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Medical science: Spain's latest 'Eureka' moments
Medical science: Spain's latest 'Eureka' moments
By thinkSPAIN Team Sun, Sep 29, 2019
AS WELL as being world-famous for possessing one of the top public health services on earth and perpetual number one globally for transplant operations per inhabitant, Spain is also home to – and the birthplace of – some of the best international medical scientists and is frequently behind ground-breaking discoveries. Pioneering new treatment and diagnostic tests have been developed in Spain, although of course, the process of taking these from laboratory to mainstream hospital takes years, as once a breakthrough is found, drugs need to be developed that the human body can tolerate at a time when it is most weakened, then clinical trials have to be carried out and their results monitored over time, before a manufacturer takes them on, authorisation given from international health departments, and a price negotiated that allows them to be widely used.
But in most of our lifetimes we have, and will, see great things coming out of the planet's science communities, especially those in Spain – after all, anyone who was at least primary school age in the late 1980s will have remembered the doom-filled campaigns about HIV and AIDS, then a progressive disease for which diagnosis meant a death sentence. Now – and, in fact, for nearly 20 years – HIV does not have to develop into AIDS, patients can lead a normal life expectancy and quality by taking as little as one pill a day, and their medication even prevents them passing on the condition through sexual contact or blood.
And nowadays, most types of cancer detected early enough are considered completely curable, nearly 90% of childhood cancers have complete cures, and some can even be prevented by zapping cells years before they develop into tumours. One of the biggest challenges for many cancer strains is finding ways to diagnose them in time, since several are asymptomatic until it is too late.
Progress within the closed doors of the world's labs is not often newsworthy enough to announce to the four winds, but every now and again a 'Eureka' moment hits the headlines to reassure us that finding effective ways to keep us healthy is something hundreds of thousands of professionals are continuously plugging away at.
We take a look at some of the most recent of these in Spain.
A cure for Alzheimer's in five to 10 years?
Officially opened by Spain's 'Queen Mother', HRH Sofía, Valencia played host two weeks ago to the seventh Neurodegenerative Illnesses Innovation and Research Conference (CIIIEN) where, along with 200-plus scientists and as many healthcare workers on the front line, a sizeable turn-out from the general public had taken seats: with the main focus of the conference being dementia, the possibility of advances in diagnosis and treatment in a condition that is likely to affect more and more of us as we live longer and in better physical health was something hundreds of ordinary citizens were eager to learn about.
Any likely cure is expected to follow on naturally from research into combined pharmaceutical drugs that help to slow down the progress of Alzheimer's, by adapting these to be able to reverse the effects already suffered.
Treatment of this kind could be at the clinical trial stage or even in use within four to five years, although a vaccination against Alzheimer's could take up to 15 years to become available, according to researchers from Spain's National Research Council (CSIC) and CIBERNED molecular biology institute.
Dr Isabel Fariñas of the CIBERNED and Valencia University says the most promising advances seen so far have been in treatment using stem cells, resulting from research into cellular and molecular alterations caused by a reduction in the brain's ability to produce the neurotransmitter dopamine - the 'happy hormone' which is often thought to be firing excessively in patients with psychosis or schizophrenia – a reduction which is commonly seen in a number of neurodegenerative illnesses.
Developing molecules that delay or block the progress of Alzheimer's when the damage is already irreversible could lead to a paradigm shift: the possibility of a cure before symptoms even start to appear in high-risk patients.
Agnetha Nordberg from Stockholm's Karolinska Institute and José Ramón Naranjo of the CIBERNED and National Biotechnology Centre said biomarkers – measures of molecules that indicate a presence or likelihood of developing a disease – are being applied to Positron Emission Tomography (PET) scan analysis to detect changes in the brains of existing or at-risk future sufferers.
PET scans, the most complex and detailed of all diagnostic imaging – as well as the most expensive – are being performed on patients in Sweden and Spain to monitor the inside of the brain and measure the quantities of the proteins Amiloide and Tau, both of which are key in developing Alzheimer's.
