Arxiu d'etiquetes: diseases

From lab to big screen (II)

As I told you in the previous article on genetics and cinema, there is a wide variety of films that talk about genetics. In the next article we will talk about science fiction, with two well-known films. Beware: spoilers!

GATTACA (1997)

Director: Andrew Niccol

Cast: Ethan Hawke, Uma Thurman, Jude Law

Genre: Science fiction

Story line: Vincent is one of the last “natural” babies born into a sterile, genetically-enhanced world, where life expectancy and disease likelihood are ascertained at birth. Myopic and due to die at 30, he has no chance of a career in a society that now discriminates against your genes, instead of your gender, race or religion. Going underground, he assumes the identity of Jerome, crippled in an accident, and achieves prominence in the Gattaca Corporation, where he is selected for his lifelong desire: a manned mission to Saturn’s 14th moon (titan). Constantly passing gene tests by diligently using samples of Jerome’s hair, skin, blood and urine, his now-perfect world is thrown into increasing desperation, his dream within reach, when the mission director is killed – and he carelessly loses an eyelash at the scene! Certain that they know the murderer’s ID, but unable to track down the former Vincent, the police start to close in, with extra searches, and new gene tests. With the once-in-a-lifetime launch only days away, Vincent must avoid arousing suspicion, while passing the tests, evading the police, and not knowing whom he can trust.

Relation with genetics: GATTACA is the “genetic” film par excellence. Starting with the title, this is formed by the initials of the four nitrogenous bases that make up DNA (guanine, adenine, thymine and cytosine). In addition, the helical shape of the DNA is repeated in several moments of the film, as in the stairs of Vincent’s house.

The main issue is about genetic selection, all children born have been genetically selected, closely linked to bioethics. The idea of ​​this selection is to reach eugenics, that is, to improve the population by selecting the “best” humans. This concept can be related to the Hitler’s Germany, who believed that Germans belonged to a superior group of races called “Aryan”. Hitler said that German Aryan race had been better endowed than the others and that this biological superiority destined Germans to oversee an empire in Eastern Europe.

Although nowadays genetic selection is valid and is used to avoid diseases, it is not applied with the same purposes as those of the film. At present, it is decided to carry out genetic selection after having studied the family and carried out the appropriate genetic counselling. It aims to help patients and their families avoid the pain and suffering caused by a genetic disease and should not be confused with the eugenic objective of reducing the incidence of genetic diseases or the frequency of alleles considered to be deleterious in the population.

This is very related to the genetic discrimination, case also exposed in the film. Gattaca is situated in a possible future in which genetics, trying to improve the quality of life of society, causes a movement of discrimination.

When we talk about discrimination, we tend to think about racial discrimination. This is defined as the different or exclusive treatment of a person for reasons of racial or ethnic origin, which constitutes a violation of the fundamental rights of individuals, as well as an attack on their dignity. Racism has been present throughout the history of mankind, especially in the twentieth century with racial discrimination in the United States and apartheid in South Africa.

For some time now, genetic discrimination has been gaining weight. It happens when people are treated differently by their company or insurance company because they have a genetic mutation that causes or increases the risk of a hereditary disorder. Fear of discrimination is a common concern among people who undergo genetic testing, and is a current problem that concerns the population because your own genome does not have to be a curriculum vitae that opens or closes doors as happens in the film. Vincent goes to work in Gattaca after performing a urine test and a blood test, since in Gattaca they do not choose workers for their ability or ability but for their DNA.

However, the film ends with the sentence “There is no gene for the human spirit”. This means that, although the society in which Gattaca is located is based on genetic modification, it does not affect the morality and final character of people because there is no way to genetically relate to the spirit, only the body has the genetic information.

Video 1. Trailer Gattaca (Source: YouTube)

JURASSIC PARK (1993)

Director: Steven Spielberg

Cast: Sam Neill, Laura Dern, Jeff Goldblum

Genre: Science fiction

Story line: Huge advancements in scientific technology have enabled a mogul to create an island full of living dinosaurs. John Hammond has invited four individuals, along with his two grandchildren, to join him at Jurassic Park. But will everything go according to plan? A park employee attempts to steal dinosaur embryos, critical security systems are shut down and it now becomes a race for survival with dinosaurs roaming freely over the island.

Relation with genetics: In the first film of this saga, from dinosaur’s fossils scientists extract DNA to be able to clone dinosaurs. The cloned dinosaurs will be part of the Jurassic park on which the film is based.

It is true that DNA can be extracted from bones, widely used in forensic genetics. Same as the issue of cloning, which was known by the Dolly sheep, the first large animal cloned from an adult cell in July 1996. But the film goes further and raises the possibility of reintroducing, in today’s world, extinct species and challenge natural selection.

Video 2. Trailer Jurassic Park (Source: YouTube)

REFERENCES

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Pharmacogenetics: a drug for each person

Sometimes, some people say that the medications prescribed by doctors are not good. Can this be true? Not all drugs work for the same population. Keep reading and discover the secrets of pharmacogenetics.

INTRODUCTION

The same that happens with nutrients, happens with drugs. Another objective of personalized medicine is to make us see that not all medicines are for everyone. However, it does not come again because around 1900, the Canadian physician William Osler recognized that there was an intrinsic and specific variability of everyone, so that each one reacts differently to a drug. This is how, years later, we would define pharmacogenetics.

It is important to point out that it is not the same as pharmacogenomics, which studies the molecular and genetic bases of diseases to develop new treatment routes.

First, we need to start at the beginning: what is a drug? Well, a drug is any physicochemical substance that interacts with the body and modifies it, to try to cure, prevent or diagnose a disease. It is important to know that drugs regulate functions that our cells do, but they are not capable of creating new functions.

Apart from knowing if a drug is good or not for a person, you also have to take into account the amount that should be administered. And we still do not know the origin of all diseases, that is, we do not know most of the real molecular and genetic causes of diseases.

