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Experimental umbilical cord stem cell therapy treats rare disease

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A girl with a rare disorder can now breathe more easily after receiving transfusions of a liquid that her sister’s umbilical cord stem cells were grown in



Humans



9 June 2022

A cell sample being pipetted into a multiwell plate containing growth nutrient medium

Andrew Brookes/Getty Images

A girl who was critically ill with heart failure is doing well after receiving an experimental treatment made from umbilical cord stem cells, in the first case of its kind.

The girl, from Germany, has an inherited form of pulmonary arterial hypertension. Defined as high blood pressure in the arteries of the lungs, this meant the blood vessels of her lungs were malformed, which leads to progressive and usually fatal heart failure. Now 6, doctors recommended she have a lung transplant at 3 years old, a procedure that is usually carried out on children who have less than a year to live.

In the experimental treatment, Georg Hansmann at Hannover Medical School in Germany and his colleagues harnessed stem cells from the umbilical cord of the girl’s sister, which her parents gave permission to be frozen.

The cells were grown in a dish. Periodically, the nutrient liquid they were bathed in was changed and the old liquid was stored. Three years ago, once enough liquid had accumulated, it was infused into blood vessels in the girl’s lungs and heart over six months.

The girl, who was previously breathless at rest and could only walk slowly, gradually improved over the following months. She now has no limitations in her exercise capacity. She also grew 10 centimetres taller within the first three months of treatment, having previously had no growth in height or weight in the preceding year.

Many measurements of her heart and lung function have also shown improvements. However, she still has high blood pressure in her lungs and may need further treatment, says Hansmann.

Stem cells have the potential to grow into different kinds of tissue and are being tested in many experimental treatments, for instance for kidney or liver failure. They can be obtained in small quantities from various parts of the body and made in the laboratory from ordinary skin cells.

Stem cell treatments usually involve putting the cells into someone’s body, which can cause immune reactions. In the girl’s case, the cells weren’t transplanted, but were grown in a dish, where they released biochemicals into the nutrient liquid they were bathed in. It is these biochemicals that seem to promote the healing of other tissues.

The girl’s treatment used mesenchymal stem cells, which are involved in the making and repairing of skeletal tissues. These cells were previously tested as a way of repairing heart muscle damaged by heart attacks, but didn’t lead to lasting benefits and studies found no trace of the transplanted cells in the heart muscle.

But some recipients had short-term improvements, suggesting that the cells released signalling chemicals that promote healing, an idea supported by various animal studies.

The team behind the girl’s treatment hasn’t yet carried out imaging procedures to visualise the blood vessels in her lungs. These procedures can be risky, particularly given her condition.

The girl also received two standard medicines for her condition before the stem cell treatment, which may have contributed to her improvement, says Martin Wilkins at Imperial College London.

When Hansmann’s team investigated samples of the stem cell liquid the girl received, they found high levels of several biochemicals that are thought to promote healing and regeneration, while suppressing inflammation, including prostaglandin E2.

This biochemical tends to be rapidly broken down in the body, so other unknown compounds may be having an effect, says Wilkins. “This is not a treatment we can rush out to other patients until we better understand the mechanism,” he says.

“There does appear to have been an improvement both in her biochemical [measurements] and in her functional capacity. It’s reasonable to assume there’s something going on here that’s of interest.”

Journal reference: Nature Cardiovascular Research, DOI: 10.1038/s44161-022-00083-z

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Hand pruners are the gift your favorite gardener deserves

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Whether they are for yourself or for a gift, it’s worthwhile to shop carefully for hand pruners.

“It’s a fundamental tool,” said Julie Janoski, Plant Clinic manager at The Morton Arboretum in Lisle. “You’re likely to use pruners every time you work in the yard.”

Well-made pruners will last a long time. If they fit your hand well, they will require less effort and hand strength. If their blades are sharp, they will cut more easily, and they will also be healthier for your plants.

“Sharp blades make clean cuts,” Janoski said. When you slice plant tissue neatly, rather than tearing it or crushing it, the wounds will be less likely to admit diseases and will seal up more quickly.

Pruners come in two major types: anvil and bypass. “Gardeners should choose bypass pruners,” she said.

