How is social media enriching neurological practice?

This is a follow up on my post, what is the state of neurology on the blogosphere. Social media is growing and pulling in professionals at a breath-taking pace. This phenomenon, which many have previously turned there noses up at, is now becoming an indispensable part of our personal and professional lives.

Social networks are important, and in today’s world, overwhelmingly digital. The importance of social networks is stressed in some books such as Linked and Connected. So what are the important social networks relevant to neurologists?

 

1. LinkedIn

The social network medium most professionals prefer is LinkedIn. It is probably the extreme lone-wolf who could afford not to have a presence on LinkedIn today. There are so many neurologists on LinkedIn, and it is a good medium to establish and broaden professional connections. These connections are almost impossible otherwise. There are quite a few valuable professional Neurology LinkedIn groups such as:

2. Twitter

Twitter is a multipurpose and open social medium which gives professionals an invaluable platform to do practically whatever they like. It is however very rapid fire, relying on quick and short messages, limited to 140 characters. These messages, called tweets, may be educative or inspirational, amusing or controversial. Anyone may follow you, but you may also block nuisance followers. You may unfollow anyone you wish, and sometimes this happens at an alarming pace. Many professionals use Twitter to circulate interesting and breaking research work or articles they come across. It is a veritable way of keeping abreast of developments across your patch, but you have to check your twitter feed frequently; unfortunately old tweets tend to fade away. Here is a list of active neurology Twitter accounts.

Right Relevance offers a fairly long List of top neurology influencers

 

3. Facebook

This is probably the most popular social network platform, perhaps considered less academically rigorous. Many Facebook accounts combine social and professional activities, but you may decide to make parts of your account private. There are some interesting Neurology Groups on Facebook worth following such as

The following accounts also give regular and prolific updates on Neurology issues

 

4. Researchgate
"ResearchGate Logo" by ResearchGate - http://researchgate.net. Licensed under Public Domain via Wikimedia Commons.
ResearchGate Logo” by ResearchGate – http://researchgate.net. Licensed under Public Domain via Wikimedia Commons.

 

ReseacrhGate is a social medium entirely focussed on research output. It links professionals and researchers to others with similar interests. You could keep track of what your collaborators are doing (or up to), and you may follow the research output in your areas of interest. ResearchGate also has an interactive service where you could ask the expertsIndispensable.

 

5. Pinterest

Pinterest may appear, at first look, to be less relevant for academic and professional activities. It is however reported, along with Instagram, to be the fastest growing social network. Businesses are reporting its value, and I suspect academics and professionals may soon be. It is a graphic network, as demonstrated by my Pinterest page. Posts are called ‘pins‘, and these are place on ‘boards‘. Take a look for example at my Neurology Board on Pinterest.

 

 Instagram
Instagram loge. matt McGee on Flikr. https://www.flickr.com/photos/pleeker/15148524023
Instagram loge. matt McGee on Flikr. https://www.flickr.com/photos/pleeker/15148524023

 

This is another network focused around pictures. You may want to scoff at Instagram but you would be surprised at how many professionals are posting very interesting and enlightening images. Take a look for example at these posts by neuroradiology. I am very poor both behind and in front of the lens, and this is reflected by My Instagram page.

6. Tumblr
Tumblr. Esther Vargas on Flikr. https://www.flickr.com/photos/esthervargasc/9471571673
Tumblr. Esther Vargas on Flikr. https://www.flickr.com/photos/esthervargasc/9471571673

 

This is probably the network your children (and grandchildren?) find most fascinating. But don’t run away yet, there are serious stuff here. You wouldn’t believe, for example, that neuroscience is flourishing on Tumblr. This network allows you to play with unlimited space for photos and text. You may find yourself going there more often than you anticipated, but don’t tell the children you are on it!

 

"Social Network Analysis Visualization" by Martin Grandjean - Own work : http://www.martingrandjean.ch/wp-content/uploads/2013/10/Graphe3.png. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Social Network Analysis Visualization” by Martin GrandjeanOwn work : http://www.martingrandjean.ch/wp-content/uploads/2013/10/Graphe3.png. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

 

Have I missed out an important platform? Please leave a comment.

 

 

What is the state of neurology on the blogosphere?

I have dipped my toes in the waters, and I am beginning to find my feet. The blogosphere is a huge universe and I wondered who else are ‘out there’ blogging on neurology?

