A newly published study from the University of Waterloo suggests that increasing the ratio of dietary potassium to sodium intake may be more effective for lowering blood pressure than simply reducing sodium intake.
“Usually, when we have high blood pressure, we are advised to eat less salt,” said Dr Anita Layton, professor at the University of Waterloo. “Our research suggests that adding more potassium-rich foods to your diet, such as bananas or broccoli, might have a greater positive impact on your blood pressure than just cutting sodium.”
Potassium and sodium are both electrolytes – substances that help the body send electrical signals to contract muscles, affect the amount of water in your body and perform other essential functions.
“Early humans ate lots of fruits and vegetables, and as a result, our body’s regulatory systems may have evolved to work best with a high potassium, low sodium diet,” said Melissa Stadt, a PhD candidate in Waterloo’s Department of Applied Mathematics and the lead author of the study.
“Today, western diets tend to be much higher in sodium and lower in potassium. That may explain why high blood pressure is found mainly in industrialised societies, not in isolated societies.”
While previous research found that increasing potassium intake can help control blood pressure, the researchers developed a mathematical model that successfully identifies how the ratio of potassium to sodium impacts the body.
The model also identifies how sex differences affect the relationship between potassium and blood pressure. The study found that men develop high blood pressure more easily than pre-menopausal women, but men are also more likely to respond positively to an increased ratio of potassium to sodium.
The researchers emphasise that mathematical models like the one used in this study allow these kinds of experiments to identify how different factors impact the body quickly, cheaply, and ethically.
Findings in the Journal of Investigative Dermatology reinforce the role of weight management in psoriasis care
Source: Pixabay CC0
Researchers have found that central body fat, especially around the abdomen, is more strongly linked to psoriasis risk than total body fat, particularly in women. This link between central fat and psoriasis remained consistent regardless of genetic predisposition, indicating that abdominal fat is an independent risk factor. The study in the Journal of Investigative Dermatology, published by Elsevier, provides insights that could help improve early risk prediction and guide personalised prevention strategies.
While it is well established that increasing levels of body fat raise the risk of developing psoriasis, the impact of specific fat distribution and genetics remains unclear.
Researchers of the current study analysed data from over 330 000 participants with White British ancestry in the UK Biobank, including more than 9000 people with psoriasis. They examined 25 different measures of body fat using both traditional methods and advanced imaging techniques, assessing how each was associated with psoriasis.
Lead investigator Ravi Ramessur, MD, St John’s Institute of Dermatology, King’s College London, explains, “Our research shows that where fat is stored in the body matters when it comes to psoriasis risk. Central fat – especially around the waist – seems to play a key role. This has important implications for how we identify individuals who may be more likely to develop psoriasis or experience more severe disease, and how we approach prevention and treatment strategies.”
Senior author Catherine H. Smith, MD, also at King’s College London, adds, “As rates of obesity continue to rise globally, understanding how different patterns of body fat influence chronic inflammatory conditions such as psoriasis is important. Our findings suggest that central body fat contributes to psoriasis risk irrespective of genetic predisposition and reinforces the importance of measuring waist circumference and pro-active healthy weight strategies in psoriasis care.”
Because this study only included individuals of White British ancestry from the UK Biobank, the generalisability of these findings to more diverse populations may be limited. Future studies incorporating datasets with dermatologist-confirmed diagnoses and broader ethnic representation will be important to further validate these associations and refine risk stratification approaches.
Dr Ramessur notes, “We were surprised by how consistently strong the association was across different central fat measures and how much stronger the effect was in women. The observed links between central body fat and psoriasis suggest that there may be underlying biological mechanisms contributing to the disease that are not yet fully understood and which warrant further investigation.”
In an accompanying editorial Joel M. Gelfand, MD, MSCE, FAAD, at the University of Pennsylvania Perelman School of Medicine, points to the potential of incretin therapy for psoriatic disease. Incretins are gut-derived hormones, principally glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP), that regulate glucose, digestion, and appetite, and are approved for treatment of diabetes, obesity, and obesity-associated obstructive sleep apnoea.
