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New class of inhibitors for angiogenesis proposed
Surgery patients at risk for herb–anaesthesia interactions taking herbal products and we know McLeskey and colleagues asked about it, we can alter care, prevent 979 patients who were about to have problems, and manage complications surgery about their use of herbal more easily”, said remedies and nutraMcLeskey. ceuticals (supple“Many patients ments not derived mistakenly believe from plants). 170 that since herbal (17·4%) patients products are labelled reported taking such ‘natural’, they must products. The most be safe. This inaccuoften used herbs rate and dangerous were ginkgo biloba assumption can put (32·4%), ginseng All herbs should be declared them at unnecessary (26·5%), and garlic risk”, comments Jessica Leak (MD (26·5%). Commonly used nutraceuAnderson Cancer Center, Houston, ticals included glucosamine (17%), TX, USA). Leak is coauthor of an chromium picolinate (17%), and ASA patients’ advisory leaflet which chondroitin (12%). “If patients are suggests that patients stop taking Herbal remedies, common uses, and possible side-effects herbal preparations at least 2 weeks Ephedra (Ma-Huang): to suppress appetite. May interact with antidepressants or before elective surgery. She also antihypertensives to cause increases in blood pressure or heart rate. coauthored an ASA patients’ educaFeverfew: for migraine, arthritis, rheumatic diseases, allergies. May increase tion pamphlet which cautions that bleeding, especially in patients already taking anticoagulants. the amount and purity of active Ginkgo: to improve circulation, memory, alertness. Side-effects as feverfew. ingredients in herbal products vary Garlic: to lower cholesterol, triglycerides, blood pressure. Side-effects as feverfew. greatly, and that little is known about Ginger: to reduce nausea, vomiting, vertigo. Side-effects as feverfew. their long-term safety. “The message Ginseng: to increase stamina, concentration. May decrease effectiveness of about herbal side-effects and interacsome anticoagulants; use associated with hypertension, tachycardia, bleeding. tions is not just for people undergoKava-kava: for anxiety, as a muscle relaxant. May increase effects of some ing surgery”, warns Leak. The effects antiseizure medications or prolong effects of some anaesthetics. of herbal weight-loss products, St John’s Wort: for depression, anxiety, sleep disorders. May prolong effects of migraine remedies, or sleep aids “can some narcotics and anaesthetics. be devastating”, she concludes.
he use of herbal medicines and nutraceuticals among patients about to have surgery is “widespread”, yet most patients do not tell their physicians, and physicians have not been asking, reported Charles McLeskey (Scott & White Hospital, Texas A & M University, Temple, TX, USA) at the annual meeting of the American Society of Anesthesiologists (ASA; Dallas, TX; USA; Oct 9–13). “As the popularity of herbal remedies continues to grow, so will reports of allergic reactions and adverse herb–drug reactions”, he warned. “We should be making this a formal part of the medical history and medications use.”
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Adapted from ASA publications (http://www.asahq.org)
Marilynn Larkin
New class of inhibitors for angiogenesis proposed d1 and Id3—inhibitors of specific transcription factors—are crucial for the development of the brain and its blood vessels, as well as for tumour angiogenesis in adult animals, according to a new study. Researchers in the USA and Germany report that knockout mice lacking all Id1 and Id3 were not viable, and died by embryonic day 13·5 from malformations and haemorrhages in their brains. However, mice engineered with lower than normal concentrations of the Id proteins (Id1+/- Id3-/- mice) developed and bred normally. In addition, the lowId mice were highly resistant to three types of tumour cells that rapidly killed their wild-type littermates. Tumour cells implanted intradermally or intracorneally in the mutant mice either grew briefly and regressed, or grew very slowly, were poorly vascularised, and failed to metastasise normally, say the scientists (Nature 1999; 401: 670–77). “This study has clearly identified a
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pivotal regulatory mechanism for angiogenesis”, says David Cheresh (Scripps Research Institute, La Jolla, CA, USA), “and [the normal development of embryonic blood vessels in the low-Id mice] underscores the notion that developmental neovascularisation may be very different from angiogenesis in the adult”. Because Id1 and Id3 are expressed at low amounts in normal cells but at high concentrations in endothelial cells in aggressive tumours, the researchers believe that inhibitors of Id1 and Id3 might be anticancer treatments. “We have [developed] an inactivator of Id, and are working on it with a company [Angiogenex]”, says one of the authors of the study, Robert Benezra (Sloan Kettering Institute, New York City, NY, USA). Now, Benezra says, he and his colleagues will examine the effect of low Id concentrations on cancer growth in genetically cancer-prone mice.