I ‘googled’ neurology blogs and came across sites listing neurology-related blogs. One is titled ’50 fascinating brain science blogs’ and another lists ‘most popular neuroscience blogs’. I plough through the lists looking for blogs that will be helpful to a jobbing neurologist. I soon discover however that most of the blogs listed are not actually neurological. Many where neuroscience and psychology, and a lot were completely irrelevant to neurology.

„Blog (1)“ von Cortega9 - Eigenes Werk. Lizenziert unter CC BY-SA 3.0 über Wikimedia Commons.
Blog (1)“ von Cortega9Eigenes Werk. Lizenziert unter CC BY-SA 3.0 über Wikimedia Commons.

 

So which are the relevant neurology blogs? Here are my choices:

Core neurology blogs

  • The Stroke Blog dissects developments in stroke
  • Blogging Stroke is a blog of the journal Stroke
  • JNNP blog is a surprise for me and worth following in view of the authority that comes with it.
  • Brainblogger has a high rating and covers a diversity of topics; it is written by different contributors and well well worth a visit.
  • Neurophilosophy blog in The Guardian is well-written and well-laid out, with good general neurology items.
  • Alltop neuroscience blog collates a variety of news and views on neurology-related items.
  • Medscape neurology blog is quite interesting
  • Neurocritic has some striking images
  • Caseblog has a section with interesting views on recent neurology issues.
  • Neurology minutiae is unapologetic for its interest in ‘arcane stuff’ but is nevertheless interesting to peruse.
  • The Neuro Times has several contributors and talks of trends in the history of neurology and neuroscience
  • Lancaster General Hospital neurology blog has a variety of professionals contributing to it although the last entry was dated 2013.
  • Neurology update is very educational and seems to target neurology trainees
  • Oliver Sachs is interesting but refers to ‘Dr. Sacks’ in the 3rd person! Hmm. I wasn’t convinced there was much there for a jobbing neurologist but nevertheless worth a look in view of the eminence associated with the name

Blogs on the margins of neurology

 

Neurology facts and trivia blogs

There are several other neurology or neuroscience themed blogs with fascinating names like ‘mindhacks‘, ‘brain windows‘, ‘brain waves‘, and ‘neurodudes‘ but I didn’t think they were relevant to practice or of sufficient general interest to explore.

Blog et blogging : définition par tags. Luc Legay on Flikr. https://www.flickr.com/photos/luc/4299610669
Blog et blogging : définition par tags. Luc Legay on Flikr. https://www.flickr.com/photos/luc/4299610669

 

Want to explore more. This link is to Webicin’s Neurology on the Medical Blogosphere.

Let me however have your thoughts on these or other blogs? Feel free to make recommendations for inclusion or exclusion.

 

Will these 10 cutting-edge advances boost stroke care?

Stroke is a global beast. It is a scourge of the young and old. It strikes suddenly, maiming and killing with wanton abandon. So much has been achieved in the attempts to tame the monster, and yet victory still seems a far-off mirage. What are in the pipelines, beyond Aspirin and Statins? What may improve the outlook beyond intravenous clot busters and intensive rehabilitation? What is the likely future of stroke care? Here is a countdown of my top 10 cutting-edge stroke advances. 

10. Uric acid therapy

By AbcdKolya (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons
By AbcdKolya (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)%5D, via Wikimedia Commons

Uric acid is a villain as anyone with gout will attest. And yet there have been recent reports of the benefit of this chemical in neurological diseases. I have previously posted on the protective effect of uric acid on Parkinson’s disease (PD). In its further attempt to change its status from sinner to saint, uric acid is creeping into the world of stroke. A recent article in the journal Stroke is titled Uric Acid Therapy Improves Clinical Outcome in Women With Acute Ischemic Stroke. It was used in conjunction with conventional clot busting of course. Uric acid appears to reduce the growth of the infarct-the part of the brain that is irreversible damaged after a stroke. Why is it only women who benefit? Testament to the fact that it is not so easy to redeem a sullied image.

9. Transdermal glyceryl trinitrate (GTN)

"Nitrogylcerin (3D ball-and-stick model)" by Woodenchemist - Own work. Licensed under Public Domain via Commons.
Nitrogylcerin (3D ball-and-stick model)” by WoodenchemistOwn work. Licensed under Public Domain via Commons.

