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.

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.

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.”