News (Updated September 5, 2010)

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Stem cell clinics: experts insist claims of cure-all are medically unproven

Health tourists travel the world and spend thousands, but their hopes of being cured are li

by Denis Campbell

5 September 2010

For the past decade stem cells have sparked huge excitement among scientists, dramatic media coverage about breakthroughs that could mean a cure for some of the nastiest diseases, and hope – sometimes desperate – among patients that the reality will match the hype. That has fuelled a booming trade in stem cell tourism – people heading to clinics abroad and forking out large sums for what are called stem cell treatments but which are unlikely to work and possibly do harm.

It is, as some of the UK 's leading stem cells experts warned last week, a world of unproven therapies, patient optimism and predatory clinicians. Despite the lack of reliable evidence underpinning the treatments being offered, the number of people resorting to stem cell tourism is growing. Experts voiced their fears and frustrations after finding that many patients, often desperately ill, were asking their advice on whether to travel overseas.

"I've made some very strong comments which could potentially land me in court, but people still go to these clinics," said Professor Peter Coffey, director of the London Project to Cure Blindness at University College London. There are now several hundred clinics around the world which claim to have turned the potential of stem cells into effective treatments. They lure those suffering from diabetes, multiple sclerosis, heart failure, Parkinson's disease, autism, HIV, eye problems, spinal cord injuries and much else besides.

Several thousand people from around the world so far are estimated to have spent up to £20,000 or more in such places. Yet while stem cells could transform medicine, there is as yet scant actual proof of their efficacy. But still the tourists come.

The fact that scientists believe it is likely to be 15 to 20 years before the continuing worldwide flurry of trials and tests results in reliable treatments has not stopped clinics from offering exactly that already. Strong regulation means there are no such places in the UK or America . But the experts did single out the XCell Centre in Düsseldorf , Germany , and Beike Technology, which runs one in Shenzhen in China .

In 2008 the Multiple Sclerosis Society warned sufferers not to be taken in by Integrated BioSciences, a company registered in the Turks & Caicos Islands, which had offices in the Seychelles , Persian Gulf and Oxford , because there was no scientific backing for the claim that stem cells could cure the condition.

People's willingness to trust their savings and their health to such clinics recently prompted the International Society for Stem Cell Research to launch a website to educate patients about the risks involved. Anyone thinking about going would be well adv

guardian.co.uk © Guardian News and Media Limited 2010

 

Gilead Submits European Marketing for Once-Daily Treatment of HIV Infection

-- Product Would Be The Second Complete, Fixed-Dose Antiretroviral Regimen --

FOSTER CITY, Calif., Sep 03, 2010 (BUSINESS WIRE) -- Gilead Sciences, Inc. /quotes/comstock/15*!gild/quotes/nls/gild (GILD 34.02, +0.87, +2.62%) today announced that it has submitted a Marketing Authorization Application (MAA) to the European Medicines Agency (EMA) for marketing approval for the fixed-dose combination of Truvada(R) (emtricitabine and tenofovir disoproxil (as fumarate)) and Tibotec Pharmaceuticals' investigational non-nucleoside reverse transcriptase inhibitor TMC278 (rilpivirine (as hydrochloride)) for the treatment of HIV-1 infection in adults. Pending approval, the new single-tablet regimen would be only the second product that contains a complete antiretroviral treatment regimen in a single once-daily tablet.

The MAA will be reviewed by the Committee for Medicinal Products for Human Use (CHMP). Review of the MAA will be conducted by the EMA under the centralized licensing procedure, which, when finalized, provides one marketing authorization in all 27 member states of the European Union. An MAA for TMC278 also is being submitted today by Tibotec to the EMA for review.

"The important role of complete, fixed-dose HIV treatment regimens is well established in Europe ," said John C. Martin, PhD, Chairman and Chief Executive Officer, Gilead Sciences. "Today, nearly one quarter of HIV patients in the major European countries are taking a one pill, once-daily regimen, and recent updates to the International AIDS Society guidelines support the use of these simplified regimens. We are pleased to work with Tibotec in contributing another potentially important new once-daily, fixed-dose treatment option."

The regulatory application for the fixed-dose combination is supported by 48-week data from two Phase III double-blind, randomized studies (ECHO and THRIVE) evaluating the safety and efficacy of TMC278 in treatment-naive HIV-1 infected adults and a bioequivalence study conducted by Gilead, which demonstrated that the formulation of the fixed-dose combination of Truvada and TMC278 achieved the same levels of medication in the blood as the component products dosed simultaneously. ECHO (Efficacy Comparison in treatment-naive HIV-infected subjects Of TMC278 and Efavirenz) evaluated TMC278 (25 mg) combined with a fixed-dose background regimen consisting of emtricitabine (200 mg) and tenofovir disoproxil fumarate (245 mg). THRIVE (TMC278 against HIV, in a once-daily RegImen Versus Efavirenz), evaluated once-daily TMC278 (25 mg) compared to once-daily efavirenz (600 mg) combined with an investigator-selected background regimen consisting of two nucleoside reverse transcriptase inhibitors (abacavir and lamivudine, or emtricitabine and tenofovir disoproxil fumarate, or zidovudine and lamivudine).

