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Tag: University of California

  • Commonly used antiretroviral drugs used to treat HIV and hepatitis B reduce immune cells’ energy production

    Commonly used antiretroviral drugs used to treat HIV and hepatitis B reduce immune cells’ energy production

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    FINDINGS

    New UCLA-led research suggests that antiretroviral drugs called TAF and TDF directly reduce energy production by mitochondria, structures inside cells that generate the power that cells use to function. Both drugs led to reduced cellular oxygen consumption rates, a measure of the ability of the mitochondria to produce energy, compared with controls. But in combination with other antiretrovirals, TAF appeared to result in a larger energy reduction than TDF did. Whether this is a cause for concern is not known at this point.

    BACKGROUND                                                                                         

    The antiretroviral drugs tenofovir alafenamide (TAF) and tenofovir disoproxil fumarate (TDF) are used to treat HIV and hepatitis B infection in millions of people around the world. These drugs are also used as pre-exposure prophylaxis (PrEP) against HIV in uninfected people.

    METHOD

    Using both a human clinical trial and experimental lab studies, the researchers assessed the impact of TAF and TDF in combination with other antiretrovirals on the ability of blood immune cells to make energy. In the clinical trial, 26 people with HIV switched antiretrovirals over nine months and the researchers assessed how the drugs affected their cells’ energy production. The investigators confirmed these findings experimentally in the lab by directly adding the drugs to healthy immune cells and analyzing their impact on the cells’ metabolism.

    IMPACT

    The clinical implications of the findings are unclear at this point, a question that requires more research. These drugs are well tolerated by millions of people worldwide, but the long-term clinical implications of these drugs on the ability of human cells to make energy is unclear.

    COMMENT

    “Mitochondria are key structures inside the cells. This is the among the first demonstrations that antiretrovirals used in humans in HIV and hepatitis B directly change the function of mitochondria to make energy,” said senior author Dr. Theodoros Kelesidis, associate professor-in-residence of medicine in the division of infectious diseases at the David Geffen School of Medicine at UCLA. “We utilized independent research methods to confirm our findings. This is an important message, given that millions of people are on these antiretrovirals. It remains to be shown whether the effects of these antiretrovirals on mitochondria are mechanistically linked to certain metabolic changes that may be seen with the use of these antiretrovirals such as weight gain.”

    AUTHORS

    Study co-authors are Eleni Ritou, Sandro Satta, Anton Petcherski, Maria Daskou, Madhav Sharma, Hariclea Vasilopoulos, and Dr. Orian Shirihai of UCLA, and Eisuke Murakami of Gilead Sciences.

    JOURNAL

    The study is published in the peer-reviewed journal Metabolism.

    FUNDING

    The study was supported by Gilead Sciences, Inc. (CO-US-311-4393) and the National Institutes of Health (R01AG059501).

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    University of California, Los Angeles (UCLA), Health Sciences

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  • UCSF Researchers Uncover New Pathway for Molecular Cancer Drug Therapies

    UCSF Researchers Uncover New Pathway for Molecular Cancer Drug Therapies

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    Newswise — A fundamental challenge in drug development is the balance between optimizing a drug’s lock-and-key fit with its target and the drug’s ability to make its way across the cellular membrane and access that target. The search for cell-permeable drugs has conventionally focused on low-molecular weight molecules with rigid, nonpolar chemical structures. However, emerging therapeutic strategies break traditional drug design rules by employing larger, flexibly linked chemical entities. 

    In a study published December 8, 2022 in Science, UCSF researchers Kevin Lou, an MD-PhD student, Luke Gilbert, PhD, and Kevan Shokat, PhD, reveal the discovery of a cellular uptake pathway important for larger molecules. These large and complex molecules bind in unconventional ways to their targets, are efficiently taken up by target cells, and can be harnessed to create new drugs for the treatment of cancer and other diseases. 

    Through a combination of functional genomics and chemical methods, the scientists uncovered an endogenous pathway involving interferon-induced transmembrane (IFITM) proteins that promote the cellular uptake of diverse linked chemotypes. These proteins are found in plasma membranes and often provide cellular resistance to viruses.

    Most traditional pharmaceuticals are small molecules that follow simple molecular rules including limits on the molecular size and number of sticky chemical groups on the molecule’s surface. Many key drug targets, such as kinase enzymes often involved in cancer, are difficult to selectively target with traditional drugs.

    “There are over 500 human kinase enzymes that are very similar in the pocket where the drug binds, making it a challenge to selectively target a single member of this family and leading to undesirable medication side effects,” explains the study’s first author Kevin Lou. “Increasingly, it has been found that certain linked molecules outside this traditional framework can maintain drug-like properties and gain new mechanisms of action.”

    There are many important intracellular drug targets that researchers have been unable to be target with small, compact, and rigid molecules. To address this challenge, scientists have taken to linking multiple ligands into a single chemical entity (a linked chemotype). These linked chemotypes can have enhanced potency, greater selectivity, and the capacity to induce the association of more than one target. 

    “Given this discrepancy between the favorable biological activity of many large, bivalent molecules and traditional concepts of passive permeability, we inferred that linked chemotypes might hijack cellular processes to assist with passage through the cell membrane,” wrote Lou. We selected as an example a bitopic inhibitor of mTOR, RapaLink-1, whose molecular weight falls well beyond common guidelines.” 

    The team designed two new linked drugs that they hypothesized might take advantage of this cellular entry pathway. They generated DasatiLink-1 through a linker-joined combination of two known inhibitors of the leukemia protein BCL-ABL1, known as dasatinib and asciminib. Since each drug binds a distinct pocket on the target protein, the researchers reasoned that the linked version could affix itself to two points of contact like a two-pronged key inserting into two locks, enhancing its specificity and effectiveness.  

