Tag: 24/6/25

Categories : Cardiovascular DiseaseTags :

Novel Therapy Saves Patient with Acute Fulminant Myocarditis

On By ModernMedia
Pericardium. Credit: Scientific Animations CC4.0

Acute myocarditis, or sudden inflammation of the heart, causes mild symptoms in most cases, but about 10% of acute myocarditis cases can be sudden and severe, leading to cardiac arrhythmias, heart pump failure, or even death. Current therapies for the condition are built on limited data and may not effectively target the underlying disease mechanisms. Patients may even require mechanical circulatory support for life support when the heart is failing.

Now a team at UC San Francisco is using a new class of drugs that target inflammation to treat acute fulminant myocarditis patients.

In an article in Circulation, the UCSF group reports on the successful treatment of a patient with sudden and severe (acute fulminant) myocarditis using an immune modulating medication known to inhibit the activity of enzymes that can trigger inflammation in the body.

“Our group has developed several animal models of myocarditis and by studying these, we became interested in a group of enzymes called Janus kinases, or JAKs, that seem to serve as communication nodes between immune cells,” said Javid Moslehi, MD, William Grossman Distinguished Professor in Cardiology and UCSF Section Chief of Cardio-Oncology and Immunology. “JAKs become hyperactive during acute heart inflammation, exacerbating the already activated immune system.”

Moslehi and his team therefore reasoned that targeting these enzymes using a novel class of therapies called JAK inhibitors would be a possible treatment modality for acute fulminant myocarditis. In recent years, the team has examined the effects of JAK inhibitor treatment on the immune cell populations for both RNA and proteins, showing acute benefit in various laboratory models of myocarditis.

Heart function improved dramatically

In the current case, the group treated a 20-year-old woman who came to UCSF with acute fulminant myocarditis.

“This patient’s heart was effectively falling apart and there was no time to lose,” said Connor O’Brien, MD, cardiologist, critical care specialist and UCSF assistant professor of Medicine. “We had put the patient on extracorporeal membrane oxygenation (ECMO) to maintain blood flow through vital organs and started the process of listing her for heart transplantation.”

O’Brien was on clinical service at the time, caring for the patient. The medical team had tried using corticosteroids as a treatment but without success. O’Brien then coordinated with Moslehi, given his expertise in myocarditis as well as some of his laboratory results with JAK inhibitors.

O’Brien added ruxolitinib, a JAK inhibitor, to the treatment strategy. The patient’s cardiac arrhythmias slowed down and her cardiac enzyme (a measure of heart damage) decreased. Over the next few days, her heart function improved dramatically allowing her to wean off ECMO support. She was successfully discharged from the hospital one week later.

Since that time, the UCSF Health cardiology team has gone on to successfully treat other patients with JAK inhibitors for acute myocarditis, but Moslehi adds a note of caution.

“The gold standard of any new treatment is a clinical trial, and it is important to note that we have not yet done this,” said Moslehi. “But the team is hopeful that these early results can lead to an eventual trial for patients.”

Moslehi and his team established the UCSF Myocarditis Center in March 2023 as part of the newly formed section of cardio-oncology and immunology. This multi-disciplinary group is focused on diagnosis and treatment for myocarditis, bringing laboratory scientists together with clinicians for more comprehensive care of patients.

“The Myocarditis Center really takes advantage of the incredible scientific environment at UCSF and specifically our cardiology team working closely with the cardiovascular research institute (CVRI) to help our patients,” Moslehi adds.

Source: University of California – San Francisco

Categories : Cardiovascular Disease Environmental EffectsTags :

Urinary Metal Exposure Linked to Increased Risk of Heart Failure, Landmark Study Finds

On By ModernMedia

In addition to cadmium, molybdenum and zinc found to have particularly high risk increases

Right side heart failure. Credit: Scientific Animations CC4.0

A new multi-cohort study at Columbia University Mailman School of Public Health, has found that exposure to certain metals, detected in urine, is associated with a higher risk of heart failure (HF). Published in the Journal of the American College of Cardiology, it is the largest investigation of its kind to date, reinforcing the importance of reducing environmental metal exposure to reduce heart failure risk. While environmental metals are recognised as cardiovascular disease risk factors, until now the role of metal exposure in heart failure risk had remained understudied.

“Most previous studies have assessed individual metals in isolation. By examining metals as a mixture, our analysis more closely reflects real-world exposure patterns,” said Irene Martinez-Morata, MD, PhD, postdoctoral research scientist in Environmental Health Sciences at Columbia Mailman School, and lead author. “In our analysis of over 10 000 adults across diverse geographic, racial, and ethnic backgrounds, we observed consistent associations between elevated urinary metal levels and increased HF risk over long-term follow-up after accounting for other established traditional risk factors for the disease such as diabetes and obesity.”

