UNC Researchers Discover a New Understanding of Chronic Pain

Does chronic pain after trauma have a physiologic basis, or is it all in a patient’s head? UNC researchers have been looking at the physiology of chronic pain.

By Stephanie Soucheray

When a patient suffers a traumatic experience – a sexual assault or a car accident – many are likely to have acute pain immediately after the event. But for an unlucky 20 percent to 30 percent of patients, that acute pain turns into chronic pain.

“We have patients who complain of pain weeks after the event, and the pain is not necessarily connected to where they were injured during the traumatic event,” said Sam McLean, director of the UNC School of Medicine’s TRYUMPH Research Program and the Center for Neurosensory Disorders.

McLean said that these patients are often told dismissively that their pain is a psychological reaction to their trauma – that it’s “all in their head.” Even worse, McLean said some providers mistake their patient’s complaints months after a traumatic event as drug-seeking behavior, and are cautious when prescribing medication.

“We have a true epidemic of under-treated pain patients in this country,” McLean said. Because the stigma of mental illness and drug-seeking behavior follows anyone who walks into a doctor’s office complaining of pain, McLean said he’s trying to show that chronic pain after a traumatic event has a physical cause.

“If we can show the biology of this type of pain, we can reduce the stigma,” he said.

In a paper published on April 29 in the journal Pain , McLean and his colleagues describe how the pain sustained after a traumatic injury may have a genetic root.

A study that looked at patients for six weeks after a traumatic event showed that people with a variation in the gene encoding for the protein FKBP5 (which helps control the HPA Axis) were 20 percent more likely to experience chronic pain after a trauma.

The HPA Axis regulates cortisol and other stress hormones, and McLean said that the axis may be overly activated in some groups of people after they experience a traumatic event. This means musculoskeletal pain may be a result of a faulty stress response, and not any injury that occurred during the traumatic stress.

McLean described one study participant who was raped. The mother of two young children did not resist her assailant because she thought it would risk her life.

“Here was a woman with no bruises, no traumatic injury or tissue trauma to speak of, yet she had terrible chronic pain after the rape,” he said.

Although finding a genetic clue to such pain is exciting, McLean doesn’t want patients to get the wrong message about his research.

“I don’t want people to think, ‘Oh, I have these genes, now I’m hosed,’” said McLean. “We have just found an influential gene, and this guides us on future genetic studies and helps us develop the biological mechanisms that elucidate chronic pain.”

McLean said his research could lead to early interventions – for example, with a serotonin norepinephrine inhibitor (SNRI), or even mindfulness meditation. Moreover, he said the work could help bring light to the existence of post-traumatic pain disorders.

“In the last century, we accepted the idea of PTSD,” said McLean. “In the 21st century, we may begin to explain that chronic pain is a sequela of traumatic stress.”

Cover photo: Nicolas P. Rougier, wikimedia creative commons

The Future of Cancer Treatment is Old

Even with new cancer medications, biological drugs and individualized gene therapy, radiation is still used in for a majority of cancer patients. Now, research brings radiation into sharper focus.

By Stephanie Soucheray

It’s a question Fang-Fang Yin has heard before.

“When I first started graduate school, people asked, ‘Will radiation be used 100 years from now? Fifty years from now?’” said Yin, a professor and director of radiation physics at Duke University. “Back then, everyone thought gene therapy would be leading us today in cancer treatment. But the fact is, radiation therapy is still used in 60 percent of all cancer treatments.”

Radiation was first used to treat and even cure cancer in the late 1890s, and was advanced under Marie Curie. Today it is used in many cancer treatment plans, especially for lymphomas. There’s been no real change in the fundamental idea of radiation for 70 years, but Yin said that quality assurance and imaging used to administer the treatment is advancing.

Because of its prevalence, and its inherent appeal to engineers, Yin presented his latest understanding of imaging and radiation therapy at the N.C. Biotechnology Center last week to the Eastern North Carolina Section of the Institute of Electrical and Electronics Engineers (IEEE).

The presentation was part of the Intellectual Exchange hosted by the IEEE that focuses on health care technology in the Triangle.

