2019
June
Vol. 15
4-5 INTERVIEWS JEON SEUNG HO, CEO of Daewoong
14-15 COLUMN Fine dust, the brain invader
22-23 INTERNATIONAL ISSUES Herpes Virus Reactivation in Space
EDITOR'S Lee Eun Chan
NOTE
Nowadays, pharmacy-related issues came one step closer to our daily lives, strengthening the inevitable connection between pharmacy and life. In this regard, Blue Vanguard wants to move a step closer to subscribers with more intriguing and wholesome contents in this 15th edition. Rather than being just erudite magazine, I hope for it to be read informatively and entertainingly by everyone. In this edition, you will find articles dealing with familiar topics such as placebo effect, fine dust and drug abuse in the fitness industry. Moreover, marvelous findings will be also covered, including a case of patients cured of HIV and reactivation of latent viruses during space-flight. Mentioned above, various issues covered in the 15th edition underlie in our daily lives and certainly have been changing our lives. Not just settling for apprehending these new findings and technologies, I hope the edition to become opportunities for readers to utilize these knowledges for improving our daily lives. For this, Blue Vanguard will give our best effort to publish a better magazine every semester.
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CONTENTS Interviews 04-05 JEON SEUNG HO, CEO of Daewoong Pharmaceutical
Pharmaceuticals For Developers, By Developers : Naver D2 Startup Factory 06-07 Development of “Drug-releasing porous implant� manufacturing technology with domestic root technology 08-09
Column 10-11 Fake treatment? Powerful Placebo! 12-13 Pioneer of new cancer treatments using light and nanoparticles 14-15 Fine dust, the brain invader
National Issues Gore's cut-off of the pediatric artificial vessels 16-17
The Pilot Project 2019 - Chronic Disease Management in Primary Care 18-19
Bodybuilding Gone Wrong 20-21
International Issues 22-23 Herpes Virus Reactivation in Space 24-25 At the crossroads of HIV/AIDS treatment 26-27 Hallucinations caused by Tamiflu - Should we keep it?
Campus Life Behind the curtains: An Interview with Professor Jeong 28-29
2019 VOL.15
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INTERVIEW
Jeon Sung Ho, CEO of Daewoong Pharmaceutical
D
EunChan Lee
bihs1@naver.com
aewoong Pharmaceutical is a global healthcare group established in 1945 under the vision of ‘manufacturing high
quality pharmaceuticals to enhance people’s health and create a healthy society.’ On April 2019, Blue Vanguard
visited Daewoong Pharma to interview Mr. Jeon, CEO of a Daewoong Pharmaceutical. Through the interview, we
could assure Daewoong Pharma’s efforts to develop it into global titan. Moreover, Mr. Jeon introduced advantages of Daewoong Pharma’s working environment and gave our pharmacy students valuable advices.
Q. Please tell me about yourself and your career. After majoring pharmacy in Seoul National University, I completed a master’s degree in pharmaceutical science in the same University. Since entering Daewoong Pharmaceutical in 2000, I’ve worked here for about 19 years. Until now, I’ve performed various duties on working at several division. At first, I started my career in the business development and worked at that division for 10 years. Especially, my main task was strategic planning of new product portfolio, in-lic nse of external new drugs and market access(regulatory affiars and pricing) until commercial launch. In 2010, I moved to global strategy divison. By that time around, feeling need for learning management skill and business knowledge, I took MBA courses as a kind of efforts to foster my personal capability to meet the qualification of executive position which may be hopefully offered to me sometime in the future. After experiencing diverse areas in the firm, I’ve been working as a CEO of the company since last year.
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Q. What kinds of efforts has Daewoong Pharma been taking to become global titan? To tap into global market, first to market and innovative portfolios are the keys to open the door. That’s why progressive new medicines and products should be developed through constant R&D. Daewoong Pharma has been developing progressive and competitive products in the global market through creative R&D efforts. For example, Daewoong Pharma is the first domestic pharmaceutical firm whose generic ‘MEROPENEM’, an antibiotic got U.S. FDA(Food and Drug Administration) permission. Moreover, botulinum toxin ‘NABOTA’ got U.S. FDA permission this year and began exporting it to the USA. Along with R&D efforts, Daewoong group established 8 foreign corporations including China, the USA and Indonesia, enabling global infrastructure. Furthermore, Daewoong Pharma has been operating manufacturing facilities and R&D center in indonesia and china. Daewoong R&D strategy is significantly placed on open collaboration which is co-developing with external parties including top qualified professors, start-ups all over the world to put together various idea and come up with new innovation that is not possible alone. The firm uses ‘glocalization strategy’ which is holistic understanding of overall business environment such as country specific culture, market environment and the law and regulation of the target country beyond simply relying on trade only without in-market understanding. Q. ‘NABOTA’ which got FDA permission recently is expected to quickly penetrate the U.S. botulinum toxin market. What are the advantages of ‘NABOTA’ compared to existing botulinum toxin products?
INTERVIEW
Basically, Nabota is a high purity product with more than 98% of the 900Kda protein which is known to be the most stable and effective of botulinum toxin type A. First of all, in terms of high purity refinement, Nabota is superior to others. Purity of botulinum toxin is very important because impurities should be precisely eliminated for the toxin to bring only expected effects. For example, if smaller protein complexes are mixed, diffusion will increase. Accordingly, the toxin may spread out to unexpected region, causing stiffen induced by the toxin’s inhibition function of acetylcholine. Second, European clinical demonstration indicated that Nabota has long duration and immediate onset of action in the subclass analysis. Third, Nabota is price competitive in the U.S. market. Nabota would be a formidable rival to Botox by Allergan, a market leader in the U.S. botulinum toxin market; thanks to Nabota’s price that would be priced 20 to 25 percent lower than Botox. All told, Nabota would penetrate U.S. botulinum toxin market quickly estimated to be worth 2 trillion won with the good quality and price competitiveness. Q. One of the Daewoong Group’s R&D visions is ‘improvement in quality of life by developing medicines for intractable disease’. Please introduce the medicines Daewoong Group has been developing. There are 5~6 new drug candidates our firm has been developing. Let me talk about some of them. First, ‘DWP212525’ is a candidate for treatment of autoimmune diseases such as Pemphigus Vulgaris. It is a novel irreversible JAK3 and BTK dual target inhibitor. Comparing to existing BTK inhibitors that often show off-target effects and related side effects, it is much more reliable and safer compound to be a next-generation inhibitor. Second, ‘DWN12088’ is a candidate using new mechanism for treating fibrosis such as myofibrosis cordis. It inhibits Prolyl-tRNA synthetase (PRS), so excessive formation of collagen is prevented. With distinctive mechanism and results of effectiveness, clinical testing has progressed as cooperative research. Q. Despite keen competition in the pharmaceutical industry, Daewoong Pharma’s sales reached 1 trillion won for the first time last year. What is driving force for sustained growth of the firm? I can express the driving force in a single word: ‘human capital.’ There are a lot of good people in Daewoong Pharma and our outstanding individuals have been
establishing good corporate culture. Under the good flow culture, our people create innovative business model. Therefore, better products are produced and then the sales flow naturally. To keep and motivate our good staffs, we have been enforcing various systems. First, Daewoong Pharma is the first pharmaceutical firm which allowed overall execution of smart office. Our employees can work with flexibility which enables them to communicate with each other and stay absorbed in their work. Second, by enforcing ‘share incentive plan’, qualified employees can be compensated for stocks of the company. The system allows us to construct firms that our employees become owners. Finally, we allow unconstrained department transfer. If our employees work for a department for 2~3 years, they can apply other department and transfer. By doing so, our employees can build up various work experiences. Q. Can you give some advices for pharmacy students? Basically, be studious. When I studied in the university, curriculum was focused on chemistry which means biology courses were insufficient. However, according to a reorganization of college of pharmacy, not only chemistry, but also various biology and clinical pharmacology courses are offered. Undergraduate courses are good opportunity for you to acquire overall expertise regarding pharmacy. Don’t miss this opportunity. Especially, if you want to work for the pharmaceutical companies in the future, studying immunology in depth will be helpful. As recent new medicine development has been based on immunology. Second, be prepared beforehand. I like the word ‘serendipity’. It means ‘heaven helps those who help themselves’. Transferring to global strategy team was also a kind of preparation for me to the advent of globalization of pharmaceutical market. Experiences I got during working in global department helped me to see the trend of global pharmaceutical market. In a similar vein, completing MBA course was also one of preparations for the future. Actually, investment, finance expertise I acquired during the course have helped me to work as a CEO of the company. If you do not make preparations for the future, opportunity doesn’t come. Fortune comes to those who are prepared in advance. Only prepared person can recognize opportunity and make it a fortune. B
2019 VOL.15
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PHARMACEUTICALS
For Developers, By Developers : Naver D2 Startup Factory Kim Yong Wook
F
demosca1911@naver.com
or Developers, By Developers. This is the words written on one side of Naver D2 Startup Factory. The
Naver D2 Startup Factory is one of the domestic startup accelerators that invest in startups and provide office space and mentoring.
