Diabetic vascular diseases: molecular mechanisms and therapeutic strategies
5 Causes Of Chronic Disease Black Folks Should Consider
Many chronic diseases are hitting the Black community hard.
In fact, due to genetic, social, and environmental factors, certain health conditions are way more prevalent and way more severe among Black patients. From high blood pressure to diabetes, prostate cancer, and cardiovascular disease, the issues range far and wide.
Fortunately, there are many things you can do to prevent and address such issues.
You may not realize it, but five major causes may be leading to your issues.
Not sure which ones are contributing? It's easier than you think…
1. Chronic Lack of SleepYou've probably heard it all the time. Get more sleep, at least eight hours per night, don't neglect it!
But it's often easier said than done. Especially if you find yourself stressed, busy, and overwhelmed by life at large. But no matter your situation, you should always make it a priority. Good sleep affects your metabolic processes, helps regulate inflammation, and even affects how your body handles sugar.
Your heart, brain, and overall health are closely connected. So, get it straight! Dedicate yourself to a consistent sleep schedule, keep away from caffeine and electronics at least a couple of hours before bed, and keep your room preferably cooler.
If need be, practicing mindfulness can help!
2. Environmental ToxinsUnfortunately, many marginalized communities are close to problem sources, like industrial areas, where toxins pollute the air and water, causing everything from cancers to respiratory conditions. This may include things like heavy metals, pesticides, and all kinds of unfriendly gasses and particulates in the air.
The last thing you wanna do is struggle with health problems that can directly be addressed by changing your environment!
So mix it up. Keep tabs on local weather and look out for bad air quality days. If you're near a corporation that is polluting the area, become more vocal. Get involved in policies or activism that push for cleaner food, air, and water.
When you're free, make it a habit to find a park or sanctuary escape. The fresh air and nature will do you good.
RELATED: 9 Important Differences Between Acute & Chronic Illness
3. Microbiome ImbalanceWhether we like it or not, we have countless microorganisms swarming in our digestive tract.
If you have an imbalance, this can lead to chronic inflammation, problems with your gastrointestinal system, and even your mental well-being. Many people with irritable bowel syndrome (IBS) and inflammatory bowel disease (IBD) have gut imbalances as well.
The easiest thing you can do is boost your diet with higher fiber content, more fermented foods, and prebiotics to help your gut. You can also consider probiotics (similar to prebiotics), which can help in keeping the 'good bacteria' up and the 'bad bacteria' down.
4. Too Many AntibioticsWhile antibiotics have their uses, and can be very effective when used correctly, they can also run their course. In other words, the overuse of these drugs may lead to health issues, such as creating antibiotic-resistant bacteria that mess up your microbiome further. Not to mention, it may be harder to treat your illnesses in the future!
So, make sure you use them as recommended and nothing more. And always, make sure to practice safe, sound daily habits, like good hygiene, eating whole and clean food, and regular exercise.
5. Poor Oral HealthYou may not realize it, but oral health is linked to all kinds of health problems across the body. For instance, poor oral hygiene may cause gum disease, tooth loss, and infections. And believe it or not, cardiovascular disease and diabetes can result.
One way to treat this is by balancing your diet and avoiding refined sugars. Make sure you see your dentist at regular intervals for check-ups and cleanings as well. Every day, opt to brush your teeth twice, using mouthwash and flossing too.
You'll be glad you took the extra effort.
Because when it's all said and done, that's what this is all about. Chronic diseases can be a major problem within the Black community, so playing games with health is not an option. That's why your best bet is to always take a preventative approach.
Be wary of your environment, use products as directed, and try to buy healthier alternatives where practical. Overall, safeguarding against disease is about making a daily commitment to smarter, safer, healthier choices.
You don't have to reinvent the wheel here. You're simply stringing good habit after good habit. Start modestly, don't get ahead of yourself, and you'll be surprised how far you come. Not to mention, how much you'll actually enjoy it!
Organoids Derived From Gut Stem Cells Reveal Two Distinct Molecular Subtypes Of Crohn's Disease
Story by: Topics covered: Share This: Article ContentCrohn's disease — an autoimmune disorder — is characterized by chronic inflammation of the digestive tract, resulting in a slew of debilitating gastrointestinal symptoms that vary from patient to patient. Complications of the disease can destroy the gut lining, requiring repeated surgeries. The poorly understood condition, which currently has no cure and few treatment options, often strikes young people, causing significant ill-health throughout their lifetime. One barrier to making progress in developing treatments has been the lack of preclinical animal models that accurately replicate this complex disease. Another is the extreme heterogeneity among patients in the clinic, making it difficult for clinicians to tailor therapies.
Previous studies of Crohn's disease have derived organoids from pluripotent stem cells reprogrammed to become gut cells. Now, by studying organoids derived from adult stem cells in the gut tissue of Crohn's disease patients — which more accurately replicated the traits of the disease — University of California San Diego researchers have discovered that the condition consists of two distinct molecular subtypes.
