New Research Points to New Route for Developing HIV Vaccine

By tracking the earliest days of one person’s robust immune response to HIV, researchers at Duke and the NIH Vaccine Research Center have begun to chart a new route for developing a vaccine that may boost the body’s ability to neutralize the virus.
 
The research team, led by Barton F. Haynes, MD, director of the Duke Human Vaccine Institute, and John Mascola, MD, acting director of the NIH Vaccine Research Center, have for the first time described the co-evolution of antibodies and virus in a person with HIV whose immune system mounted a broad attack against the pathogen. Their findings were published April 3, 2013, in the journal Nature.
 
Most vaccines work by inducing this antibody response, but the HIV virus has proved to be a difficult vaccine target. When HIV antibodies are produced, they typically have a limited range, and the virus changes rapidly to escape harm.
 
The current research was aided by new technologies that can detect early infection and track the subsequent immune response and virus evolution.
 
“This project could only have been carried out by a multidisciplinary team working closely together,” said Dr. Haynes, who led the work as a project of the Duke Center for HIV/AIDS Vaccine Immunology-Immunogen Discovery (CHAVI-ID) consortium, which is funded by the National Institute of Allergy and Infectious Diseases. “For the first time, we have mapped not only the evolutionary pathway of the antibody, but also the evolutionary pathway of the virus, defining the sequence of events involved that induce the broadly neutralizing antibodies.”
 
The key to this finding was a person in Africa whose HIV infection was detected so early that the virus had not yet mutated to avoid the immune assault. This person also exhibited a trait that occurs in only about 20% of people infected with HIV – an immune system that produces broadly neutralizing antibodies. These immune weapons attack vulnerable sites of the virus that are conserved despite mutations. In identifying the early viral infection, the team found the outer envelope, the viral surface glycoprotein, which triggered the start of the broadly neutralizing antibody development.
 
By tracking the precise virus and antibody pathways involved, the Duke CHAVI-ID and NIH teams now have a detailed road map for development of a potential vaccine, which involves immunogens with an outer envelope specifically selected to stimulate the production of broadly neutralizing antibodies.
 
“The next step is to use that information to make sequential viral envelopes and test them as experimental vaccines,” Dr. Haynes said. “This is a process of discovery and we’ve come a long way with regard to understanding what the problem has been.”

Genetic Link Connecting Diabetes and Alzheimer's?

Researchers at the City College of New York have published the results of a study that indicates that a single gene forms a link between diabetes and Alzheimer’s disease.

Biology Professor Chris Li and her colleagues write that the gene, which is known to be present in many Alzheimer’s disease cases, affects the insulin pathway. That kind of disruption of the insulin pathway is a prominent feature of diabetes.

The story is published in the June 2012 issue of Genetics.

According to Professor Li, “People with Type 2 diabetes have an increased risk of dementia. The insulin pathways are involved in many metabolic processes, including helping to keep the nervous system healthy.”

Professor Li and her colleagues hope that the new insights into the genetic link between the two diseases will help focus research in ways that might lead to new therapies in the treatment of both.

Study Links Premature Birth to Later Psychiatric Disorders

The King’s College London has reported that one of the largest studies to investigate birth complications and later mental health has found that premature birth constitutes a single, independent risk factor for a range of severe psychiatric disorders. Researchers at the Institute of Psychiatry (IoP) at King’s College London and Karolinska Institutet in Sweden suggest that neuro-developmental differences in those born prematurely may be important in understanding the link.

This study, which has been published in The Archives of General Psychiatry, found that persons born very prematurely, which is defined as less than 32 weeks gestation, were three times more likely to be hospitalized with a psychiatric disorder at age 16 years and older, compared to those born at term, which is defined as 37 to 41 weeks gestation. The risk varied depending on the condition -- for psychosis it was 2.5 more likely, for depression three times more likely, and for bipolar disorder 7.4 times more likely. The findings also revealed a smaller increased risk for those born moderately prematurely, which is defined as 32 to 36 weeks.

Previous research has shown an association between premature birth and an increased risk of schizophrenia, but this report claims that this is the first study to demonstrate an association with a broad range of psychiatric disorders, including bipolar disorder, psychosis, and depression.

Dr. Chiara Nosarti, lead author of the paper at the IoP at King’s, says, “We found a very strong link between premature birth and a range of psychiatric disorders. Since we considered only the most severe cases that resulted in hospitalization, it may be that in real terms this link is even stronger. However, it is important to remember that even with the increased risk, these disorders still only affect 1% to 6% of the population.”