Let’s look at Naver D2 Startup Factory and invested healthcare startups.
Naver D2 Startup Factory : ' supporter for creative startups.' Since last year, many domestic companies have been investing in the healthcare field. These phenomenon tell us that innovations in various technological fields such as AI, pharmaceutical industry, healthcare, and robotics are ongoing at a rapid pace. But, startups using advantage of these innovations have not been successful. It is because finding investors who can fully invest in the value of start-up and competing with other startups are big obstacles to success. Naver D2 Start-up Factory is one of the accelerators that helps startups overcome there obstacles by financing and providing community for developers and free softwares for developers. The Naver D2 Start-up Factory tried out the 2011 Big Data Developers Conference. Since then, they have run the blog “Hello World” which contains the knowledge of Naver’s developers for others. In 2013, Naver officially announced the Naver D2 and encouraged developer community activities, such as providing a small offices and server, and sponsoring conferences. Still, they continuously invest in various events and startups.
AmoLab : 'Bioelectronics-based wearable device for improving sleep' Many modern people‘s daily life is filled with stress and shortness of time. Therefore, needs for longer and better quality of sleep are increasing. The major treatments for sleep improvement are using sleep inducing drugs and electrical brain stimulation. However, these methods have stability issues and side effects such as drowsiness during the daytime and dependency. Some startups and companies have developed wearable devices for sleep improvement, but these device type products were not satisfactory enough because of their inconvenience and high price. AMO+ is a device developed by AmoLab that stimulates the vagus nerves up to 9 inches (23 cm) with fine electromagnetic signals. AMO+ activates the sympathetic nervous system and restores the balance of the autonomic nervous system. As a result, balanced system improves sleep quality by reducing stress, stabilizing heart rate and respiration.
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PHARMACEUTICALS
AMO+ is in the non-contact, non-invasive necklace form and therefore it is more convenient and cheap to maintain. The prototype of AMO + has been developed and discussing cooperation with US and European companies.
Deepmedi : ' blood pressure diagnosis tool using PTT technology for smartphone' Conventional home blood pressure measuring machines are huge and difficult to manage because of their difficulty in data management. In order to compensate for these problems, PTT(pulse transit time) blood pressure measurement technology has been developed to measure blood pressure by using smartphone. However, its reliability was low and it was not widely used. Deepmedi used PPG technology that allows smartphone’s blood pressure measurement more accurate and reliable than PTT without any additional equipment. PPG, abbreviation of photoplethysmograph, measures the intensity of light reflected when blood absorbs light. This allows toestimate heart rate signals, blood pressure and blood vessel age. The accuracy of heart rate analysis is up to 99%, and the ability to accurately analyze blood pressure continues to improve. The biggest advantage of Deepmedi is that users can check their blood pressure in real time. Although the blood pressure analysis capability announced in 2017 showed a margin of error of 8 mgHg compared to the conventional blood pressure monitor, the Deepmedi has been developing technology for the past two years and aims to register medical devices this year. It would not be long before users could check their blood pressure whenever they want to.
Pharmacists can get opportunities of startup market The Naver D2 Startup Factory is currently supporting four other healthcare startups in addition to the two startups described above and they are planning to support more. The size of stratup market is keep growing larger, and there are numerous places that pharmacist can cooperate. Healthcare startups consist with complex interactions more than we think. Not only doctors or engineers work in healthcare startups but also data scientists, social scientist, nurses, pharmacists work. It is because healthcare startups covers large spectrum, from developing new medical devices to applying them and making various systems for medical users. However, many pharmacists and students major in pharmacy do not know or consider about startup market. It is probably because they are too busy to look for other fields during the university life and get a license for stable job after state examination. But it is truely one of the attractive job fields, therefore I hope more people know about startup fields. B
2019 VOL.15
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PHARMACEUTICALS
Development of “Drug-releasing Porous Implant” Manufacturing Technology with domestic root technology
A
JaYeon Heo
heojayeon@daum.net
s the elderly population is increasing due to the aging trend, both interest in orthopedic implants and demands are on the rise. According to WHO the average life expectancy in Japan is approximately 83.7 years, and 82.3 years in South Korea. Additionally, increased government expenditure on medical device industry, and the development of favorable government regulations for the use of these orthopedic implants to influence the market growth during this period. The global orthopedic implants market is anticipated to reach USD 6,558.32 million by 2025 according to a new report published by Polaris Market Research. In 2017, application type, knee orthopedic implants segment captures the largest market shares in terms of revenue and hold the major share in the market. However, titanium materials used in the manufacture of orthopedic implants are expensive and depend entirely on imports. In this regard, the team of Chief Researcher Kim Hyun Jong of the Research Institute of Advanced manufacturing Technology formed a Team for the development of implant manufacturing technology which is human-friendly, durable and low cost.
Titanium alloy source material without impurities The first part that needed to be developed was titanium, a raw material. The team succeeded in casting a titanium alloy (Ti-6Al-4V) for the first time in the world, using electromagnetic induction devices and hydrogen plasma , which satisfies the standard for implantation. If this method is used, the manufacturing cost can be reduced to half the level of imported products. The gas impurities contained in titanium are harmful to human body and must be removed for medical use. The team also pushed the casting process and hydrogen plasma refinement process at the same time, paving the way for mass production of titanium for implantation that minimizes human toxicity.
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Pore size control for optimum strength - The size of the pore is important for
controlling the strength of the implant “Titanium has a much higher elastic modulus than bones. Failure to match the elastic modulus of a bone with an implant made of titanium can cause problems because the original bones around the implant are weakened. So we need a technique to create a porous structure inside titanium to have a similar strength to bone. “ Emphasizing the importance of porous structure, Kim said that it developed a variety of plastic processing technology to make porous structures such as freeze casting, fiber compaction, and hot forming. Among them, the dynamic freezing casting process is a process of freezing the titanium raw material powder with a freezing medium called camphin and then drying it. At this time, the size of the pore can be increased or decreased by controlling the amount of the titanium powder, temperature and time, and the parameters of the freezing casting. The team gained success in producing porous implants with world-class pore size and elastic modulus control range.
