Frontiers in Biomedicine

352 Pages·2000·10.45 MB·English

by  Calvin B. Harley (auth.)

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