    They also designed BisRoc-1 by linking two molecules of the chemotherapy drug rocaglamide together in a way that would allow it to bridge two copies of the drug’s protein target. Despite the fact that both of these drugs violate traditional drug design principles, the team showed that both drugs enter cells, bind tightly to their intended targets, and work just as well as the unlinked versions. The linked versions were uniquely dependent on IFITM protein expression in the target cells, supporting a general role for the IFITM pathway across many types of linked molecules. The researchers showed that DasatiLink-1 is specific for only the BCL-ABL1 kinase, unlike the more relaxed specificity of its two constituent drugs when unlinked.  

    “Linked inhibitors that require a multi-pronged binding mechanism are much more selective,” Lou explains. “They offer substantial advantages as long as they can enter cells efficiently.”  

    We discovered that IFITM proteins enable bitopic inhibitors to enter cells and this will likely allow us to target previously untargetable proteins in disease,” said Luke Gilbert, PhD, co-corresponding author and the Goldberg-Benioff Endowed Professorship in Prostate Cancer Translational Biology at UCSF. “Hopefully, our study will generate new clues for how IFITM proteins function mechanistically that can be pursued by drug design scientists and virologists.”  

    The scientists are working on chemically optimizing the properties of the linked BCR-ABL inhibitors to increase their potency and position them as next-generation therapeutics for BCR-ABL mutant cancers. “We are also excited to expand the scope of intracellular targets amenable to bitopic inhibition,” said Gilbert. 

    Authors: In addition to first author Kevin Lou and co-corresponding authors Luke Gilbert and Kevan Shokat, the other authors of the paper are Douglas Wassarman, Ziyang Zhang, and Megan Moore of the University of California, San Francisco and the Howard Hughes Medical Institute; Tangpo Yang, Thomas O’Loughlin, and Jack Taunton of the University of California, San Francisco; YiTing Paung and Markus Seeliger of Stony Brook University; Regina Egan and Patricia Greninger of the Massachusetts General Hospital; and Cyril Benes of the Massachusetts General Hospital and Harvard Medical School.   

    Funding: This research was supported by funding from the National Institutes of Health, the Damon Runyon Cancer Foundation, the Pew-Stewart Scholars program, the Goldberg-Benioff Endowed Professorship, the Howard Hughes Medical Institute, the Samuel Waxman Cancer Research Foundation, Wellcome Trust, the Ono Pharma Foundation, Pfizer, and Arc Institute. 

    About UCSF Health: UCSF Health is recognized worldwide for its innovative patient care, reflecting the latest medical knowledge, advanced technologies and pioneering research. It includes the flagship UCSF Medical Center, which is ranked among the top 10 hospitals nationwide, as well as UCSF Benioff Children’s Hospitals, with campuses in San Francisco and Oakland, Langley Porter Psychiatric Hospital and Clinics, UCSF Benioff Children’s Physicians and the UCSF Faculty Practice. These hospitals serve as the academic medical center of the University of California, San Francisco, which is world-renowned for its graduate-level health sciences education and biomedical research. UCSF Health has affiliations with hospitals and health organizations throughout the Bay Area. Visit http://www.ucsfhealth.org/. Follow UCSF Health on Facebook or on Twitter. 

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    Follow UCSF 

    ucsf.edu | Facebook.com/ucsf | Twitter.com/ucsf | YouTube.com/ucsf 

     

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    University of California, San Francisco (UCSF)

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  • Expert on Human Exposure to Contaminants – Response to 3M & Forever Chemicals

    Expert on Human Exposure to Contaminants – Response to 3M & Forever Chemicals

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    Newswise — Environmental health researcher, epidemiologist, and statistician, Scott Bartell, PhD, is a professor at the UCI Program in Public Health in the Department of of Environmental and Occupational Health and has joint appointments across all other UCI Public Health departments as well as the Department of Statistics at the UCI Donald Bren School of Information and Computer Sciences.

    For the past 25 years, Bartell has dedicated his research to quantifying human exposures and health effects caused by environmental contaminants, including perfluoroalkyl and polyfluoroalkyl substances (PFAS). Bartell can respond to any media inquiries about the recent public notice that 3M will stop making hazardous forever chemicals that have profound impacts on human health.

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    University of California, Irvine

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  • Some workers could see as much as 66% raise as University of California and striking union reach agreement

    Some workers could see as much as 66% raise as University of California and striking union reach agreement

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    Striking UC workers rally outside UCLA Luskin Center


    Striking UC workers rally outside UCLA Luskin Center

    01:49

    The University of California reached an agreement Friday with some 36,000 graduate student teaching assistants and other academic workers for increased pay and benefits that could potentially end a monthlong strike — the largest of its kind in the nation — at the prestigious state system.

    The strike disrupted classes at all 10 of the university system’s campuses. The agreement still needs to be ratified before the strike officially ends.

    The bargaining units said some workers could see raises of up to 66% over the next two years. The contracts would go through May 31, 2025.

    “In addition to incredible wage increases, the tentative agreements also include expanded benefits for parent workers, greater rights for international workers, protections against bullying and harassment, improvements to accessibility, workplace protections, and sustainable transit benefits,” Tarini Hardikar, a member of the union bargaining team at UC Berkeley, said in a news release Friday.

    The pay hikes and boost in benefits could have an impact beyond California. For several decades, colleges and universities have increasingly relied on faculty and graduate student employees to do teaching and research that had previously been handled by tenured track faculty – but without the same pay and benefits.

    “These agreements will place our graduate student employees among the best supported in public higher education,” Michael V. Drake, president of the University of California, said in a news release Friday. “If approved, these contracts will honor their critical work and allow us to continue attracting the top academic talent from across California and around the world.”

