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Siemens Healthineers and Braunschweig Municipal Hospital enter into strategic technology partnership

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Braunschweig Municipal Hospital and Siemens Healthineers are breaking new ground through an innovative medical technology partnership. Together, they have entered into a long-term Asset Management Services (AMS) contract. Braunschweig Municipal Hospital is one of the largest hospitals in northern Germany, with 1,499 beds and 38 clinics and institutes. Siemens Healthineers will assume responsibility for supplying and maintaining all initial and replacement equipment in the areas of radiology, radiotherapy and nuclear medicine. The partnership also includes strategic and operational consulting services to drive continuous improvement initiatives over time. On October 23, in Braunschweig, the parties signed a ten-year contract with a five-year extension option.
“The primary goal of this technology partnership is to assure high-quality and cost-effective medical care for our patients through first-class diagnostic radiological, surgical and radiotherapy services”, explains Ulrich Markurth, mayor of Braunschweig and chairman of the hospital’s supervisory board.
“We are very pleased to be able to contribute as a technology partner in the coming years to further improve the quality of patient care at the Braunschweig Municipal Hospital and its performance capability,” says Dr. Stefan Schaller, head of Siemens Healthineers in Germany. “In addition to the provision of innovative medical technology systems, we support the Braunschweig Municipal Hospital in planning new buildings and optimizing workflows in radiology, cardiology and the emergency department as well as in all steps towards the digitization of healthcare. This holistic package provides the hospital with security of planning, budget certainty and future reliability over the entire duration of the project.”
Matthias Platsch, President of Siemens Healthineers Services adds: “We are delighted to have been chosen as a technology partner for the Braunschweig Municipal Hospital and we are both proud and humbled by the vote of confidence that this important healthcare provider has placed in our new services portfolio. In this, Siemens Healthineers’ first asset management services partnership in Germany, we will combine the strength of our innovative product portfolio with the forward-looking business approach of our enterprise services to help deliver best-value clinical outcomes for patients. Together with the Braunschweig Municipal Hospital, we will transform healthcare delivery by leveraging our combined expertise in established and new care models. With a fresh look at the design and operation of the facility we will significantly improve the patient experience, and the new technologies we will deploy will enable more efficient and more precise clinical diagnosis. We are very excited to play such a role in the future of healthcare in Braunschweig.”
Hospital CEO Dr. Andreas Goepfert explains that the award of the contract for this technology partnership, including the vendor-neutral procurement and management of around 50 new systems (ranging from magnetic resonance and computed tomography, to angiography, X-ray, nuclear medicine and radiotherapy machines) is the result of a Europe-wide call for tenders via an initial selection process and a competitive dialogue. The fundamental premise is that this innovative, end-to-end partnership model – for procurement and management, in particular – will generate savings for the hospital compared to a series of individual, reactive calls for tender.
As a consequence, Siemens Healthineers will be responsible for procurement, installation, maintenance, servicing, an innovation guarantee (through updates and upgrades), and an availability guarantee for all devices. The long-term technology roadmap takes into consideration the hospital’s strategic orientation, especially its current plan to concentrate the hospital at two locations. A Syngo.via Enterprise solution will also give the hospital access to all Siemens Healthineers’ software applications, enabling it to stay at the forefront of digital innovation.
 “The technology partnership in the area of radiology will bring together the heterogeneous imaging device landscape and IT in our radiology department at Braunschweig Municipal Hospital,” forecasts its medical director, Dr. Thomas Bartkiewicz. “That ensures we always stay at the forefront of innovation in diagnostic imaging and imaging-based treatment, while ensuring radiation exposure for patients and employees is kept to a minimum.” Complex interfaces will be removed and the clinical staff will find their day-to-day work routines become noticeably simpler. Nursing director Ulrich Heller adds: “Different operating processes from various device manufacturers will be reduced to a single standardized system.” This will speed up workflows and improve quality of care at the same time. In addition, maintenance plans and contracts that were not previously coordinated will be combined as part of an optimized programme in the future. The result will be a sustainable reduction in maintenance costs.
The ‘Braunschweig Model’ for a technology partnership enables the hospital to respond flexibly to changing requirements and future device needs due to a separate ‘innovation budget’. This includes possible changes in both the scope and the timing of procurement throughout the entire term of the partnership. The fixed quarterly payment fee also provides the hospital with budgetary certainty for the contract duration.
“The technology partnership guarantees predictability of costs whilst providing security of investments in the fields of radiology, radiotherapy and nuclear medicine,” says hospital CEO Goepfert. The long-term technology partnership will enable the hospital to benefit from future technological advances in radiology, including innovative algorithms to improve image reading and computer-assisted diagnostic modules. This will ensure high-quality and cost-effective patient care for the long term.
The AMS also encompasses a number of flagship projects in which the two partners will work closely together in the future. For example, Siemens Healthineers will contribute the know-how in the area of molecular diagnostics built up by its company NEO New Oncology GmbH. Thanks to genome analyses of tumour tissue performed by NEO New Oncology, Braunschweig Municipal Hospital will be able to create customized, targeted treatment recommendations that will facilitate highly promising precision medical treatment for cancer patients. www.siemens.com/healthineers

