Feeding the Schwanns: New technique could bring cell therapy for nerve damage a step closer

ScienceDaily (Oct. 11, 2012) — A new way to grow cells vital for nerve repair, developed by researchers from the University of Sheffield, could be a vital step for use in patients with severe nerve damage, including spinal injury (1).
Schwann cells are known to boost and amplify nerve growth in animal models, but their clinical use has been held back because they are difficult, time-consuming and costly to culture.
The Sheffield team, led by Professor John Haycock, has developed a new technique with adult rat tissue which overcomes all these problems, producing Schwann cells in less than half the time and at much lower cost.
"The ability of Schwann cells to boost nerve growth was proved many years ago in animals, but if you want to use this technique with patients, the problem is: where do you get enough cells from?" says Professor Haycock, from the University's Department of Materials Science and Engineering.
"To reduce immune rejection, the cells have to be grown from the patient's own tissue. Of course, you want to take the smallest amount of tissue necessary, so the technique must be efficient. It must also be fast, so treatment can begin as soon as possible after injury. For clinical use, it must also provide pure Schwann cells. And finally, to make it viable, it has to be at a reasonable cost."
Existing methods for growing Schwann cells from adult tissue promote the growth of another type of cell, called fibroblasts, which swamp the Schwann cells, reducing the speed they grow and their numbers. This means that large amounts of tissue are needed at the outset, to grow sufficient cells for therapeutic use. It also requires extra purification stages added to the process, making it slow and costly -- taking up to 3 months to complete.
Professor Haycock and his team have come up with a very simple solution: feed the Schwann cells but starve the fibroblasts. The research, published October 11 in Nature Protocols
, uses an amino acid that only the Schwann cells can break down and feed off, and are able to produce a 97 per cent pure population of Schwann cells in a much shorter space of time -- just 19 days -- from a small sample of adult tissue.
Professor Haycock is confident the technique can be replicated in humans. His team are trialling same method using human nerve tissue, with results expected within the next 6 months.
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The above story is reprinted from materials provided by University of Sheffield, via EurekAlert!, a service of AAAS.
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Journal Reference:
Rossukon Kaewkhaw, Andy M Scutt, John W Haycock. Integrated culture and purification of rat Schwann cells from freshly isolated adult tissue. Nature Protocols, 2012; 7 (11): 1996 DOI: 10.1038/nprot.2012.118
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Preemies from low-income families at high risk for dangerous brain bleeds

ScienceDaily (Oct. 11, 2012) — Babies born prematurely to low-income parents have a disproportionately high risk for developing dangerous brain bleeds that require multiple surgeries and extensive follow-up, according to a small Johns Hopkins Children's Center study.
The findings -- published online Sept. 28 in the journal Pediatric Neurosurgery
and based on an analysis of 38 patients referred to Johns Hopkins for treatment of brain hemorrhages related to premature birth -- offer a sobering reminder of the role socio-economic factors can play in health outcomes, the researchers say.
The link between poverty and premature birth has been well-documented, the investigators say, but the new findings go a step further and focus on the consequences of one particularly dire and fairly common complication of prematurity -- brain hemorrhages.
"Our study shows just how detrimental and far-reaching the effects of prematurity can be, medically and otherwise, highlighting the critical need to better identify high-risk pregnancies and reduce the number of premature births," says Edward Ahn, M.D., pediatric neurosurgeon and senior author on the research.
"Brain hemorrhages can have a lifelong impact on a child's neurological and cognitive development, but also create a financial burden on the families, many of whom in our study were already economically challenged," Ahn adds.
The premature brain's blood vessels are highly vulnerable to rapid changes in blood and brain pressure that occur around birth. While some brain bleeds are small and contained within the blood vessel, others can spread further and significantly damage the brain, particularly if not diagnosed and treated promptly. Serious hemorrhages require surgery, intensive follow-up and, often, long-term care to deal with the neurological and developmental after-effects of the condition.
The study tracked 38 babies treated at Hopkins Children's between 2007 and 2010 for complications of brain hemorrhages they had suffered during preterm birth. Most infants in the study (65 percent) were from low-income families and received public health insurance(63 percent). Household income is not part of a standard medical record, but the researchers used zip code and Medicaid status as proxies for income. Medicaid is the public health insurance program for low-income children.
In addition to the higher risk for brain bleeds, the study showed babies from lower-income homes and those with public health insurance had fewer scheduled follow-up appointments and more emergency room visits, compared with babies with private health insurance and with those from higher income homes. The researchers note the differences were clear, even though they didn't reach statistical significance due to the small number of patients in the study.