The classification of diseases is based mainly on symptoms and signs and not on molecular causes. Sometimes, the same group of pathologies is grouped, but among them there is a very different molecular basis. This means that the therapeutic efficacy is limited and low. Faced with drugs, we can manifest a response, a partial response, that produces no effect or that the effect is toxic (Figure 1).

efectivitat i toxicitat
Figure 1. Drug toxicity. Different colours show possible responses (green: drug not toxic and beneficial; blue: drug not toxic and not beneficial; red: drug toxic but not beneficial; yellow: drug toxic but beneficial) (Source: Mireia Ramos, All You Need is Biology)

DRUGS IN OUR BODY

Drugs usually make the same journey through our body. When we take a drug, usually through the digestive tract, it is absorbed by our body and goes to the bloodstream. The blood distributes it to the target tissues where it must take effect. In this case we talk about active drug (Figure 2). But this is not always the case, but sometimes it needs to be activated. That’s when we talk about a prodrug, which needs to stop in the liver before it reaches the bloodstream.

Most of the time, the drug we ingest is active and does not need to visit the liver.

active and prodrug
Figure 2. Difference between prodrug and active drug (Source: Agent of Chemistry – Roger Tam)

Once the drug has already gone to the target tissue and has interacted with target cells, drug waste is produced. These wastes continue to circulate in the blood to the liver, which metabolizes them to be expelled through one of the two routes of expulsion: (i) bile and excretion together with the excrement or (ii) purification of the blood by the kidneys and the urine.

THE IMPORTANCE OF PHARMACOGENETICS

A clear example of how according to the polymorphisms of the population there will be different response variability we find in the transporter genes. P glycoprotein is a protein located in the cell membrane, which acts as a pump for the expulsion of xenobiotics to the outside of the cell, that is, all chemical compounds that are not part of the composition of living organisms.

Humans present a polymorphism that has been very studied. Depending on the polymorphism that everyone possesses, the transporter protein will have normal, intermediate or low activity.

In a normal situation, the transporter protein produces a high excretion of the drug. In this case, the person is a carrier of the CC allele (two cytokines). But if you only have one cytosine, combined with one thymine (both are pyrimidine bases), the expression of the gene is not as good, and the expulsion activity is lower, giving an intermediate situation. In contrast, if a person has two thymines (TT), the expression of the P glycoprotein in the cell membrane will be low. This will suppose a smaller activity of the responsible gene and, consequently, greater absorption in blood since the drug is not excreted. This polymorphism, the TT polymorphism, is dangerous for the patient, since it passes a lot of drug to the blood, being toxic for the patient. Therefore, if the patient is TT the dose will have to be lower.

This example shows us that knowing the genome of each individual and how their genetic code acts based on it, we can know if the administration of a drug to an individual will be appropriate or not. And based on this, we can prescribe another medication that is better suited to this person’s genetics.

 APPLICATIONS OF THE PHARMACOGENETICS

The applications of these disciplines of precision medicine are many. Among them are optimizing the dose, choosing the right drug, giving a prognosis of the patient, diagnosing them, applying gene therapy, monitoring the progress of a person, developing new drugs and predicting possible adverse responses.

The advances that have taken place in genomics, the design of drugs, therapies and diagnostics for different pathologies, have advanced markedly in recent years, and have given way to the birth of a medicine more adapted to the characteristics of each patient. We are, therefore, on the threshold of a new way of understanding diseases and medicine.

And this occurs at a time when you want to leave behind the world of patients who, in the face of illness or discomfort, are treated and diagnosed in the same way. By routine, they are prescribed the same medications and doses. For this reason, the need has arisen for a scientific alternative that, based on the genetic code, offers to treat the patient individually.

REFERENCES

  • Goldstein, DB et al. (2003) Pharmacogenetics goes genomic. Nature Review Genetics 4:937-947
  • Roden, DM et al. (2002) The genetic basis of variability in drug responses. Nature Reviews Drug Discovery 1:37-44
  • Wang, L (2010) Pharmacogenomics: a system approach. Syst Biol Med 2:3-22
  • Ramos, M. et al. (2017) El código genético, el secreto de la vida. RBA Libros
  • Main picture: Duke Center for Applied Genomics & Precision Medicine

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The reality of mutations

Do you remember the ninja turtles? Leonardo, Raphael, Michelangelo and Donatello were four turtles that suffered a mutation when they were bathed with a radioactive liquid. Fortunately or unfortunately, a mutation cannot turn us into ninja turtles, but it can have other effects. Next, I tell you what mutations are.

WHAT ARE MUTATIONS?

Our body is like a great factory in which our cells are the workers. These, thanks to their internal machinery, make the factory stay afloat with the least possible problems. The constant operation of our cells (24/7), sometimes causes errors in their machinery. This generates imperfections in the genetic code, which generally go unnoticed. It is true that cells do everything possible to fix the failures produced, but sometimes they are inevitable and lead to the generation of diseases or even to the death of the cell.

Mutations are these small errors, it means, mutations are stable and inheritable changes that alter the DNA sequence. This fact introduces new genetic variants in the population, generating genetic diversity.

Generally, mutations tend to be eliminated, but occasionally some can succeed and escape the DNA repair mechanisms of our cells. However, they only remain stable and inheritable in the DNA if they affect a cell type, the germ cells.

The organisms that reproduce sexually have two types of cells: germinal and somatic. While the former transmit genetic information from parents to children, somatic cells form the body of the organism. Because the information of germ cells, which are what will give rise to gametes (sperm and oocytes) passed from generation to generation, they must be protected against different genetic changes to safeguard each individual.

Most mutations are harmful, species cannot allow the accumulation of large number of mutations in their germ cells. For this reason not all mutations are fixed in the population, and many of these variants are usually eliminated. Occasionally some may be incorporated into all individuals of the species.

The mutation rate is the frequency at which new mutations occur in a gene. Each specie has a mutation rate of its own, modulated by natural selection. This implies that each species can be confronted differently from the changes produced by the environment.

Spontaneous mutation rates are very low, in the order of 10-5-10-6 per gene and generation. In this way, mutations do not produce rapid changes in the population.