Radiation, along with chemotherapy and surgery, is one of the three main treatments of cancer. Like surgery, radiation is used to remove cancer cells at a specific site in the body, often the lungs, breast or even brain. But unlike surgery, successful radiation requires the calculations of physicists to figure out where to beam ionizing radiation to guarantee cancer-cell death.

Yin is not a medical doctor; rather, he’s one of the “invisible physicians” who treat cancer patients behind the scenes. Yin described the painstaking offstage work done by physicists for cancer patients who undergo radiation. Using protons, photons and electrons as high-energy radiation beams, physicists, and not oncologists, often direct treatment for radiation patients.

“We work with the oncologist and the technician to deliver radiation therapy precisely and accurately,’ said Yin. “You can have precision but not be accurate in delivering the therapy, and you can be accurate and not precise. But if you’re not both, healthy tissue surrounding the cancer can suffer.”

Take, for instance, someone with lung cancer. While the neck or head can be immobilized during radiation therapy, the lungs are constantly breathing. Patients can be instructed to hold their breaths, but even then exactitude is needed to make sure only cancerous cells are targeted. That exactitude comes from what Yin calls the “phantom patient,” an individualized treatment plan based on a person’s dimensions that reproduces the radiation therapy before it even begins. Yin called it “organ motion management.”

“The future is in imaging,” said Yin, as he showed several slides of radiation procedures to a few dozen engineers. More specifically, the future is in high-tech 4-D imaging that uses CT and MRI scans, among other modalities, to bring individualized treatments to patients.

The biomedical sciences are one of North Carolina’s most important industries, and the N.C. Biotech website estimates there are 129 companies in the Triangle that develop medical devices. But Yin said he does not have a relationship with any Triangle-area companies.

“That’s part of why I’m here today,” said Yin. “The Triangle has the financial resources, and the schools have the research. Hopefully, we’ll build a relationship between radiation imaging and the Triangle.”

New Drug Eases Life for Child with Rare Disease

For patients with so-called “orphan” diseases, finding treatment can be next to impossible, unless they get lucky.

By Nancy Wang

Soon, six-year-old Addison Cox will sleep through the night for the first time in her life.

Addison suffers from a rare genetic disease called cystinosis, whereby an amino acid, cysteine, builds up in cells and damages them. The disorder affects the kidneys the most, and can lead to a loss of nutrients that hinders growth and development. If untreated, cystinosis can lead to early kidney failure.

“She’s almost 5, and she’s not sleeping through the night, so she’s still on diapers,” said Nicole Cox, Addison’s mom. “The cost for the tabs for the bed and the laundry adds up.

“It’s definitely a strain, especially with me being a single mom. It’s all very scary.”

Currently, the only drug available to treat cystinosis must be given every six hours, even in the middle of the night. But this Tuesday, the FDA approved a new drug, Procysbi, which only needs to be given every 12 hours. Procysbi is the first new treatment for cystinosis approved by the FDA in 18 years.

Rare diseases not so rare

Cystinosis is a rare disease that affects only 500 people in the U.S., and treatment options are limited. According to the U.S. Rare Disease Act of 2002, a “rare disease” is any medical condition that affects fewer than 200,000 people. Despite the name, approximately 30 million Americans suffer from more than 7,000 rare diseases.

Some are better known than others. Cystic fibrosis affects 30,000 people in the U.S., whereas only two people in the world have been diagnosed with Fields’ disease, a genetic condition that destroys muscles over time.

Many rare-disease patients are initially misdiagnosed or go through dozens of costly tests before doctors learn what’s going on. Then, even if doctors have the correct diagnosis, treatment options are few and hard to come by.

“There’s only one pharmacy that makes [Addison’s] medication, and they’re in a different state, so we have to have it shipped to our house,” Nicole Cox said. “If she has to be hospitalized, which is quite frequent, we have to bring it with us, because [Duke Hospitals] doesn’t have it and can’t even get her medication in time.”

Drugs to treat rare diseases

To motivate pharmaceutical companies to develop treatments for rare diseases, also known as orphan drugs, Congress passed the Orphan Drug Act in 1983. The act gives pharmaceutical companies tax incentives, subsidies and stronger patent rights for any orphan drug. Since the bill passed, more than 300 new drugs targeted at 200 rare diseases have been developed. However, this covers less than 3 percent of the rare diseases.