"If a family foregoes a scheduled follow-up and instead ends up in the ER with a serious, yet likely preventable complication, the medical and financial consequences can be far worse not only for the family but for the health care system as a whole because ER care is more expensive than routine check-ups," Ahn says.
The investigators said their findings need to be replicated on a wider scale in order to further tease out the reasons behind the disproportionate risk.
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Airborne superbugs elude hospital cleaning regimes

ScienceDaily (Oct. 11, 2012) — Hospital superbugs can float on air currents and contaminate surfaces far from infected patients' beds, according to University of Leeds researchers.
The results of the study, which was funded by the Engineering and Physical Sciences Research Council (EPSRC), may explain why, despite strict cleaning regimes and hygiene controls, some hospitals still struggle to prevent bacteria moving from patient to patient.
It is already recognised that hospital superbugs, such as MRSA and C-difficile, can be spread through contact. Patients, visitors or even hospital staff can inadvertently touch surfaces contaminated with bacteria and then pass the infection on to others, resulting in a great stress in hospitals on keeping hands and surfaces clean.
But the University of Leeds research showed that coughing, sneezing or simply shaking the bedclothes can send superbugs into flight, allowing them to contaminate recently-cleaned surfaces.
PhD student Marco-Felipe King used a biological aerosol chamber, one of a handful in the world, to replicate conditions in one- and two-bedded hospital rooms. He released tiny aerosol droplets containing Staphyloccus aureus, a bacteria related to MRSA, from a heated mannequin simulating the heat emitted by a human body. He placed open Petri dishes where other patients' beds, bedside tables, chairs and washbasins might be and then checked where the bacteria landed and grew.
The results confirmed that contamination can spread to surfaces across a ward. "The level of contamination immediately around the patient's bed was high but you would expect that. Hospitals keep beds clean and disinfect the tables and surfaces next to beds," said Dr Cath Noakes, from the University's School of Civil Engineering, who supervised the work. "However, we also captured significant quantities of bacteria right across the room, up to 3.5 metres away and especially along the route of the airflows in the room."
"We now need to find out whether this airborne dispersion is an important route of spreading infection," added co-supervisor Dr Andy Sleigh.
The researchers are hoping that computer modelling will help them determine the risk. The findings have been compared to airflow simulations of the mock-up hospital rooms and the research team have shown that they are able to accurately predict how airborne particles can be deposited on surfaces.
"Using our understanding of airflow dynamics, we can now use these models to investigate how different ward layouts and different positions of windows, doors and air vents could help prevent microorganisms being deposited on accessible surfaces," said Mr King.
The international design and engineering firm Arup, which designs hospitals, part sponsored the study.
Phil Nedin, director and global healthcare business leader at Arup, said: "We are looking at healthcare facilities of the future and it is important that we look at key issues such as infection control. Being involved in microbiological studies that inform airflow modelling in potentially infectious environments allows us to get a clear understanding of the risks in these particular environments."
The paper "Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical and Experimental Study" is published in the journal Building and Environment
.
This research is funded by an EPSRC Challenging Engineering grant held by Dr Cath Noakes. Marco-Felipe King's PhD was also partially sponsored by Arup.
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Journal Reference:
M.F. King, C.J. Noakes, P.A. Sleigh, M.A. Camargo-Valero. Bioaerosol Deposition in Single and Two-Bed Hospital Rooms: A Numerical and Experimental Study. Building and Environment, 2012; DOI: 10.1016/j.buildenv.2012.09.011
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England World Cup wins and losses linked to 30 percent rise in domestic violence, study finds

ScienceDaily (Oct. 11, 2012) — Domestic violence rates rose by an average of 30 percent each time England won or lost their games during the 2010 World Cup, but draws had little impact on the statistics.
Those are the key findings of research carried out by statistician Professor Allan Brimicombe and BBC News journalist Rebecca Cafe and published in the October issue of Significance
, the magazine of The Royal Statistical Society and the American Statistical Association.
As a consequence of this and previous research, Professor Brimicombe believes there is a strong case for schools to educate pupils of the dangers of domestic violence, event organisers should promote initiatives that tackle domestic violence and that police forces should prepare themselves for peaks in domestic violence around major sporting events.
"Domestic violence is widespread, accounting for 15 percent of all violent crimes and 35 percent of murders in the UK," explains Professor Brimicombe, from the Centre for Geo-Information Studies at the University of East London.
"It is a crime that is estimated to affect some 30 percent of women and 17 percent of men at some point in their lives."
The researchers based their findings on statistics provided by 33 of the 39 police forces in England, which between them cover 77 percent of the country's population.
