Erin Hunter, Assistant Editor

Getting the human papillomavirus (HPV) vaccine around the time of a surgery for removing precancerous cervical lessons could reduce a woman’s risk of recurrent lesions or other HPV-related diseases.

Since 2008, the HPV vaccination has been given to children in the UK who are 13 and 14 years of age, which will protect against cervical cancer and other related cancers.

 However, new research from the UK suggests that an HPV vaccine alongside cervical intraepithelial neoplasia (CIN) treatment could reduce the risk of cervical cancer for women with CIN.

“HPV vaccination is highly effective at preventing the development of precancerous cervical lesions,” wrote the researchers in an article published in 

With CIN, cervical cells become abnormally changed, and these changes can develop into cervical cancer if left untreated.

 CIN has 3 grades, from highest to lowest: CIN1, CIN2, and CIN3. Women who have higher grade CIN also have a higher risk of cervical cancer and HPV-related conditions.

Researchers analyzed 18 studies to assess the risk of HPV infection or recurrent lesions (related to HPV infection after surgery) and the HPV vaccination. Of the 18 studies, 12 were observational, 4 post hoc analyses of randomized control trials (RCTs), and 2 RCTs, the latter of which were classified as having a low risk of bias. However, the observational and post hoc analyses had a mix of moderate, serious, and critical risk of biases.

Based on the data, the investigators observed that vaccinated individuals had a 57% lower risk of recurrent high grade preinvasive disease (CIN2+) compared to unvaccinated individuals. The decrease grew to 74% when the disease was related to HPV16 and HPV18, which are 2 high-risk HPV types associated with most cervical cancers. Patients also reduced their risk of recurrent higher grade CIN3 if they were vaccinated, but the evidence may not be fully qualified by scientists.

“We are pleased to see emerging research into the value of using the HPV vaccine to prevent the recurrence of cervical cell changes, and look forward to seeing further large-scale studies into the effectiveness of this method,” Eluned Hughes, head of information and engagement at Jo’s Cervical Cancer Trust, said in a press release.

The study was limited for many reasons, one being its observational nature. Additionally, aspects of the study were low quality, the follow-up time was short, and long-term effects are still unclear.

Additionally, there was not enough evidence to report conclusive findings, according to the authors.

 More high-quality randomized trials could establish the cost of the vaccine and effectiveness for women, the investigators explained.

“This study looked at whether the HPV vaccine can stop further cell changes happening after people have had treatment to remove abnormal cells caused by HPV infection,” Alice Davies, a health information manager at Cancer Research UK, said in the press release. “But it’s still too early to say if using the vaccine in this way is beneficial, and larger high-quality studies and trials are needed.”

HPV vaccination alongside surgical treatment for cervical lesions may reduce risk of further disease. 

https://www.eurekalert.org/news-releases/960683

Campbell, Denis. HPV vaccine after removal of precancerous cells may cut cervical cancer risk.

. Aug 3, 2022. Accessed Aug 4, 2022. theguardian.com/society/2022/aug/03/hpv-vaccine-after-removal-of-precancerous-cells-may-cut-cervical-cancer-risk.

Articles

Receiving a human papillomavirus vaccine and local surgical treatment could reduce the risk of recurring cervical lesions by 57%.

Study: HPV Vaccine, Surgery May Prevent Return of Cervical Lesions

Researchers analyzed genetic and life course factors contributing to a “cognitive reserve” that could prevent Alzheimer, published in the journal 

Factors such as early-life education, having a combination of leisurely activities, occupation, and reading ability might positively influence this reserve. As a result, lifelong learning may be one of the best ways to protect the brain from cognitive decline.

“These results are exciting because they indicate that cognitive ability is subject to factors throughout our lifetime and taking part in an intellectually, socially and physically active lifestyle may help ward off cognitive decline and dementia,” said Dorina Cadar, PhD, Brighton and Sussex Medical School in the United Kingdom and study author, in a press release.

