Frontiers in Biomedicine PDF
Preview Frontiers in Biomedicine
FRONTIERS IN BIOMEDICINE FRONTIERS IN BIOMEDICINE Edited by Alian L. Goldstein The George Washington University School of Medicine and Health Sciences Washington, D.C. Springer Science+Business Media, LLC Library ofCongress Cataloging-in-Publication Data Frontiers in biomedicine / edited by Allan L. Goldstein. p.;cm. Includes bibliograpbicat references and index. ISBN 978-1-4613-6893-9 ISBN 978-1-4615-4217-9 (eBook) DOI 10.1007/978-1-4615-4217-9 1. Medical innovations. 1. Goldstein, Alian L. [DNLM: 1. Clinical Medicine--trends. 2. Drug Therapy--trends. 3. Research. WB 100 F93452000] R855.3 .F76 2000 610'.28--dc21 00-034935 Editor's Note The contributions in this book are based upon a novel series of Grand Rounds Lectures on the Internet sponsorcd by the Health Care Education Department of Glaxo Wellcome, Inc. The lectures can be accessed at www.helix.com or atJrontiersinbiomedicine.com. Alian Goldstein ISBN 978-1-4613-6893-9 ©2000 Springer Science+Business Media New York Originally published by Kluwer Academic / Plenum Publishers, New York in 2000 10 9 8 7 6 5 4 3 2 I A C.I.P. record for this book is available from the Library of Congress AII rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilm ing, recording, or otherwise, without writlen permission from the Publisher PARTICIPANTS PETER J. BARNES • National Heart and Lung Institute, Imperia College,tr,London UK SW3 6LY ROBERT N. BUTLER. International Longevity Center-USA, Ltd., New York NY 10028 AMITABHA A. CHANDA. The George Washington University, School o· Medicine, Washington, D.C. 20037 VINCENT A. CHIAPPINELLI • Department of Pharmacology, The George Washington University School of Medicine, Washington, D.C. 20037 ROBERT B. COUCH. Baylor College of Medicine, Houston, Texas, 77030 WILLIAM B. ERSHLER • Institute for Advanced Studies in Aging anc Geriatric Medicine, Washington, D.C. 20006 ALEXANDER FEFER • University of Washington School of Medicine, Seattle, Washington 98195-6527 CLAUDIO FIOCCHI • Case Western Reserve University School 01 Medicine, Cleveland, Ohio 44106-4952 ROBERT C. GALLO. Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201 KENNETH C. GORSON • St. Elizabeth's Medical Center, Division 01 Neurology, Tufts University School of Medicine, Boston, MA 02135 MARLENE HAFFNER • Food and Drug Administration, Rockville, MD 20857 CALVIN B. HARLEY. Geron Corporation, Menlo Park, CA 94025 HYNDA K. KLEINMAN. Cell Biology Section, NIDCR, National Institutes 01 Health, Bethesda, MD 20892 MARGARET ANN L1U • Chiron Corporation, Emeryville, CA 94608-2916 SIMIN NIKBIN MEYDANI • JMUSDA Human Nutrition Research Center on Aging, Tufts University, Boston MA 02111 MALCOLM S. MITCHELL. Hudson-Webber Cancer Research Center, Karmanos Cancer Institute, Detroit, MI 48201 JAN M. ORENSTEIN. Department of Pathology, The George Washington University School of Medicine, Washington, D.C. 20037 WILLEM W. OVERWIJK • Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20205 ALLAN H. ROPPER. Division of Neurology, St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA 02135 STEVEN A. ROSENBERG • Surgery Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD 20205 ARYE RUBINSTEIN • Center for AIDS Research, The Albert Einstein College of Medicine, Bronx, NY 10461 BRUCE K. RUBIN. Wake Forest University School of Medicine, Winston Salem, NC 27157-1081 y Peter J. Barnes William B. Ershler Martene Hafner Robert M. Butler Alexander Fefer CaMn B. Harley ·· rJ . , I. , . ;. ; ; . : Claudio Aocchl Hynda K. Kleinman Vincent A. Chlapplne II Robert C. Gallo Margaret Ann Uu Robert B. Couch Kenneth C. GOI"8On Simln Meydanl VI Malcolm S. Mtichell Arye Rubenstein Gary L Simon Jan M. Orenstein Bruce K. Aubin LeonJ. Thai Willem W.OverwlJk Edmund C. Tramont Allan H. Ropper laIigam N. Sekhat Alan G. Wasserman Steven A Rosenberg Kenneth Sherman William B. Wegllckl vii JONATHAN M. SACKIER • Department of Surgery, The George Washington University School of Medicine, Washington, D.C. 20037 LALiGAM N. SEKHAR • The George Washington University School of Medicine, Washington, D.C. 20037 KENNETH SHERMAN. University of Cincinnati School of Medicine, Cincinnati, OH 45267-0595 GARY L. SIMON • Department of Medicine, The George Washington University School of Medicine and Health Sciences, Washington, D.C. 