PHARMACEUTICALS
Releasing inflammation-inhibiting drugs through pore In addition, implantation of inflammation-suppressing drugs or therapeutic agents into the pores in the implants can dramatically reduce adverse effects such as inflammation after implant surgery and improve the therapeutic effect. Previously, drugs had to be applied around the implants, but implants made of porous structures make it possible to inject drugs into the internal pores. The pores may contain various drugs such as anti-inflammatory drugs, bone formation promoting proteins and stem cells, slowly release them at a constant rate. Special surface treatment techniques were applied here. Graphene-based aerogels that contain drugs and promote bone formation, and biocompatible hydrogels, provide the ability to accelerate the bonding of implants and surrounding tissues and release drugs over a long period of time. When a titanium implant is coated with a hydrogel, blood and body fluids adhere to the tissue after implantation to facilitate tissue growth around the implant. The hydrogel is generally a material that does not stick well to titanium, but the problem is solved by attaching a molecule that reacts chemically with the hydrogel to the titanium.
Synovlum
Synoviocyte
Lympathic vessel
Venules
Microparticles
Personally customized implant production could be possible in the near future. When porous titanium implants are commercialized, patients will receive high quality titanium implant surgery at a reasonable price. They do not put a burden on the bones, and once operated, they can be used semipermanently, and the recovery time is also shortened by minimizing the occurrence of inflammation. In addition, the pore size can be adjusted to make an implant optimized for the individual’s body structure and bone strength. Clinical trials will be held for three years starting from 2020 by producing prototypes. If safety and efficacy are recognized, it is expected to be widely used in various bio-health materials such as stents, artificial organs and biosensors as well as orthopedic implants in the future.B 2019 VOL.15
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COLUMN
FAKE Treatment? Powerfull Placebo! So Yeun Choi choisoyeun@yonsei.ac.kr
C
an it be possible to get drunk after drinking non-alcoholic beer? In Georgetown university, freshmen participated in a novel experiment comparing each attitude in accordance with alcoholic and non-alcoholic beverages. Even people who drank non-alcoholic beer showed drunk attitudes, which is a quite interesting result. Therefore, the effect is created by the relief that subjects drunk real beer with illusion in this case. This effect is a powerful medical treatment or procedure inducing physical effect on individuals using fake drugs which do not contain any active ingredients. The phenomenon observed in this fascinating study which has baffled many scientists and doctors is medically known placebo effect(Latin, “I shall please�). Drugs used in placebo tests are inert materials with exactly the same physical appearance and odor as the active dosage form. For example, physiological saline, sugar, and vitamins are commonly used to make placebos. Nowadays, scientists are steadily find lots of scientific evidence and mechanisms supporting the placebo effect which is no longer an unexplained mystery in the clinical field. Patients who take placebo undergo some physiological and biochemical changes: decrease in blood pressure, change in heart rate, and release of a variety of chemicals such as the pain-reliving molecule endorphin. Placebos reduce the amount of adrenalin stress hormone in some cases. As is well known, placebo effect is beneficial to ease the pain enough to substitute morphine,an analgesic, in World War II. In fact, mechanisms of placebo effect in pain are the activation of endogenous opioids and dopamine. According to active research, placebo induces the activation of dopamine in the striatum in Parkinson’s disease, and reduces beta-adrenergic activities in the cardiovascular system. Furthermore, its interesting results are caused by the change of hormones, immune mediators, electrical and metabolic activity in different brain regions, and so on. Nevertheless, little is known on the exact mechanisms of placebo effect in a wide range of diseases.
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COLUMN
Surprisingly, each test subject showed inconsistent reactions after taking the placebo because its result can be influenced by person’s own property, research period, drug price, and so on. The more the patients trust doctors or pharmacists, the better placebo effect occurs. Furthermore, the patients who accept new drugs or view clinical test positively or those who already obtained therapeutic effect after a single-dose therapy show a tendency to fit to typical result of placebo test. Interestingly, patient’s perception and expectation of drug cost significantly affects its efficacy. Research Alberto Espay team at University of Cincinnati has found that the higher drug price which is offered to test subject group, the greater efficacy. Researchers gave equally effective placebo drugs which merely consisted of saline solution to two groups of study volunteers, then told each group one costs $100 per dose and the other costs $1,500 per dose. Despite being the exact same saline solution, the more expensive placebo drug generally improved motor skills and minimized hand shaking more effectively. Scientists and doctors still consider the effect of placebo because it is beneficial to clinical test results for new drugs also for patients. Placebo effect is used with great effectiveness as analgesics, especially for patients who complain about pain or require many pills and tranquilizers, and the aged who demand a strong dose of drugs for their pain relief. According to a recent study, cancer patients also show positive results caused by placebo. In fact, the placebo effect plays a significant role in demonstrating the effectiveness of a new treatment in pharmaceutical industry. In the process of developing new drugs a double-blind test is mainly used in phase 3 in randomized and placebo-controlled test. It is essential in the measurement of the remedial effect of new drugs. The equivalent results between a real drug and a placebo represent no effectiveness. The remedial effect minus the placebo effect can be credited to real medicinal property. Briefly, understanding and controlling placebo response is essential to assess not only difference between beneficial treatments and placebo, but also important key to avoid costly drug development and repeated clinical trials.
There is no doubt that the placebo effect is powerful. In fact, lots of placebos have been used according to a survey done by head nurses in a Connecticut health district. 44% of respondents reported that they have been currently using placebo drugs in hospital. Moreover, surveys of intern doctors and registered nurses working in two university hospitals in the United States showed high percentage of placebo usage. 78% of physicians and 82% of nurses responded that they had ordered at least one placebo as an analgesic. Placebo effect must be a strong clinical tool, not a fake treatment, especially for patients with mental illness and chronic disease. Also, it plays a significant role in the economic and efficient development of new pharmaceuticals. Its effect cannot be therapeutic to total range of diseases such as injury that requires surgery. However, doctors and pharmacists can apply placebo effect properly to the clinic within a range of proven illness group to improve the curative effectiveness and minimize drug tolerance and ADR(adverse drug reaction). In addition, regardless of its pharmaceutical purpose, the placebo effect might be a physical motivator as is for energy drinks which make people believe they have obtained more energy to train harder. Likewise, we can expect to discover a variety of other applications of the effect within the next few years, which then will no longer remain an unexplained mystery in modern medicine. B
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COLUMN
Pioneer of new cancer treatments using light and nanoparticles Junseo Oh
ojoojo1194@naver.com
Common Cancer Therapy
M
alignant tumors are the most difficult human diseases to cure and have a high mortality rate. The current major cancer treatments include surgery, chemotherapy and radiation. However, these treatments have a number of problems such as low efficacy, mortality and adverse drug reaction. Among these traditional therapies, chemotherapy remains unsatisfactory due to multidrug resistance, which is a major obstacle in cancer treatment.
Photodynamic Therapy (PDT)
Photodynamic therapy is a new and alternative approach to improved cancer treatment. Photodynamic therapy is a rising cancer therapy which uses photosensitizer. In the photosensitizer, the energy is transferred from light to molecular oxygen. By this process, oxygen is converted to reactive oxygen species. The therapy focuses on the toxicity of singlet oxygen generated by a reaction between photosensitizers accumulated in tumor cells and light of a particular wavelength that excites the photosensitizers. Oxygen radicals cause damage to the particular regions such as tumors and blood vessels by surrounding them. Through the toxic activity of singlet oxygens, photochemical reactions damage tumor tissues by inflicting direct injuries which include necrosis and apoptosis of tumor cells, resulting in the occlusion of tumor vessels and enhanced adaptive immunity.
