In the footsteps of Aesculapius

The program is conducted by Evgeny Muslin. Zivivchs is a new class antibiotic, ovarian conservation in cancer patients, as well as recent medical news - these are the topics of our program today.

Evgeny Muslin:

In medical science and practice of the United States, an important and very impressive event took place: for the first time in many years, a new antibiotic was created and tested by the Federal Office for Control over food and medicines, freely suppress microorganisms resistant to other antibiotics, including the deadly outcome of staphylococcus strains. We asked to comment on this news of Professor Daniil Golubev.

Daniil Golubev:

The problem of the stability of microbes to antibiotics cannot be attributed to the number of new ones that are not known to science earlier. Nevertheless, its relevance does not decrease from this at all, because, as the poet Pablo Nerud wrote in the poet Pablo Neruda about 30 years ago: "Scientists came up with dozens of drugs and killed myriads of microbes, but the remaining ones became a million times angrier."

An increase in the number of infections caused by microbes resisted to known antibiotics, including infections that are fatal due to this resistance, forces this problem with all seriousness. FDA pays this problem to constant and very close attention, carrying out a total test of all antibiotics used in healthcare and livestock, removing drugs that have ceased to be effective, testing new antibiotics or combinations in different areas of medicine.

About 25 million kilograms of antibiotics are produced annually in the United States, but the new classes of these biologically active substances are created and introduced into practice not often. So, one of the last classes of antibiotics is the so-called fluorookvanalons that began to be used since 1986, that is, almost 15 years ago. Its most famous representatives are Ciprofloxacin, Enoxacin and similar to them, actively suppressing salmonell - pathogens of acute intestinal infections of humans and animals. For other microorganisms, in particular, on round bacteria - cocci, fluorokvanalons do not act. Here, for many years, the antibiotic of Vancromicin, who was considered the most effective means for suppressing the activity of the coccal bacterial flora, is undivided by many years.

But in 1989, the previously previously unknown strain of Vancromicin-resistant enterococci (VUE) was allocated. This strain spread quickly, causing an infection of the skin, septic conditions, lesions of the urogenital tract and pneumonia, mainly in elderly and weakened people whose immune system cannot actively resist infections. According to the Center for Control over the incidence in Atlanta, these microbes are affected annually up to 14 thousand people, and, at least in half of cases, vancomizin does not have any therapeutic effect. And only now the FDA allowed to use the new drug "Zivivkas" for the treatment of patients affected by VEU. In relation to this type of microbes, the new class of antibiotics was created for the first time in 40 years.

Evgeny Muslin:

Who produces this new antibiotic and what is it?

Daniil Golubev:

The drug was developed by the company from

New Jersey "Pharmacia", its other name is linosolide. "Zivivkas" is a representative of the new class of drugs - the so -called oxazolidins. Upon contact of molecules with a bacterial cell in the latter, the synthesis of the protein ceases, without which microbe cannot have a pathogenic effect on the body and spread in it.

Evgeny Muslin:

Do Zivivkes have analogies and competitors?

Daniil Golubev:

As I have already said, the main purpose of Zivivkas is to act on the infection of the skin, septic states, pathology of the urogenital tract and pneumonia caused by vancrikomicin -resistant enterococci. In this regard, he has an analogue - the drug of the company "Ron -Pulenk" "Sirenid" allowed last year FDA. But the SIVIVKS "SIVERDICA" is not a competitor. The fact is that Sirenid is produced in the form of suitable only for parentheric injections, and this means that its use is limited only by hospital conditions or conditions of a specialized office. This is a great drawback, since all of the listed processes tend to be long, or even chronic, and their treatment cannot be strictly limited in time. “Zivivka” is also produced in a form suitable for injection, and in the form of pills, which the patient can take at home after discharge from the hospital. This is a very great advantage that makes Zivivkes preferable for discharge and use. This circumstance was emphasized, in particular, Dr. David Bell, an expert at the Center for the Study of the Resistance of Microorganisms to Antibiotics of the Harvard Medical School.

Evgeny Muslin:

It should be assumed that the new antibiotic is positively met by doctors?

Daniil Golubev:

Yes, that is how. Dr. George Eliopolus is an expert on infectious diseases

The New York Hospital Bet-Israel notes that the drug is being introduced into practice at the most suitable time, in his opinion, with the help of Zivivchs, tens of thousands of patients of patients in hospitals and nursing homes will be saved.

Dr. Harry Shiki - Director of the FDA anti -infectious department, believes that at least 80 thousand people are subject to treatment with vanc -breeding committee during the year, but, as already noted, a significant part of them cannot be cured due to the resistance of the Enterococci to this antibiotics. From this point of view, the introduction of Zivivkas into the medical practice is very timely and useful.

Evgeny Muslin:

Do Zivivkes have shortcomings?

