2020 was undoubtedly a momentous year for medicine. From a global pandemic, to novel methods of treatment, to the development of a groundbreaking vaccine, science and healthcare have been front and center in public discourse. But with the rise of protests for racial justice in America another problem in the healthcare system was laid bare: the lack of racial diversity in American medical schools and the medical profession. According to JAMA, African Americans represent about 5% of all practicing physicians today, despite making up 13% of the population.1 Why have African Americans been so underrepresented in medicine over the last century? A transformative period of American medical education in the early 1900s changed the demographic landscape of medicine for years to come. Despite recognition of this disparity and efforts to promote diversity over the last century, there is still much work to be done to achieve equality in the medical profession.
{"title":"Racial Inequality in Medicine: How Did We Get Here?","authors":"M. Tenet","doi":"10.52504/001c.25142","DOIUrl":"https://doi.org/10.52504/001c.25142","url":null,"abstract":"2020 was undoubtedly a momentous year for medicine. From a global pandemic, to novel methods of treatment, to the development of a groundbreaking vaccine, science and healthcare have been front and center in public discourse. But with the rise of protests for racial justice in America another problem in the healthcare system was laid bare: the lack of racial diversity in American medical schools and the medical profession. According to JAMA, African Americans represent about 5% of all practicing physicians today, despite making up 13% of the population.1 Why have African Americans been so underrepresented in medicine over the last century? A transformative period of American medical education in the early 1900s changed the demographic landscape of medicine for years to come. Despite recognition of this disparity and efforts to promote diversity over the last century, there is still much work to be done to achieve equality in the medical profession.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-07-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123424482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Peter L Nguy, Deanna Ware, Cameron Kelly, M. Plankey
**Introduction:** A number of vestibular function tests have been used to evaluate vestibular symptoms among people living with HIV (PLWH). However, these tests are inconsistent due to poor sensitivity and specificity. This study attempts to identify sensitive and specific vestibular symptoms that may be useful in selecting appropriate HIV-positive adults for clinical vestibular function tests. **Methods:** Participants were enrolled from the Baltimore-Washington, DC, site of the Multicenter AIDS Cohort Study and the Washington, DC, site of the Women's Interagency HIV Study. A total of 246 participants were evaluated using the Dix-Hallpike (DH) maneuver and the eyes closed, standing on foam (ECF) position in the Romberg test, and completed the Adult Balance and Dizziness Supplemental questionnaire of the 2008 National Health Interview Survey. The sensitivity and specificity were calculated using self-reported vestibular dysfunction from the questionnaire data compared with vestibular dysfunction determined by clinical testing. **Results:** Sixty participants (24.4%) reported vestibular dysfunction. The prevalence of abnormal tests was 40.8% for DH--any nystagmus, 1.5% for DH--classical nystagmus, 40.3% for DH--nonclassical nystagmus, 38.3% for gaze-evoked nystagmus, and 15.7% for Romberg ECF. Sensitivity of self-reported vestibular symptoms for all vestibular function tests reported ranged from 23.1% to 50.0%. These symptoms were moderately specific and ranged from 73.3% to 77.9%. **Conclusions:** Despite adequate specificity, the low sensitivity of self-reported symptoms of vestibular dysfunction were not useful to rule out a vestibular disorder in this sample of middle-aged PLWH. Therefore, clinical testing is needed to confirm the diagnosis of a vestibular disorder in the management of HIV disease.
