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Palm Desert resident meets the woman whose life she saved with bone marrow transplant – Desert Sun

By daniellenierenberg

Keila Torres knew during a conference trip to Florida she was going to meet the woman who saved her life. What she didn't expect was to see someone so familiar.

Torres, 44,of Worcester, Massachusetts,desperately needed a bone marrow transplant in 2016, when she was 39, to beatacute myeloid leukemia, a cancerthat starts in the bone marrow but often moves into the blood.

A bone marrow transplant isa treatment option for people withblood cancers, such as leukemia, and it replacesunhealthy blood-forming cells with healthy ones from a donor, according to Be The Match, a nonprofit that pairs peoplewith a donor.

She had slightly less than a 50% chance, according to Be The Match. But she beat thoseodds, thanks to Palm Desert resident Odalis Trinidad.

When the two women met on June 23, Torreshad a realization. Her body had been changing since the transplant, and now it started to make sense.

"My blood type changed to Odalis blood type.I developed allergies after the transplant, and she has allergies," Torres said. "Her hair is long, beautiful and really curly, and when my hair started to grow back, it was very curly, very tight curls. When I saw her, I was like, 'Wow, that's why my hair is like that.'"

"You basically become your donor. She lives in me," she added.

Dr. Ayad Hamdan, a bone marrow transplant specialist and board certified hematologist with the Eisenhower Lucy Curci Cancer Center, explained that since new stem cells from adonor replace the stem cells in a patients bone marrow, which is the "factory of our blood cells," the patient will have the same blood type as the donor.

He added it is possible for patients to develop allergies, and"most patients who receive chemotherapy or a transplant have the experience that their hair may grow back with a different texture," but the hair follicles themselves don't change.

Not only do the two women share hair textures and occasionally stuffy noses, they're driven by their desire to inspire others to help those in need.

Most 19-year-oldsare focused on having good times with their friends, not necessarily providing life-saving donations.

Trinidadsaid she tried to donate blood as often as she could, even though the process was always a bit uncomfortable either her arm would stop pumping enough blood, or her arm would be too sensitive. During one of her visits, she noticed a poster for Be The Match and decided to do some more research.

The process to join the donor registryseemed "really easy" for Trinidad, now 24.She received a registration kit to give a swab of cheek cells and sent it back in October 2015. Then camethe waiting period.

"If you get called, you get called; if you don't, well, at least you tried, right?" the Palm Desert resident said.

People between the ages of 18 and 44 can join the Be The Match donor registry. Cells from younger donors have the best chance of successful donations, according to the Mayo Clinic.

Due to a lack of diversity on the donor registry, white patients have a better chance of finding a match on the registry than do people of other races. According to the site, African Americans have a 29% chance, Asians and Pacific Islanders 47%, Latinos 48%, Native Americans 60% and whites 79%.

In July 2015, Torres, 38 at the time, learned she was diagnosed with Stage 3 breast cancer. With two young sons, ages 15 months and 5 years old at the time, she knew she had to fight to be there for her boys. After chemotherapy, radiation, lymph node removal and a bilateral mastectomy, she was declared cancer-free a year later.

The good news, unfortunately, was spoiled in September 2016.

"I felt like I was fine. I was recovering, I was spending time with my kids, I was going to work, my hair was growing back and I felt great," Torres said. While undergoing a bone marrow biopsy, she was told "there was something wrong" with routine lab work.She remembered asking her oncologist, "What's the worst that could happen?"

"If we find leukemia," Torres recalled her oncologist saying. "When I heard leukemia, I was like, 'Oh,that's not going to be me, it's probably something else.'"

But the biopsy showed she hadacute myeloid leukemia. It isa common type of leukemia in adults, although it accounts for just 1% of all cancers,according to is also generally uncommon to find in people younger than 45. Torres was 39.

"I was in shock. I was devastated. I had already gone through so many things," Torres said, "but in the back of my head I was thinking, 'I've been through breast cancer, I can do this.'"

But the gravity of the situation didn't hit her until she met the leukemia team at Massachusetts General Hospital. Walking into one of the clinic rooms, she remembers feeling "very claustrophobic,"like she was "running out of breath."

Torres began chemotherapy atMassachusetts General, but to have a betterchance at beating leukemia, she would need a bone marrow transplant.

The two women had plenty in common even before the transplant,Torres said, almost as if Trinidad was always her"missing puzzle piece." They both have birthdays in October, mothers from Guatemala (Torres grew up there as well) and they're both mothers.

The best match for a bone marrow transplant is when a patient and donor'shuman leukocyte antigen closely match. HLA"is a marker on our stem cells thatdetermines how our immune system responds," explained Hamdan. Those markers are used by an individual's immune system to know which cells belong in the body and which ones don't, according to Be The Match.

Doctors first looked to Torres' brother to see if he was a match. Siblings have a one in four chance of being a match since half of an individual's HLA markers are inheritedfrom their mother and the other halffrom their father, according to Be The Match. About seven out of 10 people won't have a close match with a family member, as was thecase with Torres. That's when people look to thedonor registry.

After Trinidad completed her cheek swab in October 2015, she essentially forgot about it since she didn't hear back from the registry. She received a phone call a year later.

"'Hey, I don't know if you remember you signed up for this, but this is what we do and we're calling to let you know that you have a possibility of saving someone's life,'" Trinidad recalled hearing.The only information she was given was the person needing the donationwas a female, 40 years old (Torres turned 40 in October 2016) and the type of leukemia. Nothing more, not even a name.

So, yes or no? It wastime to decide.

"I called them (the next day to learn) what did I need to do, what did they need from meto make sure it could be successful," she said.

Trinidad had blood work and other tests done prior to donation day. Her family was very supportive of her decision to help save a life, she said, whileit was a bit "hard for my friends to be on board."

"We were all 19, so they were like, 'You're crazy, you don't even know them and you're going to have this whole surgery for them?'I was like, "Well, yeah, I can save someone's life,'" Trinidad recalled. "You would want someone to do it for you, so how could you not do it?"

On donation day, donorsare put undergeneral anesthesia and marrow cells are taken from the back of the pelvicbone.

"The donor lies face down, and a large needle is put through the skin and into the back of the hip bone. Its pushed through the bone to the center and the thick, liquid marrow is pulled out through the needle," according to 10%, or 2 pints, of marrow are collected, and the procedure takes up to two hours. The donor's body replaces those cells within four to six weeks.

Trinidad described the day in December 2016 as "nerve-racking,"but not because of the giant needle.

"I know everything that they're doing to me, but I can't, I literally cannot, know her perspective, what she is going through, how it is going to get to her," she said. "During this whole procedure, I'm nervous, I'm thinking, 'I hope it works, I hope it works.'I'm a match, but her body might not (accept the cells)well. I want to be sure that I'm doing the best I can so that it's the best for her."

To begin the transplant process, a receiving patient must undergo a conditioning regimen, which includes chemotherapy and sometimes radiation, to "wipe out" their immune system and leukemia cells, according to Hamdan.On transplant day, also called Day Zero, patients receive the donated cells through a blood transfusion.From Day Zero onward, the donated cells grow and make new blood cells, which is called engraftment, according to Be The Match.

Torres, admitted to the hospital on Thanksgiving, had a week straight of chemotherapy. Day Zero, which she considers one of her birthdays and her "rebirth," was Dec. 2, 2016.

It's normal for patients to feel weak, and Torres remembers being "sick to my stomach" the first few days after the transfusion. But her red and white blood counts started growing, she said, and slowly started feeling better. She was released from the hospital on Dec. 23, just in time for the holidays.

Both women had played a big part in each other's lives, and yet they still didn't know anything about one another.

Transplant recipients and donors have to wait one year before they can have direct contact with each other in the United States, according to Be The Match.

"This could only work if both of us want to know," Trinidad said."It was hard because I wanted to know her recovery, I wanted to know if it worked. What if it didn't work and they just didn't tell me anything at all?"

By the time the one-year mark came, the two women were ready to know something, anything,about each other.

It was an instant connection, almost as if they had known each other their entire lives, they both said. Finallyconnected on Facebook, they could get a glimpse of the other's family and see what they were up to. They talked and texted whenever they could.

It wasn't until a few weeks after their initial contact that Torres revealed to Trinidad that doctorsfound leukemia once again in January 2018.Torres would have to go through the transplant process all over again, but this time witha different donor.

Hamdan explained: "Transplants are most of the time the only chance for patients to be cured, and although there is a good chance of success, the cancer can come back. (It) depends on the disease, the age of the patient, the type of transplant."

Torres still wouldn't change a thing.

"She gave me life the first time around. I was able to come home and be with my kids for a year," Torres said. "Even if I had relapsed or not, Im so grateful for her for doing an act of kindness. At 20,Iwasnt thinking about stuff like that."

Trinidad, now a mother herself to3-month-old son Jimmy,said having her own child put thedonation into a whole new perspective.

"I really just am happy to give her that time with her kids. I now know how important and valued that time is," she said.

But thatwasn't the end of the journey.

They both had meeting each other in-person on their bucket lists, and when an opportunity came at aHOSA Future Health Professionals convention last month in Orlando, Floridaboth said "it was meant to be."

Representatives from Be The Match reached out to the two women and asked if they'd want to share their story to the students attending the conference. Trinidad was also a member of HOSA when she attended Palm Springs High School.

After years of texting, calling and social media lurking, they hugged on stage at the conference for quite a long time, admitted Trinidad, and "neither of us wanted to let go." She describedthe moment as "surreal,"finally seeing "the life that I gave her."

And for Torres, to see the woman who went froman anonymous lifesaver to a dear friend and a bit of a look-alike,saying thank you in-personis a moment she'll never forget.

"Theres no way that Iwill ever be able to repay her because theres no price with what she did," Torres said. "Im think I'm still kind of digesting all the emotions that came with it, but the one thing I know isIm full of gratitude for what she did for me.

Trinidad hopes more people will join the donor registry "it's so easy," she reiterated and be there to answer the call if they end up being someone's best match.

"I'm a donor because I wanted to be one," Trinidad said. "I know it required me physically giving up some bone marrow, but itsaved someones life, and I would do it again."

Torres, too, can attest to that: "If it hadnt been for her the first time around, honestly I dont think Iwould be here."


Visit learnhow to join the registry, request a cheek swab and what the next steps are if you're a match.

Ema Sasic covers health in the Coachella Valley. Reach her at or on Twitter @ema_sasic.

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Cell-Based Immunotherapy May Be Effective Against Melanoma – Technology Networks

By daniellenierenberg

An immunotherapy based on supercharging the immune system's natural killer cells has been effective in treating patients with recurrent leukemia and other difficult to treat blood cancers. Now, researchers at Washington University School of Medicine in St. Louis have shown in preclinical studies conducted in mice and human cells that this type of cell-based immunotherapy also could be effective against solid tumors, starting with melanoma, a type of skin cancer that can be deadly if not caught early.

The study is published June 29 inClinical Cancer Research, a journal of the American Association for Cancer Research.

In recent years, an immunotherapy called immune checkpoint inhibitors has revolutionized treatment for advanced melanoma. In one well-known example, this immunotherapy was successfully used to treat former President Jimmy Carter, whose melanoma had spread to his liver and brain.

