Tuesday, March 31, 2009

Cells That Mediate Steroid-resistant Asthma Identified

Children's Hospital of Pittsburgh of UPMC researchers have identified cells that may play a key role in some forms of steroid-resistant asthma, a complication of the condition that makes treatment even more challenging.

The identification of a lineage of cells known as T Helper Type 17 (Th17) may help scientists in the development of new treatments that lead to better control of asthma, according to the study's senior author, Jay K. Kolls, MD, chief of the Division of Pediatric Pulmonary Medicine, Allergy and Immunology at Children's Hospital.

More than 22 million Americans (including 9 million children) are diagnosed with asthma, according to the U.S. Centers for Disease Control and Prevention (CDC). As many as 50 percent of them have asthma that can be resistant to steroids, which are intended to reduce lung inflammation during an asthma attack, Dr. Kolls said.

"Asthma is a challenging condition to treat. For many patients, if they take preventive medications regularly, the condition can be controlled and they can lead relatively normal lives," Dr. Kolls said. "Inhaled steroids are an important treatment for patients to prevent asthma attacks. Unfortunately, some patients have attacks despite the use of inhaled steroids, meaning they don't respond to steroids or they need such high doses that side effects are experienced."

In a study published in the September issue of the Journal of Immunology, Dr. Kolls and colleagues found that Th17 cells mediated steroid-resistant airway inflammation and hyper-responsiveness in animal models of asthma. Th17 cells are part of the immune system and are found where the body comes in contact with the external environment, such as the lungs and the lining of the gastrointestinal tract.

"Identifying Th17 cells as a potential mechanism by which steroid-resistant asthma gives us a potential new target for the development of drugs that focus on these cells and lead to better overall control of asthma," said Dr. Kolls, the Niels K. Jerne Professor of Pediatrics and Immunology at the University of Pittsburgh School of Medicine.

Asthma is characterized by repeated wheezing, breathlessness, chest tightness, and nighttime or early morning coughing. Every year, more than half of all Americans diagnosed with asthma suffer at least one acute attack, according to the CDC. These flare-ups lead to approximately 2 million emergency room visits, 10 million outpatient visits and 100 million days of restricted activity every year.

Visualizing Asthma-causing Immune Cells At Work

Immune cells known as eosinophils have a central role in causing asthma. Now, a team of researchers at Massachusetts General Hospital, Boston, has developed approaches to noninvasively visualize in real-time eosinophil responses in the lungs and airways of mice with a disease that mimics asthma (experimental allergic airway inflammation); they hope that these approaches might be developed to help assess the efficacy of treatments (both old and new) for the disease.

The team, led by Mikael Pittet and Ralph Weissleder, visualized eosinophils at single-cell resolution using various noninvasive real-time molecular imaging technologies (specifically, near-infrared fluorescence fiber optic bronchoscopy, intravital microscopy, and fluorescence-mediated tomography) following injection of an optical sensor that targets proteins produced by eosinophils known as MMPs.

Using a combination of the sensitive optical sensor and fluorescence-mediated tomography, it was observed that dexamethasone (a drug used to treat severe asthma) decreased the number of eosinophils in the lungs of mice with allergic airway inflammation.

As some of the imaging techniques have the potential to be developed for the clinic, the authors suggest that in combination with an appropriate optical sensor they might improve our ability to diagnose asthma and assess treatment efficacy.

Low-sodium Advice For Asthmatics Should Be Taken With A Grain Of Salt

Following a low-sodium diet does not appear to have any appreciable impact on asthma control, according to new research.

Contrary to past studies — which have suggested a link between low-sodium diets and improved asthma control — a new study by researchers at The University of Nottingham found no evidence that cutting back on salt helps patients with their symptoms.

Dr Zara Pogson, clinical research fellow at The University of Nottingham, said: “Despite the clear benefit of a low-sodium diet on cardiovascular risk factors, there is no therapeutic benefit in the use of a low-sodium diet…on asthma control in our study population.”

Nearly 200 subjects completed the study which compared the effect of changes in bronchial reactivity — a measure of asthma activity — on asthma patients who followed a strict low-sodium diet. Each subject either received sodium supplements to approximate normal sodium intake of 80 millimoles per litre (mmol) a day, or placebo tablets, for six weeks.

Dr Pogson and colleagues hypothesized that the subjects on the low sodium intake would show improved clinical control of asthma symptoms based on a test of asthma activity, measures of lung function, asthma symptoms and use of asthma medication. Contrary to their hypothesis, however, they detected no differences in any measures of asthma between the groups.

“We observed no difference in the outcome measures related to asthma activity in adults with asthma and bronchial reactivity who adopted a low-sodium diet for six weeks compared with those who did not, despite a final difference in daily sodium excretion of 50 mmol,” wrote Dr Pogson.

While past studies have suggested a link between low-sodium diets and improved asthma control, none were as large or tightly controlled as this study, suggesting that their findings may have been artifacts of study design rather than reflective of a true therapeutic benefit.

“We were disappointed that a simple measure, such as a decrease in sodium intake, does not result in improvements in asthma control,” said Dr Pogson. “We therefore cannot advise people with asthma to alter their sodium intake to improve control of their asthma, despite the fact that a low-sodium diet improves cardiovascular risk factors. This study suggests that further dietary research in asthma should be directed to factors other than sodium.”

According to Asthma UK, 5.2 million people in the UK have asthma — and 50 per cent of these people have severe asthma symptoms that have a major impact on their daily lives.

The results of the randomised, double-blind, placebo-controlled trial were published in the second issue for July of the American Journal of Respiratory and Critical Care Medicine by the American Thoracic Society.

Ear Infections In Children Linked To Passive Smoking

A new report from Perth's Telethon Institute for Child Health Research has found a strong link between childhood ear infections and exposure to tobacco smoke.

The families of 100 Aboriginal children and 180 non-Aboriginal children participated in the Kalgoorlie Otitis Media Research Project, allowing the collection of social, demographic, environmental and biological data to investigate the causes of otitis media (middle ear infections). The children had regular ear examinations from birth until 2 years of age.

Chief Investigator Dr Deborah Lehmann, who heads the Institute's infectious diseases research, said ear infections were the most common reason that young children see a doctor and can cause life-long problems.

"Up to 20 per cent of children have more than three ear infections between 1 and 2 years of age. If their hearing is damaged, it can seriously affect their educational outcomes and social circumstances in adulthood," Dr Lehmann said.

"In Aboriginal children, these ear infections typically start at a younger age, are much more common and more likely to result in hearing loss."

Key findings from the project include:

  • Otitis media was diagnosed at least once in 74% of Aboriginal children and 45% of non-Aboriginal children.
  • 64% of Aboriginal children and 40% of non-Aboriginal children were exposed to environmental tobacco smoke.
  • If we eliminated exposure to tobacco smoke we estimate that we could reduce ear infections by 27% in Aboriginal children and 16% in non-Aboriginal children
  • The impact of passive smoking in the home on ear infections was reduced if the children also attended day care.

Dr Lehmann said there is evidence that passive smoking can increase the adherence of bacteria in the respiratory passages and depress the immune system.

"These results highlight the importance of reducing children's exposure to passive smoking, and this is particularly important for Aboriginal people where the rates of both smoking and otitis media are high," she said.

"Few Aboriginal children have access to formal childcare despite studies showing that it is an effective way to improve early development and educational outcomes for disadvantaged children. The fact that it could also reduce the burden of ear infections in Aboriginal children adds weight to calls for appropriate childcare facilities to be provided."

The results are published in the latest edition of the Medical Journal of Australia.

Common Cold Linked To Ear Infections, Researchers Confirm

A new five-year study at the University of Texas Medical Branch at Galveston confirms the suspected close link between the two most common diseases of young children: colds and ear infections.

The study, which appears in the March 15 issue of Clinical Infectious Disease, confirmed the suspected close link between the two most common diseases of young children, viral colds and ear infections. It also identified the viruses associated with higher rates of ear infections.

"Understanding how viruses and ear infections are linked will definitely help us find new ways to prevent ear infections," said Dr. Tasnee Chronmaitree, a pediatric infectious disease specialist who is the study's principal investigator. "To break the link you must first understand it."

Ear infections are the driving force behind antibiotic resistance, a troubling medical issue, as physicians often administer antibiotics for the painful, persistent ailment.

Chonmaitree has studied otitis media (ear infection) for more than two decades. She said parents could best protect their children by avoiding exposure to sick children and to have their children vaccinated against influenza. She suggested that children in day care might face reduced exposure to viruses if they are enrolled in smaller day care facilities with fewer children.

Funded by the National Institutes of Health, Chonmaitree and colleagues followed 294 children ages 6 months to 3 years for up to one year each. Researchers documented about 1,300 cold episodes and a 61 percent rate of ear infection complication including asymptomatic fluid in the middle ear, which can cause hearing problems. Researchers also identified the types of cold viruses -- adenovirus, respiratory syncytial virus and coronavirus -- that most often resulted in ear infection.

"Because we now know that the common cold is the precursor to an ear infection, it is important for parents to make extra efforts to prevent their children from catching colds," Chonmaitree said. "It's important to avoid exposure to sick children or adults, to avoid day care attendance, if possible, and if that's not an option, to choose a smaller group day care."

Chonmaitree also recommended the use of influenza vaccine, the only vaccine available to prevent respiratory viral infection, which is now available for children older than 6 months. The antiviral drug has also been shown to prevent ear infections associated with influenza, she said.