The end of pneumonia? New vaccine offers hope.

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In 2004, pneumonia killed more than 2 million children worldwide, according to the World Health Organization. By 2015, the number was less than 1 million.
Better access to antibiotics and improved nutrition account for part of the decline. But scientists say it’s mostly due to vaccines introduced in the early 2000s that target up to 23 of the most deadly forms of the bacterium that causes pneumonia, Streptococcus pneumoniae.
Now, a new vaccine under development could deal another blow to the disease, lowering the number of deaths even further by targeting dozens of additional strains of S. pneumoniae, and anticipating future versions of the bacteria responsible for the disease.
The vaccine provoked an immune response to 72 forms of S. pneumoniae — including the 23 mentioned above — in lab tests on animals. The study represents the “most comprehensive” coverage of pneumococcal disease to date, researchers say.
“We’ve made tremendous progress fighting the spread of pneumonia, especially among children. But if we’re ever going to rid ourselves of the disease, we need to create smarter and more cost-effective vaccines,” says Blaine Pfeifer, PhD, associate professor of chemical and biological engineering at the University at Buffalo’s School of Engineering and Applied Sciences, and the study’s co-lead author.
Each strain of S. pneumoniae contains unique polysaccharides. Vaccines such as Prevnar 13 and Synflorix connect these sugars — by the sharing of an electron — to a protein called CRM197. The process, known as a covalent bond, creates a potent vaccine that prompts the body to find and destroy bacteria before it colonizes the body.
While effective, creating covalent bonds for each strain of S. pneumoniae is time-consuming and expensive. Plus, this type of immunization, known as a conjugate vaccine, prompts the body to eliminate each of the targeted bacteria types — regardless of whether the bacteria is idyll or attacking the body.
Another vaccine, Pneumovax 23, contains sugars of 23 of the most common types S. pneumoniae. However, the immune response it provokes is not as strong as Prevnar because the sugars are not covalently linked.
“Traditional vaccines completely remove bacteria from the body. But we now know that bacteria — and in a larger sense, the microbiome — are beneficial to maintaining good health, says Charles H. Jones, the study’s other co-lead author.
“What’s really exciting is that we now have the ability — with the vaccine we’re developing — to watch over bacteria and attack it only if it breaks away from the colony to cause an illness. That’s important because if we leave the harmless bacteria in place, it prevents other harmful bacteria from filling that space.”
Varieties of S. pneumoniae not covered by current immunizations are responsible for a small portion — for example, 7 to 10 percent among U.S. children, according to the Centers for Disease Control and Prevention — of pneumonia, meningitis and other cases of pneumococcal disease.
But officials worry that will change, as these less common forms — and, potentially, yet-to-be discovered antimicrobial resistant strains — replace the 23 more common types targeted by current immunizations.
The new vaccine provokes a strong immune response (comparable to Prevnar) and is engineered in a way that makes it easy to add sugars (like Pneumovax) for a broad immune response.
Key to the technology is a liposome — a tiny liquid-filled bubble made of fat — that acts as a storage tank for the sugars. Because the sugars are not covalently bonded, it’s possible that the liposome could host all of the sugars that identify individual strains of S. pneumoniae.
The research team added proteins at the surface of the liposome (also non-covalently) which, together with the sugars, provoke strong immunotherapy. According to tests performed on mice and rabbits, the new vaccine stimulated an immune response to 72 of the more than 90 known strains of S. pneumoniae. In many cases, it outperformed Prevnar and Pneumovax.
“The advantage of our approach is that we don’t have to apply the more complex covalent chemistry that is required for Prevnar,” Pfeifer says. “As a result, we can extend beyond the 13 types of sugars, potentially providing universal coverage against bacteria that causes pneumonia, meningitis, sepsis and other types of pneumococcal disease.
“It holds the promise of saving hundreds of thousands of lives each year.”