Gilead entered into a license and collaboration agreement with Tibotec Pharmaceuticals for the development and commercialization of a single-tablet regimen containing TMC278 and emtricitabine and tenofovir disoproxil fumarate for the treatment of HIV in July 2009. In April 2010, Gilead announced that it had successfully formulated and obtained data supporting bioequivalence of the fixed-dose combination.

About TMC278 and the Fixed-Dose Combination

TMC278 (rilpivirine (as hydrochloride)) is an investigational non-nucleoside reverse transcriptase inhibitor being developed by Tibotec Pharmaceuticals. Tibotec submitted a New Drug Application for U.S. marketing approval of TMC278 on July 23, 2010 for once-daily use with other antiretroviral agents in treatment-naive HIV-infected adults.

The investigational once-daily single-tablet regimen of Truvada/TMC278 contains 200 mg of emtricitabine and 245 mg of tenofovir disoproxil (as fumarate), both nucleoside reverse transcriptase inhibitors, and 25 mg of rilpivirine (as hydrochloride), a non-nucleoside reverse transcriptase inhibitor.

The fixed-dose single-tablet combination of Truvada/TMC278 is an investigational product and the safety and efficacy have not yet been established.

Additional Important Information About Truvada

Truvada is a fixed-dose combination tablet containing 200 mg of emtricitabine (Emtriva(R)) and 245 mg of tenofovir disoproxil (as fumarate) (Viread(R)). In the European Union, Truvada is indicated in combination with other antiretroviral agents (such as non-nucleoside reverse transcriptase inhibitors or protease inhibitors) for the treatment of HIV-1 infection in adults.

Truvada should not be administered concomitantly with other medicinal products containing emtricitabine, tenofovir disoproxil (as fumarate) or other cytidine analogs such as lamivudine and zalcitabine. Truvada should not be administered with a third nucleoside analogue.

Emtricitabine and tenofovir are principally eliminated by the kidneys. Renal impairment, including cases of acute renal failure and Fanconi syndrome (renal tubular injury with severe hypophosphatemia), has been reported in association with the use of Viread. It is recommended that creatinine clearance be calculated in all patients prior to initiating therapy with Truvada and renal function monitored every 4 weeks for the first year and every three months thereafter.

In patients at risk of renal impairment, consideration should be given to more frequent monitoring of renal function.

Dosing interval adjustment and close monitoring of renal function are recommended in all patients with creatinine clearance 30-49 ml/min. Truvada should be avoided with concurrent or recent use of a nephrotoxic agent.

Coadministration of Truvada and didanosine is not recommended. Co-administration of tenofovir disoproxil fumarate and didanosine results in a 40-60 percent increase in systemic exposure to didanosine that may increase the risk of didanosine-related adverse reactions. Rare cases of pancreatitis and lactic acidosis, sometimes fatal, have been reported. Patients on atazanavir/ritonavir and lopinavir/ritonavir plus Truvada should be monitored for tenofovir-associated adverse events and Truvada should be discontinued if these occur.

Decreases in bone mineral density (BMD) at the lumbar spine and hip have been seen with the use of Viread. The effect on long-term bone health and future fracture risk is unknown. If bone abnormalities are suspected then appropriate consultation should be obtained. Cases of osteomalacia (associated with proximal renal tubulopathy and which may contribute to fractures) have been reported in association with the use of Viread.

Changes in body fat have been observed in patients taking anti-HIV medicines. Immune Reconstitution Syndrome has been reported in patients treated with combination therapy, including Viread and Emtriva, and may necessitate further evaluation and treatment.

Most common adverse reactions (incidence greater-than or equal to 10 percent) are hypophosphatemia, dizziness, headache, diarrhea, nausea, vomiting, elevated creatine kinase, asthenia and rash.

The parent compound of Viread was discovered through a collaborative research effort between Dr. Antonin Holy, Institute for Organic Chemistry and Biochemistry, Academy of Sciences of the Czech Republic (IOCB) in Prague and Dr. Erik DeClercq, Rega Institute for Medical Research, Katholic University in Leuven , Belgium . The inventors of Viread have agreed to waive their right to a royalty on sales of Viread and Truvada in Gilead Access Program countries to ensure the product can be offered at a no-profit price in parts of the world where the HIV/AIDS epidemic has hit the hardest.

For complete prescribing information for Truvada, visit the EMA website.

About Gilead Sciences

Gilead Sciences is a biopharmaceutical company that discovers, develops and commercializes innovative therapeutics in areas of unmet medical need. The company's mission is to advance the care of patients suffering from life-threatening diseases worldwide. Headquartered in Foster City , California , Gilead has operations in North America, Europe and Australia .

