Etanercept Ineffective For Wegener's Disease

A Hopkins-led study evaluating the ability of etanercept to maintain disease remissions in a serious autoimmune disorder has failed to show any benefit. Etanercept, also called Enbrel, is a common treatment for rheumatoid arthritis and other types of joint inflammation.

"We had hoped that this approach to the treatment of Wegener's granulomatosis would be useful in preventing disease relapses," says John Stone, M.D., director of the Hopkins Vasculitis Center and lead investigator. "The study results demonstrate unequivocally that etanercept was not effective." Because of the disease's propensity to flare up after remission and the treatment complications linked to conventional therapies, Stone believes researchers must continue to look for safe, effective ways of achieving and maintaining remission. The study appeared in the January 27 New England Journal of Medicine.

A Device to Assist in Difficult Deliveries

One of the serious challenges faced by obstetricians during delivery occurs when the baby becomes stuck after the head is already out of the birth canal. Gauging exactly how much force to use to dislodge the infant becomes crucial. Shoulder dystocia is a complication in up to 5 percent of these births, and when nerve injury results, it leaves one in 10 of those infants with permanent damage to the brachial plexus nerve network of the shoulder and arms.

Now, a team of Hopkins researchers has invented a device that pinpoints the best practices to use in difficult deliveries, while measuring the amount of force applied. They will share these skills and the device in a course May 22-23 led by obstetrician Edith Gurewitsch, neurosurgeon Allan Belzberg, and biomedical engineer Robert Allen.
Click here for information on Exploring Shoulder Dystocia and Brachial Plexus Injury.

"Pseudothalidomide" Syndrome Gene Found

Thanks to advances in technology and computer analysis, a team of scientists from the U.S., Colombia, Turkey, Canada and Italy has ended a 15-year-plus search for the genetic problems behind the very rare Roberts syndrome. Physical manifestations of the syndrome often include cleft lip and palate and shortened limbs that resemble those of babies whose mothers took thalidomide during pregnancy.

The discovery, reported in the April 10 online edition of Nature Genetics, is expected to lead to improved understanding of craniofacial and limb development, and health and disease beyond the syndrome itself.

Hope for Pancreatic Cancer Vaccine

Even with the most advanced medical care, few diagnosed with pancreatic cancer will live five years. But these discouraging odds haven't deterred vaccine researchers Daniel Laheru, M.D., and Elizabeth Jaffee, M.D.

A few years ago, Jaffee determined that an effective vaccine would rely on a manipulated version of the entire tumor cell. She extracted cancer cells from the pancreatic tumors of two Hopkins surgical patients and established those cell lines in culture. She then inserted genes for the immune-stimulating protein GM-CSF into the cells and injected small numbers of them, now made harmless by irradiation, into patients. The cells migrate to lymph tissue where they spark an immune response targeted to pancreatic tumor cells anywhere in the body.

The researchers report that three of the 14 patients who took part in clinial trials are alive and cancer-free seven years later. Adding to their progress, pathologists have identified the first pancreatic cancer-specific proteins, which will allow Jaffee and Laheru to better fine-tune their vaccine to hit its target. Recently, the research team completed a follow-up study of 60 patients who received the highest vaccine doses yet. They expect to report their findings sometime in 2006.

Earlier Use of Prostate Cancer Vaccines Urged

Timing is everything when it comes to killing prostate cancer cells with specially tailored vaccines, say scientists testing the drugs in mice at Johns Hopkins. "The window of opportunity is narrow to invigorate the immune system's attack on cancer cells and it occurs right after hormonal therapy begins to wipe out the tumor and immune cells outnumber cancerous ones," according to oncologist Charles Drake, M.D., Ph.D.. His research appears in the March issue of Cancer Cell.

In studies with mice bred to develop prostate cancer, Drake and collaborators found that the animal's immune system recognizes the cancer but fails to mount an attack, probably because immune cells become tolerant of the slow-growing cancer. "But we found that if we use the vaccine to activate the immune system right after we give the mice hormone therapy to shrink their tumors, T-cells start a reaction against the cancer."

Drake says that if the researchers' findings are confirmed, human vaccines stand a better chance of getting T-cells to respond after most of the tumor is destroyed by hormone therapy. "Most prostate cancer vaccines currently are tested on men whose cancers are growing and no longer responsive to hormone therapy," says Drake. No clinical trials are yet available for the earlier vaccine regimen.

First Human Stem Cell Trial to Repair Heart Muscle Begins

Hopkins researchers have begun what is believed to be the first clinical trial in the United States of adult mesenchymal stem cells to repair muscle damaged by heart attack. The Phase I study will test the safety of injecting adult stem cells at varying doses in 48 adult patients who have suffered a heart attack within 10 days of enrollment in the trial.

May 2-6, 2005: Topics Course Celebrates 50th Year

The Topics in Clinical Medicine course at Johns Hopkins began 50 years ago inspired by the late Dr. Philip Tumulty's belief that faculty should communicate not only its expertise in internal medicine, but also its collegiality and warmth. The current course directors have developed a fascinating program of more than 50 lectures, demonstrations, case rounds, Meet the Professor sessions, and more. Registrations accepted by telephone only at 1.410.955.2959 or view the program and fax the registration form.

June 10-11: Research and Clinical Management of Asthma and Allergy

This program is for allergists, pulmonologists, otolaryngologists, internists, pediatricians, family practitioners and others actively engaged in clinical management and research of asthma and allergic diseases. Talks will feature state-of-the-art advances in molecular biology of allergic disease, new approaches to immunomodulation and discussion of newly-approved therapeutic agents.

June 26-July 2: Orthopedics Review Course

This six-day course for orthopaedic surgeons will provide a comprehensive review of clinical orthopaedic surgery through lectures, a comprehensive syllabus, practice questions and interactive sessions with faculty. A full day will be devoted to pediatric orthopaedic surgery, bone and soft tissue tumors and total joint replacement surgery, as well as half-day reviews on spine, foot and ankle, sports medicine and trauma.

READY, SET, GOBI!

Read Dr. Krabak's daily blog during the race at www.jhintl.net

During the last week in April, many of the world's running elite will converge in China's Gobi Desert for one of the most spectacular races on the planet. Our readers will have a special window on the drama and excitement of the event with daily reports from the field by Brian Krabak, M.D., posted on our website at www.jhintl.net starting April 22.

Dr. Krabak, a sports medicine and rehabilitation specialist at Hopkins, a veteran of Olympic medical teams, and an avid racer himself will serve as a Medical Director of the 250 km event, working alongside Hopkins colleague Brandee Waite, M.D. The race will cover a varied terrain of grassland, rocks, rivers, small mountains and sand dunes, with changes in altitude from 154 m below sea level to above 2000 m.

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