But the therapy only works in about half of such patients. And even among those who respond well to the initial therapy, about half go on to develop resistance to it. Consequently, researchers have been seeking different ways to harness the immune system to attack melanoma cells. One possibility is to use natural killer (NK) cells, a part of the immune system's first line of defense against dangerous cells, whether cancer cells or invading bacteria.

Todd A. Fehniger, MD, PhD, a professor of medicine, and his team have had success in clinical trials treating recurrent leukemia with a patient's own natural killer cells or those from a donor. The NK cells are harvested from the patient's or a donor's blood and exposed to a set of chemical signals called cytokines that activate the cells and prime them to remember this activation. When these "cytokine-induced memory-like" NK cells are given to the patient, they are more potent in attacking the cancer because they already have been revved up, as Fehniger puts it.

"These 'revved-up' memory-like NK cells attack blood cancers quite well," said Fehniger, the study's co-senior author and an oncologist who treats patients at Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine. "But relatively little work has been done on whether these cells can be used against solid tumors. This is an unmet need in solid tumor oncology. Our study provides proof of principle that memory-like NK cells respond better than normal NK cells against melanoma, and it serves as a stepping stone to a first-in-human clinical trial of these cells in advanced melanoma."

Added co-senior author Ryan C. Fields, MD, the Kim and Tim Eberlein Distinguished Professor of Surgical Oncology: "We hope this is also a step toward harnessing NK cells against multiple solid tumors. Melanoma was a good place to start because we know it responds to immune therapy. But because many patients don't respond or develop resistance, we felt that targeting a different aspect of the immune system was a promising strategy to pursue."

The standard checkpoint inhibitor immunotherapy that works well in some melanoma patients targets T cells, another type of immune cell that also frequently is harnessed against different forms of cancer. According to the researchers, patients who don't respond well or stop responding to the T cell-based standard therapy and have no other options would be good candidates for NK cell therapy.

The researchers studied human NK cells from both healthy people and from patients with melanoma and found that the cytokine-induced memory-like NK cells could effectively treat mice harboring human melanoma tumors. Tumors shrank to the point of being almost undetectable in many of the mice, and the memory-like NK cells prevented the tumors from returning in most cases for the duration of the 21-day experiment. While normal NK cells also reduced and controlled melanoma tumors, they did not do so to the same degree.

"We are currently designing a clinical trial to evaluate these NK cells in patients with advanced melanoma who have exhausted all other treatment options," Fehniger said. "We would like to investigate NK cells from a donor and, separately, a patient's own NK cells to see if the cytokine-induced memory-like NK cells offer an effective treatment option for patients with this aggressive skin cancer."

The NK cell-based immunotherapy is potentially safer than other cell-based immunotherapies because the NK cells do not trigger a cytokine storm, as is seen sometimes in CAR-T cell therapy, which often is used for blood cancers, nor do the NK cells cause graft-versus-host disease, which sometimes follows a stem cell transplant.

"Even 10 years ago, we had no effective therapies for advanced melanoma -- much like the lack of therapies for glioblastoma or advanced pancreatic cancer today," said Fields, a surgeon who treats patients at Siteman. "Checkpoint immunotherapy has revolutionized melanoma treatment, but we're still not satisfied with the 50% response rate. We want to do better, and this NK cell therapy is a promising approach. And in the future, we may be able to combine an NK cell-based therapy with checkpoint inhibition for an even better response."

Fehniger and his colleagues have worked with Washington University's Office of Technology Management to license the cytokine-induced memory-like NK cell technology to a company called Wugen. Fehniger is a co-founder of Wugen and serves on its scientific advisory board.

Reference:Marin ND, Krasnick BA, Becker-Hapak M, et al. Memory-like differentiation enhances NK cell responses to melanoma. Clin Cancer Res. 2021. doi: 10.1158/1078-0432.CCR-21-0851

This article has been republished from the following materials. Note: material may have been edited for length and content. For further information, please contact the cited source.

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The Body Shop Discount Codes: 15% Off Everything – GLAMOUR UK

By daniellenierenberg

The Body Shop discount codes are hard to come by, but when they *do* rear their beautiful heads (read: now - keeping scrolling), there's one product I always make a beeline for.

We're all well aware of the fact that we should be wearing face SPF every single day at this point. Stat. It's non-negotiable. Even when the weather is as grey and drizzly as it is this July. Sob. But which one? I've got a few on rotation - from Glossier's Invisible Shield to Ultra Violette's Queen Screen Luminising Sun Serum - though my most-reached for is The Body Shop's Skin Defence Multi-Protection Lotion SPF 50+ PA++++. It's really, really good.

A fan favourite for good reason, it's a 2-in-1 moisturiser and SPF 50+ product that helps to protect against pigmentation and premature ageing. On the hydration front, it has been newly formulated with red algae extract and vitamin C to help your skin look brighter and healthier. It's also super lightweight, fast-absorbing and non-greasy, so you don't feel like your face is caked in gloopy sun cream.

On the protection front, it has SPF50, so it effectively protects your skin against UV rays - including UVA, which penetrates deeper than any other kind of UV ray and causes pigmentation and discolouration. Plus, it serves up anti-pollution protection. Oh, and it leaves no white cast (tried and tested), so the coast is clear for dark skin sisters.

Buy It Now Claim Your Discount

Tempted? We don't blame you. And there's no time like the present to bag yourself a bottle. Not just because summer is hopefully upon us (we've heard whispers of 25 days of sunshine later this month!), but because you can get 15% off right now - taking it from 18 to 15.30. Dreamy. All you need to do is head to our The Body Shop discount codes page, and claim your discount. The promo code has no minimum order value attached, applies to both new and existing customers and is valid until further notice.

Elsewhere, you can get a free 250ml The Body Shop shower gel when you spend 25, free delivery at The Body Shop or 70% off in The Body Shop sale (think 10 body butters, 30% off gifts and *tonnes* of products for 15 and under).

Claim Your Discount

After more discount codes? Head this way for Cult Beauty discount codes, over here for LookFantastic discount codes and in this direction for Neom discount codes. We've also got Feel Unique discount codes, Selfridges discount codes and MAC discount codes.

For more from Glamour UK Commerce Writer Sophie Cockett, follow her on Instagram @sophiecockettx.

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‘Black fungus’ infections on the rise in India: report – Yahoo News

By daniellenierenberg

Cases of mucormycosis or "black fungus," a rare but serious fungal infection, are climbing in India among some coronavirus patients, per news reports.

Infections have risen to over 30,000 in three weeks, with at least 2,100 deaths, the New York Times reported, compounding the need to protect the country's population, a large percentage of which remain unvaccinated against COVID-19 ahead of a feared third wave this fall.

The infection is caused by a group of molds called mucormycetes which live throughout the environment and typically do not agitate otherwise healthy people, according to the Centers for Disease Control and Prevention (CDC).

However, in those who have health problems, or take medications that lower the bodys ability to fight off germs and sickness, it could infect the sinuses or lungs when inhaled through the air or on injured skin. Diabetes, cancer, organ transplants, stem cell transplants, low white blood cells, long-term corticosteroid use, injection drug use, too much iron, skin injury and premature or low birth weight are all considered to be risk factors.


Doctors in India suspect the countrys overwhelmed hospitals and shortage of medical oxygen left patients vulnerable to the fungal infection. Dr. Bela Prajapati, in charge of treatment for hundreds of mucormycosis patients, told the Times that doctors excessive use of steroids to fight inflammation in coronavirus patients, to help them breathe easier, in turn spiked blood sugar levels and left diabetes patients at risk of infection.

Researcher and microbiologist Dr. Arunaloke Chakrabarti noted many doctors didnt have time to question patients over underlying conditions before turning to the steroids.

"Doctors hardly had any time to do patient management," Chakrabarti told the newspaper. "They were all looking at how to take care of the respiratory tract."

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Mens Guide to Cosmetic Beauty – The New Indian Express

By daniellenierenberg

Express News Service

Both internal and external factors cause the skin to age. As we age, collagen and other supportive tissues in the deeper layers of the skin decrease, causing the skin to lose its elasticity. Excessive sun exposure, air pollution, stress and chronic ill-health can hasten the process. Aesthetic and surgical treatments for men are now coming into prominence. Here are some:

Laser treatments: New technology is giving laser treatments an impetus, which are good to treat pigmentation and other skin problems. Carbon dioxide and erbium lasers are good options. Botulinum toxin and dermal filler injections: Fat is a very good, popular and natural filler. Botox is a protein that paralyses muscles and prevents them from contracting, thus smoothening fine lines and wrinkles.

Platelet Rich Plasma (PRP) therapy: This is a simple, quick and effective therapy that restores radiance. A small amount of blood is drawn from the patient, centrifuged (spun at fast speed) to separate the platelet-rich plasma and is then injected into the facial skin using a fine needle.

Autologous fat grafting: Fat is harvested from one part of the body, purified and injected into the facial area. With new techniques, the fat can be treated to extract fat stem cells, which have better rejuvenating and repairing potential. This technique is called Nano fat grafting and can be combined with micro-needling.

Thermage: Also known as the lunchtime facelift, it is a quick, non-invasive facial rejuvenation technique. A handpiece delivers radiofrequency heat energy into the collagen-containing layers of the skin, stimulating the collagen to renew and repair itself, and thus adding volume and improving the texture of the facial skin.

HIFU skin tightening: It is a new cosmetic treatment that is a non-invasive and painless replacement for facelifts. Surgical facelift: This is useful when the degree of sagging and wrinkles is unlikely to be corrected by non-surgical techniques. It is done under general anaesthesia.

The author is a SeniorConsultant and Cosmetic Surgeon, Apollo Hospital, New Delhi

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Fact check: Contact with wild parsnip harmful to humans and animals – USA TODAY

By daniellenierenberg

Continued, heavy thunderstorms along the Gulf Coast will further flash flooding concerns left by the tropical storm. Accuweather

Planning a hike or a nature walk? You probably know to avoid poison ivy by its distinguishable three leaves on a single stem or stinging nettle by its tiny hair-like projections. But there may be one seemingly innocuous plant not on your radar, as one Facebook post claims.

"(It's) about that time of the year again and we are terrified of the kidscoming into contact with Wild Parsnip. Please, please be aware of how dangerous this plant really is!" claims the May 31, 2019, post,since shared over 142,000 times on the social media platform.

The poster says the yellow flowering plant, resembling an upturned umbrella in accompanying pictures, produces a sapthat reacts violently with skin after exposure to sunlight, causing blisters, burns and potentially blindness.

Large, fluid-filled blisters on the chest, hands and arms of an unidentified child, purportedly the poster's son, are included, emphasizing the need for awareness and caution.

Fact check: Brood X cicadas are infected with a sexually transmitted fungus

"I have heard about Wild Parsnip but never knew it was this bad. Poor little guy," commented one Facebook user.

"Oh my gosh, (I) had this in the field behind my house last year, wonder if it comes back every year," said another.

Wild parsnip, an invasive plant species from Europe and Asia likely brought by European settlers to North America for its edible root, is a widespread problem in Canada and in states like Ohio, New Yorkand Minnesota. USA TODAY cannot verify the images shared in the post, but its word of warning about the plant is indeed scientifically true.