The difference is in the arrangement of the blades. Anvil pruners have one straight blade that closes against a flat surface, like a hammer hitting an anvil. They grab and crush branches and are often used by landscape contractors to remove large amounts of dead wood.

Bypass pruners have two curved blades that move past each other like the blades of a pair of scissors. They slice rather than tearing or crushing. “They’re the right tool for working on live branches of trees and shrubs,” Janoski said.

A sharp pair of bypass pruners will cut branches up to about one-half inch in diameter.

At the bottom of the price range, beware of pruners priced at $12 or $15. “Lower price pruners are often flimsy and dull and will rust easily,” she said. “They won’t last as long and they probably won’t be comfortable to use.”

At the other extreme, professional-quality pruners can cost $50 to $80. Because they can be taken apart for cleaning and sharpening and to replace parts, these tools can last for decades. They also come in a range of sizes and handle designs to fit a variety of hands. There are even left-handed models.

“Having pruners that really feel good in your hand makes a big difference,” Janoski said. “That way, your hand won’t get as tired and achy when you’re doing a lot of pruning.”

People’s hands are very individual, so it can be difficult to buy properly fitting pruners for someone else (or even for yourself). Even ergonomic models that are intended to be easy on arthritic hands may fit better in some hands than others.

Moderately priced pruners, in the $25 to $40 range, are usually sold in packaging that makes it impossible to try them out in the store. Before you buy any pair of pruners, “check to be sure that they will be returnable, even if you’ve taken them out of the package,” she said.

Already have good pruners? Consider loppers. These are essentially large-bladed pruners on 15- to 24-inch-long handles that give you more leverage to cut larger branches. Loppers also can extend your reach by a foot or more. Be sure to get the bypass version.

If you give pruners or loppers, consider tucking something extra into the package: a small diamond file or pruner-sharpening tool — which are usually less than $10 — so the gardener can keep those slicing blades sharp.

For tree and plant advice, contact the Plant Clinic at The Morton Arboretum (630-719-2424, mortonarb.org/plant-clinic, or plantclinic@mortonarb.org). Beth Botts is a staff writer at the Arboretum.

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We have the tools to stop the spread of HIV in England. So why is it on the rise? | Deborah Gold

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Today is World Aids Day: a time to show solidarity with people living with HIV/Aids across the world, and remember those we have lost. But solidarity and remembrance have limited purpose if they’re not combined with a meaningful commitment to fighting this epidemic. Earlier today, the government published new data that shows it’s not on track to meet its long-term commitment to end new HIV transmissions by 2030. This goal should be entirely achievable– yet without immediate action, it risks slipping even further out of reach.

For years the numbers of new diagnoses of HIV have been steadily declining. But in 2021, HIV cases increased for the first time since 2014. This won’t come as a surprise to anyone who works in the sector. Sexual health services are funded by local authorities, which have been hit by years of austerity-driven public health cuts (the sector has had its funding cut by 24% in real terms since 2015). This period of chronic underinvestment has been made much worse by the impact of the Covid pandemic.

This is now affecting clinics’ ability to provide basic services. Many people are encouraged to attend sexual health services for an HIV test because they’ve been notified that they might be at risk of acquiring HIV after sexual contact with someone recently diagnosed with it. This is similar to contact-tracing for Covid-19.

Last year, the number of people who attended a sexual health services after being alerted in this way was less than half that in 2019. The proportion of those diagnosed with late-stage infection rose from 35% in 2019 to 40% in 2021. These people are more likely to already have been unwell at the time of diagnosis and to experience worse long-term health. Having not been on treatment, they would have been more likely to pass on HIV, unknowingly, over a longer period of time. Most troubling of all, there has also been a sharp increase in the number of people who have already been diagnosed with HIV but have not stayed in the healthcare system. This could pose severe consequences to their health.

The data shows that existing inequalities are deepening even further. Distance and travel time to sexual health clinics is far greater outside London, and access to testing, treatment and PrEP is more difficult. And while HIV is likely to be falling among gay and bisexual men, there is no such reduction for heterosexual adults. Altogether, this is a disturbing outlook. If we want to end new transmissions, testing and effective treatment are essential tools. But lack of funding and resources are holding us back. These figures are from 2021. In 2022, the problems caused by the Covid pandemic were further compounded by the mpox (monkeypox) outbreak, when sexual health clinics were forced to deliver diagnosis and treatment with no additional resources, and to undertake a severely underfunded ongoing vaccination campaign. This means the current situation is likely to be even worse, with a long backlog building up, no capacity to manage it, and even fewer resources to go around.