Dr Gelfand comments, “The strong relationship between psoriasis and obesity and the emerging promise of glucagon-like peptide-1 receptor agonists (GLP1RA) for reducing psoriasis morbidity is a call to action for large scale clinical trials of GLP1RA monotherapy for treatment of psoriasis. Our current paradigm of just focusing on the skin and joint manifestations when treating psoriasis is outdated in the context of our evolving understanding of the tight relationship of psoriasis, obesity, and cardiometabolic disease.“
When a physician says a procedure is “rarely risky,” what does that really mean? Although terms like “common” and “unlikely” may sound descriptive enough, experts in medical decision-making suggest that leaving out numbers may be misleading for patients.
In a paper published in the Journal of General Internal Medicine, a team of researchers and clinicians explained that patients often overestimate risk estimates, like possible side effects or medical conditions, when given only verbal descriptions. They encourage doctors not to shy away from including numbers, offering a list of five science-backed tricks on how to make those numbers count.
“One of the purposes of this paper is to help physicians figure out how to communicate numeric information about risks so that patients can understand and use them to make better choices, take charge of their health and be healthier long term,” said Ellen Peters, a professor at the University of Oregon School of Journalism and Communication and Department of Psychology.
Peters draws on two decades of research on how patients understand numbers and make decisions. She said it’s a common concern that patients won’t understand numerical information, as about a third of American adults have limited numerical skills.
But she’s found that people often prefer getting numbers. According to her previous studies, people rated messages more trustworthy and their messenger more expert when they provided data.
In collaboration with physicians Paul K.J. Han of the National Cancer Institute and Clara N. Lee at the University of North Carolina, Peters hopes their recommended strategies will facilitate stronger shared decision-making between patients and their health care providers.
“There’s a whole raft of strategies that you can use, some of which might be more appropriate in one situation versus the other,” she said. “But by choosing one of them, you can help people use statistics more than they typically would. Otherwise, numbers are just abstract and meaningless.”
Communicate with numbers, not just words
Physicians often default to verbal terms, knowing that a sizable portion of American adults struggle with simple numeric concepts, Peters said. But research has shown that people better understand risks and react appropriately when numbers are discussed alongside verbal descriptions.
“When you present numeric evidence, like the likelihood of side effects for a prescription medication, what ends up happening is that it helps correct people’s original expectation,” Peters said. “They’re much less likely to overestimate the risk and are more likely to take on a physician’s recommendations.”
Do: “Headache is a common side effect and occurs in 7 percent of people.”
Don’t: “Headache is a common side effect.”
Make numbers more manageable
When patients are overwhelmed by medical information, they may rely on mental problem-solving techniques, like gut feelings, pre-existing beliefs and anecdotes they’ve heard from others. To avoid cognitive overload, Peters suggests limiting information to what’s important. If a disease has three intervention options but a patient has a condition that eliminates one as a viable option, she advises not to mention that option.
The authors also suggest clinicians do the math for their patients. For example, they can calculate the risk of birth control based on the number of years the patient expects to use it instead of the annual risk.
Do: Highlight only the key facts and tailor information to the patient’s situation.
Don’t: Provide information that isn’t relevant to a specific patient.
Provide context to statistics
Numbers said alone can be meaningless, so Peters suggests using evaluative labels, like “a 6 percent risk is generally considered poor,” or comparisons to indicate whether it’s high or low risk.
Do: “Ninety-three percent of patients survive with treatment A compared to 99 percent who survive with treatment B.”
Don’t: “Ninety-three percent of patients survive with treatment A.”
Acknowledge uncertainty
Risk information is an estimate. In some cases, being upfront about the uncertainty of whether a patient will be a part of the 40 percent side or the 60 percent side of a risk, for example, can help convey to patients how seriously they should take it.
Do: “Estimates of the chance of something happening are only a best guess based on the scientific knowledge we have right now. We do not know your personal real risk because of things about you that have never been studied and we don’t yet understand.”
Don’t: Present numeric risk information as unerringly precise and correct.
Test your communication through the teach-back technique
Experts tend to overestimate how much other people know and how clearly they’ve communicated. So doctors can use the teach-back technique, Peters said, in which they ask their patient to repeat what they understood and found important. The physician can then insert more information to either correct what’s wrong or remind them of something.
Do: “This can be hard to understand. I’d like to make sure I’ve explained it clearly. Could you tell me how you understand the pros and cons of taking drug X?”
Don’t: “What questions do you have?”