The researchers analyzed data from nearly 1.5 million Swedish birth and medical records between 1973 and 1985 and identified all those admitted to hospital with their first episode of a psychiatric disorder by 2002.

Dr. Nosarti says, “We believe that the increased risk of mental disorders in those born very prematurely can be explained by subtle alterations of brain development. The immature nervous system in those born prematurely is particularly vulnerable to neonatal brain injury resulting from birth complications.”

Dr. Nosarti continues, “The strongest association we found in this study was to mental health disorders known to have a strong biological basis, such as bipolar disorder, further adding to the theory that neuro-developmental differences in those born prematurely may play an important role for later mental health.’”

The authors point to the importance of raising awareness of the increased risk of mental health disorders in people born prematurely and suggest gestational age should be considered when investigating psychiatric disorders in young adults.

Dr. Nosarti concludes, “Future investigations of the mechanisms associated with the increased risk of mental health following preterm birth may aid the early identification of high-risk children, who could then be prospectively identified and closely monitored – to decide if, when, and what interventions may be appropriate.”

This study was funded by a National Alliance for Research on Schizophrenia and Depression (NARSAD) Brain and Behavior Research Foundation and supported by the National Institute of Health Research (NIHR) Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King’s College London.

Brown University Study Reports Higher Education Lowers Blood Pressure

In a paper published online recently in the open access journal BMC Public Health, a Brown University assistant professor says that he and his co-authors may be able to help explain the previously documented correlation in developing countries between education and a lower risk of heart disease.

Eric Loucks, an assistant professor of community health at Brown, addressed the question of whether education influences heart disease. “One of the ways to get at that is to see if education is related to the biological underpinnings of heart disease, and one of those is blood pressure.”

In the paper, Loucks and his co-authors analyzed almost 4,000 records from the Framingham Offspring Study.

Controlling just for age, the study’s authors found that women who completed 17 years of school or more had systolic blood pressure readings that were, on average, 3.26 millimeters of mercury (mmHg) lower than women who did not finish high school. Women who went to college, but did not pursue graduate studies, had a 2 mmHg benefit compared to less educated women. For men, going to graduate school versus not finishing high school made a 2.26 mmHg difference, with a lesser benefit for going to college.

Even after controlling for influences such as smoking, drinking, obesity and blood pressure medication, the benefit persisted, although at a lower level (graduate school gave a benefit of 2.86 mmHg for women and 1.25 mmHg for men).

Professor Loucks then went even further in his analysis by indexing the blood pressure readings to make them all equal at the beginning of the 1971-2001 Framingham study period. This statistical maneuver enabled him to determine whether the analysis measured a static difference apparent early on in life or whether the differences increased at all over time. The most educated group of women retained a 2.53 mmHg benefit over the least educated. In men, the difference was much less, only 0.34 mmHg.

That the gender differences are so pronounced and appear to become more so as life goes on suggests that education may have a greater impact on women’s health over their lifetime than on men’s health, Professor Loucks said. That could be because of the correlation between low educational attainment and other health risk factors found in other studies of women.

“Women with less education are more likely to be experiencing depression, they are more likely to be single parents, more likely to be living in impoverished areas and more likely to be living below the poverty line,” Professor Loucks said.

One caveat, he said, is that the population in the study, drawn from the suburban community of Framingham, Massachusetts, decades ago, is disproportionately white and that the conclusions might not generalize to other races.

Study Stresses that, When Forecasting Aging, Policymakers Need To Adjust For Increases In Longevity And Health

Indicators of aging based only on chronological age are misleading and need to be adjusted to take into account advances in health and life expectancy, a State University of New York at Stony Brook professor and colleague from the Austrian Academy of Sciences report in the September 10, 2010, issue of Science.

The article, entitled "Remeasuring Aging," by Professor Warren Sanderson of Stony Brook’s Department of Economics and Sergei Scherbov of the Vienna Institute of Demography (Austrian Academy of Sciences), both affiliated with the International Institute for Applied Systems Analysis in Laxenburg, Austria, calls for the adoption of the adult disability dependency ratio, which measures aging based on the ratio of those who need care to those who can give care.

According to the study, the policy dialogue on aging has been based on misleading information.

