Liam Kugler

Liam is a Medical Honors student and a published researcher at the University of Florida. He is currently part of the accelerated BS/MD program and wants to work to provide a source of free and accurate information to the public, especially to underserved communities.

Categories
Neurology

Social Media Use During Pandemic Linked to Increased Tic Severity in Adolescents with Tourette’s

person holding iphone showing social networks folder
Photo by Tracy Le Blanc on Pexels.com

A study being conducted at the University of Florida is investigating a correlation between the use of social media during the COVID-19 pandemic and a change in tic severity for adolescents with Tourette syndrome.

Background

Tourette syndrome is a type of tic syndrome often present at a young age even as early as 2 years old. Tics are sudden movements, jolts, or sounds that those with tic syndromes feel the urge or are compelled to do. Often times it is compared to the urge of a sneeze where the person will feel great discomfort if they do not perform the tic. That being said, tics have the urge to be suppressed but not without causing discomfort to the individual.

Often times, people confuse and associate Tourette’s syndrome with coprolalia. Coprolalia is a specific type of phonic or vocal tic in which people shout obscene language. This specific type of tic is very rare and only affects around 10% of those diagnosed with Tourette’s Syndrome.

Study

After analysis of a patient population of surveys completed by adolescent individuals (n=20) with ages ranging from 11 to 21 years old, the researchers found statistically significant data showing that social media use, and increased social media use during the pandemic, causes an increase in tic severity and frequency.

  • 90% reported using social media more frequently during the pandemic
  • 65% reported using social media for an average of 6 hours per day
  • 50% reported that social media negatively impacted their tics
  • 85% reported that their tic frequencies worsened during the pandemic

This study was recently highlighted by both the University of Florida and the American Academy of Neurology (AAN) for its findings related to the implications of the pandemic on the mental health of adolescents. The researchers plan to add new participants to the study to strengthen the data and gain new insights.

This research is important as it can help to identify possible stressors for those with tics and work towards providing relief from tic symptoms for those with Tourette’s.

This article is based on the following sources

– American Academy of Neurology. (2022, February 28). Study: Tic severity linked with social media use for teens during pandemic. https://www.aan.com/PressRoom/Home/PressRelease/4961
– Centers for Disease Control and Prevention. (2020, May 13). Five Things You May Not Know About Tourette Syndrome. https://www.cdc.gov/ncbddd/tourette/features/tourette-five-things.html
– Mayo Clinic. (2018, August 8). Tourette syndrome – Symptoms and causes. https://www.mayoclinic.org/diseases-conditions/tourette-syndrome/symptoms-causes/syc-20350465
– Tourette Association of America. (2016, May 21). Understanding coprolalia: A misunderstood symptom. https://tourette.org/resource/understanding-coprolalia/
– University of Florida News. (2022, March). Heavy social media use may be linked to increase in tic severity. https://news.ufl.edu/2022/03/social-media-use-and-tic-severity/

Categories
Cardiology Immunotherapy

CAR T Cells Produced by mRNA Injection Reduce Cardiac Fibrosis, Restore Function to Heart

Two individual CAR T cells attacking fibroblast activation protein (FAP)-producing cells. / Rurik et al., 2022

Researchers at the University of Pennsylvania’s Perelman School of Medicine have published a method to treat cardiac fibrosis using an mRNA injection that enables an individual’s own CAR T cells to fight the disease.

Background

Cardiac fibrosis is a medical condition caused by many different types of heart disease that can lead to scarring and stiffening in the muscle wall of the heart. Normally, cells in the heart called cardiac fibroblasts help to develop the heart and maintain its homeostasis (that is, it helps the heart stay in a stable condition). However, in a patient with cardiac fibrosis, these cells no longer perform their normal function. Following a cardiac injury, fibrosis can progress from scarring to complete heart failure.

T cells are a type of white blood cell that play a key role in immune response, killing cells that they recognize to be infected with viruses, cancers, or certain other pathogens. Chimeric antigen receptor (CAR) T cells are T cells that have been engineered to recognize specific proteins as harmful. This enables them to target and kill cells that have proteins from diseases that they otherwise would not recognize as harmful.

Innovation

The Penn researchers developed a CAR T-cell therapy that works by engineering T cells to recognize and kill cells that express (create) the fibroblast activation protein (FAP), a protein key to the pathology of cardiac fibrosis. Killing FAP-expressing cells consequently treats cardiac fibrosis.

By encoding a messenger RNA (mRNA) strand that results in the creation of CAR T cells that target FAP, the researchers had the idea to deliver them to a patient’s cells through an injection containing the mRNA within a lipid nanoparticle.

Lipid nanoparticles (LNP) are a relatively new technology discovered in the 1990s. To deliver an mRNA strand into cells to provoke a protein-expressing response, the mRNA is inserted into a sphere made of lipids that is injected into a patient. This then allows cells to uptake the LNP through endocytosis (bringing material into the cell). The mRNA then exits the LNP, causing the cell to read the mRNA instructions to create the desired protein.

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Structure of the LNP. / Genevant Sciences via ACS.org

Without the LNP, mRNA would be unable to enter cells. mRNA vaccines for COVID-19 are a prominent use of this technology, as the mRNA that gives cells instructions to create the spike protein is protected and brought into cells by LNP.