Such strategies also can be used by patients to advocate for themselves, Peters said. If told about a possible side effect, they can ask how statistically likely it is. If given too many possible side effects or treatments, they can request to simplify the information to the most important facts.
Peters plans to conduct a series of studies to test which of the five strategies is the most effective. She also is interested in how storytelling and anecdotes affect patient decision-making.
“Physicians have very limited time in any one appointment and are often faced with a similar patient over and over,” Peters said. “What that means is, if you’re trying to help them better communicate with patients, you’ve got to provide things that are fast and scripted so that everyone can make informed decisions about their care.”
People with Parkinson’s disease increasingly lose their mobility over time and are eventually unable to walk. Hope for these patients rests on deep brain stimulation. In a recent study, researchers at Ruhr University Bochum and Philipps-Universität Marburg, Germany, investigated whether and how stimulation of a certain region of the brain can have a positive impact on ambulatory ability and provide patients with a better quality of life. To do so, the researchers used a technique in which the nerve cells are activated and deactivated via light. Their report appeared in the journal Scientific Reports.
Improving ambulatory ability
If medication is no longer sufficient in alleviating restricted mobility in the advanced stage of Parkinson’s disease, one alternative is deep brain stimulation. An electrical pulse emitter is implanted within the brain, such as in the subthalamic nucleus, which is functionally part of the basal ganglia system.
The group under Dr Liana Melo-Thomas from Philipps-Universität Marburg was able to show in previous studies on rats that stimulation of the inferior colliculus, chiefly known for processing auditory input, can be used to overcome mobility restrictions. “There are indications that stimulation of this region of the brain leads to activation of the mesencephalic locomotor region, or MLR,” says Melo-Thomas.
Interestingly, the colliculus inferior – unlike the basal ganglia –is not affected by Parkinson’s disease. However, the research group under Melo-Thomas discovered that its stimulation activates alternative motor pathways and can improve patients’ mobility.
The current study aimed to further investigate this activating influence of the inferior colliculus on the MLR. “We suspected that this would have a positive effect on ambulatory ability,” says Melo-Thomas.
Optically influencing nerve cells
The Marburg group led by Professor Rainer Schwarting sought support by Dr Wolfgang Kruse from the Department of General Zoology and Neurobiology at Ruhr University Bochum. The team in Bochum led by Professor Stefan Herlitze played a significant role in co-developing the methods of optogenetics.
While doing so, the researchers ensure that the nerve cells of genetically modified test animals produce a light-sensitive protein in interesting regions of the brain. Light that reaches these nerve cells via small, implanted optical fibres allows the researchers to activate or inhibit them specifically. “This method is thus much more precise than electrical stimulation, which always affects the area around the cells as well,” says Kruse.
For the first time, the effect of the stimulation was directly documented with electrophysiological measurements of neuronal activity in the target structures. A multi-electrode system originally developed at Philipps-Universität Marburg was used for this purpose. By combining these methods, the researchers were able to directly understand the effect of the stimulation. Parallel measurement with up to four electrodes is also highly efficient, allowing minimisation of the number of animals used. Behavioural effects that can be triggered by the stimulation were monitored in conscious animals.
Stimulation of the inferior colliculus provides the desired effect
Optogenetic stimulation in the inferior colliculus predominantly triggered the expected increase in neuronal activity within it. “Simultaneous measurements in the deeper MLR region showed increased activity in the majority of cells, although nearly one quarter of the cells were inhibited by the additional activity in the inferior colliculus,” reports Kruse. The activation of individual nerve cells occurred with an average delay of 4.7 milliseconds, indicating a functional synaptic interconnection between the inferior colliculus and MLR.
Foundations for new types of therapy
Investigating circuits outside of the basal ganglia that are affected by Parkinson’s disease is a promising step in the search for a new therapeutic approach to alleviating motor deficits resulting from the disease. Such is the case with the connection between the inferior colliculus and the MLR that was investigated for this study.
“Even if the path toward new therapeutic approaches to alleviating the symptoms of Parkinson’s disease still appears long, such foundational research is immensely important,” emphasises Kruse. The exact mechanisms that lead to the observed relief of symptoms with deep brain stimulation in the basal ganglia are not fully understood. Further investigation of the underlying interconnections may provide new insight that could optimise therapy in the long term.