Buffalo University
www.buffalo.edu/news/releases/2017/10/039.html
 

Self-powered paper-based ‘SPEDs’ may lead to new medical-diagnostic tools

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A new medical-diagnostic device made out of paper detects biomarkers and identifies diseases by performing electrochemical analyses – powered only by the user’s touch – and reads out the color-coded test results, making it easy for non-experts to understand.
“You could consider this a portable laboratory that is just completely made out of paper, is inexpensive and can be disposed of through incineration,” said Ramses V. Martinez, an assistant professor of industrial and biomedical engineering at Purdue University. “We hope these devices will serve untrained people located in remote villages or military bases to test for a variety of diseases without requiring any source of electricity, clean water, or additional equipment.”
The self-powered, paper-based electrochemical devices, or SPEDs, are designed for sensitive diagnostics at the “point-of-care,” or when care is delivered to patients, in regions where the public has limited access to resources or sophisticated medical equipment.
The test is initiated by placing a pinprick of blood in a circular feature on the device, which is less than two-inches square. SPEDs also contain “self-pipetting test zones” that can be dipped into a sample instead of using a finger-prick test. The top layer of the SPED is fabricated using untreated cellulose paper with patterned hydrophobic “domains” that define channels that wick up blood samples for testing. These “microfluidic channels” allow for accurate assays that change colour to indicate specific testing results. A machine-vision diagnostic application also was created to automatically identify and quantify each of these “colorimetric” tests from a digital image of the SPED, perhaps taken with a cellphone, to provide fast diagnostic results to the user and to facilitate remote-expert consultation.
The bottom layer of the SPED is a “triboelectric generator,” or TEG, which generates the electric current necessary to run the diagnostic test simply by rubbing or pressing it. The researchers also designed an inexpensive handheld device called a potentiostat, which is easily plugged into the SPED to automate the diagnostic tests so that they can be performed by untrained users. The battery powering the potentiostat can be recharged using the TEG built into the SPEDs. “To our knowledge, this work reports the first self-powered, paperbased devices capable of performing rapid, accurate, and sensitive electrochemical assays in combination with a low-cost, portable potentiostat that can be recharged using a paper-based TEG,” Martinez said.

