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Torrance Orthopaedic & Sports Medicine Group – TOSMG

August 4th, 2016 9:35 am

Over the years the compassionate, board certified surgeons and physical therapists at Torrance Orthopaedic & Sports Medicine Group have helped thousands of our patients recover from orthopedic injuries of the shoulder, arm, elbow, hand, spine, hip, leg, knee, ankle, and foot. Their journey from treatment to surgery and through physical therapy inspires us to keep doing what we love: putting our skilled hands and sharp minds to good use in the best community anywhere. More about what we do...

If you haven't met them yet, the premiere team of board certified orthopedic surgeons at Torrance Orthopaedic & Sports Medicine Group are worth getting to know. They've been hand-picked to partner with you read more...

You can find out what follow-up rehabilitation really should be when you meet our experienced, friendly physical therapists and hand therapists. Visit our read more...

The spine of Torrance Orthopaedic & Sports Medicine Group is our courteous, knowledgeable, and caring staff. They make scheduling an appointment easy, and they are available to help you reach your doctor or therapist quickly. Expect to be respected and responded to in a caring manner. Office Directory

Ever heard of iPad Shoulder? How a simple fracture can be deadly? That man's best friend is not dogs, but something that's been around for millions of years? Get decades of medical know-how in this informative library of health mini-tips from our board of certified physicians and therapists. Click here for more.

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Stem cell tourism: A problem right here in the good ol …

August 4th, 2016 9:35 am

Last week, I wrote about a man named Jim Gass, a former chief legal counsel for Sylvania, who had suffered a debilitating stroke in 2009 that left him without the use of his left arm, and weak left leg. He could still walk with a cane, but was understandably desperate to try anything to be able to walk unaided and function more normally in life. Unfortunately (at least given what ultimately happened), Mr. Gass was both driven enough, credulous enough, and wealthy enough to spend $300,000 pursuing stem cell tourism in China, Mexico, and Argentina over the course of four years. The result is that he now has a tumor growing in his spinal column, as reported in The New England Journal of Medicine (NEJM) and The New York Times (NYT). Genetic analysis has demonstrated that the cells in this tumor mass did not come from Jim Gass, and the mass has left him paralyzed from the neck down, except for his right arm, incontinent, and with severe chronic back pain. Worse, although radiation temporarily stopped the tumor from growing, apparently its growing again, and no one seems to know how to stop it. Given that the traits that make stem cells so desirable as a regenerative treatment, their plasticity and immortality (ability to divide indefinitely), are shared with cancer, scientists doing legitimate stem cell research have always feared such a complication and have therefore tried to take precautions to stop just this sort of thing from happening in clinical trials. Clearly, stem cell tourist clinics, which intentionally operate in countries where the regulatory environment isshall we say?less than rigorous are nowhere near as cautious.

At the time I wrote that article, I emphasized primarily clinics outside of the US, where shady operators locate in order to be able to operate largely unhindered by local governments. Youd think that such a thing couldnt possibly be going on in the US. Youd be wrong. About a week and a half ago, Paul Knoepfler, a stem cell scientist who maintains a blog about stem cells, teamed up with Leigh Turner to publish a paper in Cell Stem Cell estimating the number of stem cell clinics in the US. The number they came up with astonished me.

In their article, Selling Stem Cells in the USA: Assessing the Direct-to-Consumer Industry, Turner and Knoepfler explain:

Businesses marketing putative stem cell interventions have proliferated across the U.S. This commercial activity generates a host of serious ethical, scientific, legal, regulatory, and policy concerns. Perhaps the most obvious regulatory question is whether businesses advertising nonhomologous autologous, allogeneic, induced pluripotent, or xenogeneic stem cell therapies are exposing their clients to noncompliant cell-based interventions. Such practices also prompt ethical concerns about the safety and efficacy of marketed interventions, accuracy in advertising, the quality of informed consent, and the exposure of vulnerable individuals to unjustifiable risks.

Prior analyses of companies engaged in direct-to-consumer marketing of stem cell interventions have not explicitly focused on attempting to comprehensively locate and examine U.S. businesses (Lau et al., 2008, Ogbogu et al., 2013, Regenberg et al., 2009), although recent scholarship has identified some U.S. businesses engaged in such activity (Connolly et al., 2014). While such companies have attracted some scrutiny from researchers and journalists, these businesses have not yet been examined in a comprehensive manner (Perrone, 2015, Turner, 2015a). This gap in scholarship has contributed to misunderstandings that need to be corrected.

For example, health researchers, policy-makers, patient advocacy groups, and reporters often use the phrase stem cell tourism when addressing the subject of unapproved cell-based interventions and even in 2016 assume that U.S. citizens must travel to such destinations as China, India, Mexico, and the Caribbean if they wish to access businesses promoting stem cell procedures for a wide range of clinical indications. While travel from the U.S. to international stem cell clinics continues, the rhetoric of stem cell tourism often fails to acknowledge the hundreds of U.S. businesses engaged in direct-to-consumer advertising of stem cell interventions.

Of course, I did exactly this in my previous post, not really acknowledging this industry in the US. True, I did mention the San Diego-based company Stemedica, but I mentioned that company mainly because its business model appears to involve doing actual FDA-monitored clinical trials of its stem cell products in the US but referring any patients contacting the company who are ineligible for its US clinical trials to one of its foreign partners, particularly its affiliate right across border in Tijuana, Novastem. It was, for example, Novastem through which Gordie Howe was treated for his stroke a year and a half ago. Patients referred to Stemedicas partners, of course, pay full price for the stem cell injections, usually around $30,000 a pop.

But what about US-based businesses? Turner and Knoepfler used key words and phrases such as stem cell treatment and stem cell therapy to preliminarily identify putative stem cell businesses and then evaluated the text on the websites of these businesses to refine their analysis. As a result, they identified 351 businesses offering stem cell therapies at 570 clinics, which they listed on this map:

Stem cell clinics in the US.

They also helpfully include a link to an Excel spreadsheet listing all 570 sites, noting:

Many stem cell companies employ multiple physicians and advertise interventions available at numerous clinics. Although such businesses are widely distributed all over the county, we found that clinics tend to cluster in particular states. For example, we found 113 clinics in California, 104 in Florida, 71 in Texas, 37 in Colorado, 36 in Arizona, and 21 in New York. Hotspot cities including Beverly Hills (18), New York (14), San Antonio (13), Los Angeles (12), Austin (11), Scottsdale (11), and Phoenix (10) are designated with stars on the map. Some metropolitan areas, including Southern California around Los Angeles and San Diego, the South Florida region surrounding Miami, the greater Denver area, and the Dallas-Fort Worth metro region, have a relatively high number of clinics even if not all such facilities are technically in one city (Figure S1). While our analyses here do not explain why these businesses cluster in particular areas, we plan to investigate this question further. Possible factors include a relationship between number of clinics and population density, regional variations in use of alternative medical interventions, aging population demographics, and regulatory orientation of state medical boards and consumer protection agencies.

Im sure population density has something to do with so many clinics in California, although one would expect more in New York and Texas if it were just population density. I also suspect that the prevalence and popularity of alternative medicine practitioners has something to do with it, since, oddly enough, I frequently see ads for stem cell clinics and articles praising stem cell therapies on websites oriented towards alternative medicine. Given how often stem cells are advertised as anti-aging treatments (something mentioned by Turner and Knoepfler) and the popularity of plastic surgery in California, it wouldnt surprise me if there is a correlation there as well. These are definitely things that I hope Turner and Knoepfler will look at in future investigations.

So what are these clinics selling stem cells to treat? What are the claims they make? Unfortunately, the claims of US clinics are not much, if at all, different from the claims made by many stem cell tourist clinics in other countries. Claims are made that specific diseases can be treated that are just specific enough to attract customers but vague enough not to promise too much.

It has to be noted that there is not just one kind of stem cell. As I described last time, they range from embryonic stem cells that require human embryos to isolate, to adult stem cells, to cells induced to be stem cells by the introduction of genes responsible for maintaining the stem cell state. As Ill discuss later, this matters when it comes to asking just what the heck the FDA is or isnt doing about this proliferation of stem cell businesses.

Turner and Knoepfler note that most of the businesses that they identified market autologous stem cell-based interventions; i.e., stem cells isolated from the patient and then reinfused. Most isolated these stem cells (or claimed to isolate them, given that its not always clear how such clinics verify that what they have isolated are indeed autologous stem cells) from adipose tissue (fat) or from the bone marrow. Be that as it may, 61% of the clinics examined market autologous adipose-derived stem cell-based interventions; 48% what they describe as autologous stem cells obtained from bone marrow; and 4% stem cells reportedly isolated from peripheral blood. Not surprisingly, lots of clinics offer stem cells isolated from more than one source. Some offer mixed stem cells from both bone marrow and adipose tissue as combination stem cell therapy.

About one in five clinics advertised allogeneic stem cell treatments; i.e., stem cells from another person or source. The usual sources of these stem cells are advertised as amniotic material/fluid (17%), placenta (3.4%), and umbilical cords (0.6%). Its noted in the report the precise source for these products was not clear in all cases, in particular for amniotic stem cells. Indeed, one wonders (at least I do) what the source of amniotic fluid is from which these clinics claim to isolate stem cells. Do they have a deal with a local obstetrical clinic or hospital to provide amniotic fluid or membranes? Do they buy placentas and amniotic membranes from a hospital? Where do these clinics get the raw material (i.e., the human tissue and fluids) to generate these stem cells from? Inquiring minds want to know!

Turner and Knoepfler also noted one business that offers what it claims to be induced pluripotent stem cells. (Remember, these are cells genetically manipulated to revert to being stem cells.) I went back to the spreadsheet and found which company offered this, Regenerative Medical Group. RMG claims to provide induced pluri-potent stem cells from your own cells via an affiliated laboratory, but what I found more interesting were the diseases and conditions it claims to treat with stem cells. Not surprisingly, as was the case for most of the clinics listed, many of the indications were orthopedic, to regenerate cartilage and repair injury. However, RMG also claims to be able to treat kidney diseases, macular degeneration, Parkinsons disease, and, yes, autism. Under a tagline of An autism therapy that WORKS, theres even a video on the website that makes claims that can only be described as grandiose and not supported by science featuring Bryn J. Henderson, DO, JD, FACPE, CIME, the executive director of RMG:

In the video, Dr. Henderson claims that RMG has helped dozens of children with autism using stem cells. He claims that the stem cells circulate through the body, cross the blood-brain barrier and make new cells that change the course and prognosis of the patient with autism. He even claims that most of the time, the change is major. How does he know? He brags about the thank you cards hes gotten from parents. I mean, seriously. This is utterly pathetic. Even antivaccine quacks like Mark and David Geier or Andrew Wakefield can do better at providing evidence. Note that that is not a compliment, given how poor their attempts at studies invariably are. Dr. Henderson, however, presents no science, no clinical trials, no preclinical trials, no nothing other than testimonials, although he does use a lot of science-y-sounding terms. Hell, Ive seen homeopaths who provide more evidence and a more convincing presentation. At least they will cite actual patients rather than thank you notes from patients families. (Oh, and Dr. Henderson, dont bother taking your video down; Ive downloaded it.)

RMGs fact sheet on autism is no better. Citing no evidence, not even case reports, the sheet claims that stem cell infusions for autism can improve:

What evidence is presented? Again, none. This might as well be a chelation therapy clinic. The treatment, however, takes three days, and the patient doesnt have to come back to an RMG clinic at all, although, the fact sheet hastens to add, they can undergo repeat treatments if necessary. In other words, stem cells appear to have been added to the armamentarium of autism biomed quackery.

I could go on, but to me stem cells for autism is so obviously dubious at best and bogus at worst that, given my interest in vaccines and the antivaccine movements mistaken belief that vaccines cause autism, I hope youll forgive me if I zeroed right in on autism. Indeed, nine of the clinics listed in the spreadsheet claim to be able to use stem cells of one kind or another to treat autism.

But, wait, theres more. In addition to RMG:

Another business markets access to what it describes as embryonic stem cell interventions. In addition, we identified two clinics that marketed bovine amniotic cells, a xenogeneic product, for use in humans. Approximately 3% of businesses marketed stem cell interventions without mentioning a particular type of stem cells.