Intakes of dietary fibre as well as high-quality and total carbohydrates in midlife were favourably linked to healthy aging and other positive health outcomes in older women, according to a new study appearing in the journal JAMA Network Open.
“We’ve all heard that different carbohydrates can affect health differently, whether for weight, energy, or blood sugar levels. But rather than just look at the immediate effects of these macronutrients, we wanted to understand what they might mean for good health 30 years later,” said Andres Ardisson Korat, a scientist at Tufts University and lead author of the study. “Our findings suggest that carbohydrate quality may be an important factor in healthy aging.”
Researchers from Tufts University and Harvard T.H. Chan School of Public Health analysed data from Nurses’ Health Study questionnaires collected every four years between 1984 and 2016. They examined the midlife diets and eventual health outcomes of more than 47 000 women who were between the ages of 70 and 93 in 2016. Intakes of total carbohydrates, refined carbohydrates, high-quality (unrefined) carbohydrates, carbohydrates from whole grains, fruits, vegetables, and legumes, dietary fibre, and the dietary glycaemic index and glycaemic load were derived from the validated food-frequency questionnaires. The researchers defined healthy aging as the absence of 11 major chronic diseases, lack of cognitive and physical function impairments, and having good mental health, as self-reported in the Nurses’ Health Study questionnaires. In the new study, 3706 participants met the healthy aging definition.
The analysis showed intakes of total carbohydrates, high-quality carbohydrates from whole grains, fruits, vegetables, and legumes, and total dietary fibre in midlife were linked to 6 to 37% greater likelihood of healthy aging and several areas of positive mental and physical health. In the other direction, intakes of refined carbohydrates (carbohydrates from added sugars, refined grains, and potatoes) and starchy vegetables were associated with 13% lower odds of healthy aging.
“Our results are consistent with other evidence linking consumption of fruits and vegetables, whole grains, and legumes with lower risks of chronic diseases, and now we see the association with physical and cognitive function outcomes,” said senior author Qi Sun, associate professor in the departments of nutrition and epidemiology at Harvard Chan School.
The authors note as a limitation that the study population was composed mostly of white health professionals; future research will be necessary to replicate these findings in more diverse cohorts.
Ardisson Korat also noted that additional work is needed to understand the potential mechanisms linking dietary fiber and high-quality carbohydrates to healthy aging.
“Studies are starting to find an association between food choices in midlife and quality of life in later years. The more we can understand about healthy aging, the more science can help people live healthier for longer,” added Ardisson Korat.
Deciding whether to start hormone therapy during the menopause transition, the life phase that’s the bookend to puberty and when a woman’s menstrual cycle stops, is a hotly debated topic. While hormone therapy is recommended to manage bothersome symptoms like hot flashes and night sweats, Matthew Nudy, assistant professor of medicine at the Penn State College of Medicine, said there’s confusion about the long-term effects of hormone therapy, especially on cardiovascular health.
However, long-term use of oestrogen-based hormone therapies may have beneficial effects on heart health, according to a new study led by Nudy. A multi-institutional team analysed data from hormone therapy clinical trials that were part of the Women’s Health Initiative (WHI), a long-term national study focused on menopausal women, and found that oestrogen-based hormone therapy improved biomarkers associated with cardiovascular health over time. In particular, the study suggests that hormone therapy may lower levels of lipoprotein(a), a genetic risk factor associated with a higher risk of heart attack and stroke.
“The pendulum has been swinging back and forth as to whether hormone therapy is safe for menopausal women, especially from a cardiovascular disease perspective,” Nudy said. “More recently, we’re recognising that hormone therapy is safe in younger menopausal women within 10 years of menopause onset, who are generally healthy and who have no known cardiovascular disease.”
The hormonal changes that accompany menopause come with an increased risk of cardiovascular disease. The decline in the oestrogen can lead to changes in cholesterol, blood pressure and plaque buildup in blood vessels, which increase the risk of heart attack and stroke.
The research team was interested in understanding the long-term effect of hormone therapy on cardiovascular biomarkers, which hasn’t been evaluated over an extended period of time. Prior research in the field primarily looked at short-term effects.