Spanish family 'resistant to HIV'
A degenerative muscular condition so rare it only affects two families in Spain and Italy carries an automatic immunity to HIV, according to researchers at Madrid's Carlos III Health Institute (ISCIII).
It's around 20 years since the genetic alteration that protects the carrier from HIV was found in the CCR5 virus entry receptor, which has led to medication being developed to halt the process – but now, for the first time since then, a second mutation that protects against the infection has been discovered.
This genetic alteration has been found in what is known as 'Transportina 3', a cellular protein that has long been under scrutiny by scientists since it is thought to be essential to HIV developing.
Investigators at Barcelona's Vall d'Hebrón hospital and Valencia's La Fe hospital have since discovered that the Spanish and Italian families affected by the rare type of muscular dystrophy known simply as '1F' also test positive for this genetic mutation.
“We've found ourselves in an exceptional situation, a common border between rare illnesses and infectious illnesses,” says Dr Pepe Alcamí of the ISCIII's National Microbiology Centre.
“The Transportina 3 mutation is involved in both: it causes an hereditary muscular dystrophy, and also protects against infection by HIV.
“If we can manage to understand the underlying mechanisms, we would be able to design pharmaceutical strategies and gene therapy to both block the HIV infection in lymphocytes and prevent the Transportina 3 mutation from reaching the muscular system, improving the symptoms of [1F].”
3D aorta print-out in record time saves patient's life
José Julio was rushed into Madrid's Gregorio Marañón hospital on April 3 with a ruptured aorta, meaning he would have barely hours to live unless medics could stop the bleeding.
They were unable to stem the flow for long enough to save him without fitting an aorta replacement – but normally, when these are needed, they have to be tailored to each patient, so it can take at least a month for it to be ordered, manufactured and delivered.
In desperation, doctors decided to try something that had only been done once before in the world – creating a new aorta using a 3D printer.
Just as happened in the world's first case in the USA, staff used information from José Julio's scans to design and print a main artery that would fit perfectly with the patient's anatomy, and had it ready to implant in record time – just 10 hours.
Doctors said they feared he could suffer a fatal bleed at any moment, and that even if he did not, he was unlikely to have survived another full day – but their presence of mind and fast-track artery printing meant they were just in time, and José Julio went on to make a full recovery.
Advances in ovarian and lung cancer treatment
Ovarian cancer is one of the deadliest strains, since it shows no symptoms until it is at an advanced stage and, when it reaches this point, it returns or metastasises in 80% of women following surgery and chemotherapy.
About 205,000 women in Europe are diagnosed every year.
But research led by Dr Antonio González Martín of Navarra University's Clinical Oncology Department and chairman of the Spanish Ovarian Cancer Research Group (GEICO) has shown that administering the drug Niraparib after chemotherapy has improved survival rates and cut relapse rates by 40%.
GEICO coordinated 181 clinical trials Europe-wide with 733 patients recently diagnosed with advanced ovarian cancer and who were given Niraparib, an inhibitor of the enzyme PARP, which is involved in repairing DNA and in cell death.
It was given to women with, and without, the BRCA gene mutation which increases the risk for ovarian cancer, and researchers studied the effects of the treatment on patients with and without a DNA-repair deficiency known as HRD.
Around half the women in the study showed the HRD deficiency, and the results in their case – reduction in relapse or in the progress of the disease – were even better, with 57% responding rather than 40%.
Approximately 29,000 cases of lung cancer are diagnosed annually in Spain – it is the type of cancer which has the highest mortality rate nationally, and prognosis is very poor, mainly because of late diagnosis due to symptoms not appearing until an advanced stage. A growing number of non-smokers with lung cancer are being reported worldwide, even where they have not been exposed to passive smoke.
