn’t figured out how to sort out yet. Sticky fingers after lunch, full hands at an airport, wearing gloves during winter, or a broken hand might also plausible affect a person’s typing speed — and, therefore, the app’s performance.\u003c/p>\n\u003cp>“One thing we’ve thought about is how we factor in those unusual environmental issues,” Insel said. “We’re working on that. But I can’t say that we’ve solved all of those possible issues.”\u003c/p>\n\u003cp>\u003cstrong>A Looming Launch in the Golden State\u003c/strong>\u003c/p>\n\u003cp>Insel and others linked with the company are fond of comparing their app to a smoke detector — something that’s intended to enhance humans’ senses to detect danger.\u003c/p>\n\u003cp>But part of the value of a smoke detector is that if it’s functioning properly, we know it isn’t going off at random. It only goes off in certain conditions and carries a specific message: Your house is on fire or about to be. Do something.\u003c/p>\n\u003cp>At least for now, that’s where Mindstrong differs from a smoke detector. There’s no way to tell, yet, how specific it is or how sensitive its algorithm is.\u003c/p>\n\u003cp>Insel said that information is coming. He said the company has the data about the app’s accuracy — but he declined to provide those figures, citing papers pending publication. “[They] square very well with clinically used biomarkers,” he said.\u003c/p>\n\u003cp>California authorities suggest they have been shown some of that data. But they’re nevertheless cautious about how the app will work in their new, different setting.\u003c/p>\n\u003cp>One official said there will be “clear writing” included with the state’s version of the app about what it can do, what it cannot do, and what goals the counties hope it will help them achieve.\u003c/p>\n\u003cp>Those goals are pretty lofty. At least some counties eventually plan to use it not only to supplement the existing system, but potentially to bring more people into its fold.\u003c/p>\n\u003cp>“We might be able to go to colleges, emergency departments, other places,” said Debbie Innes-Gomberg, a deputy director at the Los Angeles County Department of Mental Health. “There’s a process of identifying that they’re symptomatic, but [our target population is] people that are in our system and people who maybe need to be.”\u003c/p>\n\u003cp>And even before the app launched in the original five counties that had signed on, the pilot has expanded. Another 11 counties have recently decided to join.\u003c/p>\n\u003cp>Still, Innes-Gomberg said, it’s going to be rolled out with caution. “We’re not going to oversell this.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/04/mindstrong-questions-over-evidence/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003c/div>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444844/new-smartphone-app-aims-to-monitor-your-mental-health","authors":["byline_futureofyou_444844"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_537","futureofyou_56","futureofyou_1224"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_18197","label":"source_futureofyou_444844"},"futureofyou_444760":{"type":"posts","id":"futureofyou_444760","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444760","score":null,"sort":[1538609096000]},"guestAuthors":[],"slug":"artificial-sweeteners-could-be-sabotaging-your-microbiome-says-study","title":"Artificial Sweeteners Could be Sabotaging Your Microbiome, Says Study","publishDate":1538609096,"format":"standard","headTitle":"Diabetes Management | KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>Artificial sweeteners, widely regarded as a healthy alternative to sugar, may be sabotaging your gut biome.[contextly_sidebar id=\"yjhBwHasobhXnJ18NYXbIYtjXOq70PwF\"]\u003c/p>\n\u003cp>A new study published \u003ca href=\"https://www.mdpi.com/1420-3049/23/10/2454\" target=\"_blank\" rel=\"noopener\">in the journal\u003c/a> \u003cem>Molecule\u003c/em> found that \u003cem>E. coli\u003c/em> bacteria in the intestinal tract became damaged when exposed to several different kinds of artificial sweeteners.\u003c/p>\n\u003cp>The study zeroed in on six artificial sweeteners to determine their toxicity to the healthy bacteria present: aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k.\u003c/p>\n\u003cp>The researchers used as markers special light-producing bacteria known as bioluminescent \u003cem>E. coli\u003c/em> that light up when toxicity is detected, according to the collaborative study by researchers at Israel’s Ben-Gurion University of the Negev and Singapore’s Nanyang Technological University.\u003c/p>\n\u003cp>Sucralose displayed the most significant effects, with as little as 1 milligram affecting a strain of the \u003cem>E. coli.\u003c/em>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\"This is further evidence that consumption of artificial sweeteners adversely affects gut \u003ca href=\"https://www.sciencedaily.com/releases/2018/10/181001101932.htm\" target=\"_blank\" rel=\"noopener\">microbial activity\u003c/a> which can cause a wide range of health issues,\" co-author Ariel Kushmaro, a professor of biotechnology engineering at Ben-Gurion, said in a statement.