Purdue University https://www.purdue.edu/newsroom/releases/2017/Q3/self-powered-paper-based-speds-may-lead-to-new-medical-diagnostic-tools.html

Drugs found to be more effective against depression than electric current

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A new study questions the efficacy of treatments for depression based on stimulating brain areas with low-intensity electric current. The technique, known as transcranial direct-current stimulation (tDCS), was considered a promising alternative to treatment with antidepressant drugs.
In the new study, researchers at the University of São Paulo’s teaching hospital (HU-USP) and the Psychiatry Institute of Hospital das Clínicas (HC-FMUSP-IP), the largest general hospital in Brazil, describe a trial in which they found tDCS to be less effective than escitalopram, an anti-depressant.
The team of researchers led by André Brunoni, a professor in the Psychiatry Department of the University of São Paulo’s Medical School (FMUSP) and director of HC-FMUSP-IP’s Interdisciplinary Neuromodulation Service, randomly divided 245 patients with depression into three groups.
One group was treated with tDCS plus oral placebo, the second received sham tDCS treatment plus the anti-depressant, and the third received sham tDCS treatment plus oral placebo.
The tDCS treatment was administered in 30-minute sessions for 15 consecutive weekdays, followed by seven once-weekly sessions. Escitalopram was administered at a dose of 10 mg per day for three weeks and 20 mg per day for another seven weeks.
"We defined non-inferiority of stimulation compared with medication as at least 50%, meaning that tDCS would have to be at least 50% as effective as the anti-depressant, but this wasn’t the case," Brunoni said.
"We found that treatment with tDCS was not half as effective as treatment with escitalopram and concluded that transcranial stimulation cannot be recommended as first-line therapy. The anti-depressant is easier to administer and much more effective. On the other hand, tDCS performed better than placebo in our previous studies."
About 12%-14% of the world’s population is estimated to suffer from depression, and it is relatively easy to find self-help websites with videos showing how to administer tDCS at home.
Brunoni stressed the importance of not confusing tDCS with other methods such as electroconvulsive therapy (ECT), which involves a far stronger current – typically 800 milliamperes, or 800 times the current used in tDCS – and is designed to produce a controlled seizure. Other differences include the fact that ECT delivers a brief pulse rather than a steady current.

www.eurekalert.org/pub_releases/2017-08/fda-dft083117.php

New method for organ transplant monitoring promises better care for patients

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Using a combination of DNA sequencing and computer science techniques, a team of researchers has developed a new method for monitoring the health of organ transplant patients – one that promises to provide life-saving clues to diagnose organ rejection at an early stage.
More than 180,000 people live with organ transplants in the U.S., and many undergo costly and risky biopsies to determine if their body is accepting or rejecting an organ. An alternate method demonstrated by Iwijn De Vlaminck, who is also a senior author of the current study, found that cell-free DNA (cfDNA), essentially fragments of dead cells derived from an organ, can be detected in a patient’s bloodstream and used as a proxy for the organ’s health. The more cfDNA that is discovered, the greater the likelihood the organ is failing. But without knowing the donor’s DNA – which is often the case – doctors have no reference to identify the cfDNA.
But now a research team from Cornell and Stanford University has demonstrated a method for identifying cfDNA without the donor. To address the issue, Eilon Sharon, postdoctoral researcher with Jonathan Pritchard, and colleagues worked to develop a computer algorithm that estimates the donor-derived cfDNA and can predict heart and lung rejection with an accuracy similar to that in cases where donor information is available. Their work also details a refined algorithm to address closely related recipients and donors, a scenario that is common in bone marrow and kidney transplantations.
The algorithm uses publicly available genotypes and techniques of relationship inference to model which cfDNA fragments are most likely from the organ. "Specifically, the model infers the donor’s most probable ancestral population and accounts for close relationship by detecting DNA segments that are identical due to close descent," said Sharon, adding that the phenomenon is known as "identity by descent."
The findings alleviate a major barrier to using cfDNA detection – also known as genome transplant dynamics – instead of biopsies, and researchers hope the computer science-based method will help save lives. Accurate monitoring of organ health is essential to a patient’s long-term survival; currently, the median life expectancy for a heart transplant patient is around 11 years, and only 5.3 years for recipients of lungs.