Chonmaitree and colleagues will continue to study the role of viruses in ear infection aiming to find a way to prevent the disease. Continued funding from the NIH will allow them to study children born with genetic variations who are prone to having ear infections and at the interactions between genes and the environment.

Childhood Respiratory Disease Boosts Illness And Death Risks In Adulthood, Study Suggests

Respiratory disease, particularly bronchitis, in early childhood boosts the risks of illness and premature death in adulthood, indicates research published ahead of print in Thorax.

The researchers base their findings on around 10,000 male graduates who went to Glasgow University between 1948 and 1968 and agreed to be part of a long term study to track their health. No women were included because fewer went to university at that time than do now.

As students they were examined by a doctor and supplied details of childhood illness, including bronchitis, asthma, and pneumonia, as well as their weight, height, and blood pressure.

Between 1998 and 2002, efforts were made to trace and survey those who were still alive. In all, 4044 out of 8410 responded.

Those who had had bronchitis, pneumonia, or asthma in early childhood were 57% more likely to die of respiratory disease than those who had not had these illnesses as children.

And they were more than twice as likely to die of chronic obstructive pulmonary disease or COPD, the umbrella term for progressive respiratory diseases, such as emphysema and bronchitis.

Students who had had bronchitis were also 38% more likely to die of cardiovascular disease.

Respiratory illness during childhood was also associated with a higher risk of assorted respiratory problems in adulthood, ranging from the relatively minor to the severe. These findings also held true among those who had never smoked.

Journal reference: Association between early life history of respiratory disease and morbidity and mortality in adulthood Online First Thorax 2008; doi 10.1136/thx.2007.086744

Study Of 'Big Eaters' Could Lead To Better Asthma Treatments

A new study into the role of a particular immune cell in the lungs could lead to better treatments for the 5 million people in the UK affected by asthma.

Scientists from the University of Southampton's School of Medicine will study the role of macrophages (literally 'big-eaters' in Greek) in the lungs of people with asthma and examine how they affect the airway narrowing that can worsen asthma symptoms.

Macrophages are the predominant type of white cells found in the lungs and their function is to clear any particulate matter, bacteria or damaged cells that may be present in the airway.

Asthma is characterised by damage to the cells lining the airway and the act of removing these particular damaged cells can cause the macrophages to switch to working in a negative rather than a positive way. They start releasing chemicals that recruit and activate other inflammatory cells to the lung, which can cause further damage to the airway.

At the same time, the macrophages also release growth factors that can re-model the airways leading to narrowing and increased twitchiness. What is not understood is why macrophages from the lungs of people with asthma release these inflammatory and growth factors, while macrophages from those without asthma do not.

Dr Karl Staples and Professor Ratko Djukanovic, from the University's School of Medicine, will study macrophages isolated from the lungs of people both with and without asthma, to discover what inflammatory and growth factors are released from these cells when they 'eat' damaged cells. They will also be looking at the ways in which the alternative activation status of macrophages in asthma may be inhibited.

The research, funded by the charity Asthma UK, may uncover new signalling mechanisms that can be targeted using drug therapy, leading to better treatments for asthma.

Dr Staples comments: "Current asthma therapies provide symptom relief and disease control and are not cures. As a result, asthmatics are on constant medication which can impact on their lifestyle. However, these treatments do not seem to be effective in those patients with more severe disease."

Professor Djukanovic adds: "By focusing the spotlight on these important inflammatory cells, which despite being the major immune cell present in the lungs, have long been neglected in the study of asthma, we hope to clarify novel drug targets that could lead to more effective treatments."

According to Asthma UK 5.2m people in the UK are currently receiving treatment for asthma, including 1.1m children, and there is a person with asthma in one in five households in the UK.

Bronchial Thermoplasty Offers Asthma Treatment


McMaster physicians have proven that a routine medical procedure can provide an improvement in asthma control.

The study by co-principal investigators Dr. Gerard Cox and Dr. John Miller on bronchial thermoplasty as the first non-drug treatment for asthma has been published in the New England Journal of Medicine (NEJM).

The publication entitled, Asthma Control during the Year after Bronchial Thermoplasty, showed that patients treated with bronchial thermoplasty, compared to another group that did not receive the procedure, showed significant positive changes such as decreases in asthma attacks, increases in days with no asthma symptoms, improvement in quality of life, reduction in using medication, and an improvement in asthma control at one year following the procedure. Asthma affects more than 2 million Canadians.

"These findings are very encouraging and are consistent with earlier trial results on bronchial thermoplasty," explains Cox. "These results make us hopeful that bronchial thermoplasty may be a new option for asthma patients who have asthma symptoms despite use of current drug therapies."

Bronchial thermoplasty is a minimally invasive procedure that reduces the amount of airway smooth muscle that is responsible for the constriction of airways in asthma patients.

Using a flexible bronchoscope through the nose or the mouth, a routine procedure, physicians treat small to medium sized airways with bronchial thermoplasty (BT). The BT device generates radio frequency/thermal energy and reduces areas of underlying smooth muscle in the airways.

The procedure is completed in three treatment sessions, each lasting less than one hour, and spaced apart by about three weeks. The procedure, like many other flexible endoscopy procedures, is done under light anesthesia, and the patient returns home the same day.

The objective of the Asthma Intervention Research (AIR) Trial, led by Cox and Miller as part of a global clinical trial, was to examine the effectiveness and safety of bronchial thermoplasty as a treatment for patients with moderate or severe asthma. The randomized controlled trial included 112 patients between the ages of 18 and 65 at 11 centers in four countries, and followed these patients for one year after treatment.

Miller began limited bronchial thermoplasty procedures several years ago in patients who were scheduled to have lung surgery.

"We saw that this particular way of treating the airway had a profound effect on the smooth muscle and not much else," Miller said. "The amount of smooth muscle is significantly reduced by thermoplasty and we recognized that this procedure might therefore be an appropriate treatment for people with asthma."

"I'm quite pleased to say that our experience suggests that the bronchial thermoplasty procedure is quite well-tolerated, and it holds considerable promise for patients with asthma."

Cox is a professor of medicine and a respirologist at the Firestone Institute for Respiratory Health. Miller is an associate professor of surgery and head of thoracic surgery at St. Joseph's Healthcare Hamilton.

Asthma is a common disease in which the airways in the lung become inflamed, excess airway mucus is produced, and airways narrow when muscles within the airway walls contract. During an asthmatic attack, in response to an asthma trigger such as an allergen or irritant, the airway smooth muscle may contract leading to airway narrowing and breathing difficulties.

MRI Technique To ID Microstructural Changes In Asthma


Chengbo Wang, Ph.D., assistant professor of Radiology has developed a novel magnetic resonance imaging (MRI) technique that – for the first time ever –identified microscopic structural damages deep in the lungs of patients with asthma.

Wang says he and his research team used a special type of magnetic resonance imaging to detect microstructural changes in the lungs. “We found structural alterations in asthmatics, which were not expected. These findings contribute to a new understanding of the pathophysiology of asthma.”

Wang’s study, which will be published in the upcoming July issue of Journal of Magnetic Resonance Imaging, involved 14 healthy volunteers and 14 patients with difficult-to-treat asthma.

The research team polarized helium-3 to make it visible for MR imaging. Then the research subjects inhaled the polarized helium-3 gas, and MR images of the lung were obtained. These images measured how far the helium atoms could move in the lung.

Researchers found that the helium-3 atoms moved a greater distance in the lungs of patients with asthma than in healthy subjects, indicating that there are subtle lung structural differences between asthmatics and healthy volunteers. Wang previously used similar MRI techniques last year to show the first evidence of structural lung damage from secondhand cigarette smoke.

“We had expected to see the opposite effect in asthma due to narrowing of airways. Our unexpected results, however, may reflect alterations at the level of the alveoli or smallest bronchi,” says Wang. Although these findings require more study, he says, they may be the reason why some asthmatics are difficult to treat, and they may be related to “remodeling” in asthma – permanent alterations in lung tissue caused by the disease.

“This study raises new questions about our understanding of asthma,” says Wang. “We hope our further research can help resolve some of these questions and help us better understand and manage this sometimes puzzling disease.”

Wang has received the W.S. Moore Young Investigator Award for Clinical Science from the International Society for Magnetic Resonance in Medicine for this work.

Hot Drinks Help Fight Cold And Flu

A hot drink may help reduce the symptoms of common colds and flu, according to new research by Cardiff University's Common Cold Centre.

New research at the Centre has found that a simple hot drink of fruit cordial can provide immediate and sustained relief from symptoms of runny nose, cough, sneezing, sore throat, chilliness and tiredness.

Published in the December 2008 edition of the clinical journal Rhinology, the research compared the effects of a commercially produced cordial apple and blackcurrant drink either 'hot' or at room temperature in 30 volunteers with common cold symptoms.

The Centre's Director, Professor Ron Eccles, is urging people suffering from colds or flu to have a hot drink to help reduce their symptoms.

Professor Eccles said: "It is surprising that this is the first scientific research on the benefit of a hot drink for treating cold and flu symptoms.

"With temperatures falling and Christmas just round the corner, cold viruses love this time of year. Having a bottle of fruit cordial in the cupboard and making a hot drink could help fight off the symptoms of festive cold and flu. The big advantage of this type of treatment is that it is cheap as well as safe and effective."

The Common Cold Centre is the world's only centre dedicated to researching and testing new medicines for treatment of the symptoms of flu and the common cold. It is based in Cardiff University's School of Biosciences.

