Posted on April 7th, 2014 by Bob Nellis
We’re Drs. Winston Tan and John “Al” Copland and we collaborate in pursuit of cures for kidney cancer. Winston is a Mayo Clinic physician oncologist who treats kidney cancer patients and collaborates with Al, a Mayo scientist dedicated to kidney cancer research.
In talking with kidney cancer survivors and friends, we have been encouraged to begin a blog about our research efforts and discoveries in kidney cancer current FDA approved drugs are not cures. They provide some survival benefit (in a small number of cases, long term). These treatments not only have a number of toxicities issues but also do not work permanently for patients. Thus, new therapies are desperately needed. In pursuit of new treatments, we have discovered new cancer genes (from the greater than 22,000 genes expressed in human body) that may lead to new treatments for kidney cancer and for other cancers where these genes occur. So much is still unknown for every cancer but we now have the technologies including genomic and functional genomic techniques to make impactful discoveries.
Today, we are introducing our blog series with new insights and discoveries into new genes and treatment options for kidney and related cancers. We will discuss with you cutting edge discoveries and share our struggles along the way as we make new discoveries. Join us in this new adventure as an interactive learning process. We all can participate together in asking and answering questions as well as bring new cutting edge data to this forum. We encourage you to post news & links of discoveries from around the world to this blog. Together, we’ll gain a better understanding of kidney cancer, cancer biology and move forward towards cures.
Our laboratory has several technologies and capabilities that allow us to link clinical observations to functional cancer biology that may lead to new drugs to treat multiple cancers.
Thus, we can determine if a gene is elevated in a patient’s cancer tissue. If it is, we can test the cell line (developed from that patient’s tumor tissue) by silencing the gene. We then determine if the cells grow slower, don’t survive or don’t metastasize. If any of one of these three is true, then the gene is an important target to consider developing a drug that blocks its cancer promoting activity. Thus, using these step-wise methods allows us to validate many important new cancer genes.
We have discovered over 30 new genes in kidney cancer that promote tumor growth. We recently published one of these genes, SCD1. We showed an SCD1 inhibitor leads to massive cell death and it can be combined with an FDA approved drug, temsirolimus leading to greater cell death. In our next blog, we will share our thoughts on developing this combination therapy for clinical trials. And later, we will share with you discoveries of a second gene from the 30 plus genes. This gene is as exciting as SCD1 having never been described before as a cancer gene! You can see that we much to share from our laboratory discoveries on new gene targets along with insights to patient care from Winston and other topics that you may suggest important to our conversation.
We do envision that our discoveries will benefit other cancers. We know that SCD1 is over expressed in many cancers along with our second discovered gene. We have access to different types of cancer tumor tissues. From these tumor tissues, we develop patient tumor derived cell lines in the laboratory for breast, ovarian, prostate, bladder, brain, head & neck, lung, pancreatic and colon cancers as well as melanoma. We will examine these cancer cell lines for antitumor activity and share our results with you. Thus, we can test our gene discoveries for benefit against other cancers. In our next blog, we will also share with you other cancers that are growth inhibited by SCD1.
So, come on the journey with us. We hope to inspire and educate one another along the way to solving some deadly mysteries. Like a detective, we have some very exciting leads but don’t know where they will ultimately lead us or if we will solve the ultimate crime -death by cancer- and catch the gang members (genes gone bad). We have to go for it! Did you know that over 1.665 million Americans will be told “You have cancer” in 2014. About 585,720 Americans will die this year. There is 545,600 minutes in a year. Think about this – 3 people every minute will become a cancer victim and one person every minute will be die in the U.S.A. On the world stage, 2014 estimated new cancer diagnoses will be 1,665,540 made and cancer deaths will be 1,333,249 (http://www.medindia.net/patients/calculators/world_cancer_clock.asp). This calculates to 11.8 deaths per minute around the world. The need is urgent. We are called to action.
Posted on December 18th, 2013 by Admin
From Mayo Clinic's Discovery's Edge magazine
Many prostate cancer survivors live in fear of being told that their cancer has returned. It’s even scarier to be told that the doctor knows the cancer is there because of rising PSA levels, but that he can’t find it. Doctors and patients alike know that early detection of the recurrent cancer is critical to the patient’s chance of beating it a second time.
The problem, however, is locating it.
A Mayo Clinic research team has developed a new imaging technique that can often find the recurrent disease months, if not years, earlier than other imaging techniques. Prostate cancer uses choline, a B-complex vitamin, as a building block. So when a minute amount of radioactively-labeled choline (choline C-11) is injected into a patient, it is quickly taken up by the cancer — like a fish rising to the bait.