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How to overcome limitations of PDT However, almost all photosensitizers have trouble adjusting in the human body system, which is attributed to property of poorly water-soluble photosensitizers. The nanoparticle system has been used to overcome problems such as drug solubility and low efficacy in delivery. The nanoparticles are loaded with anticancer drug, small molecule drug, biomedicine and photosensitizers. For example, gold nanoparticles have been extensively studied for targeted drug delivery. They have been highlighted for applications in cancer therapy because of their highly significant resonance properties. Those properties arise from energy excitation resulting from the irradiation of light of a specific wavelength onto the surface of gold nanoparticles. The significance of this new therapy is that its improvement of phototoxicity overcomes the limitation of the existing nanoparticle system. Nanoparticle systems have overcome limitations by enhancing the ability of photosensitizers to be delivered and improving phototoxicity in a current period. Various photosensitizers have been developed to treat cancer. Some of them are commercialized and available on the market. The representative examples are Phthalocyanine 4, Photofrin and so on. There are various types of nanoparticles loading Phthalocyanine 4 to treat cancer, such as gold nanoparticles, fibronectin-mimetic peptide, iron oxide and solid lipid nanoparticles. Nanoparticles loading Photofrin to treat cancer are also very diverse, for example, PEGylation, dendrimer, hyaluronic acid and liposomes conjugated to a monoclonal antibody. Common results of those treatments are mainly used in brain cancer, breast cancer, ovarian cancer and melanoma.
Conclusion : Future of PDT In conclusion, photodynamic therapy has been used around for several years and has been on experimental clinical trial for several decades. It has the potential of being a primary therapy, depending on the specific indication. In the future, it is expected that photodynamic therapy will continue to be used as a stand-alone modality or in combination with chemotherapy or surgery. Nanoparticle systems are one of the key steps to adjust photodynamic therapy to overcome their obstacles. Photosensitizer that is loading nanoparticles is widely accepted to combat against tumors. In spite of successes mentioned above, more researches and development about nanoparticles are needed. B
2019 VOL.15
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COLUMN
Fine Dust, The Brain Invader Ye Ji Jeon
M
yejijeon97@naver.com
ost of you may have come across the news or the internet dealing with ‘fine dust’ at least once. Particularly in Korea, the government often sends citizens emergency mobile messages on bad days of fine dust to have
people refrain from outside activities. As danger of fine dust is arousing people’s attention, more people are
protecting themselves by regularly checking fine dust concentrations on smartphone applications and preparing masks
before going out. Furthermore, recent developments of cosmetics claiming to have protective functions against fine dust also clearly show the seriousness of the issue. One of the critical reasons why people are freaked out is that many
research had shown the negative effect of fine dust on human health. Actually, a recent study has highlighted that fine dust can be a great threat to us as it not only harms our respiratory system, but also arouses cognitive disorders.
How does the fine dust affect our brain? According to the research published in Translational Psychiatry, it was demonstrated that there is a significant relationship between particulate matter, also known as fine dust, and cognitive disorder. It says that fine dust has a destructive function on cognitive skills and increases the risks of Alzheimer’s disease and dementia. Professor Caleb Finch, the lead author of the study from Leonard Davis School of Gerontology at University of Southern California (USC), has warned of the danger of particular mass 2.5. PM 2.5 is a fine contaminated airborne particles with the diameter no longer than 2.5 μm. It is composed of solid and liquid mass, usually released during combustion processes in factory or cars. Its diameter is so tiny that it is easily absorbed by the human body and can cause negative effects on our lungs and heart. Professor Caleb Finch stated that if people are exposed to PM 2.5, the probability of getting dementia increases over 90% in elderly women. When applied to the whole population group, approximately 20% of the cause of Alzheimer disease can be attributed to PM 2.5.
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COLUMN
The research team estimated how much the subjects were exposed to PM 2.5 per day at their residence. The result showed that compared to the women living in low PM 2.5 areas, the women living in high PM 2.5 areas were 81% more vulnerable to cognitive disorders and 92% more vulnerable to other dementia diseases. This result was also valid when other variables, such as race, social status, life style were controlled. The experiment which demonstrates the effect of PM 2.5 on cognitive disorders was also conducted on mice. During the experiment, two groups of mice were exposed to air pollutants for 15 weeks. One group had APOE ε4 gene and the other did not. The result showed that compared to the group of mice without APOE ε4 gene, the group with the gene had 60% more accumulation of ß-amyloid plaques in the brain. It is a well-known fact that the protein-aggregated complex of β-amyloid plaque destroys the neuron and leads to dementia. The result of the experiment demonstrated that the exposure to fine dust is especially dangerous to the women who have the APOE ε4 gene which can ultimately lead to Alzheimer’s disease. Furthermore, it was a direct evidence which supports the close relationship between fine dust and Alzheimer’s disease.
How can we protect ourselves? As the experiments show, measures to prevent from fine dust are urgently needed. The very first thing can be conducted by ourselves easily in daily lives. According to the research team at University of California, fruits, vegetables and dark chocolate were recommended to people who are constantly exposed to highly concentrated fine dust. The researchers argued that antioxidants abundant in those foods can decrease the level of inflammation in brain aroused by the fine dust. Therefore by consuming these foods, we can reduce the risks of cognitive disorder. One more interesting fact is that our body has its own avoidance system that eliminates the pollutant: the cerebrospinal fluid. The latest research has shown that the function of the cerebrospinal fluid is enhanced during sleep. Therefore sleeping well can also help prevent our brain from the risk of fine dust.
Unfortunately, we are lacking of any therapeutical treatment once we get exposed to fine dust; the only way is to protect ourselves in daily lives, such as washing our hands, wearing a mask, and drinking plenty of liquids. We should not disregard the significance of our daily habits. On the bright side, according to one research, we can prevent approximately 30% of the risk of Alzheimer disease by controlling the risk factor elaborately. Keeping pace with a healthy life style mentioned above, we can delay the break out of Alzheimer’s disease by almost a year, and this effort would decrease the number of the patients about 9 million. In other words, if it is possible to delay the break out period of the disease for 5 years, it would finally decrease the number of patients into half. Therefore, by making steady efforts on maintaining healthy life styles, we can protect ourselves from the cognitive diseases caused by fine dust. Even if the disease has already appeared, our healthy life styles can slow down its progress and bring it under control. B
2019 VOL.15
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NATIONAL ISSUES
Gore’s
Cut-Off of Pediatric Artificial Vessels JeYoungSon
I
wpdud3944@naver.com
n March 1st,2019 Jin Hee Kim wrote a letter at the website of the Blue House about her son, Min Kyu Yang. He was born with abnormal heart aand had his first and second surgery. His final Fontansche operation for full recovery was arranged in March. However, the operation was delayed indefinitely due to the depletion of neonatal artificial vessels for the surgery. The neonatal artificial vessels for the surgery completely depend on import but confliction between the manufacturing company and the government led to suspension of the vessel import. In addition, the stock was all used to the Fontansche’s operation for neonatal patients has come to halt nationally. Therefore, although Min Kyu has developed cyanosis, he only have to wait without any promise.