Standing at almost 5-feet tall with a single, deeply ridged stem about 2- to 5-centimetersthick, wild parsnip is found throughout southern Canada and the northern U.S. All parts of the plant from the stems, leaves and flowers contain phytochemicals called psoralens, which kill skin cells by inserting themselves into our DNA.

Normally, our skin shields us from a type of radiation emitted by the sun called long-wave ultraviolet radiation, or LWUVR. But with psoralens essentially hijacking our genetic code, they boost the amount of LWUVR our skin absorbsand stop cellular growth.

This may sound bad, and does result in a condition called phytophotodermatitis characterized by angry-looking blisters and burn-like symptoms, but psoralens in combination with ultraviolet light therapy havebeen usedto safely treat skin diseases like psoriasis and vitiligo since the 1970s.

Fact check: Image of human-elephant hybrid is art, doesn't show real baby

Other conditions resulting from coming into contact with wild parsnipcan include blindness if the sap gets into your eyes.

The plant can also inflict injury in animals; livestock that eat it tend to lose weight and may have fertility issues.

Wild parsnip grows in a whole range of environments butis commonly foundalong roadsides, pastures, abandoned fields and any place where soil has been disturbed and native vegetation has yet to be established, according tothe New York Invasive Species Information Clearinghouse.

It's advised if you do come into contact with the yellow-flowered planttoget out of the sun as soon as possible or immediately cover the affected areas before washing with warm water and soap. While photosensitivity and discoloration typically last up to eight hours, these symptoms can linger for up to two years.

Based on our research, we rate TRUE the claim wild parsnip sap can cause skin blisters. A phytochemical secreted by wild parsnip, called psoralens, reacts when exposed to sunlight, affecting cell growth, which results in blisters, other burn-like symptoms and even blindness if the sap gets in the eyes.

Thank you for supporting our journalism. You can subscribe to our print edition, ad-free app or electronic newspaper replica here.

Our fact check work is supported in part by a grant from Facebook.


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5 potential benefits of exosome treatment – AZ Big Media

By daniellenierenberg

For the better part of the 2000s, stem cell therapy ruled the public health conversation in the United States. The only thing that came close to supplanting it as the most controversial science and health topic was cloning.

These days, its normalized enough that people line up for treatments involving stem cells without giving it a second thought. Exosome treatment is one of the more popular varieties, and theres no wonder why. It has a broad range of benefits, many of which youll learn about if you read on.

Before COVID-19, the opioid epidemic was the biggest public health issue in the United States. As important as solving that issue is, it cut the number of options available to chronic pain patients.

Without effective treatment and accommodation, chronic pain affects mobility, mood, and relationships. It makes daily life and employment difficult. Suffering from it and the ensuing struggles can even lead to suicide.

The good news is that exosome therapy and other stem cell treatments lend some hope.

Arthritis is a common immune condition that causes great pain for many. Immune system disorders often involve miscommunication between cells. Exosomes primary function is communication, solving that issue, and boosting the immune system.

Joint inflammation is a key symptom of arthritis but exists in other forms, as well. Inflamed joints after injuries can end athletes seasons without proper treatment. Exosome therapy treats joint inflammation and pain, whatever the cause.

Surgery solves an endless range of ailments and helps achieve appearance goals. In terms of risk, theres never been a better time to get surgery. Laparoscopy, lasers, and robots are a few of many tools that reduce tissue damage.

Todays post-surgery therapies have folks back to regular activity faster than we imagined possible even a decade ago. Exosome treatment and other stem cell therapies are one way to restore function sooner than later.

No matter how advanced surgery gets or how effective rehab becomes, there are always risks. Issues with anesthesia, infections, and even freak accidents like surgeons sewing their equipment into patients bodies are all too common. The only way to remove these concerns is by avoiding surgery.

Exosome therapy is a non-invasive substitute for some operations. It doesnt come with the same risks or recovery period. Its also a great option for elderly people who cant risk surgery and folks with conditions that make it impossible.

Exosomes can turn around someones quality of life by solving a painful condition or restoring mobility. Theyre also useful for less pressing matters, such as restoring youthful looks.

Treatments like Botox and collagen injections arent long-lasting and can lead to adverse reactions. Because exosome therapy stimulates cell production, the body fills in wrinkles and restores skin elasticity. It doesnt come with the infamous stiffness of Botox and wont droop as dermal fillers can.

Anti-aging therapies arent a must for everyone, but they are for some, making this extra important.

Whether you think its right or not, we have high expectations for entertainers and models. Showing your age in some professions can push you out of your field. Using exosomes to reverse the aging process has a less artificial look than some other procedures and lasts longer, extending careers.

Medication is the most popular treatment for erectile dysfunction (ED), to the point that solutions have nicknames like the little blue pill. Despite pills popularity, they have several downsides.

The most popular ED meds have no long-term benefits: You rely on them for each sexual encounter. They can interact with other drugs and arent recommended for patients with certain conditions, such as heart disease and both high and low blood pressure.

ED pills also come with ugly side effects, including headaches and gastrointestinal distress.

Exosomes, on the other hand, have long-lasting results and no major side effects. Rather than providing a temporary fix, they help heal damaged nerves and tissues. This can increase how long erections last. For some, the method also boosts penile length and girth.

The treatment also helps people with conditions such as Peyronies disease, also known as PD. The main symptom is built-up scar tissue that results in a curved penis. Some PD patients cant have sex due to erectile dysfunction and/or pain.

That all can change for PD patients who undergo exosome therapy. The healing process awakens dormant cells and improves blood flow. It makes enjoyable sex possible again.

Bald is beautiful, but its not everyones cup of tea. Those who have a lot of pride in their hair may see their self-confidence tank when they go bald. It affects some folks sex lives, whether thats because their significant others dislike it or because they dont feel attractive and struggle to get in the mood.

For all of these reasons, theres an infinite range of treatments and has been pretty much since the beginning of recorded history. The grand majority of them never amounted to much, and some were downright nasty!

If youve tried everything from hair plugs to superstitious treatments without success, dont despair.

Exosome treatment is a modern solution for hair restoration, and its effective. Its not like treatments that try to mask hair loss or graft hairs from one part of the head to another. Instead, exosomes restore follicles so hair can grow again.

Expect to hear more and more about exosome treatment in the coming years. Its one of the most modern medical treatments available and continues growing due to its wide range of benefits.

If you want to learn about more of the latest and greatest science to make your life better and info to propel you to success, youre on the right website. Our articles are sure to inform and entertain, so click on another one and pick up new knowledge today.

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Embryo research law requires updating to match up with science – Cleveland American

By daniellenierenberg

In March, Australian scientists announced a worldwide important model of an early human Embryo, blastoids, using skin cells. The finding was crucial because it enables researchers to explore the reasons for infertility, developmental abnormalities, and miscarriage in a period of human development that is not yet accessible without human embryos. The International Stem Cell Science Organization published.

In the past week of May, new criteria for early human life research are to be conducted. The International Stem Cell Research Society guidelines include current progress such as the iBlastoid models and offer several recommendations that assist scientists in understanding more about the early phases of human life. The procedures also include: There are also apparent indications, such as genetic tampering, of what should not be permitted.

The most significant proposal is to modify the 14-day limit, a regulatory line-in-the-sand that scientists cannot experiment with human embryos in Australia and nearly a dozen nations. The 14-day limit stems from the 1980s when human seeds could not be grown longer than roughly six days after fertilization. Although modern technology currently allows scientists to cultivate embryos beyond 14 days in the laboratory, the rule is that research to take them further has not taken place.

Why fourteen days? On day 14, a human embryo is no longer a cell ball. It develops the primitive stripe, the beginning of the neural cord, eventually leading to the central nervous system. At a period when embryo research was a reasonably novel notion with the twin advantage of creating confidence while at the same time allowing space for early human development study, the deadline offered total certainty. Since scientists can cultivate human embryos for longer, revisions to these standards have been called for a long time.

What restrictions can instead be established to manage research on human embryos? The recommendations suggest that researchers who wish to develop human briefings above the two-week mark should assess their project by case to determine when they have to terminate investigations, subject to many rounds of assessment. The recommendation of the ISSCR for embryos or models from human stem cells, like the blastoids produced by Professor Jose Polo with his colleagues at Monash University, is of particular relevance to Australian science.

The new rules declare because most laws worldwide do not regard such embryo models to be identical to human embryos that they are not subject to the 14-day rule limitations. This statement directly contradicts the guidelines with the Australian law of 2002, which defines an embryo not only as an egg and sperm product. But as an embryo created by any other process that initiates organized development of a biological entity with a human nuclear genome or an altering human nuclear genome that may develop.

iBlastoids can simulate several elements of embryo development, making it a fantastic study tool. However, they have sufficient molecular and cellular composition modifications that scientists see as differing from human embryos. However, under Australian laws, iBlastoids are subject to existing human embryo research regulations, including a research license and the fourteen-day limit, as the National Health and Medical Research Council decided. Australian iBlastoid research will require discussion on the concept of a human embryo and maybe regulatory reform under the latest international principles.

To identify reasons for ingratitude, developmental anomalies, and malfunction, we have operated with human embryos and human embryo models ethically and responsibly. A timely reminder is made of the complete and bold ISSCR standards, which frequently need a change in the legislation to comply with science and allow advances such as IVF to occur.

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Scientists Working On Robot That Can Detect All Kinds Of Emotions In Hopes Of Helping Patients With Mental Health Disorders – CBS Miami

By daniellenierenberg

MIAMI (CBSMiami) Scientists are working to create a robot that can detect all kinds of emotions. They say the benefits could help patients with a range of mental health disorders.

The robot is called Abel, and it is learning to smile, snarl, and frown. Twenty motors under his artificial skin give the robot emotions just like us. Engineers hope someday Abel will be a friend for people with behavioral, social, or cognitive disorders like autism or Alzheimers.

We want Abel to know how people are feeling to keep them healthy, not just physically, but mentally and emotionally, researcher Lorenzo Cominelli said.

To make Abel look eerily real, engineers teamed up with special effects artist Gustav Hoegen. His company has created animatronics for Hollywood hits Star Wars and Jurassic Park.

Right now, someone has to wear sensors for the robot to recognize their emotions. The next step may seem like something out of science fiction. Researchers say they want to give Abel a human brain with the help of tissue taken from stem cells.

Organoids are basically an aggregate of stem cells which self-assemble and self-organize to resemble the structure and function of a mini-human organ, researcher Arti Ahluwalia said.

Scientists say that would allow Abel to read our expressions all on his own. And if theyre successful, expect the team and Abel to look a bit smug.

Researchers acknowledge they are years away from their goal, but they believe Abel will one day not only be able to recognize emotions on his own but be able feel them too.

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The Creamiest, Dreamiest Way To Wash Your Face: 13 Must-Try Cleansing Balms –

By daniellenierenberg

Every skin care fanatic has a favorite step of their routinethe layer of the ritual that brings them the most joy. And while I love the tender act of massaging in a dense face cream or slipping on an oil at night, there is nothing I appreciate more than washing my face. Yes, it's a semi-controversial skin care take (as controversial as those can be), but it's true: I love the ritual of cleaning my skin.

