Author: Nancy Fliesler

Breastfeeding protects against food allergy: We have evidence

Mother breastfeeding her baby. Is she helping her child avoid food allergy?

Eating allergenic foods during pregnancy can protect your child from food allergies, especially if you breastfeed, suggests new research. The findings, in a mouse model of allergy, underscore recent advice that pregnant or nursing mothers not avoid allergenic foods like eggs and peanuts.

The study is the first controlled investigation to demonstrate protection against food allergy from breast milk, while also pointing to a biological mechanism for inducing food tolerance. It was published online today in the Journal of Experimental Medicine.

“Whether mothers should eat allergenic foods during pregnancy or avoid them has been controversial,” says Michiko Oyoshi, PhD, of Boston Children’s Division of Allergy and Immunology, who led the study in collaboration with Richard Blumberg, MD, of Brigham and Women’s Hospital, her co-senior author.

“Different studies have found different results, in part because it’s hard in human studies to know when mothers and babies first encountered a specific food,” says Oyoshi. “But in a mouse model, we can control exposure to food.”

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Shunt-flushing device for hydrocephalus gets FDA clearance; could help patients avoid extra surgery

A new shunt-flushing device flushes out shunt blockages noninvasively.
Brain shunts frequently clog up, requiring surgical repair or replacement. A new device flushes out the blockages with the press of a button. (Wikimedia/Adobe Images)

Children with hydrocephalus often have shunts implanted to drain the excess cerebrospinal fluid that builds up inside their brain. Unfortunately, shunts have a tendency to plug up. This potentially life-threatening event necessitates emergency surgery to correct or replace the shunt.

“If you have a shunt, you are always worried about what might happen in the future,” says Joseph Madsen, MD, a neurosurgeon at Boston Children’s Hospital. “Close to half of shunts will have a revision within the first year of implantation. About 80 percent will require a revision within 10 years.”

Last week, the FDA cleared a device originally conceived by Madsen that can potentially flush out a clogged shunt noninvasively, avoiding the need for surgery in both children and adults. The neurosurgeon or other trained healthcare professional could simply press a button at the back of the patient’s head, just under the skin, in an office setting, Madsen says.

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Pre-treated blood stem cells reverse type 1 diabetes in mice

autoimmune attack in type 1 diabetes
In type 1 diabetes, autoreactive T-cells (like the one in yellow) attack insulin-producing beta cells in the pancreas. What if blood stem cells could be taught to neutralize them? (Image: Andrea Panigada)

Type 1 diabetes is caused by an immune attack on the pancreatic beta cells that produce insulin. To curb the attack, some researchers have tried rebooting patients’ immune systems with an autologous bone-marrow transplant, infusing them with their own blood stem cells. But this method has had only partial success.

New research in today’s Science Translational Medicine suggests a reason why.

“We found that in diabetes, blood stem cells are defective, promoting inflammation and possibly leading to the onset of disease,” says Paolo Fiorina, MD, PhD, of Boston Children’s Hospital, senior investigator on the study.

But they also found that the defect can be fixed — by pre-treating the blood stem cells with small molecules or with gene therapy, to get them to make more of a protein called PD-L1.

In experiments, the treated stem cells homed to the pancreas and reversed hyperglycemia in diabetic mice, curing almost all of them of diabetes in the short term. One third maintained normal blood sugar levels for the duration of their lives.

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Personalized care model enhances preterm babies’ development

NICU baby with his mother
Christian, born at 26 weeks gestation, has lived in the NICU since May. (Photos: Katherine C. Cohen, unless otherwise noted)

November 17, 2017 is World Prematurity Day.

From a cozy, dark and quiet existence, a preterm baby is forced out into a harsh, bright and noisy environment. Instead of being comforted and held securely by their parents, preemies are poked and prodded, hooked up to machines and exposed to jarring sights and smells as their developing brains struggle to realign.

Each year, an estimated 15 million babies around the world — 1 in 10 — are born prematurely. Medical advances enable more of them to live, but often with medical and developmental problems.

Heidelise Als, PhD, director of Neurobehavioral Infant and Child Studies at Boston Children’s Hospital, has worked for more than 30 years to create better outcomes, developing the Newborn Individualized Developmental Care and Assessment Program, or NIDCAP.

The NIDCAP model of care seeks to support the development of fragile newborns and reduce their stress. In a series of studies, Als and colleagues at other hospitals have documented its successes: improvements in lung function, feeding and growth; shorter lengths of stay; a reduction in brain hemorrhage and improved brain function and structure, with brain effects lasting until at least 8 years of age. Benefits have been documented even in medically fragile, very preterm infants and infants with severe intrauterine growth restriction.

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Science Seen: To deliver things into cells, do as rotavirus does

rotavirus cell entry - lessons for drug delivery
Courtesy Stephen Harrison

Rotavirus, a major cause of early childhood diarrhea, could have a lot to tell drug developers about how to deliver their products into cells.

Rotavirus doesn’t have an outer membrane, so it’s had to evolve a special system to infect cells. “Viruses with a membrane, like flu or HIV, can simply fuse that membrane with the membrane of the target cell and dump their contents inside the cell,” says Stephen Harrison, PhD, chief of the Laboratory of Molecular Medicine at Boston Children’s Hospital.