Perusing the list of clinics, I found it hard not to come to the conclusion that there isnt a single disease or condition that someone, somewhere, isnt claiming can be helped with stem cells of one kind or another. Diabetes, heart disease, degenerative diseases, Parkinsons disease, Alzheimers disease, spinal cord injuries, stroke, aging, and even cancer show up on the list of conditions that these 570 clinics claim to be able to treat with stem cells, as Turner and Knoepfler note:

U.S. businesses promoting stem cell interventions claim to treat a wide range of diseases and injuries, as well as advertising stem cells for cosmetic applications, anti-aging, and other purposes (Figure 2B). Some clinics occupy relatively specialized marketplace niches. For example, many cosmetic surgery clinics advertise such procedures as stem cell facelifts and stem cell breast augmentation as well as sexual enhancement procedures. Orthopedic and sports medicine clinics often promote stem cell interventions for joints and soft tissue injuries. Other clinics take a much broader approach and list stem cell interventions for 30 or more diseases and injuries. Such businesses commonly market treatments for neurological disorders and other degenerative conditions, spinal cord injuries, immunological conditions, cardiac diseases, pulmonary disorders, ophthalmological diseases and injuries, and urological diseases as well as cosmetic indications. Many of these marketing claims raise significant ethical issues given the lack of peer-reviewed evidence that advertised stem cell interventions are safe and efficacious for the treatment of particular diseases. Such promotional claims also generate regulatory concerns due to apparent noncompliance with federal regulations.

Unfortunately, these US businesses are less unlike the stem cell tourist clinics that Ive written about before than I would like.

I thought about perusing the list of clinics in more detail and picking out the most egregious examples other than RMG, but that can wait for a potential future post. (It is, after all, a holiday weekend, and well be having visitors.) So instead Ill move on to conclude with the question that many of you are probably wondering after seeing an example such as treating autism with stem cells: What the heck is the FDA doing?

This isnt as simple as it sounds. For one thing, as noted in Turner and Knoepflers supplemental methods section:

However, it should be noted that according to 21 CFR 1271.3 (d) (4), minimally manipulated bone marrow for homologous use does not require pre-marketing approval by the FDA. 21 CFR 1271.15 (b) states that facilities removing cells or tissues from an individual and implanting those cells or tissues in the same individual during the same surgical procedure likewise do not require premarketing approval. In addition, federal regulations contain detailed criteria specifying when autologous or allogeneic cells can be used without first obtaining FDA premarketing approval. These criteria are identified in 21 CFR 1271.10. We mention these important sections of 21 CFR 1271 for a reason. Our goal was to identify businesses that engage in direct-to-consumer marketing of stem cell interventions and fit within our inclusion criteria. Judgments about regulatory compliance or noncompliance had no bearing on whether specific businesses were included in our database. Federal regulations governing marketing, manufacture, administration, and registration of cell-based interventions are complex, products are classified into different risk- based regulatory tiers, and we in no way wish to claim or imply that inclusion of particular businesses in Supplemental Table 1 means that they are noncompliant with federal regulations. Such determinations, as well as other assessments of regulatory compliance, must be made by legally authorized regulatory agencies after rigorous evaluation processes.

This is, of course, the reason why so many of these businesses offeror claim to offerbone marrow or adipose stem cells. If they dont manipulate the cells too much, they can skirt FDA regulations, although the FDA is moving to crack down on unproven stem cell treatments and have started to issue warning letters. Its a complex issue, but its hard not to look at the number of clinics and the breadth of health claims documented by Turner and Knoepfler and not come to the conclusion that there is a serious problem here. Its also clear that big money and political interests are hindering the FDA. For example:

Some proponents of deregulation argue that current federal regulations governing the advertising, processing, and administration of autologous stem cells are too onerous and have resulted in few approved stem cell therapies reaching the American marketplace (Chirba and Garfield, 2011, McAllister et al., 2012). The REGROW Act is an example of the current push from some political quarters and even from some individual stem cell researchers for lowering safety and efficacy standards for adult stem cell-based interventions. However, we found that hundreds of U.S. businesses are already promoting stem cell interventions for an extraordinary range of clinical indications. Advocates of deregulation will perhaps be pleased by our findings that many putative stem cell interventions are currently available for sale in the U.S. In contrast, proponents of a marketplace in which cell-based therapies have traditionally been tested for safety and efficacy and subject to pre-marketing review by the FDA will likely be concerned by how many U.S. businesses are currently marketing stem cell interventions. We are particularly concerned that we found many advertising claims related to ALS, Alzheimers disease, Parkinsons disease, and many other conditions for which there is no established scientific consensus that proven safe and efficacious stem cell treatments now exist.

The REGROW Act sounds a lot like the 21st Century Cures Act, ideologically-driven solutions that mistakenly argue that the way to let loose a torrent of cures for every disease imaginable is to unleash the power of the market through deregulation. In the case of the 21st Century Cures Act, its proponents propose to give the NIH a bit more money in return for weakening the FDA. Its basically a solution to a nonexistent problem. The REGROW Act is cut from the same cloth, as it would allow provisional approval of stem cell therapies without phase III trials and establishing a conditional approval paradigm. Together with right to try laws, the REGROW Act and the 21st Century Cures Act are of a piece with a libertarian, free market-driven agenda to hamper government regulatory agencies. Fortunately, the the REGROW Act v.2.0 appears to be going nowhere fast. Meanwhile these stem cell clinics are scrambling to deny that they are doing anything unethical, illegal, or dangerous.

Perusing some of the websites, I couldnt help but notice how dubious stem cell therapies seem to have found a comfortable home in alternative medicine clinics. Perhaps the most blatant example I found was the Purety Family Medical Clinic, which advertises itself as holistic medicine specialists for women, men, and pediatrics as well as prolotherapy, IV, ozone, chelation, HRT and FMT. Right alongside stem cell injections for badly injured or degenerated tissue, Purety also offers chelation therapy for heavy metal detoxification, high dose vitamin C drips, ozone therapy for cancer, naturopathy, fecal transplants for a variety of illnesses, and, yes, homeopathy, The One Quackery to Rule Them All.

Unfortunately, given how potentially promising stem cell therapies are, right now they are tainted by association with quackery like that described above. Basically, stem cells are being sold as being every bit as magical as alternative medicine like homeopathy. However, as PZ Myers points out:

Stem cells are not magic. They are plastic cells that are pluripotent they can differentiate into a variety of different tissues. But they need instructions and signals in order to develop in a constructive way, and the hard part is reconstructing environmental cues to shape their actions. Theyre like Lego building blocks you can build model spaceships or submarines or houses with them, and they have a lot of creative potential, but its not enough to just throw the Lego blocks into a bag and shake them really hard.

Thats what these stem cell clinics are doing, injecting stem cells and hoping they do their thing without knowing how the body induces them to do their thing, all while charging patients large sums of money for the privilege of being in what is in essence a poorly designed, poorly regulated clinical trial.

I dont know about you, but if I were a legitimate advocate of stem cell therapies, Id be very disturbed at how easily stem cell therapies are currently integrated with pure quackery like chelation therapy and homeopathy. Being so easily associated with clinics like Purety is not a good way to make stem cell treatments respectable, but it is a good way to make a lot of money if you arent that concerned with medical evidence or ethicsat least until the next Jim Gass hits the news.

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Integrative Health – Raritan Bay Medical Center

August 4th, 2016 9:35 am

The New Standard of Care

State-of-the-art health care has been redefined by combining the latest medical advances with complementary therapies. Called integrative health, this approach to healthcare is rapidly becoming the new standard because it introduces broader possibilities for healing and nurturing the body, mind and spirit.

Integrative health treats the whole person, not just the disease and gives patients more opportunities to participate in their care and enrich their health and well-being.

Many complementary therapies have been around for centuries, and there are numerous benefits associated with integrative health, such as:

Free Inpatient Services

Inpatients may call to schedule a free 15- to 20-minute in-room hand or foot massage, Reiki or Qigong healing session or Guided Imagery. Music and meditation CDs and CD players with disposable earphones are available by request.

Service Descriptions

Services are administered by qualified, credentialed practitioners and specialists. To schedule an appointment, or for more information, call Ext. 5257.

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Integrative Health - Raritan Bay Medical Center

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Bridgewater, New Jersey – American Diabetes Association

August 4th, 2016 9:35 am

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New Jerseyans are increasingly feeling the effects of diabetes as thousands of people suffer from the disease, and many others may have diabetes and not know it! It is estimated that one out of every three children born after 2000 in the United States will be directly affected by diabetes.

That is why the American Diabetes Association's New Jersey office is so committed to educating the public about how to stop diabetes and support those living with the disease.

We are here to help.

Additional Events

The American Diabetes Association's New Jersey office provides great local programs for people living with diabetes, their friends and family. Learn about our available programs.

The following New Jersey businesses and organizations have been designated Health Champions from the American Diabetes Association. This designation recognizes organizations that inspire and encourage organizational well-being and is part of the Association's Wellness Lives Here initiative. Learn more.

BD Horizon Blue Cross Blue Shield of New Jersey JBL Electric Nestle Nutrition Quest Diagnostics Verizon

Sign upfor our monthly newsletter to learn about news and events in the New Jersey area.

If you would like a representative from the American Diabetes Association to speak at your event or if you would like materials to distribute at a health fair or expo, please call 732-469-7979. You can also email your request tobmarsicano@diabetes.org.

We welcome your help.

Your involvement as an American Diabetes Association volunteer whether on a local or national level will help us expand our community outreach and impact, inspire healthy living, intensify our advocacy efforts, raise critical dollars to fund our mission, and uphold our reputation as the moving force and trusted leader in the diabetes community.

Find volunteer opportunities in our area through the Volunteer Center.

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Molecular Genetics and Genomics Program – Wake Forest …

August 4th, 2016 9:35 am

The Molecular Genetics and GenomicsProgram in the Wake Forest School of Medicine is an interdisciplinary research and PhD training program composed of a diverse group of investigators employing molecular and genetic approaches to biomedical research.

The Program includes molecular biologists from each of the basic science departments of the School of Medicine as well as clinical faculty involved in laboratory research. Participating investigators include faculty from the departments of Biochemistry, Cancer Biology, Neurobiology and Anatomy, Medicine, Microbiology and Immunology, Pathology, Pediatrics, Physiology and Pharmacology, and Surgery. Many program faculty are also members of the Comprehensive Cancer Center of Wake Forest University.

Part of the first-year Molecular & Cellular Biosciences (MCB) track, the objective of the PhD training program is to provide an interdisciplinary curriculum that emphasizes the detailed analysis of fundamental biological processes using the tools of molecular biology and genetics. Individualized programs of study are designed to train students for independent careers in research and teaching. The first year MCB curriculum provides broad exposure to the fundamentals of molecular and cellular biology, biochemistry, and microbiology.

After the completion of the first year in the MCB track, students that select a Molecular Genetics & Genomics research advisor begin specialization in the research area of that laboratory. Areas of active investigation include the genetics of complex diseases, genetic epidemiology, epigenetics, and bioinformatics.

Click here to obtain information on the APPLICATION PROCESS for the Molecular Genetics and GenomicsProgram.

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New England Centenarian Study BUMC

August 4th, 2016 9:35 am

New England Centenarian Study

To Discover the Secrets of A Long Healthy and Happy Life

Our two major studies are the New England Centenarian Study (founded 1995) and the multi-center Long Life Family Study (Boston Medical Center is one of 5 study sites),established in 2006.

We are actively seekingparticipants to be in the New England Centenarian Study. The criteria are simply subjects age 103+ years oldor 100+ years with siblings.

If you would like to contact the study, please call us at 888-333-6327 (toll free) where you will hear a menu tobe connected toa member of the research staff (please choose this option). You can alsoemail the study manager, Stacy Andersen PhD at stacy@bu.edu or the Principal Investigator, Thomas Perls MD, MPH at thperls@bu.edu.