 

Yes, the simple GTN, popular with those who suffer angina.GTN works in angina by dilating (widening) the arteries thereby improving blood flow to the heart. Why can’t the same effect be expected with the narrow or blocked arteries that lead to stroke? Indeed the effect appears to be the same on the brain as it is on the heart as reported in this article in Stroke titled Effect of Hyperacute Administration (Within 6 Hours) of Transdermal Glyceryl Trinitrate, a Nitric Oxide Donor, on Outcome After Stroke. The authors showed that applying GTN through a skin patch within 6 hours of stroke leads to improved outcomes. This intervention lowers the blood pressure, improves functional outcomes, and improves cognition to boot. To good to be true? Perhaps not.

8. Virtual reality augmented rehabilitation

"AC89-0437-20 a". Con licenza Pubblico dominio tramite Wikimedia Commons.
AC89-0437-20 a“. Con licenza Pubblico dominio tramite Wikimedia Commons.

 

There are many advances aimed at improving limb function after stroke. These include techniques such as constraint-induced movement therapy and mirror therapy. The exciting advance for me however is virtual reality. This came to my attention in an article in Augmented Reality Trends titled Virtual Reality Assists Stroke Patients Regain Limb Movement. It took some sleuthing to track down the scientific paper, published in Journal of Neuroengineering and Rehabilitation. Titled, in typical academic obfuscation, The visual amplification of goal-oriented movements counteracts acquired non-use in hemiparetic stroke patients, it showed the benefit of a virtual reality environment on hand-reaching in 20 stroke patients. The authors conclude that “the amplification of the movement of the paretic limb in a virtual environment promotes the use of the paretic limb in stroke patients”. Long words, small sample size, but big progress.

7. Enhanced endovascular therapy

"Merci L5" by Neilbarman at English Wikipedia. Licensed under CC BY-SA 3.0 via Commons.
Merci L5” by Neilbarman at English Wikipedia. Licensed under CC BY-SA 3.0 via Commons.

 

Conventional stroke treatment now relies on injection of clot busting agents into a vein (intravenous thrombolysis). In some cases the clot busting agent is given through an artery (intra-arterial thrombolysis). The immediate future of stroke however is moving towards actual clot removal or mechanical thrombectomy. There have been several studies showing the effectiveness of this technique. These include the appropriately named ESCAPE, MR RESCUEand MR CLEANThrombectomy makes use of devices called stent retrievers such as MerciTrevo Pro and Solitaire™ FR. The results of these trials are overwhelmingly convincing, and the title of a recent review article in Interventional Neurology says it all: Mechanical Thrombectomy Is Now the Gold Standard for Acute Ischemic Stroke: Implications for Routine Clinical Practice. It is such a significant development that a recent Lancet Neurology article was titled Stroke in 2015: the year of endovascular treatment!

6. Neurostimulation

By http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml [Public domain], via Wikimedia Commons
By http://www.nimh.nih.gov/health/topics/brain-stimulation-therapies/brain-stimulation-therapies.shtml [Public domain], via Wikimedia Commons

Neurostimulation is having a field day in neurology and I discussed this in my previous post on vagus nerve stimulation. Stroke is going to be no exception. Take this report published in Stroke titled Safety, Feasibility, and Efficacy of Vagus Nerve Stimulation Paired With Upper-Limb Rehabilitation After Ischemic Stroke. This paper suggests that combining vagus nerve stimulation (VNS) with standard rehabilitation improves upper limb function after stroke. Another report in Neurology is titled Deep brain stimulation of the dentate nucleus improves cerebellar ataxia after cerebellar stroke

5. Remote ischaemic conditioning (RIC)

Could repeatedly inflating and deflating a blood pressure cuff around the arm reduce the brain damage that occurs following stroke? Strange as it may seem, this is the idea behind remote ischaemic conditioning (RIC). A recent paper in Nature Reviews Neurology titled Remote ischaemic conditioning—a new paradigm of self-protection in the brain explains how this works. It says RIC protects organs by triggering protective chemical pathways in their cells. This is neuroprotection when applies to nervous structures such as the brain. This process has the potential not only to limit the damage caused by stroke, but to also reduce the risk of the stroke recurring. One study that has looked at this process in detail is published in Stroke and is titled Remote ischemic per-conditioning: a novel therapy for acute stroke? 

