Daily ReCAP March 22, 2017

Chronic: Biologic Agents Point to Mucosal Healing in Inflammatory Bowel Diseases

Anti-tumor necrosis factor (anti-TNF) agents help heal the intestine in patients with Crohn’s disease and ulcerative colitis. A recent analysis published in theAlimentary Pharmacology & Therapeutics Reviewshowed that anti-TNF agents such as infliximab and adalimumab more effectively maintained mucosal healing in Crohn’s disease compared with a placebo (27% versus 1%, respectively). In patients with ulcerative colitis, the anti-TNFs and anti-integrins had equal efficacy compared with the placebo (33% versus 18%, respectively). “As we are entering the era where we anticipate there will be many new treatments, each targeting inflammation directly, it is also important to understand the relative efficacy of these therapies in achieving our goal of mucosal healing to appropriately position them in our treatment algorithms,” said senior author Dr Ashwin Ananthakrishnan.

Acute: Scaffolds Made from Sea Urchin Spines Show Promise in Bone Healing

Each year, more than 2 million procedures are conducted to heal bone fractures and defects around the world. To help improve surgery outcomes, investigators developed bone grafting material made from sea urchin spines. Bone is the second most commonly transplanted tissue after blood, and although there are various approaches available to treat bone defects, they have limitations. Recent studies have shown that biological materials show promise as bone scaffolds because of their porosity and strength. In a study published inACS Applied Materials & Interfaces, investigators used a hydrothermal reaction to convert sea urchin spines into biodegradable magnesium-substituted tricalcium phosphate scaffolds while maintaining the original interconnected, porous structure of the spine. The scaffolds could be cut and drilled to a specific shape and size. The investigators tested the scaffold on rabbits and beagles, and found that the bone cells and nutrients could move through the pores and promote bone formation. Furthermore, the scaffold degraded with ease as it was replaced by the new growth.

Preventive: Stronger Nonmedical Exemption Policies Can Reduce Risk of Measles Outbreak

Strengthening nonmedical exemption policies for vaccinations could increase coverage, reduce costs, and lower risk of a potential measles outbreak. In a new study published inAcademic Pediatrics, investigators found that if states with weaker nonmedical exemption policies for vaccinations strengthened them, then it could reduce the likelihood of a measles outbreak by 140% to 190%. Furthermore, the magnitude of the outbreaks could be cut in half by strengthening exemption policies for children. “In the year 2000, measles were no longer being transmitted in the US,” said lead author Melanie Whittington, PhD. “Compare that to 2015 when we had over 150 cases in the first 3 months. Suddenly measles is an issue again despite having an effective vaccine.” For the study, investigators used mathematical models to simulate the magnitude, likelihood, and cost of a measles outbreak under different nonmedical vaccine exemption policies. Using data from the CDC’s National Immunization Study, the investigators found that easier nonmedical vaccine exemption policies—–which typically only require a parent signature or a standardized form––were associated with a greater risk for outbreaks of these preventable diseases. The investigators modeled Colorado, which has one of the lowest vaccination rates for measles, and then simulated measles outbreak under different exemption policies. The findings showed that a state like Colorado is 140% to 190% more likely to experience an outbreak with an easy exemption policy than if it has a medium or difficult nonmedical exemption policy. “There is a tradeoff here,” said senior author Jonathan Campbell, PhD. “It’s a trade between freedom and risk. Are we willing to give up a small piece of freedom that nudges us toward vaccination in order to halve the risk of a detrimental outbreak of a preventable disease? I think Colorado should be willing to make that trade.” The authors added that they are not suggesting that states can’t have nonmedical exemptions, but rather strengthening them could improve and reduce the economic impact of a potential outbreak.