EurekAlert
www.eurekalert.org/pub_releases/2017-08/p-nmf072717.php

Targeted treatment could prevent spread of pancreatic cancer, heart damage

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Researchers at the University of Cincinnati (UC) College of Medicine have shown that a new targeted treatment could benefit patients with certain pancreatic tumours by preventing spread of the cancer and protecting their heart from damage—a direct result of the tumour. Higher levels of serotonin among other tumour secretions can cause injury to the valves of the heart over time, leading to cardiac impairment—a condition referred to as cardiac carcinoid disease—in these patients.
These findings could lead to another targeted treatment for patients and prevent the onset of additional complications from their cancer.
"Pancreatic neuroendocrine tumours—pancreatic NETs, pNETs or islet cell tumours—are tumours that form from the abnormal growth of neuroendocrine cells in the pancreas,” says lead author Hala Elnakat Thomas, PhD, research assistant professor in the Division of Hematology and Oncology, Department of Internal Medicine, and member of the Cincinnati Cancer Consortium and UC Cancer Institute’s Pancreatic Cancer Center. "Most pancreatic NETs are functional, meaning they produce hormones. The overproduction of certain hormones results in a number of symptoms termed carcinoid disease which may impact the patients’ quality of life if not managed appropriately.”
She says mutations in key players of the mTOR pathway, a molecular pathway present and active in several types of cancer, have been identified in pNETs.
"Inhibiting mTOR signalling using everolimus, a targeted therapy, known as a rapalog, for patients with lung and gastroenteropancreatic NETs, has been approved by the FDA. A rapalog inhibits the mTOR protein by preventing it from activating some signals,” she says. "However, patients eventually experience progression of cancer on this treatment, highlighting the need for additional therapies. In this study, we focused on pancreatic NETs (pNETs) and thought that treatment of these tumours upon progression on rapalog therapy, with an mTOR kinase inhibitor (mTORKi), could overcome a number of resistance mechanisms in tumours and delay cardiac carcinoid disease.”
Elnakat Thomas’ team and colleagues including Jack Rubinstein, MD, a member of the Heart, Lung and Vascular Institute and an associate professor within the UC College of Medicine, performed preclinical studies using human pNET cells injected into animal models to determine tumour progression and cardiac function in those treated with a rapalog alone or switched to the mTORKi (CC-223) when cancer progression was noticed.
"Our results showed that in the majority of pNETs that progress on rapalog therapy, it is possible to reduce disease progression when switching instead to an mTORKi, such as CC-223,” Elnakat Thomas says. "The mTORKi also may lead to additional cardiac benefit by decreasing valvular fibrosis (damage) when compared with placebo or just the rapalog. The mTORKi also inhibit mTOR but they do it differently than rapalogs, and they are stronger inhibitors of signals, so the inhibition is more complete with an mTORKi than a rapalog. This data warrants further testing of the long-term cardioprotective benefit of an mTORKi in neuroendocrine tumour patients prone to carcinoid syndrome. Altogether, these results are timely as an mTORKi therapy called sapanisertib is currently in phase II clinical trial testing in pNET patients with metastatic cancer or tumours that are not reacting to treatment and cannot be surgically removed.”
University of Cincinnati
healthnews.uc.edu/news/?/29597/

Sphere Medical confirms compatibility of bedside blood gas monitoring system with leading global monitoring company