Our other most effective prevention tool is PrEP; a preventive medicine that, when taken properly, is almost 100% successful at preventing transmission. But as it stands, PrEP is failing to reach its potential. According to a report we co-authored earlier this year, almost two thirds of people trying to access PrEP found themselves unable to do so. And this data applies to people who are already trying to access PrEP. There are significant numbers of people who would benefit from the treatment but are simply not aware of its existence. Here, significant racial and gender disparities come into play. Not a single local service we spoke to reported more than a handful of women using PrEP, for instance, despite the fact that women – and particularly women from ethnic minority backgrounds – account for a growing number of new HIV diagnoses.

The 2030 goal is not a pipe dream. There’s still time to change course, and plenty of reasons to be optimistic. This week NHS England published the wildly successful results of its new scheme (launched as part of the HIV Action Plan) to test for HIV on an opt-out basis in hospital emergency departments. The scheme is available in the areas of highest HIV prevalence (London, Manchester, Brighton and Blackpool), and offers an HIV test to every single person who had a blood test for any reason at an A&E department. In the space of just 100 days, 128 people were diagnosed with HIV, reaching people who had been living with the virus without realising it.

These people will now be able to access treatment for themselves, and will avoid passing the virus on to others. A further 65 people were found who had previously been diagnosed with HIV but had slipped through the cracks of the healthcare system. This represents a significant opportunity to re-engage people with treatment. The demographics of people identified through the scheme are those less likely to come forward for testing at sexual health clinics and who may not realise they are at risk.

This scheme has been an unambiguous success. It should be available more widely. Areas such as Birmingham, Coventry and Bristol face similarly high levels of HIV, but lack of funding prevents the programme from being made available. There are no downsides to scaling up opt-out testing and PrEP: not only will it improve countless people’s lives but, at the risk of making a more cynical argument, it will save the NHS money in the long run if people are engaged in treatment more quickly or prevented from acquiring HIV in the first place.

So, while this latest data is disappointing and enormously frustrating, it only strengthens the moral imperative to do better this World Aids Day. More than 40 years after it started, we have the power to end new HIV transmissions in Britain within this decade. So many of us have lost friends and family members over the last 40 years. With this opportunity in front of us, it would be unforgivable to let it slip through our fingers. We have the tools to ensure nobody else acquires an avoidable infection or dies an avoidable death. We have the tools, and we know exactly what to do. It remains only to do it.

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Inspector General details clear disparities in NY prisons – New York Daily News

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In a data-driven model of state governance, there are some numbers you want to see trend up, and some you really don’t. The statistical overrepresentation of misbehavior reports issued against Black and Hispanic inmates in state prisons is in the latter camp, so it’s disheartening to see, in a report issued by New York Inspector General Lucy Lang this week, that these disparities had only increased in the period between when the inquiry was ordered in 2016 and now.

That order came in the wake of a New York Times investigation that found that Black and Hispanic prisoners were disciplined at rates were proportionally much higher than for whites, sometimes doubly so.

While there are multiple factors that might go into some of these disparities, such as the type of misbehavior committed by individual inmates and the median age of each racial demographic, what helps establish racial bias is the fact that the discrepancies are most pronounced in infractions that are largely discretionary, like whether a detainee has refused to obey a direct order or created a disturbance, even controlling for factors like detainee age. It doesn’t conclusively pinpoint animus as the driving force, but points strongly in that direction.

All in all, Black detainees were 22% more likely and Hispanic detainees 12% more likely to be cited for misbehavior, an eventuality that can lead to punishments ranging from loss of TV time to cell confinement, rates that were higher than when the data was first reported six years ago. Most concerningly, a total of 226 corrections employees had issued a collective thousands of citations exclusively to non-white detainees.

As the IG makes clear, this plainly suggests that the Department of Corrections must better track infractions in real time, make much clearer what constitutes grounds for certain violations and remove some officer discretion from the equation. We already know that we need to combat bias that disproportionately feeds certain people into the criminal justice system, but we must also address the disparities that exist once they’re already in.

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