Stem cell transplant ‘game changer’ for MS patients

Doctors say a stem cell transplant could be a “game changer” for many patients with multiple sclerosis.

Results from an international trial show that it was able to stop the disease and improve symptoms.

It involves wiping out a patient’s immune system using cancer drugs and then rebooting it with a stem cell transplant.

Louise Willetts, 36, from Rotherham, is now symptom-free and told me: “It feels like a miracle.”

A total of 100,000 people in the UK have MS, which attacks nerves in the brain and spinal cord.

Just over 100 patients took part in the trial, in hospitals in Chicago, Sheffield, Uppsala in Sweden and Sao Paulo in Brazil.

They all had relapsing remitting MS – where attacks or relapses are followed by periods of remission.

The interim results were released at the annual meeting of the European Society for Bone and Marrow Transplantation in Lisbon.

The patients received either haematopoietic stem cell transplantation (HSCT) or drug treatment.

After one year, only one relapse occurred among the stem cell group compared with 39 in the drug group.

After an average follow-up of three years, the transplants had failed in three out of 52 patients (6%), compared with 30 of 50 (60%) in the control group.

Those in the transplant group experienced a reduction in disability, whereas symptoms worsened in the drug group.

Prof Richard Burt, lead investigator, Northwestern University Chicago, told me: “The data is stunningly in favour of transplant against the best available drugs – the neurological community has been sceptical about this treatment, but these results will change that.”


Multiple sclerosis

  • Multiple sclerosis (MS) is a condition which can affect the brain and/or spinal cord
  • It can cause problems with vision, arm or leg movement, sensation or balance
  • Average life expectancy is slightly reduced
  • It is estimated that there are more than 100,000 people diagnosed with MS in the UK

    Source: NHS


    The treatment uses chemotherapy to destroy the faulty immune system.

    Stem cells taken from the patient’s blood and bone marrow are then re-infused.

    These are unaffected by MS and they rebuild the immune system.

    Prof John Snowden, haematologist and director of blood and bone marrow transplantation at Sheffield’s Royal Hallamshire Hospital, told me: “We are thrilled with the results – they are a game changer for patients with drug resistant and disabling multiple sclerosis”.

    Prof Basil Sharrack, neurologist and director of MS research at Royal Hallamshire Hospital, told me: “This is interim analysis, but with that caveat, this is the best result I have seen in any trial for multiple sclerosis.”

    ‘Lived in fear’

    Louise was diagnosed with MS in 2010 when she was only 28.

    She told me: “MS ruled my life and I lived in fear of the next relapse.

    “The worst time was not being able to get out of bed because I had no stability in my body – I struggled to walk and even spent time in a wheelchair.

    “It also affected my cognition – it was like a brain fog and I misread words and struggled to keep up with conversations.”

    The BBC’s Panorama filmed her undergoing her transplant in October 2015 and she is now back to full health.

    She got married to her partner Steve, on the first anniversary of her transplant, and their baby daughter Joy is now a month old.

    “I feel like my diagnosis was just a bad dream. I live every day as I want to, rather than planning my life around my MS.”

    The transplant costs around £30,000, about the same as the annual price of some MS drugs.

    Doctors stress it is not suitable for all MS patients and the process can be gruelling, involving chemotherapy and a few weeks in isolation in hospital.

    Dr Susan Kohlhaas, director of research at the MS Society, said the stem cell transplant HSCT “will soon be recognised as an established treatment in England – and when that happens our priority will be making sure those who could benefit can actually get it”.

    She added: “We’ve seen life-changing results for some people and having that opportunity can’t depend on your postcode.”

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Men with low sperm counts at increased risk of illness, study suggests

Men with low sperm counts are more likely to have a number of health issues that put them at increased risk of illness, new research suggests.

A study of 5,177 men found those with low sperm counts were 20% more likely to have more body fat, higher blood pressure and more “bad” cholesterol.

They were also much more likely to have low testosterone levels.

The study’s authors said it showed that men with low sperm counts should also be tested for other health problems.

  • Sperm drop ‘could make humans extinct’
  • Male infertility treatment ‘insensitive’

    ‘Risk factors’

    Low sperm count and problems with sperm quality are factors in around one in three couples who are struggling to get pregnant.

    But for this new study scientists analysed men in infertile couples in Italy, to see whether semen quality is also a marker for men’s general health.