The data, for the period covering the 2010 World Cup and the same period in 2009, was obtained under the Freedom of Information Act 2000, which enables members of the public to request official information from public bodies.
The figures showed that when England drew 1-1 against the USA, domestic violence fell by 1.9 percent and when England drew 0-0 against Algeria it rose by 0.1 percent.
However when England won its game against Slovenia 1-0, domestic violence rose by 27.7 percent. And England's exit from the World Cup, after losing 4-1 to Germany, was accompanied by a 31.5 percent rise in domestic violence.
The research aimed to test the validity of an analysis carried out by the Home Office that showed that domestic violence had risen during the 2006 World Cup. "Major sporting events do not cause domestic violence, as perpetrators are responsible for their actions," said the analysis, "but the levels of alcohol consumption linked to the highly charged emotional nature of those events seems to increase the prevalence of such incidents."
Professor Brimicombe concludes that the Home Office findings were right in some respects but fell short in their analysis in other respects.
Professor Brimicombe explains: "Our research shows that increased levels of domestic violence are associated with national football matches, but only if there is a definite win or lose result. The failing of the earlier Home Office analysis was that it ignored the outcome of the match, which as we have seen is crucial.
"The percentage differences that we found are so great that we believe we have established a strong case for linking wins and losses, but not draws, to increased domestic violence.
"I hope that the findings will encourage improved education around the links between major sporting events and peaks in domestic violence and greater awareness of the risk.
"And I would applaud initiatives like the recent beer mat campaign highlighting the dangers of domestic violence, run by the London Borough of Newham and Metropolitan Police during the 2012 Olympics."
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Journal Reference:
Allan Brimicombe, Rebecca Cafe. Beware, win or lose: Domestic violence and the World Cup. Significance, 2012; 9 (5): 32 DOI: 10.1111/j.1740-9713.2012.00606.x
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Nurture trumps nature in study of oral bacteria in human twins, study finds

ScienceDaily (Oct. 11, 2012) — A new long-term study of human twins by University of Colorado Boulder researchers indicates the makeup of the population of bacteria bathing in their saliva is driven more by environmental factors than heritability.
The study compares saliva samples from identical and fraternal twins to see how much "bacterial communities" in saliva vary from mouth to mouth at different points in time, said study leader and CU-Boulder Professor Kenneth Krauter. The twin studies show that the environment, rather than a person's genetic background, is more important in determining the types of microbes that live in the mouth.
For the new study, doctoral student Simone Stahringer sequenced the microbial DNA present in the saliva samples of twins. She and the research team then determined the microbes' identities through comparison with a microbe sequence database. Saliva samples were gathered from twins over the course of a decade beginning in adolescence to see how salivary microbes change with time.
After determining the oral "microbiomes" of identical twins, who share the same environment and genes, and the microbiomes of fraternal twins who share only half their genes, the researchers found the salivary microbes of the identical twins were not significantly more similar to each other than to those of fraternal twins. "We concluded the human genome does not significantly affect which bacteria are living in a person's mouth," said Krauter of CU-Boulder's molecular, cellular and developmental biology department. "It appears to be more of an environmental effect."
Krauter said while the twin data from the oral microbiome study indicates that genetics plays a more minor role, it's possible the genes still affect the oral microbiome in more subtle ways -- an effect he plans to further explore.
A paper on the subject was published online Oct. 12 in the journal Genome Research
. Other co-authors included doctoral student William Walters of MCD Biology, Jose Clemente and Rob Knight of the chemistry and biochemistry department, Robin Corley and John Hewitt of the Institute for Behavioral Genetics and Dan Knights, a former doctoral student in the computer science department.
The researchers also found that the salivary microbiome changed the most during early adolescence, between the ages of 12 and 17. This discovery suggests that hormones or lifestyle changes at this age might be important, according to the team.
Stahringer said that when several pairs of identical twins moved out of their homes and, for example, went off to college, the oral microbes they carried changed, which is consistent with the idea that the environment contributes to the types of microbes in the saliva. "We were intrigued to see that the microbiota of twin pairs became less similar once they moved apart from each other," Stahringer said.
Krauter said there appears to be a core community of oral bacteria that is present in nearly all humans studied. "Though there are definitely differences among different people, there is a relatively high degree of sharing similar microbial species in all human mouths," he said.
The authors say the new study has established a framework for future studies of the factors that influence oral microbial communities. "With broad knowledge of the organisms we expect to find in mouths, we can now better understand how oral hygiene and environmental exposure to substances like alcohol, methamphetamines and even foods we eat affect the balance of microbes," said Krauter.