Daniil Golubev:

Of course, like any medicine, there are disadvantages, side effects, and contraindications. Not without it.

Firstly, some enterococci are also resistant to this drug. Not as often as to Vancicomitsin, but still such facts take place.

Secondly, in some patients, adverse reactions were observed in the form of dizziness, intestinal disorders, and nausea.

Finally, this is very significant - Zivivchus is a synthetic chemotherapy, and not a product of cellular origin, like other antibiotics, and therefore it is almost 10 times more expensive than vanc -committee. This, of course, limits its widespread use, but we should not forget that its use is intended to save human lives, when other drugs can not cope with the infection. In addition, it must be borne in mind that the Pharmacia company has been developing this drug for more than 10 years. Only clinical trials have been carried out since 19994. This explains the high cost of the drug.

Lilia Shukaeva:

Is there any point in carrying out this operation, or there was not - there is no consensus among specialists yet. Some call her wonderful and even epoch -making, others claim that she is absurd and ridiculous. Dr. Kutluk Octuya, under whose leadership, the operation was carried out, as no doubt about her, and now, after the contradictory reaction of colleagues, did not appear.

At first glance, everything looks really ridiculous. In the patient, the ovaries are removed, they cut them into thin strips and sew these strips to the patient in the hand. However, it is not difficult to figure out why this is done. The patient is 30 years old, and she has detected cervical cancer. It will be treated with irradiation. The radiation will damage the ovaries, and the patient will have a premature menopause with all its problems - from the impossibility of giving birth to a child, to the thinning bone of osteoporosis and other troubles caused by the loss of estrogen. True, there is an estrogen-off-room therapy, but the patient did not want to take pills with the corresponding hormones and chose to preserve the ovaries. Protect the ovaries from radiation, preserve them - this is the meaning of an outlandish operation.

Now that such a patient becomes a target for rays, it will be enough for her to just raise her hand and, in continuation of the entire session, hold it above her head. Dr. Oktay is absolutely sure that thanks to this, implanted strips of ovaries will calmly survive, and they will not develop as much estrogen as nothing to prevent menopause.

But the most important thing, of course, is not in menopause as such that a 30-year-old woman seems to be an abstraction, and even more not in any osteoporosis, with which, when the time comes, you can fight-the most important thing is that by removing the ovaries from destructive trajectories, she will then be able to have a child at the end of medical procedures! And not even one. Dr. Oktay says that he is taken to extract eggs from her hand and transfer them to a test tube, where they, as it has been done for a long time, will be fertilized, and then implanted into the uterus. Is it amazing that the young patient made a choice in favor of the ovarian transplant, and not estrogenic tablets?

The patient was said that this is not an ordinary operation, but experimental, that in the process of it or after it, unforeseen circumstances may arise, and everything will go to dust. Dr. Oktay is confident in success, but anything happens. Oktay told the truth: it was an experiment, or rather, part of a large research program aimed at not depriving people of cancer treatment, the opportunity to have children. Especially young people with all the chances of getting rid of some types of cancer, such as leukemia or bone cancer. Chemotherapy and radiation can save people life, but they will make them sterile. For those who do not yet have children, it often turns out to be a severe mental trauma. They agree to be experimental rabbits and endure any hardships, just not to lose the hope of having a child.

We are talking only about women. A man who has to undergo a course of radiation or chemotherapy can always freeze his sperm before that and keep it thus to conception future children. A woman cannot do anything like that.

Unlike sperm, the eggs of freezing are not tolerated. The fertilized is another matter. However, according to Lynn Hartman, an oncologist from the Mayo clinic in Rochester in Minnesota, not every woman with cancer, there is a time and desire to take hormones that should stimulate the ovaries so that they develop eggs necessary for fertilization in a tube. She should have a “cancer with a good forecast”, as oncologists are expressed, then it is possible.

There is another option, and it is now being studied: to remove the ovaries before starting treatment, freeze them and then transplant them back. In experiments on mice and sheep, this turned out almost immediately. But the human body resisted for a long time - women did not give birth after such an operation. Scientists of the doctors already waved his hand at this venture, when suddenly, to universal amazement, Dr. Oktai and his colleagues announced that it was too early to despair. The frozen ovary fabric after a transplant earned in the patient again. She had not cancer, but another disease, but because of her the patient had already lost one ovary. The threat hung over another, and it was decided to save it. The ovary was cut into strips, and two years later, when the patient turned 30, the team of Dr. Oktai sewed the strips into the frame and special surgical foam and implanted his patient into the abdominal cavity.

A few months later, the patient who received all this time hormones that help eggs ripen, ovulation occurred, that is, the output of the germ cells into the body, and then the menstrual cycle came, this was the first case in history when the frozen ovarian tissue began to function again. The patient could have become pregnant in the usual way if she had not been removed before the phallopian pipes. She could not do without a test tube.