The findings, published in Cell Reports Medicine on September 26, 2024, could lay the foundation for improved diagnostics and the development of personalized treatment options based on which subtype a patient's disease falls into.
Pradipta Ghosh, M.D., professor of cellular and molecular medicine and executive director of the HUMANOIDTM Center. Photo by Erik Jepsen/ University Communications
The researchers sampled gut tissue from 53 Crohn's disease patients during routine colonoscopies at the Inflammatory Bowel Disease Center at UC San Diego Health. The patients came from diverse backgrounds and presented with a variety of clinical symptoms. Scientists at the UC San Diego HUMANOIDTM Center of Research Excellence at UC San Diego School of Medicine, led by its director and the first author of the study, Courtney Tindle, created a "biobank" of patient-derived organoid cultures.
Organoids are tiny, lab-grown replicas of organs or tissues that closely mimic the behavior of their real-life counterparts. They are especially useful in medical research when animal models do not adequately represent the disease.
Previous studies of Crohn's disease have derived organoids from pluripotent stem cells reprogrammed to become gut cells. However, developing the organoids from adult stem cells in gut tissue more accurately replicates the traits of the disease, according to senior author Pradipta Ghosh, M.D., professor of cellular and molecular medicine and executive director of the HUMANOIDTM Center.
"The pluripotent stem cells — whether derived from blood or skin cells, carry the genetic traits of the patient, but have no way to know the inflamed environment inside the patient's gut," said Ghosh. In contrast, the adult stem cells retain an epigenetic memory of the gut environment imprinted on the genetic background — including a history of bacterial colonization, inflammation, and altered oxygen and pH. "We show here that adult stem cell-derived organoids accurately mimic the inflamed gut, but the pluripotent cells fail, which reminds me of what Maya Angelou once said: 'I have great respect for the past. If you don't know where you've come from, you don't know where you're going,'" she added.
Upon analysis, the researchers were surprised to discover that no matter how many clinically diverse patients they recruited, the organoids consistently fell into one of just two discrete molecular subtypes — each exhibiting unique patterns of genetic mutation, gene expression, and cellular phenotypes.
The two subtypes are:
Ghosh believes the discovery of these two distinct molecular subtypes will lead to a shift in the traditional understanding of Crohn's disease. Instead of classifying patients based on a large array of clinical symptoms, categorizing them by one of the two molecular subtypes could open the door to more personalized and effective management strategies.
"Currently, because of a lack of understanding of these fundamentally different subtypes, they are all being given the same treatment — a cookie-cutter therapy," said Ghosh. "This combination of anti-inflammatory drugs helps a fraction of the patients, but only temporarily."
The study revealed that patients with immune-deficient infectious-Crohn's disease might be better served by therapies that clear their bacterial infections instead.
In contrast, for those with the stress and senescence-induced fibrostenotic-Crohn's disease subtype, Ghosh says drugs that target or reverse cellular aging — cell-based and stem cell-based therapies that rejuvenate the gut epithelium — might be more effective at treating their disease.
Testing different drugs on patient-derived organoids will help identify which drugs are most effective for each molecular subtype.
She adds that work is underway to genotype the two subtypes in order to develop a simple test that can quickly identify which subtype a patient falls into.
"It's my hope that when the genetics are completed, Crohn's disease will be viewed as two molecular subtypes that should be treated in two completely different ways."
Ghosh says future treatments for Crohn's disease — which affects more than 500,000 Americans — could one day include personalized cell therapies, including gene editing and RNA-based treatments.
"Traditionally, we have been treating this disease with anti-inflammatory drugs, an approach that can be likened to putting out fires. With this study — the first of many based on the ongoing work and the efforts that are going to translate this to the clinic — we hope to target the arsonist who is responsible for the fire in the first place."
"Traditionally, we have been treating this disease with anti-inflammatory drugs, an approach that can be likened to putting out fires. With this study — the first of many based on the ongoing work and the efforts that are going to translate this to the clinic — we hope to target the arsonist who is responsible for the fire in the first place."
Pradipta Ghosh, M.D.Ghosh says the logistics and infrastructure of HUMANOIDTM and the Institute for Network Medicine uniquely enables bold disease modeling efforts within a collaborative framework that extends from the laboratory bench to the clinic and the cloud. The team partnered with gastroenterologists William Sandborn, M.D. And Brigid S. Boland, M.D. At the Inflammatory Bowel Disease Center at UC San Diego Health, who advised them on disease modeling, and with data scientists who determined how closely the model matched the disease.
Co-authors on the study include: Ayden G. Fonseca, Sahar Taheri, Gajanan D. Katkar, Jasper Lee, Priti Maity, Ibrahim M. Sayed, Stella-Rita Ibeawuchi, Eleadah Vidales, Rama F. Pranadinata, Mackenzie Fuller, Dominik L. Stec, Mahitha Shree Anandachar, Kevin Perry, Helen N. Le, Jason Ear, Debashis Sahoo, and Soumita Das, all at UC San Diego.