THE ROLE OF NATURAL SELECTION

Changes of nucleotides in somatic cells can give rise to variant or mutant cells, some of which, through natural selection, get more advantageous with respect to their partners and proliferate very fast, giving us as a result, in the extreme case, cancer, that is, uncontrolled cell proliferation. Some of the cells in the body begin to divide without stopping and spread to surrounding tissues, a process known as metastasis

But the best way to understand the role of natural selection of which the naturist Charles Darwin spoke is with the example of spotted moths (Biston betularia). In England there are two types of moths, those of white colour and those of black colour (Figure 1). The former used to be the most common, but between 1848 and 1898 black moths were imposed.

biston
Figure 1. Biston betularia, white and black moths (Source: TorruBlog)

This change occurred at the same time that cities became more industrial, in which coal became the main fuel for power plants. The soot of this rock dyed the sky, the soil and the buildings of the cities black. Tree trunks were also affected, where the moths were camouflaged.

The consequence of this fact was that white moths could not hide from their predators, whereas those that were black found a successful exit camouflaging well on the tinted trunks. With the change of colour of their hiding place they had more opportunities to survive and reproduce (Video 1).

Video 1. Industrial melanism, white and black moth (Source: YouTube)

This is a clear example of how changes in the environment influence the variability of gene frequencies, which vary in response to new factors in the environment.

TYPES OF MUTATIONS

There is no single type of mutation, but there are several types of mutation that can affect the DNA sequence and, rebound, the genetic code. However, not all mutations have the same effect.

There are many and different types of mutations, which are classified by mutational levels. These levels are based on the amount of hereditary material affected by the mutation and go up in rank according to the number of genes involved. If the mutation affects only one gene we speak of gene mutation, whereas if it affects a chromosomal segment that includes several genes we refer to chromosomal mutation. When the mutation affects the genome, affecting whole chromosomes by excess or by defect, we speak of genomic mutation.

An example of a point mutation is found in cystic fibrosis, a hereditary genetic disease that produces an alteration in the secretion of mucus, affecting the respiratory and digestive systems. A point mutation affects the gene that codes for the CFTR protein. The affected people receive from both parents the defective gene, which, having no copy of the good gene, the protein will not be functional. The result is that the secretions produced by the human body are thicker than usual, producing an accumulation in the respiratory tract.

REFERENCES

  • Ramos, M. et al. El código genético, el secreto de la vida (2017) RBA Libros
  • Alberts, B. et al. Biología molecular de la célula (2010). Editorial Omega, 5a edición
  • Cooper, G.M., Hausman R.E. La Célula (2009). Editorial Marbán, 5a edición
  • Bioinformática UAB
  • Webs UCM
  • Main picture: Cine Premiere

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Rare diseases: fight against oblivion

We are ending the month of February, and this means that the Rare Disease Day is approaching. Marfan syndrome, Williams syndrome, DiGeorge syndrome, Crohn’s disease, Fanconi anaemia, mucopolysaccharidosis, among many others make up the list of these diseases. Why are they called minority diseases or rare diseases?

WHAT ARE MINORITY DISEASES?

A minority disease is that which affects less than 1 in 2,000 people. Although individually they are rare, there are many diseases of this type (6,000-7,000), so there are many affected patients.

Although the definition of minority disease is what I have just said, in the pharmaceutical industry it is that disease in which it is not profitable to develop a drug due to the low number of patients, the limited information available, the poor diagnosis, the lack of clinical studies and the difficult location of patients. It is for this reason that the families themselves create their own foundations to obtain financing for the investigation of these diseases.

A few years ago these diseases were socially forgotten, but, fortunately, they are now socially transcendental and recognized.

As I said, there are around 7,000 minority diseases described and every year between 150 and 250 new ones are described, thanks to new technologies.

A large number of these diseases affects children, that is, they manifest themselves at an early age. It is necessary to know that most have a genetic basis, caused by mutations in specific genes such as cystic fibrosis or several muscular dystrophies. But there are also related to environmental factors, such as some types of anaemia due to lack of vitamins or due to medications. This is the case of malignant mesothelioma, a breast cancer, in which more than 90% of cases are due to asbestos exposure. However, there are still many without knowing their origin or data on their prevalence.

MINORITY DISEASES IN NUMBERS

The fact that these diseases affect few people and the ignorance of their symptoms by the public and professionals, it is estimated that the time that elapses between the appearances of the first symptoms until diagnosis is 5 years. In 1 of every 5 cases, more than 10 years may pass until the correct diagnosis is obtained. This means not receiving support or treatment or receiving inadequate treatment and worsening the disease.

Not all hospitals have the means to treat those affected, for this reason it is estimated that practically half of sufferers have had to travel and travel in the last 2 years out of their province because of their illness, either in look for a diagnosis or treatment.

Minor diseases represent a significant economic cost. The cost of diagnosis and treatment accounts for around 20% of the annual income of each affected family. This means an average of more than 350€ per family per month, a figure very representative of the high cost involved in the care of rare diseases. The expenses to cover in the majority of cases are related to the acquisition of medicines and other health products, medical treatment, technical aids and orthopaedics, adapted transport, personal assistance and adaptation to housing.

TREATMENT FOR MINORITY DISEASES

Only 1-2% of minority diseases currently have some type of treatment, therefore, much remains to be investigated.

There are 4 basic types of treatment for rare genetic diseases:

PHARMACOLOGICAL THERAPIES

It consists in the modification of a normal or pathological biochemical reaction by an external chemical agent.

The development of a drug is a very expensive process and difficult to quantify. Currently many millions have to be invested for a new drug to reach the patient.

But what is a medication? A medicine is a small organic molecule, which typically has to be:

  • Specific to solve a molecular problem (ex: prevent an abnormal interaction between two proteins)
  • Very active and very tuned for your target
  • Very little toxic
  • Distribute well throughout the body and reach the target tissue
  • Cheap to produce or, at least, that can be synthesized in industrial quantities
  • Stable
  • New (patentable)
  • It has to be commercialized

GENE THERAPY

Attempt to correct defective genes responsible for diseases in the somatic (non-sexual) line, either by:

  • Loss of function: incorporate the normal gene (ex: phenylketonuria)
  • Function gain: eliminate the responsible mutation, eliminating the protein (ex: Huntington)

Limitations:

  • Only the reversible characteristics of a genetic disease can be corrected
  • The size of the DNA to be incorporated in the patient’s genome
  • Immune response against the viral vector (retroviruses, adenoviruses, adenoassociates)
  • Inactivation of an essential gene that can cause a problem greater than the disease
  • Directionally to appropriate target cells

CELLULAR THERAPY

Describes the process of introducing new cells into an affected tissue, with or without previous gene therapy. It is necessary to introduce many cells because the treatment is effective and, sometimes, these cells can go to unwanted tissues or have some types of abnormal growth.