[contextly_sidebar id=\"zlhu2orfRNf238Xnhya1R1LkDBb9jMGv\"]\u003c/p>\n\u003cp>Disturbances in the gut ecosystem can seriously harm human health with previous studies showing that pathogenic\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/\"> bacteria\u003c/a> can cause many chronic diseases, including inflammatory bowel disease, obesity, diabetes, and cancer.\u003c/p>\n\u003cp>The presence of these chemicals is not always obvious, with many popular foods, such as microwave popcorn and fruit juice, labeling the ingredient as a \"natural sweetener.\" That's because the Food and Drug Administration has \u003ca href=\"https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm456090.htm\" target=\"_blank\" rel=\"noopener\">yet to define\u003c/a> the term “natural” for use in food labeling.\u003c/p>\n\u003cp>Along with possible adverse health effects, the study warns that artificial sweeteners have become so ubiquitous that they're increasingly turning up in drinking water and groundwater basins.\u003c/p>\n\u003cp>\"They are resistant to wastewater treatment processes, therefore they are continuously introduced into the water environments,\" write the authors. \"Such concentrations [of artificial sweeteners] are among the highest known for anthropogenic trace pollutants.\"\u003c/p>\n\u003cp>\u003ca href=\"https://caloriecontrol.org/\" target=\"_blank\" rel=\"noopener\">Calorie Control Council\u003c/a>, the trade group for the artificial sweetener industry, criticized the study for relying solely on \u003cem>E. coli \u003c/em>bacterium, which they argue is not directly comparable to the human microbiome.\u003c/p>\n\u003cp style=\"font-weight: 400\">\"More specifically, it is unknown whether the changes to the bacterium noted in the study, or any changes in microbiome bacteria, are indicative of negative health outcomes in humans,\" the \u003ca href=\"https://caloriecontrol.org/\" target=\"_blank\" rel=\"noopener\">group \u003c/a>said in a statement emailed to KQED.\u003c/p>\n\u003cp style=\"font-weight: 400\">Moreover, the group says that all the sweeteners included in the study have been approved for use by several scientific and regulatory authorities, including the FDA.\u003c/p>\n\u003cp>To determine toxicity, researchers modified different types of \u003ci>E.coli \u003c/i>bacteria to emit light when experiencing distress. Researchers then could see what type of damage occurred, depending on which type of modified \u003cem>E. coli\u003c/em> glowed. Researchers found that each sweetener produced a specific fingerprint using three stripes of bacteria, with each stripe representing a different type of damage. From \u003ca href=\"https://www.livescience.com/63743-artificial-sweeteners-gut-health.html\" target=\"_blank\" rel=\"noopener\">Live Science\u003c/a>, quoting senior author Evgeni Eltzov:\u003c/p>\n\u003cblockquote>\n\u003cp class=\"p1\">The pattern of colors was unique for each sweetener; one might've caused more DNA damage than protein damage, for example. However, all sweeteners damaged the bacteria in some way, Eltzov said. But Eltzov noted that these findings don't mean the chemicals are \"toxic\" to humans. More research is needed to make that determination.\u003c/p>\n\u003c/blockquote>\n\u003cp class=\"p1\">One cited shortcoming of the study is that the concentrations of artificial sweetener used were higher than what's typically consumed in a can of diet soda. The \u003ca href=\"https://www.livescience.com/63743-artificial-sweeteners-gut-health.html\" target=\"_blank\" rel=\"noopener\">findings do\u003c/a> not\u003cspan class=\"Apple-converted-space\"> \u003c/span>\"tell us what happens in real life. It tells us what happens in a test tube,\" Dr. Kristina Rother, a senior research physician at the National Institutes of Health, told Live Science.\u003c/p>\n\u003cp class=\"p1\">\"Real life is just more complicated,\" Rother, who was not involved in the study, told Live Science.\u003c/p>\n\u003cp class=\"p1\">Still, she recommends avoiding artificial sweeteners.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\"I haven't seen a study that says any of these six FDA-approved sweeteners make the gut microbiome better,” she says. \"So, my recommendation is very simple and very difficult to achieve: Live a healthy life, eat little processed food.”\u003c/p>\n\n","blocks":[],"excerpt":"A new study that looked at several popular sweeteners indicates as little as 1 milligram is enough to turn gut bacteria toxic.","status":"publish","parent":0,"modified":1538609096,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":14,"wordCount":683},"headData":{"title":"Artificial Sweeteners Could be Sabotaging Your Microbiome, Says Study | KQED","description":"A new study that looked at several popular sweeteners indicates as little as 1 milligram is enough to turn gut bacteria toxic.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444760 https://ww2.kqed.org/futureofyou/?p=444760","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/03/artificial-sweeteners-could-be-sabotaging-your-microbiome-says-study/","disqusTitle":"Artificial Sweeteners Could be Sabotaging Your Microbiome, Says Study","source":"Health","path":"/futureofyou/444760/artificial-sweeteners-could-be-sabotaging-your-microbiome-says-study","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>Artificial sweeteners, widely regarded as a healthy alternative to sugar, may be sabotaging your gut biome.