Pharmacy & Therapeutics - March 2009 - (Page 132) NEW DRUGS participant must give informed consent. Source: N Engl J Med, The New York Times, February 18, 2009 DRUG NEWS go through a novel pathway to cause AD. It is not clear exactly what triggers the reappearance of a process fundamental to its early prenatal development in the adult brain. If the process reflects the unwanted death of such cells in AD, it presents several opportunities in which a drug might be able to block the process and possibly prevent damage. The fact that another protein (netrin-1) appears to regulate the production of beta amyloid suggests that AD is the result of normal processes gone awry. Beta amyloid might be only part of the story. The brain is constantly making and breaking connections; AD might be the result when that process is out of balance. Sources: Nature, February 19, 2009; Cell Death Differentiation; The Wall Street Journal, February 19, 2009 Stents May Be As Good As Heart Bypass Patients with severe heart disease who receive stents might be at no higher risk for having a heart attack or dying and may be less likely to have a stroke than patients having conventional heart bypass surgery. However, stent patients are more likely to need additional therapy. Authors of a large clinical trial concluded that coronary artery bypass graft (CABG) surgery remains the gold standard for treating severe coronary artery disease and three-vessel disease, but the pros and cons of each therapy might not be as clear as previously thought. Stenting, which keeps the arteries open, may also benefit patients with severe disease. Previously, CABG was the only option. In the study, patients were randomly assigned to either bypass surgery or percutaneous coronary intervention (PCI) with a drug-eluting stent. The patients were treated in the U.S. and Europe. The participants were mostly men, and they were tracked for only one year. Overall, the stent patients had a higher risk of adverse outcomes (17.8% vs. 12.4% for CABG). The two groups had similar risks for deaths and heart attacks, but CABG patients were more likely to have strokes (2.2% vs. 0.6%). Patients who received stents were more likely to need another procedure (13.5% vs. 5.9%). CABG was considered to be a better treatment overall. Yet some experts questioned whether an increased risk for an additional procedure, associated with stenting, should carry the same weight as the increased risk of stroke, associated with CABG. Needing another procedure is not optimal, but it was considered better than dying or having a stroke. In a subsequent analysis, CABG was determined to be preferable for about two-thirds of the patients and stenting was better for one-third of the patients. Sources: N Engl J Med; Boston Scientific. Does Alzheimer’s Disease Begin before Birth? Research at Genentech may change the way we think about the cause of Alzheimer’s disease (AD). A process during prenatal development, in which excess ner ve cells and ner ve fibers are “pruned” from the brain, might somehow be reactivated in the adult brain and may later cause the death of such cells in patients with AD. Most experts say that AD is a result of deposits of beta amyloid that accumulate as plaques in the brain, degrading and destroying nerve cells and deleting memories. The new findings indicate that AD might not develop by chance but rather through the activation of a pathway that is already present. Drugs under development for AD are intended to block the buildup of beta amyloid plaques in the brain; however, beta amyloid can accumulate in the brain without any apparent effect on memory. During human development, the prenatal brain makes about twice the number of nerve cells that it needs. Those neurons make nerve fibers seeking to connect with other cells. Those cells and nerve fibers that connect survive; those that do not connect trigger a mechanism that clears out unneeded cells. It is now known that the amyloid precursor protein linked to AD also triggers this prenatal pruning process, but the beta amyloid that appears to kill nerve cells in AD patients is not involved in the developing embryo. Instead, the pruning is sparked by another fragment that causes the death of excess nerve cells and nerve fibers. This suggests that a protein other than beta amyloid might NEWS FROM NIH Abnormal Cells Precede Leukemia Diagnosis Researchers at the National Cancer Institute (NCI) have shown that abnormal white blood cells can be present in the blood more than six years before the diagnosis of chronic lymphocytic leukemia (CLL) is confirmed. In peripheral blood that was obtained up to 77 months before a CLL diagnosis, B-cell clones were present in 44 of 45 patients with CLL. CLL usually progresses slowly over many years. Although CLL is the most common form of leukemia in adults in Western countries, little is known about its cause. Previous studies by the NCI, FDA, and others showed that some family members of CLL patients can have B cells with outer-surface proteins that are similar to proteins found on CLL cells. This condition, known as monoclonal B-cell lymphocytosis (MBL), occurs in more than 10% of CLL family members continued on page 135 132 P&T® • March 2009 • Vol. 34 No. 3
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