Cold Virus Found To Manipulate Genes

Sneezing, runny nose and chills? You might blame the human rhinovirus (HRV), which causes 30 to 50 percent of common colds. But in reality, it's not the virus itself but HRV's ability to manipulate your genes that is the true cause of some of the most annoying cold symptoms.

For the first time, researchers have shown that HRV hijacks many of your genes and causes an overblown immune response that ends up with your nose being overblown.

The research is the first study to comprehensively review gene changes caused by HRV.

"The study's findings are a major step toward more targeted cold prevention and treatment strategies while also serving as a valuable roadmap for the broader respiratory science community," said David Proud, PhD, a professor in the Department of Physiology and Biophysics at the University of Calgary, and lead author of the study. The study was done in collaboration with scientists at the University of Virginia and the Procter & Gamble Company.

Proud added that while colds are usually considered to be minor infections of the nose and throat, they can have much more serious health repercussions. "Rhinovirus is the major cause of the common cold, but it is also an important pathogen in more serious conditions, such as asthma and chronic obstructive pulmonary disease (COPD)," he said.

"Advances in our understanding of the biology of the common cold may eventually lead to improvements in treatment or methods for prevention of colds," said Dr. Ron Turner, of the University of Virginia, one of the study's authors.

The researchers recruited volunteers who were inoculated with either HRV or a sham inoculation and obtained cell scrapings from the nasal passages 8 and 48 hours after inoculation and assessed the genetic changes by microarray, also know as gene chip technology.

After 8 hours, there were virtually no differences between the control and the HRV-inoculated group, but by the 48-hour mark, more than 6500 genes has been significantly up- or down-regulated in the HRV subjects—many of the more highly up-regulated genes fell into two major categories: genes making antiviral proteins, including viperin; or genes making pro-inflammatory cytokines.

"This is the first comprehensive picture to identify several groups of genes that are likely to contribute to the pro-inflammatory and antiviral response," said Dr. Proud.

The researchers also found that viral titer more than doubled in cells that had had the viperin-producing gene "knocked down," showing that HRV replication was hampered by viperin. "This had never been examined during rhinovirus infections," said Dr. Proud. "Some evidence existed that this protein (only discovered a few years ago) had effects on influenza, but nothing was known about its role in rhinovirus infections. So it was a bit unexpected."

"Overall these data provide new insights into the host response to HRV infection and identify several novel candidate genes that require further study to clarify their role in disease pathogenesis," said Dr. Proud. "This may identify proinflammatory, or host defense pathways that could be targeted for drug development, not only as treatments for colds but also for viral exacerbations of asthma and COPD.

The fact that genes associated with structural 'remodeling' or the airways were also altered, supports further study of the role of rhinovirus infections in airway remodeling in asthma."

Common Cold May Send Some Young Children To The Hospital; Those With Asthma Most At Risk

New evidence supports the link between a cause of the common cold and more severe respiratory infections such as pneumonia and acute bronchitis. The study is published in the March 15 issue of The Journal of Infectious Diseases, now available online.

Rhinoviruses are among the most common viral infections, and are responsible for at least 50 percent of all common colds. Although the association between rhinoviruses and other acute respiratory illnesses in children is increasingly accepted and has been shown in previous reports, the new study is the first to determine age-specific rates of hospitalization across the entire population of two counties. This study shows that the link between rhinoviruses and hospitalizations is especially strong when children have a history of wheezing or asthma.

The study, conducted by E. Kathryn Miller, MD, MPH, and colleagues at Vanderbilt University, the Centers for Disease Control and Prevention, and the University of Rochester, surveyed children under the age of 5 years admitted with fever and respiratory symptoms in Davidson County, Tenn. (which includes Nashville) and Monroe County, N.Y. (which includes Rochester) over a one-year period.

Their results showed that of the 592 children involved in the study, 26 percent tested positive for rhinovirus, representing almost 5 rhinovirus-associated hospitalizations per 1000 children. The study detected more rhinoviruses (26 percent) than respiratory syncytial viruses (20 percent), which have been considered the major cause of respiratory infections in infants and children.

These findings are particularly important given the age-specific rates of hospitalization observed. Among children 0-5 months, there were 17.6 hospitalizations per thousand; among those age 6-23 months, 6.0 per thousand; and among those 24-59 months, 2.0 hospitalizations per thousand. Miller remarked, "This study shows that rhinoviruses are associated with hospitalizations for fever and respiratory illnesses, even in young infants."

Children with a history of wheezing or asthma had more than eight times as many rhinovirus-associated hospitalizations than those without such a history. Asthma was the only significant factor that distinguished children hospitalized with rhinoviruses from those with other viruses or no viruses. Of those hospitalized with a history of asthma or wheezing, rhinoviruses were found in 36 percent of children aged 0-2 years and in 48 percent of children aged 2-5 years. According to Miller, the finding that asthma was the only risk factor significantly associated with rhinovirus hospitalizations should indicate that "patients with asthma might be particularly good candidates for prevention and treatment strategies for rhinovirus infection."

As a next step to their study, Miller suggested, "additional studies over multiple years in multiple geographic regions are needed to more completely understand the role of rhinoviruses in hospitalizations in children. As discussed in our study, rhinoviruses are sometimes found in healthy children; thus, further studies are required to determine the actual rate of 'carriage' in healthy children as opposed to those who are sick or have had recent symptoms of illness. There should also be further investigation into the question, 'Why are children with asthma disproportionately burdened by the "common cold" virus?'"

In an accompanying editorial, Ronald B. Turner, MD of the University of Virginia School of Medicine, noted the value of studies on rhinoviruses because of their frequency and huge cost to society. Turner echoed Miller's sentiment, remarking that the study should stimulate future research into the medical implications of rhinoviruses.

Fast Facts

  • Rhinoviruses cause at least half of all common colds.
  • The study found 26 percent of the hospitalized children had rhinovirus infections--more than were infected with a virus previously thought to be the main cause of serious respiratory illness.
  • Children with a history of wheezing or asthma had more than eight times as many rhinovirus-associated hospitalizations than those without.

Common Cold Symptoms Caused By Immune System -- Not The Cold Virus


A University of Calgary scientist confirms that it is how our immune system responds, not the rhinovirus itself, that causes cold symptoms. Of more than 100 different viruses that can cause the common cold, human rhinoviruses are the major cause.

The research, published in the American Journal of Respiratory and Critical Care Medicine, is the first study to comprehensively review gene changes in rhinovirus. “The study’s findings are a major step toward more targeted cold prevention and treatment strategies while also serving as a valuable roadmap for the broader respiratory science community,” says David Proud, PhD, a professor in the Department of Physiology and Biophysics at the Faculty of Medicine, and lead author of the study.

Proud adds that while colds are usually considered to be minor infections of the nose and throat, they can have much more serious health repercussions. “Rhinovirus is the major cause of the common cold, but it is also an important pathogen in more serious conditions, such as asthma and chronic obstructive pulmonary disease (COPD),” Proud says.

For example, children who get recurrent rhinovirus-induced wheezing in early life are 10 times more likely to develop asthma. Rhinovirus infections are also a major cause of acute attacks of asthma and COPD and, therefore, exert a huge impact on health care costs.

The study was done in collaboration with scientists at the University of Virginia and the Procter & Gamble Company. Dr. Ron Turner, of the University of Virginia, is one of the study’s authors. He says, “Advances in our understanding of the biology of the common cold may eventually lead to improvements in treatment or methods for prevention of colds.”

In the past, researchers have measured specific compounds made by the body that may protect against a cold or may be triggered by a cold virus. This is the first time anyone has conducted a comprehensive assessment of what happens when a rhinovirus infects a person. This is also the first time researchers have established that a recently discovered antiviral protein called viperin plays a role in our body’s defense against rhinovirus. That discovery will lead scientists to targeted study and treatments against the common cold.

This assessment of gene changes was conducted using gene chip technology, performed by scientists at Proctor & Gamble. With this technology scientists can see every gene in the human genome, and see how genes respond to a stimulus, in this case a cold virus.

The results of this study will open new lines of investigation into how rhinovirus impacts asthma and COPD. A new Experimental Lung Research Suite at the University of Calgary will be integral to developing new research strategies to aid patients with asthma and COPD.

David Proud is a member of the Calvin, Phoebe and Joan Snyder Institute of Infection, Immunity and Inflammation He is a Canada Research Chair in Inflammatory Airway Diseases. His research is supported by the Canadian Institutes of Health Research (CIHR).

Giving Mice A Cold Virus Offers Hope Of New Asthma Treatments


Scientists have been able to recreate rhinovirus infection, which is behind most common colds, in a small animal for the first time. For fifty years since they were discovered, it had been thought that rhinoviruses could only infect humans and chimpanzees. But now a team of scientists led by Professor Sebastian Johnston at the MRC/Asthma UK Centre in Allergic Mechanisms of Asthma at Imperial College London, has been able to infect mice with rhinoviruses.

Rhinoviruses are an unwelcome inconvenience for the majority of the population as they cause around three quarters of common colds. However they can also have serious consequences. In susceptible people, they can be fatal. They can lead to the hospitalisation of infants, pneumonia in people with weakened immune systems and they trigger most asthma attacks. They are also the major cause of acute attacks of COPD (chronic bronchitis and emphysema), and are thus the major killer in these diseases.

Professor Johnston said: “Until now it has not been possible to study rhinovirus infection in small animals. This has been a major obstacle to developing new treatments and there is currently no effective treatment for rhinovirus infection.”