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>A new study published \u003ca href=\"https://www.mdpi.com/1420-3049/23/10/2454\" target=\"_blank\" rel=\"noopener\">in the journal\u003c/a> \u003cem>Molecule\u003c/em> found that \u003cem>E. coli\u003c/em> bacteria in the intestinal tract became damaged when exposed to several different kinds of artificial sweeteners.\u003c/p>\n\u003cp>The study zeroed in on six artificial sweeteners to determine their toxicity to the healthy bacteria present: aspartame, sucralose, saccharine, neotame, advantame, and acesulfame potassium-k.\u003c/p>\n\u003cp>The researchers used as markers special light-producing bacteria known as bioluminescent \u003cem>E. coli\u003c/em> that light up when toxicity is detected, according to the collaborative study by researchers at Israel’s Ben-Gurion University of the Negev and Singapore’s Nanyang Technological University.\u003c/p>\n\u003cp>Sucralose displayed the most significant effects, with as little as 1 milligram affecting a strain of the \u003cem>E. coli.\u003c/em>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\"This is further evidence that consumption of artificial sweeteners adversely affects gut \u003ca href=\"https://www.sciencedaily.com/releases/2018/10/181001101932.htm\" target=\"_blank\" rel=\"noopener\">microbial activity\u003c/a> which can cause a wide range of health issues,\" co-author Ariel Kushmaro, a professor of biotechnology engineering at Ben-Gurion, said in a statement.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Disturbances in the gut ecosystem can seriously harm human health with previous studies showing that pathogenic\u003ca href=\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425030/\"> bacteria\u003c/a> can cause many chronic diseases, including inflammatory bowel disease, obesity, diabetes, and cancer.\u003c/p>\n\u003cp>The presence of these chemicals is not always obvious, with many popular foods, such as microwave popcorn and fruit juice, labeling the ingredient as a \"natural sweetener.\" That's because the Food and Drug Administration has \u003ca href=\"https://www.fda.gov/Food/GuidanceRegulation/GuidanceDocumentsRegulatoryInformation/LabelingNutrition/ucm456090.htm\" target=\"_blank\" rel=\"noopener\">yet to define\u003c/a> the term “natural” for use in food labeling.\u003c/p>\n\u003cp>Along with possible adverse health effects, the study warns that artificial sweeteners have become so ubiquitous that they're increasingly turning up in drinking water and groundwater basins.\u003c/p>\n\u003cp>\"They are resistant to wastewater treatment processes, therefore they are continuously introduced into the water environments,\" write the authors. \"Such concentrations [of artificial sweeteners] are among the highest known for anthropogenic trace pollutants.\"\u003c/p>\n\u003cp>\u003ca href=\"https://caloriecontrol.org/\" target=\"_blank\" rel=\"noopener\">Calorie Control Council\u003c/a>, the trade group for the artificial sweetener industry, criticized the study for relying solely on \u003cem>E. coli \u003c/em>bacterium, which they argue is not directly comparable to the human microbiome.\u003c/p>\n\u003cp style=\"font-weight: 400\">\"More specifically, it is unknown whether the changes to the bacterium noted in the study, or any changes in microbiome bacteria, are indicative of negative health outcomes in humans,\" the \u003ca href=\"https://caloriecontrol.org/\" target=\"_blank\" rel=\"noopener\">group \u003c/a>said in a statement emailed to KQED.\u003c/p>\n\u003cp style=\"font-weight: 400\">Moreover, the group says that all the sweeteners included in the study have been approved for use by several scientific and regulatory authorities, including the FDA.\u003c/p>\n\u003cp>To determine toxicity, researchers modified different types of \u003ci>E.coli \u003c/i>bacteria to emit light when experiencing distress. Researchers then could see what type of damage occurred, depending on which type of modified \u003cem>E. coli\u003c/em> glowed. Researchers found that each sweetener produced a specific fingerprint using three stripes of bacteria, with each stripe representing a different type of damage. From \u003ca href=\"https://www.livescience.com/63743-artificial-sweeteners-gut-health.html\" target=\"_blank\" rel=\"noopener\">Live Science\u003c/a>, quoting senior author Evgeni Eltzov:\u003c/p>\n\u003cblockquote>\n\u003cp class=\"p1\">The pattern of colors was unique for each sweetener; one might've caused more DNA damage than protein damage, for example. However, all sweeteners damaged the bacteria in some way, Eltzov said. But Eltzov noted that these findings don't mean the chemicals are \"toxic\" to humans. More research is needed to make that determination.\u003c/p>\n\u003c/blockquote>\n\u003cp class=\"p1\">One cited shortcoming of the study is that the concentrations of artificial sweetener used were higher than what's typically consumed in a can of diet soda. The \u003ca href=\"https://www.livescience.com/63743-artificial-sweeteners-gut-health.html\" target=\"_blank\" rel=\"noopener\">findings do\u003c/a> not\u003cspan class=\"Apple-converted-space\"> \u003c/span>\"tell us what happens in real life. It tells us what happens in a test tube,\" Dr. Kristina Rother, a senior research physician at the National Institutes of Health, told Live Science.