In the study, 1184 participants born in 1946 took a cognitive test when they were aged 8 years and 69 years. At age 53 years, researchers tested the participants’ reading ability to measure lifelong learning.

Researchers also used a cognitive reserve index to quantify a participants’ cognitive gain from education, leisure activities, and employment. The authors also studied the link between education and cognition at 26 years of age, then gauged the cognitive effect of leisure activities at 43 years of age. Finally, they looked at the role of occupation on participants at 53 years of age.

The average score among participants 69 years of age on the cognitive test was 92, with a maximum score of 100 and the lowest score being a 53.

The participants who were 8 years of age with high cognitive skills grew up and maintained this higher cognitive index and reading ability at 69 years of age. Among the older participants, those who performed well as children also scored higher on current tests.

For every unit increase in childhood test scores, the average old-age cognitive test score, cognitive reserve index, and reading ability increased by 0.10, 0.07, and 0.22 points, respectively. However, independent of their results when the participants were 8 years of age, people with a better reading ability and cognitive reserve index showed a slower decline on their test scores.

“It’s heartening to find that building up one’s cognitive reserve may offset the negative influence of low childhood cognition for people who might not have benefited from an enriching childhood and offer stronger mental resilience until later in life,” Cader said in a press release.

Additionally, a college degree impacted the scores. The cognitive reserve index revealed that individuals with a bachelor’s degree or higher educational accomplishment scored an average of 1.22 points higher than individuals with no formal education.

In terms of leisurely activities, adults who participated in 6 or more averaged 1.53 points above those with only 4 leisure activities. Further, working a professional or intermediate level job increased a person’s average by 1.5 points compared to those in unskilled or partly skilled jobs.

Additionally, participants who completed the study in old age were more socially developed and more likely to be healthy with good thinking skills, limiting the general population of the study.

“From a public health and societal perspective, there may be broad, long-term benefits in investing in higher education, widening opportunities for leisure activities and providing cognitively challenging activities for people, especially those working in less skilled occupations,” Michal Schnaider Beeri, PhD, of Icahn School of Medicine at Mount Sinai in New York, said in the press release.

Study: Education, job, and social life may help protect brain from cognitive decline. EurekAlert! Aug 3, 2022. Accessed on Aug 4, 2022. https://www.eurekalert.org/news-releases/960535

A recent study revealed that social activities like gardening or getting a college degree could improve cognition in older age, which could possibly prevent Alzheimer disease. 

Study: Lifelong Learning Could Protect Against Alzheimer Disease

Today, the FDA approved fam-trastuzumab-deruxtecan-nxki (Enhertu; Daiichi Sankyo, Inc), which is the first HER2-low breast cancer treatment.

“Today’s approval highlights the FDA’s commitment to be at the forefront of scientific advances, making targeted cancer treatment options available for more patients,” said Richard Pazdur, MD, director of the FDA’s Oncology Center of Excellence and acting director of the Office of Oncologic Diseases in the FDA’s Center for Drug Evaluation and Research, in a press release.

In the United States, about 80% to 85% of the estimated 287,850 new cases of female breast cancer in 2022 would have been diagnosed as HER2-negative subtypes, which include hormone receptor positive and triple negative breast cancer. However, with the new approval, 60% of patients will be reconsidered as having the HER2-low subtype.

HER2-low is a subtype of HER2 breast cancer. The HER2 receptors (made by the HER2 gene) are expressed differently in HER2-negative and HER2-low. HER2-negative is comprised of hormone receptor positive and triple negative breast cancer. Both types of cancer can determine the type of treatment that the patient receives.

Researchers pulled together 557 participants with unresectable or metastatic HER2-low breast cancer. Patients ranged in age from 28 to 81 years old. The median age was age 57 years, and almost 25% of patients were age 65 years or older. Race was reported as 48% White, 40% Asian, 2% Black, and 3.8% Hispanic/Latino participants. Further, of those included in the analysis, participants either had unresectable tumors or metastatic HER2-low breast cancer.