{"title":"Diagnostic Value of Screening Questions for Vestibular Dysfunction in HIV Disease: A Pilot Study","authors":"Peter L Nguy, Deanna Ware, Cameron Kelly, M. Plankey","doi":"10.52504/001C.21372","DOIUrl":"https://doi.org/10.52504/001C.21372","url":null,"abstract":"**Introduction:** A number of vestibular function tests have been used to evaluate vestibular symptoms among people living with HIV (PLWH). However, these tests are inconsistent due to poor sensitivity and specificity. This study attempts to identify sensitive and specific vestibular symptoms that may be useful in selecting appropriate HIV-positive adults for clinical vestibular function tests.\u0000\u0000**Methods:** Participants were enrolled from the Baltimore-Washington, DC, site of the Multicenter AIDS Cohort Study and the Washington, DC, site of the Women's Interagency HIV Study. A total of 246 participants were evaluated using the Dix-Hallpike (DH) maneuver and the eyes closed, standing on foam (ECF) position in the Romberg test, and completed the Adult Balance and Dizziness Supplemental questionnaire of the 2008 National Health Interview Survey. The sensitivity and specificity were calculated using self-reported vestibular dysfunction from the questionnaire data compared with vestibular dysfunction determined by clinical testing.\u0000\u0000**Results:** Sixty participants (24.4%) reported vestibular dysfunction. The prevalence of abnormal tests was 40.8% for DH--any nystagmus, 1.5% for DH--classical nystagmus, 40.3% for DH--nonclassical nystagmus, 38.3% for gaze-evoked nystagmus, and 15.7% for Romberg ECF. Sensitivity of self-reported vestibular symptoms for all vestibular function tests reported ranged from 23.1% to 50.0%. These symptoms were moderately specific and ranged from 73.3% to 77.9%.\u0000\u0000**Conclusions:** Despite adequate specificity, the low sensitivity of self-reported symptoms of vestibular dysfunction were not useful to rule out a vestibular disorder in this sample of middle-aged PLWH. Therefore, clinical testing is needed to confirm the diagnosis of a vestibular disorder in the management of HIV disease.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"39 19","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-03-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132835953","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin Berardino, Eleanor Belilos, Xue-qin Geng, Valeriy R. Korostyshevskiy, E. Argintar
There are 2 approaches to a total hip arthroplasty (THA) that are commonly used by orthopedic surgeons. While the posterior approach has traditionally been used more frequently, the anterior approach has recently gained popularity because it has been shown to improve patient outcomes. Still, the challenge of learning any new surgical approach during practice can pose its own complications. This study’s aim was to evaluate outcomes of the different approaches, overall and along a chronological timeline, in order to better understand the learning curve for transitioning from a posterior to an anterior approach for THAs. While other studies have examined this learning curve using operating room times and procedural-specific data, this study investigates this topic through the patient’s perspective by using the Forgotten Joint Score (FJS) questionnaire to evaluate patient-perceived pain. A total of 246 patients who underwent a THA procedure performed by a single orthopedic surgeon at MedStar Washington Hospital Center were contacted. FJS questionnaire data from 39 patients (47 THAs) were analyzed. Despite results showing a higher mean FJS for the anterior approach (mean score, 77.55; standard error of the mean [SEM], 5.27; n = 29 THAs) than the posterior approach (mean score, 69.42; SEM, 7.19; n = 18 THAs ), there was no significant difference found between groups (P = .38). Furthermore, based on 2-way analysis of variance, neither the surgical approach nor the surgery year were significantly associated with FJS. Overall, while there are still important considerations in surgical practice regarding learning a new procedure, our data did not suggest that the learning curve of transitioning from the posterior to the anterior approach for THAs significantly affected clinical outcomes; however, the data were limited by a small sample size due to poor survey response rate.
{"title":"Characterizing the Learning Curve for Anterior Total Hip Arthroplasties Using the Forgotten Joint Score","authors":"Kevin Berardino, Eleanor Belilos, Xue-qin Geng, Valeriy R. Korostyshevskiy, E. Argintar","doi":"10.52504/001C.18207","DOIUrl":"https://doi.org/10.52504/001C.18207","url":null,"abstract":"There are 2 approaches to a total hip arthroplasty (THA) that are commonly used by orthopedic surgeons. While the posterior approach has traditionally been used more frequently, the anterior approach has recently gained popularity because it has been shown to improve patient outcomes. Still, the challenge of learning any new surgical approach during practice can pose its own complications. This study’s aim was to evaluate outcomes of the different approaches, overall and along a chronological timeline, in order to better understand the learning curve for transitioning from a posterior to an anterior approach for THAs. While other studies have examined this learning curve using operating room times and procedural-specific data, this study investigates this topic through the patient’s perspective by using the Forgotten Joint Score (FJS) questionnaire to evaluate patient-perceived pain. A total of 246 patients who