\u003c/p>\n\u003cp class=\"p1\">\"Real life is just more complicated,\" Rother, who was not involved in the study, told Live Science.\u003c/p>\n\u003cp class=\"p1\">Still, she recommends avoiding artificial sweeteners.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp class=\"p1\">\"I haven't seen a study that says any of these six FDA-approved sweeteners make the gut microbiome better,” she says. \"So, my recommendation is very simple and very difficult to achieve: Live a healthy life, eat little processed food.”\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444760/artificial-sweeteners-could-be-sabotaging-your-microbiome-says-study","authors":["11428"],"series":["futureofyou_308"],"categories":["futureofyou_1","futureofyou_73"],"tags":["futureofyou_1617","futureofyou_1231","futureofyou_689","futureofyou_61","futureofyou_1618","futureofyou_1619"],"collections":["futureofyou_1093","futureofyou_1097"],"featImg":"futureofyou_444759","label":"source_futureofyou_444760"},"futureofyou_444751":{"type":"posts","id":"futureofyou_444751","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444751","score":null,"sort":[1538506822000]},"guestAuthors":[],"slug":"in-rare-case-patient-developed-resistance-to-car-t","title":"In Rare Case, Patient Developed Resistance to CAR-T and Died","publishDate":1538506822,"format":"standard","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp class=\"danger-zone\">To make CAR-T therapies, the pioneering cancer treatments, scientists introduce a gene into the body’s immune cells that \u003ca href=\"https://www.statnews.com/2016/12/06/cancer-car-t-factory/\" target=\"_blank\" rel=\"noopener\">turns them into cancer-homing attackers\u003c/a>. But in one case described by scientists Monday, the gene was inadvertently delivered to a cancer cell instead, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment.[contextly_sidebar id=\"2oDy3tMb8Wl0Nea5cfkgpFgdjClpiQ4V\"]\u003c/p>\n\u003cp class=\"danger-zone\">The patient ultimately died.\u003c/p>\n\u003cp class=\"danger-zone\">The case, \u003ca href=\"https://www.nature.com/articles/s41591-018-0201-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in the journal Nature Medicine, appears to have been exceedingly rare — one occurrence among \u003ca href=\"https://www.statnews.com/2018/07/17/car-t-bottleneck-cell-collection-centers-feel-crunch/\" target=\"_blank\" rel=\"noopener\">the hundreds of cases\u003c/a> of CAR-T treatment that have been examined.\u003c/p>\n\u003cp class=\"\">But as the treatments become more widely used, experts say, the case also points to the importance of researchers understanding all the ways in which \u003ca href=\"https://www.statnews.com/2017/10/27/car-t-kite-cell-journey/\" rel=\"noopener\">the process of making them\u003c/a> can go wrong.\u003c/p>\n\u003cp class=\"\">“We’re going to need papers like this one” to identify how cancers can become resistant to CAR-Ts, said Dr. \u003ca href=\"https://faculty.mdanderson.org/profiles/jason_westin.html\" target=\"_blank\" rel=\"noopener\">Jason Westin\u003c/a>, who leads the aggressive lymphoma team at MD Anderson Cancer Center and who was not involved in the new report. “But this CAR-T data is one of the most exciting things we’ve seen in cancer in forever. Having rare theoretical things that actually happen is concerning, but it should in no way temper the potential for the future of CAR-T cells.”\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>The study’s authors have discussed the case, which occurred about five years ago, at scientific meetings, helping to spread awareness. And the process of manufacturing CAR-Ts has improved over that time, reducing the chance that a cancer cell inadvertently receives the gene meant for immune cells.[contextly_sidebar id=\"sNFqnG5MPMrhzsMuBzMQ3TNcRwq8tXmr\"]\u003c/p>\n\u003cp>“We’re getting much better at getting a purer starting population” of immune cells, said \u003ca href=\"https://www.med.upenn.edu/apps/faculty/index.php/g20001883/p8587263\" target=\"_blank\" rel=\"noopener\">Jos Melenhorst\u003c/a>, an immunology expert at the University of Pennsylvania and one of the authors of the report.\u003c/p>\n\u003cp>The subject of the newly described case was a 20-year-old man with B cell acute lymphoblastic leukemia. He was participating in a Phase 1 clinical trial for a CAR-T product then called CTL019, which \u003ca href=\"https://www.pennmedicine.org/news/news-releases/2017/august/fda-approves-personalized-cellular-therapy-for-advanced-leukemia\" target=\"_blank\" rel=\"noopener\">was developed\u003c/a> by researchers at Penn and Children’s Hospital of Philadelphia.\u003c/p>\n\u003cp>As with any CAR-T patient, the man had immune cells called T cells scooped out from his blood through a process called apheresis. Then, those cells were supercharged with a gene that codes for a receptor (the CAR in CAR-T) that turns the cells into bloodhounds on the scent for a specific marker on cancer cells — in this case, a protein called CD19.\u003c/p>\n\u003cp>The patient was infused with a phalanx of the killer T cells, which then swarmed and annihilated the cancer cells. Within a month, his cancer seemed to be in complete remission, Melenhorst said.\u003c/p>\n\u003cp>But as researchers tracked the patient, they noticed something odd. They kept seeing signs of CAR-marked cells, but it wasn’t the body’s T cells expressing CAR anymore.