20037 LEON J. THAL • University of California, San Diego VA Medical Center, San Diego, CA 92161 EDMUND C.TRAMONT • Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD 21201 ALAN G. WASSERMAN. Department of Medicine, The George Washington University School of Medicine, Washington, D.C. 20037 WILLIAM B. WEGLICKI • Department of Physiology and Experimental Medicine, The George Washington University School of Medicine, Washington, D.C. 20037 VlIl Preface Traditional methods of medical education and training are changing rapidly. This volume integrates the printed text--as provided by leading experts in science and medicine--with multimedia applications using desktop conferencing and the Internet in the delivery of instruction. The Department of Biochemistry and Molecular Biology at The George Washington University Medical Center, with the support of an unrestricted educational grant from the Healthcare Education Department of Glaxo Welcome, Inc., has created a distance-learning lecture series on the Internet for continuing medical education. In this lecture series, leading scientists and physicians discussed the most current as well as future projected treatments of prominent afflictions of mankind. These chosen speakers, who are at the forefront of research and treatment in the field of biomedicine, build a structural framework for the audience in their field of expertise, and from there looked into their crystal ball and discussed their view of the future. The lectures, approximately one hour in length, were broadcast live from The George Washington University Medical Center in Washington, D.C. as part of the Department of Medicine Grand Rounds. These lectures will be available on the Internet until 2001. In partnership with Medical Consumer Media, the lectures were simultaneously broadcast live around the world via the Internet with real-time audio streaming and digitized 35mm slide presentation. The lecture format was designed to foster questions which went beyond basic science and current treatments. The lectures focused on cutting-edge research and developments in the fields of biochemistry, molecular biology, pharmacology, immunology and genetics, and the development of novel therapies for life threatening and chronic diseases. Archived on the HELIX (www.helix.com) Web site to allow physicians, scientists, and other health care professionals to study, view, or review the material at their leisure, the lectures make promising data and information accessible to all health care providers and researchers around the globe, enabling collaboration with vivid and illustrated information to an extent not possible in the past. As distance learning programs grow dramatically in number to help meet the continuing educational needs of medical professionals, the World Wide Web makes courses and instructional environments available to learners at a time and place of their choosing. This volume, which contains 26 chapters contributed by the lecturers who participated in this grand experiment in distance learning, is divided into 8 major sections. Part I deals with the molecular biology of aging and the clinical advances in osteoporosis and Alzheimer's disease. It includes scholarly contributions by Calvin Harley, Simin Meydani, William Ershler, Hynda Kleinman, Leon Thai, and Robert Butler, who discuss the latest advances in the molecular biology of the aging process, the changes in nutritional requirements and in the immune function that occur with age, and the role of the extracellular matrix in development and disease. Current treatments for three of the major diseases of aging, i.e., osteoporosis, Alzheimer's disease, and senility, are discussed by experts in the field. Part II deals with the pathophysiology and clinical advances in infectious diseases, septic shock, and AIDS. In this section, advances in knowledge regarding the control of influenza, hepatitis C, and septic shock are discussed by Robert Couch, Kenneth Sherman, and Gary Simon. The section also includes two chapters on AIDS, the first a highly interesting chapter on the latest research findings on IX chemokines in the treatment of AIDS by Robert Gallo and Edmond Tramont, and the second by Arye Rubinstein on the "Understanding and Treatment of Pediatric AIDS". We also have a very personal view