SURGERY

For example in congenital heart defects.

RARE DISEASE DAY

For rare diseases to cease to be, Rare Disease Day is celebrated on the last day of February, with the aim of raising awareness and awareness among the public about rare diseases; as well as showing the impact on patients’ lives and reinforcing their importance as a priority in public health.

It was established in 2008 because, according to the European Organization for Rare Diseases (EURORDIS), the treatment of many rare diseases is insufficient, as well as in social networks to support people with minority diseases and their families. In addition, while there were already many days devoted to people suffering from individual diseases (such as AIDS, cancer, etc.) before there was not a day to represent people suffering from minority diseases. It was chosen on 29th February because it is a “rare” day. But it is celebrated on the last day of February in years that are not leap years.

Then I leave the promotional video for the Rare Disease Day 2015:

Video 1. Rare Disease Day 2015 Official Video (Source: YouTube)

REFERENCES

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From lab to big screen (I)

A little more than a month for the great gala of the cinema, the Oscars, I present some films related to genetics. There is a variety of feature films, especially sci-fi. For this reason, this is the first of several articles about cinema. In this article I will focus on films based on genetic diseases.

WONDER (2017)

Director: Stephen Chbosky

Cast: Jacob Tremblay, Julia Roberts, Owen Wilson

Genre: Drama

Story line: A 10 years-old boy born with a facial deformity is destined to fit in at a new school, and to make everyone understand he is just another ordinary kid, and that beauty is not skin deep.

Relation with genetics: Auggie suffers Treacher Collins syndrome, a condition that affects the development of bones and other tissues of the face. This condition affects an estimated 1 in 50,000 people. In most cases, it is due to a genetic mutation of chromosome 5. Specifically, in the gene TCOF1, involved in the development of bones and other tissues of the face.

Video 1. Wonder trailer (Source: YouTube)

JULIA’S EYES (2010)

Director: Guillem Morales

Cast: Belén Rueda, Lluís Homar, Julia Gutiérrez Caba

Genre: Terror

Story line: It tells the story of a woman slowly going blind, the death of her twin sister tries to uncover the mysterious.

Relation with genetics: Both Julia and her sister suffer from retinitis pigmentosa. This disease causes the progressive loss of vision, affecting the retina, which is the layer of light-sensitive tissue in the back of the eye.

The first symptoms tend to be the loss of night vision and difficult to guide in low light. Later, the disease produces the appearance of blind spots in the lateral vision. With the passage of time, these blind spots come together producing a tunnel vision (Figure 1). Finally, this leads to blindness.

retinitis_pigmentosapic
Figure 1. Comparison between normal view and view wtih retinitis pigmentosa (Source: EyeHealthWeb)

The inheritance pattern can be autosomal dominant, recessive or linked to the X chromosome. In the first case, a single copy of the altered gene in each cell is sufficient to cause the disease. Most people with autosomal dominant retinitis pigmentosa have an affected father and other family members with the disorder.

Video 2. Julia’s eyes trailer (Source: YouTube)

MY SISTER’S KEEPER (2009)

Director: Nick Cassavetes

Cast: Cameron Díaz, Abigail Breslin, Alec Baldwin

Genre: Drama

Story line: Sara and Brian Fitzgerald’s life with their young son and their two-year-old daughter, Kate, is forever altered when they learn that Kate has leukaemia. The parents’ only hope is to conceive another child, Anna, specifically intended to save Kate’s life. Kate and Anna share a bond closer than most sisters: though Kate is older her life depends on Anna. Until Anna, now 11, says “no. Seeking medical emancipation, she hires her own lawyer, initiating a court case that divides the family and that could leave Kate’s rapidly failing body in the hands of fate.

Relation with genetics: Leukemias are the first type of cancer in which genetic alterations were described, such as translocations, which are the most frequent (more than 50% of cases). In addition, these have high prognosis and diagnostic value. There are many types of leukemias, therefore it is a diverse group of blood cancers, which affect blood cells and bone marrow. It is the most frequent type of cancer in children; however, it affects more adults than children.

A first classification is based on the lineage: lymphoid (blood-forming cells) or myeloid (cells of the bone marrow). At the same time, you are (lymphoid or myeloid) also classified according to the clinical presentation: acute (symptoms in short period of time and severe symptoms) or chronic (the time is longer).

In adults, acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) are more frequent, while in children it is acute lymphoblastic leukemia (ALL).

Video 3. My sister’s keeper trailer (Source: YouTube)

LORENZO’S OIL (1992)

Director: George Miller

Cast: Nick Nolte, Susan Sarandon, Peter Ustinov

Genre: Drama

Story line: The story concerns 5-years-old Lorenzo, suffering mightily from an apparently incurable and degenerative brain illness called ALD. His parents, an economist and a linguist, refuse to accept the received wisdom that there is no hope, and set about learning biochemistry to pursue a cure on their own. The film becomes an intriguing scientific mystery mixed with a story of pain, grief, and the strain on the two adults.

Relation with genetics: Lorenzo suffers from adrenoleukodystrophy (ADL) or also known as Schilder’s disease. It is a disease that mainly affects boys, since it has a pattern of inheritance linked to the X chromosome. It is in this chromosome where the ABCD1 gene is located, involved in the transport of very long chain fatty acids in peroxisomes (organelles involved in the metabolism of fatty acids).

It mainly affects the nervous system and the adrenal glands, which are small glands located in the upper part of each kidney. In this disorder, myelin deteriorates, the coating that isolates the nerves in the brain and spinal cord, reducing the ability of the nerves to transmit information to the brain. In addition, damage to the outer layer of the adrenal glands cause a shortage of certain hormones, resulting in weakness, weight loss, changes in the skin, vomiting and coma.

Video 4. Lorenzo’s oil trailer (Source: YouTube)

REFERENCES

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Prions: special proteins

Do you remember mad cow disease? Some years ago it caused media hype because this illness, which affected animals, affected people too. Then, it was discovered that prions were the cause. So, I will discuss what prions are and the diseases that they produce.