“Most of our information about aging comes from indicators published by the United Nations and statistical agencies,” said Sanderson. “ These indicators, which are used worldwide to determine health care and retirement costs, are based on chronological age and in many instances consider people as being old when they reach age 65 or even earlier.”

“With advances in health and life expectancy, measuring population aging presents a problem to demographers because the meaning of the number of years lived has changed,” the authors write. “In Western Europe in 1800, for example, less than 25% of males would survive to age 60, while today more than 90% of them do. A 60-year old man in Western Europe today has around the same remaining life expectancy as a 43-year-old man in 1800. Today, a person who is 60 is considered middle-aged; in 1800, that 60-year-old was elderly.”

Traditionally the old-age dependency ratio, OADR, (the number of people above age 65+ to people in working ages) was used to assess the burden to the society of supporting elderly people. The increase of old age-dependency ratio was considered to reflect the growing burden on pension systems because of aging. “But this measure is now out of date, because people live longer and someone at age 65 is not an old person anymore,” the authors write. “In the U.S., the normal pension age is now 66, is scheduled to rise to 67, and is likely to be increased further as a means to keep the Social Security system solvent. Current legislation has normal pension ages rising in Germany, England, and other countries. As normal pension ages rise, the old-age dependency ratio provides a more and more biased indicator of the burden of aging on pension systems.”

The same sort of bias occurs if policymakers were to use the old-age dependency ratio as an indicator of the burden of aging on health care costs. Most health care costs occur in the last few years of life and these years happen at ever later ages as life expectancies increase.

The authors write that one area in which this rethinking is crucial is in measuring the burden of disability. “The traditional measure of old age dependency counts everyone 65+ years old as being a dependent on those in the working ages. However, many people over the age of 65 are not disabled and in the need of the care of others, but, on the contrary, are capable of providing care to others. On the other hand, some people below the age of 65 are disabled and in the need of care.”

In the Science article, the authors provide a new dependency measure they developed called the adult disability dependency ratio (ADDR), based on disabilities that reflect the relationship between those who need care and those who are capable of giving it. Their study shows that when aging is measured based on this ratio, the speed of aging is reduced by four-fifths compared to the conventional old-age dependency ratio.

The article is the latest in a series on aging by the authors that began with a 2005 Nature article that provided new measures of aging that take life expectancy change into account. “The first step is we redefined the concept of age because most people, when you ask how old they are, they’ll tell you how many birthdays they had,” Sanderson said. “We thought a better way to think of this is how many birthdays you have in your future. That’s what your life expectancy is. It’s like adjusting economic data for inflation.”

The authors then used that concept to create new aging measures for all countries of the world from 1955 and onward to 2045 based on the U.N. population forecasts. With the Science article, they go one step further and also take disability into account with the ADDR.

“It makes a big difference. There’s a lot of panic about aging,” Sanderson said of the ADDR. “They say ‘It’s going to happen so fast and cause troubles and difficulties.’ I think when you say there are many ways to look at aging, many of these things don’t look as bad. We’re hoping this will start a new dialog based on better science.”

One reason why policy-makers have kept on using out of date measures that do not take life expectancy changes into account is that there used to be no simple alternative to the UN measures. The reasons why policymakers have not used measures of aging like the ADDR that are adjusted for changes in disability rates are the lack of comparable data and the lack of an appropriate methodology. In the Science paper Sanderson and Scherbov use internationally harmonized data and develop a computer model that provides disability-based forecasts for high income OECD countries.

“Policymakers now have a wider variety of aging measures available to them,” the authors write. “When health and longevity are taken into account, measures of aging increase much less rapidly than they do when the implicit assumption is made that all improvements in health and longevity will suddenly come to a halt.

“Population aging will certainly be the source of many challenges in coming decades. But there is no reason to exaggerate those challenges through mismeasurement. We will be able to address those problems better with a larger array of measures of aging, using those that are appropriate to the task at hand.”

A New MDRT Consumer Study Highlights Major Opportunity for Advisors Who Close the Post-Recession Trust and Confidence Gap

The Million Dollar Round Table recently conducted the Generational Financial Confidence Study to explore current consumers’ attitudes about financial planning during the recent financial downturn. The study concluded that there is an immediate opportunity for advisors to meet the needs of more than 35,000,000 Gen X and younger Boomers who do not currently have a financial advisor but would use one if he or she could give them confidence about their financial or retirement plan and be trustworthy.