Researchers investigated fam-trastuzumab-deruxtecan-nxki in the DESTINY-Breast04 trial, which was randomized, multicenter, and an open label clinical trial that included 557 patients. Of the total trial participants, 494 were hormone receptor positive (HR+) and 63 were hormone receptor negative (HR-).

In 373 participants, researchers randomized the administration of intravenous infusion of fam-trastuzumab-deruxtecan-nxki every 3 weeks. For the remaining 184 participants, researchers gave them the chemotherapy recommended by their health care provider. As a result, fam-trastuzumab-deruxtecan-nxki improved the overall survival of unresectable or metastatic HER2-low breast cancer patients.

Granted priority review, the rapid FDA approval aligns with President Biden’s Cancer Moonshot program goals. Cancer Moonshot aims to reduce cancer death rates and help patients and families by advancing cancer research and technology. This includes individualizing treatments for new cancer variations like HER2-low.

The administration of fam-trastuzumab-deruxtecan-nxki caused adverse events including nausea, fatigue, alopecia, vomiting, constipation, decreased appetite, musculoskeletal pain, and diarrhea in some patients. Other risks include interstitial lung disease and embryo-fetal toxicity, so it is not recommended for women who are pregnant.

HER2-low patients can get fam-trastuzumab-deruxtecan-nxki if they have recurrent cancer within 6 months of adjuvant chemotherapy, or if they received chemotherapy for a metastatic case.

This approval was given priority 4 months before the deadline of the Prescription Drug User Fee Act.

“Having therapies that are specially tailored to each patient’s cancer subtype is a priority to ensure access to safe and innovative treatments,” Pazdur said in a press release.

FDA. FDA Approves First Targeted Therapy for HER2-Low Breast Cancer. FDA website. Aug 5, 2022. Accessed on Aug 5, 2022.

The FDA approved a new drug that treats unresectable and metastatic HER2-low breast cancer, giving patients with this new subtype a treatment beyond chemotherapy.

FDA Approves First Therapy for New HER2-low Breast Cancer Subtype

The Moderna mRNA vaccine may be more likely to cause myocarditis in men aged 12 to 29 years than other vaccines, requiring more surveillance of patients following the administration of booster shots.

 In the United States, cases of myocarditis are 1 to 2 per 100,000 people, regardless of age, with COVID-19 vaccinations only causing 0.2 cases per million people and only causing 1.4 cases of pericarditis per million people.

Jorge Moreno, MD, assistant professor of medicine at the Yale School of Medicine, although not involved in the study, noted in a discussion with 

 that the data show that cases of myocarditis and pericarditis from COVID-19 vaccinations are quite rare.

“COVID-19, the illness, can also [cause] myocarditis, and that is much more likely than the vaccine itself [causing it],” said Moreno in the interview.

Additionally, dosing was relevant to case numbers as well. Following patients receiving 2 doses of the Moderna vaccine, cases for anyone between the age of 12 to 39 dropped if administered 31 days following the second dose .

 For men aged 18 to 29 years, the dosing interval may need to increase to 56 days or later to ensure a decreased risk of these conditions developing.

Often caused by viral infections such as COVID-19, myocarditis is the inflammation of the heart muscle and pericarditis is the inflammation of the 2 layered sac surrounding the heart.2 Symptoms of both diseases are present as persistent chest pain, shortness of breath, palpitations, or all 3.

Most people recover from mild cases, but some cases of myocarditis or pericarditis have become dangerous.

During research assessing the correlation between reported cases of myocarditis and pericarditis and vaccinations, investigators at the University of Alberta went through 46 studies and analyzed 8000 reported cases. Based on their findings, they then narrowed the age range to being between the ages of 0 to 39 years. Subsequently, they observed that cases for males over the age of 40 years were “very low to none,” according to the data.