    The 32-day UC strike was being closely watched around the country, in part because it is the largest strike of academic workers in higher education, said William A. Herbert, executive director of the National Center for the Study of Collective Bargaining in Higher Education and the Professions at Hunter College in New York.

    The strike at UC, like the others, is “providing guidance to indicate that strikes are very forceful means of accomplishing goals,” he said.

    The agreement comes weeks after the UC system reached a similar deal with postdoctoral employees and academic researchers who make up about 12,000 of the 48,000 union members who walked off the job and onto picket lines Nov. 14. That agreement will hike pay up to 29% and provide increased family leave, childcare subsidies and lengthened appointments to ensure job security, according to a statement from United Auto Workers Local 5810.

    The academic workers had argued they couldn’t afford to live in cities such as Los Angeles, San Diego and Berkeley, where housing costs are soaring, with the current salaries.

    The strike was notable for its size and scale, but also because of what it could mean for other universities, said Tim Cain, associate professor of higher education at the University of Georgia. If graduate employees and researchers ratify the contracts, it could prompt similar changes at colleges that compete with UC or where graduate workers are organizing unions.

    Union organizing nationwide also stems from long-term changes at America’s universities, which have increasingly come to rely on graduate students to teach classes and handle other duties traditionally done by tenured faculty.

    “There’s a fundamental shift in who’s doing the academic work in higher education,” Cain said. Wages for graduate students haven’t kept up over time, he added, and many face increasingly tough competition for full-time faculty jobs.

    The strike came at a time of increased labor action nationwide, not just in higher education but among workers at Starbucks, Amazon and elsewhere and a groundswell of unionization efforts among graduate student employees at other universities.

    Just this year, graduate student employees at Massachusetts Institute of Technology, Clark University, Fordham University, New Mexico State University, Washington State University and Worcester Polytechnic Institute all voted in favor of unionization.

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  • Some University of California striking workers reach deal

    Some University of California striking workers reach deal

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    LOS ANGELES — Postdoctoral scholars and academic researchers on Tuesday reached a tentative labor agreement with the University of California but will remain on strike in solidarity with thousands of graduate student workers at all 10 of the university system’s campuses.

    The union representing the scholars and researchers hailed the deal as a major victory and said it would provide “substantial wage increases that address cost of living.”

    In addition to pay hikes of up to 29%, the agreement would provide increased family leave, childcare subsidies and lengthened appointments to ensure job security, according to a statement from United Auto Workers Local 5810.

    The agreement must be ratified in a vote by members.

    Letitia Silas, executive director of UC’s labor relations, said the university system was pleased to have reached a deal that honors the workers’ contributions.

    “These agreements also uphold our tradition of supporting these employees with compensation and benefits packages that are among the best in the country,” Silas said in a statement.

    The postdoctoral employees and academic researchers make up about 12,000 of the 48,000 union members who walked off the job and onto picket lines three weeks ago. About 36,000 graduate student teaching assistants, tutors and researchers are bargaining separately and remain on strike, calling for increased pay and benefits.

    Union leaders have said the strike could be the largest work stoppage the prestigious public university system has ever faced.

    The academic workers say with their current salaries they can’t afford to live in cities such as Los Angeles, San Diego and Berkeley, where housing costs are soaring.

    Organizers from the United Auto Workers, which represents the employees involved, have said there is no end date for the strike.

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  • University Of California Strike Hits Campuses Across The State

    University Of California Strike Hits Campuses Across The State

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    Nearly 50,000 workers at the University of California went on strike Monday in the largest U.S. work stoppage of the year.

    The strike will take place at each of the university system’s ten campuses as well as a research center, according to affiliates of the United Auto Workers union. They accused the university of “unlawful behavior” and bargaining in “bad faith.” The two sides have failed to reach an agreement on a new contract.

    Rafael Jaime, president of UAW Local 2865, said the university and union made progress in negotiations over the weekend but remained “far apart” on crucial issues. Jaime’s union represents 18,000 of the roughly 48,000 workers involved in the strike.

    “We are hopeful that UC will cease its unfair labor practices and bargain with us in good faith,” said Jaime, a doctoral candidate at the university.

    It is not clear how long the strike may last. A university spokesperson could not immediately be reached for comment on Monday.

    The workers involved in the strike include teaching assistants, graduate student researchers, postdoctoral fellows and tutors, among others. Their unions have been pressing the university for higher pay, saying academic workers can’t afford to live in the communities where they teach and conduct research.

    The UAW affiliates said the strike appeared to be the largest in U.S. academic history. They scheduled picket lines for Monday at university sites across the state.

    Late last week, more than 30 California state legislators sent a letter to the university’s president, Michael Drake, urging him to reach a deal with the unions so that the “massive disruption” of a strike could be averted.

    “The UC is one of the top public university systems and research institutions in the world, in no small part because of its ability to attract the most talented scholars from a wide array of backgrounds,” the lawmakers wrote. “But the UC system cannot live up to its mission and reputation if its own employees do not feel respected.”

    This is a developing story. Please check back for updates.

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  • Flood Modeling Framework Reveals Heightened Risk and Disparities in Los Angeles

    Flood Modeling Framework Reveals Heightened Risk and Disparities in Los Angeles

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    Newswise — Irvine, Calif., Oct. 31, 2022 – Flood risk in Los Angeles is vastly larger than previously indicated by federally defined flood maps, and low-income and marginalized communities face a significantly higher threat, according to a study led by researchers at the University of California, Irvine.