underwent a THA procedure performed by a single orthopedic surgeon at MedStar Washington Hospital Center were contacted. FJS questionnaire data from 39 patients (47 THAs) were analyzed. Despite results showing a higher mean FJS for the anterior approach (mean score, 77.55; standard error of the mean [SEM], 5.27; n = 29 THAs) than the posterior approach (mean score, 69.42; SEM, 7.19; n = 18 THAs ), there was no significant difference found between groups (P = .38). Furthermore, based on 2-way analysis of variance, neither the surgical approach nor the surgery year were significantly associated with FJS. Overall, while there are still important considerations in surgical practice regarding learning a new procedure, our data did not suggest that the learning curve of transitioning from the posterior to the anterior approach for THAs significantly affected clinical outcomes; however, the data were limited by a small sample size due to poor survey response rate.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124102948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Wilms tumor (WT) is one of the most common renal malignancies in children, comprising about 5% of all childhood cancers. If diagnosed early, WT responds well to appropriate interventions such as surgical resection, chemotherapy and radiotherapy, with a 5 year survival higher than 85%. In this review, we will describe the first-line treatment options for WT, discuss controversies related to particular modes of therapy, and highlight promising advances in molecular biology that may serve as effective therapeutics in the near future. Current treatment protocols for WT include nephrectomy followed by postoperative chemotherapy with or without preoperative chemotherapy. Though both are acceptable forms of treatment, preoperative chemotherapy prior to tumor resection has been shown to reduce tumor size and decrease the risk of intraoperative tumor rupture. Preoperative transcatheter arterial chemoembolization has also been shown to improve tumor resections and relapse-free survival rates, potentially providing an additive method to improve WT outcomes. Radical nephrectomy is the mainstay surgical treatment for WT, however evidence suggests that partial nephrectomies may be an equally viable option. Radiotherapy traditionally utilizes the anteroposterior-posteroanterior field technique, but recent advances have allowed for tumor-specific targeting and sparing of non-neoplastic tissues using intensity-modulated radiation therapy and volumetric-modulated arc therapy. Lastly, potential targets for future therapy include the β-catenin pathway, which has been found to be important in the development of WT, in addition to advances in applying microRNA, M6620, and stem cell therapy.
{"title":"Current Recommendations, Controversies, and Potential Novel Approaches in the Treatment of Wilms Tumor","authors":"K. Delijani, Carolyn M. Hofley, N. Luo, G. Yusin","doi":"10.52504/001C.18059","DOIUrl":"https://doi.org/10.52504/001C.18059","url":null,"abstract":"Wilms tumor (WT) is one of the most common renal malignancies in children, comprising about 5% of all childhood cancers. If diagnosed early, WT responds well to appropriate interventions such as surgical resection, chemotherapy and radiotherapy, with a 5 year survival higher than 85%. In this review, we will describe the first-line treatment options for WT, discuss controversies related to particular modes of therapy, and highlight promising advances in molecular biology that may serve as effective therapeutics in the near future. Current treatment protocols for WT include nephrectomy followed by postoperative chemotherapy with or without preoperative chemotherapy. Though both are acceptable forms of treatment, preoperative chemotherapy prior to tumor resection has been shown to reduce tumor size and decrease the risk of intraoperative tumor rupture. Preoperative transcatheter arterial chemoembolization has also been shown to improve tumor resections and relapse-free survival rates, potentially providing an additive method to improve WT outcomes. Radical nephrectomy is the mainstay surgical treatment for WT, however evidence suggests that partial nephrectomies may be an equally viable option. Radiotherapy traditionally utilizes the anteroposterior-posteroanterior field technique, but recent advances have allowed for tumor-specific targeting and sparing of non-neoplastic tissues using intensity-modulated radiation therapy and volumetric-modulated arc therapy. Lastly, potential targets for future therapy include the β-catenin pathway, which has been found to be important in the development of WT, in addition to advances in applying microRNA, M6620, and stem cell therapy.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"88 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133581071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Antimicrobial resistance (AMR) has been a significant concern for public health and is likely to get worse without collaborative efforts worldwide. Management of the current coronavirus disease 2019 (COVID-19) may further accelerate resistance patterns with the increased nonspecific antibiotic use for patients infected with the novel coronavirus, in an attempt to avoid secondary bacterial and fungal infections.^1,2^ Simultaneously, worldwide responses to the current pandemic have highlighted elements of human nature and societal collaboration that invite cautious optimism about humanity’s ability to prepare for and manage confrontations with incoming pathogens.