While the study authors noted that the data made clear that the time between dosing of the Moderna mRNA vaccine should be prolonged, they also observed that the data did not make clear if young men should avoid the Moderna vaccine entirely and be advised to get the Pfizer mRNA vaccines.

“The FDA and the CDC here in the US did not find that the difference was substantial enough to make that recommendation [for young men to avoid the Pfizer vaccine],” Morena said in the press release.

The study authors also noted the importance of better communication of the risks and benefits of the vaccine for young men and their families, along with more access to non-mRNA vaccine alternatives.

 Although more research regarding personal risk factors and pre-existing conditions should be done to assess potential risk further, the authors explained that due to the evolving nature of COVID-19, study findings remain limited to the investigators’ understanding of mechanistic studies and how easily diagnosable the diseases are. Additionally, although pericarditis and myocarditis often coexist, myocarditis is more easily identifiable and diagnosed using imaging and troponin protein level testing.

The authors also noted that long term follow-up may help investigators further understand the natural history, disease recurrence, and risks of COVID-19 even with its evolving nature. To address this, multicenter prospective studies could guide researchers to understand why the vaccines cause these rare cases of heart inflammation.

Incidence, risk factors, natural history, and hypothesised mechanisms of myocarditis and pericarditis following covid-19 vaccination: living evidence syntheses and review. BMJ website. July 13, 2022. Accessed July 28, 2022. 

https://www.bmj.com/content/378/bmj-2021-069445

New evidence finds heart conditions extremely rare after COVID-19 vaccination. 

. July 19, 2022. Accessed July 28, 2022. 

https://www.medicalnewstoday.com/articles/new-evidence-finds-heart-conditions-extremely-rare-after-covid-19-vaccination

While the vaccines continue to provide critical, evidence-based protection against the coronavirus, rare cases of myocarditis and pericarditis have been reported.

Myocarditis, Pericarditis Rare in Young Men After COVID-19 Vaccination With Moderna Vaccine

A swish of the wrist and a flick of the wand can usually heal any ailment in the wizarding world of Harry Potter. If not, a potion can do just as much. In the Harry Potter series, author JK Rowling shows us that medicine is magic.

Many of the people, potions, and naming conventions for spells in the Harry Potter series are derived from (and used in) real-world pharmacological conditions and treatments. Even wizards and witches have name brand pharmaceuticals lining their cupboard shelves.

Unknown to many, Harry Potter comes from a long line of wizards in pharmacy, although a rather unique form of it.

When Harry goes to Gringotts’s bank for the first time, he enters his bank vault to find a small fortune.

 JK Rowling credits Harry’s wealth to his 12th century ancestor, Linfred of Stinchocombe, the pharmaceutical tycoon that developed Skele-gro and Pepperup Potion.

 Skele-gro is an ingestible potion that can mend or regrow a broken bone.

Harry’s grandfather later increased the Potter fortune with a pharmaceutical hair growth potion.

With the wealth produced from the creation of this potion, we learn even wizards lose their hair.

Plants, Potions, and Modern Pharmaceuticals

Throughout the series, plants appear to be common derivatives of magical potions and remedies. Several plants and plant-based potions are based on real world plants that do have or may have, according to traditional Western medicine, medicinal properties of their own.

For example, the mandrake was an important anthropomorphic plant during book 2 of the Harry Potter series. Its roots resembled infant humans, and when pulled from the ground, their cries of displeasure could kill the gardener. But when the mandrake matured, it became the star component of a potion to help ‘petrified’ victims who were frozen in a coma.

Rowling based the mandrake on an actual plant native to Greece and Northern Italy.

 It was believed to have been used as a hallucinogenic and painkiller during ancient times.

 Current pharmaceutical drugs like etoposide (Toposar; SP Pharmaceuticals LLC) use an alkaloid derived from the mandrake plant called podophyllotoxin, which is also the active ingredient in podofilox gel (Condylox; Elsevier Inc).

