This breaking news story from the Reuters News Agency
*****Scientists have found that a gene linked to diabetes and cholesterol is a “master switch” that controls other genes found in fat in the body, and say it should help in the search for treatments for obesity-related diseases.

In a study published in the journal Nature Genetics, the British researchers said that since fat plays an important role in peoples’ susceptibility to metabolic diseases like obesity, heart disease and diabetes, the regulating gene could be target for drugs to treat such illnesses.

“This is the first major study that shows how small changes in one master regulator gene can cause a cascade of other metabolic effects in other genes,” said Tim Spector of King’s College London, who led the study.

More than half a billion people, or one in 10 adults worldwide, are obese and the numbers have doubled since the 1980s as the obesity epidemic has spilled over from wealthy into poorer nations.

In the United States, obesity-related diseases already account for nearly 10 percent of medical spending — an estimated $147 billion a year.

Type 2 diabetes, which is often linked to poor diet and lack of exercise, is also reaching epidemic levels worldwide as rates of obesity rise.

Scientists have already identified a gene called KLF14 as being linked to type 2 diabetes and cholesterol levels, but until now they did know what role it played.

Spector’s team analyzed more than 20,000 genes in fat samples taken from under the skin of 800 British female twin volunteers. They found a link between the KLF14 gene and the levels of many other distant genes found in fat tissue, showing that KLF14 acts as a master switch to control these genes.

They then confirmed their findings in 600 fat samples from a separate group of people from Iceland.

In a report of their study, the researchers explained that other genes found to be controlled by KLF14 are linked to a range of metabolic traits, including body mass index, obesity, cholesterol, insulin and glucose levels.

“KLF14 seems to act as a master switch controlling processes that connect changes in the behavior of subcutaneous fat to disturbances in muscle and liver that contribute to diabetes and other conditions,” said Mark McCarthy from Britain’s Oxford University, who also worked on the study.

“We are working hard…to understand these processes and how we can use this information to improve treatment of these conditions.”

Editor’s note: if this research turns out to be true, development of novel medications to treat obesity and obesity-related diseases could be just a few years away.

When the FDA approved silicone gel breast implants for general use in breast augmentation a few years ago, one of their recommendations was to have the patients get follow-up MRI’s of the breast….”just in case” of an asymptomatic implant leak. While there is not very much good science to support this decision, especially in the first 5-7 years post-op when implant leakage is very rare, you just can’t argue effectively with the FDA once they’ve made up their mind.

At the 2011 ASAPS meeting, Dr. Brad Bengston presented some good data on an alternative method of breast imaging: high resolution ultrasound. This is the same technology that many women are familiar with from their obstetrician’s office – it’s commonly used to get detailed pictures of a baby’s face, while still in utero.

Turns out, it can also work nicely for imaging breast implants, and figuring out if they are ruptured or not. In Dr. Bengston’s initial small-scale study, the high-reolution ultrasound had equivalent sensitivity and specificity as breast MRI….at a fraction of the cost. And much more convenient too, as the imaging procedure can be done in the doctor’s office. MRI also has the drawbacks of being difficult for patients who are claustrophobic, and not permitted for patients with metal stents, pacemakers or internal surgical clips.

Dr. Bengston is continuing with his study, acquiring more data comparing the two imaging methods. This data, we hope, might convince the FDA that there is a better way for our patients.

According to Reuters news service, an FDA advisory panel today recommended that the popular wrinkle-filler Restylane can be officially used to plump up and shape thin lips.

The injectable gel has been approved for years- but only for facial wrinkles and laugh lines. It is, as we know, widely used “off-label” to fill out lips and give them more attractive contours. FDA approval would allow the manufacturer (Medicis) to specifically market and promote the product for that use.

The panel was nearly unanimous in its recommendation. The FDA still has to make a final decision, but the agency usually follows advisory panel recommendations.

Healthcare giant Johnson & Johnson and orthopedic specialty device maker Syntheshave agreed to a merger deal, worth $21.3 billion (USD)

Synthes, Inc., founded in Switzerland, has long been a leader in the fields of orthopedic trauma and craniofacial surgery. They manufacture specialized bone-holding plates, screws and OR equipment, and have always been very active in clinical education efforts.

