IN THIS ISSUE:
REGULAR FEATURES:
EARLY WARNING: In a recent edition of The Lancet, Robert B. Belshe, M.D., Adorjan professor of internal medicine, director of the division of infectious diseases and immunology, and director of the Center for Vaccine Development at the School of Medicine, warned that the need is great to improve research worldwide to prepare for the next influenza pandemic and to develop better strategies to prevent influenza. Belshe made the comments in the British medical journal, equivalent in stature internationally to the New England Journal of Medicine. The A/HK/H5N1 influenza strain, also known as the "Avian or Bird Flu," was the focus of the Feb. 14 edition of The Lancet.
"The technologically advanced world must invest in the infrastructure to promote research and prevention strategies for influenza," Belshe said. "We need laboratories that can contain highly pathogenic avian influenza in order to safely conduct research on these agents. Very few universities are equipped to handle these agents, nor are sufficient government laboratories available."
Belshe also wrote in his editorial of the need for better vaccines, citing the current method of production (using fertilized hen eggs) as too lengthy and cumbersome. Instead, he suggested that vaccines grown in tissue culture would shorten the production time and improve the flexibility of industry to produce influenza vaccines. "Other modern vaccine technologies are at hand," he said. "Recombinant protein vaccines and live attenuated vaccines each have their place in the control of influenza."
Regulatory agencies are another area that need to be supported, Belshe said. There will be great pressure to approve new vaccines in the face of a pandemic. Specifically, he said these agencies need improved research laboratories and more personnel now they need insulation from political pressures to do their job independently of manufacturers or political expediency. "There will be a new pandemic," Belshe warned. "But we don't know when. Let us improve our research infrastructure now and not wait for the next true influenza pandemic."
ULCER RESEARCH: The discovery of Heliobacter pylori as a leading cause of ulcers has led to the misconception that this bacteria is to blame for all ulcer problems. But Heliobacter pylori accounts for only one piece of the ulcer puzzle, responsible primarily for those ulcers that previously were attributed to too much acid production or too much stress. Many people get ulcers and experience stomach damage from factors totally unrelated to Heliobacter pylori, such as damage from anti-inflammatory drugs, alcohol, severe closed-head injuries or burns. Because aspirin (along with non-steroidal anti-inflammatory drugs such as Advil and Motrin) is the number one drug taken by the American people, this prospect concerns a large segment of the population.
"All of these drugs that people take for aches, pains and arthritis can cause ulcers and significant damage to the stomach," said Thomas A. Miller, M.D., professor and chairman of surgery. "Of 100 people with ulcer problems, about 60 to 70 percent of them have ulcers caused by Heliobacter pylori. The fascinating thing is that the other 30-40 percent have ulcers for another reason, especially if they are stomach ulcers."
Miller's research, focusing on the mechanisms responsible for ulcer disease, is conducted with co-investigator Dr. Gregory Smith, associate professor of surgery and director of Saint Louis University Surgical Research Institute. Their research has been funded continuously by the National Institutes of Health for 17 years and recently was re-funded for four more years, taking it into its 21st year, the year 2001. The dollar value of this NIH grant approaches $1 million, indicating that Miller and Smith are on the right track.
Since they first became interested in ulcer disease in the late 1970s, Miller and Smith have seen various mechanisms evaluated: acid production, bicarbonate secretion, mucous production and blood flow. All were thought to play a role, but virtually all of them have been dismissed as the sole mechanism because they are not common to every case. Studies up to this point have not revealed an underlying common denominator. Most researchers have taken animals and given them something to cause stomach damage, then removed the stomach, photographed and examined it to try to assess the extent of the damage. "But this approach has not answered the fundamental question as to why an ulcer occurs," Miller said.
Miller and Smith are looking for something more basic going on in the affected cells, that when disturbed, sets them up for injury. "We are looking at cells that are injured to figure out why they are injured and what building blocks contribute to that injury," Smith said. "Then we can turn it around and strengthen these things so that the ulcer doesn't occur."