At-risk patients, such as those with HIV or transplant recipients, could benefit from potentially life-saving study carried out by a University of Surrey led group of international researchers.

The research, led by Professor Vince Emery, Senior Vice-President (Global Strategy and Engagement) and Professor of Translational Virology at the University of Surrey, has developed a model that will provide vital insight into how best to help patients with Cytomegalovirus (CMV) infection, particularly those who have undergone organ transplantation.

CMV can be serious if the patient’s immune system is not fully functioning, as in transplant patients on immune-suppressant drugs, or for HIV patients in the advanced stages of AIDS. In these cases, CMV can cause major health problems, affecting a range of organs and contributing to early death, which obviously makes it vital to understand how to control the virus.

The mainstay of therapy for CMV has been an antiviral drug called Ganciclovir, which mimics the building blocks of DNA and stops the virus from replicating.

In the current study, the researchers used information from a large clinical trial of Ganciclovir for the treatment of CMV disease in patients who had undergone solid organ transplantation, to assess the patterns of viral responses seen following therapy.

This is the first time that a comprehensive model has been developed which explains the full range of post-therapy virus decline patterns. It provides vital insight into how to best help patients with CMV infection, especially after solid organ transplants and is potentially extendable to stem cell transplant patients.

The researchers have identified four unique patterns of response and have then used this to develop a sophisticated mathematical model which can accurately account for these patterns of decline.

The researchers’ work also benefits patients by leading the way forward to personalised medicine, and will make it possible to predict the likely duration of therapy needed for a patient with CMV infection to clear the virus.

Professor Emery said: ‘I am very proud to have led this vital research, as it will improve the health and quality of life of patients with CMV infection. CMV is a member of the herpes virus family and related to the virus that causes cold sores; these viruses are widespread and usually harmless.

‘But in some at risk cases, such as when the patients’ immune system is not fully functioning, it could mean the difference between life and death.

University of Surrey www.surrey.ac.uk/mediacentre/press/2017/research-uncovers-life-saving-benefits-battle-against-viruses

The American Society for Radiation Oncology (ASTRO) issued a new clinical guideline for the use of stereotactic body radiation therapy (SBRT) in early-stage lung cancer. While SBRT is the current standard of care for peripherally located tumours in patients who cannot undergo surgery, the new guideline addresses the appropriateness of SBRT for medically inoperable patients with high-risk clinical scenarios requiring curative focused therapy. The guideline also reviews the role of SBRT for centrally located tumours because of their unique risks compared to peripheral tumours.
SBRT is an advanced type of external beam radiation therapy that uses sophisticated planning techniques to deliver an extremely high dose of radiation very precisely to a tumour. This high degree of precision makes SBRT notably effective at sparing healthy tissues surrounding the tumour, which is particularly important with lung tumours. For patients who are not fit enough for early-stage lung cancer surgery, SBRT presents a viable option for curative-intent treatment since it provides excellent outcomes with low toxicity. Compared to conventional external beam radiation therapy, which is delivered over several weeks, SBRT is typically administered in five or fewer treatment sessions, or fractions.
Drawing on data from retrospective and prospective studies and the available randomized clinical trials, the guideline provides evidence-based recommendations regarding the appropriate use of SBRT for early-stage non-small cell lung cancer (NSCLC). The principal goal of the guideline was to address SBRT for patients unable to tolerate surgery who require customization of SBRT in high-risk clinical scenarios, such as for salvage therapy after previous surgery or radiation therapy, for tumours invading the chest wall or for very large tumours. The guideline also details principles of SBRT directed toward centrally located lung tumours, since treating these tumours carries unique and significant risks when compared to treatment directed at peripherally located tumours. Additionally, although the focus of the guideline was the inoperable patient, the appropriateness of SBRT in the operable patient also was addressed, since it is an area of debate and controversy.

ecancernews
ecancer.org/news/11751-astro-issues-guideline-for-use-of-stereotactic-radiation-in-early-stage-lung-cancer.php

For concussion sufferers, even those who never lost consciousness, physicians may now be able to predict early on who is more likely to continue experiencing symptoms months or years after the head-jarring event, using a new non-invasive magnetic resonance imaging (MRI) method devised by a consortium of researchers led by UC San Francisco scientists.
In their new study the researchers used functional MRI (fMRI), coupled with sophisticated statistical analysis, to track activity in the brain networks of 75 patients, aged 18 to 55, within the first two weeks of their having experienced concussions.
The study revealed tell-tale patterns of brain activity that, six months later, were associated with worse performance on behavioural and cognitive tests and were different from patterns seen in healthy control subjects.
The fMRI method and analysis developed for the study highlighted abnormal patterns of brain activity that pointed to a higher risk for long-term, post-concussive symptoms, even among the 44 study participants who had no evidence of bleeding or bruising in the brain in the immediate aftermath of brain trauma on computed tomography (CT) or ordinary MRI scans.
“This is an exploratory, proof-of-concept study showing that we can identify patients soon after mild brain trauma who may have more persistent symptoms, despite no other evidence of injury within the brain,” said Pratik Mukherjee, MD, PhD, professor of radiology and biomedical imaging at UCSF and the senior author of the study. “We may be able to use this information to help guide treatment decisions and counselling of patients early on, when it may be more effective.”
Only subjects who had lost consciousness for less than 30 minutes were eligible for the study, and many study subjects never lost consciousness during their injury.

