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Global Health: Time to Pay Attention to Chronic Diseases

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Graph of projected deaths by cause in low income countries

Caption: Projected deaths (in millions) by cause in low-income countries. Note increase in non-communicable diseases (orange).
Credit: Adapted from Beaglehole R, Bonita R. Lancet. 2008 Dec 6;372(9654):1988-96.

Greetings from China. I’m here in Shanghai with other biomedical research leaders for two major meetings. The first one, which is the topic of my blog today, is on global health. So, you might expect there to be a lot of talk about malaria, influenza, MERS-CoV, Ebola virus, sleeping sickness, dengue fever, tuberculosis, HIV/AIDS, and other infectious diseases. And those are most certainly topics of intense interest to NIH and our colleagues around the world. But this particular meeting is about a different kind of global health threat that’s becoming a rapidly growing problem: chronic diseases.

While infectious diseases remain a significant problem in the developing world, cancer, heart disease, obesity, diabetes, and other non-communicable diseases are now among the fastest growing causes of death and disability around the globe. In fact, nearly three-quarters of the 38 million people who died of chronic diseases in 2012 lived in low- or middle-income countries [1].


It’s Spring! A Great Time for Cycling, Running, Walking, and Working Out!

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People with their bikes at NIH

Caption: My wife Diane Baker and I, enjoying last year’s NIH Bike to Work Day.
Credit: NIH

Happy Bike to Work Day! I really wish that I could take part in the festivities on the National Institutes of Health (NIH) campus in Bethesda, MD as I have in past years, but NIH-related travel is keeping me away from my trusty bike.

So, let me take a moment to commend all of the enthusiastic cyclists at NIH, along with everyone else out there who’s doing everything you can to get and stay physically fit.  Here at NIH, we are particularly well situated to know the facts: taking charge of your health by participating in an exercise program and eating the right foods is among the most important investments you can make in your future.


DNA Analysis Finds New Target for Diabetes Drugs

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ATCG's with a silhouette of people

Credit: Jane Ades, National Human Genome Research Institute, NIH

Type 2 diabetes (T2D) tends to run in families, and over the last five years the application of genomic technologies has led to discovery of more than 60 specific DNA variants that contribute to risk. My own research laboratory at NIH has played a significant role in this adventure. But this approach doesn’t just provide predictions of risk; it may also provide a path to developing new ways of treating and preventing this serious, chronic disease that affects about 26 million Americans.

In an unprecedented effort aimed at finding and validating new therapeutic targets for T2D, an international team led by NIH-funded researchers recently analyzed the DNA of about 150,000 people across five different ancestry groups. Their work uncovered a set of 12 rare mutations in the SLC30A8 gene that appear to provide powerful protection against T2D, reducing risk about 65%—even in the face of obesity and other risk factors for the disease [1].


Introducing AMP: The Accelerating Medicines Partnership

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Pie charts showing AMP targets reducing failures due to efficacy

Caption: Lack of efficacy currently accounts for more than half of all drug failures in Phase II clinical studies (left). If AMP’s target validation efforts improve efficacy by 90% (right), the success rate will rise significantly.

It would seem like there’s never been a better time for drug development. Recent advances in genomics, proteomics, imaging, and other technologies have led to the discovery of more than a thousand risk factors for common diseases—biological changes that ought to hold promise as targets for drugs.

But this deluge of new opportunities has to be put in context: drug development is a terribly difficult business. To the dismay of researchers, drug companies, and patients alike, the vast majority of drugs entering the development pipeline fall by the wayside. The most distressing failures occur when a drug is found to be ineffective in the later stages of development—in Phase II or Phase III clinical studies—after years of work and millions of dollars have already been spent [1]. Why is this happening? One major reason is that we’re not selecting the right biological changes to target from the start.


Metabolomics: Taking Aim at Diabetic Kidney Failure

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Patients with red tubes attached to their arms

iStock
Caption: Dialysis is often used to treat kidney failure related to diabetes.

My own research laboratory has worked on the genetics of diabetes for two decades. One of my colleagues from those early days, Andrzej Krolewski, a physician-scientist at the Joslin Diabetes Center in Boston, wondered why about one-third of people with type 2 diabetes eventually develop kidney damage that progresses to end-stage renal disease (ESRD), but others don’t. A stealthy condition that can take years for symptoms to appear, ESRD occurs when the kidneys fail, allowing toxic wastes to build up. The only treatments available are dialysis or kidney transplants.


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