Here, the team analysed biomarkers associated with cardiovascular health over a six-year period from a subset of women who had participated in an oral hormone therapy clinical trial that was part of the WHI. Post-menopausal participants aged 50 to 79 were randomly assigned to one of two groups, an oestrogen-only group and an oestrogen plus progesterone group. They provided blood samples at baseline and at the one-, three- and six-years marks. In total, they analysed samples from 2696 women, approximately 10% of the total trial participants.
The research team found that hormone therapy had a beneficial effect on most biomarkers in both the oestrogen-only and the oestrogen-plus-progesterone groups over time. Levels of LDL cholesterol, the so-called “bad” cholesterol, were reduced by approximately 11% while total cholesterol and insulin resistance decreased in both groups. HDL cholesterol, the so-called “good” cholesterol, increased by 13% and 7% for the oestrogen-only and oestrogen-and-progesterone groups, respectively.
However, triglycerides and coagulation factors, proteins in the blood that help form blood clots, increased.
The decrease in lipoprotein(a) concentration was more pronounced among participants with American Indian or Alaska Native ancestry or Asian or Pacific Islander ancestry, by 41% and 38%, respectively. The reason why was unclear, Nudy said.
More surprising to the research team, they said, levels of lipoprotein(a), a type of cholesterol molecule, decreased 15% and 20% in the oestrogen-only and the oestrogen-plus-progesterone groups, respectively. Unlike other types of cholesterol, which can be influenced by lifestyle and health factors such as diet and smoking, concentrations of lipoprotein(a) are thought to be determined primarily by genetics, Nudy explained. Patients with a high lipoprotein(a) concentration have an increased risk of heart attack and stroke, especially at a younger age. There’s also an increased risk of aortic stenosis, where calcium builds up on a heart valve.
“As a cardiologist, this finding is the most interesting aspect of this research,” Nudy said. “Currently, there are no medications approved by the Food and Drug Administration (FDA) to lower lipoprotein(a). Here, we essentially found that oral hormone therapy significantly reduced lipoprotein(a) concentrations over the long-term.”
Nudy noted that the oestrogen therapy the women received in the clinical trial was conjugated equine oestrogens, a commonly prescribed form of oral oestrogen therapy. Before being absorbed by the body, oral hormone therapy is processed in the liver, through a process called first-pass metabolism. That process could increase inflammatory markers, which may explain the rise in triglycerides and coagulation factors.
“There are now other common formulations of oestrogen hormone therapy like transdermal oestrogen, which is administered through the skin,” Nudy said. “Newer studies have found that transdermal oestrogen doesn’t increase triglycerides, coagulation factors or inflammatory markers.”
For those considering menopause hormone therapy, Nudy recommended undergoing a cardiovascular disease risk assessment, even if the person hasn’t had a previous heart attack or stroke or hasn’t been diagnosed with cardiovascular disease. It will give health care providers more information when considering the best option to treat menopause symptoms.
“Currently, hormone therapy is not FDA-approved to reduce the risk of coronary artery disease or stroke,” Nudy said.
A breakthrough study, led by scientists at Waipapa Taumata Rau, University of Auckland, has uncovered how daylight can boost the immune system’s ability to fight infections.
The circadian clock is a 2.5-billion-year-old cellular timekeeper that allows organisms to adapt to the rhythms of day and night. Evidence has shown that disruption of our internal body clock through the likes of shift work or jet lag makes people more susceptible to infections, so the researchers wanted to find out what in the body contributed to that susceptibility.
“In earlier studies, we had observed that immune responses to infection peaked in the morning, during the animals’ early active phase,” says lead researcher Associate Professor Christopher Hall, from the Department of Molecular Medicine and Pathology.
“We think this represents an evolutionary response such that during daylight hours the host is more active so more likely to encounter bacterial infections,” says Hall.
However, the scientists wanted to find out how the immune response was being synchronised with daylight.
They focused on ‘neutrophils’ the most abundant immune cells in our bodies. These cells move quickly to the site of an infection and kill invading bacteria.
The scientists used zebrafish, a small freshwater fish, as a model organism, because its genetic make-up is similar to ours and they can be bred to have transparent bodies, making it easy to observe biological processes in real time.
With this new study, published in Science Immunology, neutrophils were found to possess a circadian clock that alerted them to daytime, and boosted their ability to kill bacteria.