Rotavirus does something different, Harrison’s lab has found. First, each virion attaches itself to the cell membrane and wraps itself inside it. Next, its outer proteins, VP4 (the red spikes above) and VP7 (in yellow), disrupt that membrane — and are stripped off in a matter of seconds.

“If you will, they’re the booster the rocket has to shed so the payload can continue,” says Harrison.

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Making breastfeeding a breeze: Cleft lip/palate and beyond

Breast Breeze
Breast Breeze developers Olivia Oppel (left) and Janet Conneely (Photos: Katherine C. Cohen)

Janet Conneely, BSN, RN, CPN, was visiting a new mother in the hospital who had just delivered a baby with a cleft palate to let her know about Boston Children’s Hospital’s Cleft Lip and Palate Program. The mother was trying, without success, to breastfeed, but because of cleft palate, her baby didn’t have an intact hard surface on the roof of her mouth, so couldn’t create enough suction to draw milk.

“I was new to seeing these moms,” Conneely recalls. “This mother was in tears, pleading for ‘some way to be able to breastfeed my baby!’” She adamantly did not want to be shown the specialty bottle typically used for babies with cleft palate.

Conneely tapped her colleague, Olivia Oppel, BSN, RN, CPN, CLC, and together, they reviewed existing breastfeeding products. The few that were available — nipple shields, bottle attachments and a sling that holds the bottle against the breast — were either awkward to use or didn’t really allow for skin-to-skin contact.

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Delivered through amniotic fluid, stem cells could treat a range of birth defects

Transamniotic stem cell therapy, or TRASCET, is like amniocentesis is reverse.
Amniotic fluid is routinely withdrawn for prenatal testing. It could also be a delivery route for fetal cell therapy to treat congenital anomalies, with broader applications than once thought.

The amniotic fluid surrounding babies in the womb contains fetal mesenchymal stem cells (MSCs) that can differentiate into many cell types and tissues. More than a decade ago, Dario Fauza, MD, PhD, a surgeon and researcher at Boston Children’s Hospital, proposed using these cells therapeutically. His lab has been exploring these cells’ healing properties ever since.

Replicated in great quantity in the lab and then reinfused into the amniotic fluid in animal models — a reverse amniocentesis if you will — MSCs derived from amniotic fluid have been shown to repair or mitigate congenital defects before birth. In spina bifida, they have induced skin to grow over the exposed spinal cord; in gastroschisis, they have reduced damage to the exposed bowel. Fauza calls this approach Trans-Amniotic Stem Cell Therapy, or TRASCET.

New research findings, reported this month in the Journal of Pediatric Surgery, could expand TRASCET’s therapeutic potential.

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Can rare pain syndromes point the way to new analgesics?

analgesic drug discovery could reduce prescription opioid use
Boston Children’s Hospital and Amgen will collaborate to discover and accelerate non-addicting pain drugs.

As the opioid epidemic deepens and drug overdoses increase, effective non-addicting painkillers are desperately needed. Efforts to discover new pain pathways to target with new drugs have thus far had little success. Other promising research is investigating triggerable local delivery systems for non-opioid nerve blockers, but it’s still in the early stages.

A new collaboration between Boston Children’s Hospital and the biopharmaceutical company Amgen is aimed at accelerating new pain treatments. Announced yesterday, it will revolve around patients with rare, perplexing pain syndromes. The scientists hope that the genetic variants they find in these patients will shed new light on pain biology and lead to new ways of controlling pain. 

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What do hospitals want from prospective digital health partners?

how digital health startups can better approach hospitals
How digital health startups can better approach hospitals.

How can the growing number of digital health startups sell their products to large-scale healthcare enterprises? Earlier this year, Rock Health, a San Francisco-based venture fund dedicated to digital health, conducted 30-minute interviews with executives at multiple startups and a few large healthcare organizations. They identified several key sticking points: navigating the internal complexities of hospitals, finding the right buyer, identifying the product’s value proposition and relevance to the hospital and avoiding “death by pilot.”

Now, in a Rock Health podcast, John Brownstein, PhD, Chief Innovation Officer at Boston Children’s Hospital’s Innovation and Digital Health Accelerator and Adam Landman, MD, MS, MIS, MHS, Chief Information Officer at Brigham and Women’s Hospital and part of its Innovation Hub, offer further tips from the inside. They were hosted by Rock Health’s director of research, Megan Zweig.

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Dock Health’s shared ‘to do’ list for clinical teams — so basic, so necessary

Dock Health - a shared to-do list for clinical teams - could ease clinical burnout

While something as simple as a “to-do list” might seem trivial, a secure hub to store, prioritize and assign clinical and administrative tasks could be game-changing in healthcare.

Michael Docktor, MD, of Boston Children’s Hospital made this case yesterday at the Health 2.0 Conference in Santa Clara, Calif. He demonstrated Dock Health, a secure iOS mobile and web application that helps medical teams manage the numerous tasks that fall under clinical care. The idea was born in his gastroenterology practice at Boston Children’s and was incubated by the hospital’s Innovation and Digital Health Accelerator (IDHA).

“In an average day in clinic, I might see 15 patients and get 75 emails, 10 secure messages, three pages and five [electronic medical record] messages in my inbox,” Docktor writes on Medium. “Not too long ago, some emails were from frustrated colleagues, asking me to do something for a second or third time. Sadly, some were from parents of my patients, kindly reminding me that they were sitting in the lab waiting for the orders I forgot to place or trying to book their colonoscopy, for which I had forgotten to submit the form.”

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