Jab using body's painkillers could help 500,000 in pain
Hope for cancer patients whose suffering can no longer be eased by morphine.
Ian Sample Washington DC
Doctors in the US have begun a clinical trial of a gene therapy that uses the body's natural painkillers to bring relief to patients who cannot be helped with conventional drugs. They hope that a single injection could provide relief for up to six months in people whose pain is so severe that morphine and other frontline drugs have little effect or cannot be used because of their side-effects.
The trial was launched after a pilot study this year of people with intractable cancer pain showed the therapy was safe. The therapy smuggles a gene into sensitive nerves beneath the skin that makes the cells release natural chemicals that alleviate pain.
Dr David Fink, who is leading the research at the University of Michigan, said that the trial was the first to investigate if the technique was effective in humans.
"We have started with people who are in pain from terminal cancer, but the approach is applicable for intractable pain from inflammatory conditions, such as arthritis of the hip and any number of other situations," he said.
Half a million people in the UK experience chronic pain, often when their nerves are damaged by cancer, diabetes, surgery or disease, according to the Neuropathy Trust. The constant pain leads to sleeplessness and depression that can be devastating. The therapy uses a form of herpes virus that is modified to prevent it from replicating and causing illness when injected into the body. The virus is engineered further to carry a gene that produces a natural painkiller called enkephalin.
When the virus is injected into the skin, it finds its way into nearby peripheral nerves – those outside the brain and spinal cord – and makes them produce enkephalin for a month to six weeks. Other work by Fink's team suggests this could be extended by up to six months.
The injection allows doctors to target specific parts of the body that are in pain, rather than prescribing a drug that affects the whole body. Patients given high doses of morphine for severe pain can suffer broad and debilitating side effects, including lethargy, confusion and constipation. Fink reported a small trial to investigate the safety of the treatment in April this year. Ten patients with intractable pain were given injections. Those who received high doses reported feeling less pain than those who had medium doses. Those who had low-dose injections felt no benefit.
The latest trial will compare tens of patients who have the injections with a control group that receives a placebo jab. Fink, who outlined the trial at the Society for Neuroscience conference in Washington, expects to have results at the end of the year.
Andreas Beutler, a specialist in chronic pain at the Mayo Clinic in Minnesota, said Fink's work was impressive. "There is a clear clinical need in patients with intractable chronic pain and other diseases involving the peripheral nervous system, such as hereditary neuropathies, where current treatments, while helpful, are failing," Beutler said.
Scientists will be particularly interested to see if the herpes virus used manages to evade the human immune system indefinitely. The latest version was designed to stay active for only a few weeks and has been tested only in a small group of patients at full dose. Long-term effects involving the immune system may not have been apparent.
If the gene therapy is found to ease pain without causing serious side-effects, the virus that Fink has developed could potentially be used to deliver other genes to the nervous system.
“You wait till Larry comes and I tell him my theory!” The bids, duly sealed, were given into the keeping of the commissary officer to be put in his safe, and kept until the day of judgment, when all being opened in public and in the presence of the aspirants, the lowest would[Pg 188] get the contract. It was a simple plan, and gave no more opportunity for underhand work than could be avoided. But there were opportunities for all that. It was barely possible—the thing had been done—for a commissary clerk or sergeant, desirous of adding to his pittance of pay, or of favoring a friend among the bidders, to tamper with the bids. By the same token there was no real reason why the commissary officer could not do it himself. Landor had never heard, or known, of such a case, but undoubtedly the way was there. It was a question of having the will and the possession of the safe keys. "Well, I believe our boys 's all right. They're green, and they're friskier than colts in a clover field, but they're all good stuff, and I believe we kin stand off any ordinary gang o' guerrillas. I'll chance it, anyhow. This's a mighty valuable train to risk, but it ought to go through, for we don't know how badly they may need it. You tell your engineer to go ahead carefully and give two long whistles if he sees anything dangerous." "Fine-looking lot of youngsters," he remarked. "They'll make good soldiers." "That's just what he was, the little runt, and we had the devil's own time finding him. What in Sam Hill did the Captain take him for, I'd like to know? Co. Q aint no nursery. Well, the bugler up at Brigade Headquarters blowed some sort of a call, and Skidmore wanted to know what it meant. They told him that it was an order for the youngest man in each company to come up there and get some milk for his coffee tomorrow morning, and butter for his bread. There was only enough issued for the youngest boys, and if he wanted his share he'd have to get a big hustle on him, for the feller whose nose he'd put out o' joint 'd try hard to get there ahead o' him, and get his share. So Skidmore went off at a dead run toward the sound of the bugle, with the boys looking after him and snickering. But he didn't come back at roll-call, nor at tattoo, and the smart Alecks begun to get scared, and abuse each other for setting up a job on a poor, innocent little boy. Osc Brewster and Ol Perry, who had been foremost in the trick had a fight as to which had been to blame. Taps come, and he didn't get back, and then we all became scared. I'd sent Jim Hunter over to Brigade Headquarters to look for him, but he came back, and said they hadn't seen anything of him there. Then I turned out the whole company to look for him. Of course, them too-awfully smart galoots of Co. A had to get very funny over our trouble. They asked why we didn't get the right kind of nurses for our company, that wouldn't let the members stray out of their sight? Why we didn't call the children in when the chickens went to roost, undress 'em, and tuck 'em in their little beds, and sing to 'em after they'd said 'Now I lay me down to sleep?' I stood it all until that big, hulking Pete Nasmith came down with a camp-kettle, which he was making ring like a bell, as he yelled out, 'Child lost! Child lost!' Behind him was Tub Rawlings singing, 'Empty's the cradle, baby's gone.' Then I pulled off my blouse and slung it into my tent, and told 'em there went my chevrons, and I was simply Scott Ralston, and able to lick any man in Co. A. One o' their Lieutenants came out and ordered them back to their quarters, and I deployed the company in a skirmish-line, and started 'em through the brush toward Brigade Headquarters. About three-quarters o' the way Osc Brewster and Ol Perry, when going through a thicket, heard a boy boo-hooing. They made their way to him, and there was little Skidmore sitting on a stump, completely confused and fagged out. He'd lost his way, and the more he tried to find it the worse he got turned around. They called out to him, and he blubbered out: 'Yes, it's me; little Pete Skidmore. Them doddurned fools in my company 've lost me, just as I've bin tellin' 'em right along they would, durn 'em.' Osc and Ol were so tickled at finding him that they gathered him up, and come whooping back to camp, carrying him every step of the way." And the rush stopped. Cadnan waited for a second, but there was no more. "Dara is not to die," he said. Then he saw Orion hanging over him, very low in the windy sky, shaking with frost. His eyes fixed themselves on the constellation, then gradually he became aware of the sides of a cart, of the smell of straw, of the movement of other bodies that sighed and stirred beside him. The physical experience was now complete, and soon the emotional had shaped itself. Memory came, rather sick. He remembered the fight, his terror, the flaming straw, the crowd that constricted and crushed him like a snake. His rage and hate rekindled, but this time without focus—he hated just everyone and everything. He hated the wheels which jolted him, his body because it was bruised, the other bodies round him, the stars that danced above him, those unknown footsteps that tramped beside him on the road. Farewell to Jane and Caroline!" HoME大香蕉色人阁
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