It had been thought that mice and other small animals were resistant to rhinoviruses. Of the 100 known strains of rhinovirus, 90 per cent use a binding molecule, called ICAM-1 that is found on the surface of human cells, as their receptor. But the viruses are unable to bind to the mouse version of this receptor.

Professor Johnston explained: "We previously found that once inside the mouse cell a rhinovirus reproduces itself as well as it does in human cells. But the virus couldn’t infect the mouse cell because the receptor (acting like a door key) couldn’t get into the cell.

“Now we’ve modified the mouse receptor so it is more like a human one. This means the virus can infect the cells of these modified mice.”

Professor Johnston added: "We found that mice with the modified receptor were susceptible to infection with a rhinovirus. If combined with an allergen (ovalbumin which is found in egg white) that could cause an allergic reaction in the lungs, the virus could make the response worse and lead to an 'asthma attack'."

The team was able to observe that when the virus was combined with an allergic reaction, the mouse responded similarly to humans. This means it provides a good model for the study of severe asthma attacks.

"These mouse models should provide a major boost to research efforts to develop new treatments for the common cold, as well as for more potentially fatal illnesses such as acute attacks of asthma and of COPD."

The chief executive of the Medical Research Council, Sir Leszek Borysiewicz said: “This important and fundamental discovery will enable us to understand the effects rhinoviruses and common colds have on our health. It will open up new paths to finding treatments which have been delayed for many years and provides us with the opportunities for further breakthroughs in the future.”

Leanne Male, Assistant Director of Research at Asthma UK commented: "Ninety per cent of people with asthma tell us that colds and flu triggers their asthma symptoms but as yet there is no specific treatment for virally induced asthma attacks and steroid treatments are only partially effective against them. We welcome this latest advancement as it will lead to a greater understanding of viral infections and their link with asthma and may help the development of a suitable treatment for virus-induced asthma attacks, thus greatly improving the lives of the 5.2 million people with the condition in the UK."

Journal article: Mouse models of rhinovirus-induced disease and exacerbation of allergic airway inflammation. Published online in Nature Medicine.

The research was funded by the Medical Research Council, Asthma UK and GlaxoSmithKline.

Vitamin D Deficiency Common In Patients With IBD, Chronic Liver Disease

New research presented at the 73rd Annual Scientific Meeting of the American College of Gastroenterology in Orlando found patients with inflammatory bowel disease or chronic liver disease were at increased risk of developing Vitamin D deficiencies. Two separate studies highlight the importance of regular Vitamin D checkups in the evaluation of patients with certain digestive diseases.

For IBD Patients, Vitamin D Deficiency Associated with Lower Quality of Life and Higher Disease Activity

Researchers at the Medical College of Wisconsin investigated whether Vitamin D deficiency in patients with IBD is associated with a lower quality of life or higher disease activity independent of other known risk factors and medication use.

Disease activity and quality of life were assessed using validated questionnaires, which were administered at every clinic visit. The researchers also looked at the prevalence and seasonality of Vitamin D deficiency in this inflammatory bowel disease population, as well as its association with IBD-related hospitalizations, surgeries and medication use.

This retrospective cohort study conducted by Dr. Alex Ulitsky and his colleagues analyzed vitamin D levels of 504 inflammatory bowel disease patients. They recorded the patients' lowest Vitamin D measurements and date when each low measurement was taken.

Dr. Ulitsky and his team found almost 50 percent of the patients were Vitamin D deficient at some point, with 11 percent being severely deficient. Vitamin D deficiency was not significantly associated with being hospitalized for IBD or having IBD-related surgeries. However, in both Crohn's disease (CD) and ulcerative colitis (UC) patients, vitamin D deficiency was independently associated with having increased disease activity scores compared to those with normal levels of Vitamin D. Vitamin D deficient CD patients, but not UC patients, had worse quality of life when compared to patients who were not Vitamin D deficient.

According to Dr. Ulitsky, "All IBD patients, irrespective of their disease, disease location or nature should have their Vitamin D levels checked regularly and corrected aggressively when insufficiency is found."

Vitamin D Deficiency Prevalent in Patients with Chronic Liver Disease

Researchers from the University of Tennessee in Memphis measured the vitamin D levels of 118 chronic liver disease patients. Researchers found 92.4 percent of chronic liver patients had some degree of vitamin D deficiency and at least one third were severely deficient. Severe vitamin D deficiency was more common among cirrhotics.

"Since deficiency is common among these patients, Vitamin D replacement may hopefully prevent osteoporosis and other bone complications related to end stage liver disease," said lead researcher Dr. Satheesh P. Nair.

The study included 43 hepatitis C patients with cirrhosis; 57 hepatitis C patients without cirrhosis; 18 cirrhosis patients without hepatitis C. The severity of vitamin D deficiency was divided into three groups: mild (between 20-32 ng/ml), moderate (between 7-20 ng/ml), and severe (less than 7 ng/ml).

Importance of Vitamin D and Bone Health

Vitamin D, a fat-soluble vitamin, helps the body absorb calcium and plays a crucial role in the growth and maintenance of strong, healthy bones. A lack of vitamin D causes calcium-depleted bone, which can weaken the bones and increase the risk of fractures resulting from osteoporosis.

A diet rich in vitamin D, such as fish, eggs, fortified milk, and cod liver oil, is essential to maintaining good bone health.

Low Vitamin D Levels Appear Common In Healthy Children

Many healthy infants and toddlers may have low levels of vitamin D, and about one-third of those appear to have some evidence of reduced bone mineral content on X-rays, according to a new report.

Reports of a resurgence of vitamin D deficiency and rickets, the resulting bone-weakening disease, have emerged in several states, according to background information in the article. Vitamin D deficiency also appears to be high in other countries, including Greece, China, Canada and England.

Catherine M. Gordon, M.D., M.Sc., and colleagues at Children's Hospital Boston, studied 380 healthy children ages 8 months to 24 months who visited a primary care center for a physical examination between 2005 and 2007. Parents filled out a questionnaire regarding their nutritional intake and that of their children, and also reported on the use of vitamin D and other supplements, time spent outdoors, socioeconomic status and education level.

Among the 365 children for whom blood samples were available, 12.1 percent (44) had vitamin D deficiency, defined as 20 nanograms per milliliter of blood or less, and 40 percent (146) had levels below the accepted optimal level of 30 nanograms per milliliter. Breastfed infants who did not receive vitamin D and toddlers who drank less milk were at higher risk of deficiency (for each cup of milk toddlers drank per day, blood vitamin D level increased by 2.9 nanograms per milliliter).

Forty children of the 44 with vitamin D deficiency underwent X-rays of the wrist and knee. Thirteen (32.5 percent) had evidence of bone mineral loss, and three (7.5 percent) exhibited changes to their bones suggestive of rickets.

"Only one child had signs of rickets on physical examination," the authors write. "Thus, these infants and toddlers had a sub-clinical deficiency that could make detection of this issue particularly problematic in routine clinical practice, as a child's vitamin D status is not typically evaluated as part of routine care."

The data suggest that infants should receive vitamin D supplements while breastfeeding and raise the question of whether some children, including those with established risk factors for vitamin D deficiency, should receive regular measurements of blood vitamin D levels. "Given the potential benefits of vitamin D on bone and other tissues, and growing data supporting its immunomodulatory and antiproliferative effects, the current findings support recommendations advocating for vitamin D supplementation for all young children," they conclude.

This study was supported by grants from the Allen Foundation Inc. and the McCarthy Family Foundation; a grant from the National Center for Research Resources; and a project of the Maternal and Child Health Bureau, U.S. Health Resources and Services Administration.

Editorial: Additional Information Needed About Risks of Low Vitamin D Levels

"The results of this study suggest that a vitamin D level is not a good screening test for rickets in asymptomatic children; 92.5 percent of those with hypovitaminosis [low levels of] D, as defined by Gordon et al, had no evidence of rickets on radiograph [X-ray]," writes James A. Taylor, M.D., of the University of Washington, Seattle, in an accompanying editorial.

"Future research is needed to determine whether infants and toddlers with vitamin D levels of 20 nanograms per milliliter or lower are at significant short- or long-term risk for other bone disease or different conditions," Dr. Taylor writes. "Pending this research, the recommendations by Gordon et al that all young children should receive vitamin D supplementation and that children with risk factors should have periodic vitamin D levels obtained may be premature."

New Guidelines Double Amount Of Recommended Vitamin D For Young

The American Academy of Pediatrics (AAP) is doubling the amount of vitamin D it recommends for infants, children and adolescents. The new clinical report, "Prevention of Rickets and Vitamin D Deficiency in Infants, Children, and Adolescents," recommends all children receive 400 IU a day of vitamin D, beginning in the first few days of life.

The previous recommendation, issued in 2003, called for 200 IU per day beginning in the first two months of life.

The change in recommendation comes after reviewing new clinical trials on vitamin D and the historical precedence of safely giving 400 IU per day to the pediatric population. Clinical data show that 400 units of vitamin D a day will not only prevent rickets, but treat it. This bone-softening disease is preventable with adequate vitamin D, but dietary sources of vitamin D are limited, and it is difficult to determine a safe amount of sunlight exposure to synthesize vitamin D in a given individual. Rickets continues to be reported in the United States in infants and adolescents. The greatest risk for rickets is in exclusively breastfed infants who are not supplemented with 400 IU of vitamin D a day.

Adequate vitamin D throughout childhood may reduce the risk of osteoporosis. In adults, new evidence suggests that vitamin D plays a role in the immune system and may help prevent infections, autoimmune diseases, cancer and diabetes.

