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Copyright: © Richard Jacobs
Could a saliva swab detect cancer presence? Researchers are closer than ever to using such noninvasive biomarker tests as diagnostic tools. Why? Well, it's all about balance, even at the smallest level. Researcher Mahmoud Ghannoum joins Richard to discuss the interactions of the human microbiome.
Listen and learn
Mahmoud Ghannoum is a professor in the Department of Pathology and Dermatology with the School of Medicine at Case Western Reserve University. He also started a company called Biohm Health, which uses microbiology to develop therapeutics for human microbiome health based on gut microbiome research. Microbiome communities live all over us and inside of us, he says, and he researches how they impact our health.
He explains that the microbiome is made up of bacterial and fungal communities. The balance between pathogenic and healthy species and the interactions between each community has dynamic health implications, which is why scientist are connecting healthy microbiomes and cancer prevention. When these communities are out of balance, scientist call this dysbiosis.
His extensive studies on tongue cancer and head and neck squamous cell carcinoma showed a connection between cancer and the microbiota. The species diversity and richness of bacteria and fungi both decreased in tumor groups. In the case of head and neck squamous cell carcinoma, he was also able to look at metabolites and found high levels of 2-hydroxyglutarate, which means this chemical can serve as a biomarker of disease, enabling noninvasive diagnosis.
In 2016, he also published a well-known study showing how pathogenic bacteria and fungi in microbiomes interact and secrete polysaccharides that form biofilms in the guts of Crohn's disease patients. He's developing a therapy to remove these biofilms by inhibiting the hyphae growth of a candida species. He continues to research effective ways to bring health through microbiome balance.
For more information, see biohmhealth.com.
Available on Apple Podcasts: apple.co/2Os0myK
Managing diabetes as a type 1 through diet and exercise is a constant balancing act, but Eoin Costello feels he is healthier for the efforts he takes. Listen in as he discusses how he's taken this challenging diagnosis head on and helps others understand and manage their own diabetes. He discusses
It was Christmas time, after all, so maybe all the celebrating was causing his symptoms, and the lack of sleep and increased celebratory drinking had led to his fatigue and excessive thirst. But a doctor's call woke him up from that illusion and at age 19, Eion Costelloe learned he had incurable type 1 diabetes. "I was old enough to understand how serious to take this, but young enough to not be set in my ways," he says, showing his general positive outlook that has helped him manage his type 1 diabetes treatment with vigor and care. He already had a healthy lifestyle, heavily involved in sport, but he had to relearn how he went about his activities with this new challenge.
After posting what he learned to an Instagram page for a few years, he found he needed to enlarge the format: there was so much to engage with, that he started his own podcast called The Insuleion Podcast: Redefining Diabetes. On this podcast he shares own insights but also brings on guests from around the world with diabetes and lessons to offer. He says that because it's a well-known yet not well-understood disease, the podcast works well to dispel myths but also inspire. He helps listeners with diabetes redefine for themselves what it means to live as a type 1, enlarging their outlook on what they can accomplish. He shares some of the lessons he's learned from some memorable guests and ends this conversation on a positive note on what being a diabetic means to him at this point in life.
For more about him, see his web page, insuleoin.com, and find him on Instagram. His podcast is available through most podcast-streaming sites. Available on Apple Podcasts: apple.co/2Os0myK
First, it's just picking up the prescriptions, then it's helping out a little bit around the house, then it's accompanying them to doctor's appointments, and then, suddenly, the words "Oh, so you're the caregiver" come out of the doctor's mouth. Often, the first time someone hears that, it comes as a surprise, followed by a slow realization that it's true. But what does it mean to be a caregiver, and how to prepare for such a role? Tune in to learn:
Pamela Wilson is a podcast host, national caregiving expert, author, radio host, and keynote speaker with over 20 years of experience as a court-appointed guardian, power of attorney, and care manager. She has made it her mission to help caregivers through one of the first hurdles they often face: becoming aware of the fact that they're even a caregiver. In addition, she provides ongoing support and advice to caregivers worldwide, and works with companies and groups that want to increase caregiver education and awareness.