The New England Centenarian Study is funded by:

The Martin A. Samowitz Foundation

Since 2006, the Long Life Family Studyhas beenconducting a prospective study of 5,000 subjects belonging to about 550 families that demonstrateparticularly unusualclustering for exceptional longevity. The Long Life Family Study is funded by and collaborates closely with The National Institute on Aging.

Pleasecall Dr. Thomas Perls toll-free at 888-333-6327 or email him at thperls@bu.edu if you or a family member wish to discuss our studies, find out more information regarding enrollment or to discuss supporting our studies.

MEDIA INQUIRES: Please contact

Jenny Eriksen Leary Manager of Media Relations Boston Medical Center 617-638-6841 jenny.eriksen@bmc.org

Genes play a critical and complex role in facilitating exceptional longevity. The genetic influence becomes greater and greater with older and older ages, especially beyond 103 years of age.

Citation: Genetic Signatures of Exceptional Longevity in Humans. Paola Sebastiani, Nadia Solovieff, Andrew T. DeWan, Kyle M. Walsh, Annibale Puca, Stephen W. Hartley, Efthymia Melista, Stacy Andersen, Daniel A. Dworkis, Jemma B. Wilk, Richard H. Myers, Martin H. Steinberg, Monty Montano, Clinton T. Baldwin, Josephine Hoh, Thomas T. Perls. PloS ONE 2012. DOI: 10.1371/journal.pone.0029848.

Many of the above genetic findings were replicated in a combination of 5 collaborating centenarian studies.

Citation: Meta-analysis of genetic variants associated with human exceptional longevity. Paola Sebastiani, Harold Bae1, Fangui X. Sun, Stacy L. Andersen, E. Warwick Daw, Alberto Malovini, Toshio Kojima, Nobuyoshi Hirose, Nicole Schupf, Annibale Puca, Thomas T Perls. Aging (Albany NY) 2013 September; 5(9): 653661. Published online 2013 August 24. PMCID: PMC3808698

In another paper published January, 2012, we have produced perhaps some of our most exciting findings to date. Early oninThe New England Centenarian Study, we thought that centenarians had to markedly delay or even escape age-related diseases like heart attacks, stroke, diabetes and Alzheimers, or else they would never be able to get to their very old ages. In fact, in 1980, a Stanford researcher named James Fries proposed the Compression of Morbidity hypothesis which states that as one approaches the limit of human life span, they must compress the time that they develop diseases towards the very end of their life and he proposed that people around the age of 100 do this. However, in 2003 we found that many of our centenarian subjects had age related diseases even before the age of 80 (about 43%, and whom we called survivors), after the age of 80 (about 42% and whom we called delayers) and lastly, those who had no mortality-associated diseases at age 100 (about 15% and whom we called escapers). The key though was that 90% of all of the centenarians were still independently functioning at the average age of 93 years. Somehow, despite the presence of diseases, people who become centenarians dont die from those diseases, but rather they are able to deal with them much better than other people and remain independently functioning more than 30 years beyond the age of 60. Therefore it seemed to us that for these study participants, it was not so much the compression of morbidity that was important to their survival, but rather a compression of disability.

In this current paper though, titled Health span approximates life span among many supercentenarians: Compression of morbidity at the approximate limit of life span, we have found that we just werent looking at old enough subjects when investigating Jim Fries hypothesis. As some of you know, over the past few years we have been working hard on recruiting and enrolling the most extreme old, supercentenarians who are people that live to 110 years and older. Once we enrolled our hundredth super-centenarian (by far the largest collection of supers in the world), we were able to investigate whether or not people who truly approach the limit of human lifespan actually compress their morbidity towards the end of their lives. Inour study of a reference group, nonagenarians (subjects in their nineties), centenarians (ages 100-104), semi-supercentenarians (ages 105-109) and supercentenarians(ages 110+), the subjects had progressively shorter periods of their lives spent with age-related diseases, from 17.9% of their lives in the referent group, to 9.4% in the nonagenarians and down to 5.2% in the supercentenarians. These findings support the compression of morbidity hypothesis and the idea that there truly is a limit to human life span 125 years. Also the supercentenarians were much more alike in terms of the markedly delayed age of onset of age-related diseases compared to the subjects age 100-104 who were quite heterogeneous. That homogeneity indicates they must have some factors (presumably genetic) in common that allow them to be so similar. We believe that our oldest subjects, ages 105+ years, give us the best chance and discovering these genes.

Citations: Health span approximates life span among many supercentenarians: Compression of morbidity at the approximate limit of life span Andersen SL, Sebastiani P, Dworkis DA, Feldman L, Perls T. J Gerontol A Biol Sci Med Sci 2012;67A:395-405.

Families Enriched for Exceptional Longevity also have Increased Health-Span: Findings from the Long Life Family Study. Paola Sebastiani, Fangui X. Sun, Stacy L. Andersen, Joseph H. Lee, Mary K. Wojczynski, Jason L. Sanders, Anatoli Yashin, Anne B. Newman, Thomas T. Perls. Front Public Health. 2013; 1: 38. Prepublished online 2013 August 16. Published online 2013 September 30. doi:10.3389/fpubh.2013.00038. PMCID: PMC3859985.

The New England Centenarian Study, along with collaborators at the Scripps Institute and the University of Florida, Gainesville, performed and published the first-ever whole genome sequence of a supercentenarian and actually not one super, but two, both over the age of 114 years and one was a man and the other a woman. As with our paper on the genetic signatures of exceptional longevity, we found here as well that centenarians have just as many genetic variants associated with diseases as the general population. However, they likely also have longevity-associated variants that counteract such disease genes, thus allowing for slower aging and increased resistance to age-related diseases.

In this paper we also found several genes that occurred in our published genetic prediction model which had coding regions that led to differences in gene function. These findings support the validity of the genetic prediction model. The New England Centenarian Study has posted the whole genome sequences of these two subjects on a data repository (called dbGaP) based at the National Institutes of Health. This will allow researchers from around the world to access all of the data and use them for their own research. Our hope is that these data will lead to important discoveries about genes that help delay or allow the escape from age related diseases like Alzheimers disease.

Citation: Whole genome sequences of male and female supercentenairnas, Both ages >114 years. Sebastiani P, Riva A, Montano M, Pham P, Torkamani A, Scherba E, Benson G, Milton JN, Baldwin CT, Andersen S, Schork NJ, Steinberg MH, Perls T. Frontiers in Genetics of Aging 2012;2.

There is a growing body of evidence for a substantial genetic influence upon survival to the most extreme ages. An important question is what would be the selection pressure(s) for the evolution of longevity associated genetic variants. The pressure to have a longer period of time during which women can bear children and therefore have more of them and therefore have greater success in passing ones genes down to subsequent generations could be one such pressure. This hypothesis is consistent with the disposable soma theory where the tradeoff in energy allocation between reproductive fitness and repair/maintenance functions can be delayed when longevity associated variants facilitate slower aging and the delay or prevention of age-related diseases that also adversely affect fertility. Several studies have noted an association between older maternal age and an increased odds of exceptional survival. The New England Centenarian Study assessed maternal age history in its sample of female centenarians and a birth-cohort-matched referent sample of women who survived to the cohorts average life expectancy. Women who gave birth to a child after the age of 40 (fertility assistance was not technologically available to this cohort) had a four times greater odds of being a centenarian. Numerous investigators are now searching for and investigating genes that influence reproductive fitness in terms of their ability to also influence rate of aging and susceptibility to age-related diseases.

Citations: Middle-aged mothers live longer.Perls TT, Alpert L, Fretts RC. Nature. 1997 Sep 11;389(6647):133.PMID: 9296486 [PubMed indexed for MEDLINE]

Extended maternal age at birth of last child and womens longevity in the Long Life Family Study.Sun F, Sebastiani P, Schupf N, Bae H, Andersen SL, McIntosh A, Abel H, Elo IT, Perls TT. Menopause. 2015 Jan;22(1):26-31. doi: 10.1097/GME.0000000000000276. PMID: 24977462. [PubMed in process]

The reappearance of procaine hydrochloride (Gerovital H3) for antiaging.Perls T. J Am Geriatr Soc. 2013 Jun;61(6):1024-5. doi: 10.1111/jgs.12278. No abstract available. PMID: 23772727. [PubMed indexed for MEDLINE]

Growth hormone and anabolic steroids: athletes are the tip of the iceberg.Perls TT. Drug Test Anal. 2009 Sep;1(9-10):419-25. doi: 10.1002/dta.87. PMID: 20355224 [PubMed indexed for MEDLINE]. Abstract: Professional Athletes misuse of anabolic steroids, growth hormone and other drugs are the tip of a very large, mostly ignored iceberg, made up of people who receive these drugs for such non-medical uses as body-building, school sports and anti-aging. Although these drugs are often used in combination, this article focuses on growth hormone. Fuelling the demand for these drugs are drug manufacturers, pharmacies, websites, clinics and their doctors.

New developments in the illegal provision of growth hormone for anti-aging and bodybuilding.Olshansky SJ, Perls TT. JAMA. 2008 Jun 18;299(23):2792-4. doi: 10.1001/jama.299.23.2792. No abstract available. PMID: 18560007 [PubMed indexed for MEDLINE]

DHEA and testosterone in the elderly.Perls TT. N Engl J Med. 2007 Feb 8;356(6):636; author reply 637. No abstract available. PMID: 17288051 [PubMed indexed for MEDLINE]

Hope drives antiaging hype.Perls TT. Cleve Clin J Med. 2006 Dec;73(12):1039-40, 1044. Review. No abstract available. PMID: 17190307 [PubMed indexed for MEDLINE]

Provision or distribution of growth hormone for antiaging: clinical and legal issues.Perls TT, Reisman NR, Olshansky SJ. JAMA. 2005 Oct 26;294(16):2086-90. No abstract available. PMID: 16249424 [PubMed indexed for MEDLINE]

Anti-aging quackery: human growth hormone and tricks of the trademore dangerous than ever.Perls TT. J Gerontol A Biol Sci Med Sci. 2004 Jul;59(7):682-91. PMID: 15304532 [PubMed indexed for MEDLINE]

The hype and the realitypart I.Olshansky SJ, Hayflick L, Perls TT. J Gerontol A Biol Sci Med Sci. 2004 Jun;59(6):B513-4. No abstract available. PMID: 15215255 [PubMed indexed for MEDLINE]

Antiaging medicine: what should we tell our patients? Perls T. Aging HealthApril 2010, Vol. 6, No. 2, Pages 149-154 , DOI 10.2217/ahe.10.11 (doi:10.2217/ahe.10.11)

To speak to someone about our research, please call our toll free number: 1-888-333-NECS (6327). Choose the option to speak with a member of our staff and you will be directed to the right person.

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The Current Landscape for Direct-to-Consumer Genetic …

August 4th, 2016 9:35 am

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Integrative Medicine | Primary Children’s Hospital

August 4th, 2016 9:35 am

Integrative Medicine is healing-oriented medicine that encompasses the whole child, including all aspects of lifestyle. It emphasizes the therapeutic relationship and makes use of both conventional and alternative therapies.

First-time patients are asked to complete a patient history form in advance and bring all their medical records with them. A comprehensive evaluation takes place based on the medical history and physical findings. Then, a specific treatment plan is suggested and discussed.

During the first session, children may receive their first treatment, along with techniques to try at home. An initial consultation will usually last 45-60 minutes. Please note that it may take 6-8 clinic visits to see if a particular therapy is working for your child or to make adjustments to a therapy plan.

Discounts are available for patients who have no have no insurance or know acupuncture is a non-covered benefit by their insurance. There is an immediate 25% discount on the payment of estimated charges at the time of service. If the estimate is low, families have the opportunity with their first statement to receive an additional 5% discount by paying the balance in full. This brings the total discount to 30% on the entire bill. Call the number indicated on the statement to make these arrangements.

Families may elect to pay actual charges in full on the day of service in order to receive a 40% discount. This is the 25% discount for payment at the time of service plus an additional 15% discount for no balance billing needed.