“Consumers of all generations have lived through the financial challenges of the past two years,” said Matt Thornhill, president of the MDRT’s Boomer Project. “So it comes as no surprise that trust and confidence are their biggest concerns about financial planning. Advisors who demonstrate they understand the different priorities consumers in each generation have will achieve success even now in the midst of the ‘Great Recession.’”

The MDRT Generational Financial Confidence Study represents the views of more than 1,800 adults of all generations, with an annual household income of more than $50,000 and an interest in having a financial or retirement plan. Key takeaways from the study can be broken down to what advisors should know consumers are thinking and what to do about it.

Know:

• Today’s clients and prospects are ready to talk about plans and planning.
• There is a "new normal" for financial thinking.
• The future is with Gen X and younger Boomers, age 30 to mid-50s.
• The most important attribute is “trust.”
• Know you serve different roles for different generations.
• Understand how clients today respond to your sales tactics.

Do:

• Focus today’s calls on “confidence” issues.
• Understand how behavior is not yet matching thinking.
• Make sure you really know your younger Gen X and Boomer clients.
• Those who rebuild trust fastest will win.
• Talk about “investments” with older clients, and “making money” with younger clients.
• Use an approach based on honesty, knowledge and straight-forward advice.

Rebuilding Trust and Confidence

“There is a “new normal” for financial thinking and it is important we, as financial advisors, understand what that means to consumers,” said Julian Good, first vice president of MDRT. “This study helps us understand why a lot of people are not acting like they are thinking. This is particularly evident with younger generations who seem to have financial literacy issues, which we can help address.”

The study concluded that less than 50% of Gen Y, Gen X and younger Boomers have confidence in their financial futures. And more than 85% of them now say it is harder to trust professionals they talk with about financial matters than five years ago.

Although consumers will not be an easy sell, advisors may find people today more receptive to the idea of a financial plan because of the economy. Specifically, almost 90% of consumers surveyed of all ages say they are ready to talk about financial planning, and many do not have an advisor and even those with one may not be confident in their plan. In addition, fewer than one half of young adults are confident in their financial futures and even those Boomers and Gen Xers with plans in place now lack confidence – only 65% of Boomers with a plan feel confident about their futures.

Those with a financial advisor tend to trust them more than those without one, but overall, women trust financial advisors more than men. Advisors should tailor their approach accordingly.

“Bottom line, the MDRT Generational Financial Confidence Study is a real eye opener about the immediate and significant opportunities available to advisors,” Mr. Good said. “We’re working in a different world than existed two years ago. Advisors wanting to understand the new ‘normal way’ of thinking and help rebuild confidence and trust with consumers will find this study the cornerstone to their success this year.”

2009 Alzheimer’s Report and Ramifications for Long Term Care Insurance

On September 21, 2009, the organization Alzheimer’s Disease International (ADI) published a report stating that the number of people with dementia and Alzheimer’s will nearly double every 20 years, to 65.7 million in 2030 and 115.4 million in 2050. More than 35 million people worldwide will have dementia in 2010.

If anyone is keeping score, those numbers are up significantly over the previous estimates of the prevalence of dementia globally. In fact, the updated figures represent a 10% increase over a similar report in 2005.

The research team conducting the study was led by Professor Martin Prince from the Institute of Psychiatry at King’s College London. The study covers the global prevalence of dementia, the impact of dementia worldwide, and a detailed analysis of the challenges faced by governments and healthcare systems across the world.

The full report can be found at http://www.alz.co.uk/worldreport.

This new study has important ramifications for the business of long term care that carriers, marketers, and producers ought to think about. The report highlights that, among older people, dementia makes the largest contribution of any of the chronic diseases to disability and needs for care. The need for long term care is the primary driver for the societal costs of dementia, estimated at $315 billion a year worldwide.

According to Professor Martin, “Caring is a full-time job -- an average of around eight hours per day for a relative with moderate to severe dementia. In all parts of the world, carers, who are most commonly female and the spouses or children of the persons with dementia, often experience high levels of strain. Studies reviewed in the new report suggest that half to three quarters of carers have significant psychological illness, while up to a third have clinical depression. While these numbers are staggering, the current investment in research, treatment and care is actually quite disproportionate to the overall impact of the disease on people with dementia, their carers, on health and social care systems, and on society.”