"We are doubling the recommended amount of vitamin D children need each day because evidence has shown this could have life-long health benefits," said Frank Greer, MD, FAAP, chair of the AAP Committee on Nutrition and co-author of the report. “Supplementation is important because most children will not get enough vitamin D through diet alone.”

"Breastfeeding is the best source of nutrition for infants. However, because of vitamin D deficiencies in the maternal diet, which affect the vitamin D in a mother’s milk, it is important that breastfed infants receive supplements of vitamin D,” said Carol Wagner, MD, FAAP, member of the AAP Section on Breastfeeding Executive Committee and co-author of the report. “Until it is determined what the vitamin D requirements of the lactating mother-infant dyad are, we must ensure that the breastfeeding infant receives an adequate supply of vitamin D through a supplement of 400 IU per day.”

The new recommendations include:

  • Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.
  • All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.
  • Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.
  • Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.

Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.

No Protective Effect On Cancer From Long-term Vitamin E Or Vitamin C Supplementation, Trial Shows

The Physicians' Health Study II is a large-scale, long-term, randomized clinical trial that included 14,641 physicians who were at least 50 years old at enrollment. These physicians were given 400 IU of vitamin E every other day or its placebo, or 500 mg of vitamin C daily or its placebo.

Researchers followed these patients for up to 10 years for the development of cancer with high rates of completion of annual questionnaires, and the confirmation of reported cancer endpoints.

Analyses indicate that randomization to vitamin E did not have a significant effect on prostate cancer. This lack of effect for vitamin E also extended to total cancer. Vitamin C had a similar lack of effect on total cancer.

"After nearly 10 years of supplementation with either vitamin E or vitamin C, we found no evidence supporting the use of either supplement in the prevention of cancer," said Howard D. Sesso, Sc.D., M.P.H., an assistant professor of medicine at Brigham and Women's Hospital. "While vitamin E and C supplement use did not produce any protective benefits, they also did not cause any harm," he added.

Previous laboratory research and observational studies in which people who reported eating a diet rich in vitamins E and C were found to have a lower risk of cancer, had suggested that taking these vitamins as individual supplements may offer some protective benefits.

Study co-author and principal investigator J. Michael Gaziano, M.D., M.P.H., associate professor of medicine at Brigham and Women's Hospital and VA Boston, adds, "Individual vitamin supplements such as vitamin E and C do not appear to provide the same potential advantages as vitamins included as part of a healthy, balanced diet."

Finally, Sesso said that these results provide clinically meaningful new information. "Our results represent one of only a few clinical trials that have tested this idea. The final component of the Physicians' Health Study II, testing daily multivitamin supplementation, remains ongoing."

Fast-food Diet Cancels Out Benefits Of Breastfeeding In Preventing Asthma, Study Shows

Many studies have shown that breastfeeding appears to reduce the chance of children developing asthma. But a newly published study led by a University of Alberta professor has found that eating fast food more than once or twice a week negated the beneficial effects that breastfeeding has in protecting children from the respiratory disease.

The article appears online in the international journal Clinical and Experimental Allergy based in London, England. A number of different findings led the researchers to their conclusion – showing links between fast food and asthma, breastfeeding and asthma, and all three together.

"Like other studies, we found that fast-food consumption was associated with asthma," said the senior author, Dr. Anita Kozyrskyj (pronounced koh-ZUHR-skee), an associate professor in the Department of Pediatrics in the U of A's Faculty of Medicine & Dentistry.

The research confirmed the findings of many other studies about the benefits of breastfeeding in relation to asthma. Kozyrskyj et al. found that breastfeeding for too short a time was linked to a higher risk of asthma, or conversely that children exclusively breastfed 12 weeks or longer as infants had a lower risk.

"But this beneficial effect was only seen in children who did not consume fast food, or only occasionally had fast food," she added.

More than half the children studied ate fast food more than twice a week.

The researchers suggested the prevalence of fast food in today's society may explain why asthma rates keep rising even though more mothers are breastfeeding.

The group did not look at why fast food might cause asthma. But the authors suggest the high fat content, and high salt levels (which can increase twitchy airways and wheezing) may be to blame.

Kozyrskyj, an authority in the area of child health and asthma research, was recruited to the University of Alberta from the University of Manitoba to assume the position of Research Chair, Maternal-Child Health and the Environment.

She conducted the study with Dr. Allan Becker while at the University of Manitoba. The team looked at about 700 Manitoba children, about 250 of whom had asthma and 475 who did not. The research was funded by the Canadian Institutes of Health Research and the analyses were conducted by Xiao-Mei Mai, a postdoctoral student at the U of M.

Kozyrskyj noted that nutrition is only one of many factors involved in asthma. "But this is an interesting finding, and we hope it will stimulate other researchers to follow up and investigate this in more depth, perhaps with a cohort study."

She was a co-author in a different study that received widespread publicity last year when the researchers reported children who received antibiotics in the first year of life were at higher risk of developing asthma later on.

Other research by Kozyrskyj, published in the journal Allergy last year, suggested that girls who do not drink enough milk and are overweight may be at greater risk for asthma.

Concerns Raised About TV And Computer Screen Time Among Urban Children With Asthma

Urban children with asthma engage in an average of an hour more of screen time daily than the maximum amount American Academy of Pediatrics (AAP) recommends. This is the first study to examine screen time among children with asthma.

"We know that both asthma and excessive screen time can be associated with other difficulties, including behavior problems, difficulty with attention, poor school performance and obesity," said Kelly M. Conn, M.P.H., of General Pediatrics at Golisano Children's Hospital at Strong and lead author of the study, which was published recently in Academic Pediatrics. (Academic Pediatrics changed its name from Ambulatory Pediatrics this year.) The study was conducted out of the University of Rochester Medical Center.

As a part of a larger study on how to more effectively treat asthma, Conn and her colleagues surveyed parents of urban children with asthma in Rochester, NY, to better understand their screen time viewing habits. Screen time includes TV watching and video tapes, playing video and computer games and using the Internet. The study found that 74 percent of the 226 children whose parents were surveyed exceeded more than two hours of screen time per day. On average, these children with asthma watched 3.4 hours daily.

"Even though these findings are preliminary, a message for parents would be to remain aware of the amount of time your child is spending in front of screens and try to encourage your child to participate in a range of activities," Conn said. The types of programs children watch are also important; young children should watch shows meant for their age group, rather than watching PG-13 or R-rated movies, or playing Teen-rated games.

More than half of the parents interviewed knew that the AAP recommends a maximum of two hours of screen time per day and most parents who reported that their child had too much screen time were worried that this was the case. Though the AAP recommends that no child have a television in their bedroom, 77 percent of the children had a TV in their room and nearly half the children owned a hand-held video game system. The widespread presence and popularity of screen time activities in children's lives makes monitoring and setting limits for screen use very difficult. In addition, in an urban setting, safety concerns often limit a child's ability to engage in activities outside of the home.

Even though the goals of asthma therapy are to quell asthmatic symptoms and prevent limitations with activities, about 63 percent of children used screen time when their asthma symptoms physically limited their activities. Those children who used screens when they were having physically limiting symptoms used an average of 3.67 hours daily, which is more than half an hour extra daily than children who engaged in other non-physical activities such as resting, reading or coloring. Researchers suspect that some parents could have underestimated their child's screen time, which would demonstrate an even larger problem of excessive screen time and lack of other physical and mental activities than the study found.

The study did not have a control group of children without asthma. Children with asthma most likely watch a similar amount of screen time to all children, but children with asthma are more at risk for the health problems associated with too much screen time. In the study, children included were between 3- and 10-years-old. According to the Kaiser Family Foundation, on average children in this age range watch between two and four hours of screen time daily. So, while they may not spend more time on screens than children without asthma, the lost opportunities for physical and mental engagement may be even more detrimental to these vulnerable children.

"It is not unreasonable or uncommon for children to watch TV or play a video game when they are not feeling well or when they need to slow down their activity. For all children, it is important for parents to be aware of how much screen time their children have and the types of programs they are watching," Conn said.

Conn suggests that parents of children with asthma can encourage a variety of alternate activities for their child, including reading, drawing and arts and crafts, or playing board games or puzzles. In addition, if a child is experiencing limitation of activity due to their asthma, parents should speak with their child's medical provider about ways to improve their asthma control. Many areas have organizations that were created to provide resources and support for families of children with asthma.

Even With Medication, Asthma Patients Show Chronic Airflow Changes In Lungs

Using a special MRI technique, researchers have determined that the location and degree of airway narrowing in the lungs of asthma sufferers can be markedly persistent over time.

"A considerable number of airways appeared to be consistently narrowed over time," said the study's lead author, Eduard E. de Lange, M.D., professor of radiology at the University of Virginia Health Sciences Center. "This finding was irrespective of disease severity or the use of medication."

Asthma is a chronic inflammatory disorder in which the small and medium-sized airways of the lungs become obstructed. Narrowing or closure in the passages can be caused by swelling in the walls or changes in the structure of the airways as a result of the chronic condition.

For the study, researchers used hyperpolarized helium 3 (3He) MRI to visualize areas of airflow obstruction in the lungs called ventilation defects. To perform the imaging test, patients inhaled the helium gas prior to undergoing MRI.

In order to measure the changes in the location and size of airway defects over time, researchers performed consecutive 3He MRI studies on 43 asthma patients between 18 and 40 years old.

Twenty-six patients underwent two imaging studies on the same day (up to 82 minutes apart), and 17 underwent 3He MRI on three occasions separated by an average of 51 days. In addition to each 3He MRI exam, patients also underwent spirometry, a test that measures the amount of air exhaled from the lungs.