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Integrative Medicine | Primary Children's Hospital

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Gene Therapy in Sheep May Bring Hope to Adults With Tay …

August 4th, 2016 9:35 am

For 26 years, doctors could not piece together the medical puzzle of Stewart Altman's symptoms -- as a child growing up on Long Island, he was uncoordinated and slurred his speech. Later, as a volunteer fireman, he kept falling down and had trouble climbing the ladders.

It seemed unrelated at the time, but his older sister, who had a history of psychological symptoms, was hospitalized in a mental institution. Her psychiatrist suspected a physical disorder and consulted a geneticist who eventually connected the dots.

In 1978, Altman and his sister Roslyn Vaccaro were given a stunning diagnosis: Tay-Sachs -- an inherited neurological disease that typically affects babies, killing them between the ages of 3 and 5. Only several hundred cases exist in the United States.

Altman, now 58, has a non-fatal, adult form of the disease, late onset Tay-Sachs (LOTS), and depends on his wife and a service dog to perform most daily tasks.

"I am devastated," Altman said of the disease that has robbed him of much of his speech and muscle strength, confining him to a wheelchair. "But the alternative is much worse."

His sister died in 2000 after battling LOTS-related bipolar disorder and schizophrenia -- which occurs in 50 to 60 percent of all adult cases -- and Altman and his wife raised her two sons.

Now scientists are hopeful that gene therapy may help late-onset patients like Altman and look forward to human trials.

Tay-Sachs is caused by gene mutation results in the absence or insufficient levels of the enzyme, hexosamindase A or Hex A. Without it, a fatty substance or lipids accumulates in the cells, mostly in the brain. It comes in three forms: infantile, juvenile or adult onset.

Doctors say there can be great variations in the presentation of Tay-Sachs, even in the same family with the same mutations. Babies born with Tay-Sachs appear normal at first, but by 3 or 4 years old, their nerve cells deteriorate and they eventually die. Those with LOTS can live a long life, but, like Altman, are progressively disabled.

The story of Tay-Sachs is a miraculous one. It was first identified in the late 1800s by British ophthalmologist Warren Tay and New York neurologist Bernard Sachs, who noticed the disease was prevalent in Jews of Eastern European origin.

In the 1970s and 1980s, when genetic testing became available, synagogues launched public education campaigns encouraging prospective parents to be tested, and the disease was virtually eliminated in those of Jewish ancestry.

Now, mostly non-Jews, though their risk is not as great, are among the 100 American children who have the disease, according to the National Tay-Sachs and Allied Diseases Association (NTSAD), which leads the fight for a cure.

Altman's speech is difficult to understand, so his wife Lorrie said her husband of 37 years wanted the public to know, "it's not just an infant's disease."

"Tay-Sachs is also in the general population and people don't know," she said. "He thinks we need to get the word out. One in 250 Americans carries the gene."

French Canadians, Louisiana Cajuns and even those of English-Irish ancestry have a greater chance of carrying the recessive gene that causes the disease.

Tay-Sachs is an autosomal recessive disorder, which means each parent must carry the gene. Their children have a 25 percent chance of developing Tay-Sachs, 50 percent chance of being a carrier and a 25 percent chance of being free of that recessive gene.

Altman was born in 1952, before genetic testing was available. Both his parents were carriers of the recessive gene that causes Tay-Sachs and both he and sister were stricken with the mildest form of the disease. Two of their brothers were unaffected, although one is a carrier.

The Massapequa, N.Y., couple have two healthy sons, who are carriers, but whose wives are not, and four healthy grandchildren.

For years, Altman was able to get around with a walker until he had to drop out of a clinical trial for a new drug because of debilitating side effects. After that, he said he lost 40 pounds and so much muscle that he could no longer stand on his own.

"Between the two of us we handle it and we lead kind of a normal life," said Lorrie. "But we have no idea what the future will bring."

Altman works at Nassau University Medical Center in the security monitoring department. He raises funds for about 11 different non-profit organizations, including NTSAD, and has given presentations to the Boy Scouts and senior citizens.

Much of the public work has now ended, as his speech has become more incomprehensible because the degeneration of the nerves that control his respiratory muscles.

"Stewart has a good way of just living in the moment," said his wife, who met Altman in college. "But the worst part for him is his speech. He is such a social, outgoing person."

He has faced discrimination along the way, especially after leaving a Manhattan engineering job because he couldn't climb the subway stairs.

"He has such a hard time getting a job -- it was devastating," said Lorrie Altman. "On paper, he looked so good, but his speech was terrible. He has a college degree and isn't stupid, but all people see is the wheelchair."

Doctors say that many with the milder adult form of Tay-Sachs can lead full lives, despite their disability. And science is getting closer to finding treatments for this devastating disease.

Dr. Edwin Kolodny, former department chair and now professor of neurology at New York University School of Medicine, has been a leader in the field for 30 years. He first helped identify the role of the enzyme Hex-A and later tested more than 30,000 young adults in the 1970s and 1980s.

Today, he and others are involved in the promising gene therapy studies involving first mice, then cats and now sheep. Injecting genes into the brains of Jacob lambs has doubled their life span.

Clinical trials on humans are set to begin as soon as researchers can raise another $700,000 -- in addition to a grant from the National Institutes of Health -- to manufacture the vectors required to insert the genes into the body.

"It seems like every parent in the world would like to be part of the trial," said Kolodny. "And there are reasons to think there will be success here, especially for children who have a slightly later onset and not the classic form Tay-Sachs."

In the past, infantile Tay-Sachs has seen most of the medical attention. "These children have zero quality of life," he said.

Those with mild mutations, like Altman, who have 5 to 10 percent of Hex A enzyme activity, "sometimes lead full lives," according to Kolodny. "Intellectually, most of their cognitive function is retained. We have patients who are lawyers and accountants."

Pre-conception testing is still the gold standard for fighting the disease. "If your parents don't have the same recessive genes, you are home free," he said.

Those identified as at risk for having a child with Tay-Sachs can decide to adopt or conceive through in vitro fertilization, where geneticists can test the embryos before implantation to ensure the child will be disease-free.

Doctors can also do prenatal genetic testing and if the fetus is affected, the decision is up to the parents whether or not they want to terminate the pregnancy. "Three out of four times, they are reassured they have a normal child," said Kolodny.

Doctors say such testing -- at a cost of around $100 -- should be done routinely for 18 autosomal recessive disorders, including the gene for cystic fibrosis, which occurs in one in 20 caucasians, said Kolodny. Even with advances in Tay-Sachs testing in the Jewish community, public education must continue.

"The problem is each generation forgets what happened in the prior generation -- the grandmothers die out, " said Kolodny. "We need to educate health care professionals. Each new group of students graduating from medical school isn't prepared to ask the right questions."

Susan Kahn, NTSAD's executive director, who is involved in fundraising for research, agrees that along with a fight for a cure, genetic testing is critical.

"When there is a genetic disease, it's not just about that person, there is a whole implication for the rest of the family and how they deal with it," she said.

Stewart Altman sits on the association's board of directors and is a tireless crusader for a cure.

"He's got some disabilities that make it difficult for him to do certain things, but of all the board members asking for money to support, he is probably the boldest in our group," said Kahn. "He does have a lot of limitations, but he is still very energetic and wants to do something important. Not everyone responds with the same attitude."

His wife Lorrie backed that up with a laugh. "He is persistent," she said. "He carries these little envelopes around and will ask anyone he meets for a donation. It's almost embarrassing. He's not afraid to ask."

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Goodbye Root Canals? New Treatment Uses Dental Stem Cells …

August 4th, 2016 9:35 am

July 7, 2016 11:30 AM

Dental checkup. (Photo by Philippe Huguen/AFP/Getty Images)

CAMBRIDGE (CBS) Could root canals one day become a thing of the past?

That might just happen if a new treatment developed by scientists at Harvard University and the University of Nottingham catches on.

The freshapproach by researchers that was just awarded a Royal Society of Chemistry prize works to stimulate native stem cells inside teeth, triggering repair and regeneration of pulp tissue.

Dental fillings in their current state dont do anything to help heal teeth and are actually toxic to cells, Dr. Adam Celiz of the University of Nottingham says.

In cases of dental pulp disease and injury a root canal is typically performed to remove the infected tissues, Celiz said in a statement. The new treatment can be used similarly to dental fillings but can be placed in direct contact with pulp tissue to stimulate the native stem cell population for repair and regeneration of pulp tissue and the surrounding dentin.

The breakthrough could potentially impact millions of dental patients every year, the scientists say.

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Blindness (2008) – Plot Summary – IMDb

August 4th, 2016 9:35 am

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Showing all 4 plot summaries

A city is ravaged by an epidemic of instant "white blindness". Those first afflicted are quarantined by the authorities in an abandoned mental hospital where the newly created "society of the blind" quickly breaks down. Criminals and the physically powerful prey upon the weak, hoarding the meager food rations and committing horrific acts. There is, however, one eyewitness to the nightmare. A woman whose sight is unaffected by the plague follows her afflicted husband to quarantine. There, keeping her sight a secret, she guides seven strangers who have become, in essence, a family. She leads them out of quarantine and onto the ravaged streets of the city, which has seen all vestiges of civilization crumble.

A doctor's wife becomes the only person with the ability to see in a town where everyone is struck with a mysterious case of sudden blindness. She feigns illness in order to take care of her husband as her surrounding community breaks down into chaos and disorder.

When a big city has a mysterious outbreak of blindness, the victims are quarantined by the government in a hospital without any medical care, treatment or hygiene. Among the first people affected by the so called "white blindness" are an ophthalmologist and his reluctant healthy wife who has not lost her sight but stays with him to help him in the difficult moment. The place immediately crowds and a group of criminals takes the power, demanding jewels and electronics first and sex later for the limited ratio of food they control.

A city is ravaged by an epidemic of instant white blindness.

The story of Blindness begins on a morning in an unnamed city during rush-hour traffic. As the traffic lights change...

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What is Gene Therapy? (with pictures) – wiseGEEK

August 4th, 2016 9:35 am

Gene therapy is a way of inserting genes into a patient's cells and replacing the preexisting alleles, or gene variants, to perform some therapeutic function. It has been used thus far primarily to replace mutant defective genes, or alleles, with normal alleles, but could in theory be used to edit the human genome arbitrarily. If gene therapy were applied to reproductive cells in the gonads (the germline), these genetic changes would be heritable. This process has never been performed, but it has a name: germline genetic engineering.

Since the early 1980s, gene therapy has been used to produce medicines. Say that a human being needs a certain protein as a medicine. This therapy uses a viral vector, that is, a virus modified to contain the DNA to be introduced. Large quantities of the virus are injected to the target area, or, sometimes tissue is removed, infected with the virus, and then implanted again. The viruses are modified such that the vast majority are not capable of independent self-replication - providing little chance for pathogenic infection. The virus introduced the new DNA into the genome of human cells, much in the same way normal viruses introduce their own genetic material into human cells, hijacking the cellular machinery.

After the new DNA is integrated into the target cell, the cell begins to manufacture proteins specified by the new genetic material, which in some instances, can be lifesaving. For example, patients with severe diabetes may be given the cellular machinery to produce insulin, obviating the need for regular injections. The benefits of the therapy can last for weeks, months, or even years or a lifetime.

Gene therapy has been used successfully to treat inherited retinal disease, thalassaemia, cystic fibrosis, severe combined immunodeficiency, and some cancers. Medical miracles not possible with any other approach have been demonstrated by gene therapy, such as reprogramming the body's natural sentinels, T-cells, to attack cancer cells. Gene therapy shows promise for treating afflictions such as Huntington's disease and sickle cell anemia. As the therapy continues to mature, it could save millions of lives.

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Gene – Wikipedia, the free encyclopedia

August 4th, 2016 9:35 am

This article is about the heritable unit for transmission of biological traits. For other uses, see Gene (disambiguation).

A gene is a locus (or region) of DNA which is made up of nucleotides and is the molecular unit of heredity.[1][2]:Glossary The transmission of genes to an organism's offspring is the basis of the inheritance of phenotypic traits. Most biological traits are under the influence of polygenes (many different genes) as well as the geneenvironment interactions. Some genetic traits are instantly visible, such as eye colour or number of limbs, and some are not, such as blood type, risk for specific diseases, or the thousands of basic biochemical processes that comprise life.