“The Orphan Drug Act has been a huge success, but there is still a tremendous unmet medical need,” said Julie Anne Smith, chief operational officer at Raptor Pharmaceutical Corp, based in California. Raptor Pharmaceutical developed the newly approved Procysbi.

“Currently, I think there are about 20-ish private companies focused on rare disease, but there are some important federal initiatives that the NIH has that are helping to continue to spur development and interest.”

One such initiative is the National Center for the Advancing Translational Sciences, or NCATS. The new institute was established in 2012 and has been combined with the Office of Rare Diseases Research. The organization focuses on developing and improving cutting-edge therapies, many of which are directed at rare diseases.

Many of the advisory board members work in the private sector.

“What we’re seeing more and more of now is an increasing level of awareness in the private sector of the potential benefit they can get from investigating rare diseases,” said Michael Knowles, a physician and researcher who specializes in lung diseases at UNC Hospitals. “If you develop a drug for rare disease, you can get rapid FDA approval, and there’s no reason why you can’t take this drug and then test it for uses in more common diseases.”

Greater implications

Knowles heads one of the 10 rare disease research groups that are part of the Rare Diseases Clinical Research Network and receive NIH funding. Knowles, who specializes in rare diseases of the lung, including cystic fibrosis, said that research into rare disease has big implications for medicine.

“People create specific mice models all the time to study disease, but rare diseases are a naturally occurring genetic abnormality that give us insight into how normal [immune] defenses work,” he said. “It turns out that you learn things about rare diseases that are applicable to lots of common diseases, and that’s something that not a lot of people realize.”

For Knowles, the future of treating rare diseases is bright.

“What the cystic fibrosis foundation took 50 years to do, we’ve almost accomplished for primary ciliary dyskinesia [another rare lung disease] in a decade,” he said. “There’s been an incredible acceleration of effort and focus on rare diseases.”

Nicole Cox thinks there’s still a long way to go. But for now, she’s excited her daughter, Addison, can try out a new medication that will enable them both to get a good night’s sleep.

New X-Ray Technology Could Help Surgeons

Minimally invasive surgery is only “minimally” invasive if the tools used to perform it don’t damage surrounding tissue, but a surgeon needs to know where instruments are in order to reduce damage.

By Stephanie Soucheray

A long, thin needle enters a patient’s groin for surgery in the abdomen. A steerable needle snakes through a patient’s torso to find a tumor to biopsy, while another delivers targeted drug therapies.

As surgery is redefined by minimally invasive procedures using tools such as steerable needles, endoscopic scopes and catheters, doctors must continuously keep track of the devices in patients’ bodies.

Medical devices can easily damage a patient’s tissue, and now researchers at UNC-Chapel Hill and North Carolina State University have developed an algorithm that can help providers locate devices inside patients.

Ultrasounds and X-rays can help give doctors images of the devices. But when minimizing radiation exposure is a goal, many doctors have no idea how to best capture the image without excessive harm and radiation to the patient.

“These devices are so important for minimally invasive surgeries, but the challenge is to estimate the shape of them in the patient because they are so flexible and tend to bend and change shape,” explained Edgar Lobaton, an assistant professor of electrical and computer engineering at NC State.

Lobaton developed an algorithm with Jingua Fu, Luis G. Torres and Ron Alterovitz, all from UNC, that takes into account the surgical procedure, tool shape and placement in the body and tells practitioners the minimal amount of X-rays required to get an accurate image of the tool.

“If you don’t estimate the shape of these tools accurately, you can cause damage,” Lobaton said. “But since these surgeries and medical devices are becoming more and more popular, we need a way to track these devices. Our algorithm tells doctors where to take the image.”

Currently, surgeons rely on the cameras attached to scopes or 3D ultrasounds to track devices during surgeries. Lobaton said that while cameras are useful, 3D ultrasounds provide inaccurate and hazy images. MRIs can also be used during these surgeries, but are time consuming.

Lobaton said his research has produced a computer program that surgeons could use in practices, but first the research will be presented at the IEEE International Conference on Robotics and Automation, being held in Karlsruhe, Germany, on May 6.