University of California – San Franciscohttp://tinyurl.com/yc6cfxrn

Successful results of a University of Liverpool-led trial that utilised nanotechnology to improve drug therapies for HIV patients has been presented at the Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle, a leading annual conference of HIV research, clinical practice and progress.

The healthy volunteer trial, conducted by the collaborative nanomedicine research programme led by Pharmacologist Professor Andrew Owen and Materials Chemist Professor Steve Rannard, and in collaboration with the St Stephen’s AIDS Trust at the Chelsea & Westminster Hospital in London, examined the use of nanotechnology to improve the delivery of drugs to HIV patients. The results were from two trials that are the first to use orally dosed nanomedicine to enable HIV therapy optimisation.

Nanotechnology is the manipulation of matter on an atomic, molecular, and supramolecular scale. Nanomedicine is the application of nanotechnology to the prevention and treatment of disease in the human body. By developing smaller pills that are better for patients and less expensive to manufacture, this evolving discipline has the potential to dramatically change medical science and is already having an impact in a number of clinically used therapies and diagnostics worldwide.

Currently, the treatment of HIV requires daily oral dosing of HIV drugs, and chronic oral dosing has significant complications that arise from the high pill burden experienced by many patients across populations with varying conditions leading to non-adherence to therapies.

Recent evaluation of HIV patient groups have shown a willingness to switch to nanomedicine alternatives if benefits can be shown. Research efforts by the Liverpool team have focused on the development of new oral therapies, using Solid Drug Nanoparticle (SDN) technology which can improve drug absorption into the body, reducing both the dose and the cost per dose and enabling existing healthcare budgets to treat more patients.

The trial results confirmed the potential for a 50 percent dose reduction while maintaining therapeutic exposure, using a novel approach to formulation of two drugs: efavirenz (EFV) and, lopinavir (LPV). EFV is the current WHO-recommended preferred regimen, with 70percent of adult patients on first-line taking an EFV-based HIV treatment regimen in low- and middle-income countries.

University of Liverpool news.liverpool.ac.uk/2017/02/17/new-nano-approach-to-hiv-therapy-presented-at-leading-conference/

A brain-computer interface that can decipher the thoughts of people who are unable to communicate could revolutionize the lives of those living with complete locked-in syndrome. Counter to expectations, the participants in the study reported being ‘happy’ despite their condition.
In the trial, people with complete locked-in syndrome, who were incapable of even moving their eyes to communicate, were able to respond ‘yes’ or ‘no’ via thought to spoken questions. A non-invasive brain-computer interface (BCI) detected their responses by measuring changes in blood oxygen levels in the brain.
The results overturn previous theories that people with complete locked-in syndrome lack the goal_directed thinking necessary to use a brain computer interface and are therefore incapable of communication.
Extensive investigations were carried out in four people with ALS (amyotrophic lateral sclerosis) – a progressive motor neuron disease that leads to complete destruction of the part of the nervous system responsible for movement.
The researchers asked personal questions with known answers and open questions that needed ‘yes’ or ‘no’ answers including: ‘Your husband’s name is Joachim?’ and ‘Are you happy?’. They found the questions elicited correct responses seven times out of ten.
Professor Niels Birbaumer, a neuroscientist at the Wyss Center for Bio and Neuroengineering in Geneva, senior author of the paper said: ‘The striking results overturn my own theory that people with complete locked-in syndrome are not capable of communication. We found that all four people we tested were able to answer the personal questions we asked them, using their thoughts alone. If we can replicate this study in more patients I believe we could restore useful communication in completely locked-in states for people with motor neuron diseases.’
The question ‘Are you happy?’ resulted in a consistent ‘Yes’ response from the four people, repeated over weeks of questioning.
Professor Birbaumer said: ‘We were initially surprised at the positive responses when we questioned the four completely locked-in participants about their quality of life. All four had accepted artificial ventilation in order to sustain their life when breathing became impossible so, in a sense, they had already chosen to live. What we observed was as long as they received satisfactory care at home, they found their quality of life acceptable. It is for this reason, if we could make this technique widely clinically available, it would have a huge impact on the day-to-day life of people with complete locked-in syndrome’.

Wyss Center http://tinyurl.com/j7plj5n