Genes can acquire mutations in their sequence, leading to different variants, known as alleles, in the population. These alleles encode slightly different versions of a protein, which cause different phenotype traits. Colloquial usage of the term "having a gene" (e.g., "good genes," "hair colour gene") typically refers to having a different allele of the gene. Genes evolve due to natural selection or survival of the fittest of the alleles.

The concept of a gene continues to be refined as new phenomena are discovered.[3] For example, regulatory regions of a gene can be far removed from its coding regions, and coding regions can be split into several exons. Some viruses store their genome in RNA instead of DNA and some gene products are functional non-coding RNAs. Therefore, a broad, modern working definition of a gene is any discrete locus of heritable, genomic sequence which affect an organism's traits by being expressed as a functional product or by regulation of gene expression.[4][5]

The existence of discrete inheritable units was first suggested by Gregor Mendel (18221884).[6] From 1857 to 1864, he studied inheritance patterns in 8000 common edible pea plants, tracking distinct traits from parent to offspring. He described these mathematically as 2ncombinations where n is the number of differing characteristics in the original peas. Although he did not use the term gene, he explained his results in terms of discrete inherited units that give rise to observable physical characteristics. This description prefigured the distinction between genotype (the genetic material of an organism) and phenotype (the visible traits of that organism). Mendel was also the first to demonstrate independent assortment, the distinction between dominant and recessive traits, the distinction between a heterozygote and homozygote, and the phenomenon of discontinuous inheritance.

Prior to Mendel's work, the dominant theory of heredity was one of blending inheritance, which suggested that each parent contributed fluids to the fertilisation process and that the traits of the parents blended and mixed to produce the offspring. Charles Darwin developed a theory of inheritance he termed pangenesis, from Greek pan ("all, whole") and genesis ("birth") / genos ("origin").[7][8] Darwin used the term gemmule to describe hypothetical particles that would mix during reproduction.

Mendel's work went largely unnoticed after its first publication in 1866, but was rediscovered in the late 19th-century by Hugo de Vries, Carl Correns, and Erich von Tschermak, who (claimed to have) reached similar conclusions in their own research.[9] Specifically, in 1889, Hugo de Vries published his book Intracellular Pangenesis,[10] in which he postulated that different characters have individual hereditary carriers and that inheritance of specific traits in organisms comes in particles. De Vries called these units "pangenes" (Pangens in German), after Darwin's 1868 pangenesis theory.

Sixteen years later, in 1905, the word genetics was first used by William Bateson,[11] while Eduard Strasburger, amongst others, still used the term pangene for the fundamental physical and functional unit of heredity.[12] In 1909 the Danish botanist Wilhelm Johannsen shortened the name to "gene".[13]

Advances in understanding genes and inheritance continued throughout the 20th century. Deoxyribonucleic acid (DNA) was shown to be the molecular repository of genetic information by experiments in the 1940s to 1950s.[14][15] The structure of DNA was studied by Rosalind Franklin using X-ray crystallography, which led James D. Watson and Francis Crick to publish a model of the double-stranded DNA molecule whose paired nucleotide bases indicated a compelling hypothesis for the mechanism of genetic replication.[16][17] Collectively, this body of research established the central dogma of molecular biology, which states that proteins are translated from RNA, which is transcribed from DNA. This dogma has since been shown to have exceptions, such as reverse transcription in retroviruses. The modern study of genetics at the level of DNA is known as molecular genetics.

In 1972, Walter Fiers and his team at the University of Ghent were the first to determine the sequence of a gene: the gene for Bacteriophage MS2 coat protein.[18] The subsequent development of chain-termination DNA sequencing in 1977 by Frederick Sanger improved the efficiency of sequencing and turned it into a routine laboratory tool.[19] An automated version of the Sanger method was used in early phases of the Human Genome Project.[20]

The theories developed in the 1930s and 1940s to integrate molecular genetics with Darwinian evolution are called the modern evolutionary synthesis, a term introduced by Julian Huxley.[21] Evolutionary biologists subsequently refined this concept, such as George C. Williams' gene-centric view of evolution. He proposed an evolutionary concept of the gene as a unit of natural selection with the definition: "that which segregates and recombines with appreciable frequency."[22]:24 In this view, the molecular gene transcribes as a unit, and the evolutionary gene inherits as a unit. Related ideas emphasizing the centrality of genes in evolution were popularized by Richard Dawkins.[23][24]

The vast majority of living organisms encode their genes in long strands of DNA (deoxyribonucleic acid). DNA consists of a chain made from four types of nucleotide subunits, each composed of: a five-carbon sugar (2'-deoxyribose), a phosphate group, and one of the four bases adenine, cytosine, guanine, and thymine.[2]:2.1

Two chains of DNA twist around each other to form a DNA double helix with the phosphate-sugar backbone spiralling around the outside, and the bases pointing inwards with adenine base pairing to thymine and guanine to cytosine. The specificity of base pairing occurs because adenine and thymine align to form two hydrogen bonds, whereas cytosine and guanine form three hydrogen bonds. The two strands in a double helix must therefore be complementary, with their sequence of bases matching such that the adenines of one strand are paired with the thymines of the other strand, and so on.[2]:4.1

Due to the chemical composition of the pentose residues of the bases, DNA strands have directionality. One end of a DNA polymer contains an exposed hydroxyl group on the deoxyribose; this is known as the 3'end of the molecule. The other end contains an exposed phosphate group; this is the 5'end. The two strands of a double-helix run in opposite directions. Nucleic acid synthesis, including DNA replication and transcription occurs in the 5'3'direction, because new nucleotides are added via a dehydration reaction that uses the exposed 3'hydroxyl as a nucleophile.[25]:27.2

The expression of genes encoded in DNA begins by transcribing the gene into RNA, a second type of nucleic acid that is very similar to DNA, but whose monomers contain the sugar ribose rather than deoxyribose. RNA also contains the base uracil in place of thymine. RNA molecules are less stable than DNA and are typically single-stranded. Genes that encode proteins are composed of a series of three-nucleotide sequences called codons, which serve as the "words" in the genetic "language". The genetic code specifies the correspondence during protein translation between codons and amino acids. The genetic code is nearly the same for all known organisms.[2]:4.1

The total complement of genes in an organism or cell is known as its genome, which may be stored on one or more chromosomes. A chromosome consists of a single, very long DNA helix on which thousands of genes are encoded.[2]:4.2 The region of the chromosome at which a particular gene is located is called its locus. Each locus contains one allele of a gene; however, members of a population may have different alleles at the locus, each with a slightly different gene sequence.

The majority of eukaryotic genes are stored on a set of large, linear chromosomes. The chromosomes are packed within the nucleus in complex with storage proteins called histones to form a unit called a nucleosome. DNA packaged and condensed in this way is called chromatin.[2]:4.2 The manner in which DNA is stored on the histones, as well as chemical modifications of the histone itself, regulate whether a particular region of DNA is accessible for gene expression. In addition to genes, eukaryotic chromosomes contain sequences involved in ensuring that the DNA is copied without degradation of end regions and sorted into daughter cells during cell division: replication origins, telomeres and the centromere.[2]:4.2 Replication origins are the sequence regions where DNA replication is initiated to make two copies of the chromosome. Telomeres are long stretches of repetitive sequence that cap the ends of the linear chromosomes and prevent degradation of coding and regulatory regions during DNA replication. The length of the telomeres decreases each time the genome is replicated and has been implicated in the aging process.[27] The centromere is required for binding spindle fibres to separate sister chromatids into daughter cells during cell division.[2]:18.2

Prokaryotes (bacteria and archaea) typically store their genomes on a single large, circular chromosome. Similarly, some eukaryotic organelles contain a remnant circular chromosome with a small number of genes.[2]:14.4 Prokaryotes sometimes supplement their chromosome with additional small circles of DNA called plasmids, which usually encode only a few genes and are transferable between individuals. For example, the genes for antibiotic resistance are usually encoded on bacterial plasmids and can be passed between individual cells, even those of different species, via horizontal gene transfer.[28]

Whereas the chromosomes of prokaryotes are relatively gene-dense, those of eukaryotes often contain regions of DNA that serve no obvious function. Simple single-celled eukaryotes have relatively small amounts of such DNA, whereas the genomes of complex multicellular organisms, including humans, contain an absolute majority of DNA without an identified function.[29] This DNA has often been referred to as "junk DNA". However, more recent analyses suggest that, although protein-coding DNA makes up barely 2% of the human genome, about 80% of the bases in the genome may be expressed, so the term "junk DNA" may be a misnomer.[5]

The structure of a gene consists of many elements of which the actual protein coding sequence is often only a small part. These include DNA regions that are not transcribed as well as untranslated regions of the RNA.

Firstly, flanking the open reading frame, all genes contain a regulatory sequence that is required for their expression. In order to be expressed, genes require a promoter sequence. The promoter is recognized and bound by transcription factors and RNA polymerase to initiate transcription.[2]:7.1 A gene can have more than one promoter, resulting in messenger RNAs (mRNA) that differ in how far they extend in the 5'end.[30] Promoter regions have a consensus sequence, however highly transcribed genes have "strong" promoter sequences that bind the transcription machinery well, whereas others have "weak" promoters that bind poorly and initiate transcription less frequently.[2]:7.2Eukaryotic promoter regions are much more complex and difficult to identify than prokaryotic promoters.[2]:7.3

Additionally, genes can have regulatory regions many kilobases upstream or downstream of the open reading frame. These act by binding to transcription factors which then cause the DNA to loop so that the regulatory sequence (and bound transcription factor) become close to the RNA polymerase binding site.[31] For example, enhancers increase transcription by binding an activator protein which then helps to recruit the RNA polymerase to the promoter; conversely silencers bind repressor proteins and make the DNA less available for RNA polymerase.[32]

The transcribed pre-mRNA contains untranslated regions at both ends which contain a ribosome binding site, terminator and start and stop codons.[33] In addition, most eukaryotic open reading frames contain untranslated introns which are removed before the exons are translated. The sequences at the ends of the introns, dictate the splice sites to generate the final mature mRNA which encodes the protein or RNA product.[34]

Many prokaryotic genes are organized into operons, with multiple protein-coding sequences that are transcribed as a unit.[35][36] The products of operon genes typically have related functions and are involved in the same regulatory network.[2]:7.3

Defining exactly what section of a DNA sequence comprises a gene is difficult.[3]Regulatory regions of a gene such as enhancers do not necessarily have to be close to the coding sequence on the linear molecule because the intervening DNA can be looped out to bring the gene and its regulatory region into proximity. Similarly, a gene's introns can be much larger than its exons. Regulatory regions can even be on entirely different chromosomes and operate in trans to allow regulatory regions on one chromosome to come in contact with target genes on another chromosome.[37][38]

Early work in molecular genetics suggested the model that one gene makes one protein. This model has been refined since the discovery of genes that can encode multiple proteins by alternative splicing and coding sequences split in short section across the genome whose mRNAs are concatenated by trans-splicing.[5][39][40]

A broad operational definition is sometimes used to encompass the complexity of these diverse phenomena, where a gene is defined as a union of genomic sequences encoding a coherent set of potentially overlapping functional products.[11] This definition categorizes genes by their functional products (proteins or RNA) rather than their specific DNA loci, with regulatory elements classified as gene-associated regions.[11]

In all organisms, two steps are required to read the information encoded in a gene's DNA and produce the protein it specifies. First, the gene's DNA is transcribed to messenger RNA (mRNA).[2]:6.1 Second, that mRNA is translated to protein.[2]:6.2 RNA-coding genes must still go through the first step, but are not translated into protein.[41] The process of producing a biologically functional molecule of either RNA or protein is called gene expression, and the resulting molecule is called a gene product.