Dr. Oktay believes that if a woman is over 30, then frozen ovaries may not give the desired results. In them, already fewer germ cells than young women, and here some other cells will die during storage at low temperature and various manipulations. In a word, by the time the ovary will need to act, he may not have enough healthy cells to achieve pregnancy or develop hormones necessary to restrain menstruation.

In essence, the idea of these age -related restrictions prompted Dr. Oktay to focus on the ovarian transplanting into the patient's own body. You can’t imagine the best environment. And no climate change for you is often fraught with troubles. Such transplants are made and doctors transplant the ovaries to the abdominal cavity, away from irradiation, but in the case of the patient from whom we started our story, Oktai and his colleagues came to the conclusion that the stomach is not suitable. The hand is the best place.

The brigade set to work. Dr. Katerina Ekonomos extracted ovaries from a sleeping patient, Dr. Oktai cut them into 16 strips and, together with his colleague James, Rusinsky placed them parallel to each other under the skin of the back of his hand. Of course, you have long want to ask: why cut into strips? Then it turns out that the flat diets absorb the food from the surrounding tissues better than larger segments. The doctors encountered the advantages of stripes for the first time 20 years ago, when they mastered the technique of transplanting the near -shaped gland - also in the hand.

Whether the ovaries will work after all the procedures - it is still impossible to say it. Although Oktay is sure that they will. If the case were limited to one radiation, optimism would be justified, but they are going to combine radiation with chemotherapy. True, with chemotherapy in small doses. There would be nothing to guess about the big ones. But the small ones are not a trifle.

Clarity, the brigade believes, will come at best in six months. But clarity is not complete: even if the ovaries work normally, it is not known how much it will last. The whole life of the patient will be an experiment. All her life she will live under the supervision of doctors, and if she has children, and they will also fall under observation.

In the meantime, Dr. Oktai, as befits a real researcher, considers the following option for preserving the ovaries: he seems to him a possible and promising combination of two methods. If the fresh ovarian fabric implanted in the hand will work, then most likely, frozen stripes will work there. The patient who has chemotherapy has to be removed, he will cut the strips from them, freeze, and then transplant, but not to the pelvis, but to the hand. From your hand, after all, without any trouble, you can take eggs for fertilization in a test tube. Although, of course, women who have the phallopian pipes can prefer a transplant into the stomach, so that if you are lucky, get pregnant in a natural way, without a tube.

And Dr. Oktay himself and his colleagues, warmly discussing all the options, do not forget, of course, that their work is still experimental. But to patients, rumors about freezing and transfers reach, of course, in the most bizarre form. According to James Griff, the head of the reproductive endocrinology department at the University of Medical Center in New York, some women believe, for example, that they can delay the birth of children by freezing their ovaries for ten years, and then return them to the place.

“Many people do not understand that nothing good removal of the ovaries does not bode without the need. I have a patient who has breast cancer,” Grifor says. “She asks to freeze her ovaries. When I convinced her that no one knows exactly if her eggs would remain as capable of her, she doesn’t hear me! They don’t want to hear me. It is too early to associate today's hopes with him.

Evgeny Muslin:

Medical news:

British doctors have developed a revolutionary method of growing bones using the bone marrow of the patient himself. This method over the next five years will allow you to abandon the painful method of bone transplanted now and will allow you to grow new bones after an accident, removal of a tumor or

Due to arthritis, using natural growth substances in combination with special porous structures that serve as the basis for the grown bone tissue.

Employees of the Dutch biotechnological company Izotis managed to use such a new technique to replace a two -centimeter section of the damaged bone at the rabbit. And British researchers managed to achieve the same animal results, using simply a porous structure from a polymer polymer. This polymer is gradually absorbed by an overgrowing bone tissue. Professor of Histopathology of the Royal Free University, Peter Revell, explained that his group is now developing more effective voluminous porous structures for replacing the lost bones. In his opinion, they will find practical application in the clinics of Great Britain after three to four years.

American researchers managed to turn the so -called stem cells into liver cells and successfully use these cells to correct liver defects in mice. This experiment was another evidence that the stem, that is, the primary still undifferentiated cells, which, in principle, can be turned into any other cells, belongs to a large place in the future of medicine.

Об этой работе ее авторы, сотрудники калифорнийской биотехнологической компании "Сито-Терапеутикс", доложили на симпозиуме Общества экспериментальной биологии, проходившем в Сан-Диего.

Впрыснув мышам с заболеванием печени кровяные стволовые клетки, доктор Эрик Лагасс и его сотрудники увидели, как эти клетки сами трансформировались в работающие печеночные клетки и восстановили работу этого органа. В результате из 9 смертельно больных мышей 4 мыши выздоровели. Экспериментаторы надеются, что подобную методику лечения удастся перенести и на людей. Причем при таком лечении можно будет не опасаться биологического отторжения пересаженных клеток.