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Fontansche operation is a general term for right atrium pulmonary artery bypass surgery. The neonatal patients with innate congenital malfunction of heart must have surgery usually three times and the neonatal artificial vessel is necessary for the final surgery. If they can’t get the final surgery at the right moment, the survival rate of neonatal patients decreases. Although domestic corporations make the artificial vessels for adult patients, they don’t produce artificial vessels due to complicated standardization methods for production. The Gore corporation is the only company that produces the pediatric artificial vessels. However, it was withdrawn from the Korea market and the supply of artificial vessels and sutures was also stopped in September 2017. The Gore corporation did not announce the specific reasons for the withdrawal officially but many experts guessed two reasons. First, the drop in profitability due to the low health insurance charge of korea and small demands make them withdraw from korea medical field. However, a representative of Ministry of Health and Welfare(MOHW) said that they modified the original regulation of the medical materials for rare and incurable diseases. So by the change of the ‘The standard of
NATIONAL ISSUES
pricing for rare medical materials’, the Gore can set the upper limit cost for devices in any time. Second, there were conflicts between Gore and the Ministry of Food and Drug Safety(MFDS) because of the method of certification for GMP(Good Manufacturing Practice). About this opinion, the petitioner refuted that there was no conflict in the GMP approval process between Gore and the MFDS. According to the explanation of MFDS, GMP is the most important quality control standard and must be certified in the same international standards. Also Gore received the certification of conformity (validity period: 16.8.23 ~ 19.8.22) through GMP examination in 2016 before the withdrawal and there was no conflict with the food processing center during the examination process. The government asked the Gore to supply the artificial vessels and sutures again in 8th February 2019 but the corporation replied that it can only provide sutures as there is no alternatives. But according to the specialists, for Fontan’s operation of kids, the artificial vessels should be made of PTFE and its diameter should be 10mm but the artificial vessels of domestic company was made of different materials. In the end, the government came up with urgent measures until all inventory being exhausted. On March 10, after the reply of Gore that the suture can be supplied but artificial blood vessels could not be supplied, the MFDS, MOHW and the Health Insurance Review & Assessment Service(HIRA) announced that they will urgently visit the Gore in America to discuss the current situation in Korea and the improvement of the price of medical materials. In response to a letter from the Korea government to adjust the schedule for visiting Gore’s headquarters, Gore replied that on March 11, they decided to immediately supply 20 artificial blood vessels needed for pediatric cardiac surgeries. In addition, Gore said they would resolve the issue as soon as possible through discussion with the Korea government. The government agreed to supply the artificial blood
vessels and sutures at an early date as a result of a video conference with Gore at 9 am on March 15. Finally, on march 22, the MOHW decided the price of GORE-TEX STRETCH VASCULAR GRAFT to 1,372,000 won from 400,000 won by the reference of international price. To prevent the situation like this, the MFDS announced that they will implement the national supply system of rare medical devices. In addition, related organizations, academic societies and ministries will cooperate to check the list of items that are likely to be in short supply and secure inventory levels. Also there are import dependency problems because the Korean medical device market has been dominated by foreign medical device companies so the government suggested the introduction of the [Medical Device Industry Promotion and Innovative Medical Device Support Act]. Despite the fact that the medical equipment industry has a great potential to develop into one of the promising industries in the future due to the increasing demand for medical services, the domestic medical device companies are mostly small so they don’t have competitiveness. So many experts emphasized the need for systematic support of the government for them. As a result, the MOHW said that they will choose several companies that actively invest for development of medical devices as innovative medical device companies and support them through various methods. Also the MFDS will designate the medical devices that have significantly improved safety and efficacy compared to existing medical devices as innovative medical devices in consultation with the MOHW and the innovative medical devices will be screened step by step and prioritized compared to other medical devices, so that they will be able to quickly commercialize and provide treatment opportunities using new medical technologies to the public quickly. There are two views on whether Gore’s supply interruption is a legitimate economic demand, or whether it is the hostage of children’s lives in order to meet the budget. Whatever the reason, such a situation should not be recurred again. B 2019 VOL.15
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Dayoung Kim
961211dy@gmail.com
The Pilot Project 2019 Chronic Disease Management In Primary Care
T
he primary medical chronic disease management pilot project for community-based primary care strengthening, which will be conducted from January 4, 2019 for a year, will provide a comprehensive management service system for chronic diseases (diabetes, hypertension) centering on primary medical institutions. It is a system that receives preventive and continuous management of chronic diseases. Unlike similar precedent projects conducted in Korea, the project has been modified to include more detailed education counseling, increased hours of training, and non-face-to-face patient management as well as faceto-face management.
17.3 million and 28.2 trillion. These figures represent the number of patients with chronic diseases and medical expenses on the treatments for the diseases, respectively. It accounts for 33.6% of the total population and 41% of the total medical costs. With rapidly changing living conditions, rise in obesity, and population aging, prevalence of chronic diseases is inevitable and prevalence is expected to increase in the future. However, according to the National Health Insurance Service of Korea, the keep cost of medical care is more rapid than that of the number of patients with hypertension and diabetes , leading to serious social and economic burdens. Out of several chronic diseases, hypertension and diabetes were the ones indicating the most increase in medical expenses, which was up to 5.3 trillion won. Despite this situation, management of hypertension and diabetes is under such situations as follows: in young hypertensive patients ranging between ages 30-49, hypertension awareness, treatment, and control rates are all less than 50%, diabetic patients requiring active treatment, defined as having a HbA1c level over 8.0%, are 20.9%, while diabetic patients who are well managed in terms of blood glucose, blood pressure, and cholesterol are only 8.4%. Therefore, it is necessary to establish a management system for the mild chronic disease patients centered on the primary care services. At the present, the effort for primary care for chronic disease management is insufficient, so most of mild chronic disease patients have been visiting unnecessarily large hospitals. Furthermore, hospitalization rate of hypertension or diabetes is higher than that of OECD average. Specifically, length of hospital stay for diabetes in Korea is about 16.5 days, while patients in OECD average spend only half of the number of days, 8.1 days, in hospital. Thus, establishment of management system of chronic diseases and enhancement in quality of primary care system are necessary tasks to be dealt with in Korea. Based on this situation, the Ministry of Health and Welfare initiated a pilot project this year.
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Purpose and Goal The purpose of the project is to establish a continuous and comprehensive management system centered around local clinics. In addition, improving the rate of control and delaying or preventing the occurrence of complications through treatment based on the Evidence-based Practice Guideline are also some of the objectives of the project. In addition, the Goal of the project is to expand the application of patient care and management in accordance with the Evidence-based Practice Guideline, to activate a team-approach between doctors and care coordinators, and to expand regions that that the project controls. Furthermore, it aims to establish a foundation for building chronic disease management system in the community, and to improve the hypertension and diabetes control rate in patients in the local clinic.
Procedure The following are specific procedures of the project: 1. By comprehensive assessment and planning, the patient’s health status is assessed by questionnaire, physical measurement, clinical examination, etc., and a comprehensive plan for customized health management is established based on the results. 2. Patient management provides systematic disease management and medical care reservation management service by checking blood pressure and blood sugar of the patient. It also monitors drug use, complication occurrence and lifestyle improvement through text message or telephone. 3. Education – Counseling provides personalized education and counseling to improve understanding of diseases and self-management skills. 4. In inspection and evaluation, the degree of compliance with the management plan of the patient and the state of disease management are checked, and the result is provided after evaluation.