 Etoposide has been a successful treatment option for small cell lung cancer and testicular cancer, along with treating other types of lymphomas and acute leukemias.

But plants in the wizarding world are not only used for medicinal purposes. For example, if a wizard were bored in their History of Magic (naturally) or Charms courses, by sprinkling sneezing powder onto a friend’s robe, their friend would suddenly erupt into a sneezing fit, supplying a reprieve from the boredom inflicted upon the young wizards by a drawling professor.

This sneezing powder is also based on a real plant: the Virginia sneezeweed.

 Native to Virginia and parts of the Midwest, the flower head of 

 can treat colds and headaches in a powdered form.

Brewing the flowerhead into a tea can also reportedly treat intestinal worms, with a leaf infusion also being used as a laxative.

 Most significant are its possible cancer fighting properties.

In particular, the helenalin compound of the sneezeweed can potentially be useful for tumor reduction.

 During prior research, scientists studied helenalin as a possible treatment for prostate cancer.

 Based on study results, they discovered that helenalin triggered the reactive oxygen species inhibitor, lessening the apoptosis rate of healthy cells and repressing the viability of concentrated prostate cancer cells.

However, the helenalin plant can also be toxic if prepared in certain ways.

 With the potential risks, scientists note that more research is needed to see if it provides viable therapeutic activity for prostate cancer.

Wizards cast healing spells as well, with even the names of certain spells conjuring names common to us in modern medicine. For instance, Remus Lupin casts a 

 spell on Ron Weasley to splint his injured leg in the third book.

is Latin for ‘rod’ and refers to the fennel plant.

 And in ancient Rome, fennel was used to make splints for injuries.

Thus the spell’s name emphasizes it’s physical purpose, but we can also see the correlation to real ancient medicinal practices.

In the 21st century, fennel is a widely used supplement that supports the digestive system. It is also commonly found in natural pharmaceuticals to alleviate upper respiratory tract infections, cholera, coughs, and bronchitis.

spell is an excellent example of the power of a name. 

this spell is used in the wizarding world tocounter dark magic curses.

 It is not explicit, but the naming convention of these spells may be alluding to naming conventions of today's pharmaceutical products. Though Rowling could also be alluding to the magical power inherent in healing,

 a magic which exists in our world in the everyday medicine lining the walls of our pharmacies.

Shamsian J. 25 things you didn’t know about J.K. Rowlings ‘Harry Potter’ universe. 

 Updated Nov 4, 2018. Accessed Aug 4, 2022.insider.com/harry-potter-jk-rowling-movie-secrets-facts-2017-7

Davies M. Magic or Medicine: A Closer Look at J.K. Rowling’s Inspiration. Accessed Aug 5, 2022. https://journal.lib.uoguelph.ca/index.php/classics/article/view/6705/6531.

Mandrake (Plant). Science Direct website. Accessed on Aug 5, 2022. 

https://www.sciencedirect.com/topics/pharmacology-toxicology-and-pharmaceutical-science/mandrake-plant

U.S. Fish and Wildlife Service.The Real Magical Plants of Harry Potter. USFWS website. July 31, 2017. Accessed on Aug 5, 2022. 

https://usfws.medium.com/the-real-magical-plants-in-harry-potter-e937ea3b560e

Sneezeweed. Natural medicinal herbs. Accessed Aug 4, 2022. 

http://www.naturalmedicinalherbs.net/herbs/h/helenium-autumnale=sneezeweed.php

Yang M, Zhang W, Yu X, et al. Helenalin Facilitates Reactive Oxygen Species-Mediated Apoptosis and Cell Cycle Arrest by Targeting Thioredoxin Reductase-1 in Human Prostate Cancer Cells. National Library of Medicine. Jun 14, 2021. Accessed Aug 5, 2022. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212699/#:~:text=PMID%3A%2034125740-,Helenalin%20Facilitates%20Reactive%20Oxygen%20Species%2DMediated%20Apoptosis%20and%20Cell%20Cycle,in%20Human%20Prostate%20Cancer%20Cells

Fennel. Rx list website. Accessed on Aug 4, 2022. rxlist.com/fennel/supplements.htm

In the Harry Potter series, author JK Rowling shows us that medicine is magic. 