The saliva samples used in the new study came from the university's Longitudinal Twin Study and Colorado Adoption Project, which have involved hundreds of identical and fraternal twin pairs. Researchers also are analyzing additional frozen saliva samples collected during their studies for another project assessing possible relationships of oral bacteria to drug addiction, he said.
CU has a strong research focus on the human microbiome. In a 2011 study led by the Washington University School of Medicine and involving CU-Boulder, researchers found the diversity and abundance of gut microbes in animals varied depending on whether they were carnivores, omnivores or vegetarians. Knight is a member of a national research team funded by the Bill & Melinda Gates Foundation to look at the gut microbes of normal and malnourished infants and children around the world in search of novel microbial therapeutics.
In 2012, some 200 researchers from the NIH-funded Human Microbiome Project, including eight CU-Boulder researchers, mapped the microbial makeup of healthy humans for the first time. The study involved nearly 250 healthy U.S. volunteers and targeted 15 to 18 individual sites on the body harboring microbial communities.
Other recent studies involving CU researchers included one that found the delivery methods of babies have a big effect on their individual microbiomes, and second that showed women have a greater diversity of hand bacteria than men. Another showed personal bacterial communities living on the fingers and palms of individual computer users can be matched up with bacterial signatures on the computers and computer mice they recently used, a potential new tool for forensic scientists in the future.
According to scientists, about 100 trillion microorganisms inhabit surfaces and cavities of our bodies, which amounts to roughly 10 microbes per human cell.
Genome Research is an international, peer-reviewed journal that focuses on research that provides new insights into the genome biology of all organisms, including advances in genome medicine.
Funding for the study was provided by National Institutes of Health grants HD-010333 and DA-011015.
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Journal Reference:
Stahringer SS, Clemente JC, Corley RP, Hewitt J, Knights D, Walters WA, Knight R, Krauter KS. Nurture trumps nature in a longitudinal survey of salivary bacterial communities in twins from early adolescence to early adulthood. Genome Research, 2012; DOI: 10.1101/gr.140608.112
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Single gene variant in donors may affect survival of transplanted kidneys

ScienceDaily (Oct. 11, 2012) — A single genetic variant in kidney donors' cells may help determine whether their transplanted organs will survive long term, according to a study appearing in an upcoming issue of the Journal of the American Society of Nephrology (JASN). The findings provide new information that might be used to improve transplant longevity by revealing that the genetic make-up of kidney transplant donors affects the survival of transplanted organs.
A transplant recipient must take lifelong immunosuppressive drugs to prevent rejection of the new organ, but these drugs can have serious side effects, including kidney damage. So, ironically, the very drugs needed to prevent kidney rejection can also be toxic to the kidneys. Research suggests that how well certain proteins pump these drugs out of kidney cells may influence the drugs' kidney toxicity.
Richard Borrows, MB (Queen Elizabeth Hospital Birmingham, in the UK) and his colleagues looked to see if variants in the genes that encode such pumps might influence the health of transplanted kidneys. They investigated the links between donor and recipient gene variants with kidney outcome among 811 immunosuppressant-treated kidney transplant recipients.
Among the major findings:
One particular variant within the multidrug resistance 1 (MDR-1) gene in donors was linked to a 69% increased risk for long-term failure of transplanted organs.The researchers validated the link in another 3,660 donors, making this the largest study of its kind.This variant affects the expression of the protein that the MDR-1 gene encodes, the drug transporter P-glycoprotein.No other genetic variants in donors or recipients were linked with organ survival or failure.
"The study of donor, as opposed to recipient, gene variation is relatively uncommon in the field of transplantation, and it certainly warrants more attention," said Dr. Borrows. He added that a single genetic variant probably has limited effect on its own, but when combined, multiple genetic variants may play an important role in transplant longevity.
Study co-authors include Jason Moore, MBBS, Amy Jayne McKnight, PhD, Bernd Döhler, PhD, Matthew Simmonds, PhD, Aisling Courtney, PhD, Oliver Brand, PhD, David Briggs, PhD, Simon Ball, PhD, Paul Cockwell, PhD, Christopher Patterson, PhD, Alexander Maxwell, PhD, Stephen Gough, PhD, and Gerhard Opelz, PhD.
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The above story is reprinted from materials provided by American Society of Nephrology (ASN), via Newswise.