\u003c/p>\n\u003cp>They ran a battery of experiments and confirmed their suspicions: a leukemic B cell had gotten lumped together with the T cells during the manufacturing process and had also taken up the CAR gene. As a result, the leukemia cell was expressing the CAR, which then attached to the CD19 markers, effectively shielding it from the CD19-sniffing machinery of the boosted T cells. It was as if in a game of musical chairs the targeted seat was already filled by the time the music stopped.[contextly_sidebar id=\"nOqcMe5IVLJeCcUCHhq3Pk58784HwGoF\"]\u003c/p>\n\u003cp>“The CAR-T cell couldn’t bind to the CD19 molecule, and thereby it was essentially hiding in plain sight,” Melenhorst said.\u003c/p>\n\u003cp>As the T cells attacked the rest of the leukemia cells, this cell laid low for the most part, slowly proliferating into more resistant cancer cells over time. After about nine months, the patient’s cancer — now resistant to CAR-T — had fully returned. He ultimately died from complications from his leukemia.\u003c/p>\n\u003cp>Melenhorst noted that the case reaches back to the early days of clinical CAR-T use and that improvements in technology since then have allowed manufacturers to ensure that the cells into which they are introducing the CAR gene are less likely to include B cells.\u003c/p>\n\u003cp>A version of the treatment the patient received was \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" rel=\"noopener\">ultimately approved\u003c/a> as Novartis’s Kymriah in 2017; the paper published Monday includes some authors from Novartis Institutes for BioMedical Research. In a statement, Novartis noted that the manufacturing process used in the case described in the paper was done at Penn and differs from the company’s manufacturing process, which was used in later clinical trials and now for commercial use.\u003c/p>\n\u003cp>“We are not aware of any cases of this happening in the more than 400 patients treated with CTL019/Kymriah manufactured by Novartis for clinical trials or the commercial setting,” the statement said.[contextly_sidebar id=\"DMUx1aVKuHIZSHJYTfdQfqpmBWfT4XxH\"]\u003c/p>\n\u003cp>The company said it has checks throughout the process to clear out B cells and that it is following Kymriah patients for 15 years.\u003c/p>\n\u003cp>“Novartis is continually making improvements to our Kymriah manufacturing process to reduce variability and safely deliver this transformational, personalized treatment to patients in need around the world,” the statement said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/01/car-t-resistance-cancer-cell-hiding/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\n","blocks":[],"excerpt":"How a gene was inadvertently delivered to a cancer cell, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment. \r\n\r\nThe patient ultimately died.","status":"publish","parent":0,"modified":1538438140,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":17,"wordCount":909},"headData":{"title":"In Rare Case, Patient Developed Resistance to CAR-T and Died | KQED","description":"How a gene was inadvertently delivered to a cancer cell, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment. \r\n\r\nThe patient ultimately died.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444751 https://ww2.kqed.org/futureofyou/?p=444751","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/02/in-rare-case-patient-developed-resistance-to-car-t/","disqusTitle":"In Rare Case, Patient Developed Resistance to CAR-T and Died","source":"Hope/Hype","nprByline":"Andrew Joseph\u003cbr />STAT","path":"/futureofyou/444751/in-rare-case-patient-developed-resistance-to-car-t","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">To make CAR-T therapies, the pioneering cancer treatments, scientists introduce a gene into the body’s immune cells that \u003ca href=\"https://www.statnews.com/2016/12/06/cancer-car-t-factory/\" target=\"_blank\" rel=\"noopener\">turns them into cancer-homing attackers\u003c/a>. But in one case described by scientists Monday, the gene was inadvertently delivered to a cancer cell instead, camouflaging it from the therapy and allowing the cancer to develop resistance to treatment.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">The patient ultimately died.\u003c/p>\n\u003cp class=\"danger-zone\">The case, \u003ca href=\"https://www.nature.com/articles/s41591-018-0201-9\" target=\"_blank\" rel=\"noopener\">reported\u003c/a> in the journal Nature Medicine, appears to have been exceedingly rare — one occurrence among \u003ca href=\"https://www.statnews.com/2018/07/17/car-t-bottleneck-cell-collection-centers-feel-crunch/\" target=\"_blank\" rel=\"noopener\">the hundreds of cases\u003c/a> of CAR-T treatment that have been examined.\u003c/p>\n\u003cp class=\"\">But as the treatments become more widely used, experts say, the case also points to the importance of researchers understanding all the ways in which \u003ca href=\"https://www.statnews.com/2017/10/27/car-t-kite-cell-journey/\" rel=\"noopener\">the process of making them\u003c/a> can go wrong.