Health Newsfeed – Johns Hopkins Medicine Podcasts

Immunotherapies for cancer can be lifesavers, but they can also provoke an overwhelming immune response that can be life threatening. Now a Johns Hopkins study may help pinpoint who is at risk for this type of reaction. Kimmel Cancer Center director William Nelson describes the findings. Nelson: They could track cytokines. These are proteins that are released from the immune cells as they talk to each other and they saw a cytokines characteristic of a particular kind of T cell called a T helper 17 cell and a couple of other cytokine signatures. Once those were released they appeared to be more associated with folks who got the immune related adverse events. These are the tests you can do in the blood, you can predict who may be more likely to get them and this could be a valuable kind of tool as you begin to treat people to be much more on the lookout for these types of side effects.    :33 Nelson says the good news is these types of reactions are usually controllable when caught early. At Johns Hopkins, I’m Elizabeth Tracey.

People with a type of advanced colorectal cancer who were treated with two different immunotherapy drugs did much better than a group treated with a standard type of chemotherapy, a new study reports. Kimmel Cancer Center director William Nelson at Johns Hopkins explains. Nelson: The trial's going to go on for longer and they're going to collect more data. Only the combined immunotherapy nivolumab ipilumimab versus chemotherapy arm and the immunotherapy arm outperformed the chemotherapy arm. At 24 months 72% of the folks that got the immunotherapy were free of any disease that one could see whereas only 14% of the chemotherapy folks hadn't gotten worse. They're going to report on all the other things later, the side effects were what they expected for chemotherapy and for those combined immunotherapy.         :32 Nelson says what still needs to be reported is how one type of immunotherapy works alone. At Johns Hopkins, I’m Elizabeth Tracey.

As cancer cells grow, a study looking at their three dimensional architecture reveals that they become more like cells normally seen in fetal life. Johns Hopkins Kimmel Cancer Center director William Nelson says that may be the key to enabling them to metastasize throughout the body. Nelson: Particularly as the metastatic process occurs the cancer cells appear to adopt a more fetal kind of configuration in terms of the way the cell programs what genes it's going to use. As it gets nastier it gets a little bit less differentiated a little bit more infantile in that process, it can adopt a number of different states and this pliability or plasticity may be one of the reasons it can so readily adapt to growing in the wrong place, like in the liver or the lung as a metastasis.         :31 Such observations provide targets for strategies to treat and ultimately cure the disease, Nelson says. At Johns Hopkins, I’m Elizabeth Tracey.

An effort is underway to characterize cancerous tumors in three dimensions, with an eye toward a more complete understanding of their behavior. A series of papers have recently come out describing what’s been seen so far. William Nelson, director of the Kimmel Cancer Center at Johns Hopkins, says at least one observation is shaking up a foundational assumption of how cancers begin. Nelson: They've put in a public data place 3D renderings of tumors from more than 2000 subjects, a series of a dozen papers or so that just came out. About 15 to 30% of precancerous lesions in the colon look like they might arise from more than one cell. Since the 1960s that had been believed that cancers were the result of a single cell that's gone haywire, that that cell would then outgrow its environment but it hints at us it may not always be true.        :30 Nelson predicts more such findings will inform how cancers are treated. At Johns Hopkins, I’m Elizabeth Tracey.

When cancer exists in the body it has a three dimensional structure, an architecture, that only now is being looked at in detail to understand better how cancers behave. Kimmel Cancer Center director William Nelson at Johns Hopkins explains. Nelson: there's been this cancer research wide almost effort over the last few years to inventory all the cells that are present in cancers that are in people. Of course what you learn quickly is that there are cancer cells present and then there are normal supporting kinds of cells, there are immune cells that are allowing the cancer to grow and prosper and not eliminating it. There's a lot to be learned clearly and what this group has tried to do is aggregate some of these things and start to come to some conclusions that are somewhat provisional but all of which are interesting so far.     :32 Nelson says various technologies and techniques are empowering this line of investigation, and he expects it will bear fruit clinically by enabling identification of vulnerabilities that can be exploited to eliminate cancer. At Johns Hopkins, I’m Elizabeth Tracey.