Conclusion The district hospitals employ ‘care coordinators’ to provide patient care services directly, but this ‘care coordinator’ only include nurse or nutritionist; in other words, pharmacist is excluded in this team-approach. As mentioned above, in the patient management, health care teams monitor blood pressure and blood glucose, drug use and ADR, complications, and attainment of lifestyle goals. Among them, it is undeniable fact that drug use and ADR monitoring should be conducted by ‘Pharmacist’,a health-care professional licensed to engage in pharmacy with duties including dispensing prescription drugs, monitoring drug interactions, and counseling patients regarding the effects and proper usage of drugs and dietary supplement. According to the American Medical Association, a team-based care practice including pharmacist can improve patient outcomes. As key partners in patient care, pharmacists take on a variety of important roles to help patient’s diabetes or hypertension under control. Although the primary medical chronic disease management pilot project of this year will continue without pharmacist’s intervention, it is necessary that pharmacists should be included in community care system to improve chronic disease management especially in this increasingly aging society and structure of health inequality. B 2019 vol.15
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Bodybuilding Gone Wrong : Underreported Consequences of Steroid Ab You Sun Choi
clauchoik@gmail.com
I
t seems that the Me Too Movement has initiated yet another spark now along the fitness industry. The so-called ‘Yak Too’ Movement precipitated in a series of divulgations about the tacit use of performance-enhancing drugs in the Korean bodybuilding industry; a video posted by the YouTube creator and bodybuilder Park Seung-hyun acting as the touch off. Featuring an overt discomfort about the bodybuilding industry’s steroid abuse, the clip went viral and obtained dramatic social responses. In less than a month, similar confessions followed suit. Kim Dong-hyun, a former bodybuilder, joined the movement to elucidate some of the most serious adverse reactions he suffered from using such muscle-building drugs. In the light of astounding disclosures by professionals in the field confessing to their clandestine actions, the use and side effects of steroid drugs is a hot potato.
Unriddling Anabolic Steroids There are countless hormones involved in the slow signaling endocrine system, categorized into ‘steroid hormones’ and ‘nonsteroidal (peptide or amino acid derivative) hormones’. Steroid hormones are again divided into ‘cortisol steroids’ and ‘anabolic steroids’. While corticosteroids are mainly used as anti-inflammatory drugs, the latter is to which testosterone, a well-known male hormone, belongs. Here, the term ‘anabolic’ refers to ‘assimilation’, which, in the case of skeletal muscles, translates into protein synthesis. This means that anabolic steroid hormones such as testosterone can be used to speed up the synthesis of proteins in the muscle. An athlete taking any form of artificial anabolic steroid will experience an effective increase in muscle mass. Resultant muscle strength, endurance, power and recovering ability are rapidly improved, which in turn
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leads to a remarkable increase in performance. Track and field athletes whose victory depends on split seconds, and sprint swimmers who need that burst of power can certainly see the advantage of having an extra pack of hormones running in their blood.
Perils of Steroid Abuse If testosterone itself is a hormone naturally produced by the body, why forbid it? Externally administered steroids may cause serious side effects. When the concentration of a certain hormone is artificially increased by an external injection, the human body stops producing it. With repeated shots, production and signaling function of the hormone is no longer maintained. In this way, excess amounts of foreign testosterone can lead to sexual dysfunction and amenorrhea. Injections of testosterone inhibit endogenous production of the hormone from the testicles. As the
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hormone-releasing circuit is blocked, testicles become less labor-intensive and subsequently degenerate, resulting in erectile dysfunction and termination of sperm production. Some of the most serious cases involve gynecomastia, or swelling of breast tissue in males due to imbalance of testosterone and estrogen levels. While testosterone use by men strips them of their masculinity, female abusers conversely suffer from unwanted masculinization. According to BJ Na Hyun, the first female fitness model and YouTube creator who also joined the YakToo Movement, women who administered steroid shots have grown beards or their facial features have grown bony, and some even developed a deeper voice. Some common adverse effects seen in men and women alike include reduced cardiopulmonary function. The muscle-enlarging effect of steroids affects the heart muscle as well, limiting its movement as the heart becomes bigger while the range of motion is fixed. When an organ is larger than necessary, its function is bound to deteriorate. Therefore, continuous use of anabolic steroids can precipitate in cardiovascular diseases with life-threatening effects, such as myocardial infarction and stroke. Last but not least, withdrawal symptoms appear to those who attempt to discontinue the drug. Steroids have an addictive nature that cannot be easily refrained from. Several bodybuilders have confessed to succumb to recurrent drug usage because they could not give up on muscle mass. There is also the beguiling belief of bodybuilders who mistake their borrowed athletic ability as their own. According to medical professionals, anabolic steroids are to be used only in specific medical situations, such as
life-sustaining care or severe hormonal disorder. Due to its specificity, it is not intended for use without a doctor’s prescription. Long-term side effects may last even if the drug is discontinued.
Behind the Scenes Doping is especially prevalent in bodybuilding among all sports. According to data from the Doping Control Commission of the Ministry of Health and Welfare, more than seven out of ten doping cases have been detected in bodybuilding events. Participants overdose themselves with many kinds of drugs for the purpose of improving muscles, muscle strength, and performance, and this is assumed as an intrinsic part of the game. The reason why these so-called roiders willingly accept the potential side effects of drug use is because of the huge compensation that ensues from winning a tournament. Winners from bodybuilding competitions can flaunt their title and use it as a means to build their career as health trainers. Thus doping is an enticing shortcut that ensures easier fame and success. Punishment can be made on both the seller and the buyer thus to increase awareness on the severity of the issue. B
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Herpes Virus Reactivation in Space Kyungeun Lee
kyungeun0217@gmail.com
H
umans have always looked up to the night sky and dreamed about the outer space. Starting from the development of ballistic missiles to rockets, humans have paved the way to make these dreams come true. And now, modern space exploration is reaching further towards the areas that were once only dreamed about. Mars, or the Red Planet, is the current focus and manned exploration to the planet is a long-term goal in modern space exploration. Before humans can successfully travel to Mars and beyond as planned, there are still countless technological hurdles to overcome. In addition, recent NASA research published in Frontiers in Microbiology demonstrates that a fundamental health concern of astronauts during the space journey is another challenging hurdle.
According to the NASA study, latent herpes virus reactivation has been found in astronauts from shuttle (10-16 days) and International Space Station (≼180 days) flights. Currently, 47 out of 89 (53%) astronauts from shuttle-flights, and 14 out of 23 (61%) astronauts from ISS missions shed one or more herpes viruses in saliva and urine samples. So far, four out of eight known human herpes viruses were detected: epstein–barr virus (EBV), varicella-zoster virus (VZV), herpes-simplex-1 (HSV-1) and cytomegalovirus (CMV). In addition, the magnitude and frequency of viral shedding increase with the duration of spaceflight. Although only six astronauts developed minor symptoms and others remained asymptomatic, viral reactivation may pose a critical health risk to astronauts when they embark on deep-space missions.