    They found more of the men with low sperm counts had metabolic syndrome – a cluster of risk factors including a higher body mass index (BMI) and raised blood pressure. These increase the risk of developing diabetes, heart disease and stroke.

    The men were also 12 times more likely to have low testosterone levels, which reduce muscle mass and bone density and can be a precursor to osteoporosis, a condition that weakens the bones and makes them more likely to break.

    Dr Alberto Ferlin, professor of endocrinology at the University of Bresci, who led the study, said: “Infertile men are likely to have important co-existing health problems or risk factors that can impair quality of life and shorten their lives.

    “Fertility evaluation gives men the unique opportunity for health assessment and disease prevention.”

    However, the study’s authors stressed that their research did not prove that low sperm counts cause metabolic problems, but rather that the two are linked.

    They said low testosterone levels in particular were associated with these health issues.

    Dr Ferlin said the research showed that it was important that men being treated for infertility were given proper health checks.

    “Men of couples having difficulties achieving pregnancy should be correctly diagnosed, and followed up by their fertility specialists and primary care doctor because they could have an increased chance of morbidity and mortality,” he said.

    ‘Canary in coal mine’

    Kevin McEleny, a consultant urologist at Newcastle Fertility Centre, said at the moment men with sperm problems are rarely investigated for other health problems.

    “This is a message to fertility clinics, particularly, to think about these other health issues in the patients they see.

    “It might be the case that it’s not just about fertility, about sperm in the men, but taking a slightly wider view of male health when they see these people and think about what else needs to be done to get the patients as healthy as possible.”

    Allan Pacey, professor of andrology at the University of Sheffield, said more research is needed to properly understand the relationship between fertility problems in men and other health issues.

    “There is currently no suggestion that male sub-fertility causes health problems later in life and in my opinion, it is more likely that they both have a common cause.

    “However, this highlights why we need to design better studies to investigate male sub-fertility as it could be an important ‘canary in the coal mine’ for other aspects of male health.”

    The study will be presented at ENDO 2018, the Endocrine Society’s 100th annual meeting in Chicago.

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Why is spitting so bad?

There’s been outrage over a video of footballer turned TV pundit Jamie Carragher spitting towards a family in a car in an angry outburst in response to being “goaded”.

Carragher has been suspended from his job as an analyst at Sky Sports.

But why is spitting seen as so offensive?

Yuck factor

“Disgusting”, “vile” and “doesn’t get any lower than spitting” are among the comments posted about the video.

To some people, spitting is in a class above everything – even violence.

It’s often seen as an action of anger and disrespect, but it hasn’t always been the case.

In the past spitting was a socially acceptable habit in Europe, but by the 19th Century manners changed.

This coincided with greater awareness of the transmission of contagious diseases that could be spread by spitting, so public health campaigns were launched against it.

During the 1940s, when tuberculosis (TB) was widespread, it was common to see “spitting prohibited” signs on buses.

Health risks

Today the risk of catching a contagious disease if you’re spat at is very low.

You do stand a small chance of catching a cold or possibly the flu.

Other diseases that are spread through saliva include TB, hepatitis, viral meningitis, cytomegalovirus – a common virus similar to the herpes virus – and the Epstein-Barr virus, which is a common herpes virus that causes many diseases such as glandular fever.

If you are in the unfortunate situation that you are spat at, the NHS recommends you should:

  • Immediately wash the saliva off with soap and lots of water
  • If the saliva goes into your eyes, nose or mouth wash it out with lots of cold water
  • If you think you’re at risk of infection, get immediate medical advice

    Is spitting assault?

    On the football pitch, spitting on the ground is a common sight but spitting at your opponents is categorised as “violent behaviour” by world governing body Fifa.

    Spitting at an opponent or any other person is a sending-off offence by the Football Association.

    The police say “in most cases, spitting if done deliberately will be an assault” and they have started to introduce spit hoods to protect officers.

    The transparent mesh fabric hoods are used by 17 of the UK’s 49 police forces.

    The West Midlands Police force is one of the latest to introduce them.

    The force said in 2016, 231 officers were spat on.

    But the garments have been condemned as cruel and degrading by the campaign group Liberty.

    Fining offence

    Until 1990, spitting was an offence carrying a £5 fine in the UK. In recent years the idea of fines for spitting has re-emerged.

    In 2013, Enfield council in London introduced a by-law to make spitting in public illegal.