But face washes are a deceptively tricky category. For some time, the reigning options were of the strip-your-face variety. (You know the ones: Those sudsy numbers that left you feeling squeaky and dry.) But now, there are so many that experiment with textures, infuse deliciously hydrating actives, and elevate sensorial experiencesand finally, they're getting due attention.

There's no better example of this than the cleansing balm. (Even saying "cleansing balm" feels like slipping into a cashmere sweater.) The subcategory of face washes is marked by their thick, gel-cream texture and hydrating benefits; of course, there are subtle differences between them that make them unique, but that's the throughline.

Now, if all of the above has you thinking you need to get your hands on one, here are our favorites for you to try. Enjoy, won't you?

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Humanoid robot has super realistic facial expressions and it’s kind of eerie –

By daniellenierenberg

Abel has 20 motors under his human-like skin that allow him to show feelings just like us.

LONDON, UK Scientists in Italy are working to create a robot that can detect all kinds of emotions.

The robot is called Abel, and it is learning to smile, snarl, and frown. Twenty motors under his artificial skin give the robot "emotions" just like us. Engineers hope someday Abel will be a friend for people with behavioral, social, or cognitive disorders like autism or Alzheimer's.

Researcher Lorenzo Cominelli says, "We want Abel to know how people are feeling - to keep them healthy, not just physically, but mentally and emotionally."

To make Abel look eerily real, engineers teamed up with special effects artist Gustav Hoegen. His company has created animatronics for Hollywood hits "Star Wars" and "Jurassic Park."

Right now, someone has to wear sensors for the robot to recognize their emotions. The next step may seem like something out of science fiction. Researchers say they want to give Abel a human brain with the help of tissue taken from stem cells.

Researcher Arti Ahluwalia says, "Organoids are basically an aggregate of stem cells which self-assemble and self-organize to resemble the structure and function of a mini-human organ." Scientists say that would allow Abel to read our expressions all on his own. And if they're successful, expect the team and Abel to look a bit smug.

Researchers acknowledge they are years away from their goal, but they believe Abel will one day not only be able to recognize emotions on his own but be able feel them too.

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Burn victims like the wounded Belle Isle contractors in good hands at UMC, spray-on skin at forefront of care – ArkLaTexHomepage

By daniellenierenberg

NEW ORLEANS (WGNO) Several contract workers were burned during a gas well explosion on Belle Isle along the Gulf of Mexico on Tuesday.

Of those wounded, three were reported taken to University Medical Center the regions only Level I verified trauma and verified burn center.

According to Dr. Jeffrey Carter, Medical Director of the UMC Burn Center and professor of surgery at LSU Health-New Orleans, speed is of the essence when it comes to successful treatment of burn victims.

At 2:56 pm, Acadian received a report of a well fire. We sent 4 helicopters and 5 ground units to Morgan City (LA). We transported two patients by air (1 to NOLA and 1 to Lafayette area) and 2 patients by ground (both to NOLA)

Delays in medical treatment can result in increased amounts of resuscitation, increased length of hospital stays, increased infection risks and increased kidney problems.

Its important to realize here in Louisiana, we have a fair number of risks. About 85 percent of all hazardous waste travels through our port or rail here in New Orleans, said Dr. Carter.

There are over 3,000 rigs, gas and pipeline areas here that are at risk along the gulf. When we have injuries that occur from industrial accidents, what we find is that the mortality is increased by about 20 percent if there is a delay of about two hours in transporting the patient to a center where they can get definitive care.

Dr. Carter says being an academic medical research center, UMC is able to offer the latest technology in the treatment of severe burns.

On the forefront of burn care is the use of RECELLs spray-on skin by Avita Medical, in which the doctors take a small portion of the patients own skin, dissolve it and pull the stem cells, and then -apply it at the time of surgery.

Dr. Carter explained and demonstrated the use of RECELL during a Zoom interview with WGNOs Aaron S. Lee on Wednesday.

He also discussed how the use of artificial intelligence will soon revolutionize how burn victims are treated and how quickly they recover.

That video clip can be seen below:

According to Dr. Carter, half of his patients suffer burns to their hands and face as these are areas not covered, especially in the deep south. This can be worrisome to the victim after recovery as those are places people notice first when interacting with another person.

Not to mention, the face is extremely complex with the amount of movement and how it changes over time.

The use of RECELL on a burn victims face is making skin grafts a thing of the past.

A skin graft is like putting a piece of plywood on your roof when it has a hole in it, explained Dr. Carter. It doesnt look the same. It doesnt act the same. It doesnt behave the same.

While its OK for some types of injuries, said Dr, Carter, its not necessarily the best thing.

Dr. Carter goes on to explain the benefits of using of the RECELL system and ultimately allowing burn patients to heal themselves using their own cells during recovery.

The FDA is considering RECELL for pediatric burns, with Dr. Carter serving as one of the clinical trial investigators.

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The Rise of Longevity Therapeutics – Pharmaceutical Executive

By daniellenierenberg

Aging is the ultimate risk factor for most diseases, such as cancer, neurodegenerative, cardiovascular, diabetes, degenerative fibrosis and many others. When we are young, we are typically healthy, despite a predisposition that will lead inevitably to a specific degenerative condition. However, the degenerative processes do not kick in until a certain age, when we are older. It looks like when we are younger, the body can compensate cumulative stress and damage caused to our cells in the tissues, allowing to maintain that equilibrium, called homeostasis, that keeps our organs functional and healthy. However, over time this buffering capacity becomes thinner and thinner, until things wear off: our tissues stop working as they used to. These changes are typically caused by an initial small number of rare but bad cells, that progressively increase over time, causing additional damage to the good cells that eventually stop working efficiently, causing a vicious cycle. Eventually the bad cells take over leading to the onset of a disease.

Our body is equipped with a number or regenerative and healing functions. Some are intrinsic in every cell, such as DNA repair mechanisms that are triggered when something compromises the integrity of our genomic structures. These are important functions that enable a cell, for example when it replicates, to repair errors and other damages that might have happened to our DNA. For example, two large proteins called ATM and ATR, involved in the cellular response to DNA damage, are responsible to maintain genomic instability caused by intrinsic and external DNA-damaging agents, such as UV light or various chemicals and toxins. A lack of functions of these proteins results in progressive neurodegeneration, immunodeficiency, predisposition to malignancy or radiation sensitivity. Mutations on the genes encoding these proteins can cause premature aging and premature development of these diseases, but this occurs also naturally, over time.

Cells also have an intrinsic immune system, producing factors called interferons employed by the cells as antiviral agents and to modulate other immune functions. It can be triggers by a viral infection so when a cell is infected will release interferons, protecting the neighbor cells against potential infection. Interferons can also suppress growth of blood vessels preventing tumors to get nutrients and growing. They can also activate immune cells so they can better fight viruses, tumors and others agents. Unfortunately, an age-related decline or impaired innate interferon functions in the cells results in a number of negative consequences in the body, such as increased susceptibility of the elderly to infections, tumors and damage.

In the body there are several cell types responsible to keep the tissues in check. The immune system is specialized to recognize remove and remember damaging agents. Those could be external, such as virus, bacteria or parasites, or internal, such as tumorigenic cells or senescent cells (see below). The immune system is a very sophisticated network of cell types, intercommunicating with each other to maintain the body clean from damaging factors. As we age the immune system also ages and loses capacity to recognize or responding to these damaging agents. It also become exhausted by an increasing chronic inflammation that progressively accumulate as we age, phenomenon also called inflammaging.

Another important repairing mechanism is the regenerative tissue functions, driven by the stem cells. Those cells are progenitor cells, often dormant in a quiescent state in the tissue and waiting to be activated by some damage. Stem cells are critical because once activated they can generate a progeny of daughter cells capable of re-growing the damaged tissue back to its original structure and function. Stem cells have another important function: they can regenerate themselves, in a process called self-renewal. This is important so that the new repaired tissue can repeat the process if a new damage occurs. The regenerative capacity of our body is remarkable, allowing our tissues to keep their integrity, health and functions. However, over time also stem cells age or respond to the aged microenvironment where they live (called the niche), and they become less efficient to repair tissues or to self-renewing. As a result, our tissues change, become atrophic, fibrotic or dysfunctional leading eventually to diseases.

In regenerative medicine, the application of stem cells resulted of the generation of multiple new therapeutic opportunities. A promising area uses stem cells to generate bioengineering strategies to grow new tissues in a petri dish to be then transplanted in the body to repair damaged tissues. Some applications are already in clinical use, such as for skin grafts. Many others are on their way, either in preclinical development or in clinical trials for many different tissue types and for different clinical indications.

Another promising stem cells application is the direct transplantation into damaged tissues, where they can grow and engraft repairing. However, as we age stem cells become less efficient. What if we If we could rejuvenate them? We could restore their capacity to repair our tissues and maintain homeostasis. Promising and exciting strategies are advancing in that direction. For example, we and others showed that it is possible to reprogram epigenetically a cell so it can become the younger and healthier version of itself (Sarkar et al., 2020). This is a mechanism that every cell has encoded in its DNA, but normally works only in the germline (the sperm and the egg) during the embryogenesis to make sure that the cellular clock is turned back to zero, before initiating the cellular programs to generate the embryo. This important for example to prevent making old newborn babies. This intrinsic rejuvenative mechanism is locked in the other somatic cells of the body. We found it is possible to re-activate it transiently and safely, without changing the identity of the cell, enabling to push back the cellular clock of aged human cells to make them healthier and restore their functions. These technologies are under development to be translated into therapeutics with the promise that one day could rejuvenate the aged cells in the body so they can become the younger version of themselves, repeating the process over time when needed.

Among many of the drivers of the aging process, there is one that seems to stands out as the lower hanging fruit among the emerging space of the longevity therapeutics. This is cellular senescence. Every damage that occurs to the cells in our body can push the cells to stop what they are doing and activate a safety mechanism that locks them into an arrested state called cellular senescence. Senescent cells cannot replicate anymore preventing them to cause additional damage, such as becoming cancer cells. All sort of damage can trigger this response leading to cellular senescence such as, oxidative stress, mitochondrial dysfunctions, DNA damage, viral infection, cigarette smoking, pollutions, chemicals, etc. They all can induce that safety lock and push damage cells to become senescent.

Senescent cells dont die easily but they stick around in the tissue, accumulating slowly over time. Importantly, cellular senescence is a pleiotropic mechanism, meaning it can be both good or bad. When we are young, we can efficiently get rid of senescent cells. The body uses them positively such as for tissue repair, wound healing or tissue remodeling. However, as we age, and our immune system ages (partially trough cellular senescence, a phenomenon called immune-senescence), our body become less efficient in removing senescent cells, which then start to accumulate.

Being able to make a new generation of drugs that are very selective for senescent cells, will enable the promise to achieve rejuvenative clinical results in humans similarly to what we found in preclinical results. On that end, we recently published a targeted strategy with the goal to advance the field in that direction (Doan et al., 2020). Using a prodrug, we engineered a small molecule to generate a selective senolytic compound to develop a targeted therapy. This prodrug is inactive in non-senescent cells but activated by senescent cells, taking advantage of an enzymatic function of those cells. In geriatric mice this prodrug showed to be well tolerated but also efficacious to clear senescent cells, resulting in restored cognitive functions, muscle functions, stem cells functions, vitality and overall health. As we advance senolytic drugs to the clinic to treat age-related diseases, it is very important to be mindful that elderly individuals, who are frail, with co-morbidities and exposed to multiple medications, will not well tolerate drugs that are not safe and effective. Importantly, not all senescent cells are the same. They are rare, interspersed in the tissues but are also very heterogeneous. Being able to hit the right senescent cells, in the right diseased tissue will be key to enable effective therapies. Developing drugs that are very potent, selective and potent and safe will be pivotal.