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Sphere Medical, an innovative company in critical care monitoring and diagnostics equipment, announces that its Proxima™ bedside blood gas monitoring system is compatible with Philips IntelliVue Patient Monitoring Systems through the Philips IntelliBridge Interface Module.
Sphere Medical’s Proxima is an acute respiratory and metabolic monitoring system used in critical care settings which supports proactive patient care, particularly at critical times.  It enables rapid and frequent blood gas, glucose and electrolyte measurements directly at the bedside without the caregiver leaving the patient. Philips compatibility means that Proxima’s results can be recorded and displayed alongside other critical monitoring information, such as blood pressure, ECG, EEG, respiratory rate, cardiac output and temperature. Such consolidated information gives a comprehensive patient overview, enhancing patient management. With the increasing adoption of electronic data record systems in critical care settings, Philips compatibility will also give Proxima customers a very simple means of integrating their data into electronic medical record systems (EMR).
Commenting on the additional point-of-care connectivity functionality of the Proxima bedside blood gas analyser, Wolfgang Rencken, CEO of Sphere Medical said, “We are extremely pleased with the confirmation that Proxima is compatible with Philips IntelliVue patient monitors through the Philips IntelliBridge EC10 medical device interfacing module. Many of our customers use Philips monitoring and data management systems and this connectivity further helps the practical implementation of Proxima as an acute respiratory and metabolic monitoring device in critical care settings.”
www.spheremedical.com

New IOF Compendium documents osteoporosis, its management and global burden

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On World Osteoporosis Day, the International Osteoporosis Foundation (IOF) has issued the first edition of a comprehensive and scientifically referenced report on osteoporosis.
The IOF Compendium of Osteoporosis will be available in five languages, is to be periodically updated, and is intended as an authoritative reference document for all key stakeholders in the field of musculoskeletal health.
In addition to providing a concise overview of the pathophysiology, risk factors, prevention and management of the disease, the Compendium documents the prevalence of osteoporosis and related fractures both globally and regionally. It outlines current research on the epidemiology, mortality, health expenditure, and access to/reimbursement for diagnosis and treatment for each respective region of the world. The cycle of impairment and fracture in osteoporosis is also shown, illustrating the correlation between the number of fractures an individual suffers and the decline in physical function and health-related quality of life.
The projected increase in osteoporosis and fragility fractures documented in the Compendium is dramatic and is expected to pose a huge and growing challenge on healthcare systems. In 2010 the number of individuals aged 50 years and over at high risk of osteoporotic fracture worldwide was estimated at 158 million and this is set to double by 2040. The numbers of hip fractures – the fractures which result in the most morbidity, mortality, and healthcare costs – is set to more than double in populous countries such as Brazil and China by 2040 and 2050 respectively. In the USA, by 2025, the annual incidence of fragility fractures is projected to exceed 3 million cases, at a cost of USD 25 billion.
The IOF Compendium of Osteoporosis proposes eight key priority actions which should be initiated by healthcare authorities, healthcare professionals, and concerned stakeholders in order to stem the burden of osteoporosis and fragility fractures. These include, first and foremost, the provision of Orthogeriatric and Fracture Liaison Services for all older patients who sustain fragility fractures to prevent a cycle of potentially debilitating and life-threatening secondary fractures.
The IOF Compendium of Osteoporosis, and other informative resources, are available on the World Osteoporosis Day website.

IOF
www.iofbonehealth.org/news/new-iof-compendium-documents-osteoporosis-its-management-and-global-burden

New use of blood cleaning device saves high-risk patients with liver failure

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Severe acute liver failure (ALF), a rare but life-threatening illness, is associated with high death rates if patients don’t receive timely treatment or a liver transplant. Unlike the heart or the kidneys, there is no established mechanical device to replace the liver’s function. Now, University of Maryland School of Medicine (UM SOM) researchers report that a device that removes toxins from the blood can also effectively provide a bridge to liver transplantation or buy time for a traumatically injured liver to heal, suggesting broader uses for the device than previously thought.
The researchers, present the largest series of cases in the United States in which the Molecular Adsorbent Recirculating System has been used as temporary liver replacement for ALF.
MARS can be likened to a dialysis machine for the liver. It essentially “washes” a patient’s blood with a solution containing albumin – normally produced by healthy livers – to remove toxins such as bile acids, ammonia, bilirubin, copper, iron and phenols from the blood.
“We’ve found in the use of MARS that we’re able to get trauma patients with massive liver injury to recovery and, in patients who are deemed good transplant candidates, get them to transplant with excellent survivals,” says lead researcher, Steven I. Hanish, MD, associate professor of surgery at UM SOM and a liver transplant surgeon at the University of Maryland Medical Center (UMMC).
The US Food and Drug Administration (FDA) has approved the device to clear the liver after overdoses and poisonings, and reduce the effects of brain swelling related to liver failure. However, it is not yet FDA-approved as a bridge to transplant.