4. PHD oxygen sensor inhibition

When oxygen supply to the brain is restricted, as occurs in stroke, the brain detects this using proteins called PHD (prolyl hydroxylase domain). PHD triggers a change in the metabolism of the brain cells, letting them adapt to the new state of limited oxygen supply. Unfortunately this adaptation leads to the production of toxic oxygen radicals which cause some of the brain damage that results from stroke. A recent study has however shown that mice that are deficient in PHD develop less severe strokes than normal mice. It requires no stretch of the imagination to guess that medications which inhibit PHD may lead to less severe stroke outcomes. And this is what the title of the research paper says: Deletion or Inhibition of the Oxygen Sensor PHD1 Protects against Ischemic Stroke via Reprogramming of Neuronal MetabolismA simplified version of the paper is published in News-Medical as Oxygen sensor PHD1 identified as potential target for treatment of ischemic stroke

3. Growth factors 

"NGF Beta 2.5S RCSB 1BET" by RCSB PDB - RCSB PDB. Licensed under CC BY 3.0 via Commons.
NGF Beta 2.5S RCSB 1BET” by RCSB PDB – RCSB PDB. Licensed under CC BY 3.0 via Commons.

 

Recent studies have reported two growth factors with the potential to improve stroke care. The first is growth differentiation factor 10 (GDF10). An article in MNT titled Discovery could lead to drug to enhance recovery from stroke describes GDF10 as a chemical which “signals brain cells to make new connections following a stroke“. The scientific paper is published in Nature Neurology titled GDF10 is a signal for axonal sprouting and functional recovery after stroke. This opens the door for potential drug treatments which will improve recovery after stroke.

The second growth factor is Neurotrophin 3 (NT3). This is one type of nerve growth factor which has been shown, at least in rats, to improve brain function. It however has to be administered within 24 hours of stroke. The report published in Brain is titled Delayed intramuscular human neurotrophin-3 improves recovery in adult and elderly rats after stroke. The authors showed that NT3, injected intramuscularly, triggers the sprouting of new nerve cells. This goes beyond neuroprotection and opens a very exiting field for stroke researchers.

2. Stem cell therapy

By Human_embryonic_stem_cells.png: (Images: Nissim Benvenisty)derivative work: Vojtech.dostal (Human_embryonic_stem_cells.png) [CC BY 2.5 or CC BY 2.5], via Wikimedia Commons
By Human_embryonic_stem_cells.png: (Images: Nissim Benvenisty)derivative work: Vojtech.dostal (Human_embryonic_stem_cells.png) [CC BY 2.5 or CC BY 2.5], via Wikimedia Commons

Stem cell therapy is a very promising field of medicine, with exciting reports coming out almost daily. Most recently is the benefit in multiple sclerosis (MS). Recent reports suggest that Stroke is not lagging too far behind. A recent article in The Guardian describes what appears to be a successful trial of stem cell therapy in 5 people with stroke. A review article in International Journal of Preventative Medicine outlines the different types of approaches to stem cell therapy; these include neural, haematopoetic and mesenchymal stem cells. If you are keen on the technical aspects you may look at the research paper in Stem Cells and Translational Medicine titled Intra-Arterial Immunoselected CD34+ Stem Cells for Acute Ischemic Stroke

1. Brain repair with new nerve cells

Neurones in the brain. Welcome Images on Flikr. https://www.flickr.com/photos/wellcomeimages/19923050858
Neurones in the brain. Welcome Images on Flikr. https://www.flickr.com/photos/wellcomeimages/19923050858

 

A step which goes beyond neuroprotection, growth factors, and stem cells, is the creation of functioning nerve cells (neurones) from the supporting cells of the brain (glial cells). This technique promises to repair the part of the brain damaged by stroke by simply replacing the dead cells with new nerve cells. I came across  this first in an article in The Guardian titled Brain damage could be repaired by creating new nerve cells. The evidence so far is from studies in mice but the prospects for this are very exciting indeed. For the scientific details, the original research is in Stem Cells Report titled Sox2-Mediated Conversion of NG2 Glia into Induced Neurons in the Injured Adult Cerebral Cortex

These are all very impressive developments, hinting at a bright future for stroke care. It is hopefully not far off when a devastating stroke will be a totally reversible event.

Outstanding neurology video channels and sites

Neurology is as much a verbal, as it is a visual, specialty. Whilst the history is the bedrock of the neurological diagnosis, some conditions are only diagnosed by observation. Epilepsy and movement disorders are classical examples. Neurologists are therefore trained to observe the subtle nuances that distinguish between many of the diseases they see.