Results

In rodents with cardiac fibrosis, the Penn researchers revealed that their mRNA injection successfully resulted in the creation of FAP-targeting CAR T cells. Observing the hearts of rodents before and after treatment showed notable improvements in cardiac function. This means that as the CAR T cells killed cells that expressed FAP, fibrosis was reduced.

Video of rodent echocardiograph recorded two weeks after treatment with CAR T-cell therapy that was given after an injury that caused cardiac fibrosis. / Rurik et al., 2022

In rodents with injuries causing cardiac fibrosis, the CAR T-cell treatment halved the percentage of fibrosis in the ventricles.

Discussion

The implications of this new treatment are of great significance. Reduction of fibrosis and restoration of cardiac function in rodents with cardiac fibrosis reveals a promising new form of treatment for human patients with the potentially fatal disease.

According to the CDC, about 659,000 people in the United States die from heart disease each year, accounting for 1 in every 4 deaths–all costing the country hundreds of billions of dollars each year. Thus, biotechnological innovations in treatment of cardiac disease can have a great impact.

Earlier CAR T-cell therapies have required a patient’s T cells to be extracted from blood, sent to a lab, engineered to find and kill certain targets, then returned intravenously to the patient. This is an extremely time-consuming and cost-prohibitive process, potentially costing patients hundreds of thousands of dollars.

The innovation of using mRNA injections to create CAR T cells within a patient’s own body instead of a lab may greatly reduce the time and financial burdens associated with CAR T-cell therapies. Rather than extracting, modifying, and replacing T cells from each patient, mRNA shots that provoke the creation of CAR T cells can be mass-produced and given to any patient.

The scope of this innovation reaches far beyond cardiac fibrosis, as it can potentially be applied to CAR T-cell therapies for cancer and other diseases.

References
Categories
Cardiology

Surgeons at Duke University First to Implant New Total Artificial Heart Into Patient

Scientist with Total Artificial Heart device (carmatsa.com)

A team of surgeons at Duke University led by Dr. Carmelo Milano and Dr. Jacob Schroder were the first to implant a new generation of Total Artificial Heart (TAH) in a 39-year-old male patient with heart failure after receiving FDA approval for human trials.

Home - Carmat :Carmat
The total artificial heart made by French company CARMAT acts to replace that of an organic diseased heart of patients with heart failure, hoping to one day replace the need for living donor heart transplantation. (carmatsa.com)

CARMAT’s Total Artifical Heart product, called Aeson, is a new TAH that solves many of the issues with current treatment options associated with biventricular heart failure. Current options include human organ transplantation, which carries high risk of rejection. Such rejection can lead to the need for repeat cardiac transplant or even death. Other treatment options such as biventricular assist devices (BiVADs) carry high risk of neurological complication incidence such as stroke caused by accumulation of clots or seizures that can lead to life debilitating changes.

CARMAT’s Aeson is only the second TAH on the market. Aeson has made notable improvements over competitor SynCardia’s total artificial heart. CARMAT’s TAH is quieter and has a variable heart rate that adjusts based on patient activity, while SynCardia is notably louder and has a fixed heart rate.

Aeson replaces the patient’s heart by pumping blood to the pulmonary tract and systemic system. It does this through the use of battery-powered electrohydraulic rotary pumps with attached sensors that respond to changes in pressure and cardiac demands.

The French company’s device can be used as an intermediate heart prior to transplantation, or even as a complete replacement for living donor hearts. This development has radical implications to heart failure treatment, as American patients can expect to wait more than six months for a transplant.

Dr. Jacob Schroder (Assistant Professor of Surgery) and Dr. Carmelo (Professor of Surgery) installing the CARMAT TAH. (CBS17)

The surgery at Duke University was the first of its kind in the United States. It consisted of an 8-hour surgery in which Dr. Jacob Schroder and Dr. Carmelo Milano worked to remove Matthew Moore’s (a 39-year-old patient with biventricular heart failure on the transplant waiting list) left and right ventricles of his heart. They then installed the device successfully replacing the structures removed.

Each device costs around $190,000, not including the costs of critical care staff and other medications. However, this price point is significantly lower than the average cost for a human heart transplant, which is about $1.4 million.

CARMAT hopes to solve long wait lists and high costs with its TAH, Aeson, potentially offering a permanent solution in which a heart will always be available for any patient in need.

This article is based on the following sources

– Bailey, S. (2021, March 25). This new artificial heart responds to the patient. CNN Business. https://www.cnn.com/2021/03/25/business/carmat-artificial-heart-spc-intl/index.html
– Duke University School of Medicine. (2021, July 16). New generation artificial heart implanted in patient at Duke – First in U.S. https://medschool.duke.edu/blog/new-generation-artificial-heart-implanted-patient-duke-first-us
– Rapp, N., & Vandermey, A. (2017, September 14). Here’s what every organ in the body would cost to transplant. Fortune. https://fortune.com/2017/09/14/organ-transplant-cost/
– Tan, K. (2021, July 29). Duke surgical team successfully implants new generation artificial heart in patient, first in U.S. Duke Chronicle. https://www.dukechronicle.com/article/2021/07/duke-university-hospital-health-artificial-heart-transplant-research-study-carmat
– University of California, San Francisco Health. (n.d.). FAQ: Heart transplant. https://www.ucsfhealth.org/education/faq-heart-transplant