{"title":"Parallels Between COVID-19 and Antimicrobial Resistance: To What Extent Are We Willing to Accept Negative Personal Consequences for the Health of Others?","authors":"Jonathan Weiss","doi":"10.52504/001C.17586","DOIUrl":"https://doi.org/10.52504/001C.17586","url":null,"abstract":"Antimicrobial resistance (AMR) has been a significant concern for public health and is likely to get worse without collaborative efforts worldwide. Management of the current coronavirus disease 2019 (COVID-19) may further accelerate resistance patterns with the increased nonspecific antibiotic use for patients infected with the novel coronavirus, in an attempt to avoid secondary bacterial and fungal infections.^1,2^ Simultaneously, worldwide responses to the current pandemic have highlighted elements of human nature and societal collaboration that invite cautious optimism about humanity’s ability to prepare for and manage confrontations with incoming pathogens.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132966861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The alarming increase in opioid use in the United States, particularly during pregnancy, over the past few decades underlines the need to thoroughly investigate the consequences of opioid use within the context of reproduction and development. Opioid exposure has been linked to a number of effects on the various physiologic processes involved in embryonic development. Opioids have been shown to hinder the preimplantation embryo from progressing into the blastocyst stage and implanting into the uterus. Maternal opioid use has also been shown to be neurotoxic to the embryo. Exogenous opioids negatively affect the somatosensory cortex, hippocampus, and cholinergic system in the developing embryo, leading to consequences ranging from poor memory function to learning disabilities. Additionally, opioids have the potential to negatively affect the embryonic heart. Opioid use has been shown to slow down the growth of cardiac tissue, decrease fetal heart rate, and increase the incidence of congenital heart defects. Through review of existing studies, we conclude that opioid use during pregnancy has a significant risk of being detrimental to the embryo. Based on the available scientific literature, we recommend reevaluating current guidelines on opioid use during pregnancy to ensure that opioid exposure to the embryo is limited as much as possible.
{"title":"The Effects of Opioids During Pregnancy: A Literature Review","authors":"Saman Asdjodi, R. Rubarth, J. Hardy, Harry Lee","doi":"10.52504/001C.16759","DOIUrl":"https://doi.org/10.52504/001C.16759","url":null,"abstract":"The alarming increase in opioid use in the United States, particularly during pregnancy, over the past few decades underlines the need to thoroughly investigate the consequences of opioid use within the context of reproduction and development. Opioid exposure has been linked to a number of effects on the various physiologic processes involved in embryonic development. Opioids have been shown to hinder the preimplantation embryo from progressing into the blastocyst stage and implanting into the uterus. Maternal opioid use has also been shown to be neurotoxic to the embryo. Exogenous opioids negatively affect the somatosensory cortex, hippocampus, and cholinergic system in the developing embryo, leading to consequences ranging from poor memory function to learning disabilities. Additionally, opioids have the potential to negatively affect the embryonic heart. Opioid use has been shown to slow down the growth of cardiac tissue, decrease fetal heart rate, and increase the incidence of congenital heart defects. Through review of existing studies, we conclude that opioid use during pregnancy has a significant risk of being detrimental to the embryo. Based on the available scientific literature, we recommend reevaluating current guidelines on opioid use during pregnancy to ensure that opioid exposure to the embryo is limited as much as possible.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129611474","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Patrick Chua, Suzanne Zhou, M. Richmond, S. Romano
Cystic fibrosis (CF) is an inherited, chronic disease caused by a gene mutation that leads to a malfunctioning CF transmembrane regulator (CFTR) protein channel in cells. The life expectancy for individuals with CF has continually increased in recent decades, but is still only around 40 years of age. Current treatment guidelines call for a focus on symptom management and complication reduction. New advances in scientific research with regard to prenatal screening, viral vectors for gene therapy, and CFTR-correcting treatments are making in utero gene therapy a possibility for the first time. In utero gene therapy would allow for an early correction of the gene mutation, preventing the subsequent complications in the development of the fetus and creating the opportunity for a cure for CF as opposed to only symptomatic treatment. In this article, we review recent developments in CF gene therapy and detail the current state of the science of CF screening as well as treatment.
{"title":"An Update on In Utero Gene Therapy for Cystic Fibrosis","authors":"Patrick Chua, Suzanne Zhou, M. Richmond, S. Romano","doi":"10.52504/001C.16782","DOIUrl":"https://doi.org/10.52504/001C.16782","url":null,"abstract":"Cystic fibrosis (CF) is an inherited, chronic disease caused by a gene mutation that leads to a malfunctioning CF transmembrane regulator (CFTR) protein channel in cells. The life expectancy for individuals with CF has continually increased in recent decades, but is still only around 40 years of age. Current treatment guidelines call for a focus on symptom management and complication reduction. New advances in scientific research with regard to prenatal screening, viral vectors for gene therapy, and CFTR-correcting treatments are making in utero gene therapy a possibility for the first time. In utero gene therapy would allow for an early correction of the gene mutation, preventing the subsequent complications in the development of the fetus and creating the opportunity for a cure for CF as opposed to only symptomatic treatment. In this article, we review recent developments in CF gene therapy and detail the current state of the science of CF screening as well as treatment.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"128742074","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
As the coronavirus pandemic progressed around the world, hospitals and healthcare settings were under unprecedented demand and stress. While many areas of medicine not related to treating COVID patients were put on the sidelines, obstetric patients still required checkups and hospital stays for labor and delivery. This article provides an overview of the experiences women faced while giving birth during this time, and the unique policies necessary to provide women with quality care and safe spaces to deliver in such strenuous times.