\u003c/p>\n\u003cp class=\"\">“We’re going to need papers like this one” to identify how cancers can become resistant to CAR-Ts, said Dr. \u003ca href=\"https://faculty.mdanderson.org/profiles/jason_westin.html\" target=\"_blank\" rel=\"noopener\">Jason Westin\u003c/a>, who leads the aggressive lymphoma team at MD Anderson Cancer Center and who was not involved in the new report. “But this CAR-T data is one of the most exciting things we’ve seen in cancer in forever. Having rare theoretical things that actually happen is concerning, but it should in no way temper the potential for the future of CAR-T cells.”\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>The study’s authors have discussed the case, which occurred about five years ago, at scientific meetings, helping to spread awareness. And the process of manufacturing CAR-Ts has improved over that time, reducing the chance that a cancer cell inadvertently receives the gene meant for immune cells.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“We’re getting much better at getting a purer starting population” of immune cells, said \u003ca href=\"https://www.med.upenn.edu/apps/faculty/index.php/g20001883/p8587263\" target=\"_blank\" rel=\"noopener\">Jos Melenhorst\u003c/a>, an immunology expert at the University of Pennsylvania and one of the authors of the report.\u003c/p>\n\u003cp>The subject of the newly described case was a 20-year-old man with B cell acute lymphoblastic leukemia. He was participating in a Phase 1 clinical trial for a CAR-T product then called CTL019, which \u003ca href=\"https://www.pennmedicine.org/news/news-releases/2017/august/fda-approves-personalized-cellular-therapy-for-advanced-leukemia\" target=\"_blank\" rel=\"noopener\">was developed\u003c/a> by researchers at Penn and Children’s Hospital of Philadelphia.\u003c/p>\n\u003cp>As with any CAR-T patient, the man had immune cells called T cells scooped out from his blood through a process called apheresis. Then, those cells were supercharged with a gene that codes for a receptor (the CAR in CAR-T) that turns the cells into bloodhounds on the scent for a specific marker on cancer cells — in this case, a protein called CD19.\u003c/p>\n\u003cp>The patient was infused with a phalanx of the killer T cells, which then swarmed and annihilated the cancer cells. Within a month, his cancer seemed to be in complete remission, Melenhorst said.\u003c/p>\n\u003cp>But as researchers tracked the patient, they noticed something odd. They kept seeing signs of CAR-marked cells, but it wasn’t the body’s T cells expressing CAR anymore.\u003c/p>\n\u003cp>They ran a battery of experiments and confirmed their suspicions: a leukemic B cell had gotten lumped together with the T cells during the manufacturing process and had also taken up the CAR gene. As a result, the leukemia cell was expressing the CAR, which then attached to the CD19 markers, effectively shielding it from the CD19-sniffing machinery of the boosted T cells. It was as if in a game of musical chairs the targeted seat was already filled by the time the music stopped.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>“The CAR-T cell couldn’t bind to the CD19 molecule, and thereby it was essentially hiding in plain sight,” Melenhorst said.\u003c/p>\n\u003cp>As the T cells attacked the rest of the leukemia cells, this cell laid low for the most part, slowly proliferating into more resistant cancer cells over time. After about nine months, the patient’s cancer — now resistant to CAR-T — had fully returned. He ultimately died from complications from his leukemia.\u003c/p>\n\u003cp>Melenhorst noted that the case reaches back to the early days of clinical CAR-T use and that improvements in technology since then have allowed manufacturers to ensure that the cells into which they are introducing the CAR gene are less likely to include B cells.\u003c/p>\n\u003cp>A version of the treatment the patient received was \u003ca href=\"https://www.statnews.com/2017/08/30/novartis-car-t-cancer-approved/\" rel=\"noopener\">ultimately approved\u003c/a> as Novartis’s Kymriah in 2017; the paper published Monday includes some authors from Novartis Institutes for BioMedical Research. In a statement, Novartis noted that the manufacturing process used in the case described in the paper was done at Penn and differs from the company’s manufacturing process, which was used in later clinical trials and now for commercial use.\u003c/p>\n\u003cp>“We are not aware of any cases of this happening in the more than 400 patients treated with CTL019/Kymriah manufactured by Novartis for clinical trials or the commercial setting,” the statement said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>The company said it has checks throughout the process to clear out B cells and that it is following Kymriah patients for 15 years.\u003c/p>\n\u003cp>“Novartis is continually making improvements to our Kymriah manufacturing process to reduce variability and safely deliver this transformational, personalized treatment to patients in need around the world,” the statement said.