“What we are presenting is an approach that allows you to select the best images,” said Lobaton. He said the algorithm has yet to be tested in animals.

Duke Researcher Brings Electricity, Magnetism to Depression Treatment

Duke researcher Sarah Lisbany talks to the Wake County chapter of NAMI about neuromodulation for depression.

By Stephanie Soucheray

The Snake Pit, One Flew Over the Cuckoo’s Nest and, more recently, Homeland.

Hollywood has used the images of electroconvulsive therapy, also known as ECT, to titillate and entertain for years. But a researcher from Duke University is hoping to change the frightening images that play in people’s head when they hear about “shock therapy.”

“The brain is an organ that responds to electricity,” said Sarah Lisbany, chair of the Duke department of psychiatry.  Lisbany spoke to 50 people from the National Alliance on Mental Illness (NAMI) of Wake County on Monday about ongoing studies and clinical opportunities at the Duke Institute for Brain Sciences.

“Just like the heart, the brain can be targeted using electrical therapies that are often safe, and very effective,” she told the crowd.

Each year, depression and other mood disorders like anxiety and bipolar disorder, as well as psychotic diseases like schizophrenia, affect one-quarter of Americans.

Unfortunately, the first-line treatment for moderate depression, antidepressant medications such as Prozac, are only about 50 percent effective for most patients. Often, a patient will try a course of medication then be moved on to another while waiting the requisite one to two months to see if the drugs alleviate their depression.

“These drugs are often the best treatment we can begin with for some patients,” said Lisanby, “but if someone has failed a course of four different antidepressants, they need to look at other options.”

Lisanby spoke about neuromodulation — the term used for therapies that use electricity and magnets to change brain circuits associated with mood disorders and mental illness. Unlike medication, which targets neurotransmitters like serotonin and dopamine, neuromodulation targets nerve cells in the brain. The process is based on what psychiatry has gleaned from the last two decades of neuroscience: Depression isn’t just about a lack of neurotransmitters; it’s about faulty wiring in the brain and the shrinkage of brain structures.

“The really interesting thing about neuromodulation is that we can not only treat, which medications do, but also potentially cure mental illness,” she said.

Lisanby pioneered the magnetic seizure therapy (MST) method when she was at Columbia University. Like ECT, MST uses magnets to induce seizures in targeted parts of the brain, but is considered safer. The Duke alum (she attended undergrad, med school and residency at Duke) brought the technology with her when she returned to Durham in 2010.

Lisanby also spoke about transcranial magnetic stimulation (TMS), which uses images of the brain to guide clinicians in applying magnetic stimulation over areas associated with mood disorders. The process is non-invasive, and safe, with none of the need for anesthesia or risk of memory loss that comes with ECT.

She said that although her research is exciting, she still sees patients because they keep her clinically grounded.

“Depression kills,” said Lisanby. “I have people come to me because they are at the end of their rope and someone recommended ECT. They say, ‘Please let there be something else,’ but I tell them ECT may be exactly what they need.”

Though ECT does run the risk of some memory loss, it’s an incredibly effective treatment, with 80 percent to 90 percent of patients reporting an alleviation in depression symptoms.

On Monday night, many people picked up brochures about Lisanby’s work at Duke and asked about participating in clinical trials. Gerry and Ann Akland, the presidents of NAMI Wake County, said they were eager to host Lisanby, as her work gives people with treatment-resistant mental illness hope.

“We’re always glad to have someone talking about new therapies, or what’s on the horizon,” said Ann Akland.

Cover image: A woman gets her brain imaged before undergoing neuromodulation therapies. Image courtesy Sarah Lisanby

Duke Research Shows Family Link to Alzheimer’s Causes Brain Changes Earlier

Research from Duke University finds a stronger risk for Alzheimer’s Disease among close family members of someone with the disease.

By Stephanie Soucheray

One out of every 10 Americans will develop late-onset Alzheimer’s, the degenerative disease that robs people in their 70s and 80s of their memory. If a close family member suffered from the disease, the chances increase to about 20 percent or 30 percent. The risk of developing the disease is even higher for someone with a family member who begins showing symptoms earlier.