Circadian clocks are present in almost every cell and tissue in the body, telling them what is going on in the outside world and coordinating physiological processes like metabolism, hormone release, and sleep-wake cycles.
Light has the biggest influence on resetting these circadian clocks.
“Given that neutrophils are the first immune cells to be recruited to sites of inflammation, our discovery has very broad implications for therapeutic benefit in many inflammatory diseases,” Hall says.
“This finding paves the way for development of drugs that target the circadian clock in neutrophils to boost their ability to fight infections.”
Right side heart failure. Credit: Scientific Animations CC4.0
People with type 2 diabetes (DM2) are at increased risk of developing heart failure due to the presence of prominent risk factors (hypertension, obesity, coronary heart disease, etc).
Now, a study published in the journal Cellular and Molecular Life Sciences has identified a new factor linked to the development of pathological hypertrophy. The results of the study suggest that increasing the activity of the GADD45A protein could be a promising therapeutic strategy to slow the progression of this clinical condition.
A factor with a prominent role in cardiac function
The GADD45A (growth arrest and DNA damage inducible 45A) protein is a multifunctional factor associated with stress signalling and cell damage. In this study, the team assessed the role of GADD45A in cardiac function using animal models and human cardiac cells.
The main mechanisms involved in pathological hypertrophy include inflammatory processes, fibrosis, mitochondrial dysfunction, dysregulation of calcium-handling proteins, metabolic alterations, cardiomyocyte hypertrophy and cell death. Fibrosis and inflammation are key factors in the progression of this pathological cardiac hypertrophy and subsequent heart failure.
“Fibrosis, in particular, correlates directly with the development of the disease and with adverse clinical outcomes, and has a major impact on the clinical condition of the patient”, says study leader Professor Manuel Vázquez-Carrera.
The results reveal that the lack of GADD45A factor in mice triggers cardiac fibrosis, inflammation and apoptosis. These changes correlate with hyperactivation of the proinflammatory and profibrotic transcription factors AP-1 (activator protein-1), NF-κB (nuclear factor-κB) and STAT3 (signal transducer and activator of transcription 3).
According to the findings, deletion of GADD45A also caused substantial cardiac hypertrophy that negatively affected cardiac morphology and function in mice lacking this protein. Furthermore, overexpression of GADD45A in human AC16 cardiomyocytes partially prevented the inflammatory and fibrotic response induced by tumour necrosis factor-alpha (TNF-α).
“Taken together, the data presented in this study highlight an important role for GADD45A protein in the heart, as it may prevent inflammation, fibrosis and apoptosis and thus preserve cardiac function”, says Associate Professor Xavier Palomer, who also led the study.
This paper expands our knowledge of the action mechanisms of GADD45A in the body. To date, previous studies have identified the role as a tumour suppressor in cancer development, as well as its involvement in the regulation of catabolic and anabolic metabolic pathways and in the prevention of inflammation, fibrosis and oxidative stress in some tissues and organs. Finally, some studies have indicated that the modulation of GADD45A could be a suitable therapeutic strategy to prevent obesity and diabetes.
A UCLA Health surgical team has performed the first-in-human bladder transplant.
The surgery was successfully completed at Ronald Reagan UCLA Medical Center on May 4, 2025. The team was led by Dr Nima Nassiri, a urologic transplant surgeon and director of the UCLA Vascularized Composite Bladder Allograft Transplant Program, with assistance from Dr Inderbir Gill, founding executive director of USC Urology.
“Bladder transplantation has been Dr Nassiri’s principal academic focus since we recruited him to the UCLA faculty several years ago,” said Dr Mark Litwin, UCLA Urology Chair, “It is incredibly gratifying to see him take this work from the laboratory to human patients at UCLA, which operates the busiest and most successful solid-organ transplant program in the western United States.”
“This first attempt at bladder transplantation has been over four years in the making,” Nassiri said. “For the appropriately selected patient, it is exciting to be able to offer a new potential option.”
The patient had lost most of his bladder during a tumour removal, leaving the remainder too small and compromised to work. Both of his kidneys were also subsequently removed due to renal cancer in the setting of pre-existing end-stage kidney disease. As a result, he was on dialysis for seven years.
The biggest risks of organ transplantation are the body’s potential rejection of the organ and side-effects caused by the mandatory immune suppressing drugs given to prevent organ rejection.