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These findings coincide with the immune system dysregulation observed in astronauts. During both short and long spaceflights, astronauts are exposed to not only common stressors such as social separation, sleep deprivation, circadian rhythm disruption and anxiety, but also non-terrestrial challenges including microgravity, cosmic radiation and extreme gravitational forces at take-off and re-entry. As these spaceflight-associated stressors accumulate, the secretion of stress hormones is amplified. Hypothalamus-pituitary-adrenal axis and sympathetic-adrenal-medullary axis regulate the stress response as glucocorticoids and catecholamines are secreted proportionally to the stress stimulus. Although acute responses to stress are beneficial, long duration or chronically high concentration of stress hormones decreases
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decreases function of the immune system and ultimately leads to its inability to suppress opportunistic viral reactivation. Adrenal glands release both cortisol and dehydroepiandrosterone (DHEA) in response to stress; cortisol is anti-inflammatory and immunosuppressive, while DHEA is the antagonist to cortisol. Thus, the molar ratio of cortisol to DHEA [C]/[D] is an important indicator of immune regulation. According to the research samples, salivary cortisol was significantly higher during flight while salivary DHEA was significantly lower than before and after flight. Ultimately, [C]/[D] increases during the flight, which potentially induces immune challenge and modulation. For instance, pro-inflammatory plasma cytokines in astronauts increase significantly upon landing on Earth. Especially, Th2 cytokine IL-4 is the most responsive cytokine as it increases 21-fold through launch and return flight phases, significantly decreasing the IFNγ : IL-4 ratio. The low ratio triggers a dynamic shift from Th1 antiviral immune state to Th2 antibacterial/ antifungal immune state. Changes in cytokine profile generate various immune vulnerabilities by significantly changing the numbers, proportions and functions of leukocytes. As the leukocyte functions are diminished, the effectiveness of the immune response to pathogens is critically reduced, which in turn weakens leukocytes’ capacity to prevent virus reactivation. T-Cells and NK-Cells are particularly debilitated during spaceflight. Flight studies focusing on T-Cell function have elucidated that both CD4+ and CD8+ T-Cells of astronauts at flight phase cannot react effectively against a variety of stimuli. Furthermore, decrease in production of enzyme perforin and granzyme B dramatically abate the cytotoxicity of nuclease, because without these enzymes, NK-Cells change into an ineffective state against the
target pathogen. This impairment may last up to 60 days after flight. Thus, the alteration in cytokine during the flight induces decrement in immune system, eventually opening the doors for viruses to reactivate. Overall, the reactivation of latent viruses is a powerful biomarker for immune status of astronauts deployed to space. Viral reactivation is evident through the viral DNA shed in the body fluids of astronauts and elevated viral load with the duration in space. Therefore, there is an urgent need to develop and implement effective countermeasures to ensure the health of astronauts and success of deep-space missions. Since vaccinations are available only for VZV and trials of other herpes virus vaccines show little promise, the present focus is on developing targeted treatment regimens for individuals suffering the consequences of viral reactivation. On the other point of view, focusing on the mental health of the astronauts would alleviate the space stress, which is a crucial factor of viral reactivation. Astronauts are under extreme stress in confined spaces with seriously limited social interactions far away from home. Thus, more physiological support should be provided, such as periodic psychiatric screening, pre-flight training and healthy connections to home. All together, the prevention of viral reactivation should not only focus on immunological treatment, but also concentrate at management of the mental health. B
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At the Crossroads of Yoon Su Min
jenny.yoon@yonsei.ac.kr
C
oming across news of HIV, many would mourn the loss of someone they used to know or legends such as Freddie Mercury and Magic Johnson. How would the music industry now look different if Freddie Mercury was around? Could have the future of Los Angeles Lakers turn out differently if Johnson had survived? Over thousands of years, countless lives had been lost to diseases that were incurable with the medical advances available at the time. In this race of medical advancements against time to prolong human longevity, scientists published a journal on Nature discussing the cure of the second HIV patient.
Almost 1 million annual deaths are attributed to HIV-related causes. In 2016, it was estimated that 36.7 million people were living under HIV/AIDS. The first case of cure was presented at the 19th International AIDS conference, where scientists announced that Timothy Ray Brown (the “Berlin patient”) was cured of HIV. The breakthrough treatment involved a bone marrow transplantation originally intended to treat the patient’s leukemia. It turne d out that the donor had an HIV-resistant mutation in his genome. On March 5th of this year, a case study was published in journal Nature that detailed the treatment process of the “London patient”, the second person to be cured of HIV (the next day, a third, the “Dusseldorf patient”, was also revealed to be cured of the viral infection, but no paper was published yet). Both the first “Berlin” patient and the second “London” patient were treated with stem cell transplantations from donors who carried CCR5delta 32, a HIV-resistant genetic mutation. The London patient was diagnosed with HIV in 2003, but later diagnosed with advanced Hodgkin’s lymphoma, which led him to undergo a stem cell transplant in 2016. The patient stopped taking HIV-suppressing drugs 16 months after the transplant procedures, and remission was maintained for 18 months post-procedure.
Existing HIV/AIDs therapy involves taking a combination of drugs in an HIV treatment regimen, known as Antiretroviral therapy (ART). These drugs reduce the HIV viral load and prevent transmission. In what is known as a form of “cocktail therapy”, the initial HIV treatments usually include three drugs from two or more drug classes, included but not limited to: nucleoside reverse transcriptase inhibitors, fusion inhibitors, and CCR5 antagonists. Since ART is a life-long treatment, patients are bound to their medication regime for the rest of their lives. Now, with the report of second and third patient cured of HIV/AIDs, the case of the Berlin patient no longer appears to be an accidental miracle but a foundational step towards the emancipation from AIDS.
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HIV/AIDS TREATMENT
Whether successful cases published in march actually suggest promising alternatives to current treatments
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So how does transplantation work? Two factors are likely at play: the donor’s bone marrow is not only resistant to HIV but also actively eliminates the virally infected cells. The hematopoietic stem-cell transplantation (HSCT) procedure requires donors with a homozygous mutation (CCR5Δ32/Δ32) in the HIV coreceptor CCR5. Deletion of 32 base pairs in the gene prevents CCR5 expression, making these cells resistant to the viral interaction with the CCR5 coreceptor. After the transplant, the patient’s CD4 T cells from peripheral blood no longer expressed CCR5.
Despite various attempts of the same approach by scientists over the years, Brown had remained the only person to be cured until the London patient. A probable explanation to why it took 12 years till another patient was cured is that in both cases, the transplantation procedure was intended to treat another illness, and HIV remission occurred only as a beneficial side effect. Furthermore, past attempts of treatment report complications such as gut graft-versus-host disease (GVHD). As the procedure is not a HIV-specific treatment, even after two (possibly three) successful cases, the treatment still carries much risk to be used as a HIV treatment alone. This may bring some patients to a crossroad of dilemma: Is a cure worth committing to? In 2015, bone marrow transplant was ranked top five among the six most expensive procedures, due to the search for a donor match and the transplantation process itself.
The pretransplant process also seems to be tedious and uncomfortable. First, there is a general assessment that takes several days, to check whether the patient is physically ready for the transplant. Moreover, patients must have a long thin tube called catheter inserted into the large vein of patients’ neck or chest in preparation of the transplantati. There are also several post treatment complications. Patients who receive HSCT have to be repeatedly vaccinated, and most have to continually take immunosuppressants to prevent side effects like GVHD. Many complain of severe pain, as well as of the side effects that result from analgesics. Other risks of stem cell transplants include organ damage, infections, rise of other conditions such as cancer. From the list of downsides of the transplantation, it may be difficult to see the advantages of the procedure over ART. This brings a dilemma for HIV/AIDs patients, who may be engulfed by doubt of the improvement in the quality of life after the procedure.
Continually emerging successful cases of remission provide scientists with new insights to HIV/AIDs therapy, opening up new exciting possibilities such as gene modification therapy. However, there still remains a long way to go for a completely safe treatment and still requires a deeper understanding on why the procedure works in some patients but not in others. Though the first three successful cases are undoubtedly worth celebrating, the race against curing of AIDS should be not a sprint, but a preserving marathon. B
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Hallucinations caused by TamifluShould we keep it? Jieun Ryoo
D
ginaryoo21@gmail.com
espite its world-wide usage, Tamiflu is recently being highly criticized for some serious side effects such as hallucinations and self-hurting behaviors. Before delving into some recent issues regarding Tamiflu, let us take a brief look at what Tamiflu. is.
History of Tamiflu
What are some side effects?
Tamiflu is one of the world’s famous antiviral drugs invented to treat patients suffering from influenza A and B, both commonly known as the flu. Tamiflu was first discovered by an Austrian scientist, Dr. Norbert Bischofberger (10 January 1956 in Mellau, Austria), in 1996. Since 1993, he and his research team at Gilead struggled to design a medicine to actively block influenza viruses. Three years later, the team of scientists succeeded in developing antiviral medicine from shikimic acids. Bischofberger and the Gilead company further developed the drug and sold the right to sell to Roche company. It was first approved to be used by patients in United States in 1999.