Those are unforgiving numbers for an unforgiving disease, but researchers at Duke University are taking new steps to better understand the familial links and progression of Alzheimer’s. In a new paper published in the journal PLOS ONE Wednesday, researchers describe a study that found signs of the silent disease much earlier than expected in the brains of people with a familial history of Alzheimer’s.

“We looked for three things in the brains of people who have Alzheimer’s in their family,” explained P. Murali Doraiswamy, professor of psychiatry and medicine at Duke and author of the paper. Doraiswamy said his team looked for a buildup of Alzheimer’s telltale plaque and tangles and a shrinking of the brain’s memory center.

Doraiswamy and colleagues, including Duke undergraduate Erika Lambert, studied 257 people between the ages of 55 and 89. A positive family history of Alzheimer’s was defined as having either a sibling or parent with the disease. All participants were part of Duke’s branch of the Alzheimer’s Disease Neuroimaging Initiative (ADNI ).

Both tangles and plaque, marked by the presence of cerebrospinal fluid proteins, showed up in the brains of people genetically prone to Alzheimer’s much earlier than symptoms – usually when someone was in their 50s or 60s. Fifty percent of those with a family history of the disease met the criteria for preclinical Alzheimer’s based on their fluid samples, while only 20 percent of those without family history did. The area of the brain associated with memory was similar in all healthy people, suggesting changes to memory centers occur when the disease becomes symptomatic.

“If we know a time frame to the disease,” said Doraiswamy, “it will be easier to employ the right diagnostic test to monitor at-risk patients by targeting these biomarkers. We’ll know cut points of when fluid becomes abnormal, and we can establish a timeline for when to test people.”

Doraiswamy said this study will lead the way in making diagnostic tests available in the future; but right now, the tests can’t offer anyone with a family history of Alzheimer’s hope.

“We don’t have a way to prevent the disease except to recommend a healthy lifestyle,” said Doraiswamy. “What’s good for the brain are the same things that are good for the heart, like diet and exercise.”

Doraiswamy said people with a family history of Alzheimer’s should be wary of websites that offer tests for the disease, and to remember that they still have a strong chance of having a healthy brain well into old age.

Moreover, Doraiswamy said this paper ushers in a new wave of longitudinal studies taking place across the country that could help identify preventative interventions for those at risk for Alzheimer’s.

“I do think people with a family history should seek out clinical trials,” said Doraiswamy. “It helps science and themselves better understand the disease.”

Duke University, besides being an ADNI site, also hosts the Enlighten study, which is looking at a combination of diet and exercise on aging, hypertension and cognitive abilities.

Doraiswamy also said people should look for future trials featuring antibody therapies, which would pull the plaque out of a person’s brain before the disease begins to do its damage.

“And talk with your family,” said Doraiswamy. “Understand your risk.”

Research Sector Grows, But Jobs Require Training

Even as traditional industries in North Carolina have foundered, biotechnology has blossomed – but only for those who are willing to put in more years in the classroom.

By Stephanie Soucheray

Tobacco, textiles and timber may have built the Tar Heel State, but according to recent data cited by the North Carolina Department of Commerce, it’s biotechnology and research that’s helping create jobs for Carolinians in a post-recession economy.

A study by the Battelle Technology Partnership Practice, a group that analyzes technology-based economies, reported in March that there are 237,665 indirect and direct bioscience-sector jobs in the state. North Carolina was the fastest-growing bioscience state in the union, with sector growth expanding by 23.5 percent between 2001 and 2010.

“We remained strong during and after the recession,” said Jim Shamp, director of public relations for the North Carolina Biotechnology Center. “We gained employment in the recession while other private-sector businesses lost employment in the state.

Shamp said that after California and Massachusetts, North Carolina has the biggest bioscience sector in the country. Bioscience is especially popular among workers who’ve struck out in other sectors.

“Every month we have a jobs network meeting, and their are dozens of dozens of people in midlife career changes, or people who have been downsized looking for work,” said Shamp. “There’s more than 500 bioscience companies in the state.”

Back to school

The market may be large, but a huge key to getting one of these bioscience jobs is job training.

Unlike the textiles or tobacco of yore, bioscience jobs are rarely accessible without some advanced and specialized skill.