In the same-day examinations, 75 percent of the lung defects identified by 3He MRI remained in the same location for both imaging studies. The majority of those defects, or 71 percent, remained the same size. In the multi-day examinations, 67 percent of defects were still present in studies that were repeated with a median interval of 31 days; in studies with a median interval of 85 days, 38 percent of defects remained in the same location. The findings were not affected by disease severity or by use of asthma medication.

"Most of the change in overall defect number was caused by variability between patients rather than within patients, indicating that 3He MRI provides a reliable means for visualizing airflow impediment within the lungs of patients with asthma," Dr. de Lange said.

After an interval of about three months, repeat 3He MRI revealed that more than one-third of airway defects were in the same location and approximately one-half of those defects were the same size.

"A considerable number of airways appeared to be consistently narrowed over time, which helps us understand that asthma is largely a focal disease of the lung," Dr. de Lange said.

New Cause Of Ozone Wheezing And Potential Treatments Found

Researchers at the National Institute of Environmental Health Sciences (NIEHS), part of the National Institutes of Health, and Duke University have discovered a cause of airway irritation and wheezing after exposure to ozone, a common urban air pollutant. Using an animal model, the researchers were also able to identify several ways to stop the airways from narrowing.

These findings help identify potential new targets for drugs which may eventually help physicians better treat emergency room patients suffering from wheezing, coughing and shortness of breath.

"We found that it is not the ozone itself that causes the body to wheeze, but the way the lungs respond to ozone," said Stavros Garantziotis, M.D., principal investigator in the NIEHS Laboratory of Respiratory Biology and lead author of the paper published online this week in the Journal of Biological Chemistry.

"Animals exposed to ozone produced and released high amounts of a sugar known as hyaluronan," said John Hollingsworth, M.D., a pulmonologist who is an assistant professor in the Department of Medicine at Duke University Medical Center and senior author of the paper. "We found hyaluronan to be directly responsible for causing the airways to narrow and become irritated. We believe this may contribute to asthma symptoms in humans as well."

The researchers found several proteins which can mediate the hyaluronan effect and can be used as treatment targets. They were also able to block the airway responsiveness by binding the native hyaluronan away, as well as by administering a slightly modified form of hyaluronan. "Although more research is needed before these findings can be translated to humans, we are optimistic these treatment options could prove beneficial to patients," said Hollingsworth.

"This finding has real-life therapeutic implications," said Garantziotis. The researchers point out there are approximately 4,500 hospital admissions and 900,000 school absences each year attributed to ozone exposure, especially on high-ozone alert days. "We identified several new approaches to the treatment of ozone-induced airway narrowing."

Ozone has been estimated, in an Environmental Protection Agency analysis, to cost the United States $5 billion a year as a result of premature deaths, hospitalizations and school absences. Inhalation of ozone can lead to irritation of the airways and increased wheezing, particularly in children and adults who have asthma and chronic obstructive lung disease. Ozone is formed in the inner atmosphere in the presence of sunlight from pollutants emitted from vehicles and other sources. Exposure occurs when people inhale air containing

Chronic Asthma: Study Reveals Long-Lasting Airway Blockages, Even In Medicated Asthma Patients


Scientists now are able to get a much clearer picture of what happens inside the lungs of asthma patients, thanks to an innovative MRI technique being used at the University of Virginia Health System to visualize the flow of air within the lung.

In a new study published in the February issue of Radiology, the UVA team used this special technique to determine that asthma patients can continue to have persistent narrowing of airways over a span of a month or more – even while taking medication.

“A significant number of the same airways were consistently narrowed over time, irrespective of patients’ medication use or the severity of their disease,” says Eduard E. de Lange, M.D., professor of radiology at the UVA School of Medicine. “This suggests that asthma is a focal disease, meaning that it involves certain airways and not others.”

Asthma is a chronic lung disease characterized by inflammation and narrowing of the lung’s small and medium airways. Until now, it’s been very difficult for scientists to get a clear picture of what happens within the lung of an asthma patient, explains de Lange.

“You can’t biopsy a lung like you can the liver, for example,” he says. “And with other scanning methods you get a picture of the lung, but you can’t see where the air goes and where airways are blocked. But this technique gives us the greatest detail available today.”

In the study, researchers had 43 asthma patients inhale hyperpolarized helium 3 (3He), a harmless gas visible inside the lungs during an MRI scan. In non-asthmatic patients, the gas is evenly distributed in the air spaces of the lung, but in asthma patients the MRI scan reveals the areas in the lung where the gas can’t travel due to blockage of the airways.

To measure the size and location of these areas of decreased lung ventilation over time, researchers performed two same-day 3He MRI scans, less than 90 minutes apart, on 26 of the patients, while 17 patients underwent three separate 3He MRI scans over the course of 50 days, on average. The UVA team found that a significant number of the areas with decreased lung ventilation, also called ventilation defects, remained in the same location and stayed relatively the same in size for both patient groups.

“The 3He MRI technique has the potential to become an important research tool for scientists studying asthma,” de Lange says. “Researchers could use this technique to determine whether certain asthma medications are effective, to help in differentiating asthma from other chronic pulmonary diseases and even to determine if there are different types of asthma.”

Long-term Use Of Popular Inhalers Increases Risk Of Pneumonia For COPD Patients

Newly published research out of Wake Forest University School of Medicine finds that a popular class of anti-inflammatory inhalers significantly increases the risk of pneumonia in patients with Chronic Obstructive Pulmonary Disease (COPD

The study appears in this month's issue of Archives of Internal Medicine and focuses on the incidence of pneumonia in patients with COPD who were exposed to inhaled corticosteroid drugs, either alone or in combination with other drugs.

COPD is a progressive disease that makes it hard to breathe. It can cause coughing that produces large amounts of mucus, wheezing, shortness of breath, chest tightness and other symptoms. Cigarette smoking is the leading cause of COPD, and most people who have COPD smoke or are former smokers. Long-term exposure to other lung irritants, such as air pollution, chemical fumes or dust, also may contribute to COPD.

COPD is currently the fourth-leading cause of death in the United States, accounting for more than 120,000 deaths annually and costing more than $30 billion each year, according to the National Lung Health Education Program. It is estimated that more than 16 million Americans have COPD; however, that number is rising rapidly and the disease often goes undiagnosed, so some estimates put the actual number of Americans afflicted with the disease as high as 24 million.

Inhaled corticosteroids, used alone or in combination with other drugs for the treatment of asthma, are not approved for use alone in patients with COPD, but rather in combination with beta-antagonists, which dilate the lungs. The available inhaled steroid combinations are fluticasone/salmeterol, marketed byGlaxoSmithKline as AdvairTM, and budesonide/formoterol, marketed by AstraZeneca as SymbicortTM.

The inhalers are effective in relieving many of the symptoms of COPD, but have been associated with an increased risk of pneumonia in recent studies.

For the current study, researchers reviewed 18 randomized clinical trials, several of which were unpublished, involving nearly 17,000 patients in total. They compared the incidence of pneumonia in patients who had taken inhaled corticosteroids for at least 24 weeks versus patients who had taken a placebo, or patients who had taken combination inhaled corticosteroids and long-acting beta-antagonists versus patients who took only the long-acting bronchodilator.

Analysis of the results showed that inhaled corticosteroid use, alone or in combination with bronchodilators, for at least 24 weeks was associated with a significantly increased risk of pneumonia and serious pneumonia (60 to 70 percent increase); however, it was not associated with an increased risk of death. In absolute terms, the study showed that nearly one in every 47 patients with COPD using a corticosteroid inhaler for one year is likely to develop pneumonia linked to use of the drug.

"Our robust meta-analysis … clarifies that the risk of pneumonia reported as a serious adverse event, can be specifically attributed to the long-term use of the inhaled steroid component," the researchers wrote in their report.

Researchers advised that these results pertain specifically to COPD patients rather than asthma patients, and recommend that "clinicians should remain vigilant for the development of pneumonia with inhaled corticosteroids, as the signs and symptoms of pneumonia may closely mimic that of COPD exacerbations."

"Given the substantial emerging risk of pneumonia and its associated morbidity and mortality in patients with chronic obstructive lung disease, and the uncertain benefit of adding an inhaled corticosteroid to a long-acting bronchodilator, clinicians should re-evaluate the benefit-harm profile of long-term inhaled corticosteroid use among patients with COPD," said Sonal Singh, M.D., M.P.H., an assistant professor of internal medicine and lead investigator for the study.

Co-researchers for this study were Aman V. Amin, M.D., of Wake Forest University School of Medicine, and Yoon K. Loke, M.D., MBBS, of the University of East Anglia, Norwich, United Kingdom.

Code Of The Common Cold Cracked


Scientists have begun to solve some of the mysteries of the common cold by putting together the pieces of the genetic codes for all the known strains of the human rhinovirus. Researchers at the University of Maryland School of Medicine in Baltimore and colleagues at the University of Wisconsin-Madison have completed the genomic sequences of the viruses and assembled them into a "family tree," which shows how the viruses are related, with their commonalities and differences.

The researchers say this work provides a powerful tool that may lead to the development of the first effective treatments against the common cold.

"There has been no success in developing effective drugs to cure the common cold, which we believe is due to incomplete information about the genetic composition of all these strains," says the study's senior author, Stephen B. Liggett, M.D., professor of medicine and physiology at the University of Maryland School of Medicine and director of its Cardiopulmonary Genomics Program.