    The findings are the product of a recently developed high-resolution flood modeling platform that can assess risk every 10 feet across the 2,700-square-mile expanse of the Greater Los Angeles basin. The framework, described in a paper published today in Nature Sustainability, connects hazards from rainfall, stream flow and storm tides with demographic data including population density, ethnicity, race and economic disadvantage.

    “We have developed an innovative, new flood risk modeling platform that, for the first time, enables household exposure and inequalities to be systematically quantified across major metro regions,” said lead author Brett Sanders, UCI professor of civil and environmental engineering. “This platform could, in principle, be applied everywhere to not only assess risks but measure the efficacy and equity of proposed solutions. And because the modeling is at a very fine resolution, anyone can immediately visualize the risk and contemplate how it might impact them.”

    A 100-year flood event in Los Angeles would expose more than 400,000 people to danger, and property damage could exceed $50 billion. According to the UCI researchers, losses would be comparable to those felt in severe hurricanes such as Katrina in 2005, Sandy in 2012, and Irma and Harvey in 2017, each of which incurred tens of billions of dollars in damages and displaced hundreds of thousands of people.

    Los Angeles is less at risk of impact from a tropical cyclone – the most common source of flooding in the southeastern United States – but Southern California is subject to occasionally catastrophic levels of precipitation from climate change-driven atmospheric river events.

    “The impacts of a severe flood would not be evenly distributed across Angelinos,” Sanders said. “Disadvantaged communities are disproportionately affected, and they’re less well protected. Recovery from floods is often prolonged and incomplete in these areas due to unequal government responses, which further exacerbate the inequities.”

    A sizeable portion of the risk – and the inequality in possible outcomes – in Greater Los Angeles comes from the region’s built environment, according to the researchers.

    “The impacts of a severe flood would not be evenly distributed across Angelinos. Disadvantaged communities are disproportionately affected, and they’re less well protected,” says Brett Sanders, UCI professor of civil and environmental engineering, here walking in the Santa Ana River channel. Jo Kwon / Spectrum News

    “Recent flooding disasters across the U.S. have demonstrated that cities are underprepared and that infrastructure is undersized,” said co-author Richard Matthew, UCI professor of urban planning and public policy. “As we saw in Texas and Florida recently, areas exposed to flood risk have been underestimated by previous mapping, especially among disadvantaged communities, and this is the case here in Los Angeles and Orange County too.”

    Matthew noted that the drivers of disaster differ from inland to coastal areas. Poorer regions are more affected by intense rainfall, causing runoff to collect in streets and overwhelm flood channels, while more affluent communities along the coast are more vulnerable to flooding from storm tides and waves. Each set of hazards requires different mitigation measures, he stressed.

    “The development of this modeling framework is especially timely given that the U.S. is increasingly focused on climate change, committed to infrastructure investments, concerned about social justice, and in need of tools that facilitate community participation in infrastructure planning and design,” Sanders said.

    The project received financial support from the National Science Foundation, high-performance computing assistance from the National Center for Atmospheric Research’s Computational and Information Systems Laboratory in Wyoming, and data from Los Angeles County and Orange County. Additional researchers included Amir AghaKouchak, Steven Davis, Daniel Kahl, Jochen Schubert and Nicola Ulibarri of UCI; Katharine Mach of the University of Miami; David Brady of UC Riverside; and Fonna Forman of UC San Diego.

    About the University of California, Irvine: Founded in 1965, UCI is a member of the prestigious Association of American Universities and is ranked among the nation’s top 10 public universities by U.S. News & World Report. The campus has produced five Nobel laureates and is known for its academic achievement, premier research, innovation and anteater mascot. Led by Chancellor Howard Gillman, UCI has more than 36,000 students and offers 224 degree programs. It’s located in one of the world’s safest and most economically vibrant communities and is Orange County’s second-largest employer, contributing $7 billion annually to the local economy and $8 billion statewide. For more on UCI, visit www.uci.edu.

    Media access: Radio programs/stations may, for a fee, use an on-campus ISDN line to interview UCI faculty and experts, subject to availability and university approval. For more UCI news, visit news.uci.edu. Additional resources for journalists may be found at communications.uci.edu/for-journalists.

    NOTE TO EDITORS: PHOTO AVAILABLE AT
    https://news.uci.edu/2022/10/31/uci-flood-modeling-framework-reveals-heightened-risk-and-disparities-in-los-angeles

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    University of California, Irvine

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  • New Onset Chronic Kidney Disease in People with Diabetes Highest Among Ethnic, Racial Minorities

    New Onset Chronic Kidney Disease in People with Diabetes Highest Among Ethnic, Racial Minorities

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    Newswise — New onset chronic kidney disease (CKD) in people with diabetes is highest among racial and ethnic minority groups compared with white persons, a UCLA-Providence study finds.

    The study, published as a letter to the editor in the New England Journal of Medicine, found that new onset CKD rates were higher by approximately 60%, 40%, 33%, and 25% in the Native Hawaiian/Pacific Islander, Black, American Indian/Alaska Native, and Hispanic/Latino populations, respectively, compared to white persons with diabetes.

    Although high CKD incidence in diabetes persists, the rate declined from 8% of the overall diabetes population in 2015-2016 to 6.4% in 2019-2020”.

    “The results of our study constitute a call to action to institute directed, targeted efforts aimed at deliberately shifting the trajectory of persistently high rates of diabetes-related CKD and kidney failure that disproportionately affect racial and ethnic minority groups,” said co-author Dr. Susanne Nicholas, associate professor of medicine in the division of nephrology at the David Geffen School of Medicine at UCLA and chair of the UCLA Nephrology Racial and Health Equity Committee. “The first step should be to increase the rates of screening and detection of CKD in individuals with diabetes.”