    Councillor Chris Bond, who led the campaign to introduce it, described spitting as “utterly foul” and the “sort of disgusting behaviour” that “shouldn’t be tolerated in a civilised society”.

    “It is my belief that most people find spitting a wholly obnoxious, filthy habit which can spread germs and causes health issues,” he said.

    “Banning spitting in Enfield will help combat tuberculosis which has been on the increase in London.”

    In the same year, Waltham Forest Council in north-east London introduced fixed penalty notices of £80 for those caught spitting. It classified spitting as “waste”, which meant that creating a by-law was not necessary and it successfully took two men to court.

    ‘Spit bags’

    In some parts of the world spitting is commonplace.

    China has attempted to tackle the issue a number of times.

    One campaign ahead of the 2008 Beijing Olympics saw volunteers handed out special “spit bags” and banners across the city urged people not to spit as a way of “improving manners”.

    “Take part, contribute and enjoy yourself by welcoming the Olympics, being civilised and behaving better,” said one slogan.

How exercise in old age prevents the immune system from declining

Doing lots of exercise in older age can prevent the immune system from declining and protect people against infections, scientists say.

They followed 125 long-distance cyclists, some now in their 80s, and found they had the immune systems of 20-year-olds.

Prof Norman Lazarus, 82, of King’s College London, who took part in and co-authored the research, said: “If exercise was a pill, everyone would be taking it.

“It has wide-ranging benefits for the body, the mind, for our muscles and our immune system.”

The research was published in the journal Aging Cell.

Prof Janet Lord, director of the Institute of Inflammation and Ageing, at the University of Birmingham, and co-author of the research, said: “The immune system declines by about 2-3% a year from our 20s, which is why older people are more susceptible to infections, conditions like rheumatoid arthritis and, potentially, cancer.

“Because the cyclists have the immune system of a 20-year-old rather than a 70- or 80-year-old, it means they have added protection against all these issues.”

The researchers looked at markers in the blood for T-cells, which help the immune system respond to new infections.

These are produced in the thymus, a gland in the chest, which normally shrinks in size in adulthood.

‘Out of puff’

They found that the endurance cyclists were producing the same level of T-cells as adults in their 20s, whereas a group of inactive older adults were producing very few.

The researchers believe that being physically active in old age will help people respond better to vaccines, and so be better protected against infections such as flu.

Steve Harridge, co-author and professor of physiology at King’s College London, said: “Being sedentary goes against evolution because humans are designed to be physically active.

“You don’t need to be a competitive athlete to reap the benefits – or be an endurance cyclist – anything which gets you moving and a little bit out of puff will help.”

Prof Harridge and Prof Lazarus believe that highly physically active older people represent the perfect group in which to analyse the true effects of biological ageing.

A separate paper in Aging Cell found that the cyclists did not lose muscle mass or strength, and did not see an increase in body fat – which are usually associated with ageing.

I met a dozen of the cyclists, on a morning ride in Surrey. Despite the bitter cold, they were universally cheerful, and clearly used to riding in all weathers.

They are members of Audax, a long-distance cycling organisation that organises events ranging from 100km to 300km.

The older members – in their 80s – say they do only the “short” 100km (62-mile) rides, but this is still highly impressive.

So why do they do it?

Pam Jones, 79, told me: “I do it for my health, because it’s sociable, and because I enjoy the freedom it gives you.”

Brian Matkins, 82, said: “One of the first results I got from the medical study was I was told my body fat was comparable to that of a 19-year-old.”

Aged just 64, Jim Woods, is a comparative youngster in the group. He averages 100 miles a week on his bike, with more during the summer.

He said: “I cycle for a sense of wellbeing and to enjoy our wonderful countryside.”

Cycling 60 miles or more may not be your idea of fun, but these riders have found something that gives them pleasure, which is a key reason why they continue.

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Millennials ‘set to be fattest generation’

UK millennials are on track to be the most overweight generation since records began, health experts say.

Based on population trends, more than seven in every 10 people born between the early 1980s and mid-90s will be too fat by the time they reach middle age.

In comparison, about half of the “baby boomer” generation, born just after World War Two, were fat at that age.

Being fat as an adult is linked to 13 different types of cancer, says Cancer Research UK, who did the analysis.

The list includes breast, bowel and kidney cancer, but only 15% of people in the UK are aware of the link, according to the charity.

Child and teen obesity spreading across the globe

UK most overweight country in Western Europe

Many unaware of eating disorder signs

Teenager challenges 100-calorie snack advert

‘Generation fat?’