Childhood obesity is a worldwide problem with long term health implications, especially cardiovascular disease. Now a study co-led by Johns Hopkins pediatrics expert Eliana Perrin has shown a personalized program of text messages to parents of very young infants staved off obesity in the first two years of life. Perrin: We built it to be easy. When we were building this we were building it to be intentionally asynchronous. Basically it means that it can be done outside of that office visit. As much as parents are in the pediatrics office in the first two years of life to have a texting intervention that can reach them where they are, reminding them of these healthy goals as part of their daily routine we think that's what made the difference.   :27 Children were enrolled in this intervention at an average age of five days. Perrin says parents are exceptionally motivated participants to raise their children healthily, and that means sleep, screen time, diet and physical activity, all of which are covered in the texts. At Johns Hopkins, I’m Elizabeth Tracey.

While childhood obesity is a widespread problem, the children who are most at risk to develop this disabling condition are already those with fewer educational opportunities and lower income. Now an intervention using text messages helps to close this gap by preventing the development of obesity in very early childhood. Eliana Perrin, a Johns Hopkins pediatrics expert, explains. Perrin: Our intervention actually closed health disparities gaps. If implemented at scale could have a really huge influence on health equity. This is something that could be easily scaled widely and cheaply, it's not something that will be nearly as hard to do the next time as it was this time. Therefore it could be adopted nationwide and really prevent obesity which promotes better cardiovascular health for child's whole lifetime.   :30 Children in this study maintained healthy growth rates for 2 years, putting them on a much healthier path. At Johns Hopkins, I’m Elizabeth Tracey.

Childhood obesity is a worldwide problem that keeps accelerating, with the kids most at risk from already disadvantaged groups. Now a study co-led by Johns Hopkins pediatrics expert Eliana Perrin shows that a comprehensive texting intervention helps, with kids whose parents got text messages maintaining a healthy growth trajectory for their first two years of life. And that’s unique among the many attempts that have been made. Perrin: In this pediatric childhood obesity prevention space the vast majority of trials are what we call negative studies, meaning they didn't work. Whatever intervention the researchers were trying to do to prevent obesity it didn't work. The kids were just as overweight as kids who weren't getting whatever intervention. Ours is amongst a very small number that was effective at all. Our intervention was more effective for those children that are at greatest risk for obesity.              :31 Perrin says the text intervention meets people where they are. At Johns Hopkins, I’m Elizabeth Tracey.

New parents are motivated people. That’s one observation from a new study co-led by Johns Hopkins pediatrics expert Eliana Perrin using a text-based intervention to prevent early childhood obesity. Perrin says parents both helped design the intervention and were participants. Perrin: We had a lot of people who were very willing to be part of our project in both arms of the study. Parents were going to get information to help their kids grow up healthier. That's something all parents want. Parents have lots of questions about feeding and activity, they want to know these things. What should I be giving them to drink, what's a good meal time, how much should my baby be sleeping,is it OK if my baby watches TV? They have these questions anyway our project was a great way to make that structured and help them.  :32 Perrin hopes to use the strategy widely. At Johns Hopkins, I’m Elizabeth Tracey.

Can a texting intervention to parents of very young children prevent the development of obesity in their offspring? A study co-led by Johns Hopkins pediatrics expert Eliana Perrin shows the answer is yes. Perrin: We enrolled 900 kids. We did it from six academic medical centers and those six centers were affiliated with lots and lots of clinics, some of which were teaching clinics and some of which were not. We recruited parents from the newborn nursery or from their first pediatrics visit. The average age of enrollment was five days old. Basically we were seeing parents at the very beginning of their journey at least with that child and for the first borns it was their journey of parenting.       :31 The study followed kids for their first two years of life, with those children whose parents got the texting intervention, which was really goal setting covering diet, sleep, activity and screentime, having much healthier weights and trajectories than those whose parents did not. At Johns Hopkins, I’m Elizabeth Tracey.