The nucleotide sequence of a gene's DNA specifies the amino acid sequence of a protein through the genetic code. Sets of three nucleotides, known as codons, each correspond to a specific amino acid.[2]:6 Additionally, a "start codon", and three "stop codons" indicate the beginning and end of the protein coding region. There are 64possible codons (four possible nucleotides at each of three positions, hence 43possible codons) and only 20standard amino acids; hence the code is redundant and multiple codons can specify the same amino acid. The correspondence between codons and amino acids is nearly universal among all known living organisms.[42]

Transcription produces a single-stranded RNA molecule known as messenger RNA, whose nucleotide sequence is complementary to the DNA from which it was transcribed.[2]:6.1 The mRNA acts as an intermediate between the DNA gene and its final protein product. The gene's DNA is used as a template to generate a complementary mRNA. The mRNA matches the sequence of the gene's DNA coding strand because it is synthesised as the complement of the template strand. Transcription is performed by an enzyme called an RNA polymerase, which reads the template strand in the 3' to 5'direction and synthesizes the RNA from 5' to 3'. To initiate transcription, the polymerase first recognizes and binds a promoter region of the gene. Thus, a major mechanism of gene regulation is the blocking or sequestering the promoter region, either by tight binding by repressor molecules that physically block the polymerase, or by organizing the DNA so that the promoter region is not accessible.[2]:7

In prokaryotes, transcription occurs in the cytoplasm; for very long transcripts, translation may begin at the 5'end of the RNA while the 3'end is still being transcribed. In eukaryotes, transcription occurs in the nucleus, where the cell's DNA is stored. The RNA molecule produced by the polymerase is known as the primary transcript and undergoes post-transcriptional modifications before being exported to the cytoplasm for translation. One of the modifications performed is the splicing of introns which are sequences in the transcribed region that do not encode protein. Alternative splicing mechanisms can result in mature transcripts from the same gene having different sequences and thus coding for different proteins. This is a major form of regulation in eukaryotic cells and also occurs in some prokaryotes.[2]:7.5[43]

Translation is the process by which a mature mRNA molecule is used as a template for synthesizing a new protein.[2]:6.2 Translation is carried out by ribosomes, large complexes of RNA and protein responsible for carrying out the chemical reactions to add new amino acids to a growing polypeptide chain by the formation of peptide bonds. The genetic code is read three nucleotides at a time, in units called codons, via interactions with specialized RNA molecules called transfer RNA (tRNA). Each tRNA has three unpaired bases known as the anticodon that are complementary to the codon it reads on the mRNA. The tRNA is also covalently attached to the amino acid specified by the complementary codon. When the tRNA binds to its complementary codon in an mRNA strand, the ribosome attaches its amino acid cargo to the new polypeptide chain, which is synthesized from amino terminus to carboxyl terminus. During and after synthesis, most new proteins must folds to their active three-dimensional structure before they can carry out their cellular functions.[2]:3

Genes are regulated so that they are expressed only when the product is needed, since expression draws on limited resources.[2]:7 A cell regulates its gene expression depending on its external environment (e.g. available nutrients, temperature and other stresses), its internal environment (e.g. cell division cycle, metabolism, infection status), and its specific role if in a multicellular organism. Gene expression can be regulated at any step: from transcriptional initiation, to RNA processing, to post-translational modification of the protein. The regulation of lactose metabolism genes in E. coli (lac operon) was the first such mechanism to be described in 1961.[44]

A typical protein-coding gene is first copied into RNA as an intermediate in the manufacture of the final protein product.[2]:6.1 In other cases, the RNA molecules are the actual functional products, as in the synthesis of ribosomal RNA and transfer RNA. Some RNAs known as ribozymes are capable of enzymatic function, and microRNA has a regulatory role. The DNA sequences from which such RNAs are transcribed are known as non-coding RNA genes.[41]

Some viruses store their entire genomes in the form of RNA, and contain no DNA at all.[45][46] Because they use RNA to store genes, their cellular hosts may synthesize their proteins as soon as they are infected and without the delay in waiting for transcription.[47] On the other hand, RNA retroviruses, such as HIV, require the reverse transcription of their genome from RNA into DNA before their proteins can be synthesized. RNA-mediated epigenetic inheritance has also been observed in plants and very rarely in animals.[48]

Organisms inherit their genes from their parents. Asexual organisms simply inherit a complete copy of their parent's genome. Sexual organisms have two copies of each chromosome because they inherit one complete set from each parent.[2]:1

According to Mendelian inheritance, variations in an organism's phenotype (observable physical and behavioral characteristics) are due in part to variations in its genotype (particular set of genes). Each gene specifies a particular trait with different sequence of a gene (alleles) giving rise to different phenotypes. Most eukaryotic organisms (such as the pea plants Mendel worked on) have two alleles for each trait, one inherited from each parent.[2]:20

Alleles at a locus may be dominant or recessive; dominant alleles give rise to their corresponding phenotypes when paired with any other allele for the same trait, whereas recessive alleles give rise to their corresponding phenotype only when paired with another copy of the same allele. For example, if the allele specifying tall stems in pea plants is dominant over the allele specifying short stems, then pea plants that inherit one tall allele from one parent and one short allele from the other parent will also have tall stems. Mendel's work demonstrated that alleles assort independently in the production of gametes, or germ cells, ensuring variation in the next generation. Although Mendelian inheritance remains a good model for many traits determined by single genes (including a number of well-known genetic disorders) it does not include the physical processes of DNA replication and cell division.[49][50]

The growth, development, and reproduction of organisms relies on cell division, or the process by which a single cell divides into two usually identical daughter cells. This requires first making a duplicate copy of every gene in the genome in a process called DNA replication.[2]:5.2 The copies are made by specialized enzymes known as DNA polymerases, which "read" one strand of the double-helical DNA, known as the template strand, and synthesize a new complementary strand. Because the DNA double helix is held together by base pairing, the sequence of one strand completely specifies the sequence of its complement; hence only one strand needs to be read by the enzyme to produce a faithful copy. The process of DNA replication is semiconservative; that is, the copy of the genome inherited by each daughter cell contains one original and one newly synthesized strand of DNA.[2]:5.2

After DNA replication is complete, the cell must physically separate the two copies of the genome and divide into two distinct membrane-bound cells.[2]:18.2 In prokaryotes(bacteria and archaea) this usually occurs via a relatively simple process called binary fission, in which each circular genome attaches to the cell membrane and is separated into the daughter cells as the membrane invaginates to split the cytoplasm into two membrane-bound portions. Binary fission is extremely fast compared to the rates of cell division in eukaryotes. Eukaryotic cell division is a more complex process known as the cell cycle; DNA replication occurs during a phase of this cycle known as S phase, whereas the process of segregating chromosomes and splitting the cytoplasm occurs during M phase.[2]:18.1

The duplication and transmission of genetic material from one generation of cells to the next is the basis for molecular inheritance, and the link between the classical and molecular pictures of genes. Organisms inherit the characteristics of their parents because the cells of the offspring contain copies of the genes in their parents' cells. In asexually reproducing organisms, the offspring will be a genetic copy or clone of the parent organism. In sexually reproducing organisms, a specialized form of cell division called meiosis produces cells called gametes or germ cells that are haploid, or contain only one copy of each gene.[2]:20.2 The gametes produced by females are called eggs or ova, and those produced by males are called sperm. Two gametes fuse to form a diploid fertilized egg, a single cell that has two sets of genes, with one copy of each gene from the mother and one from the father.[2]:20

During the process of meiotic cell division, an event called genetic recombination or crossing-over can sometimes occur, in which a length of DNA on one chromatid is swapped with a length of DNA on the corresponding sister chromatid. This has no effect if the alleles on the chromatids are the same, but results in reassortment of otherwise linked alleles if they are different.[2]:5.5 The Mendelian principle of independent assortment asserts that each of a parent's two genes for each trait will sort independently into gametes; which allele an organism inherits for one trait is unrelated to which allele it inherits for another trait. This is in fact only true for genes that do not reside on the same chromosome, or are located very far from one another on the same chromosome. The closer two genes lie on the same chromosome, the more closely they will be associated in gametes and the more often they will appear together; genes that are very close are essentially never separated because it is extremely unlikely that a crossover point will occur between them. This is known as genetic linkage.[51]

DNA replication is for the most part extremely accurate, however errors (mutations) do occur.[2]:7.6 The error rate in eukaryotic cells can be as low as 108 per nucleotide per replication,[52][53] whereas for some RNA viruses it can be as high as 103.[54] This means that each generation, each human genome accumulates 12 new mutations.[54] Small mutations can be caused by DNA replication and the aftermath of DNA damage and include point mutations in which a single base is altered and frameshift mutations in which a single base is inserted or deleted. Either of these mutations can change the gene by missense (change a codon to encode a different amino acid) or nonsense (a premature stop codon).[55] Larger mutations can be caused by errors in recombination to cause chromosomal abnormalities including the duplication, deletion, rearrangement or inversion of large sections of a chromosome. Additionally, the DNA repair mechanisms that normally revert mutations can introduce errors when repairing the physical damage to the molecule is more important than restoring an exact copy, for example when repairing double-strand breaks.[2]:5.4

When multiple different alleles for a gene are present in a species's population it is called polymorphic. Most different alleles are functionally equivalent, however some alleles can give rise to different phenotypic traits. A gene's most common allele is called the wild type, and rare alleles are called mutants. The genetic variation in relative frequencies of different alleles in a population is due to both natural selection and genetic drift.[56] The wild-type allele is not necessarily the ancestor of less common alleles, nor is it necessarily fitter.

Most mutations within genes are neutral, having no effect on the organism's phenotype (silent mutations). Some mutations do not change the amino acid sequence because multiple codons encode the same amino acid (synonymous mutations). Other mutations can be neutral if they lead to amino acid sequence changes, but the protein still functions similarly with the new amino acid (e.g. conservative mutations). Many mutations, however, are deleterious or even lethal, and are removed from populations by natural selection. Genetic disorders are the result of deleterious mutations and can be due to spontaneous mutation in the affected individual, or can be inherited. Finally, a small fraction of mutations are beneficial, improving the organism's fitness and are extremely important for evolution, since their directional selection leads to adaptive evolution.[2]:7.6

Genes with a most recent common ancestor, and thus a shared evolutionary ancestry, are known as homologs.[57] These genes appear either from gene duplication within an organism's genome, where they are known as paralogous genes, or are the result of divergence of the genes after a speciation event, where they are known as orthologous genes,[2]:7.6 and often perform the same or similar functions in related organisms. It is often assumed that the functions of orthologous genes are more similar than those of paralogous genes, although the difference is minimal.[58][59]

The relationship between genes can be measured by comparing the sequence alignment of their DNA.[2]:7.6 The degree of sequence similarity between homologous genes is called conserved sequence. Most changes to a gene's sequence do not affect its function and so genes accumulate mutations over time by neutral molecular evolution. Additionally, any selection on a gene will cause its sequence to diverge at a different rate. Genes under stabilizing selection are constrained and so change more slowly whereas genes under directional selection change sequence more rapidly.[60] The sequence differences between genes can be used for phylogenetic analyses to study how those genes have evolved and how the organisms they come from are related.[61][62]

The most common source of new genes in eukaryotic lineages is gene duplication, which creates copy number variation of an existing gene in the genome.[63][64] The resulting genes (paralogs) may then diverge in sequence and in function. Sets of genes formed in this way comprise a gene family. Gene duplications and losses within a family are common and represent a major source of evolutionary biodiversity.[65] Sometimes, gene duplication may result in a nonfunctional copy of a gene, or a functional copy may be subject to mutations that result in loss of function; such nonfunctional genes are called pseudogenes.[2]:7.6

De novo or "orphan" genes, whose sequence shows no similarity to existing genes, are extremely rare. Estimates of the number of de novo genes in the human genome range from 18[66] to 60.[67] Such genes are typically shorter and simpler in structure than most eukaryotic genes, with few if any introns.[63] Two primary sources of orphan protein-coding genes are gene duplication followed by extremely rapid sequence change, such that the original relationship is undetectable by sequence comparisons, and formation through mutation of "cryptic" transcription start sites that introduce a new open reading frame in a region of the genome that did not previously code for a protein.[68][69]

Horizontal gene transfer refers to the transfer of genetic material through a mechanism other than reproduction. This mechanism is a common source of new genes in prokaryotes, sometimes thought to contribute more to genetic variation than gene duplication.[70] It is a common means of spreading antibiotic resistance, virulence, and adaptive metabolic functions.[28][71] Although horizontal gene transfer is rare in eukaryotes, likely examples have been identified of protist and alga genomes containing genes of bacterial origin.[72][73]

The genome is the total genetic material of an organism and includes both the genes and non-coding sequences.[74]

The genome size, and the number of genes it encodes varies widely between organisms. The smallest genomes occur in viruses (which can have as few as 2 protein-coding genes),[83] and viroids (which act as a single non-coding RNA gene).[84] Conversely, plants can have extremely large genomes,[85] with rice containing >46,000 protein-coding genes.[86] The total number of protein-coding genes (the Earth's proteome) is estimated to be 5million sequences.[87]

Although the number of base-pairs of DNA in the human genome has been known since the 1960s, the estimated number of genes has changed over time as definitions of genes, and methods of detecting them have been refined. Initial theoretical predictions of the number of human genes were as high as 2,000,000.[88] Early experimental measures indicated there to be 50,000100,000 transcribed genes (expressed sequence tags).[89] Subsequently, the sequencing in the Human Genome Project indicated that many of these transcripts were alternative variants of the same genes, and the total number of protein-coding genes was revised down to ~20,000[82] with 13 genes encoded on the mitochondrial genome.[80] Of the human genome, only 12% consists of protein-coding genes,[90] with the remainder being 'noncoding' DNA such as introns, retrotransposons, and noncoding RNAs.[90][91]Every organism has all his genes in all cells of his body but it is not important that every gene must function in every cell .