The prostate cancer then emits radiation, allowing doctors to pinpoint its location. A positron emission tomography (PET) scanner is “able to tell where in the body this radiation is being emitted,” explains Mayo Clinic radiologist Val Lowe, M.D..
Choline C-11 isn’t toxic, and the radioactive element is so minimal, it’s really not much of a pharmacologic safety issue, explains Dr. Lowe. “If you take a grain of sugar and divide it into 100 pieces, one of those pieces is enough to do a PET scan.”
As well as being safe, the PET scan takes little time. Once the radioactive element is added to the choline C-11, it has a very short shelf-life. The half-life of choline C-11 is only 20 minutes, meaning it loses half of its radioactivity every 20 minutes. Because the radioactivity is the imaging agent that allows the PET scanner to see the cancer, the agent must be used shortly after it’s made. It cannot be stored and shipped. It essentially must be manufactured on-site.
All told, it takes about 45 minutes to make choline C-11, and the scan itself takes only about 20 minutes. The results are analyzed and a report is typically ready half an hour after the scan is completed.
“For the first time ever, we will have a clear blueprint of where the patient stands, at a far earlier course in treatment failure,” says Eugene Kwon, M.D., a Mayo Clinic urologist. “It has basically ripped the curtain off the Wizard of Oz.”
At this time, Mayo Clinic is the only health care provider in the country authorized to do this test. But when filing with the FDA, Mayo Clinic waived all exclusivity. It wanted other sites in the country to be able to manufacture and use the drug to better serve their own patients.
Posted on December 2nd, 2013 by Admin
From Mayo Clinic's Discovery's Edge magazine
Reducing radiation exposure from CT scans has become one of the primary goals of Mayo Clinic’s CT Clinical Innovation Center. Dr. Cynthia McCollough and her colleagues are doing the Radiation Limbo: How low can they go without sacrificing image quality.
Dr. McCollough is continually looking for ways to lower radiation exposures while maintaining the needed quality. A critical step in that process includes better defining what level of image quality is needed.
“We don’t always need pretty pictures,” says Dr. McCollough. “We only need pictures that clearly show the disease or injury. For some conditions, a really low exposure of radiation can be used.”
To reduce the amount of radiation patients are exposed to, the CT Clinical Innovation Center takes several routes. “The most basic, low-tech thing we can do is to ‘right-size’ the dose,” says Dr. McCollough.
Mayo Clinic has developed a computerized set of electronic protocols that are centrally managed. If an adjustment is made to a protocol, the correct, new information is instantly available at all 25 CT scanners on the Mayo Clinic campus in Rochester, Minn., as well as at all Mayo Clinic Health System sites, and the Mayo practices in Florida and Arizona.
Much like the automatic exposure feature on a camera, CT scanners can now automatically adjust the radiation exposure that the patient receives based on the type of exam and the size of the patient. “Everything we're doing with dose reduction is to make sure patients get the exams they need at the lowest radiation doses,” says Dr. McCollough.
One area where use of medical radiation has increased dramatically in recent years is in cardiology. It is also one of the areas that has seen significant decreases in the levels of radiation exposure. Dr. Charanjit Rihal, a cardiologist at Mayo Clinic, says the results have been encouraging. “We reduced the amount of radiation by at least 40 percent, and in some cases, by as much as 70 percent.”
Another of Dr. McCollough’s colleagues, Dr. Joel Fletcher a radiologist and the medical director of the CT Clinical Innovation Center, worked with the pediatric oncology group to lower the radiation dose for follow-up CT scans for children diagnosed with cancer who had completed treatment.
“We just kept turning down the dose until finally it was down to the lowest setting the scanner would run at,” says Dr. McCollough. With each setting, a pediatric radiologist would look at the scan to ensure that the image was still clear. “We try to do the limbo: you know, ‘How low can you go?’”
With education, new technology, and collaboration between physicists, radiologists, and other physicians, Mayo Clinic is answering that question.
Posted on November 25th, 2013 by Admin
Pioneers of Kidney Transplantation at Mayo Clinic
The first transplant of a kidney took place in Saint Marys Hospital on Nov. 25, 1963. Surgeons George A. Hallenbeck, M.D., and James DeWeerd, M.D., headed a medical team that performed the first transplant, placing a kidney in a female patient. The patient’s half-sister was the donor. Mayo’s operation reflected a common theme in the early development of transplant medicine. The donor providing the kidney was a close relative of the recipient. That was important at the time to minimize rejection of the organ by the recipient’s body.