WHAT ARE PRIONS?

Prions are proteins, but with different characteristics. Proteins are molecules formed by amino acids, which are bound by peptide bonds. All proteins are composed by carbon, hydrogen, oxygen and nitrogen. They are localized in all cells of the body and they participate in all biological processes that are produced. While DNA carries genetic information of the cell, proteins execute the work led by this information.

Proteins are the most varied macromolecules. In each cell there are miles of different proteins, with an extended range of functions. Between them: to be structural components of cells and tissues, to act in the transport and storage of little molecules, to transmit information between cells and to proportionate a defence in front of an infection. However, the main function is to act as enzymes, which catalyse most of chemical reactions in biological systems.

Prions are proteins with pathogenic and infectious characteristics (Video 1). They are not virus nor alive organisms; they are proteins without nucleic acid, it means, without DNA. They are localized in the surface of the central nervous system, especially in neurons; although they are also located in other body tissues of adult animals. Significant levels have been detected in the heart and skeletal muscle, and to a lesser extent in other organs except the liver and pancreas.

Video 1. What are prions? (Source: YouTube)

THE CELLULAR PRION PROTEIN

There is a change in the configuration of the cellular prion protein PrPc (Figure 1) in the diseases caused by prions. This protein has a protector role for cells and helps them respond in front of lack oxygen. The consequence of prions on this protein is the alteration of its functionality, producing a protein PrPSc with altered configuration. However, both configurations have the same sequence of amino acids. The secret of the different behaviour is the wrong folding, it means, the wrong conformation.

prpc prpsc
Figure 1. Left: normal protein (PrPc). Right: protein with altered configuration (PrPSc)(Source: Searching for the Mind with Jon Lieff, M. D.)

PRION DISEASES

Prion diseases are neurodegenerative processes produced by abnormal metabolism of a prion protein. These affect humans and animals and have a fatal clinical evolution, with the death as final.

There are various prion diseases, however, symptoms and clinical features are shared (Table 1). Some of these clinical features are dementia, ataxia (discoordination in the movement of body), insomnia, paraplegia and abnormal behaviors. The brain acquires a spongiform aspect, it means, an aspect like a sponge. This is due to accumulation of prion proteins in neurons, where amyloid plaques are formed.

Amyloid plaques are caused by accumulation of amyloid peptide, an essential protein for cellular function of the body. This accumulation in the brain can generate toxicity for nervous cells.

Until today there is any treatment to cure, improve or control symptoms and signs of these diseases.

Tabla 1. Prion diseases and its clinical features (Source: Rubio, T. & Verdecia, M. Enfermedades priónicas. MEDISAN 2009; 13(1))

DISEASE SYMPTOMS AGE DURATION
Creutzfeldt-Jakob

Dementia

Ataxia

< 60 years

1 month – 10 years

(average 1 year)

Kuru

Ataxia

Dementia

40 years (29-60) 3 month – 1 year
Fatal familial insomnia

Insomnia

No autonomy

Ataxia

Dementia

45 years (35-55) 1 year

CREUTZFELDT-JAKOB SYNDROME

During 18th century, European farmers described a neurodegenerative disease that affected sheep and goats, called scrapie. The affected animals will compulsively scrape off their fleeces against rocks, trees, or fences. Furthermore, its brain looked like a sponge. So, this is the birth of the word spongiform.

However, until 20th century, in 1920, neurologists Creutzfeldt and Jakob described the first cases of spongiform encephalopathy in humans (Figure 2) and called the disease with their names.

creutzfeldt-jakob-disease-cjd.jpg
Figure 2. Comparison of two brains: a brain affected by Creutzfeldt-Jakob disease (left) and a healthy brain (right) (Source: Health & Medical Information)

In this disease, there is a loss of memory, lack coordination and damage of mental abilities. The balance problems are common and, sometimes, are manifested in the beginning. Many patients lose autonomy and are unable to take care of themselves in later stages of the disease.

Due to prion nature of the disease, any symptom is possible and it depends on the area of the brain that is being affected.

KURU

It is a rare disease, localized in New Guinea. The main risk factor to suffer the disease is the intake of brain human tissue, which can contain infectious particles.

It is the reason that it is associated with people who practice a form of cannibalism, in which the brains of dead people are eaten as part of a funeral ritual. Although this practice ended in 1960, cases of kuru have been reported years later.

FATAL FAMILIAL INSOMNIA

It is a familial and inherited disease, which people affected suffer progressive insomnia. The human brain needs to sleep and rest, so permanent insomnia (there is not treatment with drugs) causes the death of patients.

Insomnia is due to a permanent and irreversible alteration of the sleep-wake cycle, which is characterized by the inability of the patient to develop REM and non-REM sleep.

REFERENCES

  • Alberts, B. et al. (2016). Biología molecular de la célula. Barcelona: Omega.
  • Rubio, T. & Verdecia, M. Enfermedades priónicas. MEDISAN 2009; 13(1)
  • Wemheuer, W. M. et al. Similarities between Forms of Sheep Scrapie and Creutzfeldt-Jakob Disease Are Encoded by Distinct Prion Types. Am J Pathol. 2009; 175(6): 2566–2573
  • Manual MSD
  • Early Clinical Trial
  • MedlinePlus
  • Main picture: Canal44

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From traditional medicine to personalized medicine

From prehistory, where medicine started began with plants, minerals and parts of animals; until today, medicine has evolved very quickly. Much of the “fault” of his fact is due to genetics, which allows us to talk about personalized medicine. In the following article we discuss this.

THE EVOLUTION OF DISEASES

To talk about medicine, we have first to know diseases. We cannot think that all diseases are genetic, but there are diseases related to anatomical changes, fruit of our evolution.

Chimpanzees are the closest animal to us, humans, with which we share 99% of our genome. Despite this, humans have very particular phenotypic characteristics as the brain most develop, both in size and expansion of the cerebral cortex; hairless sweaty skin, bipedal posture and prolonged dependence on offspring, allowing the transmission of knowledge for longer; among other.

Possibly, the bipedal position was key to the early development of the divergence between the chimpanzee lineage and that of humans; and is also the reason for the appearance of some diseases related to anatomical factors. Among them are hernias, haemorrhoids, varices, disorders of the spine, such as herniated intervertebral discs; osteoarthritis in the knee joint, uterine prolapse and difficulties in childbirth.