Essential genes are the set of genes thought to be critical for an organism's survival.[93] This definition assumes the abundant availability of all relevant nutrients and the absence of environmental stress. Only a small portion of an organism's genes are essential. In bacteria, an estimated 250400 genes are essential for Escherichia coli and Bacillus subtilis, which is less than 10% of their genes.[94][95][96] Half of these genes are orthologs in both organisms and are largely involved in protein synthesis.[96] In the budding yeast Saccharomyces cerevisiae the number of essential genes is slightly higher, at 1000 genes (~20% of their genes).[97] Although the number is more difficult to measure in higher eukaryotes, mice and humans are estimated to have around 2000 essential genes (~10% of their genes).[98] The synthetic organism, Syn 3, has a minimal genome of 473 essential genes and quasi-essential genes (necessary for fast growth), although 149 have unknown function.[92]

Essential genes include Housekeeping genes (critical for basic cell functions)[99] as well as genes that are expressed at different times in the organisms development or life cycle.[100] Housekeeping genes are used as experimental controls when analysing gene expression, since they are constitutively expressed at a relatively constant level.

Gene nomenclature has been established by the HUGO Gene Nomenclature Committee (HGNC) for each known human gene in the form of an approved gene name and symbol (short-form abbreviation), which can be accessed through a database maintained by HGNC. Symbols are chosen to be unique, and each gene has only one symbol (although approved symbols sometimes change). Symbols are preferably kept consistent with other members of a gene family and with homologs in other species, particularly the mouse due to its role as a common model organism.[101]

Genetic engineering is the modification of an organism's genome through biotechnology. Since the 1970s, a variety of techniques have been developed to specifically add, remove and edit genes in an organism.[102] Recently developed genome engineering techniques use engineered nuclease enzymes to create targeted DNA repair in a chromosome to either disrupt or edit a gene when the break is repaired.[103][104][105][106] The related term synthetic biology is sometimes used to refer to extensive genetic engineering of an organism.[107]

Genetic engineering is now a routine research tool with model organisms. For example, genes are easily added to bacteria[108] and lineages of knockout mice with a specific gene's function disrupted are used to investigate that gene's function.[109][110] Many organisms have been genetically modified for applications in agriculture, industrial biotechnology, and medicine.

For multicellular organisms, typically the embryo is engineered which grows into the adult genetically modified organism.[111] However, the genomes of cells in an adult organism can be edited using gene therapy techniques to treat genetic diseases.

Alberts B, Johnson A, Lewis J, Raff M, Roberts K, Walter P (2002). Molecular Biology of the Cell (Fourth ed.). New York: Garland Science. ISBN978-0-8153-3218-3. A molecular biology textbook available free online through NCBI Bookshelf.

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Physical Therapy First

August 4th, 2016 9:35 am

Dry Needling Course presented by Myopain Seminars

Dates: March 15-17, May 3-5, Sept 27-29, and Dec 6-8, 2013

Location: Physical Therapy First 5005 Signal Bell Lane #202 Clarksville, MD 21029

Click here for more information.

Click here for map and directions.

Jan Dommerholt, PT, DPT, MPS, DAAPM, is a Dutch-trained physical therapist who holds a Master of Professional Studies degree with a concentration in biomechanical trauma and health care administration, and a Doctorate in Physical Therapy from the University of St. Augustine for Health Sciences. Dr. Dommerholt has taught many courses and lectured at conferences throughout the United States, Europe, South America, and the Middle East while maintaining an active clinical practice. He is on the editorial board of the Journal of Musculoskeletal Pain (editor Dr. I. Jon Russell), the Journal of Bodywork and Movement Therapies (editor Dr. Leon Chaitow), the Journal of Manual and Manipulative Therapy (editor Chad Cook, PT, PhD), and Cuestiones de Fisioterapia.

He has authored many chapters and articles on myofascial pain, fibromyalgia, complex regional pain syndrome, and performing arts physical therapy, and prepares a quarterly literature review column on myofascial pain for the Journal of Musculoskeletal Pain. Read "Treating the Trigger" (PDF), a 2008 interview with Dr. Dommerholt published in Advance magazine. Dr. Dommerholt is the president of Bethesda Physiocare and editor of several books on myofascial trigger points.

Robert Gerwin, MD, FAAN, is Co-Founder, Vice President, and Co-Director of Myopain Seminars. He is a Board Certified Neurologist and a Fellow of the American Academy of Neurology. He is also a Diplomate of the American Board of Pain Medicine and a member of the American Academy of Pain Medicine. Dr. Gerwin graduated from the University of Chicago School of Medicine. He had two years of Internal Medicine post-graduate training at New York University--Bellevue Hospital and did his Neurology Residency at Case-Western Reserve University/Cleveland Metropolitan General Hospital, Cleveland, Ohio. He had a two year special fellowship at NIH in neurology and immunology. He has been in private practice in the Washington DC area for many years. Dr. Gerwin has been working in the area of Myofascial Pain and Fibromyalgia for many years. Dr. Janet G. Travell was his mentor while she lived in Washington DC. Dr. Gerwin is former President of the International Myopain Society. He was the Scientific Program Chairman for the 2007 International Congress of the Myopain Society.

He is the author of over 30 peer reviewed articles, reviews, book chapters and consensus statements. He reviews articles for over a dozen medical journals. He is on the editorial board of the Journal of Musculoskeletal Pain. He is co-editor of the books Tension-Type and Cervicogenic Headache: Pathophysiology, Diagnosis, and Management and Clinical Mastery in the Treatment of Myofascial Pain (see Books). He has been teaching courses and seminars worldwide in the field of neuromuscular and myofascial pain for many years. He founded the Focus on Pain series of neuromuscular and myofascial pain conferences in 1990. His interests lie in the area of Myofascial Pain and Fibromyalgia, and in the related issues of chronic headache, low back pain, and pelvic region pain, in addition to practicing neurological medicine. He is particularly concerned with the problem of persistent or chronic pain, and why some persons do not recover as expected. Dr. Gerwin is the Medical Director of Pain and Rehabilitation Medicine in Bethesda, MD and is an associate professor in the Department of Neurology at Johns Hopkins University School of Medicine.

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Personalized medicine: The way forward? – Medical News Today

August 4th, 2016 9:35 am

Everyone is different. Research suggests that humans have somewhere between 99 and 99.9 percent in common with each other. The remaining 1 percent can make a big difference when it comes to health, whether it is resistance or susceptibility to disease, or treatment.

Being different, our bodies react differently to treatment.

Variations in chemical and genetic composition mean that one person's response to a therapy will not necessarily be the same as the next.

As developments in the fields of genetics and technology advance, the conventional, one-size-fits-all approach to medicine starts to look outdated.

Instead, we are seeing a growing range of strategies that take into consideration the quirks of the individual.

This article will look at some of the strategies already available to help healthcare professionals meet individual patient needs, in the multifaceted field of personalized medicine.

Research suggests that around 50 percent of patients with depression do not respond to first-line antidepressants. What can explain this, and how can it be solved?

Current treatment is often a case of trial and error. A patient may take one medication after another, often for 12 weeks or more each time, while symptoms remain the same, or worsen.

A team from King's College London in the United Kingdom recently announced a blood test that can predict with accuracy and reliability whether an individual patient will respond to common antidepressants.

This, they say, "could herald a new era of personalized treatment for patients with depression."

High levels of blood inflammation have been linked to a lower response to antidepressants, so the team designed a test to distinguish levels of blood inflammation.

It evaluates the levels of two biomarkers: macrophage migration inhibitory factor (MIF) and interleukin (IL)-1.

Results showed that none of the patients with levels of MIF and IL-1 above a certain threshold responded to conventional antidepressants, while with inflammation levels below this threshold did tend to respond. The findings indicate that patients with higher levels of inflammation should use a combination of antidepressants from the early stages to stop their condition from getting worse.

The two biomarkers affect a number of brain mechanisms involved in depression, including the birth of new brain cells, connections between them, and the death of brain cells as a result of oxidative stress, related to the processing of free radicals.

Depression can result when chemical signaling is disrupted, and the function of the brain's protective mechanisms is reduced.

"The identification of biomarkers that predict treatment response is crucial in reducing the social and economic burden of depression, and improving quality of life of patients."

Prof. Carmine Pariante, King's College London

Getting the right medication from the start would enhance the well-being of patients, and it would also save on healthcare costs, in terms of time and money.

In 2012, the United States Food and Drug Administration (FDA) approved a new treatment for cystic fibrosis (CF), a serious, genetic condition that affects the respiratory and digestive systems. The drug is ivacaftor, known by the trade name of Kalydeco.

People with CF have a fault in the flow of salt and water on the surface of the lungs. It leads to a buildup of sticky mucus that can be life-threatening.

In 4 percent of patients with CF, this problem comes from a mutation in the gene G551D, which regulates the transport of salt and water in the body.

Ivacaftor can help around 1,200 people in the U.S., but more significantly, it is the first therapy to target the underlying cause of CF rather than the symptoms.

Genomic science enabled scientists to pinpoint the root of the problem, to develop a repair strategy, and to establish which patients it might benefit.

Cancer treatment is well suited to a genomic and individual approach.

In 1979, scientists discovered the most commonly mutated gene in human cancer: TP53, or p53. The BRCA1 gene mutation was discovered in 1994, and BRCA2 in 1995.

Targeted therapy for women with ovarian cancer caused by BRCA1 and BRCA2 are already in use. Targeted therapies aim to attack the tumor without harming healthy cells. The drugs work on DNA repair pathways that are blocked in women with mutations in BRCA1 and BRCA2.

In 2011, the Wall Street Journal published an infographic indicating what percentage of different cancers were likely to stem from genetic mutations that could be targeted by specific drugs. The figures ranged from 21 percent of people with cancers relating to the head or neck to 73 percent of melanoma cases.

Jen Trowbridge, researching how genomics affects cancer at the Jackson Laboratory in Bar Harbor, Maine, foresees that instead of telling a person that they have brain cancer or lung cancer, doctors will be saying, "you have cancer that's caused by this mutation, and we have a drug that targets that mutation."

People's genetic makeup affects their future health and longevity. Genetic information can help scientists to predict what diseases people are likely to get, and how their bodies are likely to react.

Fast facts about BRCA1

Learn more about breast cancer.

In April 2016, scientists from the Scripps Translational Science Institute (STSI) found that in a group of over 1,400 healthy 80-105-year-olds, there was a "higher-than-normal presence of genetic variants offering protection from cognitive decline."

In particular, they found an absence of the coding variant for COL25A1, a gene that has been associated with the development of Alzheimer's disease.

