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Friday, January 13, 2006
Drano for Your Arteries
I'm going to wear my cardiologist hat for this post. The article linked refers to a treatment that could potentially revolutionize the care of heart disease if it proves to be effective. It could conceivably eliminate the need for anyone ever needing coronary artery bypass surgery or angioplasty, and prevent heart attacks just by taking a pill!
It is also a wonderful story about how a serendipitous observation by a smart physician in a small northern Italian town called Limone sul Garda could eventually result in millions of lives being saved.
This doctor saw a 49 year old man named Valerio Dagnoli who was sick with something non-cardiac and happened to order a cholesterol panel. "[He] found that the villager's HDL of 7 was dangerously low, well below the normal level of 40. His triglycerides, other blood fats linked to heart disease, were 319, more than twice the norm. Despite these ominous signs, his arteries were clear," and furthermore it turned out that he came from a family that never experienced any heart disease!
"Puzzled by the result, the doctor sent Dagnoli to a specialist, Cesare Sirtori, in Milan. The case so intrigued Sirtori that he screened all 1,100 residents of Limone sul Garda to see whether he could find others with similar blood profiles. He found 40 people, all of whom could be traced to common ancestors born in the late 1700s. Their HDL averaged less than 20, half of normal for men and women. " None of them had heart disease.
Researchers eventually found that the villagers had a mutation in HDL's biggest protein, apoA-1. They dubbed the mutant version apoA-1 Milano.
Subsequent testing in animals has shown that infusion of apoA-1 Milano can actually lead to shrinkage of the plaques that often can lead to blocked arteries and heart attacks. To date, no other treatment had ever been shown to do this effectively, and with a good safety profile.
Celebrations have ensued, particularly in the pharmaceutical industry, as they have rushed to jump on the bandwagon and get the drug tested and out on the market. A similar story exists for another mutation found in a small group of related individuals from the Japanese island of Honshu. This drug is also in the developmental stage.
What does this all mean? Well, for now nothing, so don't go out and load up on hamburgers, french fries and ice cream because the drugs aren't ready for prime time yet. But it is a great story (at least to a medical geek like me) and offers great hope for the future treatment of heart disease, the number one killer in this country. Stay tuned! - posted by wanderer @ 9:46 AM
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