Neurology is however a very broad specialty, and it is unlikely that any neurologist or medical student would have personal experience of the vast number of neurological conditions. For this reason the video is an important contributor to neurological experience and expertise. The video is also a great educational resource for teaching the fairly complex neurological examination, no easy feat.

Where then can we get the best neurological videos? Here is a selection.

YouTube-based video channels

Youtube is the veritable ‘go-to’ site for most videos. Many patients post their own interesting video clips, but there is no guarantee that these clips reflect the diseases attributed to them. YouTube however has a selection of creditable video channels and here are some credible ones.

  • JAMA Neurology Channel. This is the video channel of the Journal of the American Medical Association. It is an excellent collection of neurological examination videos, very good for basic neurological skills.
  • University of Denver Neurology Department Channel. This channel, with about 650 subscribers, provides a variety of neurology related videos covering basic clinical topics and recent advances. The videos are typically in the form of lectures.
  • Johns Hopkins Neurology and Neurosurgery Channel. With more than 18,000 subscribers, this is a very clinically oriented neurology and neurosurgery channel from Johns Hopkins.
  • Brain Journal Channel. This is the video site of Brain, a foremost neurology journal. It currently has just over 80 subscribers and has its focus on cutting-edge neuroscience.
  • AAN Channel. This is the video site of the American Academy of Neurology (AAN). This has more than 2,000 subscribers and is fairly regularly updated. It however doesn’t have a lot of clinical material for learning.

 

Neurology-specific video sites

 

 

General medicine video sites with neurology sections

  • The Doctor’s Channel This has a large selection of neurology videos sourced from other sites. It covers the wide range of neurology topics. Many videos are not clinical, but nevertheless interesting.
  • Medical Videos. This is a general medical video site but with a rather strong selection of diverse neurology videos
  • University of Toronto Faculty of Medicine videos. This is an excellent collection of teaching videos covering all aspects of the neurological examination.

Miscellaneous video sites

 

 

Looking for more? Then visit Internetmedicine.com i-Neurology-Videos page for more links to neurology video sites

Please leave a comment if you have any suggestions of helpful neurology video channels.

 

Calming the rage of brain tumours: hope for a dreaded cancer

"Glioblastoma - MR coronal with contrast" by Christaras A - Created myself from anonymized patient MR. Licensed under CC BY 2.5 via Commons.
Glioblastoma – MR coronal with contrast” by Christaras A – Created myself from anonymized patient MR. Licensed under CC BY 2.5 via Commons.

 

Brain cancer is a horrible disease even among cancers. Apart from benign tumours such as meningioma, very few brain tumours have happy endings. It is however not all doom and gloom- there are many advances raising hope for the future of brain cancer. Here are 10 hope-raisers.

10. Nanotechnology-guided radiation treatment

"Nanob". Licensed under ">CC BY-SA 3.0 via Wikimedia Commons.
Nanob“. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

 

Nanotechnology is promising a lot for neurology, and I discussed this in my previous post on 10 remarkable breakthroughs that will change neurology. It is heart-warming to learn that nanotechnology is stepping into brain cancer treatment. Their role is in reducing the damage that normal tissues sustain when brain cancer is treated with conventional radiation. Scientists hope to minimise this damage by delivering the radiation treatment through nanomolecules; because of their small size it is presumed this approach should cause less harm. In this article in Neuro-Oncology titled Rhenium-186 liposomes as convection-enhanced nanoparticle brachytherapy for treatment of glioblastoma, the authors report the efficacy of liposomally encapsulated radionuclides in rat models of glioblastoma. It is complicated stuff but Science Daily’s headline says it all: Treating deadly brain tumors by delivering big radiation with tiny tools.

9. Ultrasonic screwdriver

11th Doctor Who Sonic Screw Driver Open. Tony Buser on Flikr. https://www.flickr.com/photos/tbuser/4778412914
11th Doctor Who Sonic Screw Driver Open. Tony Buser on Flikr. https://www.flickr.com/photos/tbuser/4778412914

 

The challenge for every drug cancer treatment is to deliver the drug as close as possible to the tumour cells. This is particularly difficult for brain cancer because of the protective brain blood barrier (BBB). This shield is composed of the walls of the blood vessels, and the triple-layered sheath covering the brain called the dura.