The fact that the pelvis was remodelled (Figure 1) and narrower resulted in obstetric problems millions of years later, when the brain expanded. Consequently, the skull as well. The heads of the foetuses were longer and larger, making birth difficult. This explains why the deliveries of humans are longer and longer compared to those of chimpanzees and other animals.

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Figure 1. Comparison between human pelvis and chimpanzee pelvis in bipedal position (Source: Libros maravillosos – La especie elegida (capítulo 5))

The evolution towards modern life has behaved many changes in every way. In comparison to our hunter-gatherer ancestors (Figure 2), our diet has changed a lot and has nothing to do with what other primates eat. For the latter, the fruit represents most of the intake, but for us it is red meat. In addition, we are the only animals that continue to feed us milk after the lactation period.

cazadores y recolectores
Figure 2. Picture of hunter-gatherer humans (Source: Río Verde en la historia

If we add to the sedentary lifestyle and the limited physical activity of modern humans, it can help explain the seriousness and frequency of some modern human diseases.

Lifestyle can also affect us. For example, myopia, which rate is higher in western individuals who read a lot or do activities of near vision, compared to individuals of Aboriginal’s towns.

Another clear example is the alteration in the female reproductive stage. Currently, women have children more and more later. This is also linked to a decrease in the duration of breastfeeding. These changes, which can be considered socially positive, have negative effects on the health of the reproductive organs. It has been shown that the combination of early menarche, limited or no breastfeeding and later menopause are the main risk factors for breast and ovarian cancer.

Humans increasingly live more years and we want the best quality of life. It is easy for more longevity to appear more diseases, by the deterioration of the organism and its cells.

THE EVOLUTION OF MEDICINE

The history of medicine is the history of the struggle of men against disease and since the beginning of this century, is also the history of human effort to maintain health.

We have acquired the scientific knowledge of medicine based on observation and experience, but it has not always been so. Our ancestors experienced sickness and the fear of death before a rational picture could be made of them, and the medicine of that time was immersed in a system of beliefs, myths and rites.

However, in the last years it has been born personalized genomics, which tells you your risk factors. This opens a door to personalized medicine, which adjusts treatments to patients depending on their genome (Figure 3). It uses information from a person’s genes and proteins to prevent, diagnose and treat a disease, all thanks to the sequencing of the human genome.

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Figure 3. Personalized medicine that treats people individually, according to their genome (Source: Indiana Institute of Personalized Medicine)

Molecular methods that make precision medicine possible include tests of gene variation, proteins, and new treatments targeting molecular mechanisms. With the results of these tests and treatments can determine the state of the disease, predict the future state of the disease, the response to the drug and treatment or even the role of the food we eat at certain times, which results of great help to the doctors to individualize the treatment of each patient.

To do this, we have within our reach the nutrigenetics and the nutrigenomics, that like the pharmacogenetics and the pharmacogenomics, they help the advance of a medicine is more and more directed. Therefore, these disciplines are today one of the pillars of personalized medicine since it involves treating each patient individually and tailor-made.

The evolution towards precision medicine is personalized, preventive, predictive and participatory. There is increasing access to information and the patient is more proactive, getting ahead of problems, preventing them or being prepared to deal with them efficiently.

REFERENCES

  • Varki, A. Nothing in medicine makes sense, except in the light of evolution. J Mol Med (2012) 90:481–494
  • Nesse, R. and Williams, C. Evolution and the origins of disease. Sci Am. (1998) 279(5):86-93
  • Mackenbach, J. The origins of human disease: a short story on “where diseases come from”. J Epidemiol Community Health. (2006) 60(1): 81–86
  • Main picture: Todos Somos Uno

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What is gene therapy?

In the last years we have heard discuss gene therapy and its potential. However, do we know what gene therapy is? In this article, I want to make known this promising tool that can cure some diseases that therapies with conventional drugs cannot it. I discuss approaches of gene therapy and their key aspects, where we find animal models.

INTRODUCTION

A clinical trial is an experimental study realized in patients and healthy subjects with the goal to evaluate the efficiency and/or security of one or various therapeutics procedures and, also, to know the effects produced in the human organism.

Since the first human trial in 1990, gene therapy has generated great expectations in society. After over 20 years, there are a lot of gene therapy protocols have reached the clinical stage.

Before applying gene therapy in humans it is necessary to do preclinical studies; these are in vitro or in vivo investigations before moving to clinical trials with humans. The aim of these is protect humans of toxic effects that the studied drug may have.

An important element in preclinical studies are animal models. First, tests are made with small animals like mice. If they are successful, then tests are made with larger animals, like dogs. Finally, if these studies give good results then they are passed to higher animals: primates or humans.

WHAT IS GENE THERAPY?

Gene therapy represents a promising tool to cure some of those diseases that conventional drug therapies cannot. This therapy consists in the transfer of genetic material into cells or tissues to prevent or cure a disease.

Initially gene therapy was established to treat patients with hereditary diseases caused by single gene defects, but now, at present, many gene therapy efforts are also focused on curing polygenic or non-inherited diseases with high prevalence (Video 1).

Video 1. Explanation about what gene therapy is (Source: YouTube)

APPROACHES IN GENE THERAPY

There are two types of approaches in gene therapy (Figure 1):

  • In vivo gene therapy: introduce a therapeutic gene into a vector which then is administered directly to the patient. The vector will transfer the gene of interest in the target tissue to produce the therapeutic protein.
  • Ex vivo gene therapy: transfer the vector carrying the therapeutic gene into cultured cells from the patient. After, these genetically engineered cells are reintroduced to the patients where they now express the therapeutic protein.

in-ex-vivo
Figure 1. Differences between the two types of approaches in gene therapy (Source: CliniGene – Gene Therapy European Network)

KEY ASPECTS OF GENE THERAPY

When designing a gene therapy approach there are some key aspects to be considered:

1/ THERAPEUTIC GENE

The gene of interest is that which is introduced into the body to counteract the disease. For the one hand, for the diseases are caused by the lost or dysfunction of a single protein, the gene to be transferred is more identifiable, being that only a correct copy of the gene whose dysfunction causes the diseases will be introduced. For the other hand, for the diseases whose origin is more complex the choice of the therapeutic gene may be more difficult and will have to make several studies and know well the disease.