Wilson describes the duties and responsibilities of caregivers, examples of problems caregivers face and how best to deal with them, self-care for caregivers, the importance of taking preventative measures (which can sometimes be as simple as having some conversations—albeit some hard ones), and more. Press play for all the details, and learn more by visiting her website at https://pameladwilson.com/. Available on Apple Podcasts: apple.co/2Os0myK
Finding a cure for type 1 diabetes includes two essential goals: growing insulin-producing beta cells and introducing them into patients successfully. Those two achievements appear fast-approaching yet also seem elusive. This podcast takes a closer look at these goals, interviewing one researcher studying how beta cells grow and mature. Listen and learn
Diana Elena Stanescu is an assistant professor of pediatrics with the Department of Pediatrics at the Perlman School of Medicine with the University of Pennsylvania. She's a physician scientist, treating patients and researching how beta cells develop, grow, and mature. "As a pediatrician," she says, "everything is about growing, developing, maturing: I keep that perspective across my work." She adds that scientists think an initial cure for type 1 diabetes will center on cell replacement therapy: they're finding ways to make embryonic cells become beta cells that make insulin. By looking at how beta cells develop and mature, she hopes to advise stem cell biologists on making better beta cells. While scientists have been able to make these cells, they are still too inefficient. Her work aims to change that.
Developmental biologists like her are therefore informing these stem cell biologists how these cells need to mimic what happens in normal development to a closer degree. They also need to produce an envelope in which to deliver these cells, protecting them from the body's immune system. "We are able to do this in the lab but the problem is taking it from the lab and scaling up to a lot of people," she says. Furthermore, the cells don't make enough insulin to meet the body's demands. She's directing her research towards making higher quality cells, so that the few cells that they are able to include in this envelope are of the best possible quality and efficiency. This means researching how cells determine their glucose threshold before insulin secretion and other issues like hyperinsulin condition, when babies actually make too much insulin. This work will hopefully lead scientists closer to a cure.
For more about her work, she welcomes getting in touch via email. See her information page at the University of Pennsylvania for more information. Available on Apple Podcasts: apple.co/2Os0myK
One of the most exciting recent discoveries in microbiology involves an immunological mechanism of a single-celled organism. CRISPR-Cas technology is a technique bacteria use for fighting infection with phages. This podcast dives into the wild world of CRISPR and bacteriophage interplay. Listen and learn
Joseph Bondy-Denomy is an associate professor of Microbiology and Immunology at UCSF. His lab focuses on understanding how bacteria deal with their predators like bacteriophages, which are bacteria-infecting viruses. While they don't infect humans, they cover us and inhabit our bodies, looking for prey. CRISPR is one way bacteria protect themselves from phages, and scientists learned how to utilize the CRISPR for their own purposes, enabling foundational techniques for gene editing in the last decade. CRISPR-Cas9 and bacteriophage interaction in particular has made the news because of the usability of the Cas9 protein.
Dr. Bondy-Denomy offers listeners effective analogies for understanding how this process works, comparing this to taking a mugshot of a criminal, giving that bacteria information to retain and work from when the same type of phage tries to invade and infect again. He explains exactly how the bacteria do so, storing the DNA snip in a region that lends CRISPR its name, turns it into RNA, and then guides the CRISPR proteins, like Cas9, to the same phage type if it returns, preventing infection. He explains how understanding this mechanism led to two techniques: putting these systems into mammalian cells and showing how they could cut DNA and change a sequence intentionally and turning the mechanism into a programmable binding system. He discusses his own research as well, including continuing to understand how phages avoid CRISPR-Cas immunity and exploring new bacterial immune systems that have been discovered in the last few years.
