Could we have the diabetes/heart disease connection backwards?

Current wisdom: Insulin resistance (through unknown-as-yet mechanisms) causes changes in the endothelial cells lining blood vessels, and that leads to fat buildup and cardiovascular disease.

But what if that’s (as the headline says) backwards? That’s what researchers at Boston’s Joslin Diabetes Center are suggesting. Their finding: That it’s the endothelial cells in control and driving metabolism, rather than being on the receiving end.

In a reversal of scientific dogma, the findings suggest that vascular dysfunction may itself be the cause of undesirable metabolic changes that can lead to diabetes, not an effect as previously thought.

And then, to complicate matters, there’s a sort of feedback-ish loop in effect. Problems with the endothelial cells lead to insulin resistance (they found). That’s problem one. Problem two: Insulin is also what comes back to those same endothelial cells and causes them to produce nitrous oxide. Nitrous oxide triggers the production of brown fat cells — the good fat.

So … 1) problems in blood vessels lead to 2) insulin resistance, then insulin resistance 3) means those blood vessels produce less nitrous oxide and 3) that means less calorie-burning brown fat.

Or, as the chief researcher put it, “Everything is connected.”

Monkeypox vaccine update

Five-for-one split

With demand for the Jyenneos smallpox vaccine skyrocketing, the FDA is considering allowing one dose to be split into fifths, quintupling the supply. How can that work? By giving it intradermally instead of subcutaneously.

“There’s some advantages to intradermal administration, including an improved immune response to the vaccine,” [FDA commish Robert] Califf said. “It’s important to note that overall safety and efficacy profile will not be sacrificed with this approach.”

What about you?

The American Society of Health System Pharmacists is asking HHS to allow pharmacists to deliver the smallpox/monkeypox vaccine (via a PREP Act declaration, like with Covid vaccines) to make it easier for people to get it. You know the reasons; no word from HHS yet.

Pump it up (the implant, that is)

If you’re a gang member or mob boss, scars are good. If you’re trying to pump insulin, no so much.

The problem: Implantable insulin pumps are a great idea, but the immune system will attack them, form scar tissue around them, and eventually clog the pump.

MIT engineers came up with an unusual solution: They surrounded the pump with a balloon that could be inflated and deflated. It doesn’t need to be often, either — just every 12 hours, in testing, was enough to drive away the immune cells that lead to scar tissue formation, like trying to paint a balloon that inflates before the paint can dry.

And while scar tissue did form eventually — you can only fool Mother Nature so long — the collagen fibers were aligned, which (they believe) allowed the meds to get through anyway.

It’s been tested on mice and cadavers, so (live) human tests are next.

Everybody wins … sort of

The big news this weekend was the passage of the Inflation Reduction Act of 2022. Despite the headlines, there were actually wins on both sides of the aisle when it comes to the pharma-related portion of the bill.

For Democrats, CMS will finally be able negotiate drug prices like the rest of the world … on 10 older drugs that don’t yet have a generic version. That’s all. (The bigger deal is that it’s a foot in the door of drug-price negotiation.)

But Republicans got wins too, although they’re being overshadowed by the press around the price-negotiation news. The GOP prevailed by preventing the imposition of a $35 out-of-pocket cap on insulin on private insurance plans, as well as in other, non-pharma parts of the bill (e.g., there will be no requirements for paid family leave, nor funding for universal preschool or an expansion of the child tax credit).

As for price negotiations, despite one side saying it will mean unicorns and rainbows and the other predicting angry dragons and rains of despair, chances are the effects will be, like the weather, partly cloudy or partly sunny.

A useful plague of locusts

Cats predicting death. Dogs detecting Covid. They are sooooo last year. Now we have the world premiere of “Locusts Detecting Cancer.”

Locusts, it seems, can distinguish between cancer cells and normal cells and even distinguish different kinds of cancer.

And as tempting as it may be to send swarms of locusts through doctors’ offices*, the reality is boring: “[T]his work could provide the basis for devices that use insect sensory neurons to enable the early detection of cancer using only a patient’s breath.”

* Especially during Passover

Next in nicotine

This’ll be a Big Deal soon enough: In an effort to get their hit of nicotine, teens are turning to gum, lozenges, and gummies, often flavored just for them (mmm, “fruit medley”!). They contain plenty of drug, are easier to hide in school than vapes, are entirely unregulated, and are now second in popularltiy only to e-cigarettes , according to research out of USC.

It’s almost as if companies want to hook them on an addictive drug while they’re in middle school.

Can D do this too?

Latest on the list of “what can vitamin D do for you” is … reduce inflammation. Maybe. The whole cause/effect thing isn’t entirely clear.

When you’ve got chronic inflammation, the liver produces more C-reactive protein. But (say Aussie researchers), if you take vitamin D, the levels of that protein go down.

Their conclusion: “[T]he findings suggest that boosting vitamin D in people with a deficiency may reduce chronic inflammation.”

But note the weasel words “suggest” and “may.” That’s because there’s a black box in operation here. Does vitamin D affect the inflammation, or could it be affecting the protein? Or maybe it’s backwards — low C-reactive protein means lower vitamin D? Right now there seems to be a connection, but more work is needed to figure out just what it is.

Making vaccines last

A problem with many vaccines is that they don’t last long once they warm up. That’s why the whole cold chain thing is such a big issue.

The result, say Swiss researchers, is that half of vaccines go to waste. So, being Swiss, they came up with an elegant solution. It’s a hydrogel — “a biocompatible, synthetic polymer known as ‘PEG’ that serves as a protective, ‘cloaking device’” for large molecules like vaccine proteins.

So instead of wrapping the vial in a blanket of cold that has to be maintained, the Swiss wrap the individual molecules in the polymer, which can keep the proteins safe up to about 150°F. And to remove the coating? Just dissolve it with a sugar solution.

It’s still in the lab phase (i.e., “more research is needed”) but the Swiss Federal Institute of Technology is already flinging around Buzz’s favorite phrase: “game changer.”