2/ VECTOR

Vehicle by which the gene of interest is transported to the target cells. The perfect vector should be able to transduce target cells without activating an immune response either against itself or the therapeutic gene. But there aren’t a universal vector to treat any disease.

2.1/ VIRAL VECTORS

These type of vectors derives from viruses, but this is not a problem because much or all of the viral genes are replaced by the therapeutic gene. This means that the viral vectors do not cause pathogenic disease because the gene was deleted.

2.2/ NON-VIRAL VECTORS

These type of vectors does not derive from viruses, but the therapeutic gene is part of a plasmid.

3/ TARGET CELLS

Any cell that has a specific receptor for an antigen or antibody, or hormone or drug… The therapeutic gene must be directed to target cells in specific tissues.

4/ ROUTES OF ADMINISTRATION

The therapeutic gene must be administered through the most appropriate route. The type of route depends, as like as vector, the target tissue, the organ to manipulate or the disease to be treated.

5/ ANIMAL MODELS

Are used to find out what happens in a living organism. They are mainly used in research to achieve progress of scientific knowledge, as many basic cellular processes are the same in all animals and can understand what happens to the body when it has a defect; as models for the study of a disease, because humans and animals share many diseases and how to respond to the immune system; to develop and test potential methods of treatment, being an essential part of applying biological research to real medical problems and allowing the identification of new targets for the intervention of the disease; and, finally, to protect the safety of people, animals and environment, researchers have measured the effects of beneficial and harmful compound on an organism, identifying possible problems and determine the dose administration.

Gene therapy represents a promising tool to cure some of those diseases that conventional drug therapies cannot. The availability of animal models is key to preclinical phases because it allows thorough evaluation of safety and efficacy of gene therapy protocols prior to any human clinical trials.

In the near future, gene therapy will be an effective alternative to pharmacological efforts, and enable treatment of many diseases that are refractory or not suitable for pharmacologic treatment alone. Thus, gene therapy is a therapeutic tool that gives us virtually unlimited possibilities to develop better and more effective therapies for previously incurable diseases.

REFERENCES

MireiaRamos-angles

Nutritional genomics: À la carte menu

When Hipprocrates said “let food be your medicine and medicine be your food” he knew that food influences our health. And it tells us that nutritional genomics, which I will discuss in this article; a new science appeared in the post genomic era as a result of the sequencing of human genome (all DNA sequences that characterize an individual) and the technological advances that allow the analysis of large amounts of complex information.   

WHAT IS NUTRITIONAL GENOMICS?

The aim of nutritional genomics is to study the interactions of genes with elements of the human diet, altering cellular metabolism and generating changes in the metabolic profiles that may be associated with susceptibility and risk of developing diseases.

This study wants to improve the health and to prevent diseases based on changes in nutrition. It is very important not understand nutritional genomics how that specific food or nutrients cause a particular answer to certain genes.

When we talk about diet we have to distinguish between what are nutrients and what are food. Nutrients are compounds that form part of our body, while foods are what we eat. Food can take many nutrients or only one (such as salt).

NUTRIGENOMICS vs. NUTRIGENETICS

Within nutritional genomics we find nutrigenomics and nutrigenetics, but although their names we may seem to mean the same is not the case (Figure 1).

Nutrigenomics is the study of how foods affect our genes, and nutrigenetics is the study of how individual genetic differences can affect the way we respond to nutrients in the foods we eat.

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Figure 1. Schematic representation of the difference between nutrigenomics and nutrigenetics (Source: Mireia Ramos, All You Need is Biology)

NUTRIGENOMICS IN DETAIL

Nutrients can affect metabolic pathways and homeostasis (balance) of our body. If this balance is disturbed chronic diseases or cancer may appear, but it can also happen that a disease, which we have it, be more or less severe. It means that impaired balance can give the appearance, progression or severity of diseases.

The aim of nutrigenomics is that homeostasis is not broken and to discover the optimal diet within a range of nutritional alternatives.

Thus, it avoids alterations in genome, in epigenome and/or in expression of genes.

ALTERATIONS IN GENOME

Free radicals are subproducts that oxidise lipids, proteins or DNA. These can be generated in mitochondria, organelles that we have inside cells and produce energy; but we can also incorporate from external agents (tobacco, alcohol, food, chemicals, radiation).

In adequate amounts they provide us benefits, but too much free radicals are toxic (they can cause death of our cells).

Antioxidants neutralize free radicals. But where can we get these antioxidants? There are foods that contain them, as Table 1 shows.

table1eng
Table 1. Example of antioxidants and some foods where we can find them (Source: ZonaDiet)

The way we cook food or cooking is important for avoid to generate free radicals. In barbecues, when we put the meat on high heat, fats and meat juices fall causing fire flames. This produces more flame and it generates PAHs (a type of free radicals). These adhere to the surface of the meat and when we eat it can damage our DNA.

ALTERATIONS IN EPIGENOME

Epigenome is the global epigenetic information of an organism, ie, changes in gene expression that are inheritable, but they are not due to a change in DNA sequence.

Epigenetic changes may depend on diet, aging or drugs. These changes would not have to exist lead to diseases as cancer, autoimmune diseases, diabetes…

For example, with hypomethylation, in general, cytosines would have to be methylated are not. What does it mean? Hypomethylation silenced genes and then, they cannot be expressed. Therefore, we need methylated DNA. A way of methylate DNA is eating food rich in folic acid.

ALTERATIONS IN GENE EXPRESSION

There are agents (UV rays) that activate pathways that affect gene expression. Occurring a cascade that activates genes related to cell proliferation, no differentiation of cells and that cells survive when they should die. All this will lead us cancer.

It has been found that there are foods which, by its components, can counteract activation of these pathways, preventing signal transduction is given. For example curcumin (curry), EGCG (green tea) or resveratrol (red wine).

 REFERENCES

MireiaRamos-angles

Pangolin: poaching is condemning it to extinction

Neither the tiger or elephant or rhino: the most hunted mammals by humans are pangolins, to the point of critically threaten their survival as a species. Discover the only mammal with scales, its current condition and what can we do to prevent the extinction of all species of pangolin in the world.

