Almost 10% of Americans think there is a cure for diabetes, 20% weren’t sure. This is a glimpse at the awareness Americans have for a disease someone is diagnosed with every 20 seconds from a survey conducted by Harries Interactive. For a life-long illness that is increasing in the population (20% thought the death rate was declining) there are vey few that are aware of the basics of the disease. Most likely only those affected or who have friends and family members affected have knowledge of the disease, an indictment of the job the health community is doing to raise awareness of diabetes.

This result really was surprising to me as I feel like everytime I turn around there is a commercial or internet site about living with diabetes. I guess that is a result of me exposing myself to health related issues for hours a day, something most people in the population either don’t do or don’t have access to. I would like to see a comparison of the awareness between diabetes and other diseases that affect the general population (breast cancer for example). I’ll have to put the time in to look at different survey results but my gut feeling is the breast cancer charities and awareness programs are deeper penetrating and have a farther reach.

Considering diabetes kills more than 180,000 a year in the US, compared to 40,000 due to breast cancer it should be applauded how much the breast cancer awareness push has succeeded. I mean there is a whole month for breast cancer awareness and they even have pro sports teams sporting pink on their uniforms to boost awareness. With over 16,000,000 (and climbing) in US diagnosed with diabetes it seems there should be more general awareness of the disease. Color me surprised but not blown away, for all the health community does to promote awareness it seems that a large percentage of the population either doesn’t pay attention or simply forgets the information they hear.

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In what can be considered a minor victory for medicine and public health Dr. Christine Daniel was brought up on fraud charges.  Daniel pushed crazy remedies on those who were in the most desperate phase of life.  Facing life-threatening cancers these patients were looking for any answers they could get and Daniel was willing to provide them with very expensive advice.  Too bad none of that advice was based on any sort of science or evidence based medicine and ended any chance that these people had of living.

Take Minna Shakespeare, who contacted Daniel in December 2002 after seeing her on TBN’s “Praise the Lord” TV program espousing the effectiveness of her herbal treatment.  Daniel told Shakespeare to stop her chemotherapy “because it doesn’t work” and to pay her $13,000 for her herbal cancer treatment.  Shakespeare told Daniel she didn’t feel that the treatment was working so Daniel told her to go back on the chemotherapy.  But I thought that chemotherapy was ineffective Dr. Daniel?  I don’t understand the change of heart.  Of course what Daniel doesn’t want to say is that she knows the chemo is effective and had a chance to keep Shakespeare alive longer. If Shakespeare stays alive longer then Daniel can charge for her herbal treatment longer and continue raking in the profit.

This is absolutely despicable and a good example of what happens with cancer quackery and all types of medical woo.  Daniel even claimed that her herbal medicine could treat and cure multiple sclerosis, hepatitis, and Alzheimer’s and Parkinson’s disease.  There is absolutely no feasible biochemical mechanism that could explain how an herbal extract, even one that contains tons of different chemicals, could cure that many different mechanisms.  In fact, there is no single medication, herbal or otherwise, that can cure “cancer” as it is hugely wide range of diseases that fall under one category of cancer.

I’m glad to see this type of action taken against a quack as these people offer hope that is not there and cost desperate people tons of money for treatments that don’t work.  True, conventional treatments cost a lot of money as well, but there is proven science behind them that they may cure your disease, or at least extend your life.  The report says Daniels made $1.1 million from 55 families, a fortune for any person.  This is pretty sick, but it will not stop many of the quacks out there and the patients that seek them out.  I hope that this sets a precedent of prosecuting fraudulent activity and actively spreading medical lies.  I’m sure it won’t set off a firestorm of prosecutions, but one can always hope.

ResearchBlogging.orgOne aspect we’ve discussed before about cancer development is the requirement that the cells (more specifically cancer stem cells) become immortal, able to replicate into daughter cells indefinitely. This is seen most prominently in HeLa cells, cervical cancer cells taken from Henrietta Lacks, who died in 1951. These cells have an overactive telomerase enzyme and have continued to replicate in research labs around the world since they were collected.

Telomerase is an enzyme that adds short pieces of DNA onto the end of chromosomes (telomeres) after replication, necessary because the mechanism for replication shortens the telomeres with every round. If enough of the telomere is lost a signal is sent to the cell to quit replication. In stem cells and progenitor cells this signals the end of self renewal.

Another pathway able to produce renewal and proliferation is the Wnt/β-catenin pathway. This pathway has been shown to be important in maintaining cells in a stem cell-like state and are thought to be able to initiate tumorigenesis.

The blue dye shows where Axin2 is being expressed from TERT induction

The blue dye shows where Axin2 is being expressed from TERT induction

A paper published July 2 in Nature has shown how these two pathways are linked, finding a molecular bridge between the immortality and stem cell/proliferative pathways in the cell. The researchers were looking at a portion of telomerase called TERT (telomerase reverse transcriptase). Early looks at the molecule found that overexpression in mice could lead to anagen in the epidermis, the same result that happens when β-catenin is overexpressed.

Using the gastrointestinal tract of mice, where Wnt signaling through β-catenin is required for stem cell maintenance, the researchers showed that inducing TERT expression in the crypts significantly upregulated Axin2 expression, a gene target of the Wnt/β-catenin signaling pathway (figure b). This in vivo display of pathway convergence is great evidence for the link between the two. Furthermore, the research team used catalytically inactive TERT to show that its function in Wnt signaling is not based on its telomerase activtiy.

The link between these two pathways I guess shouldn’t be too surprising. In cells which are programmed to be stem cells and divide many times throughout an organism’s life it should be expected that a pathway to maintain chromosomal integrity would communicate with the pathway that is pushing the cell to divide. What may be surprising is just how intimately these two are linked with the actual telomerase enzyme associated directly with the chromatin and Wnt signaling targets.

Tert knockout homeotic mutationsAnother reason I love this paper is the amazing images of Xenopus homeotic transformations. Since the Wnt pathway is also involved in axis formation and early patterning when you knock out TERT you do some weird things to the frog’s body plan. These images show how the vertebra and ribs are shifted from their location or display axis abnormalities, further putting the nail in the coffin for the link between TERT and Wnt signaling.

The significance of this finding may lead to another chemical therapeutic target in the future. Now two pathways may be able to be controlled in one swoop. Ideally a drug would be able to knockout TERT activity which would have the dual effect of ending immortality in that cell and forcing it out of a stem cell state. Since most cancers have the higher morbidity and mortality with more stem cell like cells in primary tumors this could be a means at a genetic double shot. Once you can get cells to commit to a differentiation status it is very hard for them to reclaim the ability to proliferate and produce daughter cells.

As the authors say:

“Our findings provide a mechanism to understand previous observations showing that TERT overexpression activates epidermal stem cells, as well as previous findings linking TERT to proliferation, survival and stem-cell biology in diverse contexts. Our data reveal unanticipated level of convergence between the telomerase and Wnt/β-catenin signalling pathways with important implications for understanding development, stem-cell regulation and cancer.”

Park, J., Venteicher, A., Hong, J., Choi, J., Jun, S., Shkreli, M., Chang, W., Meng, Z., Cheung, P., Ji, H., McLaughlin, M., Veenstra, T., Nusse, R., McCrea, P., & Artandi, S. (2009). Telomerase modulates Wnt signalling by association with target gene chromatin Nature, 460 (7251), 66-72 DOI: 10.1038/nature08137