For more about his work, follow him on Twitter as @joeBondyDenomy and see his lab's website: bondydenomylab.ucsf.edu. Available on Apple Podcasts: apple.co/2Os0myK
While many health programs might seek spousal support, rarely is the spouse's health considered on the same level as the patient. Jannie Nielsen seeks to center these surrounding relationships in how doctors address diet, prevention, and treatment of type 2 diabetes. Listen and learn
Jannie Nielsen is an assistant professor with the Emory Global Diabetes Research Center. Her research focuses on a new angle: she wants to study how people who are socially or biologically related resemble and affect each other regarding diabetes development and health consequences. In other words, she'd like to quantify in more solid terms how relationships, whether spousal or social, determine behavioral risk factors of diabetes. She mentions a study in England that showed the higher BMI of a spouse, the higher chance that person has diabetes. This certainly has a logic to it, and she therefore asks, "Why don't we then include the spouses when we try to make people healthier?" Her research may help to do just that.
She also discusses fascinating differences across cultures and societies reflected in our health, from a cross-sectional study in Uganda to a look at sample populations on islands off of New Zealand. She says that type 2 diabetes and related pancreas function differ across the world. For example, one man in Uganda they worked with who had type 2 diabetes was 55 and never had weight issues. Yet he has severe complications from type 2 diabetes derived from one of the common causes like malfunctioning pancreatic beta cells. For him, she says the challenges to improve his health centered on accessing a more diverse diet, which, without resources, is especially challenging. She's now working on gaining funding for a "complex interventions" study that touches on many variables.
For more about this issue, she suggests checking out the Emory Global Diabetes Research Center. Available on Apple Podcasts: apple.co/2Os0myK
The fundamental goal of Juan Alvarez's research? "In a nutshell," he says, "I'm trying to cure diabetes." This podcast discusses the exciting potential of his goal by exploring the specific elements of pancreas function and metabolic misfires that lead to diabetes. Listen and learn
Recently awarded an NIH Diabetes Grant, Juan R. Alvarez is an HHMI LSRF Research Fellow with Melton Laboratory at Harvard University. His research investigates causes of diabetes such as the connection between nonfunctioning pancreatic beta cells and diabetes and the impaired uptake of insulin in adipose and muscle tissue. These describe two common causes of type 2 diabetes. In the first case, his group hypothesizes that the pancreas's beta cells are over worked—an overwhelming demand for insulin exhausts the cells and many begin to lose their mature function or phenotype. They believe these cells protect themselves and prevent cell death by returning to this progenitor state.
The other common cause of type 2 diabetes is often termed "insulin resistance." It's the job of insulin to encourage muscle and adipose tissues to take up glucose from the blood and use it as fuel. These tissues have insulin receptors to do just that, but in some cases, these receptors become less efficient due to genetics or other metabolic issues or a combination of the two. Dr. Alvarez discusses some promising ways to address these causes, including a focus on the effects eating and fasting rhythms may have on the insulin-producing cells and how a jarring of that rhythm could lead to the beta cells losing their mature state. If they understand this, they might find a protein to reactivate or a molecule to inhibit to bring the beta cells back to their mature phenotype. He and Richard discuss other health connections between diabetes and disease such as cancer and chronic pancreatitis and diabetes. Listen in for how one top researcher is working on a cure for diabetes.
For links to Dr. Alvarez's published research, see his page at Harvard: hscrb.harvard.edu/people/juan-alvarez. Available on Apple Podcasts: apple.co/2Os0myK
As medical technology advances, the "should we" questions take on even more complexity. This episode takes a fascinating look at the principles of bioethics through numerous illustrative bioethics examples with noted bioethicist Margaret Somerville. Listen and learn
Margaret Somerville is a professor of bioethics in the School of Medicine in Sydney. She received her doctorate in the field in the '70s just as major advancements in genomics and genetics heightened the complexity for bioethics in medical technology. She lends listeners the language and schemata for how people in her profession consider the most difficult medical questions. She lists the four levels of decision making, from the micro or individual level up to the global level. She and Richard then discuss specific examples, including the response to COVID-19. While Richard feels they've been too restrictive and caused other kinds of suffering, she points out that the hard lockdown Australia implemented, briefer but even stricter than the U.S., led to much less infections and deaths. She feels that if Fauci's recommendations had been uniformly followed immediately, the U.S. may have found itself in a better position now.