WHAT IS A PANGOLIN?

manis tricuspis, pangolin, árbol, tree, trepando
Tree pangolin (Phataginus tricuspis). (Photo by Bart Wursten).

The name pangolin (also known as scaly anteater or trenggiling) includes 8 different species distributed by a variety of habitats (tropical rainforests, dry forests, savanna areas, cultivated fields…) in Africa and Asia. They measure between 90 cm and 1.65 m. They are the only family in the order Pholidota: although physically similar, armadillos, sloths and anteaters are not its relatives (order Xenarthra). Most are nocturnal, solitary and shy, so there are still many questions about their biology and behavior in the wild (they don’t usually survive captivity).

MORPHOLOGY

Pangolins are the only mammals with scales: they are made of keratin (like our nails) and give them a look like a pineapple or artichoke. Scales are very sharp and they can move them voluntarily. If pangolins feel threatened hiss and puff, curl into a ball leaving the scales exposed and secrete pestilential acids to ward off predators (tigers, lions, panthers and humans).

leon, leona, pangolin, bola, lion, defensa
An impenetrable defense even to a lioness. (Photo by Holly Cheese)

The claws allow them both climb as digging: terrestrial pangolins hide and breed in underground galleries and arboreal pangolins do the same in hollows on trees. The tail of the tree pangolin is prehensile to attach to the branches. In addition, pangolins are excellent swimmers.
They are mainly bipedal animals: forepaws are so large that force them to walk on its hind legs, with a maximum speed of 5 km/h. Watch a pangolin walking and feeding:

NUTRITION

Pangolin has no teeth and is unable to chew. It feeds on ants and termites, which locates with its powerful sense of smell (the view is underdeveloped) and catch them with its sticky and long tongue (may be longer than the body itself, up to 40 cm). The stones swallowed involuntarily and corneal structures of their stomach help them to crush the exoskeletons of insects. With its powerful claws destroy their nests to access them and avoid their attack plugging his ears and nostrils, besides having an armored eyelid. It is estimated that a pangolin can consume about 70 million insects per year, which makes them important regulators of the population of ants and termites.

lengua, pangolin, tongue
The tongue of the pangolin. (Photo by Wim Vorster).

REPRODUCTION

Pangolins can reproduce at any time of the year. After pregnancy (two to five months, depending on species) only one young is born (African species) or up to three (Asian species).

pangolin, hembra, female, mamas, breast, pecho, tetas
Female pangolin. (Photo by Scott Hurd)

The pangolin is born with soft scales, which begin to harden after two days. When after a month come out of the burrow, they travel on the tail of her mother and become independent at 3-4 months. Their lifespan is unknown, although in captivity an individual lived until 20 years old.

pangolin, baby, cría, zoo bali
Female with her baby in the tail. Bali zoo. (Photo by Firdia Lisnawati)

THREATS AND CONSERVATION

In addition to habitat destruction, the main threat that pangolins face is direct hunting for human consumption. Although there are international laws to protect them, it is estimated that about 100 000 pangolins are hunted annuallyGiven the defense strategy of this animal, poachers only have to catch them of the ground. Like other species, like sharks, the food market and traditional medicine are the main causes of directing the pangolin towards extinction.

pangolin, jaulas, tráfico ilega, illegal trade, bushmeat
Illegal trade in pangolin. (Photo by Soggydan Benenovitch).

WHY PANGOLINS ARE POACHED?

  • Bushmeat is considered a delicacy and an indicator of high social status in Vietnam and China. The pangolin fetus soup is sold as an elixir to increase virility and improve breast milk production. The price of bushmeat on the black market can reach $ 300 per kilo. The price of an individual can reach $ 1,000.

sopa, feto, soup, pangolin, feto, fetus
Pangolin fetus soup. (Photo by TRAFFIC).

  • Blood is sold as a tonic to improve health and as an aphrodisiac.
  • Scales can reach $ 3000 per kilo and are used for almost anything: to cure from acne to cancer. This belief is curious, considering that the scales have the same structure as our fingernails.

pangolín, china, medicina, medicine, tradicional, cura para el cáncer
Products of traditional Chinese medicine made of pangolin. (Photo by TRAFFIC).

All these purported medicinal and magical effects have no scientific basis, making yet more nonsense pangolin smuggling.

CONSERVATION

The population trend of all species of pangolin is declining in some cases to an alarming extent. The IUCN (International Union for the Conservation of Nature) Red List of Threatened Species classifies them as it follows:

RED LIS CATEGORIES IUCN
IUCN Red List categories. (Image from iucn.org)

Because of their status, IUCN restored in 2012 a group of specialists within the Species Survival Commission (SSC) dedicated to pangolins (Pangolin Specialist Group -PangolinSG-). Its main objective are do research to increase knowledge of pangolins, the threats they face and how they can be mitigated to facilitate preservation.

The conservation projects that are being carried out include campaigns to reduce the demand of bushmeat and pangolin scales and the tightening of laws. Still, the total ignorance of populations’ state and low survival in captivity for breeding makes it difficult to design strategies for their conservation.

WHAT CAN YOU DO FOR PANGOLIN?

  • Reject any product derived from this animal, either bushmeat, scales or “miracle” products for the cure of diseases. Read the labels of any traditional remedies, especially if they are from the Asian market, and recall that its hypothetical benefits have no scientific basis, so that you can rethink their use.
  • Share information. If you own new data on pangolins, photos or videos contact with PangolinSG to cooperate with the investigation. Talk about them in your immediate environment to raise awareness and publicize this fantastic single animal.
  • Do a PhD about pangolins. Lot of research on these species is still needed, so if you are a student and you are planning to do a PhD, you can collaborate with PangolinSG with your future research.
  • Become a PangolinSG volunteer. Get involved in the development and implementation of projects and conservation programs.
  • Make a financial donation so PangolinSG can continue its work.

In conclusion, more scientific research, a change of mind and protection policies are needed to prevent the pangolin become an example of extinct species at the hands of ours, as it is about to happen to white rhino.

REFERENCES

MIREIA QUEROL ALL YOU NEED IS BIOLOGY