"We generally think of colds as a nuisance, but they can be debilitating in the very young and in older individuals, and can trigger asthma attacks at any age. Also, recent studies indicate that early rhinovirus infection in children can program their immune system to develop asthma by adolescence," says Dr. Liggett, who is a pulmonologist and molecular geneticist.

Major discoveries of the study

The researchers found that human rhinoviruses are organized into about 15 small groups that come from distant ancestors. The discovery of these multiple groups explains why a "one drug fits all" approach for anti-viral agents does not work. But, says Dr. Liggett, "Perhaps several anti-viral drugs could be developed, targeted to specific genetic regions of certain groups. The choice of which drug to prescribe would be based on the genetic characteristics of a patient's rhinovirus infection."

Dr. Liggett adds that while anti-viral drugs seem to be the most likely to succeed, "the data gathered from these full genome sequences gives us an opportunity to reconsider vaccines as a possibility, particularly as we gather multiple-patient samples and sequence the entire genomes, to see how frequently they mutate during a cold season. That work is underway now."

The researchers also found that the human rhinovirus skips a step when it makes its protein product, a shortcut that probably speeds up its ability to make a person feel sick soon after infection. "This is a new insight," says co-investigator Claire M. Fraser-Liggett, Ph.D., director of the Institute for Genome Sciences and professor of medicine and microbiology at the University of Maryland School of Medicine. "We would not have had any sort of intuition about this had it not been revealed through genome analysis. Information that comes from this discovery might present a completely different approach in terms of therapy."

The analysis shows that some human rhinoviruses result from the exchange of genetic material between two separate strains of the virus that infect the same person. Such a swap, known as recombination, was previously not thought possible in human rhinovirus. During cold season, when many different strains of rhinovirus may be causing infections, recombination could rapidly produce new strains.

Multiple mutations (as many as 800) were evident in virus samples taken recently from patients with colds, compared to older rhinovirus reference strains. Some viruses mutate by making slight changes in certain proteins to avoid being destroyed by antibodies from a person's immune system. "Mutations were found in every area of the genome," says Dr. Liggett.

The study's lead author, Ann C. Palmenberg, Ph.D., professor of biochemistry and chair of the Institute for Molecular Virology at the University of Wisconsin-Madison, notes, "As we begin to accumulate additional samples from a large number of patients, it is likely that hotspots for mutation or recombination will become apparent, and other regions resistant to mutational change may emerge. This will provide clues as to how flexible the virus is as it responds to the human environment, important hints if you are designing new therapeutics."

Study background

Human rhinovirus infection is responsible for half of all asthma attacks and is a factor in bronchitis, sinusitis, middle ear infections and pneumonia. The coughs, sneezes and sniffles of colds impose a major health care burden in the United States—including visits to health care providers, cost of over-the-counter drugs for symptom relief, often-inappropriate antibiotic prescriptions and missed work days—with direct and indirect costs of about $60 billion annually.

Prior to the start of this project, the genomes of only a few dozen rhinoviruses had been sequenced from what was considered the reference library, a frozen collection of 99 different rhinovirus strains taken from patients over a span of more than two decades. During this team's work, several other groups began to report the full genomes of some of these viruses, as well as some odd rhinovirus-like strains from relatively sick patients.

"It was clear to us that the spectrum of rhinoviruses out there was probably much greater than we realized. Further, we needed to develop a framework from which we could begin to figure out ways to combat these viruses and use their genetic signatures to predict how a specific virus would affect a patient," says Dr. Fraser-Liggett.

The current study adds 80 new full genome sequences to the rhinovirus library and 10 more acquired recently from people with colds. Each sequence was modeled and compared to each other. Dr. Liggett says, "Now we can put together many pieces of the human rhinovirus puzzle to help us answer some fundamental questions: how these rhinoviruses might mutate as they spread from one person to another; which rhinoviruses are more associated with asthma exacerbations and why rhinovirus exposure in infancy may cause asthma later in life. With all this information at hand, we see strong potential for the development of the long-sought cure for the common cold, using modern genomic and molecular techniques."

"With recent improvements in technology, including next-generation DNA sequencing tools, it has become easier to generate whole genome sequence information," says Dr. Fraser-Liggett. "There is no reason any longer to focus on a very limited part of the rhinovirus molecule to learn what it's doing, what the predominant strain is in a population, or to try to infer what the evolution of the entire molecule might be. Instead, by studying the complete genome sequence, we can answer multiple questions in parallel."

Researchers from the J. Craig Venter Institute also contributed to this study.

The University of Maryland School of Medicine funded this project.

Pollution-related Asthma May Start In The Womb

Children born in areas with increased traffic-related pollution may be at greater risk of developing asthma due to genetic changes acquired in the womb, according to new research from the University of Cincinnati (UC) and Columbia University Mailman School of Public Health.

In a study of umbilical cord blood from New York City children, researchers have discovered evidence of a possible new biomarker—an epigenetic alteration in the gene ACSL3—associated with prenatal exposure to polycyclic aromatic hydrocarbons (PAHs). These chemical compounds are created as byproducts of incomplete combustion from carbon-containing fuels, resulting in high levels in heavy-traffic areas. Exposure to PAHs has been linked to diseases such as cancer and childhood asthma.

Researchers say this finding provides a potential clue for predicting environmentally related asthma in children—particularly those born to mothers who live in high-traffic areas like Northern Manhattan and South Bronx when pregnant.

This is the first study to examine the effects of prenatal ambient air pollutant exposure on epigenetic changes linked to asthma. Epigenetic changes may disrupt the normal functioning of genes by affecting their expression but do not cause structural changes or mutations in the genes.

The team reports its findings in the Feb. 16, 2009, issue of PLoS One.

For this study, UC researchers teamed with Columbia's Mailman School of Public Health to study the relationship between prenatal PAH exposure and childhood asthma, hypothesizing that transplacental exposure to PAHs could "reprogram" fetal genes and lead to airway inflammation or asthma during childhood. Epigenetic reprogramming is the result of an organism's genes interacting with the environment.

"Our data support the concept that environmental exposures can interact with genes during key developmental periods to trigger disease onset later in life, and that tissues are being reprogrammed to become abnormal later," says Shuk-mei Ho, PhD, senior author of the paper, chair of UC's Department of Environmental Health and the director of the Center for Environmental Genetics.

"This research is aimed at detecting early signs of asthma risk so that we can better prevent this chronic disease that affects as many as 25 percent of children in Northern Manhattan and elsewhere," adds Frederica Perera, DrPH, professor of environmental health sciences and director of the Columbia Center for Children's Environmental Health (CCCEH) at the Mailman School of Public Health and co- first author on the paper.

Using biological specimens from the CCCEH birth cohort of mothers and children living in Northern Manhattan and the South Bronx, UC scientists analyzed umbilical cord white blood cell samples from 56 children for epigenetic alterations related to prenatal PAH exposure. (The mothers' exposure to PAHs was monitored during pregnancy using backpack air monitors).

The researchers found a significant association between changes in ACSL3 methylation—a gene expressed in the lung—and maternal PAH exposure. ACSL3 also was associated with a parental report of asthma symptoms in the children prior to age 5.

With confirmation in further studies, researchers say changes in the ACSL3 gene could serve as a novel biomarker for early diagnosis of pollution-related asthma.

"This study provides a blueprint for the discovery of epigenetic biomarkers relevant to other investigations of exposure-disease relationships in birth cohorts," says Wan-yee Tang, PhD, a UC research scientist and a co-first author on the paper.

"Understanding early predictors of asthma is an important area of investigation," adds Rachel Miller, MD, director of the CCCEH asthma project and study co-author, "because they represent potential clinical targets for intervention."

The CCCEH birth cohort was launched in 1998 to study the effects of prenatal exposure to common urban pollutants on the health of mothers and their children. Children in the cohort were born to non-smoking Dominican and African-American women in Northern Manhattan or the South Bronx and follow-up is ongoing.

Funding for the multi-institutional study comes from the National Institute of Environmental Health Sciences (NIEHS), the U.S. Environmental Protection Agency (EPA) and private foundations. UC's Linda Levin, PhD and Columbia University Mailman School's Julie Herbstman, PhD, and Deliang Tang, MD, DrPH, were also co-authors of the study.

Eosinophils As Markers For Asthma: Largest Scale Study So Far On Asthma Genetics Sheds Light On Disease Mechanisms

In the study, the Icelandic company Decode Genetics together with Helmholtz Zentrum München and a number of other international research institutes performed a genome-wide association scan of more than 50,000 test persons. The researchers found several sequence variants associated with asthma.

“Two of the detected sequence variants are of significance for a biochemical pathway in the interleukin-1 cluster,” explained Dr. Matthias Wjst, who was one of the initiators of the study at the Institute of Inhalation Biology of Helmholtz Zentrum München. This finding confirms the results of a research group at Helmholtz Zentrum München from 2004, which showed that the IL-1 gene cluster is associated with asthma.

“We do not yet know what mechanisms underlie the effect of these sequence variants on the inflammatory cells,” Dr. Wjst said, “but these findings give us new starting points for a better understanding of the various hypotheses of allergic inflammation.”

Allergic and respiratory diseases are among the key research areas of Helmholtz Zentrum München, which is dedicated to disease research at the interface of genetics, lifestyle and environmental influences. The center’s research goal is to elucidate biological mechanisms to achieve a better understanding of the disease process and thus to develop therapies and prevention strategies.

