WSJ highlights research findings published in Science this week on HIV-neutralizing antibodies.

The news is that an antibody has been discovered that neutralizes almost all known strains of HIV.

I wish the news was that scientists have created a vaccine to neutralize almost all strains of HIV--that would have been better.

This is the kind of news we like the most on InteractMD.com--applying a known existing therapy in a new and unexpected way. This time it's using IVIg to treat a chronic pain syndrome known as Complex Regional Pain Syndrome.

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1-21-10.mp3

New England Journal of Medicine publishes a paper this week about the use of monoclonal antibodies to prevent a feared infection: C. diff colitis. Patients who received the antibody as an IV infusion were 80% less likely to have recurrences of this bacteria, which can cause a deadly form of diarrhea.

I said Wow out loud for this one. Researchers speculate that autism is caused by antibodies the mother makes against the fetus' brain that then circulate enter the placenta and damage the brain of the unborn child leading to autism. The details are that the researchers took antibody samples from women with autistic kids and control kids and gave these to pregnant mice. The offspring of these mice then displayed behavioral changes. The results were published in Journal of Neuroimmunology April 2009.

There weren't many patients on the drug but a skittish FDA pulled Raptiva from the market today over concerns of PML the rare brain infection. Three patients died of the brain infection this year alone and given the alternatives in the market and the (usually) non life-threatening course of psoriasis the decision seems justified. The drug recognizes CD11a and is a monoclonal antibody.

The substitute PolyHeme moves closer to approval with news that FDA intends to complete a priority review of the drug by April 30 2009: http://www.pipelinereview.com/content/view/24400/111/ The problem is that the Phase III clinical trial showcasing this drug didn't show much of a benefit. The idea is to stock it in ambulances to be administered to gunshot victims or car accident patients to reduce the amount of blood transfusions needed in the hospital. Pretty good idea on paper but didn't seem to affect much of anything in the field.

 Idiopathic thrombocytopenic purpura (ITP) is a condition which creates a short supply of blood cells called platelets. This condition is also acknowledged as immune thrombocytopenic purpura or immune-mediated thrombocytopenic purpura. Since the advent of platelet transfusions purpura (bruises) are no longer a prominent component of the disease though serious bleeding may occur.  If the platelet count is below 20 000 ITP patients can experience bruising petechiae nosebleeds and bleeding gums. The cause of the illness is an immune system reaction against normal platelets.

Mayo Clinic researchers have published a paper outlining a risk-adapted strategy to treating CLL. This is the first trial asking whether some patients with the disease are better served by taking chemotherapy soon after diagnosis or waiting. CLL is an abbreviation of Chronic Lymphocytic Leukemia. This illness is characterized by an overproduction of white blood cells known as lymphocytes. The disease probably starts out as an abnormal activation of the immune system by some stimulus probably infectious agents.

A big part of the problem in medicine is the lack of good targeting technology.  This thought occurred to me as I was lamenting how slowly my steroids were reversing an autoimmune hemolytic anemia today.  If only I could target the exact antibody that was consuming the red cells! Was the antibody directed against a red cell membrane protein or a lipid component?  I have no way of finding that out clinically let alone selecting that bad antibody for destruction.  As I explained to the patient the immune system's making too much of the bad antibody and not enough of the good antibodies.

Diarrhea can be a serious adversary especially in people recently discharged from a hospital or living in a nursing home.  A form of diarrhea known as toxic enterocolitis can be caused by overgrowth of a normal bowel inhabitant: Clostridium difficile.  So called "C difficile" infections are attained in transmission from one hospital patient to another and mostly patients remain asymptomatic after acquisition. The greatest risk involved with the patients is with antimicrobial exposure particularly clindamycin cephalosporins and penicillins.