Pharmacy Fact: Harry Potter, The Boy Who Lived, Comes From a Long Line of Pharmacists

Men--and especially older men--with prostate cancer have an increased risk of death from heart disease with hormone therapy, according to the results of a study conducted in Lithuania and published in 

“Hormone therapy is often used for patients with prostate cancer, but more research is now needed to gain a better understanding of the overall risks and benefits of this treatment,” said study author Justinas Jonusas, MD, of the National Cancer Institute in Lithuania, in the press release.

The hormone therapy used for prostate cancer treatment is androgen deprivation therapy (ADT), which can help to decrease levels of testosterone in the body which can cause prostate cancer by fueling excessive cell growth.

 According the study authors, past research has suggested that there are ill-effects of hormone therapy on cardiovascular health, but not enough studies have been done to link hormone therapy with prostate cancer and cardiovascular disease.

"There are some cases where it's clear men need hormonal therapy,"said William Dahut, MD, a prostate cancer researcher and the chief scientific officer for the American Cancer Society, in the press release.

 "But oftentimes it's used for patients that are newly diagnosed, that are receiving radiation, or with men that have a rising PSA [prostate specific antigen] without cancer that we can see, something called biochemical recurrence."

During the study, investigators used data from the Lithuanian cancer registry to identify male patients aged 40 to 79 years who were diagnosed with prostate cancer between 2012 to 2016.

 To determine the risk of death by heart disease, they compared 3797 patients who had received hormone-lowering drugs and 9546 patients who had not. Approximately 5 years later, the investigators followed up with the patients.

Based on the results, the investigators found there was a 2-fold increase in risk of mortality by cardiovascular disease in the group who received hormone therapy.

 They also noticed the risk of death increased after the second year of cancer diagnosis, along with a 5-fold increased risk for patients older than age 70 years.

For men treated with hormone therapy, the risk of death from subtypes of cardiovascular disease increased, showing a 42% increased risk of death by stroke and a 70% increased risk of death from coronary heart disease.

“Prostate cancer is typically diagnosed in older men, over 65 years or older--and many of them will have already been diagnosed with cardiovascular disease. It is therefore concerning that we found such a tremendous increase in the risk of cardiovascular disease-related death in elderly males receiving hormone-lowering drugs,” Jonusas said in a press release.

Furthermore, Jonusas noted that screening for pre-existing cardiovascular disease and risk factors can help minimize the mortality risk from heart conditions among older men in particular.

However, other cancer treatments may also increase cardiovascular risk as well, explained Katelyn Atkins, MD, PhD, a specialist in radiation oncology at Cedars-Sinai Cancer Institute in Los Angeles, in the press release.

However, when it comes to cancer, providers may treat patients despite these increased risks.

To address this issue, Dahut explained patients should be treated with ADT and other cancer treatments on a case by case basis to determine risk, noting specifically that further research was needed to aid in this process.

“If we can do research to differentiate those populations, it will make the discussions much easier for patients and their physicians," Dahut said.

Hormone therapy for prostate cancer increases the risk of dying from cardiovascular disease. Taylor & Francis Group; July 27, 2022. Accessed July 27, 2022.https://www.eurekalert.org/news-releases/959617

Murez C. Prostate Cancer Treatment May Raise Heart Risks. 

https://www.usnews.com/news/health-news/articles/2022-07-27/prostate-cancer-treatment-may-raise-heart-risks

Use of hormone therapy to treat prostate cancer may require more consideration by health care providers as new study shows the therapy may increase the risk of heart disease.