George Hallenbeck, M.D., had acquired a deep knowledge of physiology and an interest in experimental surgeries before he stood at that operating table. Dr. Hallenbeck also designed Mayo’s initial kidney transplant program. Once it began, he was named to direct Mayo’s Section of Tissue and Organ Transplantation. He subsequently headed the surgical teams for more than 40 kidney transplants.
Dr. Hallenbeck was among Mayo’s most accomplished surgeons and researchers. Besides a medical degree, he held a doctorate in physiology with specialty work in gastric secretions. During World War II, Dr. Hallenbeck worked on the physiology of acceleration for Mayo, and served on the U.S. Army’s development team for the famed “G-suit.” It was created to protect fighter pilots from blackouts under extreme flight conditions.
Frank C. Mann, M.D., and his Mayo Clinic laboratory were probing the science of kidney transplants in the 1920s, decades before surgeons performed the first patient operations. A surgical resident working with the laboratory drew several insights from the failure of transplanted kidneys. Carl S. Williamson, M.D., was among the early scientists to recognize a “blood-borne” factor that needed to be overcome to prevent rejections. In later remarks, Dr. Mann observed: “The successful transplantation of a healthy organ for a diseased one awaits the discovery of those biologic factors which prevent the survival of tissues of one individual when transplanted into the body of another individual.” Dr. Mann and his associates also pioneered surgical techniques for kidneys. Among them was the method developed by Dr. Williamson, which was used in the first kidney transplants on humans. Dr. Mann came to Mayo Clinic in 1914 as director of experimental medicine and retired in 1952.
Posted on November 25th, 2013 by Admin
The Numbers, for the Record
Candidates on waiting list for kidneys for transplant (national) - Approximately 97,000
Kidney Transplants at Mayo Clinic
Mayo Clinic - Number of Kidney Transplants (as of June 30, 2013)
Rochester ( since 1963) - 4,822
Arizona (since 1999) - 1,974
Florida (since 2000) - 1,186
Kidney transplant patients at Mayo Clinic are cared for after surgery at special houses. The first, on the Rochester, Minn., campus was called the Gift of Life Transplant House.
Rochester businessman Ed Pompeian knew the personal difficulties of kidney transplants as he worked to create the Gift of Life Transplant House. He had undergone two transplants.
Pompeian envisioned a home-away-from-home atmosphere, to be shared by patients who needed a place to stay while at Mayo Clinic for transplant surgeries. The Gift of Life Transplant House opened in Rochester, Minn., in December 1984. In the past three decades it has expanded into the nation’s largest transplant house program with 84 rooms in two complexes.
A patient may be accompanied by one caregiver. The house offers common facilities that encourage interaction and support among guests. There is a minimal fee for staying at the house, easing the financial burdens on patients.
Similar residences at Mayo campuses in Florida and Arizona also welcome transplant patients.
Posted on November 22nd, 2013 by Admin
A Mayo Clinic laboratory study has revealed a possible mechanism to stop recurrence of cancer in mice. The approach, involving screening and a second-line treatment, prevented cancer from coming back in most of the mice in the study in which recurrence would have happened. The findings appear in Nature Medicine.
It’s been long known that cancer tumors change their appearance or phenotype, as well as their genomic characteristics, to avoid the natural immune response from the host body. A collaborative international team led by Richard Vile, Ph.D., Mayo Clinic molecular medicine researcher, attempted to detect or anticipate that shift and then initiate a “pre-emptive strike” before the tumor fully evolves, thus preventing a relapse.
The researchers say the findings may lead to new methods of early cancer detection and “appropriately timed, highly targeted treatment of tumor recurrence irrespective of tumor type or initial treatment.”
The research was supported by the Richard M. Schulze Family Foundation, Mayo Clinic, Cancer Research UK, the National Institutes of Health, and a grant from Terry and Judith Paul.
Other collaborators in the research are: Timothy Kottke, Nicolas Boisgerault, Ph.D., Rosa Maria Diaz Ph.D, Diana Rommelfanger-Konkol Ph.D, Jose Pulido, M.D., Jill Thompson, Debabrata Mukhopadhyay, Ph.D., of Mayo Clinic; Oliver Donnelly, M.D., Alan Melcher, M.D. Ph.D., and Peter Selby, M.D. Ph.D., of Cancer Research UK; Roger Kaspar, Ph.D., TransDerm, Santa Cruz; Matt Coffey, Ph.D., Oncolytics Biotech, Calgary; Hardev Pandha, M.D. Ph.D., University of Surrey; Kevin Harrington, M.D. Ph.D., The Institute of Cancer Research, London.