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Journal Reference:
Richard Borrows et al. Donor ABCB1 Variant Associates with Increased Risk for Kidney Allograft Failure. Journal of the American Society of Nephrology, 2012; DOI: 10.1681/ASN.2012030260
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All healthcare professionals need training to deal with the sexual needs of patients, study finds

ScienceDaily (Oct. 11, 2012) — Providing healthcare staff with a one-day training course on dealing with the sexual needs of people with an acquired physical disability gave them greater understanding of the issues patients faced and enabled them to address intimate questions more comfortably and proactively.
The findings were so encouraging that the authors of the study, published in the November issue of the Journal of Advanced Nursing
, are calling for all healthcare practitioners to receive sexuality training, regardless of their role or the area of healthcare they work in.
Researchers surveyed 29 nurses, allied health professionals and care staff, before and after the course, on their ability and confidence to address sexual issues with patients. They also held in-depth interviews with 12 of them. All age ranges were represented (20 to 55 plus), the majority were female (79 per cent) and most had been working at their current hospital for one to five years (41 per cent).
"Changes associated with an acquired physical disability can diminish a person's self-esteem, sense of attractiveness, relationships and sexual functioning" explains lead author Agnes Higgins, Professor of Mental Health at the School of Nursing and Midwifery, Trinity College Dublin, Ireland.
"Previous research suggests that people with physical disability are dissatisfied with the quality of information and support around sexuality during their rehabilitation."
Subjects addressed during the course included the impact of disability on sexual expression, how to deal with patients' sexual behaviour in the hospital setting and responding to questions such as whether they will be able to have sex in the future.
Key findings included:
Participants rated their knowledge of 13 key areas related to patients' sexuality, including rights, aging, communication and help with specific medical conditions. The mean score was 1.9 out of four before the course and 2.5 after the course -- the equivalent of a 31.5 per cent increase in knowledge.The biggest rises in knowledge were in sexual rights and disability and brain injury and sexuality (both up 0.8 out of four). Other top increases included the impact of a stroke on sexuality and managing 'inappropriate' sexual behaviour (both up 0.7).Participants also rated their ability to deal with 15 situations, ranging from seeing a patient engaging in sexual behaviour to seeking advice on their future sexual ability. The mean score was 2.1 out of four before the course and 2.6 after the course -- the equivalent of a 23.5 per cent increase in ability.The biggest rises in ability were how to deal with walking in on a patient who was masturbating or engaged in sexual foreplay with their partner (both up 0.8). Other top increases included how to respond to a patient who asked if it was OK for them to have sex and advising young and old patients who wonder if they will ever have an erection or orgasm again (all up 0.7).
Staff reported finding the course very helpful.
One participant said it made them more able to respond to difficult issues in a sensitive manner. "I'm less uncomfortable and if they [patients] raise an issue, even in a joking manner, I'm kind of happy to say 'Well is that an issue for you… would you like to talk about that a little bit more?' rather than just kind of laughing and then moving onto the next subject, which is easy to do."
Another said it made them think of more than a patient's medical needs, citing the example of a woman who was incontinent and keen to return home and to work. Normally they would have suggested a urinary catheter, without further exploring the impact of this on the person's life, but the staff member said: "Because I'd done the sexuality course it made me think well actually one of the person's goals is she's got a fiancé, and relationships are important, and that [catheter] would be a huge barrier."
This was reinforced by other staff members. "I like to think I see the patient as a person, but you don't always, you honestly don't" said one. "That [course] made me very, very aware that there is a person here."
It also made it easier for them to deal with sexual comments from patients as one participant illustrated with a pre-course experience. "We are in a room and a young nurse is passing by and she is good looking but he [patient] expresses that in a way that is not exactly inappropriate. He's a young guy… I feel a little bit embarrassed and do not know how to react."
"Patient sexuality is an area that many healthcare practitioners may be reluctant to address or discuss because of embarrassment, particularly when patients have a disability" says Professor Higgins.
"Our study suggests that systematic education and training in sexuality leads to statistically significant changes in health care practitioners' knowledge, skills and comfort. Participants also reported numerous incidents where they were more willing to raise issues for discussion and create a supportive listening space for patients.
"This course provided an effective learning experience for the healthcare practitioners and could easily be replicated elsewhere. We believe that practitioners require education in patient sexuality, regardless of their discipline."
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Journal Reference:
Agnes Higgins, Danika Sharek, Maeve Nolan, Barbara Sheerin, Paul Flanagan, Sniguole Slaicuinaite, Sinead Mc Donnell, Heather Walsh. Mixed methods evaluation of an interdisciplinary sexuality education programme for staff working with people who have an acquired physical disability. Journal of Advanced Nursing, 2012; 68 (11): 2559 DOI: 10.1111/j.1365-2648.2012.05959.x
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