What if the drugs could be sent across this barrier without breaching it? More Dr. Who than neuroscience, but this is what the ultrasonic screwdriver recently achieved to wide acclaim. Using ultrasound, the scientists successfully delivered chemotherapy drugs across the BBB. This press release from Sunnybrook Health Sciences Centre explains it further. The neurosurgeons used an MRI-guided focused low-intensity ultrasound to force drug microbubbles in the bloodstream across the blood-brain barrier. “The waves repeatedly compress and expand the microbubbles, causing them to vibrate and loosen tight junctions of the cells comprising the BBB. Once the barrier was opened, the chemotherapy flowed through and deposited into the targeted regions”. Very exciting SciFi stuff. Here is a simplified version from IFL Science titled Scientists Have Breached The Blood-Brain Barrier For The First Time And Treated A Brain Tumor Using An “Ultrasonic Screwdriver”.

.

8. Electromagnetic field therapy

"Felder um Dipol" by Averse - http://de.wikipedia.org/wiki/Datei:Felder_um_Dipol.jpg. Licensed under CC BY-SA 3.0 via Commons.
Felder um Dipol” by Aversehttp://de.wikipedia.org/wiki/Datei:Felder_um_Dipol.jpg. Licensed under CC BY-SA 3.0 via Commons.

 

Electromagnetic field therapy is a new area of brain tumour treatment and not conventional in any way. It however promises to improve survival of patients with glioblastoma who have received conventional radiotherapy and chemotherapy. I came across this in MNT under the title Use of type of electromagnetic field therapy improves survival for patients with brain tumor. This treatment is a form of tumor-treating fields (TTFields), “a treatment that selectively disrupts the division of cells by delivering low-intensity, intermediate-frequency alternating electric fields via transducer arrays applied to the shaved scalp”. The evidence for this is a trial reported in the Journal of the American Medical Association (JAMA) titled Alternating electric fields for the treatment of glioblastoma. It is not a panacea but any light at the end of the dreadful tunnel of brain cancer is worth exploring. It is a good sign that the FDA has approved this technology.

7. Pulsed electric field (PEF)

Electric storm. Romain Guy on Flikr. https://www.flickr.com/photos/romainguy/3712378856
Electric storm. Romain Guy on Flikr. https://www.flickr.com/photos/romainguy/3712378856

 

Another technique that is under investigation for treatment of brain cancer is pulsed electric field (PEF). This was the focus of a recent paper in Scientific Reports titled Targeted cellular ablation based on the morphology of malignant cells. PEF preferentially targets and destroys malignant cells relatively sparing normal cells. The mechanism, if you are curious to know, is called high frequency irreversible electroporation (HFIRE). Or, in plain English, electric disruption of cells. This has reportedly been effective in dogs, and the challenge is to translate the benefits to humans.

6. Vacquinols

"Cancer cells- death (step 1)" by Susan Arnold (Photographer) - This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 2368 (image) (next).This tag does not indicate the copyright status of the attached work. A normal copyright tag is still required. See Commons:Licensing for more information.English | Français | +/−. Licensed under Public Domain via Wikimedia Commons.
Cancer cells- death (step 1)” by Susan Arnold (Photographer) – This image was released by the National Cancer Institute, an agency part of the National Institutes of Health, with the ID 2368 (image) (next).This tag does not indicate the copyright status of the attached work. A normal copyright tag is still required. See Commons:Licensing for more information.English | Français | +/−. Licensed under Public Domain via Wikimedia Commons.

 

Touted as the drug that makes cancer cells explode, Vacquinols are experimental agents which have shown remarkable efficacy in rat models of glioblastoma. The research reported in the journal Cell is titled Vulnerability of glioblastoma cells to catastrophic vacuolization and death induced by a small molecule. The article is quite ‘scientific’ as reflected by the tortuous title, but the whole idea is that vacquinols target some cellular processes and  cause the cell membranes of glioblastoma cells to rupture . There is some way to go but imagine this advance translating into clinical practice!

5. aCT1

"Temozolomide-3D-spacefill" by Jynto (talk) - Own workThis chemical image was created with Discovery Studio Visualizer.. Licensed under CC0 via Wikimedia Commons.
Temozolomide-3D-spacefill” by Jynto (talk) – Own workThis chemical image was created with Discovery Studio Visualizer.. Licensed under CC0 via Wikimedia Commons.

