Better osteoarthritis care may improve older people’s mobility and general health

Canadian researchers have found that in individuals aged 55 years and over, hip and knee osteoarthritis (OA) was the greatest contributor to difficulty in walking, and the effect increased with more hips and knees affected by OA. Published in Arthritis Care and Research, the study included 18 490 eligible participants aged 55 years or over who were recruited between 1996 and 1998. Participants completed a standardised questionnaire assessing demographics, health conditions, joint complaints and functional limitations, including difficulty walking in the past 3 months. The authors found that 25% of participants reported difficulty walking, and that difficulty walking was significantly and independently associated with older age, female sex, body mass index and several health conditions. Of the conditions examined, the likelihood of walking difficulty was greatest with hip and knee OA, and increased with number of hips and knees joints affected. The predicted probability of difficulty walking for a 60-year-old middle-income, healthy-weight woman was 5–10% with no health conditions; 10–20% with diabetes and cardiovascular disease; 40% with OA in two hips or knees; 60–70% with diabetes, cardiovascular disease and osteoarthritis in two hips or knees; and 80% with diabetes, cardiovascular disease and osteoarthritis in all hips and knees. “Mobility to maintain independence is a top priority for people living with chronic conditions. Further, immobility is a barrier to physical activity, which plays a key role in the prevention and management of virtually all chronic diseases,” said Dr. Gillian Hawker from the University of Toronto. “Our results show that hip and knee OA is the number one cause of difficulty walking, and our prior work has found that difficulty walking due to OA is a risk factor for serious cardiovascular and diabetes outcomes,” added lead author Dr. Lauren King. “We know OA is underdiagnosed and undertreated, however. Increased awareness of the important role of OA in impacting people’s quality of life and survival is needed to compel action.” The authors suggest that comprehensive OA care including therapeutic exercise, weight management and local or topical therapies, such as intra-articular corticosteroids, will reduce OA pain and disability, and thus OA-related walking difficulty, and may improve patients’ mobility and outcomes for comorbid chronic conditions.

100-year-old technique reduces need for IVF

South Australian-led research published in the New England Journal of Medicine has found that a century-old technique has significant benefits for fertility, giving infertile couples an opportunity to achieve a successful pregnancy without the need for in-vitro fertilization (IVF). The H2Oil Study, conducted by researchers from the University of Adelaide, South Australian Health and Medical Research Institute and the Vrije University Medical Centre in Amsterdam, compared the benefits of flushing the fallopian tubes of 1119 women with either an oil-based iodised solution of fatty acids from poppy seeds or a water based solution. The procedure, known as hysterosalpingography, is a dye test of the fallopian tubes conducted under x-ray. The procedure was first carried out in 1917, and since the 1950s, both water-based and oil-based solutions have been used. The oil-based product is currently available in 47 countries. Almost 40% of infertile women in the oil group and 29% of infertile women in the water group achieved successful pregnancies within 6 months of the technique being performed. “Further research would need to be conducted into the mechanisms behind what we’re seeing,” the researchers wrote. “For now, and considering the technique has been used for 100 years without any known side effects, we believe it is a viable treatment for infertility prior to couples seeking IVF. Not only is there a known benefit, but this flushing procedure is also a fraction of the cost of one cycle of IVF. Considering that 40% of women in the oil-based group achieved a successful pregnancy, that’s 40% of couples who could avoid having to go through the huge costs and emotions associated with IVF treatment.”

Biomarkers hold clue to cognitive decline in Parkinson’s

Researchers from the University of Pennsylvania have identified biomarkers that may help predict which Parkinson’s disease patients will suffer significant cognitive deficits within the first 3 years of their diagnosis. Published in PLOS ONE, the study analysed data from 423 newly diagnosed and untreated patients with Parkinson’s disease who showed no signs of cognitive impairment at the time of their enrollment in 2010. Three years later, between 15% and 38% of these participants had developed cognitive impairment. The authors conducted brain scans, genetic tests and analyses of cerebrospinal fluid (CSF) and found that this cognitive decline correlated with biomarkers. Brain scans identified dopamine deficiency and decreased brain volume or thickness as biomarkers. The researchers also found an association with the presence in CSF of b-amyloid protein, a marker of Alzheimer’s disease, and with single nucleotide polymorphisms in the genes COMT and BDNF that had previously been associated with cognitive impairment. The study’s participants were mostly male, white and highly educated, limiting the application of these findings to other groups. The authors noted that a longer follow-up of this cohort would also reveal whether genetic risks were important in later onset or more advanced cognitive dysfunction in Parkinson’s disease.

Creating blood stem cells for leukaemia therapy

Blood stem cells, or haematopoietic stem cells (HSCs), are a step closer to being made in the laboratory, thanks to methods described in two articles published in Nature. The development could have promising implications for cell therapy, drug screening and studies of leukaemia development. Blood cells are made from HSCs that emerge during embryonic development from specialised endothelial cells found lining the walls of blood vessels during embryonic development. In the first study, researchers from the Boston Children’s Hospital and the Dana–Farber Cancer Institute used chemical signals to convert human pluripotent stem cells into haemogenic endothelial cells, and then coaxed them to become HSC-like by altering levels of seven key transcription factors. In the second study, researchers from Weill Cornell Medicine used adult mouse endothelial cells as their starting material, then altered levels of key transcription factors to drive their transition to cells with properties of mouse HSCs. Both groups then used environmental signals to mature the HSCs. The Boston team transplanted human cells into the bone marrow of adult mice, and the Cornell team grew mouse cells on a layer of fetal endothelial cells. The resulting cells had all the hallmarks of HSCs: they could engraft into transplanted recipients and give rise to multiple different blood cell lineages. Although the work by the Cornell team focuses on mouse cells, human adult endothelial cells can readily be obtained from healthy donors, and the Boston group used cells obtained from donors and reprogrammed them to pluripotency. This holds promise for personalised leukaemia therapies in which HSCs derived from a patient’s own cells could potentially be used to treat the disease.

 

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