\u003c/p>\n\u003cp>\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/10/01/car-t-resistance-cancer-cell-hiding/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444751/in-rare-case-patient-developed-resistance-to-car-t","authors":["byline_futureofyou_444751"],"categories":["futureofyou_1060","futureofyou_1062","futureofyou_73"],"tags":["futureofyou_103","futureofyou_1470","futureofyou_190","futureofyou_61"],"collections":["futureofyou_1097","futureofyou_1094"],"featImg":"futureofyou_217336","label":"source_futureofyou_444751"},"futureofyou_444707":{"type":"posts","id":"futureofyou_444707","meta":{"index":"posts_1591205157","site":"futureofyou","id":"444707","score":null,"sort":[1538430386000]},"guestAuthors":[],"slug":"video-paralyzed-man-walks-again-with-spinal-implant","title":"Video: Paralyzed Man Walks Again After Spinal Implant","publishDate":1538430386,"format":"aside","headTitle":"KQED Future of You | KQED Science","labelTerm":{},"content":"\u003cp>https://www.youtube.com/watch?v=MQ6ggOdQz2k\u003c/p>\n\u003cp>A new spinal implant developed by researchers at the Mayo Clinic and UC Los Angeles is allowing one man to walk again after a severe snowmobile accident left him partially paralyzed four years ago.\u003c/p>\n\u003cp>Researchers say the preliminary findings, published recently in the journal \u003ca href=\"https://go.redirectingat.com/?id=66960X1514734&xs=1&url=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41591-018-0175-7\" target=\"_blank\" rel=\"nofollow noopener\">\u003cem>Nature Medicine\u003c/em>\u003c/a>\u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1803588\">\u003cem>, \u003c/em>\u003c/a>shows great promise for those suffering from paralysis.\u003c/p>\n\u003cp>Surgeons implanted the electrode below 29-year-old Jered Chinnock's spinal cord injury, which left him without motor control below the middle of his back. After 43 weeks of physical therapy, Chinook can now walk about the length of a football field with the help of a walker.\u003c/p>\n\u003cp>A\u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1803588\" target=\"_blank\" rel=\"noopener\"> separate study\u003c/a> conducted at the University of Louisville reported similar results for patients who also received an electrode implant, which sends electrical pulses to the spinal cord.\u003c/p>\n\u003cp>Researchers say the next stage of their work will focus on understanding why electrically stimulating the spinal cord allows the brain to regain control of the legs.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>\u003c/p>\n","blocks":[],"excerpt":"Researchers at UCLA and the Mayo Clinic have developed an electrical device that is allowing one paralyzed man to walk again.","status":"publish","parent":0,"modified":1538430443,"stats":{"hasAudio":false,"hasVideo":true,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":7,"wordCount":171},"headData":{"title":"Video: Paralyzed Man Walks Again After Spinal Implant | KQED","description":"Researchers at UCLA and the Mayo Clinic have developed an electrical device that is allowing one paralyzed man to walk again.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":""},"disqusIdentifier":"444707 https://ww2.kqed.org/futureofyou/?p=444707","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/10/01/video-paralyzed-man-walks-again-with-spinal-implant/","disqusTitle":"Video: Paralyzed Man Walks Again After Spinal Implant","source":"Hope/Hype","path":"/futureofyou/444707/video-paralyzed-man-walks-again-with-spinal-implant","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\u003cp>\u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutube'>\n \u003cspan class='utils-parseShortcode-shortcodes-__youtubeShortcode__embedYoutubeInside'>\n \u003ciframe\n loading='lazy'\n class='utils-parseShortcode-shortcodes-__youtubeShortcode__youtubePlayer'\n type='text/html'\n src='//www.youtube.com/embed/MQ6ggOdQz2k'\n title='//www.youtube.com/embed/MQ6ggOdQz2k'\n allowfullscreen='true'\n style='border:0;'>\u003c/iframe>\n \u003c/span>\n \u003c/span>\u003c/p>\u003cp>\u003cp>A new spinal implant developed by researchers at the Mayo Clinic and UC Los Angeles is allowing one man to walk again after a severe snowmobile accident left him partially paralyzed four years ago.\u003c/p>\n\u003cp>Researchers say the preliminary findings, published recently in the journal \u003ca href=\"https://go.redirectingat.com/?id=66960X1514734&xs=1&url=https%3A%2F%2Fwww.nature.com%2Farticles%2Fs41591-018-0175-7\" target=\"_blank\" rel=\"nofollow noopener\">\u003cem>Nature Medicine\u003c/em>\u003c/a>\u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1803588\">\u003cem>, \u003c/em>\u003c/a>shows great promise for those suffering from paralysis.\u003c/p>\n\u003cp>Surgeons implanted the electrode below 29-year-old Jered Chinnock's spinal cord injury, which left him without motor control below the middle of his back. After 43 weeks of physical therapy, Chinook can now walk about the length of a football field with the help of a walker.\u003c/p>\n\u003cp>A\u003ca href=\"https://www.nejm.org/doi/full/10.1056/NEJMoa1803588\" target=\"_blank\" rel=\"noopener\"> separate study\u003c/a> conducted at the University of Louisville reported similar results for patients who also received an electrode implant, which sends electrical pulses to the spinal cord.\u003c/p>\n\u003cp>Researchers say the next stage of their work will focus on understanding why electrically stimulating the spinal cord allows the brain to regain control of the legs.