“Because of the need for long-term immunosuppression, the best current candidates are those who are already either on immunosuppression or have an imminent need for it,” Nassiri said.
Nassiri and Gill collaborated for several years to develop the surgical technique. Numerous pre-clinical procedures were performed at USC and OneLegacy, Southern California’s organ procurement organisation, to prepare for the first human bladder transplant.
During the complex procedure, the surgeons transplanted the donated kidney, following that with the bladder. The new kidney was then connected to the new bladder using the technique that Nassiri and Gill pioneered. The entire procedure lasted approximately eight hours.
“The kidney immediately made a large volume of urine, and the patient’s kidney function improved immediately,” Nassiri said. “There was no need for any dialysis after surgery, and the urine drained properly into the new bladder.”
Current treatment for severe terminal cases of bladder dysfunction or a bladder that has been removed due to various conditions includes replacement or augmentation of the urinary reservoir. These surgeries use a portion of a patient’s intestine to create a new bladder or a pathway for the urine to exit the body.
While these surgeries can be effective, they come with many short-and long-term risks that compromise a patient’s health such as internal bleeding, bacterial infection and digestive issues.
“A bladder transplant, on the other hand, results in a more normal urinary reservoir, and may circumvent some short- and long-term issues associated with using the intestine,” Nassiri said.
As a first-in-human attempt, there are naturally many unknowns associated with the procedure, such as how well the transplanted bladder will function immediately and over time, and how much immunosuppression will ultimately be needed.
Bladder transplants have not been done previously, in part because of the complicated vascular structure of the pelvic area and the technical complexity of the procedure. As part of the research and development stage, Nassiri and Gill successfully completed numerous practice transplantation surgeries at Keck Medical Center of USC, including the first-ever robotic bladder retrievals and successful robotic transplantations in five recently deceased donors with cardiac function maintained on ventilator support.
The two surgeons also undertook several non-robotic trial runs of bladder recovery at OneLegacy, allowing them to perfect the technique while working closely with multi-disciplinary surgical teams.
The bladder is strictly within the domain of urologists. At UCLA, kidney transplantation is also housed within the department of urology. This is why the combined kidney and bladder transplant was ultimately performed at UCLA, which has the necessary infrastructure, clinical expertise, and multidisciplinary support to carry out the procedure and manage the patient from pre-transplant evaluation through post-transplant care, all within the one department.
The procedure was performed as part of a UCLA clinical trial. Nassiri hopes to perform more bladder transplants in the near future.
UCLA Urology has long been at the frontier of urologic transplantation, with pioneering research in kidney transplantation and now, bladder transplantation.
A new study in the European Heart Journal shows that people who develop type 1 diabetes in adulthood have an increased risk of cardiovascular disease and death, and that those diagnosed later in life do not have a better prognosis than those diagnosed earlier. The study, conducted by researchers at Karolinska Institutet, points to modifiable factors – smoking, poor glucose control and obesity – as the main risk factors.
Type 1 diabetes used to be called childhood diabetes but can start at any time during life – a situation for which there is limited research. The researchers behind the current study wanted to investigate the risk of cardiovascular disease and death in this group, particularly for those diagnosed after the age of 40.
The registry-based study identified 10 184 people diagnosed with type 1 diabetes in adulthood between 2001 and 2020 and compared them to 509 172 matched people in the control group.
The study shows that these people with adult-onset type 1 diabetes had a higher risk of cardiovascular disease and death from all causes, including cancer and infections, compared to the control group.
“The main reasons for the poor prognosis are smoking, overweight/obesity and poor glucose control. We found that they were less likely to use assistive devices, such as insulin pumps,” says first author Yuxia Wei, postdoctoral fellow at the Institute of Environmental Medicine, Karolinska Institutet.
The prognosis can be improved
The results emphasise the seriousness of type 1 diabetes, even when it starts later in life, the researchers say. But the prognosis can improved by avoiding smoking and obesity, especially for those diagnosed later in life.
The researchers plan to continue investigating adult-onset type 1 diabetes, including risk factors for developing the disease and the prognosis of other outcomes, such as microvascular complications. Optimal treatment in adult-onset type 1 diabetes, including the effect of pump use and other advanced technologies, also needs to be explored.