J&J already owns DePuy Orthopedics. I suspect they think that the combination will dominate the orthopedic market. J&J already owns Ethicon (sutures), Mentor (breast implants), Cordis (cardiac & vascular surgery), Codman (neurosurgery) and Lifescan (diabetes)…so they have a huge range of medical subsidiaries already. The deal must still pass U.S financial regulatory agencies.

Both DePuy and Synthes have had some recent problems with the FDA. DePuy had to recall artificial hip components. A Synthes subsidiary, Norian, was charged by the FDA with improper promotion of bone cement for non-approved / off-label uses.

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It’s nearly time for the annual Aesthetic Society meeting! This year, it’s being held in Boston, which is familiar ground to me! Plastic Surgeons from around the world will be there, discussing all the latest trends, hot topics, and new innovative devices and procedures. It’s the biggest meeting of the year for aesthetic plastic surgeons.

I’m hoping to hear more about:
– new, improved methods of fat grafting
– High-intensity ultrasound for non-surgical fat & cellulite treatment
– improved EMR’s for plastic surgeons
– new cosmeceuticals, filler agents and other cool stuff!

And as always, I’ll file a “Best in Show” report for the loyal readers of PSB- the Plastic Surgery blog! I’ll give you the insider report on what’s hot, and what’s not in plastic surgery. Stay tuned!!

Linda Lu, a 21-year-old Valencia College student, received the Southeast’s first hand transplant March 12th at Emory University, in Atlanta. The operation was detailed in a press conference earlier this week.

She lost her left hand at age 1 due to Kawasaki disease, a vascular condition that can restrict blood flow to extremities, resulting in an amputation at her wrist. She wore a hand prosthesis until the third grade, but after that managed with just one hand.

Looking at her new hand, Lu said, “It feels like magic.”

Lu’s new hand will be able to make a fist, will have feeling in her fingertips and discern temperature, and assist her other hand. But it may never be completely normal. A career as a concert pianist or a surgeon, for example, would still not be possible. Like all transplant patients, she will be on a lifetime of anti-rejection medication. Also, she has 3 months of physical therapy to help maximize the function of her new hand, before she gets to return home to Oviedo.

Fewer than 15 hand transplants have been performed in the U.S. so far.

Editor’s note: To me, the most amazing thing about these operations, known as composite tissue allograft (CTA) transplantation, is the anti-rejection medication. Without this, the transplant would be rejected within a month. Hand surgeons replant fingers, repair bones and tendons every day…but it’s the magic of the immunosupressive medications that makes this particular operation work.

On friday, the FDA approved a new drug, called Yervoy, that should help some people with very advanced cases of melanoma. The drug works in an interesting way – by revving up the body’s own immune system to fight the melanoma tumors. When melanomas are detected early – as a mole “gone bad” – they can be treated with surgery. But once the cancer has spread (metastasized), treatment of metastatic melanoma has been very difficult. According to the American Cancer Society, there were about 8700 deaths from melanoma in the U.S. last year.

“This is really the first time in the melanoma field that there is a drug that extended survival in a meaningful way,” said Dr. Gerald P. Linette, an assistant professor of medicine at Washington University in St. Louis, who participated in a clinical trial of the drug.

In a randomized study, melanoma patients that had such advanced disease that they had stopped responding to standard treatments that were treated with Yervoy lived about 10 months, compared with 6.4 months for patients in a control group, who received a placebo treatment. Interestingly, more than 20 percent of the people who received Yervoy in the trial lived at least two years, and some of them much longer. So far, there’s no way to predict who will get the long-term response.

Yervoy works by essentially disabling a “brake” on the surface of the body’s T-cells, known as CTLA-4, and could possibly also work for other tumor types, although this has not yet been proven. The drawback is that loosening the restraints on the immune system can lead to dangerous side effects, such as colitis, hepatitis, endocrine dysfunction and skin problems. The F.D.A. said that 12.9 percent of patients treated with Yervoy suffered severe or fatal autoimmune reactions. It’s also crazy expensive, at $120,000 for a 4 dose infusion, given over three months.