Lung cancer is notoriously difficult to raise money for research for – campaigns and charity events for cancer investigation funds do not attract much response for lung cancer since the general public view is that sufferers 'had the choice not to take up smoking' and that it is 'self-inflicted', although Spain's main cancer organisation AECC says this is not always the case and non-smoking lung cancer patients worry about stigma.
Research is happening, but slowly – although a potential breakthrough was presented at the recent European Society of Medical Oncology (ESMO) annual conference, with two types of treatment that may be able to substitute chemotherapy in advanced non-microcytic lung cancer, increasing survival rates.
Specialist in the field at Madrid's Ramón y Cajal University Hospital Dr Pilar Garrido says the first study, titled FLAURA, shows that the latest-generation medication Osimertinib – taken orally – not only slows down the progression of the disease, but increases survival rates and is far less toxic than chemotherapy.
It is used in patients with Epidermic Growth Factor Receptor (EGFR) mutations and who represent around 10% to 15% of the total.
The second study, Dr Garrido announced – titled CHECKMATE 227 – involves a medication that can be used instead of chemotherapy for patients whose cancer does not have any identifiable targets for direct, focused treatment.
She stresses that neither drug cures lung cancer, but they increase the 'therapeutic storage' in the body and prolong life without depleting quality of life – the patient will not be feeling ill all the time in exchange for living longer, as is often the case with chemotherapy in incurable (chronic, but controllable) or terminal cancer.
'Specific' migraine drugs now available in hospitals
Not all medical science is aimed at curing, slowing down, preventing, diagnosing or improving symptoms of life-threatening conditions, however. Some of Spain's latest discoveries and achievements focus on non-fatal but life-limiting health issues – such as migraines.
An estimated 12% of the population suffers migraines, with women outnumbering men three to one due to hormone fluctuations which either trigger them per se, or extreme tiredness during the menstrual cycle which brings on a migraine when rest is not possible.
Migraines are thought to be genetic, and a growing number of cases are being diagnosed – partly through increased awareness, and partly, according to Dr Isabel Beltrán of Alicante General Hospital, because of 'the pace involved in working life' which means 'having to meet specific schedules, timetables and deadlines' and 'causing more stress', leading to increased frequency in episodes of this debilitating condition or it even becoming chronic, which is defined as having more than 15 headaches, of which eight are migraines, per month.
Dr Beltrán says migraines are 'one of the top illnesses' on the list of those which cause 'the most years of life lost'.
“They don't kill you, but they leave you incapacitated and decrease your quality of life,” she says.
“There are some patients who, when you ask them how many migraines they have a month, reply that it's easier to tell you how many days a month they don't have migraines.
“Everyone thinks it's just a headache that goes away when you take an aspirin, but it isn't. And it's not just absenteeism at work that it causes – it also causes presenteeism, or rather, where the employee goes to work when he or she is not up to it, but doesn't get anything done.
“Migraines cause extreme pain, usually in one side of the head and affecting at least half the head, nausea or vomiting, sensitivity to light, noise and smells, among other symptoms,” the neurologist explains.
Some migraine sufferers report an 'aura', or a weird, dizzy sensation, double vision, flashing lights and even euphoria and excess energy, some hours before a migraine comes on, but this is not always the case and it is recognised that 'migraine with aura' is different from 'migraine without aura'.
Alicante General Hospital's neurology consultancy spends about a quarter of its time attending to migraine patients.
But 75% of cases can be managed with 'relatively simple treatments', Dr Beltrán says.
“Until now, there has never been a treatment that targets migraine specifically, but the medication rolling out across Spain's hospitals now is administered subcutaneously and blocks the peptide that sends the pain message.
“It is already authorised for use in Europe, and in Spain, we're waiting for the price to be set for general use.
“They have already been used in one-off cases on 'compassionate grounds'; that is, given to the most serious cases.”
But the drug is said to be very expensive and will not just be dished out to everyone – the Comunidad Valenciana regional government has set up a working committee to determine which patient profiles would most benefit from the new medication.
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