Temozolomide is a conventional treatment for glioblastoma but unfortunately some patients become resistant to this useful drug. Scientist have observed that glioblastoma cells achieve temozolomide-resistance via a protein called connexin 43 (Cx43).  Working on this knowledge, they have developed a Cx43 inhibitor called aCT1. I came across this agent in a piece in EurekaAlert titled Scientists find way to make resistant brain cancer cells sensitive to treatment. The scientific paper, published in Cancer Research, is titled Connexin 43 inhibition sensitizes chemoresistant glioblastoma cells to temozolomide. A lucid title for a scientific paper for a change!

4. Propentofylline

"Glioblastoma (1)" by No machine-readable author provided. KGH assumed (based on copyright claims). - No machine-readable source provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Commons.
Glioblastoma (1)” by No machine-readable author provided. KGH assumed (based on copyright claims). – No machine-readable source provided. Own work assumed (based on copyright claims).. Licensed under CC BY-SA 3.0 via Commons.

I came across propentofylline in the blog brainmysteries.com under the title Drug that could limit spread of deadly brain tumours. Propentofylline seems to enhance the effects of temozolomide and radiotherapy, the conventional treatments of brain cancer. In this way propentofylline may slow the spread of the brain tumour cells. It seems to work by inhibiting TROY, the protein that enables glioblastomas to spread to healthy brain cells. For the small print you may read the paper published in Journal of Neuro-oncology titled Propentofylline inhibits glioblastoma cell invasion and survival by targeting the TROY signaling pathway.

3. Medical Marijuana

cannabis-400832_1920

A recent study published in Molecular Cancer Therapeutics appears to show that constituents of cannabis drastically increase the anti-cancer effects of conventional radiotherapy. The authors suggest that ‘these cannabinoids can prime glioma cells to respond better to ionizing radiation’. A couple of caveats; this is an in vitro (in a dish) study, and it was carried out in mice. Some way to go then, but you wouldn’t think so going by this headline from the Huffington Post which says Marijuana drastically shrinks aggressive form of brain cancer.

2. New cellular targets for cancer treatment

"Cell membrane3" by Boumphreyfr - Own work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.
Cell membrane3” by BoumphreyfrOwn work. Licensed under CC BY-SA 3.0 via Wikimedia Commons.

 

Two recent papers have reported on cellular proteins which brain tumours depend on. These are therefore potential targets for future therapeutic interventions. The first is hypoxia inducible factor-1 (HIF-1) which cancer cells produce when their oxygen supply is threatened. HIF-1 enables the cancer cells to produce new blood vessels (angiogenesis) thereby maintaining their supply of nourishing oxygen. This process is under investigation by researchers at Emory University.

The second property is related to proteins called sterol regulatory element-binding proteins (SREBPs). SREBP’s control the metabolism of glucose and fat in all cells, and researchers at Ohio State University are looking at ways to inhibit these proteins. This would potentially impair the ability of cancer cells to build their cell walls (membranes). Yes, only in mice again but still, hope. Here is a review of SREBP’s and cancer.

1. Pembrolizumab

"Melanoma" by Unknown - National Cancer Institute (AV Number: AV-8500-3850; Date Created: 1985; Date Entered: 1/1/2001), http://visualsonline.cancer.gov/details.cfm?imageid=2184. Licensed under Public Domain via Commons.
Melanoma” by Unknown – National Cancer Institute (AV Number: AV-8500-3850; Date Created: 1985; Date Entered: 1/1/2001), http://visualsonline.cancer.gov/details.cfm?imageid=2184. Licensed under Public Domain via Commons.

 

The news that Jimmy Carter has melanoma, and this had spread or metastasised to his brain, came as a shock to many of his admirers. It was therefore a relief when they learnt later that Carter’s cancer has all but cleared away. Very unusual to say the least, especially with a cancer as dreadful as melanoma. This remarkable achievement is attributable to an immunotherapy drug called Pembrolizumab, one of several types of drugs called humanised monoclonal antibodies.

Pembrolizumab has demonstrated effectiveness in melanoma and there are now NICE Guidelines for Pembrolizumab in melanoma. But how good is it in primary brain cancers? A trial is currently in progress to assess the efficacy of Pembromizumab in glioblastoma, the most dreaded of brain cancers. There are several other immune therapies that may be effective in brain metastases, and these are reviewed in an article in Current Treatment Options in Neurology titled Targeted therapies in brain metastases.

 

Brain tumours rage on, but the science is hopefully catching up. Victory beckons over this dreaded disease.

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