TTHealthWatch is a weekly podcast from Texas Tech.
Today’s subjects include workout for knee osteoarthritis, tocilizumab for COVID-19, gut plants and their function in health and disease, and heparin and COVID infection.
Program notes:
0: 41 Tocilizumab and COVID
1: 46 All required oxygen
2: 48 How costly?
3: 18 Exercise and knee osteoarthritis
4: 18 High or low intensity strength training
5: 18 Very detailed study
6: 18 Keeping individuals in the research study for 18 months
6: 38 Heparin for minimizing blood clots in COVID
7: 40 Subcutaneous injection
8: 41 Research study coming soon
9: 10 Human gut microbiome and health
10: 10 Driven by healthy and plant-based foods
11: 10 Less of one bug in the gut might be associated with heart disease
12: 10 Is it a cause or an impact?
13: 15 End
Transcript:
Elizabeth Tracey: Is exercise of any benefit whatsoever in knee osteoarthritis?
Rick Lange: Do individuals with COVID benefit from a blood thinner?
Elizabeth: A truly extensive appearance– so far– at the human gut microbiome and how it might be related to illness.
Rick: And a various anti-inflammatory medication for people with COVID and respiratory issues.
Elizabeth: That’s what we’re discussing today on TT HealthWatch, your weekly look at the medical headlines from Texas Tech University Health Sciences Center in El Paso. I’m Elizabeth Tracey, a Baltimore-based medical reporter.
Rick: And I’m Rick Lange, president of the Texas Tech University Health Sciences Center in El Paso, where I’m also the dean of the Paul L. Foster School of Medication.
Elizabeth: Rick, we’re still top of mind with COVID, so I’m going to let you pick among yours to begin with.
Rick: Elizabeth, let’s talk about this anti-inflammatory agent, and I called it new– it’s actually not new.
We know that there are different therapies. Early on, there’s monoclonal antibodies before individuals enter into the hospital; once they get in and they’re slightly impacted, remdesivir; however those that are most significantly impacted– those on a ventilator or about to– benefit from high-dose steroids.
What that alludes to is the reality that our immune system is accountable for a few of the lung damage, the inflammation. There is a monoclonal antibody called tocilizumab, which has actually been utilized for rheumatoid arthritis because it’s likewise an inflammatory condition. Specifically, it inhibits what’s called interleukin 6.
They took control of 4,000 grownups that had actually COVID that had evidence of swelling– elevated C-reactive protein– and they all had some requirements for oxygen– some were on a ventilator– and they randomized them to the usual care or a single infusion of tocilizumab. Often, if they wished to, they could offer a 2nd dose the next day, and the easy result was, how did they do with regard to mortality?
What they discovered was that the addition of tocilizumab to typical care, 29%of the individuals that received tocilizumab died within 28 days versus 33%of the clients who did not get it. Overall, that was a 14?crease in death.
Elizabeth: Let’s simply remind everyone that this is published on the preprint server medRxiv and that this is part of the RECOVERY trial, that giganto and, in my mind, an exceptionally well-designed study that’s occurring in the U.K. that’s looking very rigorously at a lot of these things. We can say that our dexamethasone outcomes were truly an outcome of the RECOVERY trial likewise.
Let’s return, however, to “toci”– that’s how I’ve heard people abbreviate it when they’re discussing it– how costly is this?
Rick: Elizabeth, it doesn’t say in this specific article so I can’t resolve that, however the paper does point to the reality that we need to do a cost-benefit analysis.
Elizabeth: We enjoy those repurposed things because, naturally, we already have plentiful experience with them which’s an excellent thing. Let’s rely on something way more pedestrian in JAMA Internal Medicine This is a research study having a look at something that’s so really, very typical. That’s knee osteoarthritis.
In point of fact, as we know, osteoarthritis is the # 1 type of arthritis and a leading reason for special needs amongst adults around the world and the knee, of course, an extremely common joint to be impacted. In this study, they said, “Hey, if we put people on different kinds of exercise programs or normal care, will we be able to ameliorate the pain and the disability that go with knee osteoarthritis?”
They had 377 community-dwelling adults– I would like to have actually seen more individuals, honestly– and they also had varying BMIs, so varying from 20 to45 They didn’t stratify this. This is one criticism I have of this research study since we know that those increasing BMIs really do worsen this condition, however in any case, they had among 3 groups, a high-intensity strength training group, a low-intensity strength training group, or what they called an “attention control group” where they had this mindfulness kind of based technique for assisting them learn to sort of concerned terms with their discomfort, if you will.
They did have a truly long follow-up which was 18 months. The problem was that whether you had high-intensity or low-intensity strength training or the attention control, it truly did not matter with regard to your pain or more an unbiased metric that’s referred to as knee joint compression forces. Frustrating.
Rick: Elizabeth, as you said, it affects millions of people– particularly over 250 million individuals worldwide. Now, one of the important things I liked about this particular research study is it was done incredibly well. You stated there weren’t a lot of individuals– there were under 400– however again, they did numerous measurements. They did gait testing on everyone. They did strength screening, muscle volume, fat volume, and inflammatory markers. I indicate, this was a very thorough research study, with the idea that if you might enhance your leg muscles it would in some way realign the knee a bit better and reduce the osteoarthritis.
Eighteen months, really no benefit. On the one hand, it wasn’t thousands of individuals. On the other hand, it was so well done I think it truly lays to rest the truth that high-strength strength training would be useful for knee osteoarthritis.