Britain is the most obese nation in Western Europe, with rates rising faster than in any other developed nation.

Obesity prevalence has been increasing in the UK, from 15% in 1993 to 27% in 2015.

In 2015, the highest obesity levels were seen in people aged 55 to 64, but experts are concerned that younger generations are on track to become fatter still.

Cancer Research UK wants to make the associated health risks clear to the wider public.

Spokeswoman Prof Linda Bauld said: “Extra body fat doesn’t just sit there; it sends messages around the body that can cause damage to cells.

“This damage can build up over time and increase the risk of cancer in the same way that damage from smoking causes cancer.

“While these estimates sound bleak, we can stop them becoming a reality.

“Millennials are known for following seemingly healthy food trends, but nothing beats a balanced diet.

“Eating plenty of fruit, vegetables and other fibre filled foods like whole grains, and cutting down on junk food is the best way to keep a healthy weight.”

Prof Russell Viner, from the Royal College of Paediatrics and Child Health, said: “There is a danger that being overweight is becoming normalised, as we know that many people struggle to recognise obesity in themselves, and often are unable to see when their child is overweight.

“Knowledge of the links between cancer and smoking have driven smoking rates down dramatically amongst our young people.

“We need the same recognition of the dangers of obesity.”

Ultra-processed foods ‘linked to cancer’

A link between highly processed foods and cancer has been suggested by French researchers.

They classified foods including cakes, chicken nuggets and mass-produced bread as “ultra-processed”.

A study of 105,000 people hinted the more of such foods people ate, the greater their risk of cancer.

A lot of caution is being expressed about the study, but experts said a healthy diet is best.

What counts as ultra-processed

  • Mass-produced packaged breads and buns
  • Sweet or savoury packaged snacks including crisps
  • Chocolate bars and sweets
  • Sodas and sweetened drinks
  • Meatballs, poultry and fish nuggets
  • Instant noodles and soups
  • Frozen or shelf-life ready meals
  • Foods made mostly or entirely from sugar, oils and fats

    Diet is already known to affect the risk of cancer.

    Being overweight is the biggest preventable cause of the disease after smoking and the World Health Organization says processed meat does slightly increase the risk of cancer.

    But what about ultra-processed foods?

    The team – at Universite Sorbonne Paris Cite – used food surveys on two days to work out what people were eating.

    Those on the study, who were mostly middle-aged women, were followed for an average of five years.

    The results, in the British Medical Journal, showed that if the proportion of ultra-processed food in the diet increased by 10%, then the number of cancers detected increased by 12%.

    During the study:

    • On average, 18% of people’s diet was ultra-processed
    • On average, there were 79 cancers per 10,000 people each year
    • Upping the proportion of processed food by 10% would lead to nine extra cancers per 10,000 people per year

      The researchers concluded: “These results suggest that the rapidly increasing consumption of ultra-processed foods may drive an increasing burden of cancer in the next decades.”

      But they said the findings need to “be confirmed by other large-scale” studies and research was needed to establish what could be behind the link.

      A ‘warning signal’

      This study is far from the definitive take on ultra-processed foods and cancer.

      It cannot say ultra-processed foods are a cause of cancer.

      There are also factors that muddy the waters as people who ate a lot of ultra-processed foods had other behaviours that have been linked to cancer.

      They were much more likely to smoke, were less active, consumed more calories overall and were more likely to be taking the oral contraceptive.

      While the researchers did adjust their analysis for this they say their impact “cannot be entirely excluded”.

      Prof Linda Bauld, Cancer Research UK’s prevention expert, said: “It’s already known that eating a lot of these foods can lead to weight gain, and being overweight or obese can also increase your risk of cancer, so it’s hard to disentangle the effects of diet and weight.”

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        Overall she said the study was a “warning signal to us to have a healthy diet” but people should not worry about eating a bit of processed food “here and there” as long as they were getting plenty of fruit, vegetables and fibre.

        Dr Ian Johnson, from the Quadram Institute in Norwich, said the study had “identified some rather weak associations”.

        But he criticised the vagueness of the term ultra-processed.

        He said: “The problem is that the definition of ultra-processed foods they have used is so broad and poorly defined that it is impossible to decide exactly what, if any, causal connections have been observed.”

        For Prof Tom Sanders at King’s College London, the definition of ultra-processed foods throws up too many quirks.