Posted on November 6th, 2013 by Admin
Certain types of "hard to treat" prostate cancer present an unanswerable challenge for physicians. That's a nicely worded sentence for very bad news for the patient. After hormone treatment yields no response, the patient usually has two years or less to live. Surgery isn't possible because the tumor cannot be shrunk. The reality of the condition underscores the urgency of a new study at Mayo Clinic's Center for Individualized Medicine that uses the genomic information of the patient's tumor to find possible solutions, such as more targeted drugs. For more details on the study or to learn how you might participate, check the news release Mayo issued today.
Posted on November 6th, 2013 by Admin
From the pages of Mayo Clinic's Discovery's Edge --
Two years after a heart attack left him too exhausted to even tend his garden, Miroslav Dlacic is now able to walk again without becoming worn out. An international team of Mayo Clinic doctors and researchers, led by André Terzic, M.D., Ph.D., director of Mayo Clinic’s Center for Regenerative Medicine, helped Dlacic reclaim his life by discovering a way to regenerate heart tissue through stem-cell therapy.
For decades, treating cardiac patients has typically involved managing heart damage with medication. It’s a bit like driving a car without fixing a sluggish engine; you manage the consequences as best you can and learn to live with them. But in collaboration with European colleagues, Mayo Clinic researchers have discovered a revolutionary means of repairing a damaged heart—of actually fixing the machine.
“It’s a paradigm shift,” says Dr. Terzic. “We are moving from traditional medicine, which addresses the symptoms of disease, to being legitimately able to cure disease.”
In this breakthrough process, stem cells are harvested from a cardiac patient’s bone marrow. They undergo a laboratory treatment that guides them to become cardiac cells. The treated cells are then injected into the patient’s heart in an effort to grow healthy heart tissue. The study is the first successful demonstration in human beings of the feasibility and safety of transforming adult stem cells into cardiac cells.
“We guide the stem cells to become something useful, in this case, cardioprogenitors,” Dr. Terzic explains.
This discovery has implications for millions of people. Cardiovascular disease is the leading cause of death worldwide. In the U.S. alone, about 5.8 million people have heart failure, and the number is growing. Beyond heart failure, the Mayo research also is a milestone in the emerging field of regenerative medicine, which seeks to go beyond palliative treatments to fully heal damaged tissue and organs.
Mayo Clinic is uniquely positioned to pursue this complex therapy. In addition to its global reach, Mayo Clinic has its Center for Regenerative Medicine at the forefront of efforts to develop reparative solutions for a range of conditions.
“With the cardiopoiresis research, we have shown that regenerative medicine can really work,” Dr. Terzic says. “We are now actively working on regenerative medicine in the areas of diabetes, liver and lung disease, neurologic disorders, and orthopedic surgery.”
To read the full story about Dr. Terzic's research into regenerative medicine, visit Discovery's Edge, Mayo Clinic's research magazine, at http://www.mayo.edu/research/discoverys-edge/regenerating-heart-tissue-stem-cell-therapy.
Posted on October 31st, 2013 by Admin
It's a common ailment, but we're trying to get to the bottom of it. Researchers at Mayo Clinic in Florida have launched a clinical trial on gastroesophageal reflux. You either need to have the condition or to be perfectly healthy, as they need people for a control group for the study.
The Gastroesophageal Reflux - Respiratory Consequence Study
To be eligible, participants must be 18-60 years old and be within traveling distance of Mayo Clinic’s campus in Jacksonville, Fla.
Posted on October 15th, 2013 by Admin
I write this two weeks after Mayo Clinic's Individualizing Medicine Conference. The first keynote talk at that conference, on Sept. 30, was Dr. Eric Green, head of the National Human Genome Research Institute. Following his talk, he spoke with Mayo Clinic Radio about how genomics is transforming medicine (the theme of the conference). He flew out that afternoon and the next day the government, including the institutes of NIH, shut down. So, this was undoubtedly his last interview before federal health science went dark.
When asked about the impact of the sequester and the then looming shutdown on research, he quickly responded, "Tragic, it's absolutely tragic." Now I suppose you would expect that kind of response from a director whose main job is to ensure sustainability of his organization through continued funding, but what he said after that was what resonated with me. Referring to the five-point-eight percent cut to the NHGRI budget under sequestration, he said "That would be tolerable if genomics was some kind of boring, not very exciting and we didn't see a real potential for improving human health.
"If there was ever a moment in time where we should be pushing the accelerator (it's now)...the opportunities are boundless. And to not have enough fuel in our tank to push the accelerator hard is truly tragic. And it's particularly sad because in many ways the United States has led in genomics and we've written the playbook. And what's sad is the U.S.. is not funding science as aggressively as other countries and these countries are going to use our playbook and move this faster than us. And that seems to me really tragic."
And the next day, other than its hospital and a skeleton staff, the NIH was silent.