More information about melanoma here (NCI link)

Source: New York Times (link)

As reported in detail on, the first whole face transplant in the U.S. was successfully performed at Boston’s Brigham & Women’s Hospital last week.

The transplant recipient, a 28 year-old Texan named Dallas Wiens, had suffered devastating full facial burns following a high-voltage electrical accident in 2008. This left him blind and with a badly disfigured face, one without obvious facial features, despite skin grafting. He was a good candidate for the face transfer procedure, (even though it does not restore his vision) which took a team of 30 doctors about 15 hours to complete.

The surgery has replaced the nose, lips, skin and muscles as well as the nerves that power them and provide sensation. According to the medical team, he is making good progress with his recovery.

Amazing stuff!


Sometimes, fantastic discoveries happen by chance. Take, for example, the discover of penicillin by Alexander Fleming. He left some dirty petri dishes by an open window when he left the lab for the weekend… but was observant enough to notice some surprising changes when he got back to work, which led to the discovery of the antibiotic. As Louis Pasteur said, “Chance favors the prepared mind.”

Now, a team led by researchers from UCLA may have found a chemical compound that cures baldness — entirely by accident. They were initially investigating stress-related changes in the GI system…until the research took them in an entirely new direction.

“Our findings show that a short-duration treatment with this compound causes an astounding long-term hair regrowth in chronically stressed mutant mice,” said Dr. Mulugeta, one of the authors of the research. “This could open new venues to treat hair loss in humans…”

For their experiments, the researchers had been using mutant mice that overproduce a stress hormone called corticotrophin-releasing factor, or CRF. As these mice age, they lose hair and eventually become bald on their backs, making it easy to tell these mice from normal mice, which keep their hair.

A newly-developed compound called astressin-B blocks the action of CRF. The researchers injected the astressin-B into the bald mice to observe how its CRF-blocking ability affected gastrointestinal tract function. They measured the inhibitory effects of this regimen on the stress-induced response in the colons of the mice and placed the animals back in their cages with their hairy counterparts.

About three months later, the investigators returned to these mice to conduct further gastrointestinal studies and lo and behold! the treated mice had regrown hair on their previously bald backs. They couldn’t tell the difference between normal mice and the previously-bald genetically mutant mice!

“When we analyzed the identification number of the mice that had grown hair we found that, indeed, the astressin-B peptide was responsible for the remarkable hair growth in the bald mice,” Mulugeta said. “Subsequent studies confirmed this unequivocally.”

One shot per day for five consecutive days maintained the hair-growth effects for up to four months. “This is a comparatively long time, considering that mice’s life span is less than two years,” Mulugeta said.

Furthermore, the same treatment also prevented future hairloss in young mice.

So far, this effect has been seen only in mice. But wouldn’t it be cool if it turns out to work in humans, too!

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Row A: Male CRF-OE mice (4 months old) injected once daily for 5 consecutive days with saline at 3 days after the last injection and Row B: astressin-B (5 µg/mouse) at 3 days after the last injection, and Row C: the same mice as in the middle panel Row B at 4 weeks after the last injection.


According to an article on the BBC news page, scientists at the UK’s Institute of Cancer Research have made a significant breakthrough: they have prevented breast cancer from spreading to other organs in mice by blocking a particular enzyme, called LOXL2.

The enzyme, also known as lysyl oxidase, seems to be important in the early stages of cancer spread. It helps the cancerous cells escape from the breast and get into the bloodstream. The researchers used several techniques to suppress and reduce the enzyme levels in this latest animal study, and found that the rate of metastatic spread of breast cancer to distant organs was significantly reduced.

In people, previous studies have shown increased lysyl oxidase expression has been correlated with decreases in both metastases-free, and overall survival in breast cancer patients. Approximately one third of patients that are treated for localized breast cancer will eventually develop recurrence at distant sites. Once metastases are present (stage IV), life expectancy is less than 2 years.

This new study is therefore important for the development of drug therapy against LOXL2 and improving breast cancer survival, but also for developing a test which can predict the likelihood of cancer spreading.

Image: high power microscopic view of breast cancer cells,
courtesy of

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