February, 2017

Debris or Not Debris

By Michael J. Katin, MD

Because of the huge impact expected from the 21st Century Cures Act it was not realistically possible to list anything else as the major event in Oncology for the year 2016. Whereas there is no question that throwing money and additional levels of bureaucracy at this problem will undoubtedly result in the goal to "accelerate the discovery, development, and delivery of 21st century cures," it is beyond belief that there had, in fact, been discoveries made in 2016 prior to the passage of this legislation. The American Society of Clinical Oncology had listed 25 major clinical advances for 2017, plus an additional 60 (!) additional "notable advances," although, the period of time was not exactly 2016 but actually October, 2015, to October, 2016. If 85 noteworthy advances were made in that time period prior to enactment of the 21st Century Cures Act, imagine what will happen this year (barring unforeseen events, of course).

Amazingly, these 85 advances did not include what may have been the major discovery of the decade, let alone the year. The February 11, 2016, issue of Nature described the findings of Jan van Deursen's group in terms of identifying the detrimental effects of naturally-occurring cells on optimal organ function, risk of cancer, and, ultimately, length of survival. These cells express p16 suprascript lnk4a, and build up in the body over time. Mice who have clearance of these senescent cells following twice-weekly injections of AP20187, starting at age 1 (age 58 in mouse years ) have delayed tumorigenesis and extended median survival. It is further noted that AP20187 is a readily-available homodimerizer ligand which can be ordered from any of several biological supply companies.

Dealing with breakdown products is a hot topic, having already been considered worthy of a Nobel Prize in Medicine in 2016 for Yoshinori Ohsumi and Brian Williams, NBC News, for identification of 15 genes in baker's yeast which were responsible for a cell's ability to move damaged proteins and organelles to specific compartments where they can be broken down to provide nutrition, in a process called autophagy. This is the ultimate in recycling. It is theorized that when debris builds up, it can trigger an immune response that can lead to problems such as lupus, and a paper in the Proceedings of the National Academy of Sciences described that indoleamine 2,3-dioxygenase (IDO ) can reduce this immune response It is to be noted that indoleamine 2,3-dioxygenase is a recombinant protein that can be ordered from any of several biological supply companies. The debris can still build up, but it is more acceptable. Still, it would seem that getting rid of the breakdown products would be optimal, and, in addition to efforts in treatment of cancer and autoimmune disease, research is also proceeding in mechanisms that clear out unwanted deposits in the brain to maximize brain function and longevity.

Will this set off a rash of interest in using this as a cure for cancer, preventative for cancer, and rejuvenation agent in persons who otherwise would be deep into macrobiotic diets, yoga, bioidentical hormones, and other cash-only modalities. In fact, many of the complementary approaches are based on the idea that senescent cells and waste products need to be purged from the body, indicating that Dr. van Deursen's approach is nothing new.

Detoxification has been common to many therapy programs, even though eternal life or even eternal youth have not seemed to have been achieved by any of them. Removing toxins by chelation has been around for years, and is just as popular now as ever, since accumulating heavy metals in one's body is the cause of most disease. There may be somewhat of a conflict, then, with experts who claim there are all kinds of other toxins (that wouldn't be cleared with EDTA) that we absorb that cause us to be ill. Children are particularly vulnerable, leading to a myriad of products to keep our future generations as free as possible from harm. It is no surprise that even as distinguished a person as Gwyneth Paltrow, with her figurative hand on the proverbial pulse of society, has endorsed an annual detox program, with lemon water being a daily component and including such entrees as buckwheat soba noodle salad and grilled zucchini socca tacos. Actually sounds pretty good, and I'm certain the science behind this is valid. Not to be left behind, there are techniques available to detoxify Fido and Fluffy, certainly a valid investment considering how much money is wasted on less important projects.

A more traditional method of detoxification has been with direct flushing of the colon, which, as we know, is the repository of all evil. Mae West was renowned for starting her day with coffee....enemas and lived to the age of 87, a good accomplishment although not dramatically so. Fortunately, we have contemporary celebrities to continue her tradition, and it is probable that there will be newer developments and modifications to appeal to Millennials. P> Medical oncologists and radiation oncologists may become obsolete as the result of these new developments, but it will be worth it if the secret of health and long life is finally determined. As with most scientific discoveries, it will have been achieved through the process of elimination.

Emanuel Countdown: Dr. Ezekiel Emanuel's biographies list his birth year as 1957 but, interestingly, do not list a birth date. He has expressed that he does not wish to live past his 75th birthday. Giving him every benefit of the doubt, he will have his 75th birthday no later than December 31, 2032. Including February 1, 2017, this leaves 5,813 days to his goal