Vitamin D Deficiency In Infants And Nursing Mothers Carries Long-term Disease Risks

Once believed to be important only for bone health, vitamin D is now seen as having a critical function in maintaining the immune system throughout life. The newly recognized disease risks associated with vitamin D deficiency are clearly documented in a new report.

Vitamin D deficiency is common across populations and particularly among people with darker skin. Nutritional rickets among nursing infants whose mothers have insufficient levels of vitamin D is an increasingly common, yet preventable disorder.

Carol Wagner, MD, Sarah Taylor, MD, and Bruce Hollis, PhD, from the Department of Pediatrics, Medical University of South Carolina (Charleston), emphasize the need for clinical studies to determine the dose of vitamin D needed to achieve adequate vitamin D levels in breastfeeding mothers and their infants without toxicity.

The authors point out that vitamin D is now viewed not simply as a vitamin with a role in promoting bone health, but as a complex hormone that helps to regulate immune system function. Long-term vitamin D deficiency has been linked to immune disorders such as multiple sclerosis, rheumatoid arthritis, type I diabetes, and cancer.

"Vitamin D is a hormone not a vitamin and it is not just for kids anymore," writes Ruth A. Lawrence, MD, Editor-in-Chief of Breastfeeding Medicine, from the Department of Pediatrics, University of Rochester School of Medicine and Dentistry, in an accompanying editorial. "Perhaps the most startling information is that adults are commonly deficit in modern society. Vitamin D is now recognized as a pivotal hormone in the human immune system, a role far beyond the prevention of rickets, as pointed out in the article by Wagner et al in this month's issue of Breastfeeding Medicine."

Immunotherapy Alleviates Hay Fever And Asthma In Children, Study Finds

Taking one grass pollen tablet every day can alleviate hay fever and asthma in children.

These are the results of a study by medical experts in the team led by Prof. Dr. Albrecht Bufe (Experimental Pneumology) at the Ruhr-Universität Bochum. The study was carried out jointly with national colleagues and featured 253 children. Under this particular treatment, asthma symptoms declined by 64% and hay fever symptoms by 24%. The results are published in the current issue of the Journal of Allergy and Clinical Immunology.

Dreaded allergic march

Up to 25% of the population in western industrial countries have hay fever. Far worse than the impact of the hay fever syndrome on the quality of life and capacity to work is the risk of the so-called allergic march, particularly in children: 10 to 50% of all child patients with untreated hay fever will develop asthma later on. To prevent this, medical experts opt for immunotherapies that aim to get the immune system slowly accustomed to whichever types of pollen are causing the allergy so that it no longer overreacts.

Active substance vs. placebo

This is also the aim of the grass pollen tablets which patients place once a day under their tongue where it dissolves. The participants in the study aged between 5 and 16 years were allocated at random to one of the two study groups, receiving either real tablets with active substance or placebos without active substance. Daily intake began two to six months before the start of the pollination season and continued until the season finished. The test persons kept records about their symptoms and their intake of corresponding medication, such as nasal spray or asthma spray. In addition, regular blood tests were carried out to see how their immune system reacted.

Clear improvement thanks to the grass pollen tablet.

The results confirmed the effect of the grass pollen tablets: hay fever symptoms were up 24% less pronounced in the group taking the active substance than in the placebo group. Accordingly, the group needed 34% less medication. Asthma symptoms decreased by up to 64%. The immunological blood tests confirmed the effect of the tablet. In general, the grass pollen tablets were well tolerated, apart from frequent itchiness in the mouth as a temporary side effect.

"Just as with adults, this immunotherapy with the tablet being placed under the tongue is also very promising in children", concludes Prof. Bufe. Further studies will be necessary to see whether there are any long-term improvements in the allergy. "For a long time now, standard hay fever treatment has consisted of desensitization/immunotherapy with the allergens being injected under the skin. If it transpires that the grass tablets have a similarly effective long-term impact, in future it will be possible to replace the injection therapy with sublingual treatment, and now also in children."

Traffic Exhaust Can Cause Asthma, Allergies And Impaired Respiratory Function In Children

Children exposed to high levels of air pollution during their first year of life run a greater risk of developing asthma, pollen allergies, and impaired respiratory function. However, genetic factors are also at play. These are the results of a new study conducted under the BAMSE project.

The BAMSE project has monitored 4,000 children in Stockholm county from birth in order to assess whether exposure to traffic pollution during their first year of life affects the risk of developing asthma and allergies. Levels of traffic exhaust were measured at the site of the home. The results show that the children who were exposed to high concentrations of pollutants ran a 60 per cent higher risk of suffering of persistent asthma symptoms. Respiratory function was also adversely affected, and the children were much more likely to be allergic to airborne allergens, particularly pollen.

Studies were also made of how the risk of developing air pollution-related allergies is influenced by genetic factors. It was found that children carrying a variant of GSTP1 (glutathione S-transferase P1) gene, which is crucial to the body's ability to take care of air pollutants (the antioxidative system), run a greater risk of developing an allergy linked to traffic-related air pollution. According to new analyses, variants of another 'asthma gene', TNF (tumour necrosis factor), also affect sensitivity to air pollution. Children with a particular combination of GSTP1 and TNF variants run a considerably higher risk of developing allergies.

The children studied in the BAMSE project are now 12 years old, and an on-line follow-up survey of the children and their parents has now been launched. The answers to the survey will provide information about health, lifestyle and environmental conditions, including air pollution, during the children's lives.

Conclusions

  1. Children who grow up in Stockholm are at greater risk of developing asthma, respiratory problems and pollen allergies if they live in areas where there are high concentrations of traffic pollution.
  2. Not all children who live in areas with high levels of air pollution develop allergies. Whether they do or not is partly determined by genetic factors.
  3. For the first time, data are now obtained for the BAMSE project using web-based techniques, which give more reliable answers.

The BAMSE project is run by the Stockholm County Council's unit for Occupational and Environmental Medicine and the Institute of Environmental Medicine at Karolinska Institutet.

Vitamin D Deficiency May Increase Risk Of Colds, Flu

Vitamin D may be an important way to arm the immune system against disorders like the common cold, report investigators from the University of Colorado Denver (UC Denver) School of Medicine, Massachusetts General Hospital (MGH) and Children's Hospital Boston.

In the largest and most nationally representative study of the association between vitamin D and respiratory infections, people with the lowest blood vitamin D levels reported having significantly more recent colds or cases of the flu. The risks were even higher for those with chronic respiratory disorders, such as asthma and emphysema. The report appears in the February 23 Archives of Internal Medicine.

"The findings of our study support an important role for vitamin D in prevention of common respiratory infections, such as colds and the flu," says Adit Ginde, MD, MPH, UC Denver Division of Emergency Medicine and lead author of the study. "Individuals with common lung diseases, such as asthma or emphysema, may be particularly susceptible to respiratory infections from vitamin D deficiency."

While vitamin C has been used for the prevention of colds and other respiratory disorders for decades, little scientific evidence supports its effectiveness. In contrast, in recent years evidence has accumulated that vitamin D – most commonly associated with the development and maintenance of strong bones – may also play a key role in the immune system. Circumstantial evidence has implicated the wintertime deficiency of vitamin D, which the body produces in response to sunlight, in the seasonal increase in colds and flu; and small studies have suggested an association between low blood levels of vitamin D and a higher risk of respiratory infections.

The current study analyzed data from the Third National Health and Nutrition Examination Survey (NHANES III), conducted by the National Center for Health Statistics. Participants were interviewed in their homes regarding their health and nutrition, and most participants also received a physical examination that included collection of blood and other samples for laboratory analysis. The research team analyzed blood levels of 25-hydroxyvitamin D (25OHD) – the best measure of vitamin D status – from almost 19,000 adult and adolescent NHANES III participants, selected to be representative of the overall U.S. population.

Study participants with the lowest vitamin D blood levels – less than 10 ng per milliliter of blood – were about 40 percent more likely to report having a recent respiratory infection than were those with vitamin D levels of 30 or higher. The association was present in all seasons and even stronger among participants with a history of asthma or chronic obstructive pulmonary disease (COPD), including emphysema. Asthma patients with the lowest vitamin D levels were five times more likely to have had a recent respiratory infection; while among COPD patients, respiratory infections were twice as common among those with vitamin D deficiency.

"A respiratory infection in someone with otherwise healthy lungs usually causes a few days of relatively mild symptoms," explains Carlos Camargo, MD, DrPH, MGH Department of Emergency Medicine and senior author of the study. "But respiratory infections in individuals with an underlying lung disease can cause serious attacks of asthma or COPD that may require urgent office visits, emergency department visits or hospitalizations. So the impact of preventing infections in these patients could be very large."

The authors stress that the study's results need to be confirmed in clinical trials before vitamin D can be recommended to prevent colds and flu. "We are planning clinical trials to test the effectiveness of vitamin D to boost immunity and fight respiratory infection, with a focus on individuals with asthma and COPD, as well as children and older adults – groups that are at higher risk for more severe illness," Ginde says. "While it's too early to make any definitive recommendations, many Americans also need more vitamin D for its bone and general health benefits. Clinicians and laypeople should stay tuned as this exciting area of research continues to expand."

Ginde is an assistant professor of Surgery at UC Denver School of Medicine, and Camargo is an associate professor of Medicine at Harvard Medical School. Jonathan Mansbach, MD, of Children's Hospital Boston is a co-author of the Archives of Internal Medicine report. The study was supported by grants from the National Institutes of Health, the National Heart, Lung and Blood Institute, and the MGH Center for D-receptor Activation Research.

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