Some of the common side effects of tamiflu are diarrhea, nausea, headaches, vomiting and insomnia. More serious and devastating adverse effects include seizures, sudden confusion, delirium, hallucinations and self-injury behaviors.
How does Tamiflu work? Tamiflu is a competitive inhibitor of an influenza enzyme called neuraminidase. This enzyme mainly cuts sialic acids of glycoproteins on the cell surface. Such cleavage prevents new viral particles exiting host cells, thereby inhibiting the reproduction of influenza viruses.
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A problem with Tamiflu for some people is that it only effectively works for patients in their early stages of influenza infection, even before they are prescribed with the drug. While some studies demonstrate Tamiflu’s benefits, a study conducted by Cochrane in 2014 concluded that there is little to no evidence that tamiflu reduces the hospitalizations of flu patients. However, another metaanalysis that soon followed concluded that tamiflu does keep people from having influenza complications. Recently, a 6-year-old girl from North Texas showed some serious side effects such as hallucinations and attempts of self harm. Most seriously, all of these symptoms occurred after simply taking Tamiflu. Her family told the press that she showed hallucination symptoms and tried to jump from a second-story window after taking the medication. Her family made a request to remain anonymous, yet indicated they will be making a report to the Food and Drug Administration (FDA).
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Recent Tamiflu Incidents
Then what should we do with Tamiflu? Should we keep it?
What is most interesting about the recent Texas incident is that it is not the very first report of Tamiflu causing hallucinations. In 2012, Bonnie Rochman, a reporter at Time, wrote an article claiming that Tamiflu could lead to delirium in children after witnessing her son’s experience with the drug. Moreover, there have been 103 cases (95 of which occurred in Japan) of people who experienced delirium after taking Tamiflu. Those people were reported to be mostly under age of 17. Some serious cases even included suicides. In fact, such relay of events triggered a ban on Tamiflu usage among teenagers in Japan. The decision met some disagreements from people claiming that these serious side effects are extremely rarely reported and could be due to the flu itself, not the medicine. The ban prompted FDA to conduct a safety review on Tamiflu. Unfortunately, FDA could not pinpoint the exact reason for the recent series of Japanese children experiencing neuropsychiatric events. Instead, it concluded that those events could be attributed to various other factors besides Tamiflu, including increased awareness on public reporting of adverse drug effects, and encephalopathy caused by influenza viruses. FDA claimed it is still far-fetched to conclude a direct cause-and-effect relationship between Tamiflu and reported psychiatric side effects and deaths.
Although these scary incidents of patients experiencing hallucinations and self-injuring behaviors are quite uncommon, it is still strongly advised to take extra care when it comes to giving Tamiflu to children. Experts advise parents to give their children Tamiflu only when prescribed by a real doctor and to never purchase Tamiflu online, as well as keeping a close eye on children after they take their medications. Any Tamiflu medication without parents’ thoroughgoing guidance and presence should always be avoided. B
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CAMPUS LIFE
Behind the Curtains: An Interview with Professor Jeong Grace Eun Yi Kim
kimgr2002@yonsei.ac.kr
Be Proud. -Prof. Jin Hyung, Jeong
P
rofessor Jin Hyung Jeong is one of the most renowned professors in the field of Pharmaceutical Organic Chemistry, that, he also goes by Organic Jeong. As an advisory professor, his perspiration for 9 years was what helped the BlueVanguards to pave its way, yet not much of his deeds gained spotlight. The BlueVanguards sat down with Professor Jeong to find out more about his long ventures of reaching the zenith of success, as well as the sparks of what he endeavors to.
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CAMPUS LIFE
Q. Professor Jeong, you have recently been awarded such an impressive prize, namely, ‘GeunJeong PoJang’ for your contribution in the fields of Pharmaceutical Industry. Tell us about your story. A. I truly appreciate all my peers and fellow students for placing trust in me. Without their support, I would not have been honored with such prize. In fact, as being the first professor ever in history to be awarded with it, I still feel very overwhelmed. This reminds me of the very first day of finding ‘Smart BioPharm’. While being the professor of Pharmaceutical Organic Chemistry in Yonsei University, I have also been working as the head of ‘Smart BioPharm’ for already 9 years; because I believed that innovating new measures in Korea with greatly aspiring students would augment our biopharmaceutical industry. ‘Smart BioPharm’ focuses on flow chemistry, so as to develop a continuous production process that produces pharmaceutical ingredients of utmost quality while having more space, and the least impurities ever. While the outcomes of our project saw no improvements in the beginning, our persistent efforts in our headway were what eventually sprung us to a success. Henceforth, I was able to open more seminars and lectures on my story, which apparently became so popular that many students began to apply for my graduate program. Successful outcomes on my research and my teaching abilities, I think, were what shined a spotlight, precipitating the event.
Q. Not only do you inspire us with what you research on, but also with your commitments outside of the school. What activities do you do and what do they bring us? A. One of my huge commitments is the ODA grant equivalent, namely, Official Development Assistance. ODA is a concessional part of the OECD venture, in which the affiliated countries recruit experts to measure and grant aid to developing countries, so as to promote their economic development and welfare. Here, the so-called “aid” involves soft loans as well as provision of technical and medical assistance. The South Korean government joined in the act, and henceforth, I was given the duty of being the lead professor of the Ethiopia sector, while also the medical aid research executive in the development of North Korean health. My responsibilities make me feel very overwhelmed, not because of the workload, but because of the fact that I am given such an influential role. This is where I truly wanted to spread my words. Be responsible, be proud, and be persistent with what you’re doing. B
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FAREWELL Grace Eun Yi Kim The Blue Vanguards has already reached its 15th issue and so is the epitome of bittersweet. It’s already been two years since I’ve been taking part in issuing our magazines, and I have never felt so delighted as I am now, to introduce our 15th issue. Going pass through numerous papers, 2019 was when I’ve began to see how much I’ve shaped my own self as a BlueVanguard, as well as my peers, and so as much as I feel happy and excited to leave, I can’t resist thinking about how empty I would feel after leaving. I truly want to send much thanks to each and everyone!
Je Young Son The reason why I joined The Blue Vanguard was “curiosity”. Honestly, the first semester as a journalist of BV members was a challenge to me. I never had wrote an English article and even just an article before. Being The Blue Vanguard member was a very invaluable experience in my Yonsei Pharmacy life. I can get energy and confidence through the BV activities. Also I can write my articles and finish my BV activities successfully thanks to the fellow members. Working with the BV members was the best thing that ever happened to me.
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Dayoung Kim I can’t believe how fast time flies and I’m writing this farewell message. Not only have I enjoyed working as a journalist in the Blue Vanguard, but I have also gained a lot of experiences and opportunities to learn many things. I really appreciate all the good times and meaningful memories we shared together in the BV.
You Sun Choi To be part of this community was one of the most terrifying experiences I yet had at Yonsei University. Every semester it challenged me to extend beyond my capabilities and stretch myself to learn something new. I would like to thank all Blue Vanguardians with whom I had the priviledge to work.
Do Yun Oh The first start here was somewhat pressure to me. But I was able to grow up with the guidance of BV’s seniors and advice by colleagues, and I am really grateful to them. Whole activities in BV were great experiences, and I know they would be a big help when I try new things in the future. I hope readers enjoy BV megazine since we all make it carefully with affection.
Yong Wook Kim For last two and half years, I have experienced various activities and BV influenced my viewpoint of pharmaceutical industry a lot. It was quite busy years, but it worth more than any other experiences in yonsei. I hope Blue Vangard to be loved from a lot of readers and read articles from it after I graduate the school. Thanks to everyone of Blue Vanguard.
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