    Researchers from the Geffen School, Providence, and the Centers for Disease Control and Prevention tracked 654,549 adults with diabetes from 2015 through 2020 using electronic health records from Providence Health and UCLA Health, two large not-for-profit health systems serving the Western United States.

    The prevalence of kidney failure requiring dialysis or transplant more than doubled to nearly 800,000 persons in the United States between 2000 and 2019, with diabetes as the leading cause. The rate of new onset of CKD in people with diabetes was previously unknown, yet the value of such incidence data is vital for identifying high-risk populations, determining the effectiveness of interventions, and assessing the effects on health care delivery and public health responses. Even more striking, less than 10% of patients with early stage kidney disease are aware of having CKD at this stage in its progression, when therapies are most effective. 

    “Given the rapidly growing population with diabetes in the United States and the corresponding high rates of kidney failure, the persistently high incidence of CKD marked by racial and ethnic disparities is troubling,” said lead author Dr.  Katherine Tuttle, executive director for research at Providence Inland Northwest Health and professor of medicine at the University of Washington. “Inclusive strategies for prevention, detection, and intervention are needed to reduce CKD risk in people with diabetes.”

    Additional study authors are Dr. O. Kenrik Duru and Dr. Keith Norris of UCLA; Cami Jones, Kenn Daratha, Dr. Radica Alicic, and Joshua Neumiller of Providence; and Nilka Ríos Burrows, Alain Koyama, and Dr. Meda Pavkov of the Centers for Disease Control and Prevention.

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    University of California, Los Angeles (UCLA), Health Sciences

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  • New Analysis Led by Ucla Jonsson Comprehensive Cancer Center Finds Timing Androgen-Deprivation Therapy with Radiation Therapy Improves Outcomes in Localized Prostate Cancer

    New Analysis Led by Ucla Jonsson Comprehensive Cancer Center Finds Timing Androgen-Deprivation Therapy with Radiation Therapy Improves Outcomes in Localized Prostate Cancer

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    Newswise — UCLA Research Brief

    BOTTOM LINE:

    Men with prostate cancer who are receiving radiation often benefit from adding to the treatment androgen deprivation therapy, a form of medication that reduces testosterone. Historically, men have been placed on androgen deprivation therapy prior to beginning radiation. In a large analysis of over 7,000 men treated internationally across 12 randomized trials, Dr. Kishan and colleagues have shown that it is almost universally optimal for men to begin androgen deprivation therapy when starting radiation, so that most of the period of having a low testosterone is “backloaded” after radiation is complete.

    BACKGROUND

    Androgen-deprivation therapy (ADT), also called hormone-suppression therapy, has consistently been shown to improve survival rates when added to radiation therapy (RT) for lower-risk patients with localized prostate cancer. However, the optimal sequencing of ADT for these patients remains controversial. Two previous studies suggested that ADT beginning with RT and continuing afterward may be superior to the before-and-during RT sequencing option, but both randomized trials had limitations that made it difficult to infer broad conclusions, according to the authors. 

    Based on those trials, this study’s researchers theorized that concurrent/adjuvant ADT sequencing would offer improved metastasis-free survival compared with neoadjuvant/ concurrent ADT sequencing in patients receiving short-term (four to six months) therapy in a RT field size-dependent manner.

    This meta-analysis was designed to investigate how the sequencing of ADT combined with RT administered via prostate-only RT or whole-pelvis RT might impact outcomes for prostate cancer patients.

    FINDINGS

    The analysis examined more than 7,400 patient records, including 6,325 patients who had received ADT before and during (neoadjuvant/concurrent) their radiation therapy and 1,084 patients who received ADT during and after (concurrent/adjuvant) undergoing RT. The median follow-up period was 10.2 years.

    Researchers observed a significant interaction between ADT sequencing and RT field size for all study endpoints except overall survival. For patients receiving prostate-only RT, ADT occurring during and after radiation was associated with improved metastasis-free survival compared with neoadjuvant/concurrent ADT.

    However, with patients receiving whole-pelvis RT, no significant difference was observed with ADT sequencing, except greater distant metastasis occurrence among those who had concurrent/adjuvant ADT.  However, that finding should be interpreted with caution due to details on how the individual trials were structured.

    The study appears in the Journal of Clinical Oncology.         

    CONCLUSION

    The authors concluded that ADT sequencing demonstrated a significant impact on clinical outcomes with a strong correlation to RT field size. They believe that concurrent and adjuvant ADT should be the standard of care where short-term ADT is indicated in combination with prostate-only RT.

    METHODS

    The researchers conducted a new analysis of individual patient data from 12 randomized trials in which patients received short-term ADT either before and during their radiation therapy or during and after for localized prostate cancer. Data was obtained through the Meta-Analysis of Randomized Trials in Cancer of the Prostate (MARCAP) Consortium, a first-of-its-kind repository for worldwide clinical trials involving patients with prostate cancer. The consortium was co-founded in 2020 by Drs. Amar Kishan of the UCLA Jonsson Comprehensive Cancer Center and Daniel Spratt with University Hospitals Seidman Cancer Center in Cleveland.

    Their analysis included performing inverse probability of treatment weighting (IPTW) with propensity scores derived from factors such as age, initial PSA score, Gleason score, T stage, RT dose and mid-trial enrollment year. Metastasis-free survival and overall survival were assessed by Cox regression models adjusted for IPTW and analyzed independently for men receiving prostate-only RT versus whole-pelvis RT. Adjusted Fine and Gray competing risk models were built to evaluate distant metastasis (DM) and prostate cancer-specific mortality.

    EXPERT COMMENTS

    “To our knowledge, this study represents the first time a significant association has been demonstrated between concurrent and adjuvant ADT sequencing and overall survival rates among prostate cancer patients,” said Kishan, corresponding author for the study. “For patients receiving prostate-only RT, concurrent/adjuvant sequencing is associated with optimal outcomes.”