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444707/video-paralyzed-man-walks-again-with-spinal-implant","authors":["11428"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_80","futureofyou_1010"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444735","label":"source_futureofyou_444707"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? Each episode also includes a short fiction story generated by advanced AI GPT-4, serving as a thought-provoking springboard to speculate how humanity could leverage technology for good.","airtime":"SUN 2pm","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2023/08/possible-5gxfizEbKOJ-pbF5ASgxrs_.1400x1400.jpg","officialWebsiteLink":"https://www.possible.fm/","meta":{"site":"news","source":"Possible"},"link":"/radio/program/possible","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/possible/id1677184070","spotify":"https://open.spotify.com/show/730YpdUSNlMyPQwNnyjp4k"}},"1a":{"id":"1a","title":"1A","info":"1A is home to the national conversation. 1A brings on great guests and frames the best debate in ways that make you think, share and engage.","airtime":"MON-THU 11pm-12am","imageSrc":"https://ww2.kqed.org/radio/wp-content/uploads/sites/50/2018/04/1a.jpg","officialWebsiteLink":"https://the1a.org/","meta":{"site":"news","source":"npr"},"link":"/radio/program/1a","subscribe":{"npr":"https://rpb3r.app.goo.gl/RBrW","apple":"https://itunes.apple.com/WebObjects/MZStore.woa/wa/viewPodcast?s=143441&mt=2&id=1188724250&at=11l79Y&ct=nprdirectory","tuneIn":"https://tunein.com/radio/1A-p947376/","rss":"https://feeds.npr.org/510316/podcast.xml"}},"all-things-considered":{"id":"all-things-considered","title":"All Things Considered","info":"Every weekday, \u003cem>All Things Considered\u003c/em> hosts Robert Siegel, Audie Cornish, Ari Shapiro, and Kelly McEvers present the program's trademark mix of news, interviews, commentaries, reviews, and offbeat features. 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We cover topics like how fed-up administrators are developing surprising tactics to deal with classroom disruptions; how listening to podcasts are helping kids develop reading skills; the consequences of overparenting; and why interdisciplinary learning can engage students on all ends of the traditional achievement spectrum. This podcast is part of the MindShift education site, a division of KQED News. KQED is an NPR/PBS member station based in San Francisco. You can also visit the MindShift website for episodes and supplemental blog posts or tweet us \u003ca href=\"https://twitter.com/MindShiftKQED\">@MindShiftKQED\u003c/a> or visit us at \u003ca href=\"/mindshift\">MindShift.KQED.org\u003c/a>","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2022/02/mindshift2021-tile-3000x3000-1-scaled-1.jpg","imageAlt":"KQED MindShift: How We Will Learn","officialWebsiteLink":"/mindshift/","meta":{"site":"news","source":"kqed","order":"2"},"link":"/podcasts/mindshift","subscribe":{"apple":"https://podcasts.apple.com/us/podcast/mindshift-podcast/id1078765985","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5tZWdhcGhvbmUuZm0vS1FJTkM1NzY0NjAwNDI5","npr":"https://www.npr.org/podcasts/464615685/mind-shift-podcast","stitcher":"https://www.stitcher.com/podcast/kqed/stories-teachers-share","spotify":"https://open.spotify.com/show/0MxSpNYZKNprFLCl7eEtyx"}},"morning-edition":{"id":"morning-edition","title":"Morning Edition","info":"\u003cem>Morning Edition\u003c/em> takes listeners around the country and the world with multi-faceted stories and commentaries every weekday. Hosts Steve Inskeep, David Greene and Rachel Martin bring you the latest breaking news and features to prepare you for the day.","airtime":"MON-FRI 3am-9am","imageSrc":"https://ww2.kqed.org/app/uploads/2021/10/ME_1400.jpg","officialWebsiteLink":"https://www.npr.org/programs/morning-edition/","meta":{"site":"news","source":"npr"},"link":"/radio/program/morning-edition"},"onourwatch":{"id":"onourwatch","title":"On Our Watch","tagline":"Police secrets, unsealed","info":"For decades, the process for how police police themselves has been inconsistent – if not opaque. In some states, like California, these proceedings were completely hidden. After a new police transparency law unsealed scores of internal affairs files, our reporters set out to examine these cases and the shadow world of police discipline. On Our Watch brings listeners into the rooms where officers are questioned and witnesses are interrogated to find out who this system is really protecting. Is it the officers, or the public they've sworn to serve?","imageSrc":"https://cdn.kqed.org/wp-content/uploads/2024/01/OOW_Tile_Final.png","imageAlt":"On Our Watch from NPR and KQED","officialWebsiteLink":"/podcasts/onourwatch","meta":{"site":"news","source":"kqed","order":"1"},"link":"/podcasts/onourwatch","subscribe":{"apple":"https://podcasts.apple.com/podcast/id1567098962","google":"https://podcasts.google.com/feed/aHR0cHM6Ly9mZWVkcy5ucHIub3JnLzUxMDM2MC9wb2RjYXN0LnhtbD9zYz1nb29nbGVwb2RjYXN0cw","npr":"https://rpb3r.app.goo.gl/onourwatch","spotify":"https://open.spotify.com/show/0OLWoyizopu6tY1XiuX70x","tuneIn":"https://tunein.com/radio/On-Our-Watch-p1436229/","stitcher":"https://www.stitcher.com/show/on-our-watch","rss":"https://feeds.npr.org/510360/podcast.xml"}},"on-the-media":{"id":"on-the-media","title":"On The Media","info":"Our weekly podcast explores how the media 'sausage' is made, casts an incisive eye on fluctuations in the marketplace of ideas, and examines threats to the freedom of information and expression in America and abroad. 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