The longevity therapeutics space is emerging, but is already disrupting the medical industry. The goal of longevity therapeutics is not just to add years to life, extending lifespan. The true goal is to add life to years and extend health span. A target that gets closer every day.

Marco Quarta is CEO, Rubedo Life Sciences.

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Keytruda Side Effects: What They Are and How to Manage Them – Healthline

By daniellenierenberg

If you have certain types of cancer, your doctor might suggest Keytruda (pembrolizumab) as a treatment option for you.

Keytruda is a prescription medication thats used to treat certain advanced forms of the following kinds of cancer in adults and some children:

Keytruda can also be used to treat these kinds of cancer in some children as well as adults:

Keytruda comes as a solution a healthcare professional injects into your vein over a period of time. This is called an intravenous infusion.

Keytruda is a biologic, which is a treatment made from parts of living organisms. It isnt available in a biosimilar form. Biosimilars are like generic drugs. But unlike generics, which are made for non-biologic drugs, biosimilars are made for biologic drugs.

For more information about Keytruda, including details about its uses, see this in-depth article on the drug.

Like other drugs, Keytruda can cause mild and serious side effects. Keep reading to learn more.

Some people may experience mild or serious side effects during their Keytruda treatment. These side effects can vary depending on whether Keytruda is used alone or with other cancer drugs.

Examples of Keytrudas commonly reported side effects include:

* To learn more about this side effect, see Side effects explained below.

Read on to learn about other possible side effects of Keytruda.

Keytruda may cause mild side effects. These side effects can vary depending on whether Keytruda is used alone or with other cancer drugs.

Examples of mild side effects that have been reported with Keytruda include:

* To learn more about this side effect, see Side effects explained below.

In most cases, these side effects should be temporary. And some may be easily managed, too. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. And dont stop using Keytruda unless your doctor tells you to.

Keytruda may cause mild side effects other than the ones listed above. See the Keytruda medication guide for more information.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If youd like to notify the FDA about a side effect youve had with Keytruda, visit MedWatch.

Serious side effects may occur with Keytruda. These side effects can vary depending on whether Keytruda is used alone or with other cancer drugs.

Many of Keytrudas serious side effects happen because of an overactive immune system. These are called immune-mediated side effects, and they often cause inflammation (damage and swelling) to tissues. Examples include:

Other serious side effects that have been reported with Keytruda include:

* To learn more about this side effect, see Side effects explained below.

If you develop serious side effects while using Keytruda, call your doctor right away. If the side effects seem life threatening or if you think youre having a medical emergency, immediately call 911 or your local emergency number.

Get answers to some frequently asked questions about Keytrudas side effects.

In most cases, Keytrudas side effects should be temporary. Most should go away soon after you start or stop the drug.

But Keytruda can cause serious side effects that may lead to long-term problems. In some cases, these problems can take many weeks or months to resolve. Here are some examples, all of which cause inflammation (damage and swelling) in different parts of the body:

If you have questions about what to expect long term while using Keytruda, talk with your doctor or pharmacist. But dont stop using Keytruda unless your doctor recommends it.

Yes, in rare cases, Keytruda may cause serious eye side effects (sometimes called ocular side effects).

Examples of eye problems that may happen while using Keytruda include:

Symptoms of eye side effects from Keytruda will depend on the exact eye problem you have. But possible symptoms that may happen with one or both eyes include:

Tell your doctor right away if you have any symptoms of eye problems while using Keytruda.

Keytruda is prescribed to treat many types of cancer, including non-small cell lung cancer and small cell lung cancer. The side effects of Keytruda are expected to be the same regardless of the type of cancer its treating. For a full list of the cancers Keytruda is used to treat, see this in-depth article on the drug.

To learn more about possible side effects of Keytruda, see the What are the mild side effects of Keytruda? and What are the serious side effects of Keytruda? sections above.

If you have questions about what to expect when using Keytruda to treat lung cancer, talk with your doctor.

Yes, confusion is a possible side effect of Keytruda. In fact, confusion was a common side effect of Keytruda in studies of the drug.

Confusion can make you feel as though you cant think clearly. You may also have problems making decisions or focusing on a task. This side effect can also lead to abnormal or slurred speech.

Its important to remember that encephalitis (inflammation of your brain) may cause confusion. Encephalitis is a rare but serious side effect of Keytruda. For this reason, you should tell your doctor right away if you experience confusion while using Keytruda. Theyll likely check you for signs of encephalitis.

Learn more about some of the side effects Keytruda may cause.

Muscle pain or bone pain are common side effects of Keytruda.

You can relieve muscle or bone pain by:

Before using OTC drugs with Keytruda, talk with your doctor or pharmacist. And ask your doctor about other ways to relieve bothersome muscle or bone pain that Keytruda may cause.

In rare cases, some people may have hair loss while using Keytruda. In studies, hair loss was more common when Keytruda was used with chemotherapy drugs than when used alone.

Hair loss as a side effect of Keytruda is usually temporary. If you have hair loss from using Keytruda, your hair should start growing back several weeks after your last dose.

Cooling caps, which are caps designed to keep your scalp cold, might help prevent hair loss. Cooling caps lessen the blood flow to your scalp, which may decrease the effect of Keytruda or chemotherapy on your hair. Ask your doctor if a cooling cap is right for you.

When your hair does start to return, dont overuse hair styling tools that are harsh on hair. These include blow dryers and hair straighteners. You should also avoid bleaching or coloring your hair so it stays healthy enough to grow.

If you experience bothersome hair loss while using Keytruda, talk with your doctor about ways to help with this side effect.

You may have itchy skin or rash from using Keytruda. Itchy skin and mild rashes are common side effects of the drug.

In rare cases, Keytruda may also cause severe rashes and other skin reactions. These include Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). With SJS and TEN, you have a rash along with painful sores on your eyes, genitals, mouth, or throat.

Here are a few tips for helping relieve itching and rash:

If you have a severe skin reaction to Keytruda, youll likely need treatment in a hospital. If you have severe skin peeling or blisters after using the drug, call 911 or your local emergency number right away. These may be signs of a serious skin reaction, which can be life threatening.

If youre concerned about your risk for a severe skin reaction from using Keytruda, talk with your doctor.

Like most drugs, Keytruda can cause an allergic reaction in some people.

Symptoms can be mild or serious and can include:

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an over-the-counter antihistamine you can take by mouth, such as diphenhydramine (Benadryl), or a product you can apply to your skin, such as hydrocortisone cream, to manage your symptoms.

If your doctor confirms you had a mild allergic reaction to Keytruda, theyll decide if you should continue using it.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you had a serious allergic reaction to Keytruda, they may have you switch to a different treatment.

During your Keytruda treatment, consider keeping notes on any side effects youre having. Then, you can share this information with your doctor. This is especially helpful to do when you first start taking new drugs or using a combination of treatments.

Your side effect notes can include things like:

Keeping notes and sharing them with your doctor will help your doctor learn more about how Keytruda affects you. And your doctor can use this information to adjust your treatment plan if needed.

Keytruda is used to treat certain types of cancer in some children. (For information about the cancers Keytruda can treat in children, see this detailed article on the drug.)

Most side effects that occur in children receiving Keytruda are similar to those that adults experience. However, some side effects of Keytruda are more common in children. These include:

Talk with your childs doctor about their risk for side effects from Keytruda.

Keytruda may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Keytruda. Factors to consider include those in the list below.

Allergic reaction. If youve had an allergic reaction to Keytruda or any of its ingredients, you shouldnt take Keytruda. Ask your doctor what other medications are better options for you.

Receiving certain other treatments for multiple myeloma. Using Keytruda with certain other treatments for multiple myeloma can be fatal. (Multiple myeloma is a cancer that affects a type of white blood cell called a plasma cell.) Before using Keytruda, tell your doctor if youre taking any treatments for multiple myeloma.

Received an organ transplant. Before using Keytruda, tell your doctor if youve had an organ transplant. Keytruda can raise the risk for your immune system attacking the transplanted organ. If youve had a transplant, your doctor will tell you what symptoms of organ rejection you should watch for while using Keytruda.

Received or plan to receive a stem cell transplant. Before using Keytruda, tell your doctor if youve received stem cells from a donor in the past or plan to do so. You may be at a higher risk for graft-versus-host disease. This condition causes your immune system to attack the transplant stem cells. Talk with your doctor about whether Keytruda is safe for you to use.

It should be safe to drink alcohol while using Keytruda.

But be aware that alcohol can cause side effects that are similar to some of Keytrudas. These include diarrhea, fatigue (lack of energy), and nausea. If you drink alcohol during Keytruda treatment, it may make these side effects worse.

Talk with your doctor about the amount of alcohol thats safe for you to drink while using Keytruda.

You shouldnt use Keytruda while pregnant or breastfeeding.

Keytruda hasnt been studied during pregnancy. But based on how the drug works, Keytruda may cause harm to infants born to pregnant females* who used the drug during pregnancy.

For this reason, you should use birth control while taking Keytruda if you or your partner can become pregnant. And you should continue to use birth control for at least 4 months after your last dose.

It isnt known if Keytruda can pass into breast milk. To be safe, you shouldnt breastfeed while using Keytruda and for at least 4 months after your last dose.

Before starting Keytruda treatment, tell your doctor if youre pregnant or planning to become pregnant. Also tell them if youre breastfeeding or planning to breastfeed. They can discuss your options with you.

* In this article, we use the term female to refer to someones sex assigned at birth. For information about the difference between sex and gender, see this article.

Keytruda is a drug used to treat certain types of cancer in adults and some children.

Some people who use Keytruda may have mild side effects. Although rare, serious side effects can occur with Keytruda. Many of these happen because of an overactive immune system. Keep in mind that the side effects of Keytruda can vary depending on whether Keytruda is used alone or with other cancer drugs.

Talk with your doctor or pharmacist if you have questions about Keytrudas side effects. Here are a few questions you may want to ask:

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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Citius Pharmaceuticals Selected to Receive Best Poster Award at the International Society for Cell and Gene Therapy 2021 Annual Meeting – PRNewswire

By daniellenierenberg

CRANFORD, N.J., May 25, 2021 /PRNewswire/ --Citius Pharmaceuticals, Inc. ("Citius" or the "Company") (Nasdaq: CTXR), a biopharmaceutical company dedicated to the development and commercialization of first-in-class critical care products with a focus on anti-infective products in adjunct cancer care, unique prescription products and stem cell therapy, today announced that it has received the Best Poster Award at the prestigious International Society for Cell and Gene Therapy (ISCT) 2021 Annual Meeting.

The poster, titled "Novel Induced-Mesenchymal Stem Cells (i-MSCs) Attenuate Severity of ARDS in Septic Sheep," will be presented today, May 25, 2021 by Dr. Perenlei Enkhbaatar, Professor and Director of the Translational Intensive Care Unit at The University of Texas Medical Branch.