Just ask Lorie Solomon-Beale. Solomon-Beale is a lab research technician for Allan Brown at the N.C. Research Campus in Kannapolis, where she works in Brown’s lab studying the cancer-fighting compounds in foods such as cabbage and broccoli.

“My job is something different every day,” said Solomon-Beale. “It’s very diverse. Today, I was looking at cabbage cells under the microscope. The other day, I was in the greenhouse. But mostly I’m extracting glucosinolates – the cancer fighting properties – from vegetables.”

Solomon-Beale said Brown’s, and the lab’s, goal is to make a smarter vegetable by increasing glucosinolates in the produce you buy in the grocery store.

Solomon was one of the inaugural graduates of the Rowan-Cabarrus Community College Biotechnology Training Center at the N.C. Research Campus. The program prepares students, often those making a career change, for work at the campus. She sought an associate’s degree in applied sciences with about 10 other students.

“I loved science when I was a little girl and loved playing with a microscope,” said Solomon-Beale. “But I spent 20 years in the trucking industry.”

When Solomon-Beale was laid off from her job at Freightliner in Cleveland, in Rowan County, in 2007, she made the leap to go back to school.

“I hadn’t had chemistry or algebra in years,” she said. Soon she was studying recumbent DNA and bioprocessing techniques.

“It took me two and a half years, but I got my associate’s degree,” said Solomon-Beale, who received a degree in biotechnology. Training at the college prepares students to be lab techs, quality-control agents or research assistants. The campus is hoping to add agriculture and health care courses in the future.

Solomon-Beale found work in Brown’s lab. And though her job hinges on Brown’s ability to receive funding and grants, she’s grateful to have her job, but doubtful there are many success stories like hers in the state.

Though bioscience workers earn about $15 billion per year, highly skilled workers fill most of those positions.

“I grew up in Concord and lived in Kannapolis when people were working in the mills,” explained Solomon-Burke. “Many of those people thought there were jobs coming with a research campus, but you have to have advanced degrees.”

 

Two New Papers Highlight North Carolina’s Race to an HIV Breakthrough

North Carolina has always been a research hotspot, but in the past few years, a stunning number of breakthroughs in HIV have been coming out of the state.

By Stephanie Soucheray

Over the last 20 years, the Research Triangle has become an epicenter for American research concerning the treatment, prevention and cure of HIV. Now two papers have the Triangle racing toward a new understanding of how to end HIV as we know it, 30 years after it came to the attention of medical professionals.

A paper authored by UNC-Chapel Hill professor Victor Garcia-Martinez, published in PloS Pathogens, describes how Garcia-Martinez and colleagues used the first “humanized” mouse models to kill, or deactivate, the HIV virus.

Using humanized mouse models is a major breakthrough for HIV research. For years, researchers were limited to using the rhesus monkey for HIV research, but monkeys are expensive and in short supply.

“If you use mice, you have many more subjects,” explained Myron Cohen, director of the Center of Infectious Diseases at UNC, who collaborates with Garcia -Martinez and others at the UNC Center for AIDS Research.

Cohen also said that when developing a novel treatment or vaccine, a rhesus monkey takes up more of the experimental drug because of its weight, leaving little wiggle room for scientists.

“Remember, we can never think about doing it in the human without an animal model,” said Cohen. “So using mice is invaluable.”

Garcia-Martinez’s work with mice began six years ago at the University of Texas Southwestern Medical Center, where he and colleagues saw that the HIV virus could be killed in test tubes by a protein, APOBEC3, present in human cells.

But HIV has evolved to contain a gene called vif, or viral infectivity factor gene, that destroys the human immune system’s innate ability to control HIV. HIV antivirals kill vif, but Garcia-Martinez postulated that if the gene itself could be targeted it could be important for drug discovery.

But proving something in a test tube means little in the battle against HIV. Garcia-Martinez and colleagues needed an animal model: enter the humanized mouse, an animal whose immune system reflects the human system when confronted with HIV. The humanized mice are created by placing human bone marrow, liver and thymus tissues into animals that don’t have an immune system.

“The results were amazing,” Garcia-Martinez said. “If you remove vif from HIV and you challenge humanized mice, the virus did not grow at all. In some instances, you could not find it in the animal. It was eradicated from the body. It was a vestige of the original virus that had been mutilated so much by human oration that it was dead.”