News in brief H pylori and non-ulcer dyspepsia Eradication of Helicobacter pylori is of no benefit to patients with non-ulcer dyspepsia, reveals a new report (N Engl J Med 1999; 341: 1106–11). Only 69 (46%) of 150 patients who received triple therapy for H pylori eradiction for 14 days had dyspepsia relief after 12 months; this number was not significantly different from that in the placebo group (71 of 142 [50%]). Time for cardiac death People in Los Angeles county, CA, USA, are more likely to die from coronaryartery disease during December and January than in any other month, say researchers. The data came from an analysis of death certificates of people who died during 1985–96 (Circulation 1999; 100: 1630–34). Variations in temperature were not thought to be the only explanations; overindulgence during the holiday season may also have had a role.
Paul M Rowe
THE LANCET • Vol 354 • October 16, 1999
he use of herbal medicines and nutraceuticals among patients about to have surgery is “widespread”, yet most patients do not tell their physicians, and physicians have not been asking, reported Charles McLeskey (Scott & White Hospital, Texas A & M University, Temple, TX, USA) at the annual meeting of the American Society of Anesthesiologists (ASA; Dallas, TX; USA; Oct 9–13). “As the popularity of herbal remedies continues to grow, so will reports of allergic reactions and adverse herb–drug reactions”, he warned. “We should be making this a formal part of the medical history and medications use.”
T
Adapted from ASA publications (http://www.asahq.org)
Marilynn Larkin
New class of inhibitors for angiogenesis proposed d1 and Id3—inhibitors of specific transcription factors—are crucial for the development of the brain and its blood vessels, as well as for tumour angiogenesis in adult animals, according to a new study. Researchers in the USA and Germany report that knockout mice lacking all Id1 and Id3 were not viable, and died by embryonic day 13·5 from malformations and haemorrhages in their brains. However, mice engineered with lower than normal concentrations of the Id proteins (Id1+/- Id3-/- mice) developed and bred normally. In addition, the lowId mice were highly resistant to three types of tumour cells that rapidly killed their wild-type littermates. Tumour cells implanted intradermally or intracorneally in the mutant mice either grew briefly and regressed, or grew very slowly, were poorly vascularised, and failed to metastasise normally, say the scientists (Nature 1999; 401: 670–77). “This study has clearly identified a
I
1362
pivotal regulatory mechanism for angiogenesis”, says David Cheresh (Scripps Research Institute, La Jolla, CA, USA), “and [the normal development of embryonic blood vessels in the low-Id mice] underscores the notion that developmental neovascularisation may be very different from angiogenesis in the adult”. Because Id1 and Id3 are expressed at low amounts in normal cells but at high concentrations in endothelial cells in aggressive tumours, the researchers believe that inhibitors of Id1 and Id3 might be anticancer treatments. “We have [developed] an inactivator of Id, and are working on it with a company [Angiogenex]”, says one of the authors of the study, Robert Benezra (Sloan Kettering Institute, New York City, NY, USA). Now, Benezra says, he and his colleagues will examine the effect of low Id concentrations on cancer growth in genetically cancer-prone mice.
News in brief H pylori and non-ulcer dyspepsia Eradication of Helicobacter pylori is of no benefit to patients with non-ulcer dyspepsia, reveals a new report (N Engl J Med 1999; 341: 1106–11). Only 69 (46%) of 150 patients who received triple therapy for H pylori eradiction for 14 days had dyspepsia relief after 12 months; this number was not significantly different from that in the placebo group (71 of 142 [50%]). Time for cardiac death People in Los Angeles county, CA, USA, are more likely to die from coronaryartery disease during December and January than in any other month, say researchers. The data came from an analysis of death certificates of people who died during 1985–96 (Circulation 1999; 100: 1630–34). Variations in temperature were not thought to be the only explanations; overindulgence during the holiday season may also have had a role.
Paul M Rowe
THE LANCET • Vol 354 • October 16, 1999