of AIDS from the vantage point of Jan Orenstein, a pathologist involved with the AIDS epidemic since its beginning. Part III of the book deals with cardiovascular disease. In this section, William Weglicki and Alan Wasserman discuss the nutritional and pharmacological approaches to the treatment of cardiovascular disease and the advances that have been made in the treatment of acute myocardial infarction. Part IV deals with the molecular biology of the brain and the treatment of a number of neurodegenerative diseases. We learn from Vincent Chiappinelli the latest approaches to the treatment of neurodegenerative diseases via our understanding of the nicotine receptors in the brain and from Allan Ropper and his colleague Kenneth Gorson of the recent advances that have been made in Guillain Barre' syndrome and a number of other common neuropathies. Part V focuses on the pathogenesis and treatment of Crohn' s disease, asthma, cystic fibrosis, and other inflammation diseases. Three world renowned authorities, Claudio Fiocci, Peter Barnes, and Bruce Rubin, provide their unique insights into the pathogenic mechanisms and treatment of these inflammatory diseases of the bowels and lungs and provide insights into future treatments in this area. The sixth section of the book (Part VI) focuses on advances in bone marrow transplantation and a discussion of several of the novel vaccines being developed for the treatment of cancer and infectious diseases. Alex Fefer describes the latest strategy used in the treatment of cancers of the blood, using bone marrow or other hematopoietic stem cells. Margaret Liu provides an update on current research in the area of gene-based vaccines, and William Overwijk, Steven Rosenberg, and Malcolm Mitchell, focusing on melanoma, describe exciting and important advances in the search for and development of effective cancer vaccines and document the coming of age of this scientific approach. In Part VII we have two presentations of important advances in surgery. Jonathan Sackier discusses advances in surgical treatments using endoscopy, and Laligam Sekhar and Amitabha Chanda describe extraordinary advances that have been made in the treatment of cerebral aneurysms. The last section (Part VIII) of the volume deals with the important contribution that the orphan drug program has played in medicine. In this insightful chapter, Marlene Haffner, Director of the Orphan Drug Program of the FDA, describes the extraordinary benefits that have occurred in the development of new drugs that treat life threatening orphan diseases and offers a look at what the future holds in store. In summary, this volume describes many of the extraordinary advances that have occurred in the decade of the 1990's exploring the "Frontiers in Biomedicine". The chapters outline the development of significant new "cutting edge" approaches to the treatment of a number of life threatening diseases which until recently were difficult to treat successfully. This volume should be of interest not only to the basic scientist working on the frontiers of science, but also to the clinicians involved in providing better health care for their patients. The volume provides many insights into the future directions of biomedical research as we enter the 2151 century. Allan L. Goldstein Washington, D.C. x CONTENTS PART I. MOLECULAR BIOLOGY AND CLINICAL ADVANCES IN THE GENETICS AND TREATMENT OF AGING, OSTEOPOROSIS, AND ALZHEIMER'S DISEASE Aging: Genes and Molecular Mechanisms Calvin B. Harley Advances in Preventive Medicine: Nutrition and Immune Function in the 19 Elderly Simin Nibkin Meydani Advances in the Role of the Extracellular Matrix in Development and Disease 31 Hynda K. Kleinman New Concepts in the Pathogenesis and Treatment of Osteoporosis 41 William B. Ershler Advances in the Diagnosis and Treatment of Alzheimer's Disease 53 Leon 1. ThaI "Senility"-The Epidemic of the 20th Century 63 Robert N. Butler PART II. PATHOPHYSIOLOGY AND CLINICAL ADVANCES IN INFECTIOUS DISEASES, SEPTIC SHOCK, AND AIDS Influenza: Advances in Knowledge of Impact and Approaches to Control 79 Robert B. Couch Recent Advances in the Treatment of Hepatitis C 91 Kenneth Shennan Recent Advances in the Pathophysiology and Treatment of Septic Shock 107 Gary L. Simon XI
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