The study pooled data from three large cohorts with more than 20 years of follow-up:

  •  MESA (Multi-Ethnic Study of Atherosclerosis), U.S. adults aged 18–85 from six urban-suburban areas in Maryland, Illinois, North Carolina, California, Minnesota and New York.
  • SHS (Strong Heart Study), American Indian adults aged 18–65 in the U.S. from Oklahoma, Arizona, North Dakota and South Dakota.
  •  Hortega Study, a general population cohort in Spain

Among the 10 861 participants, a thousand people developed heart failure. In a subset, researchers assessed left ventricular function, which measures how effectively the heart pumps blood.

Metals were measured in urine samples, which can indicate how much metal is in the body and how much is being eliminated from it. Health and lifestyle data – including medication use, cholesterol levels, blood pressure, glucose, BMI, and more – were collected via questionnaires, lab tests, and physical exams. The team used advanced machine learning models to evaluate the combined effects of five urinary metals as a mixture.

Key findings included:

  •  Higher levels for the mixture of five metals in urine: arsenic, cadmium, molybdenum, selenium, and zinc, was associated with a 55% higher risk of heart failure in rural American Indian adults (SHS), a 38% higher risk in urban and suburban diverse populations (MESA) and a 8% increased risk in adults in Spain (Hortega).
  •  In the analysis of metals individually, a doubling in the levels of urine cadmium, a toxic metal found in tobacco products, foods and industrial waste, was associated with 15% higher risk of heart failure.
  • Similarly, a doubling in the levels of molybdenum and zinc was associated with 13% and 22% higher risk of heart failure across the three cohorts. These metals have an essential function in the body, but high levels can be toxic.

“The strongest association between the 5-metal mixture and HF risk was seen in the SHS cohort,” said Martinez-Morata. “This population faces a historically high burden of contaminant metal exposure and cardiovascular disease and public health action is urgently needed.”

The sources of exposure to these metals can vary from urban and rural environments. Toxic metals such as arsenic, cadmium, and tungsten can occur as a result of mining and industrial activity leading to contamination of drinking water, foods that grow in contaminated soils, and air pollution. Many of these metals are also present in smoking devices, consumer products, and certain foods, observes Martinez and her co-authors. “Essential metals such as zinc and selenium are needed for biological functions, but high levels can be toxic.”

“We consistently found higher urinary levels of cadmium, molybdenum and zinc linked to increased heart failure risk,” noted Ana Navas-Acien, MD, PhD, Columbia Mailman School professor and chair of the Department of Environmental Health Sciences. “Even after adjusting for diabetes – a known HF risk factor – the zinc association remained significant.”

These results support the relevance of metal exposures as contributors to heart failure risk. “In ongoing research, we aim to clarify biological mechanisms and to explore the role of environmental interventions in cardiovascular disease prevention,” said Navas-Acien, who also is senior author.

“This study’s strengths include its large, diverse sample size, high-quality data, and robust, long-term follow-up,” said Martinez-Morata. “Our findings underscore the importance of continuing efforts to monitor and reduce environmental metal exposures, particularly in communities with historically high exposure levels as an innovative approach to improve cardiovascular health.”

Source: Columbia University Mailman School of Public Health

Categories : Cardiovascular Disease Implants and Prostheses PaediatricsTags :

Heart Valve Which ‘Grows’ with Young Children Undergoing Preclinical Testing

On By ModernMedia
The Iris Valve, a transcatheter, growth-accommodating pulmonary valve designed for very young children, was developed at UC Irvine and is currently progressing toward FDA clinical approval. Arash Kheradvar

Researchers at the University of California, Irvine have successfully performed preclinical laboratory testing of a replacement heart valve intended for toddlers and young children with congenital cardiac defects, a key step toward obtaining approval for human use. The results of their study were published recently in the Journal of the American Heart Association.

The management of patients with congenital heart disease who require surgical pulmonary valve replacement typically occurs between the ages of 2 and 10. To be eligible for a minimally invasive transcatheter pulmonary valve procedure, patients currently must weigh at least 20.4kg. For children to receive minimally invasive treatment, they must be large enough so that their veins can accommodate the size of a crimped replacement valve. The Iris Valve designed and developed by the UC Irvine team can be implanted in children weighing as little as 7.7 to 10kg and gradually expanded to an adult diameter as they grow.

Research and development of the Iris Valve has been supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Heart, Lung, and Blood Institute; and the National Science Foundation.

This funding has enabled benchtop fracture testing, which demonstrated the valve’s ability to be crimped down to a 3mm diameter for transcatheter delivery and subsequently enlarged to 20mm without damage, as well as six-month animal studies that confirmed successful device integration within the pulmonary valve annulus, showing valve integrity and a favourable tissue response.

“We are pleased to see the Iris Valve performing as we expected in laboratory bench tests and as implants in Yucatan mini pigs, a crucial measure of the device’s feasibility,” said lead author Arash Kheradvar, UC Irvine professor of biomedical engineering. “This work represents the result of longstanding collaboration between our team at UC Irvine and Dr Michael Recto at Children’s Hospital of Orange County built over several years of joint research and development.”