The study was funded, in part, by the Leona M. And Harry B. Helmsley Charitable Trust, the National Institutes of Health (Grants AI141630, DK107585, R56 AG069689, DiaComp Pilot and Feasibility award, R01-GM138385), and Padres Pedal the Cause/C3 Collaborative Translational Cancer Research Award (San Diego NCI Cancer Centers Council [C3] #PTC2017).
Financial interests disclosure: Soumita Das and Pradipta Ghosh hold a patent on the methodology described in the paper. The authors declare no other competing interests.
Prolonged Symptoms After Lyme Disease: What CDC Wants Doctors To Know
A new toolkit can help physicians navigate the management of patients with prolonged symptoms after antibiotic treatment for Lyme disease, discussants said during a CDC webinar for clinicians last week.
"Chronic Lyme disease is really so much more than a medical issue. It's a social phenomenon that's driven by a combination of patient desperation for answers, physician frustration, and also medical misinformation," said Grace Marx, MD, MPH, of the division of vector-borne diseases at the CDC. "So, as the physician, bringing a solid, science-based understanding of Lyme disease to these clinical encounters is very important."
Erica Kaufman West, MD, director of infectious diseases for the American Medical Association (AMA), noted that Lyme disease is caused by an infection with Borrelia burgdorferi transmitted by the Ixodes blacklegged tick. Early diagnosis is critical to preventing disseminated disease, and treatment involves 10 days to 4 weeks of antibiotics, depending on the case.
However, clinical studies have found that prolonged courses of antibiotics do not offer a lasting benefit over placebo, Kaufman West added during the Clinician Outreach and Communication Activity (COCA) call.
Post-treatment Lyme disease syndrome (PTLDS) is a condition in which symptoms persist 6 months after the patient has received appropriate treatment with antibiotics. Studies have shown that 5% to 10% of patients experience symptoms of PTLDS, which include fatigue, joint and muscle pain, and difficulty concentrating, Kaufman West explained.
Controversy around the condition emerged when patients who never received a formal Lyme disease diagnosis, but had symptoms of PTLDS, began asking why they weren't also being diagnosed with Lyme disease.
This led to the development of a new term, "chronic Lyme disease," which is ascribed to patients who describe symptoms similar to Lyme disease but have no clinical or diagnostic evidence of current or past infection.
"There are hundreds of thousands of patients suffering from medically unexplained symptoms ... And those patients are understandably concerned and looking for a diagnosis," Kaufman West said, suggesting that some of these patients may have another post-acute infection syndrome or infection-associated chronic illness, such as post-polio syndrome or long COVID, among others.
Expert Insights
Given the lack of evidence-based guidance to support comprehensive treatment for these patients, the CDC and the AMA, in partnership with Mathematica, a research and data analytics consultancy company, conducted interviews and focus groups with 25 experienced physicians, and gleaned the following core insights:
"I can't overemphasize the importance of how critical it is to actively listen to the patient's story, and that includes really thoroughly exploring the patient's timeline of their symptoms, as well as their response to any prior treatments that they might have tried or been prescribed," Marx said, noting that a comprehensive physical assessment is also key.
"Most of these patients will ultimately be diagnosed with a condition other than Lyme disease. So, it's really important not to anchor prematurely to a particular diagnosis, [but] rather systematically consider a broad differential diagnosis that is specifically tailored to the patient's symptoms and also their exam findings," she added.
Patients who feel "dismissed" by mainstream clinicians may be more likely to seek out alternative providers who may recommend unproven and potentially dangerous treatments -- something Kaufman West and Marx described as "medical wandering."
Instead of turning patients away, Marx encouraged physicians to welcome patients into their practice -- recognizing that every visit is a chance to offer support and encouragement -- and to identify trusted sources of information for patients who are in search of help.
Toolkits and Resources
The AMA developed a continuing medical education (CME) module, which includes an overview of Lyme disease with a focus on prolonged Lyme disease. The module details how to conduct a broad differential diagnosis, how to put together a multidisciplinary team, and how to develop an individualized care plan.
A clinician toolkit, also found on the AMA's website, includes resources for physicians and patients including the CME module, interviews, videos, and supplemental handouts for patients, such as symptom diaries and goal trackers. The tool kit also includes clinician-focused handouts dealing with motivational interviewing and managing differences of opinion.
Symptom diaries allow patients to document their experiences in real time and in their own words, and goal trackers remind physicians not to make assumptions about what's most meaningful to patients, Kaufman West said. For one patient, getting through a workday without any naps might be meaningful, while completing an entire shopping list in one trip might be meaningful for another. Whatever the goal, it's important that it be specific and measurable, she added.
"The goal of the toolkit is to improve the lives of these patients, no matter the cause," Kaufman West stressed. "It's about saying, 'You've got pain. How can we get you ... [fewer] pain days? How can we have better quality-of-life days?' And not 'How can we get to a diagnosis?'"
Shannon Firth has been reporting on health policy as MedPage Today's Washington correspondent since 2014. She is also a member of the site's Enterprise & Investigative Reporting team. Follow
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