"The ISCT annual meeting brings together the brightest minds in cell and gene therapy and highlights cutting edge research in the field," stated Dr. Myron Czuczman, Chief Medical Officer and Executive Vice President of Citius. "We are honored to be selected for the Best Poster Award from among this distinguished peer group. The interim results demonstrate a marked improvement in i-MSC treated animals over control animals in key clinical parameters including: improved oxygenation, less systemic shock, and reduced bacterial burden and vascular injury to the lungs. We are encouraged by the data and welcome the support and engagement of the scientific research community," concluded Dr. Czuczman.

Myron Holubiak, President and Chief Executive Officer of Citius added, "We are grateful to be recognized by our peers for this award as we advance our novel stem cell program for the treatment of ARDS. In parallel to the expansion of our proof-of-concept ARDS sheep study, we are following guidance from the U.S. Food and Drug Administration (FDA) in the development of a cGMP Master Cell Bank of i-MSCs. I am pleased to report that we have completed the development of an i-MSC Accession Cell Bank (ACB) which is to serve as the basis for a scalable cGMP compliant manufacturing capability to support all of our planned pre-clinical and clinical trials. Compared with donor-derived cells that require a continuous supply of new donors, we believe our i-MSCs,derived from a single clonal induced pluripotent stem cell (iPSC), offer multiple advantages including consistent and scalable manufacturing and a potentially limitless supply of i-MSCs to meet our future needs. Moreover, we believe that our i-MSC stem cell program has the potential to meaningfully impact the treatment of ARDS and we appreciate the recognition received from the cell and gene therapy community as we advance our program."

Citius' i-MSCs are derived from iPSCs originating from a qualified single-donor dermal fibroblast, resulting in one homogeneous, validated source for all future cells. A patented synthetic, non-immunogenic mRNA high efficiency cell reprogramming technique is applied to create a clonal iPSC Master Cell Bank from which our i-MSCs are differentiated and expanded to create an i-MSC Accession Cell Bank. Citius has completed the development of its i-MSC ACB and is currently testing (as per FDA guidance) and expanding the cells to create an allogeneic cGMP i-MSC Master Cell Bank to support all future i-MSC needs.

The poster will be available to conference attendees via the conference website. The poster will be available on Citius' website once the event commences.

Conference Details:

Abstract Title:

"Novel Induced-Mesenchymal Stem Cells (i-MSCs) Attenuate Severity of ARDS in Septic Sheep"


K. Hashimoto, N. Bazhanov, P. Enkhbaatar, M. Angel, A. Lader, M. Czuczman, and M. Matthay

Abstract Number:


Date and Time:

May 25, 2021

Session I

12:30 2:00 PM EDT

Session II

8:00 9:30 PM EDT

About Acute Respiratory Distress Syndrome (ARDS)

ARDS is an inflammatory process leading to build-up of fluid in the lungs and respiratory failure. It can occur due to infection, trauma and inhalation of noxious substances. ARDS accounts for approximately 10% of all ICU admissions and almost 25% of patients requiring mechanical ventilation. Survivors of ARDS are often left with severe long-term illness and disability. ARDS is a frequent complication of patients with COVID-19. ARDS is sometimes initially diagnosed as pneumonia or pulmonary edema (fluid in the lungs from heart disease). Symptoms of ARDS include shortness of breath, rapid breathing and heart rate, chest pain (particularly while inhaling), and bluish skin coloration. Among those who survive ARDS, a decreased quality of life is relatively common.

About Citius Pharmaceuticals, Inc.

Citius is a late-stage biopharmaceutical company dedicated to the development and commercialization of first-in-class critical care products, with a focus on anti-infectives in adjunct cancer care, unique prescription products, and stem cell therapy. The Company's lead product candidate, Mino-Lok, an antibiotic lock solution for the treatment of patients with catheter-related bloodstream infections (CRBSIs), is currently enrolling patients in a Phase 3 pivotal superiority trial. Mino-Lok was granted Fast Track designation by the U.S. Food and Drug Administration (FDA). Through its subsidiary, NoveCite, Inc., Citius is developing a novel proprietary mesenchymal stem cell treatment derived from induced pluripotent stem cells (iPSCs) for acute respiratory conditions, with a near-term focus on Acute Respiratory Distress Syndrome (ARDS) associated with COVID-19. For more information, please visit

Safe Harbor

This press release may contain "forward-looking statements" within the meaning of Section 27A of the Securities Act of 1933 and Section 21E of the Securities Exchange Act of 1934. Such statements are made based on our expectations and beliefs concerning future events impacting Citius. You can identify these statements by the fact that they use words such as "will," "anticipate," "estimate," "expect," "plan," "should," and "may" and other words and terms of similar meaning or use of future dates. Forward-looking statements are based on management's current expectations and are subject to risks and uncertainties that could negatively affect our business, operating results, financial condition and stock price. Factors that could cause actual results to differ materially from those currently anticipated are: risks relating to the results of research and development activities, including those for our NoveCite stem cell therapy; uncertainties relating to preclinical and clinical testing; the early stage of products under development; our dependence on third-party suppliers; our ability to successfully undertake and complete clinical trials and the results from those trials for our product candidates; the estimated markets for our product candidates and the acceptance thereof by any market; the ability of our product candidates to impact the quality of life of our target patient populations; our need for substantial additional funds; market and other conditions; risks related to our growth strategy; patent and intellectual property matters; our ability to attract, integrate, and retain key personnel; our ability to obtain, perform under and maintain financing and strategic agreements and relationships; our ability to identify, acquire, close and integrate product candidates and companies successfully and on a timely basis; our ability to procure cGMP commercial-scale supply; government regulation; competition; as well as other risks described in our SEC filings. These risks have been and may be further impacted by Covid-19. Accordingly, these forward-looking statements do not constitute guarantees of future performance, and you are cautioned not to place undue reliance on these forward-looking statements. Risks regarding our business are described in detail in our Securities and Exchange Commission ("SEC") filings which are available on the SEC's website at, including in our Annual Report on Form 10-K for the year ended September 30, 2020, filed with the SEC on December 16, 2020 and updated by our subsequent filings with the SEC. These forward-looking statements speak only as of the date hereof, and we expressly disclaim any obligation or undertaking to release publicly any updates or revisions to any forward-looking statements contained herein to reflect any change in our expectations or any changes in events, conditions or circumstances on which any such statement is based, except as required by law.

Investor Relations for Citius Pharmaceuticals:

Andrew ScottVice President, Special ProjectsT: 908-967-6677 x105E: [emailprotected]

Ilanit AllenVice President, Corporate Communications and Investor RelationsT: 908-967-6677 x113E: [emailprotected]

SOURCE Citius Pharmaceuticals, Inc.


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Australia’s Magic Valley On How to Turn Cells From "Cell Volunteer" Lucy the Lamb Into Lamb Steaks and Chops – vegconomist – the vegan…

By daniellenierenberg

Founded to meet the future protein demands of an expanding global population, Australias Magic Valley is developing cell-cultured lamb products including mince, strips, steaks and chops. With lambs currently slaughtered at an incredibly young age using traditional farming methods, its founder tells us this particular meat became the obvious choice for the companys first product range.

There is absolutely no need for the mass slaughter of animals for food and hopefully intensive animal agriculture will soon be a thing of the past

Vegconomist spoke with Founder Paul Bevan, who says that he had become frustrated by the pace of change and effectiveness of his own activism so he turned his attention to technology, specifically the development of slaughter-free cultured meat, beginning with lamb.

Utilising induced pluripotent stem-cells and FBS-free media, Magic Valley is able to grow real animal meat from animal cells, using animals such as Lucy, who Paul refers to as cell volunteers.

Eventually we would like to expand into developing cultured meat products for all other animal species

Lucy the lamb is our very special cell donor. From just a tiny skin biopsy less than 4mm in diameter we are able to generate an infinite number of muscle and fat cells without ever having to interfere with an animal again. That is one of the distinct advantages of our technology and using induced pluripotent stem cells.

Meanwhile, Lucy gets to live out the entirety of her natural life (up to 20 years of age) happy and unharmed, blissfully unaware that her cell donation has potentially saved the lives of billions of lambs that would otherwise have been slaughtered at just 6 months of age.

Magic Valleys team consisting of Australias leading scientists have extensive experience in both stem cell biology and livestock production. As part of its ambitions to become a leader in the field, the company also announced this week the onboarding of industry pioneer Dr. Sandhya Sriram, PhD, Co-Founder & CEO of the cell-based crustacean producers Shiok Meats, to its advisory board.

Eventually we would like to expand into developing cultured meat products for all other animal species that have traditionally been farmed for human consumption. With the advancement of this technology, there is absolutely no need for the mass slaughter of animals for food and hopefully intensive animal agriculture will soon be a thing of the past, Bevan commented to vegconomist.

Our immediate goal is to develop the safest, healthiest and tastiest cultured lamb products possible. We know that to be successful, cultured meat products have to become the obvious choice for consumers and that means taste, price & convenience are paramount. We know that ethical or environmental concerns alone are not enough to change consumer behaviour it has to be a better product.


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Thin skin vs. thick skin: What is the difference? – Medical News Today

By daniellenierenberg

Skin is the largest and heaviest organ of the body. It consists of three main layers; the epidermis, dermis, and hypodermis. Skin can either be thin or thick. The main difference is the thickness of the epidermis and dermis, which are the top two layers of skin.

Thin skin covers most of the body and can vary in thinness, with the thinnest skin covering the eyelids. Thick skin is present on the soles of the feet and palms of the hands.

In addition to differing thicknesses, the skin also differs in what is present in the layers. For example, thick skin has no hair follicles or sebaceous glands, whereas thin skin does.

In this article, we look at the differences in appearance, structure, and function of thin and thick skin.

Thin skin covers most of the body, except on the soles of the feet and palms of the hands, and contains fewer cellular layers than thick skin.

The epidermis of thin skin ranges from 0.070.15 millimeters (mm). Thin skin can vary in thickness in different parts of the body and is particularly thin across the eyelids. Thin skin is thickest on the upper back.

Thin skin also contains hair follicles, sweat glands, and sebaceous glands.

Thick skin is present on the soles of the feet and palms of the hands. This is because these areas receive more friction than other areas of the body, and thicker skin helps to protect from potential damage.

The epidermis of thick skin can be up to 1.5 mm. Thick skin does not contain any hair follicles or sebaceous glands. Thick skin also contains no arrector pili muscles, which cause goosebumps.

Thick skin is thicker due to it containing an extra layer in the epidermis, called the stratum lucidum. Thick skin actually has a thinner dermis layer than thin skin, but is still thicker due to the stratum lucidum layer present in the epidermis.

Thick and thin skin appear differently under a microscope. Thin skin contains four layers in the epidermis, while thick skin contains a fifth layer. These layers include:

The stratum basale, also known as the stratum germinativum, is the deepest layer of the epidermis. It is the layer just above the dermis.

This layer continuously produces new skin cells. It also contains melanocytes, which are cells that produce skin pigment and help protect the skin from sun damage.

The stratum spinosum consists of eight to ten layers of cells. People may refer to the stratum spinosum as the prickle cell layer because of the irregular structure of cells, which look like spines or prickles.