        He said mass-produced bread would be classed as ultra-processed, but a home-made loaf or bread from a posh local bakery would not.

        “This classification seems arbitrary and based on the premise that food produced industrially has a different nutritional and chemical composition from that produced in the home or by artisans. This is not the case,” Prof Sanders said.

        Even the accompanying commentary in the British Medical Journal warned against jumping to conclusions.

        Martin Lajous and Adriana Monge from the National Institute of Public Health in Mexico, warned “we are a long way from understanding the full implications of food processing for health and well-being”.

        They said the study was simply “an initial insight”.

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Dementia ‘linked’ to common over-the-counter drugs

A study has linked commonly used medicines, including over-the-counter treatments for conditions such as insomnia and hay-fever, to dementia.

All of the types of medication in question are drugs that have an “anticholinergic” effect.

Experts say people should not panic or stop taking their medicines.

In the US study in the journal JAMA Internal Medicine, higher doses and prolonged use were linked to higher dementia risk in elderly people.

The researchers only looked at older people and found the increased risk appeared when people took drugs every day for three years or more.

Side-effects

All medicines can have side-effects and anticholinergic-type drugs that block a neurotransmitter called acetylcholine are no exception.

Patient information leaflets accompanying such drugs warn of the possibility of reduced attention span and memory problems as well as a dry mouth.

But researchers say people should also be aware that they may be linked to a higher risk of developing dementia.

Dr Shelly Gray and colleagues from the University of Washington followed the health of 3,434 people aged 65 and older who had no signs of dementia at the start of the study.

They looked at medical and pharmacy records to determine how many of the people had been given a drug with an anticholinergic effect, at what dose and how often and compared this data with subsequent dementia diagnoses over the next decade.


Drugs in the study

The US study does not name specific brands, but does outline the types of treatments investigated, which include:

  • Tricyclic antidepressants for treating depression
  • Antihistamines used to treat hay-fever and allergies
  • Antimuscarinics for treating urinary incontinence

    Most of the drugs were given on prescription, rather than bought at the pharmacy over-the-counter.


    The most commonly used anticholinergic-type drugs were medicines for treating depression, antihistamines for allergies such as hay-fever or to aid sleep/promote drowsiness, and drugs to treat urinary incontinence. Nearly a fifth were drugs that had been bought over the counter.

    Over the course of the study, 797 of the participants developed dementia.

    ‘Not causal’

    The study estimated that people taking at least 10 mg/day of doxepin (antidepressant), four mg/day of diphenhydramine (a sleep aid), or five mg/day of oxybutynin (a urinary incontinence drug) for more than three years would be at greater risk of developing dementia.

    The researchers say doctors and pharmacists might want to take a precautionary approach and offer different treatments instead. And when there is no alternative, they could give the lowest dose for the shortest time possible.

    Dr Gray says some of the study participants have agreed to have an autopsy after their death.

    “We will look at the brain pathology and see if we can find a biological mechanism that might explain our results.”

    Dr Simon Ridley, head of research at Alzheimer’s Research UK, said the study was interesting but not definitive – there was, he said, no evidence that these drugs cause dementia.

    Dr Doug Brown, from the UK’s Alzheimer’s Society, said: “There have been concerns that regular use by older people of certain medications with anticholinergic effects, such as sleep aids and hay-fever treatments, can increase the risk of dementia in certain circumstances, which this study supports.

    “However, it is still unclear whether this is the case and if so, whether the effects seen are a result of long-term use or several episodes of short-term use. More robust research is needed to understand what the potential dangers are, and if some drugs are more likely to have this effect than others.

    “We would encourage doctors and pharmacists to be aware of this potential link and would advise anyone concerned about this to speak to their GP before stopping any medication.”

    He said the charity was funding more research in this area to better understand any connections between these and other drugs on the development of dementia.

    The Medicines and Healthcare Products Regulatory Agency, which monitors the safety of medicines in clinical use in the UK, said it would review any new evidence.

    Drug company Johnson & Johnson Ltd said many hay-fever products sold in the UK now contain newer, second generation antihistamines – not the type looked at in the study.

    Matthew Speers, who represents the UK trade association for manufacturers of over-the-counter drugs, said: “Over-the-counter allergy and sleeping aid products are not intended to be used continuously and people are advised to talk to their pharmacist or doctor if they need to use these products long-term.

    “There are a range of allergy products on the market which contain a number of different ingredients, many of which were not considered in this study.”