Gene-editing techniques, such as "CRISPR," that modify DNA by "snipping" it, could prevent the onset of age-related diseases such as Alzheimer's in later years.

Women with a family history of breast cancer can undergo screening for BRCA1 and BRCA2 mutations to decide whether to take preventive action, such as a mastectomy, to minimize the risk of developing breast or ovarian cancer in future.

Recent research has suggested that women with the BRCA1 mutation should consider having children earlier, because the fault may affect the number of eggs in the ovaries.

Jen Trowbridge puts it this way: "Conventional medicine continues to treat the symptoms, but genetic scientists are now working to get right to the roots of diseases, the 'birth of a cancer,' starting from cell one."

Advances in biotechnology also contribute to personalized medicine.

New imaging technology means that assessments of a patient's condition and needs can be ever more precise.

The data gathered can lead to tailor-made devices, and even regenerative medicine.

One example is the personalized tinnitus masker, with custom-tailored audio signals that can be configured to meet the needs of the individual patient.

Mobile health (mHealth) solutions include interconnected, wearable medical devices that feed back to the doctor a person's heart rhythms and other vital data, enabling remote monitoring, and any appropriate tweaking of treatment.

3-D printing and regenerative medicine have already provided patients with replacement body parts, including bone and a windpipe.

A CT scan assesses patient needs, computer-aided design plans the structure, and 3-D printing creates the final product. A device that is implanted surgically can then dissolve over time, as the body naturally replaces it with human tissue.

Researchers in the U.K. recently created the prototype of a 3-D-printed bone scaffold. The device would allow tissue to grow around it and new human bone to develop, as the artificial bone dissolves.

The device would match the patient's exact size and shape, and its porous nature would allow blood flow and cell growth to occur.

In 2013, physicians at the University of Michigan and Akron Children's Hospital created a bioresorbable airway splint to treat a critically ill infant. The child's airway walls were so weak that breathing or coughing could cause them to collapse. The device provided a placeholder for cells to grow naturally around it, as the body healed itself.

An FDA report describes this as "a glimpse into a future where truly individualized, anatomically specific devices may become a standard part of patient care."

Until now, diseases have been treated with a relatively narrow range of therapies. Randomized controlled trials have been the most reliable guarantee of safety and efficacy.If the majority of people respond to a treatment in tests, it is considered successful.

But no treatment is 100 percent successful, because everyone is different.

Genome sequencing and advancing technology are shifting the perspective on healthcare, bringing tailor-made treatment further within reach.

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Personalized medicine: The way forward? - Medical News Today

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Stem Cell Network

August 4th, 2016 9:35 am

The Stem Cell Network is back and we are moving quickly. In March 2016, the federal government announced an additional $12 million for SCN, and for that we are grateful. This funding will be used to fund innovative ...

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The Stem Cell Networks Annual General Meeting, which metamorphosed into the Till & McCulloch Meetings, is a one-of-a-kind venue for trainees and young scientists to network and gain experience in the competit...

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The multidisciplinary research and training program offered by the Stem Cell Network enriched and accelerated the careers of hundreds of young researchers, many of whom can now be found across industry, government a...

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By prioritizing multidisciplinary research partnerships among stem cell researchers across Canada, the Stem Cell Network integrated the countrys previously fractured landscape into a comprehensive and globally re...

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SCN established and funded a world-leading arms-length research program to examine the key social, legal and ethical implications of stem cell research and, based upon this credible and research-based evidence, has ...

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The Stem Cell Networks catalysis of commercialization of stem cell research has led to 399 patent applications, 60 issued patents, 43 licenses granted, the growth or launch of 11 start-up biotechnology companies ...

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Natural Health & Wellness Center | Integrative Medicine Texas

August 4th, 2016 9:35 am

Integrative Medicine Some people call it alternative medicine, but at Southlake Vitality Health & Wellness Center, we see it differently. We recognize the value of using integrative medicine in functional diagnostic testing, supportive cancer care, detoxification, nutrition, with additional therapies. This helps us offer The Best of Both Worlds in this new millennium of health care (alternative first then traditional only when needed). We combine old fashioned doctor-patient care with 21st century technology. Southlake Vitality Health & Wellness Center is an Integrative & Functional Health, multidisciplinary medical practice. Our primary focus is health restoration and health balance utilizing the latest technology in integrative medicine and nutritional therapy.

The difference about Southlake Vitality Health & Wellness Center is that our primary commitment is to enable our patients to achieve optimal health and live a life full of vitality and longevity. Our patients will be educated about diseases associated with aging and how to prevent and/or possibly reverse the disease process. Mind Body and Spirit Integrative medicine is healing-oriented medicine that takes into account the whole person mind, body and spirit, including all aspects of lifestyle. It emphasizes the therapeutic relationship between patient and practitioner and makes use of all appropriate therapies, both conventional and alternative. Diseases such as: cardiovascular disease, coronary disease, cancer, hormonal imbalance, weight gain, dementia, diabetes, chronic fatigue, chronic pain and Alzheimers disease. We offer classes on nutrition, weight loss, detoxification and general health. Once educated our patients will be able to take charge of their own health and be able to have well informed and intelligent discussion with their doctors about their health. We understand the importance of your overall wellness. To achieve your wellness objectives, you have come to expect the highest levels of service and patient care. As a result, we continuously commit ourselves to meeting and exceeding your expectations.

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Natural Health & Wellness Center | Integrative Medicine Texas

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Osher Center for Integrative Medicine at Northwestern …

August 4th, 2016 9:35 am

Specialties

Integrative Medicine has been called the "new medicine" but in many ways, it is a return to the original practice and philosophy of medicine. It emphasizes the relationship between the doctor and patient, the innate healing ability of the body and the importance of addressing all aspects of an individual's life to attain optimal health and healing.

Our physicians and complementary medicine practitioners consciously blend the very best of conventional medicine, cutting-edge diagnosis and treatment with appropriate therapies. We strive to include therapies backed by scientific evidence to improve health and promote healing, while minimizing any side-effects or harm. All factors that affect health, wellness and disease are considered to promote optimal healing of the mind, body and spirit in all their complexity.

Established in 1997.

In 1997 Northwestern Memorial Hospital created an integrative medicine program (the NMPG Center for Integrative Medicine) in response to both patient demand and a clear need in the Chicagoland community for safe and effective integrative and complementary medicine approaches.

In 2008 we moved to our current location, a larger and more convenient space for patients to receive a broad array of services. In addition to growing our staff and clinical offerings, our program expanded to provide services to other areas of Northwestern, such as the cancer center.

We also grew our education initiatives. We have a wide array of public classes/symposiums throughout the year. We educate Northwestern Feinberg School of Medicine students and physicians, with the goal of helping the next generation of doctors be knowledgable in integrative therapies. In 2011 our name changed to Northwestern Integrative Medicine to reflect our commitment to the 3 pillars: clinical care, education and research.

Link:
Osher Center for Integrative Medicine at Northwestern ...

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Regenerative medicine consultation service – Mayo Clinic …

August 4th, 2016 9:35 am

At Mayo Clinic, an integrated team, including stem cell biologists, bioengineers, doctors and scientists, work together and study regenerative medicine. The goal of the team is to treat diseases using novel therapies, such as stem cell therapy and bioengineering. Doctors in transplant medicine and transplant surgery have pioneered the study of regenerative medicine during the past five decades, and doctors continue to study new innovations in transplant medicine and surgery.

In stem cell therapy, or regenerative medicine, researchers study how stem cells may be used to replace, repair, reprogram or renew your diseased cells. Stem cells are able to grow and develop into many different types of cells in your body. Stem cell therapy may use adult cells that have been genetically reprogrammed in the laboratory (induced pluripotent stem cells), your own adult stem cells that have been reprogrammed or cells developed from an embryo (embryonic stem cells).

Researchers also study and test how reprogrammed stem cells may be turned into specialized cells that can repair or regenerate cells in your heart, blood, nerves and other parts of your body. These stem cells have the potential to treat many conditions. Stem cells also may be studied to understand how other conditions occur, to develop and test new medications, and for other research.

Researchers across Mayo Clinic, with coordination through the Center for Regenerative Medicine, are discovering, translating and applying stem cell therapy as a potential treatment for cardiovascular diseases, diabetes, degenerative joint conditions, brain and nervous system (neurological) conditions, such as Parkinson's disease, and many other conditions. For example, researchers are studying the possibility of using stem cell therapy to repair or regenerate injured heart tissue to treat many types of cardiovascular diseases, from adult acquired disorders to congenital diseases. Read about regenerative medicine research for hypoplastic left heart syndrome.

Cardiovascular diseases, neurological conditions and diabetes have been extensively studied in stem cell therapy research. They've been studied because the stem cells affected in these conditions have been the same cell types that have been generated in the laboratory from various types of stem cells. Thus, translating stem cell therapy to a potential treatment for people with these conditions may be a realistic goal for the future of transplant medicine and surgery.

Researchers conduct ongoing studies in stem cell therapy. However, research and development of stem cell therapy is unpredictable and depends on many factors, including regulatory guidelines, funding sources and recent successes in stem cell therapy. Mayo Clinic researchers aim to expand research and development of stem cell therapy in the future, while keeping the safety of patients as their primary concern.

Mayo Clinic offers stem cell transplant (bone marrow transplant) for people who've had leukemia, lymphoma or other conditions that have been treated with chemotherapy.

Mayo Clinic currently offers a specialty consult service for regenerative medicine within the Transplant Center, the first consult service established in the United States to provide guidance for patients and families regarding stem cell-based protocols. This consult service provides medical evaluations for people with many conditions who have questions about the potential use of stem cell therapy. The staff provides guidance to determine whether stem cell clinical trials are appropriate for these individuals. Regenerative medicine staff may be consulted if a doctor or patient has asked about the potential use of stem cell therapies for many conditions, including degenerative or congenital diseases of the heart, liver, pancreas or lungs.

People sometimes have misconceptions about the use and applications of stem cell therapies. This consult service provides people with educational guidance and appropriate referrals to research studies and clinical trials in stem cell therapies for the heart, liver, pancreas and other organs. Also, the consult service supports ongoing regenerative medicine research activities within Mayo Clinic, from basic science to clinical protocols.

Read more about stem cells.

Share your Mayo Clinic transplant experience with others using social media.

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Regenerative medicine consultation service - Mayo Clinic ...

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Sanare Center for Integrative Medicine – NJ Integrative …

August 4th, 2016 9:35 am

Homeadmin2016-04-19T15:19:38+00:00

Integrative Medicine enhances traditional medical care by incorporating medical nutrition, mind body practices, herbal medicine and other complementary treatments. The focus is on health promotion and addressing the root cause of disease.

Non Surgical Orthopedics and Sports Medicine (Physiatry /Physical Medicine and Rehabilitation) focuses on the assessment and treatment of musculoskeletal and neurologic conditions.

Interventional Pain Management utilizes a variety of the most up to date and advanced image-guided non-surgical treatment options for a diverse range of conditions.

Myofascial Release Therapy treats the whole person intellectually, emotionally and structurally having a profound effect on the bodys own ability to eliminate pain, restore motion and enhance personal growth and awareness.

Acupuncture is a holistic medical system that activates the bodys Qi energy and promotes natural healing by enhancing recuperative power, immunity and physical and emotional health.

Mindfulness is a conscious decision to pay attention to what is going on in the present moment. This means a moment-to-moment awareness of thoughts, emotions, physical sensations, and the surroundings.

Sanre Center for Integrative Medicine offers a unique blend of Eastern and Western principles and practices in a welcoming, peaceful, and personalized environment. Sanare the Latin word to heal is our singular focus and the common thread that binds all of our practitioners. We emphasize respect for the human capacity for healing, the importance of our relationship with each patient and a collaborative approach to patient care among our practitioners.

At Sanre, our practitioners understand that healing is an integrative process that may require attention to the mind and spirit as well as the body.Our services includeintegrative medicine physician consultations, non-surgical orthopedics, sports medicine, interventional pain management, acupuncture, therapeutic massage andmindfulness mentoring.

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Sanare Center for Integrative Medicine - NJ Integrative ...

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