Forward-Looking Statement

This press release includes forward-looking statements, within the meaning of the Private Securities Litigation Reform Act of 1995, which are subject to risks, uncertainties and other factors, including risks related to Gilead 's ability to successfully commercialize the fixed-dose combination of Truvada/TMC278. The EMA, FDA or other regulatory agencies may not approve TMC278 or the fixed-dose combination of Truvada/TMC278 for the treatment of HIV-infection in treatment-naive adults, and any marketing approval, if granted, may have significant limitations on its use. These risks, uncertainties and other factors could cause actual results to differ materially from those referred to in the forward-looking statements. The reader is cautioned not to rely on these forward-looking statements. These and other risks are described in detail in Gilead 's Quarterly Report on Form 10-Q for the first and second quarters of 2010, as filed with the U.S. Securities and Exchange Commission. All forward-looking statements are based on information currently available to Gilead, and Gilead assumes no obligation to update any such forward-looking statements.

 

Revaccination Could Benefit HIV-Infected Children

02 Sep 2010   

HIV-infected children receiving highly active antiretroviral therapy (HAART) may require revaccination to maintain immunity against preventable diseases. There remains no standard or official recommendation on revaccination of children receiving HAART, an effective intervention in reducing morbidity and mortality in HIV-infected children. Researchers at the Johns Hopkins Bloomberg School of Public Health reviewed published data to assess these children's immune responses to vaccines and found that most children treated with HAART remained susceptible to vaccine-preventable diseases, but responded well to revaccination. Their review was published in the September issue of the Lancet Infectious Diseases.

"Most children on HAART responded to revaccination, although immune reconstitution was not sufficient to ensure long-term immunity for some children," said William Moss, MD, MPH, senior author of the review and an associate professor with the Bloomberg School 's Department of Epidemiology. "Because of the progressive effects of HIV infection on the ability of the immune system to mount an effective response, many infected children have poorer responses to vaccines than do uninfected children. In addition, fewer children infected with HIV achieve protective immunity, and those who do might experience greater and more rapid waning of immunity. These results suggest that children on HAART would benefit from revaccination, but levels of protective immunity might need to be monitored and some children may need additional vaccine doses to maintain protective immunity."

Researchers reviewed 38 published studies to establish whether children infected with HIV on HAART have protective immunity to vaccine-preventable diseases and to assess short-term and long-term immune responses to vaccination of children given HAART. Short-term was defined as less than or equal to 3 months, and long-term was defined as greater than 3 months. They found that starting HAART in infancy, before receipt of routine childhood vaccines, might preserve immunity to vaccine-preventable diseases. Currently, the World Health Organization (WHO) recommends giving most routine childhood vaccines to children infected with HIV, but does not make recommendations on revaccination.

"Continued efforts are needed to identify and treat HIV-infected children at younger ages and at earlier stages of disease," said Catherine Sutcliffe, PhD, lead author of the review and a research associate with the Bloomberg School 's Department of Epidemiology. "Vaccination policies and strategies for children infected with HIV on HAART should be developed in regions of high HIV prevalence to ensure adequate individual and population immunity. Without such recommendations, as treatment programs scale up and more children receive HAART and live into adolescence and adulthood, a larger proportion of these children could be susceptible to childhood diseases."

"Do children infected with HIV receiving HAART need to be revaccinated?" was written by Catherine Sutcliffe and William Moss.

This review was supported by the Canadian Institutes of Health Research and the National Institute of Allergy and Infectious Diseases.

 

Breakthrough test gives fast diagnosis of drug-resistant TB

(AFP) – 2 September, 2010

WASHINGTON — A groundbreaking new test can accurately diagnose drug-resistant tuberculosis (TB) in as little as two hours, researchers wrote in a study published Thursday in the New England Journal of Medicine.

The test -- remarkable not only for its ease-of-use and accuracy, but its cost-effectiveness -- works on the molecular level, identifying genetic markers for the illness in the saliva of test subjects.

Researchers said the result is a far quicker diagnosis than when using traditional testing methods.

"Early, rapid and accurate detection of TB, including identification of drug-resistant strains, is critical to effectively treating the disease, reducing secondary resistance, stopping further transmission and saving lives," said Giorgio Roscigno, chief executive officer of the Foundation for Innovative New Diagnostics (FIND), one of the funders of the research.

The milestone, he said, can "help save the millions of lives needlessly lost to TB every year."

The test not only detects the presence of TB, but also identifies whether it is the strain of the disease that is resistant to rifampin -- a frontline medication used to treat the illness.

Of 1,730 patients suspected to have drug resistant TB, the test was able to correctly identify 98 percent.

"The need for accurate and rapid detection of tuberculosis for the growing at-risk populations in the developing world has been well-documented," said John Bishop, Cepheid, the company which developed the molecular diagnostic exam.

Experts say a speedy diagnosis of TB, particularly the drug-resistant variant, is especially vital in sub-Saharan Africa and Southeast Asia because of the close connection between HIV and TB.

Existing tests to diagnose TB generally take weeks before results are available -- a critically important window of time for patients with compromised immune systems who need may need immediate treatment.

The study's authors said that undetected and untreated, 90 percent of these patients die within months of first contracting tuberculosis, underscoring the need for quick detection and treatment.

TB remains one of the major causes of disability and death worldwide, with an estimated 1.8 million deaths in 2008 and an increasing incidence of drug-resistant disease.

 


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