Curing people

Garcia-Martinez said the next step will be probing this axis to test new drugs that will target vif and APOBEC3.

“We can literally heal the virus if we can develop drugs that target this pathway,” he said. “The virus will be dead in its tracks. We can find a way we can actually cure people.”

Using words like “cure” is not something to be taken lightly, but Cohen said it’s not an impossible goal for researchers in the Triangle, especially if they work together.

In 2011, Cohen led a team of researchers in the HPTN 052 trial, which successfully used antiretroviral medications to prevent HIV transmission in healthy people exposed to the disease. His work used RTP’s FHI 360, and was named Science magazine’s breakthrough of the year.

“That was the first time in 17 years that HIV was part of the breakthrough of the year,” said Cohen.

More recently, Cohen collaborated with scientists at Duke’s Center for HIV/AIDS Vaccine Immunology (CHAVI) for a paper published in Nature this week. The study looked at HIV in one patient, identified by Cohen, and the antibodies present in the patient after infection. The antibodies may help researchers at CHAVI in their quest for an HIV vaccine.

“What that paper does is give us a big clue about an alternative way to make an HIV vaccine; it gives us another direction,” said Cohen. “And we learned it from one patient.”

The paper, co-authored by Hia-Xin Liao, research director of Duke Human Vaccine Institute, follows a Malawian man infected with HIV who had a strong immune response to the disease.

Researchers followed the man for three years, watching how his immune system used broadly neutralizing antibodies (BnAbs) to fight the infection. BnAbs usually develop two to four years after infection, but if they can be harnessed before a patient is exposed to HIV they could become valuable tools for an immunization.

“This is a very important glimpse at the co-evolution of BnAbs and HIV,” said Liang. “The work will help us identify the vaccine candidate, and eventually develop a vaccine.”

A Man’s Best Friend, and a Genius

A Duke researcher looks at dogs, and learns that they tell us a lot about people.

By Stephanie Soucheray

If you want to understand, from a scientific perspective at least, what it means to be human, it might help to study non-humans. That’s the ethos behind Brian Hare’s work at Duke University, where the founder of the Duke Canine Cognition Center works with dogs to better understand different types of cognitive processes and profiles.

Hare is a professor of evolutionary anthropology. Besides dogs, he studies bonobos and lemurs to explore issues of cognition. His work at the Canine Center (which he started in 2009, gaining national recognition) has led to many discoveries, some of the most interesting gathered in “The Genius of Dogs: How Dogs are Smarter Than You Think,” written with his wife, science writer Vanessa Woods.

The book, released on Feb. 5, made it to The New York Times bestseller list, and is helping dog owners become “citizen scientists” who can use simple games to explore Sparky’s inherent cognitive abilities.

“You can play the same games with your dog as with non-verbal human infants,” said Hare. “You can determine what and how they’re thinking.”

Hare explained that his work with dogs shows the animal’s genius for inference, or making logical guesses based on past experiences. He said dogs, more than any other animal on the planet, use humans as tools. Like pre-verbal infants, dogs know how to use humans to solve their problems.

“The book is about cognitive science and human evolution through the eyes of dog research,” Hare said. “It’s a bigger project than just dogs.”

He said that like humans, dogs display different types of intelligence: empathetic, social, problem-solving and others. Not all dogs are smart in the same way though, a lesson Hare said must be translated to humans.

“My work shows how something like standardized tests are incredibly biased and bad at showing us a real reflection of different types of intelligence,” he said.

One of the most important types of intelligence is based in empathy, or kindness.

“The first misconception people have is that evolution is the survival of the fittest,” Hare explained. “Through research with dogs and bonobos, we see what’s super-powerful is survival of the friendliest.” Hare said survival of the fittest just measures success in reproduction. But in the case of dogs and bonobos, success comes through cooperation – not being aggressive and not dominating.

“That’s a big part of our human story too,” he said. “There have been changes in our species that make us more tolerant and peaceful than before. The main thing you learn: There’s a very powerful force in evolution that often favors the friendliest.”

On the book’s website, Dognition, readers can pay a one-time fee of $60 to join a community where they learn how to do their own experiments with pets and common household objects.