The stratum granulosum consists of three to five layers of cells. The stratum granulosum contains granules, which are rich in lipids.

Only thick skin contains the stratum lucidum layer. The stratum lucidum is a thin, transparent layer consisting of two to three layers of cells. It contains a protein called eleidin.

The stratum corneum is the upper layer of the epidermis. It consists of 2030 layers of cells. It contains keratin and horny scales, which make it tougher and able to thicken into calluses.

The stratum corneum contains dead keratinocytes, which produce defensins. Defensins are strings of amino acids that protect the body from infection.

Connecting the dermis and epidermis are structures called dermal papillae. Dermal papillae are more prominent in thick skin than thin skin.

Dermal papillae increase the surface area between the epidermis and dermis, allowing for more oxygen, food, and waste to pass between the layers.

The following table summarizes the key structural differences between thin and thick skin:

Skin in general has many different functions, such as protection, sensation, and thermoregulation. Both thin and thick skin have properties that allow the skin to function correctly.

For example, thin skin contains hair follicles, which are important in producing hair to help regulate temperature and protect from ultraviolet radiation. Hair follicles also provide epithelial stem cells, which help repair wounds.

In addition, thin skin contains sebaceous glands, which produce sebum. Sebum helps to lubricate the skin and protect against infections.

Thin skin also contains eccrine and apocrine sweat glands. Sweat glands help to regulate body temperature by releasing sweat to cool the body, and also help to repair skin damage.

Thick skin provides protection from damage in areas that experience more friction and abrasion, such as the palms of the hands and the soles of the feet. Thick skin also contains eccrine sweat glands to help regulate body temperature.

Skin is a large, complex organ with a wide range of vital roles. Thin skin and thick skin have different structures and functions in the body. The layers they contain provide their thickness and allow them to carry out their roles.

Thin skin is present on most of the body, and helps to protect against infections, regulate temperature, and allows hair to grow. Thick skin covers the palms of the hands and the soles of the feet and protects these areas from extra abrasion and friction.

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Global To Drive The Substantial Growth Of The Medical Skin Care Products Market KSU | The Sentinel Newspaper – KSU | The Sentinel Newspaper

By daniellenierenberg

The Medical Skin Care Products Market report by Persistence Market Research throws light on the fact that the healthcare industry is more towards value-based care and continuous improvements based on the feedback. The mainstreaming of this practice is increasing all through. As such, the healthcare providers could make way for customized, lasting, and effective solutions to render utmost care to patients.

Medical skin care products are used for beautifying or to address some other skin care problems. The cosmetic industry is booming and skin care forms a very huge part of this industry. The aesthetic appearance is so important that people spend a lot on skin care products and treatment. People being more technologically aware of the various new skin care products trending in the market. In addition to the aesthetic application, the medical skin care products are also used to address issues such as acne, pimples or scars.

The medical skin care products is primarily driven by the need of natural based active ingredients products which are now trending in the market. Consumers demand medical skin care products which favor health and environment. Moreover, the consumers are updated with the trends so that various companies end up providing such products to satisfy the customers. For instance, a single product face mask has thousands of different variants. This offers consumers different options to select the product depending on the skin type. Moreover, the market players catering to the medical skin care products are offering products with advanced technologies. For instance, Santinov launched the CICABEL mask using stem cell material based on advanced technologies. The stem cells used in the skin care product helps to to protect and activate the cells and promote the proliferation of skin epidermal cells and the anagenesis of skin fibrosis.

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Medical Skin Care Products Market: Segmentation

On the basis of product type the medical skin care products market can be segmented as:

On the basis of application, the medical skin care products market can be segment as:

On the basis of distribution channel, the medical skin care products market can be segment as:

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Medical skin care products are used to address basic skin problems ranging from acne to scars. There are various advancements in the ingredients used to offer skin care products to the consumers. For instance, the use of hyaluronic acid and retinoids is the latest development in the industry. The anti-aging creams are at the forefront as the help treating issues such as wrinkles, scars, acne, and sun damage. Another, product in demand is the probiotic skincare which include lactobacillus and bifidobacterium.

In terms of geography, medical skin care products market has been divided into five regions including North- America, Asia- Pacific, Middle-East & Africa, Latin America and Europe. North America dominated the global medical skin care products market as international players are acquiring domestic companies to make their hold strong in the U.S. LOral is accelerating its U.S. market by signing a definitive agreement with Valeant Pharmaceuticals International Inc. to acquire CeraVe, AcneFree and Ambi skin-care brands for US$ 1.3 billion. The acquisition is expected LOreal to get hold of the brands in the price-accessible segment. Asia Pacific is expected to be the fastest growing region owing to the increasing disposable income and rising awareness towards the skin care products.

Some of the medical skin care products market participants are Avon Products Inc., Beiersdorf AG, Colgate-Palmolive Company, Kao Corporation, LOral S.A., Procter & Gamble, Shiseido Company, The Estee Lauder Companies Inc., Unilever PLC, Revlon, Clinique Laboratories, llc., Murad, LLC., SkinCeuticals, RMS Beauty, J.R. Watkins and 100% PURE.

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Icy Microneedle Patch Delivers Cell Therapy, Then Melts – Freethink

By daniellenierenberg

City University of Hong Kong (CityU) scientists have created a new microneedle patch to deliver cell therapies but rather than using traditional materials for their needles, they used ice.

The challenge: Cell therapies use living cells to treat medical conditions. Stem cell transplants are a form of cell therapy, as are some types of cancer immunotherapy.

These cells are typically transplanted into the patient via an implant, injection, or surgical graft. Not only can those delivery methods be painful and invasive, they also carry a risk of infection and must be administered by an experienced professional.

That limits the use of cell therapy to people who are willing to subject themselves to the transplantation process and who also have access to professionals capable of administering them.

Ice, ice baby: Microneedle patches are a growing trend in drug delivery. They're usually about the size of a postage stamp and are covered in tiny needles made of biodegradable substances packed with drugs.

Press the patch down on the skin like a band aid, and the needles break off from the back of the patch. They then dissolve into the skin, painlessly delivering the drug.

CityU created the microneedles for its patch out of ice, packed with living cells, coated in a protective medium.

Ice is easier to make and work with than the materials traditionally used for dissolving micropatches, but it melts just as readily. Even better, the icy microneedles can preserve the viability of living cells something other types of patches can't do.

The freezing cold water: Because the microneedles are made of ice, they would have to be transported and stored frozen, which could be a limiting factor in some places.

Additionally, the icy microneedle patch performed well when used to deliver a cell therapy to mice as a proof of concept, but it still needs to be proven safe and effective in humans.

What's next: If CityU's microneedle patch is cleared for use in people, it could have applications even beyond cell therapy.

"This device can also package, store, and deliver DNA, vaccines, and more."

"This device can also package, store, and deliver other types of bioactive therapeutic agents, such as proteins, peptides, mRNA, DNA, and vaccines," lead researcher Xu Chenjie said in a press release.

"I hope this device offers an easy-to-use and effective alternative method for the delivery of therapeutics in clinics."

We'd love to hear from you! If you have a comment about this article or if you have a tip for a future Freethink story, please email us at [emailprotected].

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Munshi Explains Staging, Prognosis, and Treatment for a Patient With Acute Graft-vs-Host-Disease – Targeted Oncology

By daniellenierenberg

During a virtual Targeted Oncology Case-Based event, Pashna N. Munshi, MD, associate clinical director, Stem Cell Transplant and Cellular Immunotherapy Program, assistant professor of Medicine, Georgetown University School of Medicine at MedStar Georgetown University Hospital, discussed the case of a 48-year-old male patient with acute graft-versus-host-disease (GVHD).

Targeted OncologyTM: What factors contribute to the risk of acute GVHD in a patient like this one?

MUNSHI: A lot of donor-recipient factors and other conditions increase the risk of acute GVHD. [These include] gender matching, human leukocyte antigen disparity, degree of mismatch, and having an older donor. Theres also [blood group] incompatibility and definitely CMV mismatched status. Though now that the FDA has approved letermovir [Prevymis] for patients who are undergoing allogeneic transplant if they have a CMV-positive donor,1 were seeing very little CMV reactivation. That has been a bit of a game changer for the good.

Patients have an increased risk of GVHD if they receive a transplant from a peripheral blood stem cell source versus a bone marrow graft, because the peripheral blood has more T cells in its composition. The myeloablative regimens [are associated with greater risk of GVHD than] reduced-intensity regimens.2

Do you agree with these poll results? Would you start with systemic therapy for this patient?

It can get a little tricky whether you want to give patients systemic steroids or wait and see if something gentler might work. I tend to agree that, at this point, the patient needs to immediately start with systemic steroids, because there are 2 organ systems involved. Once the lower gastrointestinal [GI] tract gets involved, it surely portends a poor prognosis if the grade becomes worse. And they become refractory to steroids very quickly: 50% of these patients will eventually not respond to steroids.

How would you stage this patients GVHD?

There are many criteria for staging GVHD. The criteria that most clinical trials use are the Mount Sinai Acute GVHD International Consortium [MAGIC] criteria.3 They are adapted from the Glucksberg criteria, which are very similar.4

Three organ systems [are involved in] acute GVHD: the skin, the liver, and the GI tract. Skin involvement is graded on the basis of the body surface area involved. Liver involvement is graded on the basis of the total bilirubin level. Upper GI involvement is graded on the basis of anorexia, nausea, and vomiting, and it just comes in stage 0 or stage I, depending on if its persistent or not. To determine lower GI tract involvement, we measure stool volume, especially when patients are admitted to the hospital. But once they go home, we cant do that, so we ask them how many times a day they have diarrhea. Is it watery? Is it muddy? Whats the volume? Is it large or small?

The patient can characterize the stool and tell their doctor how many times per day: 4 times, 5 times, 6 times. This patient is having 4 episodes per day; that puts them in stage I lower GI GVHD. But with a 60% body rash, that puts them in stage III skin GVHD. So really getting up there with skin, but not so much yet for GI. Once each organ [involvement is] staged, theres an aggregate score based on the combination of these organs. Then we come up with the grade.

In this patient, with a stage III rash, stage I upper GI, and stage I lower GI GVHD, they have a total score of a grade 2 acute GVHD. This is still in the mild to moderate zone. Anything above grade 2 is considered very severe GVHD.

Would you recommend that this patient receive systemic steroids?

In the scheme of things, somebody who didnt have symptoms and now is having active symptoms, especially with lower GI tract involvement, definitely needs high-dose steroids to get in there and [stop] the inflammation.

On what would you base a prognosis for this patient?

We can risk stratify these patients on the basis of the stage of organ involvement.5 Broadly, they can be at a standard risk or at a high risk [of poor response to treatment, mortality, and transplant-related mortality]. The patient is at high risk once they have very active GI involvement [or] if they have 2 organs involved. This is one more reason to think about starting these patients early on steroids. Why is this important? Because once a patient has high-risk GVHD, the chance of response to steroids is even lower, and once they dont respond to steroids, there is a higher [risk of] transplant-related mortality. The probability of transplant-related mortality is 44% for patients with high-risk acute GVHD flares, [versus] 22% for patients with low-risk GVHD [P < .001]. These are a few things to think about. Act very swiftly if a patient has 2-organ involvement, especially the lower GI tract.