She points out that there is harm caused even while implementing policies for good. Bioethicists help decisions makers consider what to do when there is conflict between the four decision-making levels, and calls it the "world of competing sorrows." She says that sometimes in bioethics in medicine, the decision is "who will you harm?" She adds, "Often, there is harm in the good that we do—we need to be aware of that," and justify the decisions made by facing this. She also talks about up-and-coming issues including alteration of the human germ line, ectogenesism, and creating artificial sperm or ovum. She discusses how she has handled controversy regarding her own opinions and her overall world view.
For more about her, see examples of her work at mercatornet.com/author/margaret-somerville. Available on Apple Podcasts: apple.co/2Os0myK
This podcast explores how one researcher is working to keep babies safer without turning to antibiotics. Group B Streptococcus (GBS) presence in the mother is a leading cause of neonatal morbidity and mortality. Doctors often treat mothers with antibiotics to curb the infection, which presents its own complications. Richard interviews a microbiologist working on alternatives. Listen and learn
In this episode, Richard speaks with a researcher specializing in perinatal microbiology and infections of the perinatal period. She examines how these infections can modify the outcome for mothers and babies. By looking at the epidemiology and how GBS strains change regarding capsule type and other factors in different regions, she hopes to learn more about the bacteria to utilize a bacteriophage for infecting the bacteria. What's a bacteriophage versus a virus? One way to understand the difference is to consider the host: bacteriophages are viruses that infect bacteria. The bacteriophage life cycle is intertwined with the host bacteria, and many researchers are looking at bacteriophages in the human body as a treatment alternative to antibiotics.
Because antibiotics are used to treat bacterial versus viral infections and can kill beneficial organisms inhabiting the baby, phage therapy may benefit babies in multiple ways. GBS transmission occurs during the vaginal birth process if the mother has the bacteria. While some babies can remain healthy despite this, others are infected with harmful results including death. Therefore, widespread screening is in place, testing the mother. Generally a mother is given antibiotics a few hour before labor. This microbiologist is researching candidate phages for therapy and also trying to understand more about natural exposure to phages during pregnancy. Listen in for more about this dynamic and potentially life-saving work. Available on Apple Podcasts: apple.co/2Os0myK
Suffering from the pain of headaches and migraines? This podcast offers vital information for those who experience migraine symptoms. Dr. Lucas helps listeners both understand what we know about these conditions and explains different therapeutics and what they do. Listen and learn
Dr. Sylvia Lucas is a Clinical Professor Emeritus of Neurology at the University of Washington Medical Center. She brings an approachable, clear delivery of information for all-things-migraine in this episode. Her overview includes an explanation of why research has been less than optimal until recently. Research wasn't there in the early part of modern medicine in part because it was considered a "women's condition." Because stress is one of the most common triggers, sufferers were told to "buck up." But now scientists have a biological model and resources such as imaging to invest in careful study.
For the most part, migraines are thought to be a genetic process. There are about 40 major and hundreds of minor genes linked to migraines. A major class of drugs to treat migraines called triptans were developed in the '80s and then advancement in therapeutics stalled. Recently, however, CGRP drugs were introduced, which are small molecule drugs. They block receptors very specific to migraine pain. In spring of 2020, one such drug called Nurtec was released, which can be taken without water and brings relief within an hour. She explains in detail how and also discusses daily habits that might help. She emphasizes the help a regular routine can offer migraine sufferers as well as other stress-relieving habits. She also talks about her current research into concussions and headache-related symptoms from this injury. Listen in for more about strategies for relief.
For more information, see the National Headache Foundation and the American Headache Society. Available on Apple Podcasts: apple.co/2Os0myK
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