University of Maryland School of Medicine http://tinyurl.com/ya32cuxm

Medical treatment may prevent, alleviate mitral valve damage after a heart attack

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A research team led by investigators from Massachusetts General Hospital (MGH) and collaborators has shown, for the first time, that it may be possible to non-surgically treat or even prevent the damage to a major heart valve that often occurs after a heart attack. In their report the investigators – including co-senior authors at Boston Children’s Hospital and Brigham and Women’s Hospital – describe how treatment with the antihypertension drug losartan reduced mitral valve damage in an animal model of heart attack.
“Our study supports a new concept transforming how we think about heart valves,” says Robert Levine, MD, of the Heart Valve Program and the Cardiac Ultrasound Laboratory in the Corrigan Minehan Heart Center at MGH, co-senior author of the report. “They are not just passive tissue flaps, as previously thought, but are biological battlegrounds where medicines can be used to help patients. Patients with heart valve disease are currently treated with interventions – surgery or implanted devices – late in their illness when the heart is failing. We aim to prevent disease progression at an early stage and keep our patients’ hearts healthy.”
When blockage to a coronary artery causes the death of heart muscle, the body responds by sending immune cells and other inflammatory factors to the site of the damage. Co-lead author Jacob Dal-Bianco, MD, also of the MGH Heart Valve Program, explains, “A heart attack is like a fire in the heart;  inflammation triggered by damage to the heart muscle attracts cells to clear up the damage and form a healed scar. The mitral valve can be caught up as an innocent bystander in this process and become inflamed and scarred, eventually becoming shorter, stiffer and less able to close effectively.”
Located between the left atrium, which receives oxygenated blood from the lungs, and the left ventricle, from which blood is pumped out to the body, a healthy mitral valve keeps blood flowing in the right direction. But if the valve tissues called leaflets don’t close properly after the heart beats, blood can leak back towards the lungs – a process called mitral valve regurgitation – reducing the efficiency of the heart and placing additional stress on the already-damaged organ. While it had been thought that post-heart-attack damage to the mitral valve was caused only by physical forces exerted by the scarring and stretching of damaged heart muscle, recent research by MGH team members found that the valve itself becomes thicker and stiffer, further reducing its ability to close.
Among the factors released by immune cells in an attempt to heal damaged heart muscle is transforming growth factor (TGF)-beta. While it is an important regulator of processes involved in growth, development and the immune response, excess levels of TGF-beta can overactivate other cells, leading to further scarring and stiffening of the mitral valve. Surgical repair of a damaged mitral valve fails within two years in 60 percent of patients, leading to shortness of breath and eventual heart failure.
The hypertension drug losartan is known to inhibit the effects of TGF-beta, and the current study was designed to see whether it could reduce post-heart-attack mitral valve damage in an animal model. For two months, daily doses of the drug were given to sheep in which a heart attack had been surgically induced. A control group of animals that did not receive the drug had surgical mesh sutured to their left ventricular walls to restrict the stretching that typically follows a heart attack and keep the size of the ventricle the same as in the drug-treated animals. At the end of the study period, significantly less inflammation, thickening and scarring had developed in the mitral valves of the losartan-treated animals, compared with the control group. Another study by the same group is investigating whether losartan treatment actually can reduce mitral valve regurgitation.

Massachusetts General Hospital
www.massgeneral.org/about/pressrelease.aspx?id=2141

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