Congenital heart defects affect about 1% of children born in the United States and Europe, with over 1 million cases in the US alone. These conditions often necessitate surgical interventions early in life, with additional procedures required to address a leaky pulmonary valve and prevent right ventricular failure as children grow.

The Iris Valve can be implanted via a minimally invasive catheter through the patient’s femoral vein. The Kheradvar group employed origami folding techniques to compress the device into a 12-French transcatheter system, reducing its diameter to no more than 3mm. Over time, the valve can be balloon-expanded up to its full 20mm diameter.

This implantation method, along with the ability to begin treatment earlier in very young patients, helps mitigate the risk of complications from delayed care and reduces the need for multiple surgeries in this vulnerable population.

“Once the Iris Valve comes to fruition, it will save hundreds of children at least one operation – if not two – throughout the course of their lives,” said Recto, an interventional paediatric cardiologist at CHOC who’s also a clinical professor of paediatrics at UC Irvine. “It will save them from having to undergo surgical pulmonary valve placement, as the Iris Valve is delivered via a small catheter in the vein and can be serially dilated to an adult diameter and also facilitate the future placement of larger transcatheter pulmonary valves – with sizes greater than 20 millimetres, like the Melody, Harmony and Sapien devices – if needed.”

Source: University of California, Irvine

Categories : IT in HealthcareTags :

Scientists Argue for More FDA Oversight of Healthcare AI Tools 

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New paper critically examines the US Food and Drug Administration’s regulatory framework for artificial intelligence-powered healthcare products, highlighting gaps in safety evaluations, post-market surveillance, and ethical considerations.

An agile, transparent, and ethics-driven oversight system is needed for the U.S. Food and Drug Administration (FDA) to balance innovation with patient safety when it comes to artificial intelligence-driven medical technologies. That is the takeaway from a new report issued to the FDA, published this week in the open-access journal PLOS Medicine by Leo Celi of the Massachusetts Institute of Technology, and colleagues.

Artificial intelligence is becoming a powerful force in healthcare, helping doctors diagnose diseases, monitor patients, and even recommend treatments. Unlike traditional medical devices, many AI tools continue to learn and change after they’ve been approved, meaning their behaviour can shift in unpredictable ways once they’re in use.

In the new paper, Celi and his colleagues argue that the FDA’s current system is not set up to keep tabs on these post-approval changes. Their analysis calls for stronger rules around transparency and bias, especially to protect vulnerable populations. If an algorithm is trained mostly on data from one group of people, it may make mistakes when used with others. The authors recommend that developers be required to share information about how their AI models were trained and tested, and that the FDA involve patients and community advocates more directly in decision-making. They also suggest practical fixes, including creating public data repositories to track how AI performs in the real world, offering tax incentives for companies that follow ethical practices, and training medical students to critically evaluate AI tools.

“This work has the potential to drive real-world impact by prompting the FDA to rethink existing oversight mechanisms for AI-enabled medical technologies. We advocate for a patient-centred, risk-aware, and continuously adaptive regulatory approach – one that ensures AI remains an asset to clinical practice without compromising safety or exacerbating healthcare disparities,” the authors say.

Provided by PLOS

Categories : Diet and NutritionTags :

4:3 Intermittent Fasting Outperforms Daily Calorie Restriction in Weight-Loss Study

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The finding bucks a research trend that has shown little difference in weight lost between the two diet strategies

Photo by Ayako S

Comparing intermittent fasting with traditional daily calorie restriction, researchers at the University of Colorado Anschutz Medical Campus found greater weight loss among the intermittent fasting group, a significant finding given that most previous studies reported no notable difference between the two diet strategies.

Singling out the 4:3 plan of the popular intermittent fasting (IMF) model – where dieters eat freely four days a week with three days a week of intense calorie restriction – the researchers found an average body weight loss of 7.6% among IMF participants at the one-year mark compared with 5% in the daily caloric restriction (DCR) group.

The study was published in the Annals of Internal Medicine and funded by the National Institutes of Health.

“It was surprising and exciting to me that it was better,” said Victoria Catenacci, MD, co-lead author and associate professor of endocrinology at the CU School of Medicine.

“The more important message to me is that this is a dietary strategy that is an evidence-based alternative, especially for people who have tried DCR and found it difficult,” Catenacci said, noting the weight-loss difference was modest.

An endocrinologist who specializes in obesity medicine, Catenacci’s work targets a decades-long health crisis in this country, with 40% of Americans 20 and older meeting the medical criteria for obesity. She works at the CU Anschutz Health and Wellness Center (AHWC), the study’s primary site.

She and co-lead author Danielle Ostendorf, PhD, who worked on the study as a post-doctoral fellow with Catenacci in 2018 and has since moved to the University of Tennessee Knoxville, share more about the research in the Q&A below.

Source: University of Colorado Anschutz Campus