“We’ve had thousands of visitors from all over the world on the website,” said Hare. “Dogs from Chile, Argentina and Austrailia. It helps owners understand their dogs better”

Joining the website helps pet owners learn about Sparky and Spot, but it also helps Hare broaden his research on dogs. He said that each year at Duke, he has the chance to work with 100 or so dogs (he noted that no animals are harmed in his work and the same standards for giving children psychological tests are used with dogs). Still, comparing 100 dogs is not a large sample. But with information gleaned from the website, Hare can create a database that compares the intelligence types of shelter dogs, breeds and dogs of certain ages or even color.

“Are dogs in North Carolina different than New York? Are Great Danes relatively empathic relative to Chihuahuas? Are younger dogs better at differential reasoning or more reliant on other ways of solving problems?” Hare asked. “There are 50 million questions to answer from this data.”

Hare said dogs are worthy of rigorous scientific study. After all, they’re a successful species (dog jobs have withstood the recession, he noted). And they like us.

“If you give dogs the choice of being with dogs or people, they prefer us,” he said. “That doesn’t happen with any other animal.”

NCSU Research Shows Video Games Might be Useful for Grandma

Video games can challenge a player’s responses, concentration and creativity. They also might keep an older player’s brain limber.

By Stephanie Soucheray

It’s not every psychology professor who could coax his grandma into playing World of Warcraft, an online fantasy game. But a few years ago, that’s exactly what Jason Allaire did when he found himself hanging out with his grandmother, who was then 75.

“After she was done playing, she said, ‘My brain is tired,’” said Allaire, a researcher at N.C. State University. “She found it stimulating and enjoyable.”

Allaire, a longtime fan of video games, decided that digital games – computers, phones, handheld devices or consoles like Nintendo Wii – were a good tool to measure cognition and memory in the elderly. But his most recent study, co-authored with Anne McLaughlin, entitled “Successful Aging through Digital Games: Socioemotional differences between older adult gamers and non-gamers,” in Computers in Human Behavior, shows that video games may also be beneficial for promoting good mental health in older adults.

In a data analysis that looked at a four-year study from the National Science Foundation concerning video games and the elderly, Allaire and McLaughlin found that those adults over the age of 63 who reported playing digital games in any amount were happier about their lives compared to adults without digital games.

“They had more positive emotions and lower rates of depression,” said Allaire.

He said two-thirds of those polled said they played digital games at least once per month, but often more frequently. More than 30 percent played once per week or more.

“Oftentimes the gaming industry focuses on young players, the 13 to 27 demographic; they don’t focus on adults,” said Allaire. “So it’s surprising that so many were playing games, but not surprising that we saw those differences in mental health. When individuals choose what they do and are engaging and it’s fun, it’s going to have a positive effect.”

Changing stereotype

After years of studies that linked video game playing to antisocial behavior and poor health, there seems to be a groundswell of new research supporting video games. Recent studies have shown that games can help surgeons perform better before surgery or help dyslexic kids learn to read.

“There was the old stereotype that a gamer is a 40-year-old in his parent’s basement,” said Allaire. “But that’s not true anymore.”

Allaire said this study will help him move forward with research that looks at developing games that help the elderly retain certain cognitive skills as they age and work key neuropathways for memory and learning.

But he said he got some unwelcome attention last month when House Majority Leader Eric Cantor (R-VA) called out  Allaire and his work during talks about wasteful government spending during the sequester debates.

“Eric Cantor used me as an example, and basically said, ‘Look, we’re paying someone $1.2 million to have old people play World of Warcraft,’” he said. “I agree with him; spending $1.2 million on World of Warcraft would be a waste, but he got it wrong.”

Allaire said the World of Warcraft study ran about $5,000 and the $1.2 million referred to an NSF study of experimental design that assigned 150 adults to play games with different conditions: either alone or with a partner, and at easy or hard levels. And, most importantly, the $1.2 million was paid out long before Americans even knew the word “sequester.”

Currently, Allaire is working on a food-preparation game and app that would be used by older adults to “practice between switching tasks,” Allaire said. “The more you can get older adults to switch their attention back and forth, you can improve their cognitive functioning.

“Digital games are a great way to do that.”