    Kishan, who is vice-chair of Clinical and Translational Research and chief of genitourinary oncology for Radiation Oncology at UCLA, noted that the results should be “considered practice-changing with regards to how ADT is sequenced with radiation for patients getting short courses of ADT with prostate radiation.”

    He says future trials currently in the pipeline may yield more answers about the benefit of neoadjuvant/concurrent ADT sequencing with whole-pelvis RT in patients with intermediate- and high-risk prostate cancer.

    AUTHORS

    First author Ting Martin Ma is with the UCLA Department of Radiation Oncology, as is corresponding author Kishan, who also represents the MARCAP consortium. Yilun Sun, an equal contributor to the study, is with Case Western Reserve University School of Medicine. MARCAP co-founder Spratt also was an equal study contributor. Other authors are listed in the publication.  

    FUNDING / POTENTIAL CONFLICTS OF INTEREST

    Kishan reports funding support from grant P50CA09213 from the Prostate Cancer National Institutes of Health Specialized Programs of Research Excellence and grant W81XWH-22-1-0044 from the Department of Defense, as well as grant RSD1836 from the Radiological Society of North America. Additional funding came from the STOP Cancer organization, UCLA Jonsson Comprehensive Cancer Center, Prostate Cancer Foundation and American Society of Radiation Oncology, as well as donations from the DeSilva, McCarrick and Bershad families.

    No other authors had conflicts to declare.

    DOI: 10.1200/JCO.22.00970

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    University of California, Los Angeles (UCLA), Health Sciences

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  • Age vs. genetics: Which is more important for determining how we age?

    Age vs. genetics: Which is more important for determining how we age?

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    Newswise — Amid much speculation and research about how our genetics affect the way we age, a University of California, Berkeley, study now shows that individual differences in our DNA matter less as we get older and become prone to diseases of aging, such as diabetes and cancer.

    In a study of the relative effects of genetics, aging and the environment on how some 20,000 human genes are expressed, the researchers found that aging and environment are far more important than genetic variation in affecting the expression profiles of many of our genes as we get older. The level at which genes are expressed — that is, ratcheted up or down in activity — determines everything from our hormone levels and metabolism to the mobilization of enzymes that repair the body.

    “How do your genetics — what you got from your sperm donor and your egg donor and your evolutionary history — influence who you are, your phenotype, such as your height, your weight, whether or not you have heart disease?” said Peter Sudmant, UC Berkeley assistant professor of integrative biology and a member of the campus’s Center for Computational Biology. “There’s been a huge amount of work done in human genetics to understand how genes are turned on and off by human genetic variation. Our project came about by asking, ‘How is that influenced by an individual’s age?’ And the first result we found was that your genetics actually matter less the older you get.”

    In other words, while our individual genetic makeup can help predict gene expression when we are younger, it is less useful in predicting which genes are ramped up or down when we’re older — in this study, older than 55 years. Identical twins, for example, have the same set of genes, but as they age, their gene expression profiles diverge, meaning that twins can age much differently from each other.

    The findings have implications for efforts to correlate diseases of aging with genetic variation in humans, Sudmant said. Such studies should perhaps focus less on genetic variants that impact gene expression when pursuing drug targets.

    “Almost all human common diseases are diseases of aging: Alzheimer’s, cancers, heart disease, diabetes. All of these diseases increase their prevalence with age,” he said. “Massive amounts of public resources have gone into identifying genetic variants that predispose you to these diseases. What our study is showing is that, well, actually, as you get older, genes kind of matter less for your gene expression. And so, perhaps, we need to be mindful of that when we’re trying to identify the causes of these diseases of aging.”

    Sudmant and his colleagues reported their results this week in the journal Nature Communications.

    Medawar’s hypothesis

    The findings are in line with Medawar’s hypothesis: Genes that are turned on when we are young are more constrained by evolution because they are critical to making sure we survive to reproduce, while genes expressed after we reach reproductive age are under less evolutionary pressure. So, one would expect a lot more variation in how genes are expressed later in life.

    “We’re all aging in different ways,” Sudmant said. “While young individuals are closer together in terms of gene expression patterns, older individuals are further apart. It’s like a drift through time as gene expression patterns become more and more erratic.”

    This study is the first to look at both aging and gene expression across such a wide variety of tissues and individuals, Sudmant said. He and his colleagues built a statistical model to assess the relative roles of genetics and aging in 27 different human tissues from nearly 1,000 individuals and found that the impact of aging varies widely — more than twentyfold — among tissues.

    “Across all the tissues in your body, genetics matters about the same amount. It doesn’t seem like it plays more of a role in one tissue or another tissue,” he said. “But aging is vastly different between different tissues. In your blood, colon, arteries, esophagus, fat tissue, age plays a much stronger role than your genetics in driving your gene expression patterns.”

    Sudmant and colleagues also found that Medawar’s hypothesis does not hold true for all tissues. Surprisingly, in five types of tissues, evolutionary important genes were expressed at higher levels in older individuals.

    “From an evolutionary perspective, it is counterintuitive that these genes should be getting turned on, until you take a close look at these tissues,” Sudmant said. These five tissues happen to be the ones that constantly turn over throughout our lifespan and also produce the most cancers. Every time these tissues replace themselves, they risk creating a genetic mutation that can lead to disease.

    “I guess this tells us a little bit about the limits of evolution,” he said. “Your blood, for instance, always has to proliferate for you to live, and so these super-conserved, very important genes have to be turned on late in life. This is problematic because it means that those genes are going to be susceptible to getting somatic mutations and getting turned on forever in a bad, cancerous way. So, it kind of gives us a little bit of a perspective on what the limitations of living are like. It puts bounds on our ability to keep living.”