Elizabeth: I understand, but it’s just so frustrating.
Rick: No. I mean, the hypothesis was excellent; it was that if you actually enhance the muscles it will make the joints much better. However in this specific case, the low-intensity and the high-intensity strength training, actually no different. Again, I applaud the authors for what I believe what is an incredibly well-done study, and not very simple to do, to keep all these people in this research study for 18 months.
Elizabeth: Well, when it comes to me– and I suspect maybe even for thee– I’m going to promote for doing all of this strength training previous to developing knee osteoarthritis so that we might maybe ameliorate a few of that.
Rick: And managing our BMI too, at the same time.
Elizabeth: You got it.
Rick: We talked a minute ago about hypoxic respiratory arrest. The other concern that’s truly been plaguing with people with COVID is they seem to have actually an increased incidence of developing embolisms, and those clots can add to death. We see this even in younger people.
It’s been approximated that about 30%of hospitalized COVID clients will establish some evidence of venous thromboembolism– venous embolisms– so there many people have actually been promoting about using anticoagulants, not full dosage, however low dose, as kind of prophylaxis to prevent that.
There is a randomized controlled trial going on, but even prior to that, these authors tried to address the question– Would initial prophylactic usage of anticoagulation improve death?– by taking a look at the largest integrated healthcare system in the United States, which is the VA Health System.
They looked at over 4,000– in truth, practically 4,300– patients confessed to the health center with COVID-19
What they found was that it reduced mortality from about 18.7%to 14.3%, about a 34?crease in mortality overall, and you say, “Well, gosh, that must have increased the threat of bleeding because it was low dose.” It did not do that. It does recommend, until the randomized trials are readily available, that prophylactic anticoagulation may be advantageous in COVID-hospitalized patients.
Elizabeth: I would hearken back to what you said about the very first– the toci study, which is that we have actually got a lot of experience medically with heparin.
Rick: Definitely.
Elizabeth: Which ought to be happening really quite shortly, I believe.
Rick: It is, Elizabeth. I believe you and I have currently received some wind that the results might agree with, however we haven’t reported on it since prior to we report on late-breaking news we want to have the ability to look at the research study to evaluate it in terrific information.
Elizabeth: Another thing that I think it’s incumbent upon us to mention about COVID before we leave it is this just-released data relative to the variations that are emerging and increased mortality with them, so a little word of caution. It’s good that we’re getting our arms around a lot more of these clinical elements.
Rick: .
Elizabeth: Enough of the gloom and doom relative to COVID, at least for a minute, and let’s rely on something that I believe tickled my fancy in Nature Medication This is two studies, in fact, that we’re going to deal with together looking at the microbiome. That’s all those bugs that are inhabiting our guts.
Of course, we have actually got them everywhere else too.
They did this metagenomic sequencing of over 1,200 gut microbiomes from these 1,100 folks in this Tailored Actions to Dietary Structure Trial or PREDICT-1 research study. They looked at all these various microorganisms, or bugs, and specific nutrients, foods, food groups, general dietary indices. They say that these were driven particularly by the presence and diversity of healthy and plant-based foods.
They have actually had lots of historic difficulty trying to characterize the microbiome because we understand that a lot of these bugs that live in our gut are either anaerobic or facultative anaerobes, and it’s tough to culture those things when you go out there, however what they’re really counting on is this whole genomic type of analysis.
In the very first research study, the one that’s having a look evaluating the microbiomes, they recognize one organism, Prevotella copri, and then another bacterial types as indicators of beneficial postprandial glucose metabolic process, so let me change to the second consistent, given that we’re switching them both together. Their title is The Gut Microbiome Modulates the Protective Association between a Mediterranean Diet Plan and Cardiometabolic Illness Danger, which they evaluated with different aspects.
They likewise identify this organism, Prevotella copri, with an increased rate of cardiovascular disease risk when they had less of this specific bug in their gut, so we think this is interesting. We have been searching for so long for evidence in between the gut and total health and other things that happen, and I just discover this to be an extremely interesting and nerdish type of set of studies. How about you?
Rick: You’re right. It was nerdish. This was a really tough study since of the quantity of product– the raw data– that they had. Again, these were, in the bigger study, over 1,100 people that they had a longitudinal follow-up, so they had actually detailed long-term diet information, hundreds of fasting and postprandial cardio-metabolic blood markers and in addition to the microbiome.
As you recommended, there appears to be a relationship between microbiome, diet, and likewise a relationship between what are called cardio-protective aspects such as lipids, postprandial sugar, that is postprandial glycemic control. Now, the real concern is, “Is it a cause or is it effect?” Do these specific microbiomes as an outcome of the way that they digest nutrients or affect bile acids– and therefore impact triglycerides and cholesterol– are they the cause? Or is the truth that because of the diet plan, it affects the microbiome? Now, I ‘d call it an association, however I do not think we can show causation. What are your thoughts?
Elizabeth: I think it’s extremely provocative. We’ve been speaking about this for many years and the other question I would contribute to yours is, “OK, then how about if we surge somebody’s gut with Prevotella copri or one of these other bugs that have been identified as being helpful? What occurs then?” I do not believe we understand anything about that.
Rick: You’re right, and this moves from a study that is detailed to one that it actually is possibly healing. That’s actually the thing that I think individuals find most interesting.
Elizabeth: No doubt we’re going to be hearing more about this.
Rick: And I’m Rick Lange. Y’ all listen up and make healthy choices.
Last Updated February 19, 2021
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