{"title":"Maternal Healthcare Faces Challenges in Uncertain Times","authors":"M. Kaplan","doi":"10.52504/001C.13649","DOIUrl":"https://doi.org/10.52504/001C.13649","url":null,"abstract":"As the coronavirus pandemic progressed around the world, hospitals and healthcare settings were under unprecedented demand and stress. While many areas of medicine not related to treating COVID patients were put on the sidelines, obstetric patients still required checkups and hospital stays for labor and delivery. This article provides an overview of the experiences women faced while giving birth during this time, and the unique policies necessary to provide women with quality care and safe spaces to deliver in such strenuous times.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114859965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The increased vulnerability of patients with cancer to COVID-19 and the implementation of stay-at-home orders have made delivery of the normal standard of care challenging. Innovative practices and new guidelines have been developed by cancer centers worldwide to provide high-quality care while also decreasing the risk of infection with the novel coronavirus.
{"title":"Cancer Care in the Era of COVID-19","authors":"M. Tenet","doi":"10.52504/001C.13401","DOIUrl":"https://doi.org/10.52504/001C.13401","url":null,"abstract":"The increased vulnerability of patients with cancer to COVID-19 and the implementation of stay-at-home orders have made delivery of the normal standard of care challenging. Innovative practices and new guidelines have been developed by cancer centers worldwide to provide high-quality care while also decreasing the risk of infection with the novel coronavirus.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"108 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130099985","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Regeneration of human pancreatic β cells has the direct ability to treat type 1 and type 2 diabetes mellitus because important characteristics of diabetes include compromised function and/or reduced mass of β cells. While there has been limited success in transplanting pancreatic islets to supplement β cells in patients with diabetes, the low supply of donors requires a continuation of the search for sustainable sources of β cells. Research investigating different mechanisms of β-cell regeneration has been promising. First, neogenesis of β cells in vivo can be conducted by precisely differentiating embryonic stem cells and induced pluripotent stem cells. Second, duplication of β cells occurs in vivo but significantly slows down after infancy. Studies using animal models have suggested ways to induce β-cell duplication in the adult pancreas. Third, the potential to induce endogenous transdifferentiation of other mature pancreatic cells into β cells has recently attracted attention, especially in research involving the use of α cells as progenitor cells. This review summarizes the 3 major mechanisms through which β cells are regenerated and discusses the challenges associated with translating this research into clinical therapeutics for patients with diabetes. Furthermore, current findings suggest that transdifferentiation of existing pancreatic progenitor cells has the most potential as a source of β cells in this field of regenerative medicine.
{"title":"Reviewing Major Mechanisms of β-Cell Regeneration: A Prospective Treatment for Diabetes Mellitus","authors":"E. Jin, Emma J. Djabali, F. Dadrass, E. Hannon","doi":"10.52504/001C.12643","DOIUrl":"https://doi.org/10.52504/001C.12643","url":null,"abstract":"Regeneration of human pancreatic β cells has the direct ability to treat type 1 and type 2 diabetes mellitus because important characteristics of diabetes include compromised function and/or reduced mass of β cells. While there has been limited success in transplanting pancreatic islets to supplement β cells in patients with diabetes, the low supply of donors requires a continuation of the search for sustainable sources of β cells. Research investigating different mechanisms of β-cell regeneration has been promising. First, neogenesis of β cells in vivo can be conducted by precisely differentiating embryonic stem cells and induced pluripotent stem cells. Second, duplication of β cells occurs in vivo but significantly slows down after infancy. Studies using animal models have suggested ways to induce β-cell duplication in the adult pancreas. Third, the potential to induce endogenous transdifferentiation of other mature pancreatic cells into β cells has recently attracted attention, especially in research involving the use of α cells as progenitor cells. This review summarizes the 3 major mechanisms through which β cells are regenerated and discusses the challenges associated with translating this research into clinical therapeutics for patients with diabetes. Furthermore, current findings suggest that transdifferentiation of existing pancreatic progenitor cells has the most potential as a source of β cells in this field of regenerative medicine.","PeriodicalId":340325,"journal":{"name":"Georgetown Medical Review","volume":"85 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116200199","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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