Pain Reliever May Produce Anti-Atherosclerotic Effect

After reporting the 1998 findings, lead investigator Addison A. Taylor, MD, decided to examine other cardiovascular indices that could be beneficially affected by acetaminophen. His team chose to examine hardening of the arteries, a major contributor to coronary heart disease and stroke.

The Baylor research team induced above-normal levels of cholesterol in rabbits, half of which received doses of acetaminophen comparable to the recommended doses for humans. “At the end of the 12-week study, we examined the rabbits for evidence of fatty streaking in the aorta, an early manifestation of atherosclerosis. The rabbits that received acetaminophen had 50% less fatty streaking compared with controls,” Taylor said in reporting the study results.

These findings and similar findings reported by other investigators are helping to build a body of evidence suggesting that acetaminophen may help protect against cardiovascular disease, Taylor commented.

‘Pharmacogenomics’ May Increase Use of Existing Cancer Drugs

According to Peter S. Ringrose, president of the Princeton, New Jersey-based Bristol-Myers Squibb Pharmaceutical Research Institute, who spoke with a reporter at The Wall Street Journal, “Efforts of this kind may create a new disease nomenclature, so that we no longer diagnose a cancerous tumor by its site of primary origin—breast, colon, lung—but instead by the underlying genetic mutation that causes it.”

To start, companies are beginning to decipher the chemical makeup of deoxyribonucleic acid (DNA) and the approximately 100,000 genes that control the biology of human life. With “pharmacogenomics,” the science of understanding the correlation of individual genetic make-up and response to drug treatment, tests can be developed to predict the genetic make-up of a patient’s tumor, enabling the design of more specific pharmaceutical agents to attack gene targets in cancer.

The response rate for today’s cancer agents is only in the range of 20%– 30%, and physicians cannot distinguish in advance the responders from the nonresponders. Early research in pharmacogenomics, though, shows that one tumor can be distinguished from another by identifying genes that are either highly expressed or inactivated. By typing which genes are switched on and which are switched off, some of the guessing about appropriate treatment is eliminated.

Possible Future Uses of Existing Antineoplastic Agents
Drug	Target Cancers
Paclitaxel	Prostate, melanoma, GI cancer
Epothilones	Paclitaxel-resistant cancers
Ras gene inhibitor	Pancreas, colon, lung, bladder cancer
UFT and leucovorin calcium	Colon cancer
Matrix Metallo-    proteunase inhibitor	Breast, colon, lung, other cancers
Source: Bristol-Myers Squibb.

It sounds simple except for the fact that some tumors may be classified by the action or inaction of hundreds of genes. According to Bristol-Myers Squibb Vice President, Applied Genomics, Elliott Sigal, “Some lung cancers may wind up being more genetically like certain colon or breast cancers than they are like other lung cancers.”

Pharmacogenomics may sharply reduce the rate of failure of cancer drugs, and the National Cancer Institute has already embraced the new gene-based approach. Sigal said, “There is a revolution taking place in genetics, and we strongly believe it is time to integrate that into our development of cancer drugs.”

First Synthetic General Cancer Vaccine Patented

The U.S. Patent Office granted Samuel Bogoch, MD, PhD, a patent for the AMAS® test. Immunochemical evidence from Bogoch’s tests show that humans are born cancer immune, to a certain degree, and that antimalignin antibody increases in concentration with age as the risk of cancer increases. Actuarial survival studies show that the level of antimalignin antibody in the body is directly related to the length of survival of cancer patients.

The AMAS® test quantitatively measures the level of antimalignin antibody in the blood and has been used as a diagnostic tool in detection of cancer and monitoring recurrent cancer. In studies of more than 8,000 patients, the test was found to be 95% accurate, and antimalignin antibody-concentration elevation proved to be a universal immune response in breast, prostate, lung, colon, and other common forms of human cancer.

Antimalignin antibody may be produced in the laboratory by adding malignin to human blood lymphocytes, and in recent work Bogoch determined the structure of and synthesized two critical parts of malignin that are responsible for the production of antimalignin antibody. When injected into animals, the synthetic peptides produce antimalignin antibody.