    Sudmant noted that the study indirectly indicates the effect on aging of one’s environment, which is the impact of everything other than age and genetics: the air we breathe, the water we drink, the food we eat, but also our levels of physical exercise. Environment amounts to up to a third of gene expression changes with age.

    Sudmant is conducting similar analyses of the expressed genes in several other organisms — bats and mice — to see how they differ and whether the differences are related to these animals’ different lifespans.

    UC Berkeley graduate students Ryo Yamamoto and Ryan Chung are co-first authors of the paper. Other co-authors are Juan Manuel Vazquez, Huanjie Sheng, Philippa Steinberg and Nilah Ioannidis. The work was supported by the National Institute of General Medical Sciences (R35GM142916) of the National Institutes of Health.

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    University of California, Berkeley

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  • 195 ways to help California’s painted ladies

    195 ways to help California’s painted ladies

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    Newswise — By documenting hundreds of new nectar plants for painted ladies, scientists have renewed hope these charismatic butterflies may prove resilient to climate change. 

    Every spring, swarms of the colorful butterflies can be spotted in Southern California as they make their way from western Mexico to the Pacific Northwest to breed. Some years, the number of migrating butterflies is in the millions. 

    Additionally, California is home to resident painted lady populations that require food sources year-round.

    Though they are a major North American butterfly species, there is a lack of baseline data to quantify a decline in painted ladies. However, scientists believe they are being negatively affected by hotter, drier weather and habitat loss.

    “The lack of rainfall in Southern California likely impacts the butterflies’ ability to move through the state, potentially decreasing nectar sources and causing them to die without reproducing,” said Jolene Saldivar, UC Riverside ecologist who led this effort to identify new painted lady nectar plants. 

    “There’s so much to be learned about these butterflies before drought and climate change damage them irreparably,” Saldivar said. This study, which identifies 195 new nectar plants for the species, is now published in the journal Environmental Entomology.  

    To obtain this result, the UCR team sorted through more than 10,000 images of painted ladies in California shrublands, supplied by community scientists through the iNaturalist website. Any images in which the butterflies did not have mouth parts extended and were not obviously feeding were omitted from analysis, as were any images of caterpillars. 

    The newly discovered nectar sources may offer Southern California gardeners wanting to support the species a wide range of options. 

    “Much of what we identified could responsibly be planted during a drought,”      said Erin Wilson-Rankin, study co-author and UCR associate professor of entomology. 

    Of the top 10 most frequently observed plant species, seven are native to California. These include yellow-flowered rubber rabbitbrush, blue wild hyacinth, common fiddleneck, Fremont’s pincushion, black sage, wild heliotrope and desert lavender, which belongs to the mint family. 

    These butterflies also readily feed on showy ornamental plants common to California landscaping, such as lantana, butterfly bush and rosemary, as well as flowering weeds.

    “It’s an uber generalist insect, not picky at all,” Saldivar said. 

    Painted lady caterpillars consume plants, but they are not known to eat any agriculturally important species, nor are they known spreaders of any illness. They serve as good sources of prey for insects, spiders, birds, wasps and reptiles, and mature butterflies can pollinate some of the many plants they visit.

    “It might be getting tougher for painted ladies in some places, but these butterflies will feed on what flowers are available — even a few plants in a window box could help them,” Wilson-Rankin said. 

    Saldivar says she believes the results of this paper may encourage community scientists, whose contributions to knowledge should be celebrated and promoted. 

    “Adding a photo and a little information to a community science website or through an app on your smartphone might seem minor, but in the big picture, it helps inform us about ecological processes we’d otherwise be very challenged to learn about,” Saldivar said. 

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    University of California, Riverside

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  • Study casts doubt on routine use of anesthesiologists in cataract surgery

    Study casts doubt on routine use of anesthesiologists in cataract surgery

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    Newswise — Ophthalmologists may be able to safely cut back on having anesthesiologists or nurse anesthetists routinely at bedside during cataract surgery, which accounts for more than two million surgeries per year in the U.S., according to a study publishing Oct. 3 in JAMA Internal Medicine

    A team of researchers from UC San Francisco examined Medicare claims for 36,652 patients who had cataract surgery in 2017 and found the use of anesthesia care was substantially higher for cataract surgery when compared to patients undergoing other elective, low-risk outpatient procedures—such as cardiac catheterization or screening colonoscopy. However, they found that these patients experienced fewer systemic complications—such as myocardial infarction or stroke—than did patients undergoing the other low-risk procedures.  These results held true even in cases where anesthesia experts were not present for the cataract surgery, suggesting that for many cataract patients, it may be reasonable to consider doing the procedure without routine anesthesia support.

    “It’s important to note we only looked at systemic complications and not ophthalmologic outcomes from the procedure,” noted senior study author Catherine Chen, MD, MPH, UCSF associate professor in  Anesthesia and Perioperative Care and researcher at the Philip R. Lee Institute for Health Policy Studies. “We are evaluating those next, but it would be premature to say we should change practice now based on this study. Hopefully we can get a conversation going, though.” 

    Some type of anesthetic and possibly sedation is needed for cataract surgery, Chen noted, but the question is who should be present for administration and intraoperative monitoring of these patients. In the past, cataract surgery carried a much higher risk of complications, which helps explain the historic and legacy use of anesthesiologists and/or certified registered nurse anesthetists (CRNA). 