Can biomarkers guide treatment decisions in this case?

In the field of GVHD, biomarkers are a very exciting advancement. We want a prognostic model of which patients will get GVHD. Can biomarkers in the blood [help] prevent GVHD and improve transplant outcomes?

A large prospective trial was done through the Bone and Marrow Transplant Clinical Trials Network where a set of 6 biomarkers were tested at several time points after the transplant.6 They saw that they could predict when GVHD happened by using these biomarkers. They could see that as the levels of these biomarkers increased, the patients had higher scores of GVHD. Once treatment was started, if specific biomarkers went down it was predictive of response at day 28 [56% vs 17%; odds ratio, 6.32; P = .001] and also predictive of [decreased] transplant-related mortality by day [180 (49% vs 87%; P < .0001)]. If all these biomarkers went up aggressively, overall survival was lower [P < .0001].

The MAGIC Consortium also tried to test biomarkers.7 They looked at 2 biomarkers, REG3Athe regenerating islet-derived 3-alpha, which is specific for the GI tract and ST2. Looking at these 2 biomarkers, they came up with an algorithm of prediction. On the basis of how these biomarkers responded at the time of GVHD and to treatment, they could predict mortality by 6 months. In clinical practice, it is difficult to use this day in and day out. We still use our clinical skills to assess the degree of GVHD. But all patients eventually get treated the same waywith high-dose steroidsdespite biomarkers being elevated or not.

At this point, [biomarker data] may tell us an association rather than a causality. Were not openly using biomarkers to guide our practice, but I think were learning to use them a bit more and knowing that theres something out there that could be used as a predictive tool. It is an exciting development.

Are there alternatives to systemic steroids?

Steroids remain the mainstay. We need to see if we can move to other therapies that are coming down the pipeline.

Data from the REACH1 [NCT02953678] and REACH2 [NCT02913261] trials led to ruxolitinib [Jakafi] approval.8,9 If we can use ruxolitinib in an up-front setting, [maybe we] can use the newly approved rho-kinase or ROCK2 inhibitors as well.10 We want to think about steroid-sparing agents. Maybe biomarkers can guide us in the future for that. But right now, in terms of, Do I start my patient on treatment? or Will they respond to this treatment, I find that [biomarkers are] still not a very useful tool because at the end of the day, the patients all still need to be started on steroids.

The minute you see that your patient is not responding to steroids, very quickly start them on a JAK2 inhibitor.

How do you dose steroids?

This patient received 2 mg/kg of prednisone per day for 14 days. Two mg/kg is a very high dose. The standard is 1 to 2 mg/kg.11 There are data to show that 2 mg isnt any different from 1 mg.12 But a lot of times, if its a very active, severe flare, we will use 2 mg/kg. Im not sure if I would have done 2 mg/kg in this case, but its certainly not out of the realm of treating these patients.

The goals of primary therapy for acute GVHD are to stabilize the organ manifestations, or improve them, and limit long-term treatment toxicity. We want to improve functional capacity and prevent any reduction in quality of life. First-line therapy is always with corticosteroids. Now ruxolitinib is approved for second-line therapy.8 There have been data to show that it can improve overall survival.

How do you taper glucocorticosteroids after achieving initial response?

If the patient is taking 2 mg/kg of steroids, an average 70-kg person, thats over 100 mg of steroids. After 2 weeks, they probably are not getting up from a seated position anymore with all the muscle wasting that can happen.

[As soon as they start to show improvement, it would be safe to start to taper the dose.] Traditionally, [the patient receives the full dose for] at least a week or 10 days. Then it is traditional to decrease the dose 10% every 5 to 7 days, gently coming down, making sure that the patient is not having any flares.

Describe the multidisciplinary teambased approach that you use for acute GVHD.

The incidence of acute GVHD in the patient population is anywhere from 30% to 50%, despite the best [efforts at] prophylaxis. Most patients will get some form of acute GVHDit can go up to even 80%. This [necessitates] a multidisciplinary team approach. If the patient is having diarrhea, theyre having malnourishment. Theres nausea or anorexia, so theyre not eating on top of that. Then theres skin rash, so the risk of infections and cellulitis. Theyre in pain. A dermatologist probably should be involved at some point. A nutrition team is also needed. If theyre on high-dose steroids, physical therapy should be involved up front. So early involvement of a whole team is very important. Thats usually how I treat my patients and usually how centers of excellence continue to treat active patients with GVHD after transplantation.

How do you determine if a patients GVHD is steroid refractory?

The strict definition of steroid refractoriness or resistance is if theres progression of acute GVHD within 3 to 5 days of starting high-dose steroids, or theres failure to improve within 1 week of starting these steroids, or theres incomplete response after more than 28 days of any immunosuppressive treatment.13 So, by and large, in 3 days or a maximum of 7 days, [it will be clear] if the patients GVHD is going to be steroid refractory or not.

Steroid dependence is [defined as when] the patients GVHD initially responded to steroids, but the disease flares when the dose is tapered, so they cannot be taken off the steroids.

Steroid intolerance is when the patient develops [unacceptable toxicity from steroids such as] uncontrolled diabetes or myopathies. Then it becomes hard to keep them on steroids.

What are the treatment options for patients with steroid-refractory GVHD?

Ruxolitinib now has been FDA approved for steroid-refractory acute GVHD, and its a category 1 definition.8,11 Ibrutinib [Imbruvica] has also been approvedits only FDA-approved indication is for chronic GVHD.14 There are many other treatment options [in the National Comprehensive Cancer Network guidelines].11 Oncologists always end up using some combination or other depending on which of these different immune suppression medications they are comfortable using.

What new treatments are in the pipeline?

In terms of BTK inhibitors, I dont think theres anything other than ibrutinib at this time point. There are many JAK inhibitors being studied.15 Baricitinib is another JAK inhibitor thats actively being studied for chronic GVHD, as well as for pulmonary GVHD.16 Then there are other rho-kinase inhibitors, called ROCK2 inhibitors. This is really making waves. Were very excited about this drug because the response rates are very high, about 70%.10 Its a smaller study, but clearly it has antifibrotic pathways. So I think thats going to be used much more in the up-front setting.

Then theres also alpha-1 antitrypsin, which targets the liver and macrophages and has very promising results from trials done at Dana-Farber Cancer Institute and Michigan.17 So I think were going to see very different characteristics of how to approach GVHD.

What data support the use of ruxolitinib in this setting?

The REACH1 study led to the approval of ruxolitinib for steroid-refractory acute GVHD.9,18 In this phase 2 trial, patients with steroid-refractory acute GVHD got ruxolitinib (5 mg twice a day) with or without a calcineurin inhibitor. They were allowed to remain on steroids. The primary end point of this trial was overall response rate [ORR] at day 28. They also looked at response rates at day 56 and day 100, biomarkers, failure-free survival, and durability of these responses. The ORR at day 28 was very high: 54.9%.18 The best ORR, which was at any given time during the treatment, which was as high as 73.2%. The median time to response was 7 days. So this was very quick. The median duration of response was 345 days, with more than 6 months follow-up. Nonrelapse mortality at 6 months was 44.4%. There were deaths from infections, etc, but not related directly to ruxolitinib.

Subsequently there was a phase 3 trial, REACH2.19 They looked at higher doses of ruxolitinib in steroid-refractory acute GVHD. They started off with 10 mg [of ruxolitinib] twice a day. This study had a similar primary end point of ORR at day 28. This was compared with best available therapy. This was done in Europe, so [the comparison was to the] best available therapy used in Europe, like anti-thymocyte globulin, sirolimus [Rapamune], etanercept [Enbrel], photopheresis, or other therapies; all things that we would use in the United States as well. They looked at similar key secondary end points, [including] duration of response at day 56.

The ORR for ruxolitinib was 62% at day 28, compared with the best available therapy arm, which was 39% [odds ratio, 2.64; 95% CI, 1.65 to 4.22; P < .001].19 Durable overall response at day 56 [was higher in the ruxolitinib group than it was in the control group (40% vs 22%, odds ratio, 2.38; 95% CI, 1.43-3.94; P < .001)].19

The lower grade acute GVHD, which was grade 2, had the highest complete response rate with ruxolitinib: 50.9% compared with just 26.4% with best available therapy.19 This is quite remarkable to have a complete response in GVHD so quickly. When you get to higher grades of GVHD, the complete response rate for ruxolitinib is not as impressive; its less than 30%. But its still much higher than the [response rates of] other therapies we would have otherwise treated these patients with in steroid-refractory disease. The key point is to diagnose steroid refractoriness early. Then get ruxolitinib in there to break the cycle and break the progression of organ grade to something higher.

The loss of response wasnt statistically significant. The estimated cumulative incidents for the loss of response at 6 months was 10% in ruxolitinib compared with 39% in the control arm.19 So patients continued to maintain responses, which, again, is what we want to see. We dont want to see flares if they come off steroids.

[Of the 4 organ systems involved in GVHD], the skin responses were the best with ruxolitinib. Lower GI and liver GVHD did have good responses, but the responses were not as remarkable. Ruxolitinib is an ideal drug in this setting, on the basis of the organ responses.

A secondary end point was failure-free survival, basically indicating a time point from randomization to either nonrelapse-related death or any new GVHD. This was not statistically significant because it was not designed to compare ruxolitinib survival outcomes with control therapy. But there were 5.0 months median failure-free survival with ruxolitinib compared with 1.0 month with control [hazard ratio for relapse or progression of hematologic disease, nonrelapse-related death, or addition of new systemic therapy for acute GVHD, 0.46; 95% CI, 0.35-0.60]. That tells you that the responses were maintained, and the treatment was still working.

[Most of the adverse events associated with ruxolitinib] were expected; the bone marrow is recovering so its a bit fragile. [The most common was] thrombocytopenia. You can reduce the dose of ruxolitinib down to 5 mg adjusted accordingly or support patients with transfusions. CMV reactivation was also common. But again, with letermovir, that happens less and less.

References:1. Merck receives FDA approval of Prevymis (letermovir) for prevention of cytomegalovirus (CMV) infection and disease in adult allogeneic stem cell transplant patients. News release. Merck. November 9, 2017. Accessed April 7, 2021.

2. Scott BL. Long-term follow up of BMT CTN 0901, a randomized phase 3 trial comparing myeloablative (MAC) to reduced intensity conditioning (RIC) prior to hematopoietic cell transplantation (HCT) for acute myeloid leukemia (AML) or myelodysplasia (MDS) (MAvRIC Trial). Biol Blood Marrow Transplant. 2020;26(3):S11. doi:10.1016/j.bbmt.2019.12.07

3. Harris AC, Young R, Devine S, et al. International, multicenter standardization of acute graft-versus-host disease clinical data collection: a report from the Mount Sinai Acute GVHD International Consortium. Biol Blood Marrow Transplant. 2016;22(1):4-10. doi:10.1016/j.bbmt.2015.09.001

4. Martino R, Romero P, Subira M, et al. Comparison of the classic Glucksberg criteria and the IBMTR Severity Index for grading acute graft-versus-host disease following HLA-identical sibling stem cell transplantation. International Bone Marrow

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Munshi Explains Staging, Prognosis, and Treatment for a Patient With Acute Graft-vs-Host-Disease - Targeted Oncology

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