These peptides may soon be the first synthetic human general cancer vaccine. Bogoch’s research gives hope that early detection of transformed cells will lead to cancer vaccination and prevention of clinical cancer. (For details, see the Web site www.antimaligninantibody.com).

Pocket Guidelines for Pacemakers

The two organizations teamed up with the North American Society of Pacing and Electrophysiology to develop a pocket guide that addresses permanent pacing as well as implantable cardioverter-defibrillator therapy. The user-friendly, full-color, 42-page document contains a number of tables and figures and fits in the pocket of a lab coat.

Copies of the pocket guideline may be purchased for $5 each through the ACC Resource Center at 800-253-4636, ext. 694. ACC and AHA are in the process of developing pocket guidelines on valvular heart disease, acute myocardial infarction, chronic stable angina, coronary artery bypass graft surgery, and unstable angina.

Pharmacy Plays Active Role in Controlling Influenza Outbreak

According to the authors, chemoprophylaxis is warranted when there is a cluster of influenza-like illness (ILI) cases during influenza season and at least one patient has laboratory-confirmed influenza A. A cluster is defined as three or more cases of ILI on a single nursing unit over a 48- to 72-hour period. ILI is defined as fever plus at least one of the following: cough, rhinorrhea, nasal congestion, and sore throat.

During the 1997 to 1998 influenza season, an outbreak of influenza A was confirmed in a 570-bed long-term care facility in Toronto, Ontario, Canada. With the outbreak confirmed, the pharmacy department quickly assisted the infection control team by facilitating prophylaxis with amantadine throughout the facility.

The pharmacy department was ready to assist because over the past several years they had played an active role in preventing influenza by participating on the infection control committee and by developing a policy on annual immunization. At the time of the outbreak, the patient population of the facility was 92% vaccinated (however, only 25% of the staff in the facility were vaccinated).

A total of 48 cases of ILI were reported to infection control, and amantadine was offered to 382 patients (349 agreed to the prophylaxis). Members of the infection control team asked the pharmacists to be responsible for the dosing of amantadine. The attending physicians agreed that the pharmacists could write orders for amantadine and that the physicians would cosign the next time they were in the facility.

A total of 22 patients (6%) had an adverse reaction to amantadine, the most common of which was confusion. Only two patients were considered to have failed to benefit from amantadine, as they developed ILI while receiving the prophylaxis.

No deaths occurred during the outbreak, and only one patient was transferred to an acute care facility for treatment of pneumonia secondary to influenza. The pharmacy department’s role in educating patients, family members, and staff about the benefits and risks of prophylaxis against influenza illustrates the important contributions pharmacists can make to the management of influenza A. The pharmacy department prepared an information pamphlet outlining the benefits and adverse effects of amantadine when used for this indication. Nurses gave the pamphlet to all patients or their families and referred concerns to a pharmacist. In weekly information sessions, pharmacists met with patients and their families to update them about the outbreak.

This pharmacy department’s success lay in its frequent communications with nurses, patients, family members, and infection control. The pharmacists’ active role set a standard in preventing and managing future outbreaks.

Space Flight Produces Physiological Changes Similar to Aging

Wang is researching the genetic signatures that are shared between space flight and the aging process seen on earth. Her goal is to ensure that the world’s bulging elderly population is not plagued by age-dependent diseases such as cancer, diabetes, and cardiovascular and neurodegenerative disorders. Now is the perfect time for this research, she says, because humans have not only attained longer life spans, but also the ability to go into space.

The difficulty of working in human longevity areas is that researchers can do only retrospective experiments. They cannot investigate questions of life-long exposure to ultraviolet irradiation because the researchers would not live long enough to complete the experiments. Space flight, it turns out, produces physiological changes similar to aging and life-long exposures.

When Wang pinpoints the genetic signatures shared between organismic aging and space flight, therapeutic treatments for diseases of the elderly will be within reach via new drugs, gene, or behavioral intervention.

Barbara Eilenfield
Senior Editor