     “The risk of the procedure itself used to require general anesthesia with paralysis and inpatient admission. Over time, ophthalmologists improved their technique so it [cataract surgery] is much safer and can be done on an outpatient basis,” said Chen. “Often the patient just needs a topical anesthetic such as numbing drops in the eyeball, and, at UCSF anyway, a little fentanyl and midazolam, which are agents a sedation nurse can administer safely.”

    A Question of Resources

    The study found that, for cataract surgery, 90% of U.S. Medicare patients have an anesthesia provider at the bedside compared to a range of <1% to 70% at bedside for other low-risk elective procedures. In contrast, fewer cataract surgery patients experienced systemic complications within seven days (7.7%) than patients undergoing other low-risk procedures (range, 13% to 52%).  

    Approximately 6% of ophthalmologists never used anesthesia providers, 77% always used anesthesia providers, and 17% used them for only a subset of patients. Patients of those ophthalmologists who never used anesthesia providers had a 7.4% rate of systemic complications. 

    There is no specific guidance from professional associations on whether to include an anesthesia expert during cataract surgery, but other countries do not routinely use them, to no ill effect, Chen noted. 

    With U.S. anesthesiologists being asked to staff an increasing number of non-OR procedures, such as endoscopic or interventional radiology procedures where patients tend to be much sicker and the procedure potentially more invasive, there often aren’t enough of these specialists go around, Chen said. 

    “Add to this a general shortage of anesthesiologists since COVID, and it’s clear we need to ensure staff resources are used efficiently,” said Chen.

    In an upcoming study, Chen and her colleagues will look at both systemic and ophthalmologic outcomes stratified by whether patients received care from an anesthesia provider during cataract surgery. While the current study used a sample of 5% of Medicare claims, the upcoming study will use 20% of claims. 

    “It’s certainly possible that by having an anesthesiologist there, the patients are calmer and possibly less likely to move, and so the ophthalmologic outcomes could be better—so we are working on those studies now,” Chen said. “Where I think where we could end up, when the results are in, is that instead of automatically defaulting to include an anesthesiologist, we stratify patients by risk so that their level of sedation and anesthesia support matches their likelihood of complications.”

    Co-authors and funding: Please see paper for additional co-authors and funding disclosures.

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    University of California, San Francisco (UCSF)

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  • Most Twitter users don’t follow political elites, researchers suggest

    Most Twitter users don’t follow political elites, researchers suggest

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    Newswise — While social media platforms are the primary source of political information for a growing number of people, a majority of Twitter users do not follow either members of Congress, their president or news media, a new study suggests.

    They are much more likely to follow Tom Hanks or Katie Perry than an elected official.

    “Those users who do follow political accounts on Twitter, however, stick to insular online communities and mostly follow and share information from their political in-group,” said Magdalena Wojcieszak, lead author and professor of communication at the University of California, Davis, and the University of Amsterdam.   

    In other words, speaking to ongoing debates about so-called “echo chambers” on social media platforms, the small group of users who do follow political elites display clear political biases and engage with these elites in a very one-sided way.

    The findings come after researchers from UC Davis and New York University analyzed four years’ worth of data from a sampling of 1.5 million Twitter users.

    Researchers concluded that even though the group of social media users who display political biases in their online behaviors is small, it is nevertheless consequential. These users are much more vocal, participatory and active online, thus amplifying the general perception of unprecedented polarization.

    The study was published Friday (Sept. 30) in Science Advances.

    “In this project, we focus on national political elites due to their visibility and national-level influence on public opinion and the political process,” Wojcieszak said. Yet, despite the prominence and impact of presidents, congressmen, journalists, pundits and the news media, researchers found that only 40% of Twitter users follow one or more political “elites.” The remaining 60% follow no political actors at all.

    “Given that we analyzed over 2,500 American political elite accounts including Donald Trump, Joe Biden, prominent pundits including Rachel Maddow and Sean Hannity, and the most popular media outlets such as MSNBC and Fox News, the fact that only 23% of the representative sample of over 1.5 million users follow three of more of such elite accounts is revealing,” Wojcieszak said.

    The authors found that those users who do follow politicians, pundits and news media follow their political in-group at much higher rates than out-group elites (around 90% vs. 10%) and share tweets from in-group elites overwhelmingly more frequently than out-group tweets (at about a 13:1 ratio). And when users share out-group tweets, they tend to add negative comments to these reshares, further reinforcing ideological biases online.

    The research also reveals important ideological asymmetries: conservative users are roughly twice as likely as liberals to share in-group versus out-group content, as well as to add negative commentary to out-group shares.

    Surprising findings

    “Overall, the majority of American Twitter users are not sufficiently interested in politics to follow even a single political or media elite from our list,” Wojcieszak said. Researchers wrote that they found this surprising, since it is generally believed that Twitter users are more politically engaged than the general population.

    Given a growing radicalization in America, decreasing support for democratic norms, and rising support for political violence, concerns about political biases on social media platforms are valid, no matter how small the groups displaying those biases may be.

    “At the same time,” Wojcieszak said, “we have to remember that these political biases are far removed from the everyday online behaviors of most politically disinterested Americans, who simply don’t care and prefer to immerse themselves in entertainment or sports. Our findings should help us all keep in perspective the concerns about the so-called ‘echo chambers’ online.”

     Co-authors of the study include: Andreu Casas, Free University of Amsterdam; Xudong Yu, former doctoral student at UC Davis, now University of Amsterdam; and Jonathan Nagler and Joshua A. Tucker, New York University Center for Social Media and Politics.

    The Center for Social Media and Politics at New York University is supported by funding from the John S. and James L. Knight Foundation, the Charles Koch Foundation, Craig Newmark Philanthropies, the William and Flora Hewlett Foundation, the Siegel Family Endowment, the Bill and Melinda Gates Foundation and the National Science Foundation.

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    University of California, Davis

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